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E R.Walters, M.D.
THE
WORCESTER
MEDICAL LIBRARY
INC.
THE
WORCESTER
MEDICAL LIBRARY
INC.
fe
ao
^
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SANATORIA FOR CONSUMPTIVES
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ABEBDBEN UNIVEBSITY PBB88
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SANATORIA FOR CONSUMPTIVES
A CRITICAL AND DETAILED DESCRIPTION
TOGETHER WITH AN EXPOSITION OF
THE OPEN-AIR OR HYGIENIC TREATMENT OF
PHTHISIS.
F, RUFENACHT WALTE RS, M.D., M.R.C.P.
PILLOW OF THF ROYAL COLLBGK OF SURGEONS ; PHYSICIAN TO THE NORTH LONDON
HOSPITAL FOR CONSUMPTION AND DISEASES OF THE CHEST.
WITH AN INTRODUCTION
BY
Sir RICHARD DOUGLAS POWELL, Bart., M.D., F.R.C.P.
SECOND
EDITION
LONDON :
SWAN SONNENSCHEIN & Co., Lim.
NEW YORK: E. P. DUTTON & Co.
I 902 .
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HARVARD MEDICAL LIBRARY
MTHE
FRANCIS A. COUNTWAY
UBRARY OF MEDICINE
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PREFACE
TO THE SECOND EDITION.
This volume is intended to present a general review of
Sanatorium treatment and a detailed description of the
more important existing Sanatoria. It is based upon
original information obtained from medical officers and
others attached to these institutions^ which has been
carefully compared with published descriptions, and in
many cases checked by personal visits.
Since the publication of the first edition of this book
in January, 1899, a great change has taken place in
public opinion with regard to the utility of Sanatoria for
Consumptives and the treatment adopted therein. A
much more hopeful feeling exists as to the curability
of consumption under favourable circumstances; and it
is recognised that rational hygienic and medicinal treat-
ment, which gives by far the best prospect of recovery, is
most conveniently carried out in a special institution in
a suitable neighbourhood under the immediate personal
control of a physician.
Many Sanatoria have recently been erected in the
British Isles and elsewhere, and many more are projected.
The time has not yet come for a comparative study of
these institutions ; but an attempt has been made in this
edition to bring the book up to date by re-writing the
British portion and adding an appendix summarising
recent changes in foreign countries and the colonies.
The number of my informants is so great that I cannot
well give separate acknowledgment to each; but I wish
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IV PREFACE TO THE SECOND EDITION.
to express my thanks for their kind co-operation, which
alone has made it possible for me to write this book.
I am also particularly indebted to Sir Richard Douglas
Powell for his kindness in contributing an Introduction to
the book, as well as for very welcome encouragement and
advice.
F. R. WALTERS.
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PEEFACE.
Bt Sib Biohabd Douglas Powell.
The present little work of Dr. Walters, which is based
upon careful investigation and expert knowledge, brings
before us in a purposively arranged manner the most
modem methods of hygienic treatment of consumption.
The chief object of the author is to advocate the establish-
ment in this country of public institutions of the con-
valescent hospital class, and of sanatoria designed for the
reception of cases of tuberculosis from amongst those who
are more or less well-to-do.
Such institutions already exist on the continent and in
America ; and there is no doubt whatever that there are
numbers of patients of both kinds suflBcient to keep such
sanatoria very usefully occupied. Nor can any thoughtful
person doubt the value of such sanatoria, and the boon
that they would be to a large number of people in this
country, who under conditions of prolonged illness have
no (or at least no adequate) home accommodation available.
Their usefulness, however, in my judgment, extends far
beyond the immediate purpose for which they are proposed.
Lessons in self -management are learned by those who
sojourn for a time in such sanatoria ; habits of self-discip-
line and attention to hygienic laws are acquired which are of
much importance to those aflSicted with consumption, and
which have a favourable influence upon prophylaxis ; and
these persons when they pass again into the general com-
munity become centres ojE instruction in domestic hygiene.
It is only during certain periods or phases of this usually
prolonged malady that sanatoria can ever be available;
and many patients are able to carry out, and will prefer,
home treatment. For consumption is a disease that can
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VI PBBPACE.
be treated safely, and on the best lines, without dismpting
the family life. During quiescent periods, and the some-
times prolonged periods of arrest that occur, the patient
may — nay, in many cases must — ^pursue his calling; or
he may enjoy the freedom of hotel or domestic life in chosen
climates ; but he must not forget the sanitary requirements
and hygienic discipline which will maintain him in well-
being with a measure of working power, and which tend
to prevent relapses.
Patients with consumption have often a happy-go-lucky,
sometimes a despairing way, of following their own devices
at health resorts and elsewhere for long periods together ;
they need more supervision in their mode of living, both
at home and abroad, than they now generally receive, or
are indeed willing to tolerate.
The family medical adviser and the health resort phy-
sician need, perhaps, more closely to supervise and regulate
the conditions of life as regards exercise, rest and diet,
which, as a part of the general treatment of the case, are
as important as the administration of remedies for par-
ticular symptoms. All the most approved principles of
hygienic treatment will be found embodied in these pages ;
as well as many hints in sanitation upon which the managers
of hotels at health resorts will do well to ponder, and to be
advised by their local physicians, in the best interests of
their guests and of themselves.
Medical ofl&cers of health in this country have yet to
acquire authority to do much more to regulate the sanita-
tion of their districts with regard to consumption ; and it
is, I believe, through this means, in conjunction with better
instructed advice given more uniformly by family medical
practitioners to their clients, that the public will best learn
the sanitary requirements necessary for that further dimi-
nution of the prevalence eind mortality of the disease which
medical science has already done so much to lessen.
E. Douglas Powell.
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CONTENTS.
CRAPTBft I. Introductory.
Dtfinition and Objects of Sanatoria for Consumptives— Difference from
Chest Hospitals. Nursing Homes, Convalescent Homes. Hydropathic
Establishments and General Health Resorts — Of^en and Closed Sana-
toria Compared-r-Sanatoria for Consumptive Children — Sanatoria for
other Forms of Tuberculosis pag$ x
Chapter II. Climatbs for Consumptivbs.
A Variety Required— Advantages of Cool Bracing Climates— Essential
Climatic Factors — Importance of Artificial Shelters and Accessories —
Advantages and Disadvantages of Alpine Climates . page 4
Chapter III. Treatment in Home Climates.
Often Advisable — ^Journey Abroad often Dangerous — Drawbacks of a Sea
Voyage — Climate of Less Importance than Accommodation. Diet and
Manner of Life — Medical Supervision Essential — Disadvantages of
Treatment in Foreign Countries — Danger of Relapse . pag$ 8
Chapter IV. Outlines op Sanatorium Treatment.
Regulation of Hygienic and Medical Details of Daily Life — Open-air Ufe
—Prevention of Cold-catching — Rest and Exercise — Diet— Frecautions
against Infection-<-The Resident Medical and Nursing Staff: their
Duties — ^Advantages over Treatment at Home . fagi 11
Chapter V. Sites for Sanatoria.
Altitnde^Seaside or Inland Sites—Should not be near Towns or High-
roads, Factories or Railways— Chalk Downs Doubtful — Character of
Vegetation— Soil and Shelter pag$ 13
Chapter VI. The Sanatorium Grounds.
Extent and Nature— Should be on a Slope— Sunny Aspect— How Laid
Out — Position of Outbuildings page 16
Chapter yiL .Construction, Decoration and Furniture.
Essential Points— Two Extreme Groups : Their relative Advantages and
Disadvantages — Verandahs and Balconies — Kitchens. Cloak-rooms,
Lavatories, Bathrooms and W.C.'s — Ventilation and Size of Rooms —
Protection against Rain, Wind, Sun and Noise— Heating and Lighting
— Arrangements to Facilitate Cleansing — Avoidance of Dust-traps —
Open-air Pavilions — ^The Building in Relation to Climate . page x8
Chapter VIII. Cleansing and Disinfection : Sewerage and
Water Supply.
Cla«iiafaig and Disinfection of Linen and Rooms: Reception and Disin-
fection of Sputar-Di^osal of Sewage— Water Supply . page 28
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Vlll CONTENTS.
Chapter IX. The Fresh-air Treatment.
Climate may Help or Hinder— Natural and Artificial Shelter— Protection
against Hot Sun— Shelter against Wind, Rain and Dust— Recum-
bency— Hydrotherapy— Clothing t^^ll
Chapter X. Rest and Exercise.
Chief Indications — Graduated Exercise — Occupation — Amusements-
Respiratory Exercises — Mental Repose page 38
Chapter XI. Diet in the Sanatorium.
Modifying Circumstances— Proportion of Foodstuffs— Milk Supply — Fruit
and V^etables — Preparation of Food — Number of Meals— National
Tastes and Customs — Forcible Feeding — Alcohol— Idiosyncrasy —
Dyspepsia and other Complications page 41
Chapter XII. Sanatoria for the Poorer Classes and for Children
How many should Sleep Together— Furniture — Should the Patient Work?
— ^Educational Measures— Sanatoria for Children . page 45
Chapter XIII. The Results of Sanatorium Treatment.
Fallacies Underlying Statistics — Various Classifications — Sanatoria for
the Poor — Sanatoria for Paying Patients — Permanence of Good
Results— Comparison with Chest Hospitals .... page ^'^
Chapter XIV. Size, Staff and Management, and Relation to
Other Institutions.
Best Size for a Sanatorium — Nursing and Medical Staff— Administrative
Department — Mode of Admission — Duration of Treatment— Cases
Suitable for Admission — Need of other Institutions for Consumptives,
and of Model Villages page 58
Chapter XV. Objections Answered.
Sentimental and Ethical Objections— Danger of Infection Insignificant —
Evidence from Chest Hospitals and Sanatoria — Harmlessness of such
Institutions— Open Health Resorts page 63
Chapter XVI. The Cost of a Sanatorium.
Sanatoria for Paying Patients — Sanatoria for Poor Patients — Circum-
stances Affecting the Cost— Alteration of Pre-existing Buildings —
Cost of Various Foreign Sanatoria— Cost of Maintenance in Various
Countries— Charges at Foreign Sanatoria — How a Sanatorium for the
Poor may be. Supported pageji
Chapter XVII. Sanatoria in America, Eastern States.
Table of American Sanatoria with their Altitudes — The Adirondack
Cottage Sanitarium— The Gabriels Sanitarium — The Loomis Sani-
tarium—The De Peyster Hospital for Children— The Montefiore
Ifome Country Sanitarium — The Seaton Sanitarium— The Sharon
Sanitarium — The Massachusetts State Hospital for Consumption —
The Philadelphia Hospital for Diseases of the Lungs — The House of
Mercy— The Chestnut Hill Hospital— The Winyah Sanitarium— The
Aiken Cottages — Dr. Sajous' Co-operative Village — The Hygeia
Sanitarium page 83
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CONTENTS. ix
Craptbr XVIII. Sanatoria in America, Western States.
The Glockner Sanitarium— The Home, Denver— The Las Vegas Sani-
tarium— The Colorado Sanitarium— Manitou Park— St. Mary's Sana-
torium—The Bellevue Sanatorium— White Gables Sanitarium.
fage I02
Chapter XIX. Homes and Hospitals por Consumptives in America.
St. Joseph's Hospital— The New York Hospital and Dispensary for
Consumption — The House of Rest for Consumptives— The Monte6ore
Home for Chronic Invalids — ^The Brooklyn Home for Consumptives
pagt 115
Chapter XX. Sanatoria in Austria-Hungary.
The Alland Sanatorium— The Sanatorium of Marilla-Vdlgy— The Sana-
torium of Uj-Tatra-Fared— Dr. Schreiber*s Alpenheim fa(^ 120
Chapter XXI. French Sanatoria.
French Societies for the Erection of Sanatoria— Existing and Projected
Sanatoria— Table of French Sanatoria with their altitude . pag$ 127
Chapter XXII. French Sanatoria for Paving Patients.
The Canigou Sanatorium— The Durtol Sanatorium— The Trespoey Sana-
torium — The Sanatorium of Mont Bonmorin — The Sanatorium of
Mont Pacanaglia— St. Martin Lantosque .... fag$ 130
Chapter XXIII. French Sanatoria for Children.
The Ormesson Hospital— The Villiers-sur-Marne Hospital— Other Sana-
toria for Children— Seaside and Mountain Sanatoria page 139
Chapter XXIV. Hospital Sanatoria in France.
The Boucicaut Hospital— The Lariboisiere Hospital pag$ 146
Chapter XXV. German Sanatoria for Paving Patients.
Table of Sanatoria, with Beds and Altitudes .... page 148
Chapter XXVI. Silesian Sanatoria for Paying Patients.
The Brehmer Sanatorium— Second-Class Patients— Dr. Rompler's Sana-
torium— Dr. Weicker's Sanatorium page 150
Chapter XXVII. Saxon Sanatoria for Paying Patients.
Dr. Driver's Sanatorium at Reiboldsgriin — Dr. Lahmann's Sanatorium
page 160
Chapter XXVIII. Private Sanatoria of the Harz District.
The Altenbrak Sanatorium— St. Andreasberg— Dr. Ladendorf s Establish-
ment— Dr. Jacubasch's Establishment .... page 167
Chapter XXIX. The Rehburg Sanatoria for Paying Patients.
Dr. Michaelis' Sanatorium— Dr. Lehrecke's Sanatorium page 171
Chapter XXX. Private Sanatoria in the Rhine District.
The Falkenstein Sanatorium — The Hohenhonnef Sanatorium — The
Laubbach Sanatorium— Second-class Patients . page 177
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X CONTENTS.
Chaptbr XXXI. Thb Black Forest Privatb Sanatoria.
The Nordrach Colonie— The Schdmberg Sanatorium— Dr. Sander's Sana-
torium at St. Biasien— Dr. Leiser's Sanatorium at Badenweiler
pag0 190
Chapter XXXII. German Sanatoria for the People, and for
Children.
German Societies for the Erection of Sanatoria— The Sickness and Old
Age Assurance Act— Table of Sanatoria with Beds and Altitudes-
Seaside Sanatoria for Children pag$ 203
Chapter XXXIII. Sanatoria for the People in Eastern Germany.
Pr. Weicker's Krankenheim at Gorbersdorf— The Loslau Sanatorium
pMgeioS
Chapter XXXIV. Sanatoria for the People in Brandenburg,
Mecklenburg, and Pomerania.
The Beelitz Sanatorium— The Belzig Sanatorium— The Bleichrdder Sana-
torium — ^The Blankenfelde Sanatorium — ^The Grabowsee Sanatorium
—The Malchow Home for Consumptives— The Stettin Sanatorium
page 214
Chapter XXXV. Saxon Sanatoria for the People.
The Albertsberg Sanatorium — The Plauen Sanatorium — ^The Jonsdorf
Convalescent Home — The Prinzessin Maria-Anna Helm page 222
Chapter XXXVI. Sanatoria for the People in the Harz District.
The Andreasberg Sanatoria— The Oderberg Sanatorium— The Hanse
Insurance Company's Sanatorium for Women — The Felixstift Sana-
torium — ^The Sti^e Sanatoria: Albrechtshaus and Marienheim— The
Sulzhayn Sanatoria : The Sulzha^n Miners' Sanatorium ; the Fem-
sicht Sanatorium for Paying Patients; The Sulzhayn Village Sana-
torium for Paying Patients — The Altenbrak Sanatorium for the People
— The Konigsberg Convalescent Home — The Zellerfeld Sanatorium
pagt 226
Chapter XXXVII. Sanatoria for the People in Thuringia.
The Colony in the Harth Forest — The Berka Sanatorium— The Manebach
Sanatorium page 243
Chapter XXXVIII. Sanatoria for the People in Hanover. West-
phalia. Oldenburg and Lippe Dettmold.
The Rehburg Bremen Sanatorium— The Hanover Sanatorium Society —
The Altena Sanatorium — Other Institutions at Altena for Consump-
tives page 246
Chapter XXXIX. Sanatoria for the People in the Rhine District.
Projected Sanatoria— The Ruppertshain Sanatorium page 252
Chapter XL. Sanatoria for the People in S.W. Germany.
Projected Sanatoria — The Dannenfels Sanatorium— The Wiirzburg Sana-
torium—The Speyer Sanatorium— The Schdmberg People's Sanato-
rium — The Arlen Sanatorium — The Marzell Sanatorium — The
Krailling Sanatorium— The Harlaching Sanatorium . page 256
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CONTENTS. XI
Chapter XU. Sanatoria in Norway and Swbdbn.
Tftbto of Norwagian Sanatoria, with Beds and Altitudes— Tonaaassen
Sanatorinm-'The Gausdal Sanatoriam— The Reknaes Consumption
Hospital— Other Sanatoria for the Poor in Norway . • p^e 267
Chapter XLII. Russian Sanatoria.
Existing and Projected Sanatoria— Table of Sanatoria, with Beds and
Altitudes— Lindhdm Sanatorium— Quisisana Sanatorium at Yalta—
The Sanatoria at Halila: the Alexander Sanatorium; the Maria
Sanatorium; the Nikolaj Sanatorium— The Taitzi Sanatorium— The
Military House Sanatoria at Zarskoje Selo and at Wola . pag$ 272
Chapter XLIH. Swiss Sanatoria for Paying Patients.
Table of Swiss Sanatoria, with Beds and Altitudes— The Arosa Sanatorium,
Davos— Dr. Turban's Sanatorium —The New Davos Sanatorium —
The Maison de Diaconesses- The Villa Pravignan— The Leysin Sana-
torium — ^The Montana Sanatorium — The Weissenburg KurhBius
t(igi 283
Chapter XLIV. Swiss Sanatoria for Poorer Patients.
The Basel Sanatorium at Davos— The Dutch Sanatorium at Davos— The
Davos Invalids' Home— The Davos Benevolent Society — The St.
Moritz Aid Fund— The Heiligenschwendi Sanatorium— The Zurich
Sanatorium— The Sanatorium of Braunwald — The Aegeri Sana-
torium page 299
Chapter XLV. Projected Sanatoria in other Foreign Countries.
The Sanatorium Movement in Belgium — Bulgaria— Denmark — Egypt —
Holland — Italy— Japan — Portugal— Roumania— Spain . pag$ zii
Chapter XLVI. British Colonial Sanatoria.
Sanatoria in Australia and New Zealand — Canadian Sanatoria — The
Sanatorium in Cape Colony page 315
Chapter XLVII. British Institutions for Poorer Consumptives.
London Chest Hospitals and Sanatoria— Homes for advanced cases —
Provincial Chest Hospitals and Sanatoria — Provincial Homes for
advanced cases— Sanatoria in Southern England— In the Northern
Counties— Scottish Sanatoria— Irish Sanatoria . . page 318
Chapter XLVIII. British Sanatoria for Paying Consumptives.
Inland Sanatoria in the Southern Counties — Southern Sanatoria on the
Coast — Western Counties — Eastern Counties— North of England —
Scottish Sanatoria— Irish Sanatoria page 348
Chapter XLIX. British Needs and British Resources.
Mortality from Consumption— Beds for Consumptive Poor in Great
Britain and in Germany— Need for Country Sanatoria, Nursing
Homes, and Model Villages— Decentralisation — Schools for Delicate
Ctiildren— Beds for Middle-class Consumptives in Great Britain and
in Germany — Need for cost-price Sanatoria— A Forecast . page 393
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Xll CONTENTS.
Appendix.
America — United States — Argentine Repoblic—Aostralia— Aostria and
Hungary— Belgium— Canada— Canary Isles — Cape Colony— Denmark
— Egypt — France— Germany — Holland— Italy — Monaco — Norway —
Portugal— Roumania— Russia — Spain — Sweden — Switzerland.
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LIST OF ILLUSTRATIONS.
PIO. PAOB
1. Plan of thb Falkbnstbin Sanatorium .... 19
2. Plan of thb Hohbnhonnbf Sanatorium ... 19
3. Thb Adirondack Cottagb Sanitarium .... 85
4-5. Thb Loomis Sanitarium 88-89
6. Thb Homb, Denver 104
7-8. Las Vegas Sanitarium Z06-107
9 a-f. The Alland Sanatorium 121
10. The Durtol Sanatorium 133
11. The Trespoey Sanatorium 135
12. The Ormesson Hospital 140
13-13* The Villibrs-sur-Marne Hospital 142
14. The Brehmer Sanatorium, GdRBBRSDORF . -151
15. Dr. R5mplbr's Sanatorium, GdRSBRSDORF - > '^^^
16. Dr. Weickbr's Sanatorium, G5rbbrsdorf .158
17. Thb Reiboldsgrun Sanatorium 161
18. Dr. Lahmann's Sanatorium. Sleeping Box . .165
19. Dr. Michaelis* Sanatorium, Rbhburg .172
20. The Falkbnstbin Sanatorium 178
21-22. The Hohbnhonnep Sanatorium 183
23. The Sch5mberg Sanatorium 197
24. The Albertsberg Sanatorium 222
25-26. Thb Odbrbbrg Sanatorium 227-228
27. The Fernsicht Sanatorium, Sulzhayn .... 238
27*. The Bremen Sanatorium, Bad Rbhburg .... 247
28-30. The Ruppertshain Sanatorium 253-254
31. The Dannenfels Sanatorium 258
31*. The Krailling Sanatorium 263
32. tonsaassen sanatorium, norway 268
33. Thb Arosa Sanatorium 285
34. Dr. Turban's Sanatorium, Davos 289
35-36. The Lbysin Sanatorium 293
37. The Montana Sanatorium 296
37*-39- The Basel Sanatorium, Davos 299-301
40. The Heiligenschwendi Sanatorium 307
41. The North London Consumption Hospital . .321
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XIV LIST OF ILLUSTRATIONS.
^ibis. Thb Vbntnor Consumption Hospital .... 325
42-43. The North London Consumption Hospital . 322-323
44. The Westmoreland Sanatorium . . . . : 338
45. Bridge of Weir Sanatorium 342
46. Forster-Gresn Consumption Hospital .... 346
47-49. Crooksbury Sanatorium 35^35^
50-52. Hailey Sanatorium 352-353
53-54. Linford Sanatorium 355*35^
55-56. Inolewood Sanatorium 364-365
57. Overton Hall, Bournemouth .... . 366
58-59. The Cotswold Sanatorium . 370-371
60-62. nordrach-upon-msndip 374-37^
63-64. East Anglian Sanatorium 378-379
65. The Mundesley Sanatorium 380
66. Knocksualtach Sanatorium 385
67-69. Nordrach-upon-Dee . ■ 386-387
70-72. WooDBURN Sanatorium " 388-389
73. Rostrevor Sanatorium , . ^ , . . .392
74. Massachusetts State Sanitarium 404
NoTE.^The buildiDg figured aod described at pp. 295-8 as the Montana
Sanatorinm is now an hotel, and has been replaced as a sanatorium by
another building.
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CHAPTER I.
INTRODUCTORY.
Sanatoria for consumptives are establishments for the
open-air treatment of presumably curable cases of con-
sumption under medical direction, mainly by hygienic and
educational measures. They are not intended for patients
whose prospects of recovery are small; nor are they in-
tended for non-tuberculous cases, or for those who are
merely out of health. Consumptive patients who are
seriously ill are better treated in the first instance in a
hospital or nursing home, or in their own homes, if these
are suitable. Their treatment is quite as much a question
of medicine and of nursing as of hygienic measures ; and to
send them to a sanatorium is to fill up beds which might
be more usefully employed in other ways. For the same
reason it is inadvisable for a sanatorium to receive people
who are merely in need of change of air, as a less expensive
health resort, without the special arrangements of a sana-
torium, is quite sufficient to restore them to health. Such
visitors are only admissible to minister to the comfort or
happiness of other patients, or where they have themselves
shown a tendency to pulmonary tuberculosis.
The sanatorium is intended to receive the consumptive
in any stage which offers a reasonable prospect of recovery,
and where there is sufficient power of reaction to render an
open-air life possible without mischief. A sanatorium of
this kind has therefore a strictly limited though most im-
portant function, and is no substitute for the nursing home
or hospital, the convalescent home or hydropathic establish-
1
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2 INTRODUCTORY.
ment, although it resembles each of these in certain respects.
Owing to the necessity of being near centres of population
most hospitals — even most consumption hospitals — have
been erected in situations which are by no means the best
for the hygienic treatment of consumptives. Perhaps if
they were to be erected at the present day, many would be
placed in more suitable neighbourhoods. Some convales-
cent homes and hydropathic establishments are quite suit-
ably placed for the open-air treatment of phthisis, and
might with a little modification be adapted to this purpose.
But the class of visitors which they receive, and in some
cases the inadequate provision of shelter against wind and
weather, would make it diflBcult to satisfactorily treat con-
sumptives there. Many of those who go to a convalescent
home do not need the special arrangements of a sanatorium.
Hydropathic establishments, too, are intended for a widely
different class of visitors, whose dietary is often by no
means the best for the average consumptive; and in a
different way this is also true of hotels and boarding houses
in health resorts. Such establishments are primarily in-
tended for the reception of pleasure seekers, whose pre-
dominating presence is a serious hindrance to the systematic
treatment of phthisical visitors. In a sanatorium the main
object is the recovery of health; and for consumptive
patients and their advisers this is a sufficiently difficult
task, to which everything else must be subordinated.
Sanatoria for consumptives often go through several
stages of existence. At first simply health resorts, in
which the visitors do whatever seems best in their own
eyes without being necessarily under medical advice or
guidance ; later they become " open sanatoria " for a mixed
class of patients, tuberculous and non-tuberculous together,
under medical supervision. They are termed " closed sana-
toria " when they are entirely under medical direction, and
sufficiently complete to provide for all the wants of their
inmates ; and in many cases a further step is taken by
excluding all but phthisical patients. Closed sanatoria
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INTRODUCTORY. 3
possess great advantages in the treatment of consumptives,
who are apt with the best intentions to do most unwise
actions, and to be led astray by the example of visitors of
a diflTerent kind, if they wander from the sanatorium into
public roads and resorts. The ordinary amusements of a
health resort — theatres, concert - rooms, skating - rhiks,
casinos and even public-houses — may present fatal tempta-
tions to the phthisical in an open sanatorium, whereas this
cannot so easily happen in a closed one. There are also
great advantages in treating a number of consumptives in
the same sanatorium, provided they be judiciously chosen ;
for the arrangements necessary for two or three will often
suffice for a much larger number, and a corresponding sav-
ing of time, trouble and expense is thus effected. Nearly
all the more recent sanatoria for consumptives erected in
Germany are closed sanatoria, exclusively reserved for such
patients. Sanatoria for consumptive children require a
slightly different organisation from those for adults. In
dealing with patients who suffer from external tuber-
culosis, a much more bracing and exposed situation may
often be chosen with advantage. In this country many
such cases are treated at our seaside convalescent homes
with the best results, whereas these institutions, with pre-
sent arrangements, are at certain times and seasons for the
most part unsuitable for ordinary consumptives. The
medical and surgical requirements in the two sets of cases
are also usually different.
Digitized by LjOOQIC
CHAPTER II.
CLIMATES FOR CONSUMPTIVES.
In his recent book on The Coiwumptive and his Treat-
ment^ Dr. L^on Petit says : " We are now-a-days convinced
that there is no climate, however favoured, which by itself
can cure the consumptive". I may add that there is no
climate which is equally suited to every case of con-
sumption. People in health differ greatly in their powers
of reaction, so that the same climate may be bracing to
one which is depressingly cold to another. Amongst con«
sumptives there is an even greater difference to be found.
At certain stages, and in some cases, a mild equable climate
is essential ; whereas for most of the more hopeful cases, a
cool bracing climate will be best, although this must be
associated with plenty of shelter against wind and weather.
It is a mistake to suppose that consumptives generally do
best in warm climates. Pulmonary phthisis runs a rela-
tively rapid course in warm climates; and patients who
have gained weight in winter often lose it when the warmer
weather sets in. In this respect England compares favour-
ably with Italy and the south of France. Consumptive
patients from the cooler parts of Germany are said to do
badly at the Riviera ; and the same thing has been observed
of those who go there from the north of France. Some
years ago a number of selected cases were sent from the
Brompton Hospital to Madeira; but most of them were
no better for their change of climate. A similar result is
said to have followed in the case of some hospital patients
sent from Manchester to Bournemouth. The health resorts
^ Le Phtisiquc et son Traitement Hygiinique^ Paris, 1895, p. 49.
(4)
Digitized by LjOOQIC
CLIMATES FOR CONSUMPTIVES. 5
which have been most successful in the treatment of con-
sumptives are almost without exception places which are
cold, or at all events cool, during some part of the twenty-
four hours. This is true of Alpine health resorts, elevated
tablelands in various parts of the world, German hill sana-
toria, and many places with marine or semi-marine climates.
Confining our attention to the localities which benefit the
more curable cases, we find they possess certain common
features which we are justified in regarding as essential.
(1) They have a pure air, free from dust and smoke and
the impurities which are inseparable from a dense popula-
tion; (2) they are fresh and bracing, but well protected
against cold or stormy winds ; (3) they have sufficient tine
weather, or sufficient artificial shelter, to render an out-of-
door life possible; and (4) they have a dry, warm, well-
drained soil. Wherever these four conditions are found,
and suitable arrangements can be made, it should be possible
to treat consumptives with success. Neither high altitude,
dry atmosphere, fine weather, equable temperature, nor
abundant sunshine is essential to success, however useful
they may be, or desirable in particular cases. Were high
altitude an essential, we should not hear of recoveries on
the ocean, or in low-lying health resorts. Were fine weather
a sine qud non, the remarkable success of the sanatoria in
the Black Forest and other parts of Germany would never
have been chronicled. Many of these have a moist and
chilly climate during part of the year; but patients do
just as well at such seasons as during finer weather. Indeed
the results are if anything better in winter, and Dr. Dett-
weiler. Dr. Walther, and other competent observers regard
the weather as of little importance. Moist still air is sooth-
ing to irritable air passages ; intense cold, mountain fogs,
snowstorms and the like, need not interfere with treatment if
reasonable precautions are taken. The health resorts which
enjoy the best climates do not usually possess the greatest
amount of shelter from bad weather ; but rather those with
a variable and indifferent climate. Visitors have been half-
Digitized by LjOOQIC
b CLIMATES FOR CONSUMPTIVES.
frozen in Italy and Georgia, and chilled with cold winds at
the Riviera. Of greater importance than the climate is the
use which is made of it; and with the help of artificial
shelters this may be independent even of continued bad
weather. Consumptives have been cured in the most un-
likely climates ; and many things point to the conclusion
that it is fresh air and medical supervision rather than a
fine climate which are needed for success.
This statement is not intended to imply that other climatic
characters are of no value ; but rather that they are not of
paramount importance in most consumptive casea Alpine
climates, for example, are unrivalled in their beneficial in-
fluence over certain forms of the disease ; but they are by
no means universally applicable, and other climates can
often with advantage be substituted, for a shorter or longer
time. The value of Alpine health resorts depends- partly
on characters which are common to some other stations.
Their power in expanding healthy parts of the lungs can
scarcely be found lower down ; but their tonic influence,
their cool air with a warm sun, their atmospheric dryness
and purity, their absence of dust, their freedom from strong
wind, are possessed in various degrees by places at lower
levels. It is probably easier in Alpine climates to prevent
the growth or continued vitality of the tubercle bacillus out-
side the body, partly because of the large amount of sun-
shine, partly owing to the atmospheric dryness and the
winter coat of snow ; but if the sputa are properly disposed
of in every case, this becomes of little importance. It is
most unwise to indiscriminately recommend the Alps to every
consumptive patient. To obtain benefit from such a climate
a certain degree of reactive power is essential ; and just as
many people cannot without previous training get a proper
reaction after a cold bath, so it is with an Alpine climate.
Douglas Powell indeed has said : " Notwithstanding the
enthusiasm with which cold mountain climates have been
of late years advocated for the treatment of consumption, it
remains certain that those resorts are not adapted for the
Digitized by LjOOQIC
CLIMATES FOR CONSUMPTIVES. 7
majority of patients, as they come before us, suffering from
this disease ; and perhaps it might with truth be said that a
large number of the very cases that do well aloft do equally
well in the plains "} " In order to reap the benefit of high
altitudes, patients must be free from pjrrexia, and possess
sufficient lung surface to carry on adequately the process of
respiration in the attenuated atmosphere." ^ Those who are
markedly febrile, who have feeble circulation, damaged
kidneys, double cavities or extensive lung disease, rapidly
advancing lung destruction, laryngeal complications, or irri-
table nervous systems, do badly at Alpine resorts. Even at
Reiboldsgriin, which has not an Alpine climate, being only
700 metres (2300 feet) above the sea-level, it has been found
that some patients do not progress so well as at lower levels,
and Dr. Wolff- Immermann is in the habit of sending away
such as do not show decided improvement within the first
fortnight. Most of the existing sanatoria are not placed at
high altitudes, as will be seen from the tables given at pp.
84, 129, 149, 206, 267, 273 and 283.
In comparison with Davos and the German hill sanatoria,
many health resorts at lower levels are at a disadvantage,
owing to the absence of proper provision for the hygienic
treatment of consumptives. When this defect has been
remedied, it will probably be found that they too, as well as
others yet untried, have an important part to play in the
battle against tuberculosis. The warm low level health
resorts of the Riviera have no longer the reputation they
formerly had in this respect; and many think that the
climates of some parts of the British Isles would be more
useful for our countrymen. " There are many places in this
country where, on a dry soil and in a sunny sheltered part,
on the southern slope of some upland, most of the conditions
can be obtained which are now dearly bought and far sought,
and often not obtained, in distant parts of the world." ^
1 Diseases of the Lungs, 4th ed., 1893, p. 513.
* C. Theodore Williams, Practitioner^ June, 1898, p. 627.
* A. Ransome, The Treatment of Phthisis, London, 1896, p. 138.
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CHAPTER III.
TREATMENT IN HOME CLIMATES.
There are some very strong reasons for the treatment of
consumptives in their own country.
Many patients are quite unfit to take a long journey ;
and this is true very often of quite early stages of the
disease. So long as there is fever, or fatigue after slight
exertion, or a tendency to free perspiration, a long journey
must be full of risk. The presence of inflammatory com-
plications is also a contra-indication, or persistent or recent
and copious haemoptysis. To those patients who cannot
afford to travel comfortably, a long journey will always be
undesirable. In a long land journey the intermediate
halting places will often be of a most unsuitable kind.
Average hotel accommodation is far from ideal for a con-
sumptive or delicate patient. The larger rooms in even
good hotels are frequently left to ventilate themselves ;
the bedrooms may have been previoiLsly occupied by
visitors suflTering from influenza or other infectious com-
plaints. Even hotels which have been specially built for
the reception of delicate persons or invalids often leave
much to be desired. *' It is not too much to say that they
are most unsuitable places in which to make an extended
sojourn." ^ For dyspeptic consumptives, dietetic treatment
is of great importance ; but a suitable diet is often difficult
to obtain during a journey.
In a sea journey passengers are greatly at the mercy of
the weather. The average cabin is too small and ill venti-
* •* The Climate of the Dwelling-house," by G. Vivian Poore, Journal
of Balneology and Climatology y October, 1897.
(8)
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TREATMENT IN HOME CLIMATES. 9
lated to be suitable for a consumptive patient, who may in
stormy weather be much worse off than at home. There is
often great danger of chill in passing from the sheltered to
the more exposed parts of the vessel in windy weather. In
traversing the tropica the extreme heat is ill borne by deli-
cate passengers. The fare on board ship is often very good
for healthy people ; but for many invalids it is by no
means suitable ; while the monotony of the voyage and
the absence of effective medical supervision lead some to
spend an undesirable proportion of their time in drinking
and smoking in ill-ventilated saloons. Before we recom-
mend a consumptive patient to take a long voyage, we
must take into account his purse, tastes and inclinations,
his seafaring capacity, the probability of good weather or
the reverse, and his ability and willingness to conform to
the necessary hygienic rules.
When the patient reaches his journey's end, it will make
a great difference whether he goes to a medically -supervised
sanatorium or is left to the tender mercies of chance and
his own medical skill. To send a feeble patient to rough it
in the colonies is obviously wrong. Equally so would it be
to expose him, even in the best of climates, to the tempta-
tions of sight-seeing and the injudicious pursuit of pleasure.
In either case he would have been far better in his native
country. Climate is but one factor in treatment, and
accommodation, diet, and above all the use which the
patient makes of his time, are at least of equal importance.
Without systematic medical supervision, the sojourn in a
foreign health resort is nearly always a mistake for a con-
sumptive patient. Dr. Knopf states that in the beautiful
climate of Colorado there is an enormous difference in the
mortality among consumptives under systematic medical
treatment, as compared with those who merely consult a
physician when they think it necessary ; and the same is
borne out by Dr. Solly's statistics.^ But even if the patient
^ Medical Climatology ^ London, 1897, pp. 133-141 ; Knopf, Les Saiia-
-toria poui- la Phtisie Pulmonaire^ Paris, 1896.
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10 TREATMENT IN HOME CLIMATES.
can safely travel, and is under medical care, there are still
some arguments in favour of treatment in home climates.
As a rule (although there are exceptions) it is more expen-
sive to go abroad for treatment ; and many patients may
consequently have to curtail the time of systematic treat-
ment. National tastes, and even national prejudices, have-
also to be considered, and the depression which arises when
the average patient is separated from his friends and rela-
tives. A more important argument is drawn from the
liability to relapse which is shown amongst patients who-
return to a damp and variable climate from sunnier lands.
Many of the foremost physicians abroad are agreed as to
the desirability of attempting the cure of consumptive
patients in their own country. This is the opinion of Prof..
V. Leyden, Prof. v. Ziemssen, Prof. Naunyn, Prof. Senator,
Dr. Dettweiler, Dr. Gerhardt, Dr. Frankel, Dr. Knopf of
New York, and others. There was recently a fund started
in Germany to establish a sanatorium at Davos for German
consumptives of the poorer classes. Germany has no Alpine
climates ; while patients in the sanatorium at Davos would
probably have been under the supervision of a German
doctor ; yet an influential protest was raised on medical
grounds against this mode of attacking consumption, and
the fund may eventually be devoted to the establishment,
of other hill sanatoria in Germany itself.^
1 Heilstdtten Correspondenz, Berlin, Dec., 1897 ; Jan. and Feb., 1898.
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CHAPTER IV.
OUTLINES OP SANATORIUM TREATMENT.
Sanatorium treatment is based on a careful regulation of
each patient's daily life in all its hygienic and medical
details. He is gradually trained to stand a life in the
fresh air in all weathers, while his tendency to chill is
removed by simple hydropathic applications and other
common-sense precautions. The nature and amount of his.
daily exercise are regulated according to the weather, and to
his momentary state of health, in an ascending scale, begin-
ning with absolute rest in bed. His food ranges from fever
diet to a rich and varied though digestible dietary. Strict
precautions are taken to prevent all risk of infection, while
the training he receives is useful not only to himself but to
the whole community after his departure from the sana-
torium. A resident medical and nursing staff assist him in.
carrying out these daily measures, and are immediately
available in case of haemoptysis, night sweats, catarrhal
and other complications. Not that this constitutes the-
whole duty of the medical and nursing staff. They have to
prevent imprudences in some cases, to encourage to per-
severance in others ; to strictly enforce all essential rules,
while they allow sufficient personal liberty in less important
matters to prevent the irksomeness of restraint ; to suggest
harmless and beneficial forms of recreation, while they dis-
courage all those which are likely to do mischief. Mind
has a great influence over bodily health, and the stimulus
of hope and the encouragement which results from steady
(11)
Digitized by LsOOQIC
12 OUTLINES OF SANATORIUM TREATMENT.
progress and sympathetic attention will count for much in
<3uring the patient.
Those who try to live in the open air in a climate like
•our own will meet with many diflSculties, owing to the
absence of special shelters and contrivances for warding ofl*
xain and wind while admitting fresh air. The ventilation
of rooms even in good-class houses is seldom quite satis-
factory; and it is quite exceptional to find an adequate
provision of verandahs and covered walks for use in wet
weather. Such arrangements may not be needed in very
favoured climates, but they are essential in an uncertain or
A rainy one, especially in dealing with phthisical patients.
Consumptives are very apt to over-heat and under- ventilate
their rooms, forgetful or ignorant of the dangers which
they thus incur. Graduated and increasing exercise is very
useful in quiescent phthisis, provided that it is not allowed
to excite dyspnoea or greatly accelerate the heart action.
But in febrile or dyspeptic patients who are losing weight,
all unnecessary exertion is mischievous, and rest in the open
air the only permissible method of treatment. The sana-
torium and its grounds have therefore to be arranged with
A view to both of these contingencies, and paths provided
with every variety of gradient as well as sheltered resting
places. Dust and organic effluvia are most injurious to
phthisical patients. The former excites useless cough and
irritates the air passages, while the latter lower constitu-
tional vitality and foster the growth of tubercle bacilli.
To banish dust and dirt, special methods of furnishing and
•decoration, and still more, special methods of cleansing, are
necessary, which are scarcely if ever found in ordinary
households. Each of these points will be more fully dealt
with in later chapters.
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CHAPTER V.
SITES FOR SANATORIA.
A SANATORIUM foF consumptives should be placed on a dry-
soil, in a sheltered situation, with pure fresh bracing air.
The best soil is sand or rock, as with a proper fall these
are not retentive of moisture, and are consequently soon
dry after rain and are warm to the feet. Rising ground
should be chosen ; with a southerly aspect, and good shelter
from hills or woodland against cold or boisterous winds.
The question of altitude has already been considered (see
chap. ii.). Various elevations according to geographical
position have been recommended by Liebermeister, Breh-
mer, Weber and others. As, however, their reasoning is
partly based upon theoretical considerations, it is not neces-
sary to reproduce their figures here. Moreover, as we have
already said, many diiferent elevations would probably be
needed to suit various degrees of reactive power and lung
capacity. The only systematic attempts at sanatorium
treatment in England have been at low levels but little
above the sea. Nearly all the British health resorts which
have a reputation for the treatment of consumptives are on
or near the coast. A great advantage of the seaside, also
shared by mountain resorts, consists in the recurring breezes
which purify the air and increase the bracing effect. Local
tuberculoses do exceedingly well on the seashore ; but for
pulmonary phthisis the immediate and unprotected sea-
front is not the best. Dr. Ransome has written in strong
terms about the danger of such a situation; and other
older authorities — Walshe, Beneke, Fodere — were equally
emphatic. Where the bracing qualities of seaside air are
combined with suflScient wind-shelter, consumptives will
(13)
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14 SITES FOR SANATORIA.
probably do well. Individual peculiarities must, however,
not be overlooked. There is a great lack of sheltered yet
bracing health resorts in this country with provision for
the open-air treatment. Some of those which exist are too
relaxing in summer; and others which are more bracing
are not t)rovided with sufficient shelter. And if the accom-
modation for consumptives is inadequate on the coast, it is
still more so inland, although many suitable spots could
t>e found for the purpose. Where a high hill is available,
it by no means follows that the top is the best place to
choose. A slightly lower situation is often both more
sheltered and less rainy. Comet of Reichenhall pointed
out^ that there were often strong winds at the top and
at the foot of a mountain ; and to a smaller extent this
may be true of lesser elevations. Blumenfeld recommends
for North Germany the south side of a hill 400 metres (1300
feet) high. The French sanatoria for children at Ormesson
and Villiers are on a breezy, somewhat unprotected high
plateau, 114 to 121 metres (374 to 397 feet) above the sea-
level. The local configuration of the land, as well as the
geographical position, have a great influence over climate,
and would have to be taken into account.
Purity of the air is of paramount importance. For this
reason the neighbourhood of a large town or factory is in-
admissible, or the presence of organic refuse near by. One of
the drawbacks to the treatment of consumptives in popular
health resorts is the increasing contamination of the air
from growth of population. As L^on Petit says : " We
are now-a-days convinced that there is no climate, however
favoured, which alone can cure consumption. The places
which are free from tuberculosis are those where the scanty
population lives constantly in an atmosphere which has
not yet been polluted. They attract invalids, and when
they become fashionable they have long since lost the
qualities which gave them renown."^ On the sea coast
^ Buda-Pesth International Congress of Hygiene and Demography.
«Loc.ci^, pp. 49-60.
Digitized by LjOOQIC
SITES FOR SANATORIA. 15
the water and the sea breezes play an important part in
counteracting such atmospheric impurity ; but we have
abeady seen that the near neighbourhood of the sea is not
the best for consumptives. No sanatorium should be near
a high road ; in dry weather the dust is sure to fly up and
increase the tendency to useless cough. A large extent of
grass land round the sanatorium is an advantage in pre-
venting dust from rising.
High chalk downs have been recommended by some
for the treatment of consumptives. They are, however,
open to two important objections. In dry weather
the short grass of such land is insufficient to prevent
the dust from flying up ; while in wet weather the soil
remains cold and damp, and the air above it is apt to
be foggy. Where hills are covered with a thick layer of
sand or gravel they may be suitable for the open-air
treatment, provided the area of pervious soil is sufficiently
extensive to influence the atmospheric condition. A gravel
patch near a marsh or in an ill-drained depression would
be unsuitable. The character of the vegetation is a useful
guide to the underlying soil. Where pine trees abound the
soil is usually sandy and dry ; and these trees are useful
in other ways, as they give more permanent shelter against
wind and rain, and are active producers of ozone. Some
people also believe that their terebinthinate secretions are
curative; although this is not quite so well established.
Dr. C. T. Williams has pointed out that where jgorse and
heather and short springy turf abound, the locality is
usually suitable for consumptives, whereas long rank grass
should be avoided. It must be remembered that an under-
lying stratum of clay may render a sandy soil unsuitable
for consumptives. Soil and shelter are the two most impor-
tant points in choosing the site for a country sanatorium.
But if a country place is the most suitable, it must be
reasonably accessible to prevent the need for a long journey.
The sanatoriu\ii should however not be close to a railway.
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CHAPTER VI.
THE SANATORIUM GROUNDS.
The acreage required for the grounds of a sanatorium will
depend somewhat upon the amount of open public land in
the neighbourhood. The grounds of the Brehmer Sana-^
torium at Gorbersdorf amoimt to about 300 acres ; and
some of the American sanatoria have very extensive
grounds. Land is, however, too expensive in this country
for such luxurious proportions; and a much smaller area
will suflSce if it is of the right kind, and not surrounded
with houses or with ploughed fields. Brehmer laid stresa
on the importance of carefully graduated walking exercise
in strengthening the heart of the consumptive ; and his
results to a large extent justify his contentions. For such
a purpose it is necessary to have a reasonable length of
level paths, and a number of others at various easy
gradients, so arranged that the patient can take walks
increasing in length and in diflSculty, always returning
down-hill to the sanatorium. Since Dettweiler's powerful
advocacy of the treatment of consumptives by rest in the
open air, the need for systematic exercise out of doors has
been somewhat underrated in many quarters ; but there
is little doubt that facilities should be provided for both ;
and this view is adopted in some of the best German and
American sanatoria. At certain stages, absolute rest in the
open is the best treatment ; later on, graduated exercise,
which should be taken without having to quit the sana-
torium for the public roads, as in some states of the
weather these may be unfit for consumptives. The
(16)
Digitized by LjOOQIC
THE SANATORIUM GROUNDS. 17
grounds should be freely provided vdth seats and shelters,
and covered walks for exercise in rainy weather. In the
Brehmer Sanatorium there are seven kilometres (four and
a half miles) of walks, and a seat every twenty paces^
besides large winter gardens and shelters for wet weather.
Trees — preferably evergreen — should be so arranged as to
give shelter against wind while they permit the free access
of sunshine and air. In these comparatively sunless islands,
every ray of sunshine should be utilised to the utmost ; for
if it be not essential to recovery, it is always grateful to
chilly subjects, and the best of nature's disinfectants. In
a country sanatorium, stables and other outbuildings are a
necessity. They should, however, be placed at a distance
from the patients' haunts.
Digitized by LjOOQIC
CHAPTER VII.
CONSTRUCTION, DECORATION AND FURNITURE.
The main facts to be borne in mind are, that the sanato-
rium is for the open-air treatment of patients, that every
part should be extremely well and independently ventilated,
readily cleansable without raising dust, and, as regards the
patients' quarters, freely open to the sunshine, while shel-
tered from wind. It is conducive to economy, both in con-
struction and in management, to have a building which is
concentrated on a relatively small area. From a purely
medical point of view it would be best to have a series of
scattered but intercommunicating buildings of few storeys.
Existing sanatoria fall into two extreme groups, represent-
ing these two ideals, with various intermediate forms. On
the one hand we have such a building as Dr. Rompler's at
*Gorbersdorf, or the main building at Reiboldsgriin, or at
Leysin ; on the other we have the Cottage Sanatoria at
Nordrach in the Black Forest, the Adirondack and Loomis
Sanitaria in America. One of the chief diflSculties in de-
signing a sanatorium for consumptives consists in the
advisability of providing a sunny aspect for every patient's
bedroom. In an ordinary hotel or boarding-house the
rooms may face every point of the compass ; they often
block the ends of corridors ; while space may be further
economised by arranging many rooms round the sides of a
hollow square. But such an arrangement is inadmissible
for a sanatorium. The plan adopted at Falkenstein is that
of a central five-storey building with diverging wings, pro-
tecting a terrace round which are placed the deep verandahs
for fresh-air treatment. Diverging at a still more open
(18)
Digitized by LjOOQIC
Digitized by LjOOQIC
-^-<..Q,'
?^->'y
S
^:.-y
Winter Garden.
Reading Room.
Conversation and
Dining Saloon.
Office.
Winter Garden.
/ /
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Digitized by VjOOQIC
Digitized by LjOOQIC
UPPER FLOORS
mm
OJ JO
[ftfr;
FiQ. 2.— Thb HoHraHomrsF Sanatobiux. [Faeepagt 19.
Digitized by LjOOQIC
Basement: —
Thb Hohbnhonnbf Sanatorium.
1. Cloakrooms.
2. Inhalation Room.
3. Heating Apparatus.
4. Douche Rooms.
Oroiind Floor : —
1. Consulting and Waiting Rooms.
2. Winter Garden.
3. Reception Room.
4. Reading Room.
5. Ladies' Room.
6. Music Room.
7. Billiard Room.
15. Serving Room.
8. Cloakrooms.
9. Servants' Room.
10. Nurses' Room.
11. Hairdressing Room.
12. Office.
13. Post Office.
14. Dining Saloon.
Upper Floors:—
1. Nurses' Room.
2. Balcony.
3. Small Kitchen.
4. Rooms for Convalescents.
Digitized by LjOOQIC
Digitized by LjOOQIC
CONSTRUCTION, DECORATION AND FURNITURE. 19
angle are covered corridors (one open to the weather), which
lead to later-built annexes. Immediately behind one of
these corridors is the separate large dining saloon,
which is over the kitchens (see fig. 1). The same plan
has been adopted at Hohenhonnef, with the exception of
the lateral corridors and annexes, and the position of the
dining saloon (see fig. 2). In such an arrangement
nearly all the parts tised by. patients are on the south
side. At Hohenhonnef, for instance, the verandah is placed
in front of the basement, which is occupied by cloak-rooms,
store-rooms, and the like. On the floor above are the recep-
tion-rooms ; above this are placed the chief of the patients'
rooms on three floors, a few more being situated on other
aspects in the wings. Such tall buildings make a lift almost
a necessity, although at Falkenstein this has not yet been
provided. Another possible drawback is that each floor is
apt to ventilate into the one above, unless special precau-
tions are taken.
In the cottage sanatoria, on the other hand, most of the
buildings consist of just two (or at most three) storeys — a
ground floor, which may be occupied by reception-rooms
or (if raised and damp-proof) by some of the patients' bed-
rooms. Thfe kitchen and its adjuncts would form a separate
building, and there would also often be a recreation pavilion.
This is an ideal plan where land and material are cheap, and
there are plenty of suitable spots for a number of buildings,
and the weather is fine during most of the year. Where
these conditions are not present some compromise between
the two systems must be adopted, or at all events the build-
ings must be connected by covered ways. The cottage
system is the more convenient for isolating such patients as
may catch an intercurrent infectious disease ; and also for
grouping patients according to the form and stage of disease
where there is much diversity in this respect. It is however
more expensive and more dilBScult to supervise.
Verandahs and covered balconies are an essential part
of every sanatorium for consumptives. These should be
so arranged as not to darken the patients' rooms. Glass
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20 CONSTRUCTION, DECORATION AND FURNITURE.
roofs will often be a help in this respect; or the veran-
dahs may be placed at a lower level or to one side, as at
St. Blasien and at Ruppertshain (see fig. 29, p. 254). There
should if possible be at least one verandah or summer-house
with a northerly aspect for use during hot weather, which
may otherwise be exceedingly debilitating to phthisical
patients. To properly shelter the patients, the verandahs
should be twelve feet wide or more. In rainy climates they
should be provided with movable glass screens, as at
Hohenhonnef and the Adirondack Cottage Sanitarium.
It would be a great convenience if the verandah floors
could be warmed in winter. They should in every
case be sloped, to throw off moisture.
The kitchens should be placed at a distance from the
haunts of the patients, to prevent loss of appetite from the
smell of cooking. Where this is not possible, they must be
cut off by ventilating lobbies and corridors. Cloak-rooms
and lavatories should be readily accessible to patients on
their way from the grounds to the dining-saloon to prevent
unnecessary fatigue, and the cloak-rooms should have hot
pipes or drying cupboards for damp clothes. In other
respects the buildings must be constructed according to the
accepted rules of hygiene. Dry foundations are of course
essential, as well as adequate provision of suitable closets,
bath-rooms and the like. Most of the German sanatoria
contain a douche-room, which may be placed in a lower
floor on the northern side. At Nordrach there is a douche
apparatus in each of the bedrooms. In some sanatoria
this method of treatment is not even used. The provision
of baths in foreign sanatoria is sometimes inadequate,
although there are notable exceptions. Waste pipes from
lavatories and bath-rooms become almost as foul as soil
pipes from water-closets. They should therefore be placed
in built-out pavilions, and be as short as possible. It
would be an improvement to provide for their cleansing by
mechanical means, as this is not properly accomplished by
even a powerful flush of water.
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CONSTRUCTION, DECORATION AND FURNITURE. 21
The ventilation of rooms should be as perfect as possible.
It is quite impossible to rival the open air in its purity, but
as near an approach should be made as is practicable.
The ordinary allowance of 3000 cubic feet of air per head
per hour is often regarded as a ** counsel of perfection '* ;
but for open-air treatment this is not sufficient. With open
windows and open chimneys or ventilating shafts, more
than this can be provided even in winter ae soon as patients
have learned to stand a very moderate degree of cold. Dr.
Bansome states that at the Manchester Consumption Hos-
pital aa much as 18,000 cubic feet per head per hour was
often provided ; ' and with the help of special arrangements
there should be no difficulty in improving upon the ordinary
standards of indoor ventilation, high as these are above
those observed in most of our private houses and hotels.
In many continental sanatoria the windows are kept open
in all weathers and seasons for the whole twenty-four
hours. Where the climate is variable, special shutters are
often provided (as at Ruppertshain Sanatorium) which let
in air while they exclude rain. Small glass screens might
be arranged for the same purpose. Some sanatoria have
double windows. This is unnecessary and may be mis-
chievous, as they can be of no use unless the windows are
shut. Even in Alpine sanatoria it is doubtful whether
they are necessary. All windows and shutters should be
so constructed as not to clatter when the wind blows. I
have known it to happen that with ordinary fittings no
sleep was obtainable until the windows were shut. Abun-
dant light should be admitted into all the rooms, and all
those used by the patients should admit the sun s rays
during part of the day. The main front of the building
should therefore be south, south south-east, or south south-
west. People are apt to forget that the eastern side of a
house receives more sun than the west, especially in hilly
districts. If there is adequate shelter against east winds,
» Weber-Parkes Prize Essay, London, 1898, p. 73.
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22 CONSTRUCTION, DECORATION AND FURNITURE.
the east side may quite properly be used for some of the
bedrooms. In summer time it is unpleasant to have the
hot noonday sun streaming into the room. A direct
southerly aspect is therefore not so good in summer for any
patient who is confined to his bed. This difficulty may,
however, be overcome by wheeling the bed on to a balcony
or verandah with a different aspect ; and in the same way
a cold aspect may be rendered suitable for a patient in
winter. In such cases the bedroom would be ased solely
during the night. In the main building at Nordrach, the
noonday sun falls aslant along the roof in summer, but
shines into the bedrooms in winter.
According to Trelat (Buda-Pesth International Congreas)
the light on a dull day indoors should be at least equal to
that of ten-metre candles. At least half of one side of each
room should consist of window space. Many people cannot
sleep unless the bedroom be darkened. This should be
effected by the outside blinds rather than by thick curtains,
which are apt to hold the dust.
Artificial lighting should be by electricity, as other
methods add to atmospheric impurity. At Hohenhonnef
even the open-air verandahs and shelters in the woods are
lit by electricity. More primitive methods are however
employed in some otherwise good sanatoria.
The cubic space is of less importance than the size and
position of the ventilating openings, although, of course,
within certain limits the larger the rooms are made the
better. The large dormitory at the Villiers Sanatorium for
children (p. 141) contains over 4200 cubic feet per head.
At Hohenhonnef none of the patients' rooms are smaller
than 2470 cubic feet. At Nordrach, where very good results
are obtained, they average 1500 cubic feet. At Albertsberg
and Oderberg (both for the artisan class) from 1200 to
1400 has been allowed. Patients in sanatoria spend most
of their time out of doors, so that with adequate ventila-
tion 1500 cubic feet should suffice, with a minimum of 120
to 150 square feet of area in the bedrooms. Heating in the
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CONSTRUCTION, DECORATION AND FURNITURE. 28
continental sanatoria is usually by low-pressure steam,
which is probably the cheapest method and one of the
most easily regulated. Charring of dust particles by con-
tact with the heated pipes may be prevented by reasonable
care. In some cases hot-water pipes, closed stoves, or, in
America, open fires are employed. On the continent
chimneys are by no means always present in all the bed-
rooms, although they are usually provided in the newer
sanatoria for paying patients. The absence of a chimney
or a corresponding air-shaft is of course a great drawback.
Open fires are most admirable ventilating contrivances.
They are, however, relatively expensive ; they demand
more attention from servants, and there is a little risk of
dust blowing about in windy weather. Closed stoves must
be very carefully constructed tg be admissible in a sanato-
rium. In the Adirondack Cpttage Sanitarium the patients'
rooms open out of a common sitting-room, being separated
by an incomplete wall seven feet high, the part next the
ceiling being open, and the doors having a ventilating space
below. This considerably increases the air-space, and makes
it easier to ventilate in doubtful weather without draught.
Where the incoming air is warmed, care must be taken
not to overheat it. The temperature in some of our con-
sumption hospitals is often too high for consumptives,
although suitable for ordinary bronchitics. This is one of
several reasons for separating the diflerent kinds of patients
in chest hospitals. At the Loomis Sanitarium the winter
temperature in the bedrooms at night is kept under 40° F.
It is highly desirable that each room should be capable of
being ventilated from more than one quarter, according to
the direction of the wind. It is essential that they should
be flushable with a direct current of fresh air. This is the
chief reason why the bedrooms of a good sanatorium are
arranged in a single row with a corridor behind. The
windows of the corridor should be opposite the door of
each bedroom. In summer time ventilation may be greatly
improved by removing the doors. With the bed in a
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24 CONSTRUCTION, DECORATION AND FURNITURE.
sheltered position both door and window may often be
safely left open. For the sake of privacy, and to check
the too rapid passage of air, skeleton doors with permeable
centres may be substituted for the solid ones. This has
been done at my suggestion by Miss Jane Walker, M.D.,
in a small sanatorium in Norfolk under her supervision,
"greenhouse shading" of double thickness being used.
The material should of course be removable for periodical
cleansing. A similar contrivance may with advantage be
adopted where the windows do not reach the floor, the
permeable screen replacing the wall below the window
frame. The inlet may in this case be made smaller outside
than in, on the principle of Ellison's perforated bricks.
With a wind screen an amount of ventilation will often
be possible which would otherwise not be tolerated. At
Nordrach draughts are entirely disregarded. It is worth
remembering that a draught often disappears when the
ventilating inlet is enlarged.
Every part of the sanatorium should be so constructed
as to facilitate cleansing. Comers should be rounded, and
unnecessary ledges avoided. The floors may be of polished
wood, or painted, or covered with linoleum. Cracks and
joins should be as far as possible avoided. By waxing, the
cracks may be often filled in. A paraffin composition is
also used for the same purpose. In bath-rooms, kitchens
and corridors, cement, artificial stone, or tiles may be used ;
but these are less suitable for parts which cannot be well
warmed. At Sulzhayn many floors are made of " torga-
ment,'* a kind of cement which unites with wood or iron,
and has incorporated with it wood shavings, so that it is
both cleanly and warm to the feet. Walls may be lime- or
colour-washed ; or panelled with wood and varnished, oiled,
or painted; or covered with lincrusta or other washable
materials. If wooden panelling be used, cracks must be
carefully avoided. Cement walls, as in most of our hos-
pitals, would be quite suitable. In some continental sana-
toria wall paper is used, but this is not advisable unless it
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CONSTRUCTION, DECORATION AND FURNITURE. 25
l3e washable. In the Basel Sanatorium at Davos an ex-
-cellent linen-backed washable paper is used. Silicate paint
And other impermeable coatings might be useful in covering
inner walls. The ceilings in most continental sanatoria are t
white-washed or colour-washed, and free from mouldings.
At the Maria Sanatorium at Halila in Finland they are
panelled with wood ; and the same has been done at Nord-
rach. In planning a sanatorium, care should be taken to
place all noisy portions at a distance from the patients'
rooms and resorts. Even apart from this reason, it would ^
not be advisable to place the kitchen department, scullery ^L
and servants' quarters, next the open-air verandahs or bed- ^
rooms. In the "Home*' at Denver, the walls are made
•extra thick and solid in order to prevent one patient from
being disturbed by another's coughing. But in a sana-
torium it is chiefly the early cases that would be received,
-and by suitable training, together with simple harmless
remedies, all unnecessary coughing can in such patients be
usually prevented. Moreover, where this cannot be done,
as the windows have to be kept open, the sounds would
.still travel from room to room. A large building with long
bare corridors is very difficult to keep quiet. Many of
•our otherwise admirable hospitals fail lamentably irf this
respect. Where thick curtains are permissible, these will
help to prevent the echoing sounds from travelling ; but in
a sanatorium for consumptives this is not advisable, and in
Any case it adds to the work of management. At Hohen-
honnef the bedrooms are provided with double doors to
^hut out the noise. A well-planned smaller building has a
great advantage in this respect.
But few common rooms need be' provided in a sanatorium,
AS it is advisable to encourage patients to stay out of
doors. Recreation pavilions and the like should be open-
Air structures ; and even the dining saloon may be usually
kept open along one side. In an English sanatorium it
would be idle to slavishly copy any of the foreign institu-
tions. Climate and national customs and prejudices have
\
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^
/^
/
26 CONSTRUCTION, DECORATION AND FURNITURE.
to be considered ; and what is suitable in sunny Colorado-
or snowy Switzerland would be out of place in this country..
The Alpine sanatoria have to be made on a more con-
/ centrated plan than those in the Lowlands, in order to*
economise warmth; and verandahs, which leave rooms
suflSciently lighted abroad, would sadly darken those in
our less sunny country. The class of patients for whom^
the sanatorium is designed will also somewhat modify the
plan of construction. Every sanatorium should be suitably
provided with drug-room and laboratory for bacteriological
^ and other work. Most of the more recently constructed
ones have a room with apparatus for radiographic work.
There should be means for isolating and nursing the graver
cases, and a room available for use as a mortuary in case
of need, even though only early cases are admitted.
The furniture of the sanatorium should be light and free
from unnecessary ornamentation or dead space ; the heavier-
articles readily movable for cleaning purposes and capable
of being cleaned all over, as well as the floor on which they
stand. If stuffed furniture is used, the stuffings should be
removable, or else kept covered with washable covers^
Leather-covered lounge chairs would, however, be un-
objectionable ; but saddlebag covering is unsuitable. Bent-
wood cane chairs are good. For the open verandahs and.
summer houses the most convenient couches are adjustable
cane ones, convertible into chairs by removal of the foot
piece. There is no reason why they should not be provided,
with comfortable cushions, provided these have washable-
covers. Tuberculosis is not like scarlatina in its infectious,
properties. It has been suggested to me that the furniture
should be capable of being " stoved '* en rtiitsse ; but this
would necessitate a very expensive method of construction,,
or a great lack of comfort, and appears to me quite un-
necessary. Carpets, mats, curtains and other hangings,
should be only sparingly used. The carpets should be in.
movable strips, with a free margin of floor around the
room. Hairy mats and long-pile carpets are not advis-
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CONSTRUCTION, DECORATION AND FURNITURE. 27
able. Skins are also best avoided, as leather is not easy to-
disinfect by heat without damage. Screens and hangings,
need not, however, be entirely banished, as they are useful
in preventing draught and noise, and if of washable
materials are otherwise unobjectionable.
Plain iron bedsteads are the best kind for a sanatorium.
In some of the continental sanatoria horsehair mattresses
are used with coverfe to button, so that the contents can be
taken out and separately sterilised by heat. At Siilzhayn
(an institution for those with small incomes) the horsehair
is mixed with one-third sissal fibre, which is springy and
clean, and considerably cheaper than horsehair. The
pedestals are often made of open japanned ironwork with
a glass top, which is better than the usual wooden kind.
As it is undesirable to have bags and boxes in the bed-
rooms, cupboards or wardrobes of some kind are necessary.
In some sanatoria these are placed outside in the corridors.
Cupboards encroach less upon the cubic space of the room
than wardrobes. Their floors should not be sunk below
the floor of the room, and the interior should be made as.
carefully as that of the room itself. The chief objection ta
their presence is that they may escape the daily cleansing
which is so important for every part of the room. Boots,
and shoes (beyond those actually, in use) are best kept in
a special well-ventilated boot-room. Outdoor clothing caa
be kept in one of the cloak-rooms. For washstands, a.
choice may be made frotn several of the ordinary types of
marble-topped or japanned iron ones. It is customary in ^ j
many of the sanatoria for the poorer classes for all per- j
sonal ablutions to be done in lavatories or bath-rooms. At /
the projected sanatorium at Mont Bonmorin (p. 136), no
decorations or pictures are to be permitted beyond those
painted on walls and ceilings. Elaborate picture frames,
and intricate ornaments are, of course, unsuitable for
a sanatorium ; but the sii»fte' kinds may quite safely
be admitted under good management, although they add
to the work of the establishment.
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i>
CHAPTER VIII.
CLEANSING AND DISINFECTION ; SEWERAGE AND
WATER SUPPLY.
Although tuberculosis belongs to the infectious diseases,
it is probably the easiest to prevent from spreading. Simple
cleanliness alone will go a long way to prevent its exten-
sion to other people ; so that many were doubtful whether
it was really infectious, until Koch and others proved it to
be so. The consumptive in all but the earliest stages is,
however, a source of danger to those around him, unless he
adopts certain simple precautions. The danger lies not in
his breath, but in what he coughs up. It has been calcu-
lated by Hiller that there may be as many as 300,000,000
tubercle bacilli in each expectorated morsel of 3 ccm.
Were these sputa to be allowed to dry and mingle with
the dust, they would constitute a serious danger for every
susceptible person who happened to inhale them. Nor
does the danger stop here ; for Ransome has shown that
the bacilli are capable of growing in ordinary temperatures
on damp wall-paper, especially in presence of organic
effluvia from the breath or the soil. Fortunately, sunlight
and fresh air are most efficient disinfectants; and if the
sputa are received into suitable receptacles and destroyed
before they dry, there can be no possible danger (see also
p. 65). In most continental sanatoria Dettweiler's portable
spitting flasks are used by the patients ; various kinds of
spittoons are also employed indoors, and at Falkenstein
are placed about the grounds. This latter plan is how-
ever likely to defeat its own ends. Dettweiler's flask has
(28)
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CLEANSING AND DISINFECTION. 2*
done most important services, but is too complicated to be
perfect, and is rather expensive. Spitting flasks with one
opening should have it large enough to admit of proper
cleansing by mechanical means as well as by boiling. They
should be free from comers and angles and cracks, prefer-
ably of one material throughout the interior, so that no
junctions exist in which dirt might accumulate. They
may with advantage be opaque or semi-opaque. They
should be readily opened, but not liable to leak ; and
should be of a convenient shape and size for the pockets
Spitcups for the bedside or shelf should not be readily
upset. They might with advantage be made with hinge-
less automatically closing lids. Spittoons for the floor
should never be used in a sanatorium. In some continental
establishments elegant vases of coloured glass are placed
instead of spitcups on shelves in the reception rooms, and
on the pedestals in the bedrooms. Another method, adopted
in some American and German sanatoria, as well as in
England, is to use cuspidores with paper linings, which can
afterwards be burnt.
Handkerchiefs of the ordinary kind are banished fron^
most sanatoria ; in some, however (e.gr., Sharon Sanitarium),,
patients are allowed to use them, keeping them in india-
rubber pouches, and frequently changing them. Detach-
able linen linings to the pockets would answer the same
purpose as these pouches. It is often ditficult to induce
patients to use spitting flasks ; and in any case, it is often
necessary to have something for wiping the mouth. For
such purposes Japanese paper-handkerchiefs are convenient,
as they are cheap and tough, and can be readily burnt.
They may also be used instead of napkins at dinner-time.
At Falkenstein each patient has his own linen napkin at
table, in a linen pouch marked with his number ; but the
other plan is preferable. Bedridden patients should not
be allowed to keep handkerchiefs under their pillows or
under the sheets, but in some cleansable receptacle outside
the bed. Whatever method is adopted, it is most essential
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32 SEWERAGE AND WATER SUPPLY.
would require a larger area of land ; but the waste water
from kitchens, etc., would in any case be applied to the
land in some way.
That a pure and abundant water supply is necessary at
a sanatorium is obvious. For the douche a pressure of one
atmosphere is advisable, and a temperature of 10° to 14° C.
at all seasons ; but in many sanatoria the douche is not em-
ployed, being replaced by cold ablutions and cold frictiona
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CHAPTER IX.
THE FRESH-AIR TREATMENT.
An open-air life is the keynote of sanatorium treatment.
The patient, instead of being kept in a carefully warmed
room ventilated from other parts of the house, according
to the popular notions of old, lives in the open air from
morning till night, at all seasons and in all weathers.
Lack of fresh air is the greatest predisposing cause of
consumption ; fresh air is the most potent means of re-
storing him to health.
Now this prescription is very easy to carry out in dry
climates such as those of Egypt, the Alpine health resorts.
South Africa or Colorado; but requires special arrange-
ments and special precautions in a damp and rainy climate.
The credit of showing how this may be accomplished be-
longs mainly to Brehmer, Dettweiler and their followers*
The open-air method may perfectly well be carried out in
any climate which is healthy for those who are not con-
sumptive. As Leon Petit observes : " Here the climate
may help the cure, . . . there it may hinder it ; but it only
exerts a secondary influence on the treatment".^ More-
over, just as the pleasantest climates are not always those
which are best for healthy people,^ so it may be that the
most pleasant climates for an out-of-door life — where the air
^ hoc, cit., p. 49.
* Hermann Weber and Michael G. Foster, article in AllbutVs Syst. of
Med.f on " Climate in the Treatment of Disease '\
(33) 3
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34 THE FRESH-AIR TREATMENT.
is warm and dry, and little rain falls — are not the best for
those consumptives who have later on to return to a less
favoured place. It is bracing climates rather than warm
and equable ones which have the greatest influence in
restoring the consumptive to health, in all but exceptional
cases.
For the open-air treatment, a fourfold shelter should be
provided against wind, excessive cold, extreme sun heat
.and rain. Wind raises dust, increases cough and dyspnoea
in consumptives, and intensifies the chilling effects of cold.
The foreign sanatoria with few exceptions have both
natural and artificial shelter against wind. Cold within
certain limits is useful to the consumptive ; but it should
be a windless cold, and suited to the individual power of
reaction. As damp intensifies the climatic effect of both
heat and cold, the chilly consumptive will be able to with-
. stand a lower temperature in a dry than in a humid climate.
Protection against rain and snow will seem to most people
an obvious necessity, although at Nordrach rain is often
disregarded. It is not enough to provide resting places in
the sanatorium which are protected against rain. At certain
;8tages exercise is imperative, and sheltered paths and open
^covered corridors are needed for exercise in rainy weather.
At Falkenstein there is such a corridor 200 feet long.
In places where the sun's rays are very powerful, as
at Canigou in the Pyrenees, direct exposure to the sun is
found to increase the tendency to fever. Even at Hohen-
honnef on the Rhine, which is not far south, a large verandah
has been provided which in hot weather can be artificially
cooled by a stream of water. Protection against wind and
weather is afforded in most sanatoria by large verandahs,
which may be fitted with movable glass screens, as at the
Adirondack Cottage Sanitarium. In our own cb'mate it
would be useful to have a verandah with a hollow floor which
could be warmed, as cold and damp can be much more easily
borne if the feet are kept warm. Other simpler ways are the
provision of hot bottles and warm clothing. Recumbency
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THE FBESH-AIR TREATMENT. 35
also helps a chilly patient to keep warm, the blood circulating
with less cardiac effort in this position. According to Dr.
Weicker and Dr. Jacoby the recumbent position also
favours the flow of blood to the apices of the lungs. In
most foreign sanatoria summer-houses or sun-boxes are
also provided ; at Falkenstein, some of these can be
rotated according to the direction of the wind. Dr.
Burton-Fanning, in his experimental sanatorium near
Cromer, has modified the well-known shelters of our sea-
side resorts by providing them with reversible glass
screens (see Practitioner, June, 1898, and Lancet, March,
1898).
Patients who begin their open-air treatment in wintry
weather usually need a short period of acclimatisation,
during which the time and extent of exposure are gradually
increased. Evening air is not found to be injurious to
such patients as are trained to an out-of-door life ; and
they are provided with artificial light so as to be able to
sit out after dark and read their books and papers, even
where the climate is moderately humid. Rest out of doors
in the verandahs is practised in all but the coldest, wildest
weather. Thus at Falkenstein, patients have been able to
stay out of doors even during thick fog, during snowstorms,
and when the temperature was 10"* or 12° C. below freezing.
As many as 40 per cent, were able to stay out seven hours
or more ; and 6 per cent, could stay out ten or eleven
hours a day.^ Blumenfeld, at the same sanatorium, made an
elaborate investigation of the number of patients confined
to their bedrooms under various meteorological conditions,
and could find no noticeable/iifference, except during the pre-
valence of north-east winds.^ This is somewhat remarkable
when it is remembered how readily an untrained consump-
tive becomes chilled. It is no doubt in part attributable
^ P. Dettweiler, Die Behandlung der Lungensclvwindsucht in geschhs-
senen Heilanstatten. Second edition. Berlin, 1884.
' F. Blumenfeld, Ueher den Einfluss meteorologischer Vorg&nge auf den
Verlauf der bacilUiren Lungenschwindsucht,
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36 THE FRESH-AIR TREATMENT.
to the still air usually prevailing at Falkenstein, but
largely also to the careful individual training and attention
to details.
In many German sanatoria there is a systematic applica-
tion of a simple kind of hydrotherapy, which trains the skin
to withstand changes of temperature. At first, patients
are rubbed with a dry sheet ; then with spirit ; then
with spirit and water; in the next stage a wet sheet
is used; and in those who are sufficiently prepared,
cold sponging and douching. A divided cold douche
acts as a powerful stimulant to the skin, and through it to
the rest of the body, increasing the tissue changes, improv-
ing circulation and digestion, as well as the tone of the
skin itself. Its stimulating properties depend within cer-
tain limits on its coldness, and the force and sub-division
of the stream. It was formerly much used in sanatoria for
consumptives, but owing to some bad results in a few cases,
has been less and less employed, being only occasionally
used in some sanatoria and not at all in others. If used at
all, it should only be applied for a very few seconds. The
other simpler applications are not open to the same dangers,
and, although less powerful, are probably sufficient in most
cases. There is a strong objection at Falkenstein to the
use of hot baths, which are only occasionally permitted,
and never very hot or for more than a few minutes. The
contention is that such baths relax the skin and debilitate
the patient. But the experience of very hot baths in
Japan and elsewhere would seem to prove that they may
have stimulating effects. The matter is one which should
be decided by individual experience rather than by a priori
reasoning, ^t Nordrach, afebrile cases are allowed to
freely douche themselves with water of any comfortable
temperature; but are enjoined not to actively dry them-
selves.
The clothing of consumptive patients should be no
thicker than is necessary to keep them warm. More than
this relaxes the skin, and increases the tendency both to
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THE FRESH-AIR TREATMENT. 37
profuse perspiration and to catching cold. The clothing
should be evenly distributed, and not too heavy. It should
not hamper the movements of the chest. Woollen gar-
ments are usually recommended next the skin, mainly
because, by their hygrometric qualities, they keep the skin
dry. Dr. Walther, however, prefers a less irritating ma-
terial for underclothing ; and there is something to be said
for his contention.
Digitized by LjOOQIC
CHAPTER X.
REST AND EXERCISE.
If the fresh-air treatment merely consisted in letting every
patient rest in the open air, or follow his own inclinations
as to the amount of exercise, it would be an exceedingly
simple matter, scarcely requiring medical supervision. But
the essence of Brehmer's and Dettweiler's methods is the
elimination of haphazard treatment and the prescription of
absolute repose or of various degrees of exercise according
to definite medical indications. Patients who are febrile
must be kept at rest ; if persistently febrile or with high
temperatures at night, absolute rest in bed is needed, win-
dows being kept open, or the bed wheeled on to the balcony
according to weather and season and other indications.
Where there is only moderate pyrexia during part of the
twenty-four hours, they may be allowed to come on to the
verandah and rest there on reclining chairs. In this way
the fever is usually reduced, and the appetite and other
symptoms improve. Another class of patients who are best
kept at rest are the decidedly dyspeptic, and those who are
rapidly losing weight. If the nutritional income is less than
the expenditure, the latter must be as far as possible reduced.
The same is true of those who are very ansbmic or very
feeble.
In all other cases exercise is needful, according to an
ascending scale. We may begin with passive motion, or
very gentle massage, followed by resisted movements in the
recumbent position. After this, very gentle walking exer-
cise may be tried, at first restricted to a few yards at a time
on level ground. As the invalid gets stronger the length of
his walk is gradually increased ; he then attempts a gentle
(38)
Digitized by LjOOQIC
REST AND EXERCISE. 39
uphill walk ; and in time he is able to take long walks up even
steep hills with advantage. He is however never allowed
to walk quickly ; about two miles an hour is a very good
regulation pace for most. He must never put himself out
of breath by his exertion, and should stop directly he begins
to feel fatigued. Prolonged fatigue, profuse perspiration from
the walk, a decidedly raised pulse rate or respiratory rate
show that the exercise has been too much. If patients come
in chilled from their walk, brisk friction with a warm towel,
or a little digestible warm food, will often set them right.
With few exceptions patients should rest for half an hour
or more before every important meal and for an hour after.
The most active exercise is best taken in the morning.
The same rules must guide us as regards the occupation of
the patients. Sedentary occupations which contract the chest
are usually forbidden : in German sanatoria knitting and
sewing are not allowed, for this and other reasons. Indoor
occupations must be restricted as much as possible ; but
with a little management many things usually done indoors
may be carried out in the open air. Thus periodical con-
certs, recitations, tableaux vivants, and amateur theatricals
may take place out of doors during a great part of the year.
At some sanatoria there are fortnightly social evenings ; at
others, various societies for reading, music, chess, and other
ijuiet games, or for botany, photography, and other scien-
tific or artistic pursuits, are formed amongst the patients.
Nearly all the continental sanatoria have well -stocked
libraries ; and as verandahs and siunmer-houses are lighted
up after dark patients can read out of doors until bed time.
Fairly robust patients may be allowed to indulge in out-
door games. Croquet is often permitted ; tennis is looked
on with less favour, as it is seldom advisable, until convales-
cence is far advanced, to exert the arms too freely, owing
to their close connection with the chest. Damaged parts of
the lung should as far as possible be kept quiet, although it
is useful to freely expand the sound parts when the disease
• is quiescent. Sledging is a recognised amusement at the
Digitized by LjOOQIC
40 REST AND EXERCISE.
Alpine sanatoria; but this, and still more skating, are
somewhat risky for most patients. Gentle cycling on level
ground involves far less exertion, and may more often be
permitted. . Quiet drives are also often permissible. Walk-
ing however is the most universally applicable form of exer-
cise, as soon as there is no more fever.
When the disease is quiescent many authorities lay stress
on the value of respiratory exercises, which consist mainly
in methodical deep inspirations together with simple arm
exercises calculated to expand the chest. Waldenburgs
pneumatic cabinet is occasionally employed for similar pur-
poses. At the Colorado Sanitarium systematic gymnastics
are a recognised method of treatment for convalescent con-
sumptives Without careful supervision, however, these
methods might easily do more harm than good.
In the earlier stages of treatment rest is far more im-
portant than exercise ; and this should include mental
as well as physical repose. Mental activity necessarily
involves expenditure of energy which is needed for the
repair of damaged lung tissue and the restoration of
constitutional strength. Those who are familiar with the
Weir-Mitchell method of treatment will know the impor-
tance of economising strength in feeble patients by the
avoidance of emotion and of active exertion of all kinds.
For this reason it is better to abstain from all business,
especially of a worrying nature. At Reiboldsgriin exciting
books are marked with a star and forbidden to febrile
patients. At Nordrach mental repose is persistently aimed
at, the visits of friends and relatives being discouraged. As
soon as fever has completely disappeared the patients take
walking exercise regardless of rainy weather ; but are only
allowed to go in small parties of not more than three or
four. The reputation of Dr. Walther stands so high that
one cannot regard such rules as of no account ; but they
seem to be somewhat unnecessarily stringent. Still it is
impossible to forget the effect of *' visiting day *' in raising
temperatures amongst the inmates of a general hospital; and'
such precautions are based upon perfectly sound principles.
Digitized by LjOOQIC
CHAPTER XI.
DIET IN THE SANATORIUM.
'The food of consumptive patients must conform to the
^ordinary rules of dietetics. It must be of a mixed char-
.acter, containing representatives of the different classes of
food stuffs ; it must be digestible, appetising and varied ; it
imust be sufficient to nourish without overloading the
stomach ; and it must bear some relation to the loss of
tissue and energy resulting from exercise and other circum-
: stances. It must also to a certain extent be suited to the
national and individual tastes and customs, and be directed
by the results of experience, both of the physician and the
.patient.
All these matters should be taken into consideration by
the medical director of a sanatorium, who should settle
the daily menu in consultation with cook or housekeeper,
take his chief meals with his patients and notice how they
fare, and introduce suitable modifications to suit individual
requirements.
The proportioiv3 of food stuffs advisable for the majority
'Of early consumptives who are not dyspeptic do not greatly
differ from those required in health. As, however, there is
.a tendency to rapid loss of weight, and the need for rapid
•constructive metabolism, there should be a relatively large
proportion of easily digestible nitrogenous food and fat.
Milk, butter and cream are convenient for such purposes,
-and figure largely in the dietaries of sanatoria abroad.
The milk should be obtained from tuberculin-tested cows,
.as a large proportion of our milch cows are affected with
(41)
Digitized by LjOOQIC
/
/
42 DIET IN THE SANATORIUM.
tubercle, and in some cases yield contaminated milk.
Where the supply cannot be controlled, the milk should be
boiled before being used ; but it is believed by some
authorities that it thereby loses some of its useful pro-^
perties. However, at Oderberg none but boiled milk ia
given, although it comes from carefully tested cows, on
the ground that the patients are more likely to continue
the precaution after their return home. Consumptives in
an early stage are very subject to constipation. For thia
and other reasons, ripe fruit and vegetables should. figure
largely in their daily diet. Consumptive patients are apt
to be fastidious, and often sufl'er from loss of appetite, sa
that the food must be supplied in a palatable and appetis-
ing form, suflBciently flavoured and sufficiently varied to
tempt the palate without offending the eye or upsetting the
digestion. Many common dishes — such as suet puddings.
— are digestible or otherwise according to the way in which
they are prepared, so that a good cook is of the greatest,
importance to a sanatorium.
The quantity taken at one meal, and the number of meals,
should vary in inverse proportion. A patient who can only
eat a small amount at a time must have frequent meals, while
the patient with a robuster appetite may content himself
with three a day. The meals taken abroad depend so largely
upon national tastes and customs that it is difficult to draw
useful conclusions from them. In France, two substantial
meals — or even one — are the rule among healthy people; in
Germany, three or four are usual ; while in the mode of pre-
paring the food the greatest differences exist, even between
different parts of the same country ; and what pleases one
patient will disgust another who comes from a different,
locality. In some places, cooking is largely done with olive
or poppy oil ; in others with butter or various kinds of fat.
The garlic which pleases the Spaniard would nauseate the
average Englishman, who also usually detests the sauerkraut,
and vinegar which the German delights in. At some of the
sanatoria — as at Reiboldsgriin — the bulk of the patients.
Digitized by LjOOQIC
DIET IN THE SANATORIUM. 43
come from the same part of the country ; but in others, as.
at Falkenstein, the company is cosmopolitan, so that an
attempt is made to suit diverging tastes by different
national memis on different daya In most of the German
sanatoria two breakfasts are provided ; a mid-day dinner
of three or four courses ; afternoon tea or coffee with milk ;
and an early supper of three or four courses, besides in
some cases milk or soup on rising and at bed time. This ia
more than is required by most patients, who would find
three meals enough with two supplementary ones if the
appetite is poor. Debove and others have obtained very
striking results by forcible feeding of consumptives with
concentrated foods ; there is, however, some danger in this,
way of increasing the quantity of blood beyond the capacity
of the lungs, and so leading to haemoptysis, undesirable
fatty changes or overwork of excretory organs.
Physicians are not agreed as regards the use of alcohol.
Whereas Dettweiler recommends full quantities of brandy,,
often in a concentrated form, others (such as Liebe at
Loslau) give none at all excepting in emergencies. It
appears to me that of the two this is the more useful
course, as there is less risk of inducing undesirable habits ;
but I see no reason why alcoholic drinks should not be
used medicinally or dietetically, in reasonable quantities
and properly diluted, to improve digestion or for other
definite purposes.
A great authority used to teach his students that we
should treat the sick man rather than the disease ; and in no
department of medical treatment is it more important to take
into account individual tastes and peculiarities than in diet-
ing consumptive patients. Many of these will of course take
almost anything put before them, but a large minority are
exceedingly dainty and capricious ; and at critical stages will
have to be greatly humoured in the choice of food in order
to induce theip to take sufficient for their needs. Sabourin ^
1 Traiteynent Rationiiel de la Phtisie, p. 98. Paris, 1896.
/
Digitized by LjOOQIC
44 DIET IN THE SANATORIUM.
tnentions a patient who for a time would scarcely touch any
food but eggs, but partook freely of these in increasing num-
bers until he was taking from eighteen to twenty-four per
"day ; and this strange diet sustained him through a critical
period of his illness until he could digest a little bread.
Another patient who could not take milk was able to
digest large quantities of raw meat and alcohol, and made
A good recovery. It is of course most important to attend
to the digestive functions both medicinally and dietetically
— as indeed to the state of all the mucous membranes — but
it is unnecessary to enlarge here upon this topic. Large
quantities of whey seem useful in certain cases in assisting
ren^l excretion (see p. 171). Febrile patients will need a
simple and digestible diet consisting largely of milk; in
<liarrhoea all laxative articles of food must be omitted,
Alid farinaceous milk foods given together with astringents
and intestinal antiseptics. Where digestion is feeble, pre-
digested foods will often be useful. The diet in a sana-
torium in fact will have to range from the ** fever diet" of
A hospital to the elaborate dietary of a high-class hotel.
Digitized by LjOOQIC
CHAPTER. XII.
SANATORIA FOR THE POORER CLASSES AND
FOR CHILDREN.
There are on the continent and in America sanatoria for
' every grade of society, from those who pay nothing to
those who pay from £4 to £7 per week. They are divisible
into three classes, according as they are intended for those
with means, those of moderate incomes, and the poor. Some
of the cheaper sanatoria are for the " working classes," while
others are for the poorer members of the middle classes,
including teachers, clerks, struggling professional men of
various kinds, and the like. These are really even worse oflT
than the working classes ; for their incomes are dependent
on their own exertions and on their keeping up appearances,
so that their net income is often lower than that of the
workman. Moreover, they are not rightly eligible for
hospital treatment or for many of the convalescent houses,
while their own domestic surroundings are as little suited
to hygienic treatment as those of the mechania
Sanatoria intended for the poorer classes are usually
somewhat different from those where higher charges are
expected. Their rooms are less luxuriously furnished ; the
food is somewhat plainer and less recherche; more than
one patient are often put into the same bedroom; and a.
certain amount of the lighter work is expected to be done
by those patients who are fit for it.
At German sanatoria for the poorer classes, from one to-
four patients are usually put into each bedroom. At Rup-
pertshain as many as six are put into some of the rooms ;
(45)
Digitized by LjOOQIC
CHAPTER XIII.
THE RESULTS OP SANATORIUM TREATMENT.
The statistics which have been publish'ed concerning the?
results of treatment in sanatoria for consumptives are in.
one sense eminently satisfactory, as they show a very large
proportion of apparent recoveries. It must however be
remembered that such statistics are often misleading, owing-
to want of uniformity in the patients received, in the
methods of treatment, and in the assessment of the results..
In the first place, the material dealt with is often very
different in different places. Some few sanatoria accept-
all stages of consumption, and only exclude the obviously
dying. But most of them only receive such cases as are-
deemed likely to be benefited; and the standard will
necessarily vary according to the views of the medical
officers. At Reiboldsgrun patients are kept under observa-
tion for a fortnight, and if there is not distinct improve
ment within that period, they are sent elsewhere. At
many other sanatoria more patience is exhibited, as im-
provement may set in after a much longer period of treat-
ment. The results will also depend upon the social class-
and antecedents of the patients; and this should always
be taken into account. In America it is stated that the
poorer patients apply in an earlier and more curable stage
of illness than their wealthier brethren; besides which
there may be a greater difference in one class than in the
other between their food and general conditions of life at
home and in the sanatorium. Corresponding with these
difierences, it is found that the statistics from sanatoria for
(48)
Digitized by LjOOQIC
THE RESULTS OF SANATORIUM TREATMENT. 49
the poor are slightly more favourable than those from
establishments for the more wealthy classes in similar
climates. Solly ^ believes his statistics prove that those
who are intelligent and well-educated improve more readily
than the ignorant or careless, which is extremely probable.
Secondly, the treatment at sanatoria, being made up of a
number of separate factors, necessarily varies in different
establishments, greater prominence being given to individual
factors in one place than in another. In Germany hydro-
pathy is much resorted to ; in some American sanatoria it
is not used at all. In some places patients take exercise
even if they are slightly feverish ; in others they are main-
tained at absolute rest not only in case of fever, but for a
variety of other reasons. In some sanatoria patients are
carefully kept under medical supervision ; whereas in others
much more liberty is allowed, which is not always wisely
used. Some establishments are incomplete in their arrange-
ments, or receive a mixed class of patients — asthmatics,
bronchitic subjects, and those with heart disease, as well as
consumptives, so that supervision is more difficult and treat-
ment less effective. Sanatorium treatment is further compli-
cated by questions of climate and altitude, which of themselves
are already sufficiently complex. Such diversity will in future
give opportunities for the discovery of many important facts;
but so long as the various details are imperfectly recorded,
it only adds to the difficulty of drawing any reliable conclu-
sions. The duration of treatment is also most variable : in
some cases averaging two or three months, while in others
it usually lasts for eight or nine months or even longer.
Finally, the personal equation is again involved in the
statement of results, which are differently classified in
different places, while the true results can only be obtained
by special inquiries instituted some time after the departure
of the patient. At some sanatoria the patients who leave
are classed as cured, nearly cured, improved, stationary, and
worse ; in others as better, stationary, and worse ; in yet
^ Medical Climatology y p. 128.
4
Digitized by VjOOQIC
50 THE RESULTS OF SANATORIUM TREATMENT.
others the results are classed as very good, good, fair, and
bad. A very complete system of classification is adopted
by the Hanseatic Sickness and Old Age Insurance Co.,
under the direction of Dr. Gebhard. The results are
mainly classified under three heads, according to the local
signs, the general condition, and the capacity for work.
Under the first head five degrees are recognised, according
as the local signs, (1) originally slight, have disappeared, or
(2) remained stationary, or (3) originally more pronounced,
have diminished, (4) remained the same, or (5) increased.
Under the second heading four degrees are recognised : (a)
much improved, (6) improved, (c) stationary, or {d) worse.
Under the third heading four degrees are recognised,
-according as the patient leaves the institution (i.) with full
working capacity likely to be maintained, (ii.) full but
probably temporary working capacity, (iiL) conditional
working capacity, or (iv.) none at all. Under each heiading
it is ailso stated if the results are not evident or not
recorded, or if the patient died. In another table the
effect on the patient s weight is recorded. In other tables
the results are classified according to the original extent of
the disease into seven groups : (1) catarrh of one apex, (2) of
both, (3) extensive catarrh, (4) slight infiltration of one
apex, (5) of both, (6) moderately advanced infiltration, (7)
far advanced infiltration. Another table gives the results
in four groups, according to the general condition on
admission. Yet others show the influence of age and sex,
duration of the illness before treatment, presence of com-
plications, and of inherited tendency to consumption. The
permanence of working capacity in those who regained it
has also been inquired into. Such tables are too elaborate
to reproduce in detail, but they are most valuable for
reference and comparison ; and if similar ones were
prepared by our chest hospitals, and by other institutions
which receive numbers of consumptive patients, the com-
parison would be most instructive. In the Hanseatic
Company's report for 1897 the results are given in 1541
cases treated from 1893 to 1897, as follows : —
Digitized by LjOOQIC
THE RESULTS OF SANATORIUM TREATMENT. 51
Locally, improvement (1 and 3) took place in 58*1 °/o
Generally, „ (a and b) „ „ 86-6 7o
Full recovery of working capacity (i. and ii.) resulted in 71*8.
The permanence of results could only be ascertained in
1073 cases ; out of this number 65 % w®^® still fit for work
at the end of 1897. In 77'3 7o ^^ those received up to the
end of 1896 the disease had not advanced. In some of these
(10*7 7o) ^^ abnormal physical signs were discoverable ; in
26 7o ^ocal improvement was noted since leaving the sana-
torium ; in 40*6 7o ^^ ^oqbX change. Of those treated in
1897 the results were good even when the general health
was decidedly affected at the time of entry, 50 7o ^^ Q^ch
patients showing improvement (1 and 3) in the local condi-
tions, and 73 7o ^^ improvement in general health. Most
of the patients were treated at Oderberg, St. Andreasberg,
or Altenbrak.
Less elaborate statistics have been published of the
results at many of the German sanatoria.
At the Rehburg Sanatorium (see p. 246) of the Bremen
Society, 334 patients were treated from 1st June, 1893,
to the end of 1896. Of these, thirty-seven were not
certainly phthisical, and are excluded from the statistics.
Of the remaining 297, there were on entry : —
71 = 28-9 % slightly affected.
97 = 32-7 °/o moderately affected.
129 = 43'4 °/o seriously affected.
The results were as follows : —
Better.
Unci
tiange^
d.
Worse,
General condition
253
= 86-2
7o
20 =
6-7
7o
24
= 81
7<
Local condition
63
= 21-2
o.-
/o
194 =
66-3
7o
40
= 13-6
7<
Of the more serious cases 75*2 7o increased in weight, and
of the slighter cases, 81*8 7o-
In the report for 1897, the results as to working
capacity in ninety-four undoubtedly tuberculous cases are
worth quoting : —
Restored to full, and probably permanent, working capacity 38'3 °/o
Restored to full, but probably temporary, working capacity 36-1 °l^
Restored to conditional working capacity . . . 16*0 °/o
Unfit for work 10-6%.
Digitized by LjOOQIC
52
THE EESULTS OF SANATOBIUM TREATMENT.
Beaulavon^ gives the results on working capacity of
patients treated during 1894 and 1895 at the same sana-
torium. From this it appears that out of 170 cases, 37 7o
were restored to their full working capacity, and 9*4 7e>
more were able to do light work. In the first stage, out
of 53 patients, 81*1 7o were restored to full working
capacity; in the second stage, out of 89 patients, only
22*5 7o5 ^^ ^^® third stage none were restored to full,
and only 28*6 7o ^ conditional, working capacity. The
influence of inheritance on the results seems to have been
inappreciable.
At Dr. Weicker 8 Krankenheim in Qorbersdorf (see p.
209), 185 patients completed their treatment in 1896. Out
of these —
180 = 70*8 °/^ had r^ained their working capacity.
18 = 9*7 °/o were capable of light work.
22 = 11*9 °/o were better but not fit for work.
16 = S'l °/o were no better.
Manasse ^ has published the results of 5032 patients
treated from 1876 to 1886 inclusive, at the Brehmer Sana-
torium at Gorbersdorf (see p. 150).
stage of
Difleaae.
1 1
No. 1 Cured. Nearly Cured.
1 1
Total Improved. '
I.
II.
III.
t
1890 = 27-6% 387 = 27-8%
2226 = 44-2% 152= 6-8%
1517 = 28-2% 12= 0-8 7^
480 = 31 %
826 = 14-6 ^/o
33 = 2-3 7o
817 - 58-8 % f
477 = 21-4 7o (
45= 8-1%
5082 551 = 11 %
788 = 15-6 %
1889 = 26-6%
From Dettweiler 8 statistics of 1022 patients treated at
the Falkenstein Sanatorium, it appears that 13*2 7o were
apparently cured, 11 7o nearly cured, or a total of 24*2 7^
greatly improved.
Statistics of 2000 patients treated at Reiboldsgriin (see
p. 160) under Dr. Driver showed that 13'6 7© were cured,
28 7^ greatly improved, 28*6 7^ improved, 25*2 7^ un-
* Rev. de la Tuberctdose, April, 1897.
^ Die Heilung der Lungentvb. durch didUtisch hygienische Behandl. iti
Anstalten und Kurorten^ Berlin, 1891.
Digitized by LjOOQIC
THE RESULTS OF SANATORIUM TREATMENT,
53
improved, 4*5 7o di^-^ From the two most recent reports
it appears that in 1896, of 349 patients who left the in-
stitution, 263 (or nearly 76 %) were improved ; in 1897, of
366 patients, 295 (or 80 7o) were improved. These figures
include every degree of improvement. It should be re-
membered that owing to Dr. Wolff-Immermann*s system
of selection, a relatively favourable material is dealt with
at this sanatorium. On the other hand, the average dura-
tion of treatment is only sixty-six to seventy days, which
is less than at most sanatoria. The following tables show
the results at some of the foreign sanatoria : —
Pay Sanatoria.
1
Total
Name.
^^t^-
Appar-
ently
Cnred.
Nearly
Cared.
Im.
proved.
Pro.
portion
Im-
Aathority.
' i
proved.
1 1
Brehmer ... 5032 1 aU
11
16-6
Manasse.
Do.,excl.8rd8t. 1 8815 ' 1 & 2
14-9
20-9
Do.
Do ' ... 1 all
25
56I55
75^80
Achtennann (Ransorae).
Do 1 ...
251
60-9
86
Robert Hohe).
Dettweiler
Falkenstein . ?
1022
?1&2
18-2
11
Do
...
14
I
14
nearly
46*
78*
Do. k Hess (Ransomo).
Do. . .
14.16|
as
}••
Hfsss, Practitianer.Hov 1897
Reiboldsgrim .
2000
?1&2
13-6
many
28
28-6
70-2
Driver.
Do. . .
715
n&2
78
Wolff-Immermann.
Hohenbonnef .
?1&2
14-*6
28"9
69
Meissen (Ransome).
Nonlrach . .
all
30
65*
95
Walther do.
Rompler . . .
Weicker . . .
...
...
...
75
Rdmpler (Hohe).
Weicker do.
...
84-8
Schomberg . .
...
82-9
Bandach do.
St. Bladen . .
...
...
84
Sander do.
Canigou . . .
■■ 43-8
Sabourin (Ransome).
Do
...
22.28
40^50
6i78
Giresse (private letter).
DaToe-Turban .
•••{
no
advd.
}20
4
30
40
90
Turban.
Do.
do.
)
40
80
Do. (Ransome).
Arosa ....
259 {
few
advd.
}...
82
Jacobi.
Leysin . . .
79
all
12-7
59-5
72-2
Bumier (Montmeylian).
Do. , 1.9t stage .
15
Ist
58-3
33-3
86-6
Do. do.
Do.. 2nd stage .
22
2nd
9
86-3
95-8
Do. do.
Do.. 8rd stage .
42
8rd
50
50
Do. do.
Do
all
12-5
56-6
69
Exchaquet.
Winyah—
Early stage . .
81
19
100
v. Ruck (private letter).
More advanced .
35
28
58
Do. do.
Advanced, but
still in fair ppen-
24
38
Do. do.
eral condition .
9
All stages . .
all
22-6
42-5
65-1
Do. (Ransome).
Hygeia . . .
aU
22-5 ...
46-25
68-75
A. C. Klebs (private letter).
1 *« Yolkssanatorien for Lungenkranke," Deutsche MecU Zeit.y 1890.
Digitized by LjOOQIC
64
THE RESULTS OF SANATORIUM TREATMENT.
Sanatoria for the Poorer Classes.
Name.
No. of
Oases.
Falkenstein, 1
for the poor /
Ruppertshain
Malcnow . .
Rehbarg . .
Schomberg .
Weicker . )
Krankenheim {
Jonsdorf . .
Ednigsberg .
Grabowsee
Blankenfelde
Hanseatic
Instir. Co.
Local .
Greneral.
Halila
Alexander
313
219
239
].jl64l|
\ 300/
Davos (Basel)
Adirondack
Do.
185-^
mean
of 10
years
105
Stages.
^PPf",Nearly^7*''y
Curwl. ^^»»^- proved.
13
141
ected } ...
•9 % J
slightly
affected
30
I 437
69-6
60-9
70
20
72
68-1
20% :^ '
severely >26'4
affected I
42-3
20-25! 20-80
21-9 ! 35-2
Im-
proved.
77
40-3
26-2
33-3
22
73
13
1 64-4
38-9
43-7
231
20
Total
Propor-
tion
Im-
proved.
90
77-6
84
84-7
94-2
92
85
78-5
97
58-1
85-5
70-7
90-8
77-1
Authority.
/ Dettweiler & Nahm
1 (Ransome).
1895-6. Nahm.
Renter (Hohe).
Michaelis (Hohe).
Baudach do.
Weicker do.
Toop do.
Andrse do.
Brecke, 1896-7(Liebe).
EUerhorst, 1896 do.
Report for 1897.
Do.
Da
Gabrilovitsch ,5 years.
fKUndig, Report for
i 1897.
Trudeau (Knopf).
/ Do., 12th Annual
( Report
SoUjr ^ discusses the statistics from various parts of the
worid, and concludes that the percentage of improvement
is as follows : —
AU stages.
nrst Stage. Sec
x>ndandT
Lowland climates . 58
71
28
Sanatoria . . 63
95
58
Highland climates 76
89
63
As the statistics of sanatorium cases were exclusively
from those in non- Alpine climates, this is striking testi-
mony as to the value of sanatorium treatment. Generally
speaking, one may say that from one-fourth to one-third of
the patients treated in sanatoria are practically cured, or a
still greater proportion if they are treated in an early stage.
* Medical Climatology, p. 141.
Digitized by LjOOQIC
THE RESULTS OF SANATORIUM TREATMENT. 55
Probably systematic and prolonged treatment from an early
stage would restore to health from one-half to two-thirds of
our consumptive patients, even without the advantage of
an Alpine or other high altitude statioa Unfortunately, it
is quite out of the question to expect patients to submit to
more than a few months' treatment in a sanatorium, so
that we must trust to the educational influence of the
sanatorium to complete the recovery of those treated in it.
Improvement frequently — perhaps usually — continues after
patients have left the sanatorium, if only the conditions of
life are fairly satisfactory.
The good results of treatment are permanent in a large
proportion of cases. Special inquiries were made in the
year 1890 to ascertain how many of those treated at the
Brehmer Sanatorium continued in good health. In five
cases the cure had lasted from twenty to twenty-nine
years; in fifty-two cases, from twelve to twenty-one
years; and in thirty-eight cases, from seven to twelve
yeara Of forty patients discharged from the sanatorium
in 1876 as cured or nearly cured, of whom particulars could
be obtained, there were still twenty-five living in good
health, while one sufiered from fibroid phthisis, one had
died four years previously from phthisis, and thirteen
others had died from unknown causes.^ Similar investiga-
tions by Dettweiler, at Falkenstein, in 1886, led to the
discovery that seventy-two out of ninety-nine patients who
had left the institution as " cured " were still living from
three to nine years after in perfect health ; in fifteen cases
there had been relapse, although twelve out of these fifteen
subsequently recovered.^ At St. Blasien, Dr. Haufe in-
quired in 1891 after all those who had been treated there
from 1878 to 1889. Forty-six did not answer ; five were
dead ; twelve had had a relapse after an interval of three
* Wolff und Saugmann, Ueber die dauemde Heilung der Tuberculose,
Wiesbaden, 1891.
' Dettweiler, Bericht ilber 72 seit 3-9 Jahren in Falkenstein vOllig geheilte
FUlle von hungenschtoindsucht^ Frankfurt, 1886.
Digitized by LjOOQIC
56 THE BESULTS OF SANATORIUM TREATMENT.
to six years; 201 who left from two to twelve years
previously were at work without difficulty, although they
continued to cough; seventy-two were apparently quite
cured, and had been so for three to twelve years. Amongst
the latter were six officers who for several years (one for
six years) had done their work well without interruption.
Some had originally had symptoms of acute phthisis ; the
others had been long tubercular and had repeatedly coughed
up blood Of the seventy-two, twenty-one were in the
third period : these had lost their bacilli in the sanatorium
and increased in weight. Assuming that the non-replies
were worse or dead, 21 4 per cent, might be regarded as
cured, and 59*8 per cent, more as in good health.^ K^opf
states ^ that Dr. v. Ruck, of Winyah Sanitarium, wrote to
605 patients who had left this institution from one to three
years previously. He received 457 replies, which showed
that 14*6 per cent, were absolutely cured ; in 15'3 per cent
more the disease had made no further progress ; and 56*4
per cent, were better than when they left the sanatorium,
or a total of 86*4 per cent, better or cured, 13*6 per cent,
worse or dead. If all the non-replies were dead, these
figures would be reduced to 65*3 and 34*7 per cent, re-
spectively. The results obtained by Dr. Gebhard of the
Hanseatic Insurance Co. have already been quoted.
Every victim of unarrested phthisis is a possible focus for
the dissemination of the disease. He is also a burden to his
family, or to the State, or both, for months or years, and, if
a bread-winner, plunges those dependent upon him into
Serious pecimiary and social difficulties. Remembering these
facts, and remembering also that, in even the best managed
hospital, the chances of recovery for the average consump-
tive are much smaller than at a sanatorium, we may more
easily realise the important services which these institu-
tions are able to perform. From the statistics of Brompton
Hospital, it appears that the percentage of improvement is
* Manasse, loc, cit. « Les Sanatoria, Paris, 1896.
Digitized by LjOOQIC
THE RESULTS OF SANATORIUM TREATMENT. 57
only 20 to 30, as compared with 50 to 90 at sanatoria ; and
making every allowance for the possibility that serious or
unfavourable cases are treated in larger proportion at the
hospitals, it must be evident that they are quite unable to
play the part of sanatoria. Weeks and months often go by
while the poor consumptive waits for admission to a chest
hospital Were sanatoria established in the numerous suit-
able localities in England, the hospitals would be relieved
and the patients cured in far larger numbers.
Digitized by LjOOQIC
*0 SIZE, STAFF AND MANAGEMENT.
managing director, or in a small sanatorinm a matron or
housekeeper : bat it is essential that he or she should be
subordinated to the chief medical officer, with an appeal if
necessary to the managing board or committee. There is
a feeling in this country amongst the medical profession
against one of their number being the owner of any kind
of medical institution — whether jHrivate hospital, nursing
home, hydropathic establishment, asylum or sanatorium.
This feeling is, in my opinion, well founded ; and while it
is only right and proper that the medical officer should
receive adequate remuneration, this should not be directly
in the shape of patients' payments, nor should he be directly
responsible for the finances of the establishment
The admission of patients may be managed somewhat
•after the method adopted by the Basel Sanatcnium at
Davos. There is a medical boahl in the town of Basel, to
whom applications are sent, signed by the family medical
attendant, and stating the stage of the illness and the
condition of the patient The latter then calls on a member
of the medical board at an appointed hour, and if approved
.starts on hie journey to the sanatorium. The resident
medical officer, however, has power to send home any
patient who appears to be unsuitable for treatment.
Patients enter for at least thirteen weeks at the Basel
Sanatorium. Three months is a very common duration of
treatment abroad, although most medical officers of sana-
toria regard this as barely sufficient to train the patient in
necessary hygienic methods and to put him on the road to
recoverj'. At Canigou patients who begin to be home-sick
are sent home for a time, to return again for further courses
of treatment. Dr. Giresse regards this interruption as a con-
•cession to human frailty rather than as medically desirable.
In some sanatoria quite a different system prevails, the
patient staying until he is apparently cured, irrespective of
how long this may require. Thus, at Nordrach patients
stay until for about twenty examinations no tubercle
bacilli have been found in their sputa, and until the injec-
Digitized by LjOOQIC
SIZE, STAFF AKD MANAGEMENT. 61
tion of their sputa into a guinea pig (which is next done)
does not caase tuberculosis in the animal. At Davos and
other Alpine sanatoria at least two winters and one summer
are advised ; in Colorado, too, at least two years' residence
is considered necessary. At the Adirondack Cottage Sani-
tarium patients stay until they are apparently cured ; the
average stay being six months, and one year nominally the-
limit.
It seems to me that it depends on circumstances what,
course shoidd be pursued. Where the patient comes
from a suitable home and district, and can carry out the
treatment in a modified form after his return home, this,
may be permitted after a few months if he has made pro-
gress ; but if he relapses he should be promptly sent back
to the sanatorium. Where the locality or the domestic
circumstances are unsuitable, a longer residence — if possible
until apparent recovery — is advisable. In every case the
course should be pursued which promises the best medical
^results ; pecuniary considerations are of very subordinate
importance in dealing with a dangerous disease. And if
the patient's finances will not stand the strain, some means,
should be devised whereby he may be assisted. A man
who is held to ransom by brigands, or who is drowning at
sea, does not stop to count the cost, but leaves his money
to save his life ; a consumptive patient should do the same.
The sanatorium, however, should not be expected to re-
ceive hopeless cases ; these, if not treated at home, should
enter a different class of institution — the home or refuge for
incurables. There are several such institutions in America,
France and Switzerland ; possibly also in Germany, and
several in England. More of these refuges are needed in
this country for the poor, who are not welcome in either
general or chest hospitals, and usually gravitate to the
poor-law infirmaries. In the course of time, with a more
perfect organisation, the number of such cases will diminish,,
but in the meantime institutions for their reception are as
necessary as sanatoria, both for the sake of the public and
Digitized by LjOOQIC
64 OBJECTIONS ANSWERED.
creet and do not interfere with the treatment Aggrega-
tion of patients there must be to a certain extent, in order
to obtain the benefits of co-operation ; but isolation is seldom
required — far less than during the course of other febrile
complaints, as the isolation (so far as it is needed) is for the
sake of the patient rather than in order to prevent infection,
which is with reasonable precautions quite unlikely to
happen. As a matter of fact, life in a properly-managed
sanatorium is far more pleasant than in an ordinary health
resort for consumptives, where all kinds of cases and all
stages of phthisis are received, and medical supervision is
necessarily less effective.
It might be argued that the establishment of sanatoria
for consumptives damages the prospects of the ordinary
medical adviser. I have never yet heard so selfish and
short-sighted an argument ; for the medical profession is
ever ready to take a wide and enlightened view of what-
ever concerns the good of its patients, and (as the achieve-
ments in sanitary matters amply testify) often promotes
measures which are intended to prevent disease. As a
matter of fact, sanatoria not merely benefit consumptives,
but also benefit their family advisers, inasmuch as the
patients' lives are prolonged, while medical and hygienic
advice will be needed for some time after leaving the sana-
torium. Treatment in such an establishment is of strictly
limited duration ; and is intended, not to cure the patient
during the time of his stay — for this is often impossible —
but rather to put him on the road to recovery. The good
obtained in the sanatorium is often very striking ; but the
promise of future improvement is even more important. It
is only where a patient would have to go to an utterly un-
suitable neighbourhood or mode of life that the period of
treatment would have to be considerably prolonged ; and in
this case a kind of hygienic colony would best meet the
difficulty. In any case, the treatment at a sanatorium will
only continue until the patient can safely go home with a
prospect of further improvement
Digitized by LjOOQIC
OBJECTIONS ANSWEBED. 65
There are no purely medical arguments against sana-
torium treatment which will bear examination. The danger
of infection is far greater in an open health resort. The
experience of chest hospitals and sanatoria, both here and '
abroad, shows that there is absolutely no danger if simple
precautions are observed. At the Brompton Hospital care-
ful inquiries, extending over a period of thirty-seven years,,
were made by the late Dr. Cotton and Dr. Theodore Williams
as to possible infection from patienta The old building was
very badly ventilated ; but although the foul air from
phthisical patients produced attacks of sore throat and
erysipelas, it did not lead to spread of tubercular disease
amongst the healthy attendanta None of the resident
medical officers, matrons, gallery maids, porters or secre-
taries and clerks became phthisical, although most of these
were brought into frequent contact with the patients. Out
of about 150 house physicians only one appeared to have
contracted the disease in hospital ; out of 101 nurses three
died of consumption after leaving the institution, but in
only one did the disease show itself while in hospital. Of
twenty-two dispensers three died of phthisis, one while in
the building: and two of the dispensers held office for
twenty years.^ Similar investigations by Heron at the
City of London Hospital for Diseases of the Chest also
failed to prove infection among the attendants.^ No case
has ever been reported from any modem chest hospital which
takes even elementary precautions concerning the sputa.
Aufrecht states that at the hospital of Magdeburg- Ajitstadt
34,560 patients were received during a period of seventeen
and a quarter years, of whom 3820 were phthisical, mostly
in an advanced stage ; but none of the other patients, and
none of the large nursing staff, became consumptive. Two
tabetic patients and four with multiple sclerosis remained
from three to eight years side by side with consumptives,.
> See Pollock, Practitioner ^ June, 1898 ; Wilson Fox, Diseases of the
Lungs and Pleiira, London, 1891.
« Lancet, 6th Jan., 1894.
Digitized by LjOOQIC
66 OBJECTIONS ANSWERED.
and another with adherent pericardium became intimate
with his phthisical neighbour, without any becoming in-
fected.^ At the meeting of the American Climatological As-
Bociation, in May, 1896, Dr. V. Y. Bowditch, of Boston, said :
" I wish to refute the statements that properly-regulated
consumptives* hospitals are a source of danger to the com-
munity, when I believe them to be exactly the opposite, as
fihown by statistics ". This opinion will be accepted by all
practical physicians; but in view of the scare which ap-
pears to be arising among certain sections of the laity the
ihatter needs to be called attention to.
Dr. I. H. Hance, assistant to Dr. Trudeau at the
Adirondack Cottage Sanitarium, proved by the inoculation
of guinea pigs that sixteen out of seventeen cottages in-
habited there by consumptives for so long a period as ten
years were absolutely free from infectious material In the
exceptional cottage the patient had disobeyed instructions
and expectorated wherever convenient. In a further
investigation Dr. Hance took dust from tenement houses
containing consumptives. Where instructions had been
followed no guinea pigs suffered; while in the dirtier
tenements two out of three were found infected. In
street cars one out of every five were found to be
dangerous. In the two hospitals, Bellevue and Charity,
no infectious dust was discovered, excepting in the out-
patient room at Bellevue. In the Winyah Sanatorium
none was found.^
Rompler investigated the mortality from consumption
from 1790 to 1889 in the village of Gorbersdorf, which is
close to several large sanatoria, with an aggregate of 500
to 600 beds. Before the establishment of the oldest sana-
torium the deaths from consumption in the village were
at the rate of 0"83 per annum ; whereas since that time the
' Zur VerhUtung und Heilung der chronischen Lungenttiperkulose,
Vienna, 1898, quoted by Rdmpler, Deutsche MediemcU Zeitung, 1898,
No. 35.
8 N, Y. Med, Rec., 28th Dec., 1895.
Digitized by LjOOQIC
OBJECTIONS ANSWEBED. 67
rate was 0*47 ; and yet the population had doubled in
twenty-five years, and in forty years some 25,000 consump-
tives had been treated in the different sanatoria.^ Nahm,
who made similar investigations in the village of Falken-
stein, obtained corresponding results. During the twenty
years preceding the establishment of Dettweiler's institution
an average of 4 per 1000 of the inhabitants died annually of
consumption. After the sanatorium was opened the average
annual mortality from this disease fell to 2*4 per 1000.^
Dr. Rompler has had five servants for twenty-three years at
his large sanatorium, and seven more than five years, out of
twenty-three in his present staff; not one of these twenty-
three are consumptive, nor any whom he can trace who have
been in his employ, although they necessmly come freely
into contact with the patienta' Dr. Achtermann, for many
years connected with the Brehmer Sanatorium, and now at
Laubbach, states that he was for years in the habit of test-
ing by inoculation the dust from the corridors, saloons,
W.C.s, and patients' rooms. Only once did he find evi-
-dence of the existence of tubercle bacilli, on a washing
board where a spitcup had stood.* Ransome states that
sputum, which retained its virulence for several months in
a poor cottage in Ancoats, entirely lost its power of com-
municating the disease to guinea pigs by inoculation when
freely exposed to the air and light in a consumption hospi-
tal, and in a well-lighted, well- ventilated, and well-drained
house.* Moreover, in another series of experiments, sputa
as well as pure cidtivations lost their power for evil on ex-
posure to air and light for two days, or to bright sunshine
for one hour.®
^ Beitrdge gur Lehre von der chronischen Limgenschmndsuchtt Berlin,
1892. See also Knopf, loc, cit.
« Miinch. Med, Wochenschr., 1896, No. 40.
' Deutsche Medisinal Zeitung, 1898, No. 86.
^ Prospectus of Laubbach Sanatorium.
' Bansome, The Treatment of Phthisis^ London, 1896, p. 87 ; Bansome
and Dreschfeld, Proc. R. Soc,, xlix., 66.
* Bansome, ibid, ; Bansome and Del^pine, Proc. R, Soc.^ Ivi., May, 1894.
Digitized by LjOOQIC
68 OBJECTIONS ANSWERED.
Even in open health resorts there is very little danger of
infection excepting in crowded towns and cities, or where
ordinary hygienic precautions are neglected. It is true
that at the Riviera the deaths from consumption amongst
the native inhabitants are said to have increased ; but this
is not quite certain, and is in any case capable of explana-
tion in other waya It is quite possible that the hotter
climate may encourage the saprophytic existence of the
tubercle bacillus. But the conditions of life in a densely-
crowded town are very different from those in a scattered
village ; and if the facts are correct, they point to the need
of more reasonable methods of building, better ventilation,
and less overcrowding, together with more systematic
precautions concerning cleanliness, disposal of the sputa,
and the like. Consumptives should not live in towns, or if
compelled to do so should inhabit dry and well-ventilated
rooms. If they do so, and refrain from random spitting
and other uncleanly ways, they will never be a serious
danger to their companions. Bansome states ^ that he has
never seen a case of infection in an ordinarily well*
ventilated house, and gross neglect of ordinary rules would
probably be needful to cause tubercular infection in such a
house. Haupt made a careful investigation at Soden, and
found that there were fifty-two people between seventy
and ninety years old who had lived in thirty-one different
houses which they let out in summer to consumptives.
Half of them also waited on the invalids, but none became
phthisical Michaelis has practised over thirty years in Bad
Rehburg. This bathing resort has existed for over fifty
years, and is annually visited by about 500 consumptives.
There are at present about 350 inhabitants in sixty-five to
seventy houses ; and only three consumptives were found
amongst them who had been bom there, while these had
acquired the disease elsewhere.^ Even amongst married
^ Ransome, The Treatment of Phthisis ^ London, 1896.
2 Monats, /. prakt, BaXneol. , 1897, No. 1 ; quoted by Unterberger, St.
Pet. M. Woch,, 1897, n. F. xiv., No. 29.
Digitized by LjOOQIC
OBJECTIONS ANSWERED. 69
couples, where one is phthisical it is exceptional to find the
other affected. Leudet found only seven out of 112 such
cases, and Haupt only 7 per cent, out of 1061 married
couples.^
It is perfectly certain that under ordinary hygienic con-
ditions the danger of infection from a phthisical patient is
purely imaginary. But this should not blind us to the
very real danger which exists where hygienic rules are
disregarded, and this is in fact a strong argument in
favour of hygienic training of consumptives in a sana-
torium.
It may be argued that since many patients recover from
consumption without being treated in a sanatorium, this is
unnecessary. It is perfectly true that such recoveries take
place, but they can only be expected in selected cases ; and
as Prof. V. Ziemssen has said : ** The possibility of treatment
outside a sanatorium with equally good results cannot be
denied, but it requires much more prolonged rest, and much
more time on the part of the physician, and has by no
means so certain a result".^
It is a financial impossibility to provide one or two
patients at home at reasonable cost with the systematic
treatment they would obtain in sanatoria, and although
patients may be able occasionally to do without these aids
to recovery, there are stages and forms of the disease in
which it would be most unwise to discard them, if they
could be found within a reasonable distance from home.
Even ordinary treatment at home, if properly carried out,
is more expensive than is usually realised ; and this is with-
out any special shelters or conveniences for exercise in the
open air ; often without skilled nursing in case of feverish
attacks, night sweats, or sudden haemoptysis ; and without
systematic training or graduated exercise, which indeed
can scarcely be carried out under the circumstances. Once
* Unterbeiger, loc, cit.
* Ueber den gegenwUrtigen Stand der Behandlung Tuberculdser, Berlin,
1897, pp. 22, 23.
Digitized by LjOOQIC
70 OBJECTIONS ANSWERED.
it is admitted that these measures are of value in restoring
the consumptive to health — and this can scarcely be dis-
puted — it follows that special institutions are needed to
put them within the reach of those who cannot afford a
special establishment of their own.
Digitized by LjOOQIC
CHAPTER XVI.
THE COST OF A SANATORIUM.
Sanatoria for consumptives diflTer enormously in original
cost. Even apart from the value of the land on which
they are placed, it is possible to spend much or little in
constructing the buildings, according to the design, the
natural obstacles to be overcome in laying the foundations^
the cost of labour and materials, the luxuriousness of the
accommodation, the cost of water supply, lighting and
sewerage, and a number of other circumstances. Even
among sanatoria for the poorer classes there are consider-
able differences in the cost per bed; and those for the
wealthy present as much diversity as do inns and hotels in
various place& So many more sanatoria have been built
in Germany than in any other country, that most of the
available information concerning the cost of sanatoria
comes from that country. It is difficult to obtain authentic
information as to the cost of sanatoria for paying patients.
Hohenhonnef, which is perhaps the most luxurious of
recent establishments, appears to have cost nearly £72,000,
or about £660 per bed, without reckoning the ground, but
including the recently-built doctor's and director's resi-
dences. It is more difficult to estimate the cost of other
first-class sanatoria, even where trustworthy figures are
available, as the original cost per bed always largely ex-
ceeds the final cost after successive additions have been
made. Enormous sums have been spent on the Brehmer
Sanatorium, as it is situated in an unusually large and fine
park, and much money has been lavished on unnecessary
(71)
Digitized by LjOOQIC
72 THE COST OF A SANATORIUM.
architectural ornamentation, as well as more practical ad-
vantages. Judging by a statement by Leon Petit,^ a
building of the size and character of Falkenstein Sanato-
rium would cost in France or Germany about £40,000 for
100 beds. Of first-class sanatoria, probably the one at
Nordrach has been the most simply and least expensively
constructed. The abundant water supply there consider-
ably diminishes the cost of electric lighting; while the
buildings, though carefully finished, are mainly of wood.
Building operations are more expensive in England than
abroad ; but there is reason to believe that a satisfactory
sanatorium for paying patients could be constructed in a
suitable locality for considerably less cost per bed than has
been done at Hohenhonnef.
Turning now to the institutions for the poorer classes,
we find that they cost on the Continent from £120 to over
£300 per bed. Prof. v. Ley den gives £150 as a fair aver-
age estimate, or a total cost of £200 to £250 ; but this only
refers to the larger ones with about 100 patients.* Small
sanatoria necessarily cost more per bed than larger ones, as
the administrative portions for a small number of patients
are nearly as costly as those for twice or thrice as many.
Electric lighting, too, is relatively much more expensive for
a small number of rooms ; and the ground required for a
3mall sanatorium would equally well accommodate a large
one. Sanatoria for both sexes are more expensive than
those for only one, as many parts have to be duplicated.
This, of course, applies much more to a people s sanatorium
than to one for the middle and upper classes. Sanatoria
built in one block are less expensive than those for a
similar number of patients lodged in several smaller build-
ings. This has already been alluded to in chap. vii. It
ia customary in this country to reckon the cost of a solidly-
constructed building at 9d. per cubic foot. Wooden build-
> Loc, Ht,, p. 258.
• Ueber den gegenwdrtigen Stand der Behandlung Tuberculdser, Berlin,
1897.
Digitized by LjOOQIC
THE COST OF A SANATORIUM* 73
ings and "bungalows" are less expensive, and in most
years would do perfectly well for a sanatorium. A building
for sixty beds would probably cost as much as three.sepa-
rate buildings, each to accommodate fifteen patients.
In planning a sanatorium, the possibility of extension
must be taken into account. At Qrabowsee, a large number
of patients have been accommodated in " Dbcker'sche Ba-
^racken," which are temporary erections constructed of a
.sort of painted paper on a wooden skeleton. Thede are too
cold for use in severe winters such as are common in North
Germany ; and are being gradually supplemented by more
^ solidly-constructed buildings for use all the year r^nd.
It is false economy to erect a sanatorium on a small patch
of ground, unless this is surrounded by public woods or
moors of a suitable kind. It is also usually a mistake to
attempt the trajnsformation of a pre-existing building into
-a sanatorium. The prime cost is undoubtedly thereby
often diminished ; but the alterations and additions which
are nearly always required, are very apt to swallow up the
resulting economy. According to Kuthy , a house in Berlin,
transformed into a hospital, cost £128 per bed for altera-
tions. Few buildings not of recent construction are satis-
factory from a hygienic point of view. Nature's purifying
processes take time to remove the effects of leaky sewers
and drains. Solid foundations and damp-proof courses are
both difficult and expensive to put into an already con-
.structed house. In a sanatorium everything is (or should
be) sacrificed to superabundant ventilation and free access
of sunlight ; whereas the average house is constructed with
the idea of making the largest possible number of rooms on
a given space. Many convalescent homes and hydropathic
establishments would, however, have to be excepted from
this statement, and, if suitably situated, might be usefully
converted into sanatoria. A hospital in a town costs more
than a sanatorium of the same size in the country. The
Basel-town Hospital is estimated to cost £400 per bed,
whereas the Basel-town Sanatorium at Davos has been
Digitized by LjOOQIC
76 THE COST OF A SANATORIUM.
250 mks.^ At Ruppertshain the daily cost is 2*77 mks.,
of which 1-22 is for food.^ It was 330 and 1-53 mks.
respectively at the old house at Falkenstein. Ruppertshain
and Falkenstein are in the most expensive part of Germany.
At Malchow the daily cost is 316 mks.^ This is, however,
more a home for consumptives than a true sanatorium. At
Grabowsee the cost per head is 247 mks. ;^ at Rehburg
(Bremen Sanatorium), 2-26 mks. ; ^ at Blankenfelde, 335
mks. ;2 at Dannenfels, 4*15 mks., or for food alone, 2*20
mks.^ The estimated daily cost at Marzell is 2*38 mks. ; *
at Wiirzburg Sanatorium, 2*19 mks.;* at Altena, 3*02
mka^ Both at Malchow and at Blankenfelde much
alcohol is used. At Dannenfels there are only 18 beds.
The daily cost at the Konigsberg Sanatorium in its first
year (1895) amounted to 2*31 mks., or with interest on
capital, 312 mks.* In 1896 the cost was 223 mks., or
with interest, 2*71 mks. ^ This sanatorium was formed
out of a pre-existing villa.
In Switzerland, the daily cost at the Heiligenschwendi
Sanatorium in its first (and most expensive) year amoimted
to 1*92 frs. At the Basel Sanatorium at Davos in its
first year the cost was as high as 4*09 frs., including
1*59 frs. for expenses of administration at Basel; the
daily cost for food, drugs, washing and a few simdries
amounting to 2*2 frs.*^
In France, Beaulavon ^ states that the average cost of a
consumptive in a general hospital is 2*93 frs. per diem ;
about one-third of the beds in the Paris hospitals are occu-
pied by consumptives, whose average stay is ninety days or
more. He estimates that the average cost per head in
these hospitals amounts to 315 frs., while in a sana-
torium the daily cost would probably be only six centimes
more (3*21 frs.), and declares that whereas practically
no consumptive is ever cured in hospital, 28 per cent, are
more or less completely cured in a sanatorium.
1 hoc. dt, ' Liebe, loc. cit. ^ Kuthy, loc. cit,
* Annual Report for 1896-6. * Annual Report for 1897. • Loc. cit.
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THE COST OF A SANATORIUM. 77
In London, the cost per head of in-patients in chest hos-
pitals varies from 4s. 9d. to 6s. 6d. per day ; at the Ventnor
Hospital, which is practically a sanatorium, it is 5& 4d. ; so
that we may expect the cost of maintenance in a country
sanatorium in England to be no greater, and possibly less^
than in a London chest hospital^ At the Adirondack
Cottage Sanitarium in America, each patient costs a dollar
a day. The average cost per day in most of the London
general hospitals is considerably less than at the special
hospitals, owing to the larger proportion of patients on low
diet Excepting for the absence of resident medical officers
and nurses in convalescent homes, these would give a
better standard for the probable expenditure in an English
sanatorium for consumptives than a general or a chest
hospital. Some of our convalescent and nursing homes
receive consumptives; a few almost exclusively. But in
order to draw trustworthy conclusions from the published
reports, the average proportion of different stages admitted
and the treatment adopted, as well as other circumstances,
would have to be taken into account. The following esti-
mate of probable expenses at the Altena Sanatorium (100
beds) is of interest : — ^
Marks.
34,400 days of treatment at 1*60 mks 55,040
Physician, including dwelling 8,500
Assistant physician 2,000-
3 sisters, 1800 ; 2 nurses, gardener, fireman, coachman, 2680 4,480
1 cook, 2 kitchenmaids, 2 housemaids .... 1,080
Food of staff : 12 at 1 mk. ; 2 at 2 mks. . . . 5,840
Stocktaking, 2000 ; repairs, 1000 ; washing and soap, 1620 4,620
Water supply, heating and lighting .... 2,500
Bureau, 1000 ; horse, 1500 ; sundry and unforeseen . 2,890
Interest on capital, SJ "U \ sinking fund, 1 7^ = 4J "/^
on 300,000 mks 12,750
Total . . . 99,700
34,400 days at 3 mks. would yield 103,200 mks.
The expenses of maintenance of a sanatorium are partly
dependent upon the size of the building, as a small estab-
^ BurdetVs Hospitals and Charities^ 1897. ' Liebe, loc. cit.
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80 THE COST OF A SANATORItJM.
genschwendi are from 1^ to 4 frs. per diem, according to*
means ; at the Basel Sanatorium at Davos 5 frs., or under
certain circumstances 2 or 3 frs. ; at the Dutch Sana-
torium in the same place, 4 fra ; in the British Davoa
Invalids* Home, 4 to 4j frs. ; at St. Moritz, about 6 fra.
with the help of the " Aid Fund'*. It may be remembered
that at the Ventnor Consumption Hospital a charge is made
of 10s. 6d. per week.
Most of the above-mentioned charitable and semi-charit-
able institutions are more or less supported by private
subscriptions and donationa In Germany, however, there
is a law enforcing compulsory insurance against sickness:
and old age, which has largely contributed to the founda-
tion as well as the maintenance of popular sanatoria (see-
p. 204). In Switzerland, where no such law exists, the first
sanatorium was founded by public subscription to com-
memorate a national anniversary ; and patients recom-
mended by subscribers have the preference in admission^
In the Basel Sanatorium at Davos those who pay the full
amount (5 frs.) have first choice of the single-bedded
rooms ; certain societies and hospitals who contribute to-
wards the funds have the privilege of sending patients (if
suitable) at reduced rates ; and in addition, an auxiliary
society exists to help those who are too poor to pay the
usual charges. At Davos, too, a society exists which secretly
assists those who are unable to continue paying the fees at
one of the pay sanatoria, on recommendation of the medical
officer of the institution.
In France the sanatoria for consumptive children and
youths at Ormesson and Villiers were established by private
subscriptions, being the first charitable institutions in
France to be started in this way. The Assistance Publique
and the Municipality of Paris, however, now subscribe to-
the funds in return for certain privileges. The sanatoria,
are free and non-sectarian, and open to the natives of every
country if resident in France. To stimulate the generosity
of donors to the children's sanatoria, certain honorary titlea
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THE COST OF A SANATORIUM. 81
are bestowed according to the amount contributed ; and if
a sufBcient sum be given, the names of the donors are in-
scribed on the wall of the vestibule at Villiera L^on Petit
has suggested in his book ^ another expedient for raising-
the necessary funds for popular sanatoria in France, an
expedient which in fact has been adopted in theory by the
Societe dea Scmatoria de Frcmce, It is that the ridi shall
pay for the poor. In many German and Swiss sanatoria
for paying patients voluntary oontributicms are made to-
wards the funds of the popular sanatoria ; but in Leon
Petit's plan this would be done systematically, by devoting
a portion of the profits of the pay sanatorium to the pay-
ment of the expenses at the popular sanatorium. He bases
his calculations on the figures furnished by Falkenstein and
Davos, and asserts that a sanatorium for one hundred pay-
ing patients would support another for fifty poor patients^
allowing for the payment of 3 per cent, on the joint capital.
Translated into pounds sterling, his table appears as fol-
lows : —
A. — Prime Cost.
1. Sanatorium for paying paiiente £40,000
2. „ poor „ 10,000
£00,000
B. — Annual Cost of Maintenance.
1. Sanatorium lor paying patients —
Daily cost at 66. 4d £11,680
Unforeseen 320
£12,000
2. Sanatorium for the poor-
Daily cost at 48. ..... £3,450
Unforeseen ...... 550
4,000
3. Interest on capital at 3 per cent 1,500
4. Sinking fund at 5 per cent, (depreciation) . . . 2,500
£20,000
1 Loc. oit,, p. 258.
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82 THE COST OF A SANATORIUM.
C. — Receipts.
Sanatorium for paying patients —
Daily charges, 128 £21,880
Sundries at Is. 6d 2,920
£24,800
J.e., profit nearly 10 per cent.
There is little doubt that were such a scheme started in
England under proper auspices it would prove to be finan-
cially sound as well as socially beneficial. Owing to the
greater cost of labour and material in this country, and the
greater expense of living, it would not be safe to reckon on
«o large a dividend ; but even if no profits were made, and
the two institutions were together to be rendered self-
; supporting, they would be the means of effecting a great
.saving of useful lives and a corresponding diminution in
poverty and suffering ; while their indirect influence in
educating the public in hygienic methods would be still
jnore important.
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CHAPTER XVII.
SANATORIA IN AMERICA— EASTERN STATES.
There are eleven or twelve sanatoria for the open-air
treatment of consumptives in the Eastern States of
America (one in process of erection), and seven more in
the Western States, one of which, however, is not open for
want of funda Many of these admit other than con-
sumptive patients; but the following profess to be ex-
clusively for phthisical patients : The Adirondack Cottage
Sanitarium, the Gabriels Sanitarium (being erected), the
Loomis Sanitarium, the Sharon Sanitarium, the Winyah
Sanitarium, and the Hygeia Sanitarium — all in the Eastern
States. Of these, Winyah is a private institution for
paying patients, the rest being charitable or semi-charitable.
Most of the Western sanatoria are for paying patients.
There are also a number of homes and hospitals for
consumptives in the towns, intended mainly for more
advanced and less hopeful cases. The term sanitarium is
generally used in America in place of sanatorium. These
two names might with advantage be used with stricter
attention to their derivative meaning. The former might
be applied to any specially healthy place ; the latter to a
place with arrangements for restoring people to health —
the former to an open health resort ; the latter to an estab-
lishment for hygienic treatment. The following is a list of
the principal American sanatoria for consumptives : —
(83)
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84
SAMATORIA IN AMERICA — EASTERN STATES.
Adirondack Cottage San.
New York State
1780 feet
94 beds
Gabriels „
>»
1970 „
60 „
Loomis „
If
2800 ,,
90 „
Seaton
? »
? „
De Peygter
i»
1100 „
40 „
Montcmore Country Home
»»
? „
40 „
Sharon San
Massachusetts .
360 „
9 »
Mass. State Hosp. lor Cons. .
,j
1800 „
? ,.
Philad. Hosp. for Dis. Lungs .
Pennsylvania .
600 „
72 ,.
WinyahSan
N. Carolina
2350 „
60 „
Aiken Cottages .
S. Carolina
?850 „
? „
Hygeia San. .
860 „
66 „
Glockner „
Colorado .
6000 „
40 „
Colorado „
»»
6800 ,,
100 „
Bellevue „
It
?6280 „
15 ,.
The Home, Denver
«i
6260 „
22 „
White Gables San. .
Texas
1428 „
26 „
St. Mary's „ .
1 California
?4700 „
? .,
Las Vegas „
New Mexico .
6767 „
860 „
The Adirondack Cottage Sanitarium
was founded in 1884 as an attempt to place within the
reach of working men and women the advantages of
climatic and sanatorium treatment at as moderate a cost
as possible.
It is situated one and a half miles from the village of
Saranac Lake, in the Adirondack Mountains, New York
State, on sandy soil resting on primary rocks. The
grounds, which cover an area of about forty-five acres,
are surrounded on most sides by densely wooded heights
covered with evergreen trees, which protect the place
against wind. The sanatorium itself is several hundred
feet above the Saranac river valley, at an altitude of 1780
feet above the sea level, on a protected shelf-like plateau on
a hillside which slopes to the east and south-east. The pre-
vailing winds are west and south. The climate in winter is
cold, with many windless snowy days. Snow lasts from
the middle of November to the middle of March or ApriL
Rain and snowstorms are frequent ; and cloudy weather pre-
ponderates at all seasons, especially in winter. In February,
1894, the mean temperature was IS"*, the minimum ~ 31** F.
In July, 1894, the mean was 66^ the maximum 91^ Gener-
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Pio. 3.— The Adirondack CJottaoe SANiTARnjM, New York State.
ADMnnsTRATivB Block.
[Face page 85.
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8ANAT0BIA IN AMERICA — BASTEBN STATES. 85
ally speaking, the climate may be characterised as cold and
moist, but in winter cold and dry.^
The sanatorium was originally built to accommodate nine
patients, but now has beds for ninety-four. It consists of
twenty-two different buildings, from 75 to 100 feet apart,
grouped around a large main structure on three floors. This
contains the executive department, dining-room, offices,
kitchen, baths, closets, nurses' and doctors' rooms, together
with a few large rooms for a limited number of patients (fig.
3). The general sitting-room is 30 X 40 feet ; the common
dining-room, 40 X 50 feet. One of the buildings, enclosed
by glass, is used as a recreation pavilion. Two of its sides
(to the windward) are kept closed, the others being always
open. Another building is used as an " infirmary," for the
care of those who require to be kept in bed. The cottages
are small one-storey buildings for from two to nine patients,
the majority accommodating four or five. Each patient
has his own bedroom, opening into a central sitting-room.
The bedrooms average 10 X 14 feet, the sitting-rooms
18 X 25 feet. The partitions between the rooms are of
solid masonry, but those between the bedrooms and the
central sitting-room are only seven feet high, so as to
give a larger ventilating space ; moreover, the inner doors
do not touch the floor. Ventilation is by means of open
fireplaces in the central sitting-rooms, and by transoms
over the verandahs and small openings over the windows
of the bedrooms. The main building is ventilated by open
fireplaces and ventilators in the ceiling, which lead by tin
pipes to the chimneys. It is also heated by hot water.
The cottages are heated by hot water, stoves and fireplaces.
The whole sanatorium is lighted by electricity. The build-
ings are all constructed of hard wood and masonry, with as
few angles as possible ; the walls being of smooth varnished
wood, without curtains or hangings, and the floors of hard-
wood, without carpets and with as few rugs as possible.
Verandahs are placed outside the cottages, with glass par-
1 Solly, MediciU Climatology, London, 1897, pp. 210-214.
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86 SANATORIA IN AMBBICA — EASTERN STATES.
titions on the windy side. The water supply is from the
village waterworks, about two miles distant, and has a
pressure of 90 lb. The drinking water comes through
iron pipes from a spring 85 feet above the sanatorium, at a
point higher than any human habitation. The sewage is
discharged into the river 200 feet below the bluff on which
the sanatorium is built
For disinfecting the rooms reliance is placed upon ample
ventilation, sunlight, and soap and water. The walls,
floors and furniture are washed daily with damp cloths.
Strict rules are enforced concerning the sputa. Each
patient is furnished daily with two small pasteboard spit-
cups in a frame. These are placed in a receptacle and
burnt in a crematory. In the halls, passages, and veran-
dahs about four feet from the ground, are small boxes with
lids containing pasteboard glazed spitcups, which are burnt
and replaced every day. At meal-times Japanese paper
napkins are freely supplied and afterwards burnt
The exercise taken by patients is prescribed by the
physicians. Those who show any appreciable rise of
temperature are only allowed to walk to the dining-room
for meals, and kept sitting out-of-doors during the febrile
period in the afternoon. If the temperature rises above
100** F. no exercise is allowed. The exercise taken by non-
febrile patients is determined by the state of circulation,
nutrition and appetite. Hydrotherapy is not used, but
patients have free access to the baths in the institution.
Few medicines are given, and principally those of a
reconstructive kind, such as cod-liver oil, hypophosphites,
arsenic, and, where indicated, creosote in small doses. No
other antiseptics or specific remedies are given, excepting in
a few selected cases which have been treated with tuberculin.
The sanatorium is under private management. State aid
having been refused. It is directed by its founder. Dr.
K L. Trudeau, and a board of trustees, with the help of
two resident physicians, examining physicians in New York
and other large cities, and trained nurses in the "infirmary'*.
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SANATORIA IN AMERICA— BASTEBN STATES. 87
The charges are S6 per week to all alike, the deficiency
(about S2) being covered by subscriptions and oontributions.
There are no extras, excepting for extra washing, medicines
(supplied at cost price), and a small charge for nursing in
tiie " infirmary '*.
The average length of stay is six months ; one year
is the limit ; but in exceptional cases when necessary this
rule is not enforced. Patients who show no improvement
after a reasonable period are advised to return homa
Advanced cases and active types of disease are only
exceptionally admitted. Those who can aflTord to pay more
than the low prices charged are not admitted. Friends are
only allowed to remain a week, and pay $1'60 per day.
The institution is non-sectarian ; there is a stone church
in the grounds, in which services are held nearly every
Sunday by clergymen of any denomination who may
volunteer their services.
Statistics, — 20 to 26 per cent, are apparently cured, and
in 20 to 35 per cent, more the disease is more or less per-
manently arrested (mean results of ten years). If the most
favourable of the cases admitted are separated under the
term " incipient," the proportion of patients cured is as high
as from 30 to 36 per cent.
Saranac Lake village can be reacted in thirteen hours
by rail from New York without change of carriage. The
patient can have all his meals brought to him in the train.
The Gabriels Sanitarium
is being erected in the Adirondack Mountains, at an
altitude of about 1970 ft., near Paul Smith's, Franklin Co.,
New York, and will have fifty beds, under the care of
Catholic Sisters. Paul Smith's is on the north shore of
the Lower St. Regis Lake, a lovely chain of lakes about five
miles long, with sandy shores and very little rock. The
neighbourhood is comparatively level, with one mountain
(St. Regis), about 3000 ft. high.^
J S. E. SoUy, loc. ciL, p. 210.
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88 sanatoria in america— eastern states.
The Loomis Sanitarium
is situated about 120 miles from New York, at Liberty,
Sullivan Co., in the midst of a rolling mountainous country,
which forms the highest land between New York and the
great lakes. The Catskill Mountains are some twenty
miles to the north and east; southward is a wide valley
for forty miles ; westwards the view extends over the tops
of hills for fifty miles along the river Delaware into Penn-
sylvania. The value of this beautiful country was advo-
cated years ago by Dr. St. John Roosa and the late Dr.
Alfred Loomis. There are practically only two seasons,
winter and summer, with a rapid transition between the
two. The winters are cold and dry, while even in summer
the air is dry and exhilarating and the nights cool and
refreshing.
The sanatorium was erected by public subscription and
opened on 1st June, 1896, with accommodation for twelve
patients, but has now beds for ninety with additional tent
accommodation in summer. It stands 2300 feet above the
sea level on a southerly slope, protected by a rocky wooded
ridge to the north. The grounds belonging to the institution
have an extent of 193 acres, and form part of a very
large tract of open country. The grounds have been laid
out with roads, paths and terraces.
The sanatorium consists of a group of buildings scattered
across the turf and connected with paths. The largest is
the administration building (fig. 4), which is a picturesque
three -storey building with verandahs and round pointed
roofs, and out-buildings attached in a long line beside it.
This contains on the ground fioor the reception-room,
library, dining-room, offices, drug-room, butler's pantry,
kitchen, store-room and laundry. On the next fioor are the
solarium, four emergency wards, laboratory, nurses' rooms,
baths and closets, guest rooms and sleeping quarters for the
resident stafi*. On the third fioor are servants' quarters
and store rooms. Another building, the casino, is a two-
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SANATORIA IN AMERICA— EASTERN STATES. 89
.•storey building with pointed roof and large open verandah
devoted to amusement, and containing a billiard table,
-piano, harmonium, etc. Two other cottages of two storeys
»each accommodate respectively twenty-three and sixteen
patients. Five other one-storey cottages accommodate
•eight, eight, four, four and five patients respectively.
There are two other buildings, of which one accommodates
:8even, the other ten patients. The buildings are mostly flat
•on one side and rounded on the other with verandahs which
are protected in winter by glass at the exposed ends, but
remain open to the south (fig. 5). There are bathrooms and
•closets in every cottage, averaging one to every four patients.
Elach cottage has one or two parlours. The bedrooms aver-
.age twelve by fourteen feet in size, some provided with
•chimneys. Nearly all accommodate but one patient, eight
Tiave beds for two a piece. Each building is heated by its
•own hot water or steam pipe plant, and is lighted with
I •electricity from a central dynamo. Ventilation is by open
windows, through the steam heating level, and through
I the open fireplaces. The temperature is not allowed to
•exceed 65° F. by day and 40** by night in the winter
jnonths.
, The walls and floors are capable of easy cleansing and
•disinfection. The furnishing is comfortable but simple,
^thout unnecessary hangings, and without fixed carpets.
'The water supply is from two large springs which fill a
ireservoir above the highest part of the sanatorium. The
sewage is disposed of according to the Waring system.
Trained nurses are kept in the sanatorium. There is also
.a nurses' training school consisting at present of thirteen
members who are given practical training every day, and
lectures and recitations every four days. The superinten-
•dent is a graduate of a New York training school; the
•course of training of two years* duration. The physician
iin charge (Dr. J. E. Stubbert) lives in a separate house ; a
house physician and assistant house physician are lodged
iin the administration building. Service is held every
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92 SANATORIA IN AMERICA — EASTERN STATES.
at a charge of $2.50 per week, including medical attendance
and drugs. There is accommodation for forty children.
The Montefiore Home Country Sanitarium
is under the same management as the Montefiore Home for
Chronic Invalids at New York, described at p. 117.
It is situated at Bedford Station, Westchester Co., New
York State, in a sheltered situation on the Berkshire Hills,
which form the highest part of the county, and is sixty
miles from New York or one and a half hours by rail.
Opened early in 1897 with beds for ten patients, it was
very soon enlaf ged to accommodate forty ; and it is hoped
to further extend the number of beds to sixty.
The two buildings are frame houses, one of which has a
large verandah. There is also a good bathroom, and heat-
ing by hot water.
The grounds coyer 136 acres of land. It was originally
a farm ; and patients are sent there who are able to do a
little light work, with the object of ultimately making the
sanatorium self-supporting. It has already begun to
supply the Home in New York with milk and eggs.
Nearly all the patients are consumptives in an early stage ;
but a few are sufferers from asthma, neurasthenia, etc
Only men are admitted, and no charge of any kind is made.
There is at present no house physician ; but one of the visit-
ing physicians of the Home in New York attends once a
week, and more frequently if called through the telephone.
The Seaton Sanitarium
is situated at Spuyten Duyvil, N.Y., and has two visiting
physicians, Dr. Jackson and Dr. Shrady, but no house phy-
sician. I have, however, no further information about it.
Sharon Sanitarium,
which was founded by Dr. V. Y. Bowditch in 1890 by
means of public subscription, is situated about one and a half
miles from the village of Sharon, five minutes' walk from the
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SANATORIA IN AMERICA — EASTERN STATES. 93
station on the Providence Railway, and eighteen miles from
Boston. It stands amidst hilly country covered with pine
woods, on thirty feet of gravel and sand, at a height of 300
to 400 feet above the sea. The climate is moist and variable.
The sanatorium is on the southern slope of a hill, in about
130 to 140 acres of woodland, protected by hills to the N.
and W., and by thick pine woods in the immediate neigh-
bourhood, and has a large amount of open land to the south.
It is a large wooden building with accommodation for nine
patients, and has been constructed so as to obtain as much
fresh air and sunlight as possible by means of numerous
windows and open fireplaces in every room.. Each patient
has her own special bedroom, which averages lOx 12 feet.
The walls are painted, the floors of hardwood, the comers
rounded in the newer parta Rugs are used instead of
fixed carpets, and no dusting or sweeping is done, the rooms
being cleansed with damp cloths, which are afterwards
boiled or burnt. The heating is by a hot-air furnace, with
hot- water attachment in the bathrooms. There is a good
supply of pure spring water. The sewage runs into a cess-
pool with an overflow 200 yards from the house. There
are broad piazzas for rest in the open air, part covered with
a verandah.
TTie place is intended for consumptive women only of the
refined but not wealthy classes — such as school teachers^
needlewomen and the like. Only cases in an early stage
are admitted. It is managed by a matron who is a trained
nurse, other nurses being obtained if necessary. The medi-
cal director is Dr. V. Y. Bowditch, of Boston, whose assis-
tant visits the sanatorium every day. The treatment is
for the most part hygienic — good food, fresh air, regular
hours, and carefully regulated exercise. Three meals per
day are provided, with two lunches of milk and eggs. The
windows are always kept open ; febrile patients rest in
bed ; others rest on the piazza in all weathers, or take
increasing exercise according to their condition, always
stopping short of fatigue. Respiratory exercises and the
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•94 SANATOBIA IN AMERICA — EASTERN STATES.
pneumatic cabinet are used in all suitable cases. Hydro-
pathy is not employed excepting in the shape of cold spong-
ing. Cod-liver oil and counter-irritants are occasionally
used. Klebs* antiphthisin has also been tried in a few cases.
Hypophosphites, bitters, malt extract, and iron are the drugs
•chiefly used ; and special attention is also paid to the state
of the stomach and bowels. The ofpuia are received into
^ sanitas paper sputa cups," and afterwards burnt. Patients
in the grounds carry rubber pouches with Japanese paper
napkins, which are also used at meal times and destroyed
by burning. Linen is disinfected by boiling. The rooms
tifter a patient leaves are disinfected with chloride of lime
:«olution. The charges are $5 per week, including all but
washing.
The results are very satisfactory, when it is remembered
that the sanatorium possesses no special advantages from
•climate or elevation above the sea level, and is situated in a
-district where phthisis abounds. It may fairly be said that
Dr. Bowditch has proved that the treatment can be satis-
factorily .carried out within a very moderate distance of a
large town or city, and with very simple meana He stated
in June, 1896, that out of sixty-four cases treated during
the last five years the disease was arrested in over one-third
(twenty-two cases). In all but six the arrest continued, and
the patients had remained in good health, mostly for more
than two years. One had died after an operation for uterine
•disease without recurrence of the pulmonary symptoms ;
three others had died of phthisis ; but two of these had
resumed an unhealthy mode of life contrary to advice.
The Massachusetps State HosprrAL for Consumption
has recently been finished (January, 1898), and is to
be immediately opened. It is situated in Worcester Co.,
near Rutland, 1300 feet above the sea. It consists of a
number of one-storey wooden buildings of various sizes,
.arranged in a semicircle, with the administrative block in
the centre. On one side are pavilions for men, on the
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SANATORIA IN AMERICA — EASTERN STATES. 96
-other for women. The larger buildings have each seven
private rooms and one large ward for twenty-two patients.
The smaller have only a ward for ten patients. Elach
pavilion has its own solarium constructed entirely of glass,
And is surrounded by a broad veran(^h.^
The Philadelphia HosprrAL for Diseases of the Lungs
belongs to the Protestant Episcopal Mission of that city,
And is managed by a board appointed by the bishop of the
diocese. It includes a small temporary hospital for men
(House of Mercy) in the heart of the city, and a larger
hospital for women at Chestnut Hill. These institutions
Are mainly, but not exclusively, intended for the reception
of consumptives, and formerly went under the name
of Homes for Consumptives. The patients are for the most
part poor people, who are admitted free of charge ; but
well-to-do patients also enter at times, and make a dona-
tion to the funds, there being no stated charges for such
cases. All stages are admitted, the length of stay being
usually three months, prolonged to six, or more if advis-
able. The mission also has a number of sick-diet kitchens
in the city, and helps the poor in this way in their own
homea Last year (1897) 164 were admitted to the two
hospitals, and thirty-six helped in their own homes with
^ood and money. From 25 to 33 per cent, of those ad-
mitted to the hospitals are said to be apparently cured, a
fair proportion permanently. The medical staff consists
of two resident oflBcers, a clinical clerk, and eight visiting
physicians. There are altogether nine nurses.
The House of Mercy,
or male branch, is at 411 Spruce Street, next to the general
offices of the missioa It consists of an ordinary house,
which has been adapted for the purpose, and has twelve
beds. This will probably be replaced by a more permanent
and more suitable building.
^ HeiUUitten Correspondena, Jan., 1898.
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96 sanatoria in america — eastern states.
The Chestnut Hill Hospital
is within twelve miles of the City -Hall, in a residential
suburb of Philadelphia at its most northerly part. It
is surrounded by gentlemen's country seats of one to two*
acres, and has farm lands to the north, being practically in
the country. The mean temperature of this part is some
6° colder than that of Philadelphia itself. The soil is.
of limestone. There are about thirteen acres of ground
belonging to the hospital, partly wooded and partly open.
The sanatorium is about 500 ft. above the sea, on the crest
of a hill which forms the highest ground for miles. There
is no special shelter against wind from hills or tree& The
buildings are on the southern slope, and consist of a central
administrative block, with a number of cottages on each
side, mostly built within the last ten years and accom-
modating sixty patients. The administrative building-
contains the day rooms, doctors' quarters, dining-room^
kitchen and emergency room. There is also a small
kitchen in each cottage. The patients' bedrooms are
all to the south, corridors with double windows to the
north. The rooms are large, and mostly contain but one
bed, a very few having two. Most of them have chimneys.
The walls are undecorated, the comers rounded. Every
cottage has a large common room, which is used as a sun.
parlour and for other purposes. The heating is by hot air ;
fresh air entering an empty space under the building, where
it is heated by radiation from a drum, and then driven into
the rooms. The lighting is by the city gas supply ; the
sewerage and water supply being also connected with the
city systems. There is ample provision for both rest and
exercise in the open air without exposure to bad weather.
Patients rest either in their own rooms, with windows
open, or in the sun parlours, winter as w^U as summer.
The douche is not used. Very little cod-liver oil is given.
At the House of Mercy the sputa are received into porcelaia
spitcups, which are disinfected with corrosive sublimate
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SANATORIA IN AMERICA — EASTERN STATES. 97
solution ; at Chestnut Hill paper spitcups are used, which
are afterwards burnt. Linen is disinfected by boiling*
Booms were formerly disinfected by 10 per cent, carbolic
solution and by burning large quantities of sulphur. Now
formaldehyde vapour is used instead. I am indebted for
these particulars to Dr. William M. Angney, consulting
physician.
The Winyah Sanitarium,
at Asheville, North Carolina, was founded in 1878 by Dr.
J. W. Ghitsman, of New York City ; remodelled in 1888.
It is situated on lime and sandstone substrata on a
south-westerly slope at a height of 2350 feet above the
sea, with mountains to the north which shelter it from
prevailing winds.
The grounds are about four acres, and touch the woods
on the mountain slope.
The sanatorium is a three-storey brick building with
accommodation for sixty patients, and has toilet and bath
rooms on each floor. It contains three general assembly
rooms, measuring about 40 X 60 feet. The bedrooms
average 16 x 16 feet, and are provided with chimneys.
Ventilation is by air shafts and open fireplaces. In addi-
tion to these, the building is heated by steam pipes. The
lighting is by electricity. The water supply and sewerage
are those of the city of Asheville. The establishment is
under the direction and control of Dr. Karl v. Ruck, to
whom it belongs. There are also an assistant physician and
a resident house physician. There are no trained nurses,
excepting as called in for emergenciea
Pay patients alone are admitted, and no hopelessly
advanced cases are received. Patients take their meals in
the general dining-room or, if they cough and expectorate
freely, in their own rooms or on the piazza surrounding
the building. They take exercise under daily medical
prescription, according to the state of the heart and the
body temperature. The cold rub is administered in all
7
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98 SANATORIA IN AMERICA — EASTERN STATES.
cases, the cold douche in selected cases. Counter-irritants
are not often used. Tuberculin is made use of in special
cases. Sputa are received into spitting-flasks, and after-
wards destroyed by fire. Handkerchiefs are permitted,
but not for expectorating. Linen and eating and drinking
utensils are purified by steam or boiling water. Booms
Are disinfected by the generation of formaldehyde. They
Are constructed so as to facilitate cleansing.
The charges are $20 to $30 per week ; no extras.
BtatisHcs : Early stage . apparent recovery 81 %, improvement 19 %
More advanced . „ „ 35%, „ 28%
Advanced, but^j
still in fair V „ „ 9%, „ 24%
condition .j
The average length of stay is six months.
The sanatorium is easily accessible from Asheville by
electric tramcara
The Aiken Cottages,
at Aiken, South Carolina, have been mentioned to me by Dr.
Trudeau as a sanatorium for consumptives. Aiken stands
650 feet above the sea-level on an elevated plateau between
the Savannah and Edisto rivers, a little over a hundred
miles from the ocean. It lies on sandy soil amidst pine
woods. The climate is mild ; there is a considerable rain-
fall (average 48 in.), but not much cloudy weather in
winter, when the relative humidity is 59 per cent^ There
is said to be a good water supply.
Dr. Sajous* Co-operative Village.
In the British Medical Journal for 31st October, 1891,
it is stated that Dr. Sajous had started a company for
supplying middle class consumptives with model cottages
in suitable places under sanitary and medical supervision.
The scheme was to be co-operative ; provisions, trained
servants and nurses being supplied by the company. The
IS. E. Solly, loc. ciL, pp. 223-4.
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SANATORIA IN AMERICA — EASTERN STATES. 99
rent of a furnished cottage was to vary from $20 to $60
per month, and the first of these villages was to be
founded at New Florence, near the Gulf of Mexico. I have
been unable to learn whether the scheme was ever carried
out.
The Hygeia
is situated one mile from Citronelle, Alabama, a town of
about 3000 inhabitants, free from factories, on the Mobile
and Ohio railroad, and has a special station of its own. It
is surrounded by rolling pine-clad country, and stands in
260 acres of land, part of which is laid out as a park, with
walks and roads, croquet grounds, golf links and tennis
court. Shooting and (at a distance) fishing can also be
obtained in the neighbourhood.
The climate is sub-tropical, equable owing to the
proximity of the Gulf Stream, yet free from extreme
humidity and fogs, and mild in winter without being
oppressive. There is usually very little rain, excepting for
a short time in January.
The sanatorium, which is open from 15th October to
15th May, is on sandy soil, 350 feet above the sea-level,
and is sheltered from winds by the extensive pine woods to
north, east and west. It consists of three large buildings
and five cottages, all of them wooden-frame houses with wide
porches, and balconies or verandahs on every floor. The
main building, which was built in 1889, consists of a dining-
room, parlours and reading-room, the office and a certain
number of bedrooms ; while an annexe contains the kitchen
and pantry, bath-rooms and barber's shop. Another build-
ing contains a billiard-room and a bowling alley, also a
drug store, newspapers, books, etc There is a separate
building for consulting rooms and inhalation room, with
arrangements for inhalation of medicated vapours and com-
pressed air. The bedrooms average 15x15 feet, some at a
lower price being 12 x 8 feet ; all are to the south in the
cottages, those in the main building having various aspects.
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100 SANATORIA IN AMERICA — EASTERN STATES.
The walls are oil-painted or calcimined, the angles being
partially rounded, and no prominent decorations being
added. The heating is by open fireplaces; the lighting
will probably be by electricity, but it is at present by oil.
Ventilation is by means of open windows, transoms and
other special appliances. The sewerage is carried into a
stream one and a half miles off The water supply is from
springs and pumped into tanks.
The sanatorium, which is a private institution exclusively
for consumptives of both sexes in presumably curable
stages, has sixty-five beds. Only paying patients are
received, but some are admitted at reduced rates into one
of the buildings. The treatment is mainly hygienic, rest
or exercise in the open air being regarded as of supreme
importance. The douche is not used, but in most cases
cold affiision with sponging and friction, a few receiving
the dry rub instead. Cod-liver oil is not given excepting in
some cases to children. Tuberculin, tuberculocidin, pre-
ventive serum and the new tuberculin T.R., have all been
used in small doses in a certain number of cases, and are
regarded as of value. Counter-irritation by iodine or
faradisation is also occasionally employed. For the sputa
the use of handkerchiefs is strictly prohibited, enamelled
spittoons being used instead, with 1 in 1000 corrosive sub-
limate, the contents being afterwards sterilised by heat
Linen is steam-sterilised; rooms disinfected by formalin
vapour. At the most two patients are allowed to sleep
in one room. The average length of treatment is about
130 days, the longest stay having been 240 days. Patients
are not advised to leave before three months in any case.
There are two or three resident medical oflScers, the chief
being Dr. A. C. Klebs ; three consulting medical oflScers,
including Dr. Edwin Klebs of Chicago. There are also a
general manager and a staff of three nurses, others being
obtained if necessary. The charges are from $15 to $30,
including board, lodging, baths and ordinary medical and
nursing attendance.
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SANATORIA IN AMERICA — EASTERN STATES. 101
The results of the two winters, 1895-6 and 1896-7, were
as follows : —
On admission 31*26 per cent, were in first stage, 82*50 per oent. in
second, 86*25 per cent, in third.
In 22*50 per cent, all signs and symptoms disappeared.
In 46*25 per cent, there was decided objective improvement.
16*25 per cent, remained stationary.
2*50 per cent. died.
In 65 per oent. there was gain of weight.
In 62*60 per cent, the fever diminished, in 82*50 per cent, it re-
mained stationary, in 6 per cent, it increased.
The bacilli were absent on last examination in 40 per cent.^
** The Necessity of Special Institutions for the Treatment of Pulmon-
ary Tuberculosis," by A. C. Klebs, Tri- State Med, Joum, and Pract.,
St. Louis, May, 1897. Also private letter.
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CHAPTER XVIII.
sanatoria in america— we stern states.
The Glockner Sanitarium,
at Colorado Springs, is situated at an altitude of 6000 feet
above the sea-level on a plateau at the northern end of the
city, and two miles from its centre, being easily accessible
by electric cars. The surrounding country is mountainous
to the west and north, with plains to the east and south. The
soil consists of gravel and sand, seventy feet thick, lying on
a clay bed which slopes to the south. The Rocky Mountains
and foothills surround the city on all sides and protect it
against wind. The sanatorium, which was specially built
for invalids by Mrs. Glockner in memory of her husband,
Mr. Albert Glockner, stands in a garden 400 feet square,
and has accommodation for about forty patients, consump-
tives in all stages being admitted as well as other patients.
It is managed by sisters of charity and has trained nurses
but no regular medical staff, the patients calling in what-
ever doctor they please. The building is of brick, with a
southerly aspect, and is so constructed that every room
receives the sun, and every part is readily cleansed. It is
said to have every modem convenience and appliance, with
porches and covered balconies on every storey, some
enclosed by glasa It is heated by steam, the assembly
rooms and some of the bedrooms being provided with
chimneya Ventilation is by means of transoms and
windows. The assembly rooms are 52 x 16 ft. ; the bed-
rooms averaging 12 x 18 ft. The place is lighted by
electricity. There is a good water supply. The sewerage
(102)
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SANATOEIA IN AMERICA— WESTERN STATES. 103
is connected with the city system. The sputa are received
into sanitary cuspidores which are afterwards burnt. The
rooms are disinfected by formaldehyde gas. The meals are :
breakfast at 8 A.M., dinner at 1 P.M., supper at 6 p.m. ; milk,
meat juice and eggs as requested between meals. Massage
is often used ; counter-irritants and cod-liver oil in suitable
cases, but no specifics as a rule. Patients take plenty of
exercise if their strength permits. Hydropathy is not
employed, excepting ordinary baths. The charges are from
$8 to $15 per week for board and lodging ; medicines,
stimulants and medical attendance being extra*
The Home, Denver, Colorado,
was founded in September, 1895, by the Council of the
Episcopal Church of Colorado, with the help of subscrip-
tions from wealthy people in New York and elsewhere.
The object was to establish a home for consumptive
Christian ladies and gentlemen of limited means, mainly
of the professional classes. A reference is required as to
character before admission. The sanatorium is chiefly
intended for early and presumably curable cases, but every
stage is received and provision is made for nursing those
who require it.
The home is under the superintendence of the Rev. F.
W. Oakes, with the help of a manager who has had long
experience in both hotels and hospitals. There is a Board
of Management consisting of the Rev. F. W. Oakes, Dr.
Samuel A. Fisk and Rev. David H. Moffat, under the
presidency of the Rt. Rev. Dr. Spalding. There is no
medical resident, but each patient selects his own medical
adviser from Denver or elsewhere.
/ The home is about ten minutes' ride by cab or tramcar
from the post office at Denver on an elevation commanding
an extensive view over the city, the Rocky Mountains for
about 150 miles and the plains to the east for several
hundred miles. An uninterrupted view may be had from
the porches of Pike's Peak, Mount Evans and Long s Peak.
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104 SANATORIA IN AMERICA — WESTERN STATES.
The sanatorium lies at an elevation of 6250 feet above the
sea-level, on three or four acres of ground which slope to
the south and east. The Rocky Mountains protect it to
the west.
There are no trees within 500 feet of the building. The
soil is very porous and sandy. The sanatorium consists of
four separate buildings (fig. 6), united by a roomy, well-
lighted corridor, which itself forms a sort of elongated
sitting-room, and the roof of which is used as an open-air
lounge. One building (" St. Andrew's House ") is for men ;
another C*»Grace House ") is for husband and wife, or mother
and son ; next in order is the " Emily House " for women ;
and next to this " Heartsease," for those in need of nursing.
The three former consist of two floors and an attic floor.
There are sitting-rooms in every house and covered porches
front and back surmounted by large balconies with awnings;
also a music room ; a library with 2000 volumes ; a gym-
nasium with billiard tables, dumb-bells, etc. ; a large dining
saloon; and an abundance of bathrooms, lavatories and
closets. The place is most luxuriously furnished and
decorated with valuable pictures, rich carpets, and all the
comforts and conveniences of a well-appointed home. All
walls are painted in oil, the angles being square. Floors
are all varnished, the rooms are all sunny and of good size,
none less than 14 x 15 ft. and 11^ ft. high, some are
18 X 20 ft. Every room, including bedrooms, is furnished
with a fireplace and chimney, and separated from the next
by a brick wall. "Heartsease," which was built in 1897,
is connected with the rest of the establishment by a covered
corridor with tiled floor. It is a four-storey building.
The basement, which is partly above ground, contains
kitchen, pantry and servants' quarters ; the ground floor
has a large and beautiful sitting-room with large bow
windows and window seats ; a dining-room, diet kitchen,
bath-rooms and seven large bedrooms ; the upper floors con-
tain more patients' rooms, of which there are twenty-two
in all. Every partition consists of a thick (15") brick wall,
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H
I
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SANATORIA IN AMERICA — WESTERN STATES. 105
which is practically sound-proof. There is only one bed in
each room, the walls and fumittire being of much the same
character as in other parts of the establishment. There is
a diet kitchen on each floor where light cooking is done
by electricity. This kitchen is connected with the main
kitchen by a dumb-waiter. Each room has its separate
silver service, linen and china, and each floor is in charge
of trained nurses, of whom there are one to every six
patients, besides the superintendent nurse. Every floor has
its own baths, eta, with tile, marble and porcelain fittings.
There is a lift to every floor, and a well-stocked drug room.
The whole house is in charge of a skilled and trained nurse
matron.
The home is heated by indirect central steam heating,
and lighted by electricity. The water supply, which is
cool, soft and abundant, is from a private artesian well
The house is connected with the city sewers, and its
sanitary arrangements are said to be very good. Ventila-
tion is by the fan system. There are two 100 in. fans in the
basement forcing fresh air into every room and replacing
the air twelve times per hour. Windows are kept open
whenever it seems advisable. The sputa are exclusively
received into cuspidores, which are cleansed four or five
times a day with a strong solution of corrosive sublimate.
The linen is steam-cleaned ; the rooms disinfected with
formaldehyde and then washed ; bedding and rugs sterilised
by heat. Most of the patients who enter the home are
fairly well and able to take plenty of exercise. There
is accommodation for altogether 100 visitors. Three meals
a day are provided : at 7 '30 to 9 A.M., 1 to 2 p.m., and 6 to
7 P.M.
The charges are $9 per week for board and room, or $25
in " Heartsease," also including the nursing, but not the
medical fees. These charges, which only pay about half the
expenses, are supplemented by subscriptions. There is one
endowed room for a male visitor. A chapel is soon to be
built, which will be lighted at night and always kept open.
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106 sanatoria in america — western states.
Las Vegas Sanitarium
is situated at Las Vegas Hot Springs in the northern
portion of New Mexico, U.S.A. Las Vegas Hot Springs is
a health resort six miles from Las Vegas, on a branch of the
Santa F^ Railway, which has five trains each way per
diem. It is under the control of the railway company, and
forms a village entirely devoted to the needs of visitors and
invalids, and specially laid out with a view to hygienic
requirements. The position and climate are unusually
good Standing in the same latitude as the African
Sahara, it is at a considerable elevation, so that hot weather
is unknown. Blankets are required every night of the
year, and the summers are delightfully cool. During the
two summers of 1896 and 1897 the temperature never rose
to 90°, and in 1897 it did not reach 80''. In winter there
is sometimes snowy weather, but as the place shares in the
dryness characteristic of the Rocky Mountain region, the
cold is beneficial to tubercular conditions without being
disagreeable. The average winter sun temperature is 76°»
The daily average is said to be 20° higher in winter than
at Denver, and 20° lower in summer. The average annual
rainfall is 127". From September to June the average
is considerably less than 1". The average number of
sunny days is 326. The sanatorium stands on granite
and sandstone^ at a height of 6767 feet above the sea-
level, at the entrance of a canon of the Rocky Mountains,
in the Canadian valley (fig. 7). Neighbouring peaks of the
true Rocky Mountain range to the west rise to heights
of 10,000 and 14,000 feet ; north and south are spurs from
the same range, and all round, forming four-fifths of a
circle, are the foothills. There is consequently very com-
plete protection against wind, and sandstorms are said not
to occur there. Owing to the dryness of the air, it is quite
possible for invalids to remain out of doors day and night ;
but the precipitation is just sufficient to ensure the growth
of vegetation in the neighbourhood. Over 500 acres of
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8
I
i
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SANATORIA IN AMERICA— WESTERN STATES. lOT
land belong to the place, through which runs the Gallinas.
river. There are about thirty hot springs in the place,
ranging in temperature as high as 144° F., and varying in
chemical constitution from saline to lithia, iron and sulphur
springa Some of these are conveyed by pipes to the sana-
torium. The mountains around are covered with pine trees^
cotton woods, cedars, and the like. The sanatorium consists
of one large (fig. 8) and several smaller buildings grouped
round a central park of fifty acres. The main building (the
" Montezuma ") accommodates 250 visitors; another ("Moun-
tain House ") will hold sixty ; and forty or fifty more can be
lodged in cottages and at the bath establishment. There is
a dining saloon to seat 250 people, and a lecture hall for
500. The main building is of stone, and consists of an irre-
gular oblong mass, with a round tower at one end furnished
with a spire and with a circular sun gallery just under the^
roof. At the foot of the building is a verandah 15 feet
wide and 544 feet long, pirotected by 70 feet of glass in case
of bad weather. The bedrooms average 13x15 and 13 feet
high, but some are much larger. The whole establishment,
including the cottages, is heated by steam pipes, and lighted
by electricity. There are no stoves or chimneys. Pipes,
convey fresh air into each room, and independent flues carry
out the foul air through the roof. The sewerage is accord-
ing to the Bertin system. A reservoir 200 feet above the
sanatorium hewn out of the solid rock and containing
4,000,000 gallons is filled with water pumped out of the
stream, and flushes the sewers. These are carried down
150 feet lower and one mile away to a farm of fifty acres
and purified by irrigation. The drinking water is abun-
dant and entirely from natural springs. The meals are at
7-30 to 9-30, 1 to 2-30, 6 to 8 ; and an early breakfast at.
6 to 7 A.M. in the bedroom if desired. Two lunches are
served free out of doors at 11 a.m. and 4 p.m. The supplies
come partly from the farm and from hothouses belonging
to the establishment. A herd of goats is also kept. A
bath-house 140 feet long provides swimming and various
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108 SANATORIA IN AMERICA — WESTERN STATES.
hydropathic appliances. In another house peat baths are
provided. There is a hospital with all modem appliances
facing the park some distance from the main building.
Attached to this are trained nurses and a training school.
Other buildings connected with the sanatorium are a
casino, post oflSce, station house, power house, school house,
bam with stables, telegraph and telephone oflSce, open day
and night, as well as express and money order oflSce. The
sanatorium is oflScially recognised as a meteorological sta-
tion. Altogether IJ million dollars have been spent upon
the place to render it as perfect as possible for both invalids
and pleasure-seekers. No advanced cases of phthisis are
received, nor any infectious or otherwise obnoxious or in-
curable cases. Indiscriminate spitting is strictly forbidden,
and great care is taken to disinfect the sputa, which are
received into cuspidores half full of water, collected twice
daily, no handkerchiefs being permitted for this purpose.
The cuspidores are disinfected by carbonate of soda, followed
by steam, then by pure carbolic acid, again by steam, and
finally washed with hot water, and left half full of water.
The linen is disinfected by steam. Rooms vacated by
invalids are disinfected by formaldehyde gaa The sana-
torium is under medical control and management. The
medical director is Dr. Wm. C. Bailey. There is in addi-
tion a second medical officer; also a consulting board of
three and an advising board of seven, who are non-resident
Consumptive patients are kept out of doors as much as
possible. Cod-liver oil is not used, and counter-irritation
only occasionally. Monthly reports are sent to physicians
who send cases. For those who are fit for it there is plenty
of amusement in the shape of riding, driving, mountain
•climbing, hunting, fishing, and out-door sports generally,
besides entertainments in the lecture hall.
The institution is one year old. Last year there were 195
patients received, with four times as many guests and friends
accompanying them. No charity cases are received. The
length of stay is most variable. The charges are from $2
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SANATORIA IN AMERICA — WESTERN STATES. 109'
per day • upwards, or $1260 per week upwards. For
patients $5 to 810 are charged for the first examination, after
which a weekly charge is made of 816 upwards, including
board, room, medical attendance, ordinary medicines and
ordinary nursing, and meals in room if so ordered by the
medical director ; but not including the treatment of un-
foreseen complications or special nurse. Goats' milk is
supplied free of extra charge.
The Colorado Sanitarium
is a branch of the Battle Creek Sanitarium in Michigan,
and was established five years ago on the western outskirts
of Boulder, twenty-nine miles north-west of Denver, on a
branch of the Union Pacific Railway. Boulder is an incor-
porated city of 8000 inhabitants, without any factories,
and is the seat of the University of Colorado. It is placed
at the entrance of three beautiful ca£Lons to the east of the
Rocky Mountains, 5300 feet above the sea-level, being also
protected by mountain spurs to the north. It enjoys a
very fine climate throughout the year, having about 340
sunny days, a cool and pleasant summer, with the tempera-
ture of the North American lakes, and a mild and genial
winter. The air is exceedingly dry and bracing.
The sanatorium stands about 200 feet above the city,
close to the foothills of the Rocky Mountains, and over-
looks to the east and south a land of fertile prairies which
grow com and fruits in great variety. The city of Denver
can just be seen from its upper floors, as well as a number
of small towns and villages in the distance. To the west
of the sanatorium are the snow-clad peaks of the Rockies^
As the prevailing winds are from the west, and no towns
or villages of any size exist on this side for 300 miles, the
air is exceedingly pure. In some parts of Colorado the
wind is sometimes unpleasantly strong, but at the Boulder
Sanitarium strong winds are not common, and come chiefly
in early spring and late autumn. The soil of the district
is of sandy loam and clay. The grounds of the sanatorium.
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110 SANATORIA IN AMERICA — WESTERN STATES,
cover ninety acres, consisting partly of foothills, partly of
more level ground, and laid out in drives, walks and paths.
There is a lawn in front of the sanatorium with flower-
beds, fountains and shady trees.
The building, which is two years old, consists of a main
building, with three smaller ones, all built of brick, faced
with red stone, heated by steam, and supplied with lifts,
electric bells and lighting. The main block, which faces
east, is 110 feet long by 66 feet wide, with a large wing in
the rear, and has four floors and a few attic rooms. The
kitchen and dining saloon are on the fourth floor, the latter
being provided with numerous large windows, with a fine
view over the prairies. The three lower floors have large
balconies or verandahs, the two lower running the whole
length of the building on the east and south sides. The
patients* rooms average 15 sq. feet and 10 feet high, and
are mostly to the south or east. They are all single-
bedded, with independent ventilation, and a separate air
shaft to each. In addition to these there are various
parlours and common rooms and two large suites of rooms
for treatment, including inhalation rooms, bath and douche
rooms for ladies and gentlemen, and a gymnasium where
Swedish movements and various gymnastic exercises are
carried out under a trained superintendent. The decoration
and furniture are simple and cleansable, with no unneces-
sary hangings or carpets. The engines and machinery for
heating and lighting are in a separate building. The water
supply, which is from melted snow, comes in closed pipes
for ten or fifteen miles down the mountain side. The
sewerage is said to be good.
The institution is conducted by an association, controlled
by a board of seven, of which the president is Dr. W. H.
, Riley, Professor of Diseases of the Mind and Nervous
System in the University of Colorado, who was for fifteen
years attached to the Battle Creek Sanitarium. With him
are three other physicians, and a staff" of trained nurses
«nd attendants. The institution is not a money-making
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SANATORIA IN AMERICA — WESTERN STATES. Ill
-concern, and declares no dividends. Those connected with
it receive only nominiskl salaries, or none at all.
Patients with all kinds of ailments are admitted, of both
sexes. The majority pay from $13 to $35 per week,
including rooms, board, medical attendance, and "two
treatments daily by a skilled attendant". Some are re-
ceived free of charge. There is accommodation for '100
patients, but, owing to the large number of applications, it
is proposed to enlarge the establishment. Last year (1897)
about 700 were treated, and $8000 worth of charitable
work was also done. The poorer patients lodge in the
cottages, where the expenses are lower. Of consumptive
patients all stages are admitted so long as there is a
reasonable chance of cure ; others being advised to return
home. The average length of stay is about three months.
Treatment is very systematic. At first it is often found
advisable to keep patients at rest Later on various
exercises are adopted to expand the chest and restore the
balance of muscular development. Massage, electricity,
Swedish movements, breathing exercises, inhalations of
medicated vapours from a nebuliser under compressed air,
hydrotherapy of various kinds, are all employed. There is
systematic instruction in mountain climbing by a trained
attendant for those in suitable condition. All drugs likely
to be useful are employed. Cod-liver oil and creosote
carbonate are occasionally used. For the sputa handker-
chiefs are not allowed, and patients are forbidden to smoke
or spit on pain of instant dismissal. They are provided
with paper cuspidores in metal holders. The former are
burnt and replaced every morning. Most of those who are
treated for consumption receive signal benefit. Dr. Riley
informs me that of early stage cases 80 to 90 per cent, are
completely cured.
Manitou Park,
in Colorado, which has many natural advantages, is visited
by a certain number of consumptives, as well as by other
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112 HASATOHJA IN AMERICA — WESTERN STATES.
)u'tihh' am] pU;a8ure-w;ekerH. In the abeence of regular
uitu\ivji\ oflfirtiyrn, however, it can Hcareely be regarded as a
HfiufiUfrinm.
St. Mary's Sanitarium,
Hi l*iieblo, (/alifoniia, is mentioned by Beaulavon (Revue de
lit TufmrrMloHe, Dec, 1896). I have been unable to obtain
any infonnation a^xmt it.
I'iKihIo in a rining manufacturing town of 35,000 in-
liabitantH, Htanding at an elevation of 4700 feet on both
HJdi'N of th(5 Arkansas river, which is a muddy, rapid-flow-
ing stream. The soil is of clayey loam, "caking to the
hardness of brick under the hot summer sun, dusty under
the inHnonc(j of a strong wind, muddy and tenacious after
hortvy rain or snow. From late September to March the
climate is usually all that can be desired ... a season of
almost perpetual sunshine and moderate temperature. The
spring months are more doubtful on account of occasional
dust-storms and parching winds. The summers are very
hot"»
The Bellkvue Sanitarium,
at Colorado Springs, has accommodation for fifteen patients^
but is Hhut up for want of funds,'' The climate of the place
is adniirablo. Dr. S. R Solly has acted as medical officer.
Colorado Springs is at an elevation of 5280 feet above the
Mt^-lovol
Whitk Gables Sanitarium,
iU* St Mary s Sanitarium, is at Boerne, Kendall Co., S.W.
Toxas, The town of Btx^rne^ which was originally a colony
i>r iUnnuans, is on the river dbolo* about thirty miles north-
wtvst i\{ San Anti^iio, with which it is connected by rail. It.
vHU\tains hIhhU 700 inhalutnntvs and has no factories except-
^ Ss K* Sv^ll\\ A H»iH*i\Hwt iv' .V(\}KM4 r«tMhiAHtyj>» London, 1897,
• IV*uUn\u\v Kn%w »H* Ai r*tV»v:%.\v!^. IVc 1S96; pnTmte leuer from
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SANATOBIA IN AMEBICA — WESTBBN STATES. 113
ing one cotton gin, and is surrounded by very hilly coun-
try with deep gulches. The climate is a very good one for
consumptives ; average rainfall, 26 inches ; mean tempera-
ture in January, about 56"*, in July about 89°, with usually a.
pleasant breeze in summer. The soil is a black loam over
limestone.
The sanatorium is situated 1428 feet above the sea-leveF,,
in ten acres of ground, which is wooded to the north and
east, and laid out as a flower garden and shrubbery to the
south. It is sheltered from the north by a range of hills,
and is open to the south.
The building is arranged round three sides of an open
courtyard, the main block of three floors being at the
western end, with a one-storey projection on the north side,
of the courtyard, and a separate block to the east contain-
ing chapel, kitchen and laundry. The main block has four
rooms on the ground floor, in addition to the oflSce, nurse'a
room and vestibule ; on the next floor are a reading-room,,
small kitchen, and seven other rooms ; on the top floor a
nurse's room, two large wards and two other large rooms*
Along the western side of the block is a large verandah^
with a balcony above it ; along the lateral prolongation is
another long verandah. There are water-closets on each
floor, and a bath-room at the eastern end of the ground
floor. The heating and lighting are somewhat primitive,
and some of the rooms have no chimney. There is accom*
modation for twenty-five patients ; the bedrooms are 10 feet
high, and vary from 10 x 12 to 16 x 16, and face in every
direction.
The sanatorium belongs to the Sisters of the Incarnate
Word (RC.) ; it was originally an old stone building bought
by Dr. Wm. Miller, who acted as medical officer until last
year, when it passed medically under the management of
Dr. A. H. Davidson, and was completely reconstructed.
The number of nurses varies according to need.
Consumptives in every stage are admitted, as well as
sufferers of both sexes from other ailments. Infectious
8
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114
SANATOBIA IN AMERICA — ^WESTERN STATES.
eases are not admitted. Patients spend much time in the
open air. The douche is not employed. Cod-liver oil, with
or without maltine, is often given. Paquin's serum was
tried in some cases, but without much succes& The
sptUa are disinfected by " chlorides," spitting flasks being
used indoors and handkerchiefs out of doora Linen is
disinfected by boiling.
The charges are from $25 to $90 per month.
I am indebted to Dr. Miller for an account of his system
t)f managing the institution. Mainly intended for con-
sumptives, it was necessary also to provide rooms for other
medical and surgical cases, which were placed in a different
part of the building. Acute and advanced cases were ad-
mitted to the institution, but hopeless cases were sent home.
Early and quiescent (first and second stage) cases were not
retained in the building, but sent on to one of a number of
<x)ttage sanatoria in the surrounding country, which were
gradually organised by Dr. Miller. These consisted of a
number of detached cottages of two and three rooms, well
built and ventilated, with a central dining hall and sitting-
room, all comfortably furnished. Five such sanatoria were
built up under his supervision, with accommodation for
about 150 visitors, who were lodged and boarded with an
abundance of well-cooked suitable food for about £6 per
month. During 1896-7, 731 patients were under treatment
at the sanatorium and the auxiliary resorts, with the follow-
ing results : —
Number of
patienta.
Stage.
ATOTjge
rnmiDer of
days under
treatment.
BBSULT8.
Died.
Im-
proved.
Unim-
proved.
Un-
known.
1896. 42o|
1897, 811.
First 78
Second 102
Third 245
Firat62
Second 69
Third 190
22
81
42
20
35
48
24
85
45
29
21
18
5
12
55
4
8
42
44
55
131
19
40
118
I"
l 12
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CHAPTER XIX.
HOMES AND HOSPITALS FOR CONSUMPTIVES IN AMERICA.
The following institutions, which are scarcely to be classed
with sanatoria, exist in the United States : —
Loomis Hospital and Dispensary, New York.
St. Joseph's Hospital for Consumptives, New York.
Brooklyn Home for Consumptives, New York.
The Montefiore Home for Chronic Invalids, New York.
House of Rest for Consumptives (Prot. Episc), 1831
Anthony Avenue, Tremont, New York.
The Rush Hospital for Consumptives, Chicago.
The Cullis Home for Consumptives, Boston.
The Channing Home for Consumptives, Boston.
The Free Home for Consumptives, Dorchester, Boston.
The Hospital for Diseases of the Lungs, Philadelphia,
and the Massachusetts State Hospital for Consumptives,
however, which appear to base their treatment on hygienic
methods, and to be suitably situated for the purpose, have
been included among sanatoria, and described at pp. 94,
95 and 96.
St. Joseph's Hospital,
in New York City, although not strictly a sanatorium,
merits a brief description, as it is probably the largest con-
sumption hospital in the world. It is owned and managed
by the R.C. order of the Sisters of the Poor of St.
Francis, who also have a number of other hospitals in
various parts of Europe and America. It is open to the
poor, irrespective of race, nationality or religion, and also
(115)
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116 INSTITUTIONS FOR CONSUMPTIVES IN ABfBRICA.
admits patients for a small payment into small wards and
private rooms. Consumptives in all stages are admitted,
but are distributed into different wards according to their
stage and condition.
The hospital is situated in the suburbs of the city, be-
tween 143rd and 144th Streets and St. Ann's and Brook
Avenues, occupying the whole block. It is surrounded by
a garden, and looks out on the south and east on to open
park grounds. It is a large pile, built ten years ago, with
projecting wings on five floors including basement, with a
south aspect, and contains accommodation for 365 patients.
There are five large wards containing from twelve to six-
teen beds on each floor, all looking south ; and at the
eastern and western ends of the buildings other small
wards for from two to eight, and small private rooms for
one patient each. The walls are of plaster or covered with
glazed paint ; the floors of varnished hardwood. The
kitchen and laundry are in a separate wing. The water
supply, sewerage, and gas lighting are connected with the
city systems. Besides the garden, small sheltered balconies
at the ends of the building are used in all weathers for
the open-air treatment, but patients are drafted as soon as
they are fit to one of the country sanatoria. Both sexes
are admitted ; the men on the first and second, the women
on the third and fourth floors. In the private wards $5
per week is charged, in the private rooms $10 ; but most
of the patients admitted are too poor to pay anything.
Last year (1897) 1500 cases were treated, and about 1000
applicants were refused for want of room. One of the
cases had been under treatment for eight years.
The treatment adopted is rest in the open air ; cod-liver
oil and creosote if well borne ; attention to the digestive
organs, which is rightly considered to be of first importance ;
tuberculin, aseptolin and similar remedies in selected cases;
counter-irritants if needful, but not as routine treatment.
For expectorations handkerchiefs are not allowed. Every
patient must use his own spitcup or small cuspidore ; and
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INSTITUTIONS FOR CONSUMPTIVES IN AMERICA. 117
the spv^ta are not allowed to dry until they are destroyed
by boiling water and chloride of lime. Rooms, floors, and
walls are cleaned with moist mops and cloths.
There are twenty-seven nurses in the building. The
medical staff consists of a physician-in-chief (Dr. C. M.
Cauldwell, who kindly furnished the above-mentioned par-
ticulars), ten visiting physicians, and a house physician.
The New York Hospital and Dispensary for
Consumption
is under the same management as the Loomis Sanitarium,
and was started in the spring of 1894 in a small four-storey
house at 230 West 38th Street. It is intended for incurable
and dying cases of consumption, and contains two wards ;
one for men and the other for women, with twelve beds
in all. There are two visiting physicians and a house
physician. The hospital is to be moved to a larger building.
The House of Rest for Consumptives
in New York has no separate sanatorium, but possesses
sixty-two endowed beds in St. Luke's Hospital, in which
patients in an advanced stage may be treated.
The Montefiore Home for Chronic Invauds
is an institution founded and maintained in New York
mainly by Jewish munificence. It is not entirely devoted
to consumptives, but has two wards with thirty beds each
for male consumptives and one ward of forty-two beds for
female consumptives. It is primarily intended for those
who are poor but are not suitable for treatment in hospital
owing to the chronic nature of their ailments. Consump-
tives who are admitted (who need not be Jews) may stay
there for the rest of their lives, but some who recover their
ability to work leave of their own accord, or are (if men)
sent to the country sanatorium described at p. 92. The
home was built in 1887 on the Grand Boulevard about 300
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118 INSTITUTIONS FOB CONSUMPTIVES IN ABfEBICA.
yards from the Hudson river. Attached to the home is
a park with large tents for use during rainy or windy
weather. For weaker patients broad piazzas are available.
The home itself is a fine building of red brick and granite
in Italian style with a central block and two projecting
wings, which together enclose an open courtyard. The
centre is on five floors, including attics, the wings on four
floors. In the rear between the two wings are the kitchen
and laundry, the dining-room for 300 being over them, and
accessible from the main hall in the centre building. In
addition to the wards already mentioned, there are bed-
rooms for from two to sixteen patients mostly to the south,
very few to the west and north. The larger bedrooms
(eight to sixteen beds) have six to ten windows on N., E.
and S. There are also two very large sun rooms mainly
for the winter months, a smoking-room, and large syna-
gogue. The rooms are painted with a light-coloured oil
paint, and have rounded angles. The heating is by steam ;
the lighting by gas and electric light; the ventilation is
said to be good ; sewage goes into the Hudson river ; water
supply is from the city supplies.
For disinfection carbolic acid is liberally used. Linen is
disinfected in a dry hot air disinfector. Handkerchiefs
are not allowed. The rooms are periodically fumigated
and repainted. The douche is used; cod-liver oil and
maltine liberally given ; creosote in small doses.
The male wards have two nurses each, the female ward
has three nurses. There are three resident medical officers,
to the senior of whom (Dr. Joseph Frankel) I am indebted
for these particulars. Twenty-three other physicians have
professionally visited the institution. During 1897, 158
were admitted and 493 treated, 189 being for phthisis. The
average of admissions for the previous five years was 241.
The Brooklyn Home for Consumptives
was founded in 1881 under the name of the Garfield
Memorial Home as a home for invalids, especially consump-
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INSTITUTIONS FOR CONSUMPTIVES IN AMERICA. 119
tives, who were not admissible to hospitals owing to the
chronic nature of their ailments. It is a purely benevolent
and non-sectarian institution and has two sections, one of
which is attended by homoeopathic physicians. A children's
ward has recently been added. Both sexes are admitted
free of charge, and patients in any stage, even the dying.
During 1897, 236 patients were under treatment, eighty-
four of them in the homceopathic section. Of those tr.eated,
eighty-five died, thirty-nine left improved, eighty-five
remained in the home.
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CHAPTER XX.
SANATORIA IN AUSTRIA-HUNGARY.
A SANATORIUM for consumptives of the poorer classes has
been established at Alland in connection with the hospitals
of Vienna. Count Batthyani and Prof. Koranyi are at the
head of a society for the establishment of a similar sanato-
rium for the poor of Buda-Pesth. A beautifully wooded
site has been chosen for this purpose not far from Buda-
Pesth on the right bank of the Danube. There is also
a project for erecting a sanatorium for Reichenberg in the
Biesengebirge, and a similar movement at Graz under
Dr. Kraus. The Minister of the Interior has had under
consideration a proposal for the appointment of a special
sanitary inspector for consumptives alone.^ A number of
open health resorts also exist which are frequented (mainly
in summer) by paying consumptive patients ; but no closed
sanatorium exclusively for this class of patients has yet
been opened.
The Alland Sanatorium
was founded in 1894 and opened in 1897, mainly through
the exertions of Prof. Schrotter, of Vienna, aided by Dr.
Conrad Clar and Hofrath Christian Lippert. An abortive
attempt was made in 1883, but it was not until ten years
later that a syndicate was formed as the result of a fresh
appeal, and the necessary funds subscribed, mainly by
inhabitants of Vienna. The society entrusted with the
erection of the sanatorium received a donation of 10,000
^Heilst. Corresp,, Ist Aug., 1898.
(120)
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SANATORIA IN AUSTRIA-HUNGARY. 121
:florins from the Emperor and Empress, together with others
iranging from 100 to 100,000 florins. The site, which is of
unusual beauty, is said to have cost over 62,000 florins, the
various buildings nearly. 362,000 florins, and the water
jgupply another 18,000 florins.
The sanatorium is situated in a valley in the Wienerwald,
About 16 kilometres (10 miles) to the west of Baden,
57 kilometres (16f miles) from Vienna, and about a mile
from the little town of Alland. The grounds, which have
A southerly slope, cover an area of 76| hectares (about 190
Aci'es), and consist of woodland, meadows, and cultivated
land in about equal proportions. The lowest point stands
At an altitude of 400 metres (1310 feet) above the sea-level,
the sanatorium itself is at 430 metres (1411 feet), and the
highest part of the property reaches the top of the adjacent
mountain, 680 metres (2230 feet) above the sea. Mountains
«xist to the east, north-east, and north-west, ranging from
485 to 680 metres (1591 to 2230 feet) above the sea-level,
J30 that there is an absence of strong wind. Dust is also
jseldom noticed, and no factories or dense clusters of houses
^xist in the neighbourhood to sully the purity of the air.
The soil is mainly of limestone, with a certain amount of
tday. There was some difficulty in providing an adequate
water supply, as all the streams in this region run north-
wards from the hilla To meet this difficulty a local land-
owner gave the sanatorium the springs which exist on the
other side of the hill, and an aqueduct was made with iron
pipes, provided by the Archduke Albrecht, to bring the
water (which is pure and abundant) round the hill to the
•sanatorium.
This consists of a main building, with separate kitchen
block, and of other necessary buildings which are separated
from the former by a little hill. The main block (fig. 9),
which looks to the south, has three upper storeys, and con-
tains on the ground floor in the centre a large day room 11
metres long (36 feet). On either side of this is a bedroom
with two beds, and behind these the space for a lift, a
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124 SANATORIA IN AUSTRIA-HUNGARY.
niirses in the establishment. The fresh air treatment is
carried out in the fresh air galleries, or in the day rooms
in the wings. The douche is only applied to robust
patients. Cod-liver oil is not given. Drug treatment con-
sists mainly of codeia, phenacetine, etc Sputa are received
into Dettweiler's flasks, or at night into spitcups of papier
^mAche, The contents of these vessels are mixed with peat
mould and burnt. Linen is disinfected by steam ; rooms,
in case of need, by formalin vapour.
The sanatorium may be reached by the Southern Rail-
way or the South- Western Railway. In the first case
there is a drive of one and a half hours to Schwefelbad,
three-quarters of an hour by rail from Vienna; in the
aecond, a drive of three-quarters of an hour to Altenmarkt
or Weissenbach, one and a half hours' journey from Vienna.
The Sanatorium of Marilla Volgy,
in the South Carpathians,^ stands at an elevation of 714 metres
(2342 feet) above the sea-level. It is well sheltered on all
aides against wind, and is isolated by beautiful woods. Dr.
Hofienreich, the medical oflScer, also receives non-phthisical
patients. The place is lit with electricity, and has covered
verandahs for the fresh air treatment. The diet is very
strict.
The Sanatorium of Uj-Tatra-Fured,
or Neuschmecks, also in the Carpathians, is under the care
of the well-known Dr. v. Szontagh, and is placed 1004
metres (3294 feet) above the sea-level, in the highest part
of the village of Gerlach. The soil is of clay ; the winter
dry and cold, the summer cool, of medium humidity. Fogs
are rare ; and the absence of any glacier in the neighbour-
hood is also an advantage. Mountains of 3000 metres
(9840 feet) shelter the sanatorium to the north, and there
is very little dust or wind from any quarter. The sana-
1 1 am indebted to Kuthy {A TOd&v^z Sstcmatoriumok, Buda-Pesth, 1897)
for the following desoriptions of Hungarian sanatoria.
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SANATORIA IN AUSTBIA-HUNGARY. 125
torium has a southern aspect, and has a ground floor and
two upper floors. The eastern end consists of four pro-
jecting square towers with pointed tops, connected by a
lower central portion. Great pains have been taken to
render the building thoroughly dry. There is central
heating by warm air, and ventilation of the same kind
in cold weather. In the rooms for one patient the air can
be renewed fifty times per diem. The sanatorium com-
municates with the thermal bathing establishment and the
dining saloon by means of a covered corridor. It is a great
drawback that, owing to this arrangement, and to the
proximity of several other bathing establishments, patients
cannot be completely supervised. There are several bal-
conies on the south and west sides of the building, and<a
large winter garden. The rooms are well lighted; there
are double windows, hot- water pipes in the corridors and
staircases, and a separate stove in each room.
It is mainly a summer resort, and not exclusively re-
served for consumptives, who are received in the early
stages alone. Dr. v. Szontagh uses massage and cold
ablutions, friction with moist compresses, seldom any
douches, but pulmonary gymnastics and inhalationa The
diet is abundant, but not medically supervised. Milk and
kefir are largely given.
The sanatorium is nine kilometres (five and a half miles)
from the railway station of Poprad Felka, nine hours by
rail from Buda-Pesth, and a little more from Breslau.
A few poor patients are received, but the institution is
essentially for paying patients.
Kuthy mentions three other places in Hungary which
would be suitable for consumptives, but are little frequented
by them. Of these, Feketehegy is 660 metres above the sea-
level ; it is right in the country ; but the diet is meagre.
Stoosz is 670 metres above the sea, and is directed by Dr.
Dezsoe Czirfusz, a specialist in consumption.
At Keresztenysziget (Isle of the Christians), in the pro-
vince of Szeben, there is a fine establishment founded by a
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128 FEENCH SANATORIA.
hood of Ajaccio (Corsica) for three sanatoria — one of which
will be on the coast; another at Vivario, at an elevation of
950 metres, for 100 beds ; the third at Monte d'Oro, at 1700
metres above the sea, also for 100 beds, only fifty of which,
however, will be kept open in summer. These sanatoria
will be partly for pajang, partly for poor patients, the one
set paying for the other. The society also proposes to
erect pavilions for the reception of consumptives in various
towns, the current expenses to be defrayed by the Assist-
ance Publique. A sanatorium for the poor is being erected
at Angicourt (Oise) jointly by the Paris Municipal C!ouncil
and the Assistance Publique. This has been a long while
under construction, but is not expected to be open for &
year or two. It has already cost a large sum of money,,
and there is a fear in some quarters that it is being built-
in an unnecessarily luxurious style. Eventually intended
to accommodate 200 patients, it will at first be opened with
beds for fifty or 100. It is said to be modelled on the
Falkenstein Sanatorium, with a deep verandah along the
southern side, but with only two floors. The rooms are to
accommodate from one to eight patients each. The heatings
will be by means of steam and hot water, the lighting by
electricity. There are twenty-eight hectares (sixty-nine
acres) of ground set apart for the institution. A sanatorium
is also being erected at Hauteville for the poor of Lyon. A
society of eighty medical men exists at Arcachon for the
erection of two sanatoria in the neighbourhood of that
place for phthisical adults. There are also schemes for the
erection of a sanatorium at Magny (D^p. du Rhone) and
for another in connection with the Canigou institution for
paying patients. A sanatorium at St. Symphorien started
by Dr. Chaumier of Tours unfortunately failed for want of
funds.^ There is a sanatorium at Agnetz (Oise), which waa
.recently erected by the Assistance Publique^ which receives
patients at a charge of ISs. per diem.^ The Berck-sur-
^ Mdller, Les Sanatoria^ Brussels, 1894.
« British Medical Journal, 28th May, 1898.
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FRENCH SANATORIA.
129
Mer Hospital and some of the Paris hospitals also receive
paying patients at £2 10s. per month. A home or refuge-
for incurable cases of the female sex exists at Villepinte-
(Seine et Oise), and a similar institution for 400 patients
has been projected near Brevannes.^ Three of the French
hospitals (Boucicaut, Laennec and Lariboisi^re) have set
apart certain wards for the reception of phthisical patients ;
6,000,000 francs have been voted for the construction of
new wards for the same purpose at the hospitals of St.
Antoine, Cochin, Broussais, Bichat, La Pitie, Tenon, and a
new hospital on the right bank of the Seine ; and special
wards have also been opened under Prof. Qrasset at the
hospital of Montpellier.^ There is a "sanatorium" at
Algiers, but I believe it is of a different kind.
Fbbnch Sanatoria fob Paying Patients.
Canigou
Durtor
Trespoey .
Mont Bonmorin
(being built)
Mont Pacanaglia
(projected)
St. Martin Lantosque
Pyr^n^es Orientales
Puy-de-Ddme .
Basses Pyr^n^es .
Puy-de-D6me .
Alpes Maritimes .
Do.
21200 feet
1706 „
696 „
2680 „
100 beds
82 „
14 „
120 „
1640 „
120 „
3280 „
?
Sanatoria fob Children of the Poor.
Ormesson .
Villiers-sur-Mame
Seine et Mame
Do.
874 feet
897 ,.
180 beds
220 „
' Knthy, loc, cit,
^ Jj^on Petit, Tuberculosis Congress, Paris, 1898 ; Netter et Beauvalon»
QoM, Hebd. de M4d. et de Chir., 18th August, 1898.
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CHAPTER XXII.
:prench sanatoria for paying patients.
The Canigou Sanatorium.
This sanatorixim, which is near Vemet les Bains, Pyrenees
Orientales, was the first private establishment of the kind
in France, being founded in 1890 under the direction of
Dr. Ch. Sabourin. Situated at an altitude of 640 to 700
metres (2100 to 2297 feet) above the sea-level, at the inter-
section of the valleys of the Cadi and the Tech, it has a
southerly aspect, looking towards the Puig de Falgouras
and the town of Le Vemet, which has been known since
1181 for its sulphur springs. Mountains protect it from
wind on nearly all sides — the Canigou to the east, the
•Cerdagne Mountains to the north and the Perra to the
south, leaving an open valley towards the south-west. The
soil consists of sand and pebbles resting on gneiss and
granite.
The sanatorium is situated in a park of 20 to 25 hectares
(49 to 61 acres), which is well wooded with chestnut trees,
acacias, oaks and evergreen oaks, and various kinds of pine
trees. Palms, aloes, olive trees and cacti grow freely
without artificial shelter. It was originally an "open
sanatorium," in which the patients merely spent the day
during the winter season, returning to sleep in hotels and
apartments in the town. At that time it consisted of a
series of verandahs open on one side, glazed on the other ;
of a dining-room, drawing-room, consulting-room, adminis-
trative and douche rooms. In September, 1896, however,
(130)
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FRENCH SANATORIA FOR PAYING PATIENTS. 131
when Dr. Giresse succeeded Dr. Sabourin, it was opened for
the whole year, and completed by the addition of sleeping
quarters.
The present building, which is of three storeys, has
accommodation for about 100 patients ; a new building is,
however, in contemplation. The bedrooms, which face south,
south-east, west and north, have a mean capacity of 60 cubic
metres (2119 cubic feet). The windows, which are wide
open during the day, and partially open at night, are pro-
vided with screens near the beds, but no curtains. During
the coldest part of the year (15th December to 15th January)
they are heated with warm air ; for the rest of the year no
artificial heat is required. The passages are lighted with
gas, the bedrooms only with candles. The drinking water
is taken from a torrent which comes down from Mount
Canigou, and is filtered through sand, pebbles and iron
scoria. The sewage is carried by an abundant water supply
into the river a few hundred metres below the village.
There are nurses as well as servants in the establishment.
Every patient has two spitcups of porcelain, one for his
room, the other in the open-air gallery, besides a pocket
flask ; and spitting elsewhere is strictly forbidden. The
spitcups are emptied every morning, the sputa mixed with
sawdust and burnt in the gasometer furnace. Linen is
•disinfected with steam by means of one of Geneste and
Herscher's disinfectors. Rooms are disinfected with formol
vapour. Some of the fresh-air galleries are near the main
tuilding, others scattered through the park.
The average length of stay is five to six months ; patients
are allowed to go home after a while, returning for other
courses of treatment until they are cured. There would be
great advantages if they were to stay until their recovery
is assured ; but they would seldom stand so long a separa-
tion from their families.
Drugs are not much used; those most employed being
iirsenic, phosphates and opium. The douche and tbe wet-
sheet are only occasionally applied. Counter-irritation is
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132 FRENCH SANATORIA FOR PAYING PATIENTS.
employed, either as actual cautery, or in the form of sina-
pisms or blisters.
The charges are from 14 to 16 francs, including lodging,
board and medical attendance ; drugs, etc, and laundry
being extra.
The statistics furnished by the present medical director
(Dr. Giresse) show 22 to 23 per cent, cured, 40 to 50 per
cent, improved, 20 per cent, stationary, and 10 per cent,
worse — chiefly patients who come for treatment in a late
or acute stage of the disease. Dr. Giresse believes that of
early cases and with manageable patients there should be
from 50 to 60 per cent, cured.
The most convenient route to the sanatorium from Paris
is by the Barcelona night express to Perpignan, thence to
Villefranche de Conflent, which is about half an hour's
drive from the sanatorium.
The Durtol Sanatorium,
or the sanatorium of the Chateau of Durtol, is situated on
very pervious black volcanic sand, 520 metres (1706 feet)
above the sea-level, at a little village three kilometres from
the large town of Clermont-Ferrand in Puy-de-D6me. It
has a station of its own on the line running from Clermont-
Ferrand to Limoges, and is half an hour's drive from the
Clermont station, or nine hours* journey from Paris. Being
somewhat raised above the plains, it has a good view of the
valley of Clermont and of the distant mountains of Forez.
It is open to the south, protected to the north, north-east
and north-west by mountains and hills thickly wooded with
pine trees, and provided with numerous good roads and
paths. The strong winds, which come from the north-east,
are completely warded off by the woods extending the whole
length of the park, which is of five hectares (twelve acres).
The climate is sedative compared with the rest of Auvergne.
The rainfall is regular but not abundant, and prolonged
droughts are unknown. Excepting in very severe winters^
the cold weather is of short duration and not very intense.
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^H
k^P
A|:
F* ^^"-^^^^HHI
I
PS
Q
I
- f
I
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FRENCH SANATORIA FOR PAYING PATIENTS. 133
Fogs seldom reach the place. The sanatorium consists
mainly of an old Louis XIV. chateau (fig. 10), which has
been altered and added to by the proprietor, Dr. Chas.
Sabourin, formerly director of the Canigou Sanatorium.
There are rooms for thirty-two patients on two upper floors.
Nearly all the rooms have chimneys, and the windows are
kept open permanently. It is very seldom that a fire is
needed, rugs and plaids, etc., being sufficient to keep the
patients warm. The lighting is by petroleum. The floors
are of pinewood, polished with linseed oil. The angles of
the rooms are rounded; the walls papered. Dettweiler's
flasks are used, the sputa being destroyed by boiling.
Linen is disinfected by steam heat. On the departure
of a patient the walls are repapered, the paint renewed,
and the furniture disinfected. There are two large
verandahs for the fresh air treatment. The sanatorium
has its own dairy farm and its own private (RC.)
chapel. Hydropathy is not employed excepting in the
form of cold bathing or friction with cold water, and so-
called specifics are not administered. Dr. Sabourin attaches
great importance to the digestive functions, and has ob-
tained very striking results from super-alimentation with
raw meat, meat powder, beef peptones, eggs, milk, and the
like. Cod-liver oil he gives in full doses where it does not
upset the stomach. Dyspepsia in his opinion often disap-
pears promptly under the fresh air treatment. He has
published a case of incoercible vomiting which ceased within
twenty-four hours of starting the treatment.^ Dyspepsia
may also sometimes be prevented by the simple expedient
(which Sabourin always prescribes) of gargling the mouth
and thoroughly cleansing it with an alkaline water such as
Vichy or Vals, as this prevents the fermentation of particles
of food and the entrance of various bacteria into other parts
of the alimentary tract. Many patients are quite easy to
feed, but some will tax the ingenuity of their physician to
1 Gaz. Hebdoniadaire, Slst Oct., 1891.
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134 FEBNCH SANATORIA FOR PAYING PATIENTS.
the utmost. Many dyspepsias disappear if patients drink
little at meal times and give up wine. Where drugs are
needed to control cough, Sabourin depends mainly upon
opiates, which in his opinion do much good and little harm.
The fever which is due to excessive waste usually subsides
with rest in the fresh air. That due to tubercular processes
cannot be prevented by any known drug, so that Sabourin
only gives antipjnretics to prevent irregular febrile attacks
at unusual hours and those accompanied by much discom-
fort. The latter as a rule is not present where the patient
lives in fresh air day and night.^
The sanatorium, which was started in 1898, is open the
whole year. Durtol is a telegraph station, and is very near
some of the famous bathing resorts of central France. The
charges are 14 frs. per diem, including wine, three meals per
diem and medical attendance. The room is from 3 to 5 frs.
extra.
The Trespoey Sanatorium,
about half an hour's drive from Pau (Basses Pyr6n6es), is
situated in the midst of a cultivated plain, on the edge of
the valley of the Ourse, which is about 40 metres below.
Originally a private house, it was altered and adapted to
its present purpose in 1896 by the proprietor and medical
director, Dr. Crouzet. The climate is chiefly remarkable
for the absence of wind, high wind only blowing three or
four times during the course of the winter. There are no
forests in the neighbourhood ; the high road to Pau has a
number of villas on each side with patches of woodland,
which form a protection against the west wind ; there is
similar protection towards the east The soil is a very
permeable sand to a depth of about 4J to 5 metres, where a
thin layer of clay is met with. The elevation is 212 metres
(696 feet) above the sea-level, the mean B.P. being 740 mm.
The sanatorium is on a steep hill, and has a fine view of
the Pyrenees in the distance and the river valley in the
^ Traitement Batianelle de l/i Phtisie^ Paris, 1896.
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Fig. 11.— The Trespoey Sanatorium, near Pau, S. France.
[Face page 135.
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FBENCH SAKATOBIA FOB PAYING PATIENTS. 135
foreground. It stands in a park of about 7 hectares (17
acres), containing pine trees and other conifers, and laid
out in paths at various inclinations, well provided with
seata Bound it is meadow land.
The sanatorium consists of two buildings, the chief of
which is of two storeys above a basement and ground
floor. In the basement are the kitchen department and
bath-room. On the ground floor the dining-room, library,
drawing-room, consulting-room, and two rooms for patients.
The next floor has six bedrooms, and the top floor two
bedrooms for patients. There is no lift. The patients^
rooms are all to the south, with at least one south window ;
they vary in size from 60 to 110 cubic metres (2119 to 3885
cubic feet). Ekkch has its own chimney and open wood fire ;
ordinary French windows ; papered walls, without rounded
comers ; pinewood floors, without carpet or curtains ; and
varnished pitchpine furniture, without carpets, pictures, or
curtains in any of the rooms. The lighting is by petroleum.
I am informed that there will be electric light at the end
of 1899. There is a good water supply ; sewage goes into
a cesspool. Near the chief building is a fresh air gallery,
with a southerly aspect (fig. 11). The annexe, which
is a building of one storey, contains bedrooms for four
patienta The total accommodation in the sanatorium is
for fourteen patients. The sanatorium is open from 15th
October till 15th May, and receives none but pajdng
phthisical patients at an early stage. Sputa are disin-
fected by boiling with solution of carbonate of soda, and
then poured down the water-closet. Expectoration is ex-
clusively into Dettweiler's flasks or spittoons, which contain
one per cent sulphate of copper. The Thoinot system is
to be introduced. Linen is disinfected once a week in the
municipal steam disinfector. Rooms are disinfected after
the departure of each patient by means of pulverisation
with sublimate solution. This is done by employees of
the city of Pau. The wall paper is of a cheap kind, and is
frequently renewed.
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136 FRENCH SANATORIA FOR PAYING PATIENTS.
The treatment is by fresh air, good food, daily friction
with a wet horsehair glove, and as few drugs as possible.
Patients who are not feverish take frequent short walks.
The diet is highly nitrogenous, and the medical director
takes his meals with the patients. There are three meals
a day. Cod-liver oil, specific remedies, counter-irritation,
and douches are not employed.
Dr. M. Crouzet is the sole medical officer.
The charges are from 16 to 20 frs. per diem, and a fee
of 20 frs. on departure for disinfection. Extras are laundry,
special drugs, and nurses for the night if required.
The Sanatorium of Mont Bonmorin,
although not yet opened, has been fully described by E.
Marty-Martineau in L*IndSpendance M6dicale for 25th
March, 1896.
It is situated near Ardes (Puy-de-D6me), at an altitude
of 2630 feet above the sea-level, on the side of a mountain,
and has a fine view to the south over the rich plains of the
Limagne. The sanatorium consists of three principal build-
ings united by slightly curved covered corridors, forming
altogether a somewhat concave southern front, as at Rup-
pertshain (p. 253). It has behind it a park of about 500
metres depth, traversed by geometrically arranged paths
and drives which unite in a rond point. The villa of the
chief medical officer is at some distance from the main
building, on the western side of the park, and is balanced
by the bathing establishment on the east. The sides of
the park are occupied by private and kitchen gardens. In
front of the main buildings is a flower garden with a central
fountain and geometrical walks and drives.
Of the three principal buildings, the middle one consists of
a central block with lateral wings. The former is surmounted
by a cupola, and contains on the ground floor a large vesti-
bule with carriage drive through to the park at the back,
and a drawing-room on each side. Behind are the two
approaches to the grand staircase. Above the vestibule is
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FRENCH SANATORIA FOR PAYING PATIENTS. 137
« large concert hall, 13*50 metres square, with balconies
front and back, and above this, under the dome-shaped
roof, another large assembly room. The wings of the
•central block consist of a single row of rooms in front
and corridors to the back, excepting at the ends, which are
aomewhat higher and have rooms back and front. On the
ground floor are a series of rooms for common use — in the
left wing the dining saloon (48 x 5'50) and staff" dining-
room (20 X 6), in the right wing a reading-room (16 x
5'50), writing-room, billiard-room (16 X 5*50), lavatory,
and two large recreation-rooms (19 x 6). Behind the
staff" dining-room is the administrative block with kitchen
department under it. The first and second floors on each
«ide contain in front eighty patients' rooms, and behind
sixteen rooms for the staff", with more under the roof. In
addition to the grand staircase, there are two lateral ones,
and two for the servants. There are four groups of water-
-closets on each floor at the back, occupying the projecting
portions of the building. The lateral buildings are somewhat
similar, but without a cupola. They contain on the ground
floor a vestibule leading to staircases, waiting and consulting
rooms, laboratory and doctors* rooms ; and on the first
and second floors forty ^ bedrooms for the patients and
sixteen for the staff! Here also there are four staircases, of
which two are for servants, and two groups of water-closets
on each floor. An arched fresh air gallery runs the whole
length of all three buildings level with the ground floor,
the intermediate portions being glazed and 50 metres long.
The bedrooms are all 4x4^ metres and 3'40 high (13
feet X 14f X 11), containing therefore 61*30 cubic metres
(2165 cubic feet) of air space. Each has a chimney and a
balcony, a large window in three parts, the upper of which
lias a ventilator which cannot be completely closed ; above
the balcony is a ventilating inlet which is larger inside
^According to the description it would appear that there are forty
patients* bedrooms in each lateral building, but I believe there will only
be twenty on each side.
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140 FRENCH SANATORIA FOR CHILDREN.
ailments ; and an attempt is made by systematic cross-
•questioning to prevent the abuse of the charity by those
lyho can afford to pay a fee. Dr. Derecq and Dr. George
Petit are the physicians.
The hospital of Ormesson receives consumptive boys up
to the age of twelve, those from twelve to sixteen being
.sent to the hospital of Villiers. None but consumptive
-children are admitted, and no selection is made, those in
•every stage being accepted.
The Ormesson Hospital
•was started in an ordinary house at the end of 1888 ; en-
larged to one hundred beds in 1890, with the help of the
wood from the .Exposition Universelle ; and completely
rebuilt in 1896 with 130 beds, so that it now covers an
area of 1956 square metres (21,000 sq. feet). It is situated
•on a breezy plateau overlooking the valley of the Mame,
in the little village of Ormesson, just above Champigny.
*The ground slopes towards the south, and the building,
together with the high walls surrounding the grounds,
afford a little protection against high winds ; but the situa-
tion is breezy rather than sheltered. There are 5f acres
l)elonging to the institution, which are partly devoted to
playgrounds, partly consist of garden, cultivated and grass
land. The soil is calcareous, and rapidly dries after rain.
The building (fig. 12) is 114 metres (374 feet) above the sea-
level. It is of one storey, and consists of a large central glass-
covered winter garden with huge windows to the south,
and forming with the administrative oflSces a central axis,
•on either side of which are two parallel pavilions, making
with it a letter H. One of these pavilions forms the refec-
tory, and has at the western end the kitchen block. The
•other three form dormitories, each for about forty beds,
and having at the free ends lavatories, bath-rooms and water-
-closets. The latter are arranged in radiating compart-
ments, so that a number can be supervised by one person.
They are isolated by the lavatories and bath-rooms, which
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Fio. 12.— Thb Ormesson Hospital. [Face page 140.
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FRENCH SANATORIA FOR CHILDREN. 141
can be ventilated from end to end. The sisters' rooms lead
off the dormitories. The beds are of enamelled iron ; floors,
are of wood in the dormitories, of tiles in the dining hall ;
the walls everywhere washable, with rounded angles. Win-
dows are large, of the usual French type, in three parts^
with the tops rounded. The whole place was exquisitely
clean when I visited it. Along the south side of the build-
ing is an open verandah on each side of the projecting^
winter garden. This is somewhat narrow ; and there are,.
I believe, no other open-air shelters for bad weather ; but.
the winter garden is very large and well-ventilated, and is
probably sufficient for the purpose. The children in the-
playground are placed under the supervision of two men ;
indoors they are under the care of the sistera Drugs] arc
but little used, reliance being chiefly placed on fresh air,,
good food and cleanlinesa The results of treatment have
been very satisfactory. In 1897,^34 per cent, were ap-^
parently cured, 30 per cent, more improved Out of fifty-
three who were apparently cured, fifteen had very serious
and extensive lesions on admission. Dr. Jaoul is the medical
officer.
The Villiers-sur-Marne Hospital,
wWch has accommodation for 220 boys, is about three-
miles from that of Ormesson, and stands on the same high
plateau, 121 metres (397 feet) above the sea. It is in the
midst of cultivated fields and gardens, at the extreme end
of the village, and has 9^ acres of ground belonging to it.
It consists of three blocks arranged along one line nearly
400 feet long, forming a long two-storey building. The
southern side is separated from the road (which is not a
main road) by a large gravelled courtyard. On the other
side of the road is a patch of garden bounded by trees.
The grounds on the north are occupied by playgrounds and
meadows ; they rise towards the fortifications of Villiers^
with wooded crests in the distance. As in the case of the
Ormesson Hospital, there is very little shelter. The soil is.
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142 FRENCH SANATORIA FOR CHILDREN.
the same. The building was founded in 1891, but was
-completed in 1896 by the addition of the Pavilion des
Enfants de France. The central block contains on the
aground floor two large day rooms, the library, drug room,
^nd doctor's room ; and has in front along the south side a
Terandah with stone arches. On the floor above is a dor-
mitory for the more serious cases, with a single row of
beds. It is incompletely divided into separate rooms, and
opens in front into a covered balcony with stone arches.
Attached to the dormitory are two rooms for the nurses.
The left or eastern wing, called the Pavilion des Enfants
de France (fig. 13), is a large hall containing 10,000 cubic
metres of air, or 120 cubic metres (4238 cubic feet) per head,
with an ogival roof rising to 12 metres (39 feet) above the
ground, divided into a central and two lateral naves, and
partly composed of glass. This is supported by graceful
iron columns, and provided with a gallery 6 metres (19^
feet) wide, which runs all the way round. The building is
of brick and stone, coated internally with white imperme-
able enamel, the angles being also rounded. The centre of
the ground floor is tiled, and contains the ventilating open-
ings and ozonisers, and is furnished with a few chairs and
tables. The part underneath the gallery is slightly raised
above the ground level. This and the gallery have var-
nished boarded floors, and are provided with a single row
of blue enamelled iron beds radially arranged, together
with other simple furniture. The windows are very large,
being 2 metres wide and 4 metres high. They consist of
two parts, of which the lower is a sashed window (English
fashion) ; the upper a French window in four pieces, each
of which can be separately opened, two moreover being
perforated. The hall rests on a basement 3 metres deep
impermeable to moisture, and containing the heating and
ventilating apparatus, the bacteriological laboratory and
electric lighting machinery.
In this basement, beside the calorifer is a reservoir for
s medicated solution of creosote, turpentine and encalyptol.
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Ficj. 13.— Tub ViLUKitS'Sin M \nsfc H<>ii(rrAi..- Pa villain
Fio. 13*.— Thb Vilubrssur-Marne Hospital. --South Front.
[Face i>age 142.
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FRENCH SANATORIA FOR CHILDREN. 143
^hich serves to medicate and purify the incoming hot air.
The fresh air from outside passes through metallic gauze
either directly into the hall or past the warming apparatus.
The hot and cold air inlets are placed side by side in the
embrasures of the windows. Round the galleries at the
head of the beds are a series of tubes with trumpet-shaped
'ends, which supply ozone produced by the dynamo. The
windows also allow of the direct entrance of fresh air. The
vitiated air is carried off through holes in the roof with
the help of a jet of steam in a turret. In this way at least
200,000 cubic metres (over 7,000,000 cubic feet) of au- are
provided in the hall per diem. Eighty children can sleep
in this hall, and two sisters, one for each floor, can readily
look after them. At the northern end of the Pavilion des
Enfants de France on the ground floor are the dressing-
rooms, lavatories, and bath-room. The latter forms half a
•circle, and is incompletely divided by radiating partitions
2 metres high, separating ten white enamelled iron baths.
Hot and cold water are laid on in the bath-rooms and lava-
■ tory, which are arranged in English fashion, and (like the
rest of the building) are heated with hot- water pipes. The
walls are covered with Dutch tiles, and have rounded
Angles ; the floors are of mosaic ; the wash-basins of white
stoneware on white marble. Uniting the Pavilion des
Enfants de France to the central block is the grand stair-
case, behind which are water-closets and lavatories on each
floor.
The western wing is older than the eastern, and contains
on the ground floor the kitchen department and chapeL On
the upper floor are the quarters for the personnel.
The hospital is lighted with electric light. Filtered and
sterilised water is laid on in the sick ward.
To the west side of the hospital grounds is a long line of
one-storey buildings, beginning with the lodge, and includ-
ing the laundry, steam disinfector, linen store, clothing
store, provision department, and workshops for repairs.
They are large enough to serve all three establishments
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144 FRENCH SANATORIA FOR CHILDREN.
— the dispensary and the two hospitals at Ormesson and
Villiers. Dr.,Vaquier is the medical officer. The treatment
at Villiers is of the same character as at Ormesson. During^
1897 there were ninety children who were treated at Vil-
liers. Out of these, twenty-three left the place apparently
cured ; thirty-one improved (two of these left the place ;
some others are nearly cured) ; twenty-four remained
stationary ; four are in a grave condition, and eight have
died. This gives a percentage of 25*5 cured ; 34*4 cured or
nearly cured ; 8*8 dead. Most of the latter entered at a
late stage of the disease.
Altogether 1068 children have been treated at the two
hospitals from 1889 to 1897 inclusive ; 317 of these (or
29*7 per cent.) have been cured, 47 (or 4*4 per cent) have
died. The average duration of treatment has been 230 days.
The results at Ormesson are better than those at Villiers,
probably because the patients more often enter at an earlier
stage of the disease, and because under suitable conditions
the younger patients are more readily curable. There is year
by year a greater proportion of apparent cures, although
all phthisical children without selection are sent to the
hospitals.
The agricultural colonies connected with the movement
are at present two in number — one of 12 hectares (29 acres)
at Noisy-le-Grand, not far from Villiers ; the other at
Tremilly in the Haute Mame. At each of these colonies
there is a medical man in charge. In addition to these,
a few patients have been sent to a farm at Rougemont
(Doubs). Altogether eighteen patients have left the hos-
pitals apparently cured. Every one has remained in good
health ; six have been drawn for conscription, and five
accepted, the sixth being rejected for a reason quite uncon-
nected with tuberculosis.
Other Sanatoria.
Another sanatorium was also for a time in existence
at Touraine, near Tours (St Rad^gonde), for delicate and
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FRENCH SANATORIA FOR CHILDREN. 145
consumptive boys of the poorer classes, founded and super-
vised by Dr. Chaumier. It was at this establishment that
creosotal was first clinically tested in phthisis. The sana-
torium failed for want of funds. A similar establishment
(Villa Lapierre at St. Symphorien) also failed. Over twenty
seaside and mountain sanatoria also exist in France, with
between 2000 and 3000 beds, mostly for children with
scrofulous or consumptive tendencies, but not confined to
these ailments. They resemble our own convalescent homes
rather than true sanatoria for consumptives.
10
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CHAPTER XXIV.
HOSPITAL SANATORIA IN FRANCE.
During the last twelve months special arrangements have
been made at three of the Paris hospitals (Boucieaut,
Lariboisifere and Laennec) and at the Montpellier hospital
for the hygienic treatment of consumptives.
At the Boucieaut Hospital, which was founded by the
late proprietors of the Bon March6, two out of five wards
have been set apart for this purpose since November, 1897.
There are twenty-one beds for male consumptives, eighteen
in one large ward on the ground floor, one single-bedded
room reserved for the staff of the Bon March6, and
two other beds; and fourteen beds for women, of which
ten are in one large ward on the ground floor, and two
jsingle-bedded and one double-bedded room on the first
floor, all three smaller rooms being also reserved for the
Bon March6. This section of the hospital is under the
care of the senior physician. Dr. LetuUe. According to
a report given at the Tuberculosis Congress at Paris, in
August, 1898, the beds reserved for the Bon March6 staff
have remained almost unoccupied ; but the other thirty-one
beds have been constantly in use. During eight months
125 patients have been under treatment, mostly suffering
from the more advanced stages of the disease ; with the
result that thirty-eight have died and twenty-seven have
improved. Amongst the latter, only those are included
who have decidedly increased in weight, as well as showing
improvement in other respects. The precautions against
infection and against the dissemination of dust are said to
(146)
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HOSPITAL SANATORIA IN FRANCE. 147
be very complete. No handkerchiefs are allowed, but
linen rags are used instead, and a large number of spitcups.
The patients are clad in aseptic dresses; they disinfect
their buccal cavity regularly and thoroughly, and great
care is exercised to keep the whole body exceptionally
clean. Excepting on visiting day, little or no dust is
brought in from outside. The windows are kept open day
and night; and twenty-two reclining chairs with pillows
of oats have been provided in the garden for rest in the
open air in tents. A very copious diet is adopted. Beyond
subcutaneous injections of guaiacol in 1000 parts of sterilised
oil, the drugs usually administered elsewhere have been
employed, arsenic, quinine and tannin being largely pre-
scribed.
The arrangements at the Lariboisiere are said to be less
satisfactory, owing to the old-fashioned wards, which have
been partially sub-divided into compartments. Dr. XJnter-
berger was probably the first to introduce the treatment of
consumptives in hospital sanatoria (see p. 281) . In England,
owing to the existence of special hospitals, the problem has
been differently solved.
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CHAPTER XXV.
GERMAN SANATORIA FOR PAYING PATIENTS.
Since the late Dr. Brehmer founded his sanatorium at
Gorbersdorf in 1859, the number of these institutions has
been steadily increaQing in Germany, so that there are now
a dozen or more for paying patients, besides open health
resorts where a similar treatment is carried out, and a large
and increasing number of closed sanatoria for the poorer
classes. The latter are described in chapters xxxii. to
xl. As might be expected, most of the sanatoria for
paying patients are in or near the mountains. There are
several at Gorbersdorf near the Riesengebirge ; one is at
Reiboldsgriin in the Erzgebirge ; several more (Altenbrak,
St. Andreasberg, Sulzhayn) in the Harz ; two at Rehburg
in hilly ground near Hanover ; two at Hohenhonnef and
Laubbach respectively, on the Rhine; the Falkenstein
Sanatorium in the Taunus Mountains ; while others are in
the Black Forest (Nordrach, St. Blasien, Schomberg, and
Marzell).
Consumptive patients are also treated by hygienic
methods at Ems, Briickenau, Sophienbad, Kissingen, Baden
Baden, Blankenhain, Dillenburg, and other health resorts^.
There are however no closed sanatoria in these places ; and
most of them suffer from the inevitable drawbacks attach-
ing to open sanatoria in fashionable health resorts.
(148)
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german sanatoria for paying patients. 149
German Sanatoria for Paying Patients.
Feet.
B^
Brehmer'8 .
Silesia
1840
156
2nd cl.
It
t>
179
Rdmpler's .
Weicker^s .
> ft
1805
120
1887
80
Reiboldsgriin
Saxony
2296
108
Lahmann's
,,
780
Altenbrak .
Harz
1017
?20
St. Andreasberg, Jacubasch
1 M
?2160
17 +
St. Andreasberg, Ladendori
t
♦»
12 +
Siilzhayn Femsicht .
ft
?1640
10
., ViUage
?980
9 +
Rehburg, Michaelis
Hanover
300
20
,, Lehrecke
J
?800
22
Hohenhonnef .
Rhine
774
109
Laubbach .
^^
260
113
Falken stein
Taunus
1312 ♦
112 +
Nordrach .
Black Forest
1470
45
St. Blasien
It
2625
62
MarzeU .
1378
?
Sch5mberg
»»
2180
50
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CHAPTER XXVI.
SILESIAN SANATORIA FOR PAYING PATIENTS.
•
This chapter comprises the Brehmer sanatorium with its
second-class section, Dr. Rompler's sanatorium, and Dr.
Weicker's private sanatorium. The " Krankenheim " is
described in chapter xxxiiL
The Brehmer Sanatorium,
which is the oldest in existence, is situated at Gorbersdorf ,
a small village in the valley of the Steine, between the
Eulengebirge and the Riesengebirge, in Upper Silesia, near
the Bohemian frontier. The valley, which runs from north-
west to south-east, is sheltered by densely wooded heights,
which reach an altitude of 800 to 900 metres above the sea.
It is here that Dr. Hermann Brehmer started his treatment
in 1854, and from 1859 onwards erected the picturesque
establishment which bears his name, the right wing being
built in 1862, and the left wing sixteen years later.
Brehmer died in 1889, after which the sanatorium was
successively directed by Dr. Felix Wolff-Immermann, Dr.
Achtermann, and Prof. Dr. Rudolf Kobert formerly of
Dorpat University, who manages it for the benefit of
Dr. Brehmer's heirs.
The main climatic features of Gorbersdorf are its
atmospheric purity and freedom from dust, dryness of soil,
shelter against strong wind, and cool summer temperature
with abundant sunshine. Its altitude is insufficient to
give it the character of an alpine climate, although the
barometric pressure is somewhat reduced.
(150)
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^
X
I
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SILESIAN SANATORIA FOB PAYING PATIENTS. 161
The sanatorium, which stands on porphyritic soil, 561
metres (1840 ft.) above the sea-level, has a park of 300 acres,
consisting mainly of woodland, more than two-thirds of
which is laid out in over nine miles of walks. Some of
these are on level ground, while others are inclined at
various gradients leading uphill from the sanatorium ; and
all of them well provided with seats and summer-houses, so
that the patient can, under medical advice, take exercise
proportioned to his strength, and return downhill when he
is getting tired. For robuster patients there are also walks
up the mountain side to a height of about 200 metres (656
ft.) above the building.
The sanatorium itself consists of a main building (fig.
14) with a number of isolated villas. The chief part of the
structure is a huge Gothic pile, with towers, turrets and
arches, consisting of three buildings of different dates, united
in one line by covered passages and glazed galleries form-
ing the winter garden. Xl^® central portion contains the
doctor s quarters and administration. The right wing, a
square building with a square tower attached to it, goes by
the name of " Old Curhaus " ; the left being called the
*' New Curhaus ". On the ground floor are the two dining
saloons, library, ladies and gentlemen's conversation rooms,
conservatory (or " cold winter garden ") and palm house (or
** warm winter garden") with a spring of water. The
new Curhaus has a handsome entrance and staircase,
ornamented with frescoes and useful maxima There are in
the old and new Curhaus eighty-eight bedrooms with 104
beds. Those on the first floor of the left wing open on to an
arcade with Gothic arches ; those on the two upper floors
have mansard windows. The walls are oil-painted up to a
height of 1 J metres. The floors are also painted or covered
with linoleum. No large carpets are permitted ; but stuffed
chairs, rugs and curtains are not objected to. The ventila-
tion is partly by open windows, partly by air shafts for the
foul air. The dining-rooms have " Kosmos ventilators,*'
which renew the air five times per hour. The heating is
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152 8ILE8IAN SANATORIA FOR PAYING PATIENTS.
partly by hot air, partly by hot water, partly by tiled
stoves for burning wood. The rooms are lighted by oil
lamps and candles. There is a lift for patients. There
were in Dr. Brehmer's time no " liegehallen " or open-air
galleries, as he objected to them, and laid more stress on
exercise in the open air than on the rest cure. Under
Dr. Robert, however, several roomy fresh-air galleries have
been built.
Of the three villas, the " White House " is close to the
new Curhaus, and contains twelve bedrooms with thir-
teen beds; the "New House," with eighteen rooms and
twenty-two beds, is a little farther oft*; and the " Villa
Rosa," with sixteen rooms (one double-bedded), is on a
higher level in the woods. The establishment also includes
chemical and bacteriological laboratories, a meteorological
observatory, a large library with several thousand volumes
(medical and general), a model dairy with sixty cows under
strict veterinary control, stables, laundry and disinfection
apparatus. There are two hydropathic installations — one
in the main building, one in a cottage in the park. The
sewerage is dealt with according to the " Heidelberg Tonnen
System " ; the disinfection of the waste waters according to
Dr. Hulwa's system.
The patients, who are exclusively consumptives, are
treated much as in other establishments. In febrile stages
they rest in the summer-houses, on the balcony, or in their
own rooms with open windowa In other stages they walk
out in the park. There are five meals per day, about 7,
10, 12*30, 4 and 7 o'clock, the time being notified by horn
signals. Patients are woke at 6*45,' and take a walk after
breakfast. They rest half an hour before midday dinner,
and go for a walk after it ; rest again from 6 till 7 p.m. ;
after dinner they stay in the park in summer, in the
assembly rooms in winter, and go to bed at 9 p.m. All the
patients take a large quantity of milk ; those with gastric
disturbance have kefir from the farm. Febrile patients
are given a glass of milk every hour. The hydrotherapy,
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SILESIAN SANATORIA FOR PAYING PATIENTS. 153
iwrhich is applied in the morning, is of all degrees from
ivashing with acidulated water to the douche. Dettweiler s
flasks and spittoons fiUed with sawdust are used for the
sputa, which are mixed with lime and buried, or else
mixed with sawdust or peat mould and burned. There is
a Protestant chapel near the sanatorium, and a Roman
•Catholic church at Friedland, from which a priest comes
over once a fortnight For the patients' amusement a
series of concerts, theatricals and the like are arranged.
ITie charges are from 56 to 87 marks per week in
summer, according to rooms, 7 J marks more in winter.
In addition there is an entrance fee of 25 marks, and extra
for beverages, baths, rubbings, douches, inhalations, disin-
fection (5 marks), bedding, and a few other things. Patients
buy their own spitting flask and thermometer. Visitors
and friends, attendants, and children under ten, are received
at reduced rates.
Statistics, — The average number of patients receive<l
into the sanatorium of late years has been 445 per annum,
with a total of 36,348 days of treatment, showing a steady
increase in popularity.
Mode of Access. — The nearest stations are Friedland,
on the line from Breslau to Freiburg ; and Dittersbach, on
the Silesian Mountain Railway. The former, which is 6
kilom. (nearly 4 miles) from Gorbersdorf, is best suited to
those coming from Breslau or Austria ; the latter, 9 kilom.
(5J miles), is more convenient for the majority of patients.
•Carriages should be ordered from the sanatorium. Gor-
bersdorf is a post and telegraph station, but with no night
service.
Second-Class Patients.
Since April, 1894, patients have also been received under
treatment at Gorbersdorf at reduced rates. For this purpose
a number of houses near the sanatorium, with 149 bed-
rooms and 153 beds, have been utilised, in addition to twenty-
six bedrooms let to the institution in the village. Each
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154 SILESIAN SANATORIA FOR PAYING PATIENTS.
house has a common assembly room, while kitchen, dining-
room, music and reading rooms are in a separate building.
The rooms are described by Hohe as roomy, lofty, light and
cheerful. Patients have the use of the park and woods of
the sanatorium. The dietary is about the same as in the-
other establishment, but somewhat simpler ; the treatment
in other respects being identical.
The charges are from 32 to 40 marks per week according^
to room ; the entrance fee is 15 marks. A reduction is made-
for friends, visitors, and children under seven. In winter
4 marks extra per week are charged for heating and light.
Wine and drugs are also extra. A reduction is made iiii
railway fares for the patients of this section, as in the case^
of other sanatoria for the less wealthy classea Dr. Tir-
mann, second medical officer under Dr. Robert, is in charge:
of the second-class patients.
The Brehmer sanatorium is by far the largest in exist-
ence. Including first and second class patients, a total o£
335 patients can be accommodated, twenty-six in the village?
houses with which arrangements have been made, the rest
in the various buildings belonging to the sanatorium. Int
Dr. Brehmer*8 time the largest number under treatment at
one time was about 330; of whom two-thirds had to be.
lodged in the houses of the village. After his death there
was a diminution in the popularity of the sanatorium ;. but
under Dr. Kobert the number of its patients has again in-
creased, so that there were this year for a time as many aa
315 patients simultaneously under treatment. There are
now eight medical officers, three bath attendants and six.
nurses attached to the institution. Statistics of this sana-
torium may be, found at p. 53.
The sanatorium has been somewhat severely criticised by
Leon Petit and others, mainly on the ground that hygienic
requirements have been sacrificed to architectural beauty..
Doubtless much money has been spent on unnecessary
adornments ; and the heating, lighting, and ventilation,
were open to improvement ; but there is reason to believe
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SILESIAN SANATORIA FOR PAYING PATIENTS. ISS*
that under Dr. Robert's energetic management many re-
forms have been effected The sanatorium grounds are
probably the finest in existence ; and the place will always,
be of special interest to practical physicians as the first in
which the hygienic methods of treatment of consumption
were systematically carried out, and the value of " closed
sanatoria " demonstrated.
Dr. R6mpler*s Sanatorium. '
This establishment, which is placed within a few hundred
yards of Brehmer's establishment at Gorbersdorf, was.
opened in 1875 by Dr. Rompler, in two houses belonging to-
Freiherr v. Rossing, which were shortly after bought by the
doctor. The main building of the sanatorium, which is
550 metres (1805 ft.) above the sea-level, is in a strip of
land of 25 to 30 acres, separated from the rest of its.
grounds in most of its extent by those of the Brehmer
establishment. The total area which belongs to it is about
230 acres, 70 being woodland, and is laid out fti the same^
style as that of the larger establishment, but has not yet
had time to attain to the beauty of the latter. However, it
has every requirement for successful treatment, and the
.sanatorium is stated to be comfortable and well managed.
The park is on the slopes of the mountain side, and rises to
a height of 800 metres above the sea-level, a Swiss chalet
with balconies and verandahs, which is warmed in winter,
being placed in the middle of the grounds for patients to rest
in, and get books and refreshments. Other resting places-
and summer houses are scattered through the park.
The main building, or Curhaus (fig. 15), consists of two-
parts united by a large and well- ventilated winter garden.
£2ach part consists of a centre and two projecting sides,
four storeys high. The main entrance opens on the one
hand into the winter garden, on the other into a large
dining saloon capable of seating 200 persons. Near this
are a reading room, and waiting and consulting rooms for
the medical staff. On the first floor are other assembly
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156 SILESIAN SANATOEIA FOR PAYING PATIENTS.
rooms, music, billiard and ladies' rooms. The Curhaus has
over 100 bedrooms for patients, all of them comfortably and
suitably furnished, and some provided with balconiea A
large fresh-air verandah surrounds the Curhaus from north-
east to south-west Communicating with this is a long
<K)vered walk extending into the grounds and provided with
a concert hall. There is also a large terrace with glass roof
on the first floor on the south-west side of the Curhaus,
affording a fine view of the mountains. The sanatorium is
-so constructed as to facilitate cleansing. The walls in the
■corridors and bath-rooms are oil-painted; elsewhere of
washable paper. The floors in the bath-rooms, winter gar-
den, reading-room, balconies and terraces are tiled ; in the
bedrooms of lacquered wood. The sanatorium is heated by
Perkins' system of hot- water pipes ; heating and ventilation
of baths and douche rooms being effected by hot-water
pipes from the kitchen. Chimneys are only present in one
of the common rooms. The water supply is from a spring
on the borders of the park 70 metres above the sanatorium,
and is therefore able to supply every floor. There are baths
in the Curhaus, and baths and douches in a separate bath-
house in the park. The water-closets in the Curhaus are
provided with a good flush, the waste waters of every kind
being filtered through coke one metre below the surface in
the park, and the resulting eflluent being pure and clear.
Two separate villas in the park near the Swiss chalet are
devoted respectively to convalescents and to those who wish
to live apart from the other patients. There is also a chapel
in the park, where service is held once a fortnight. A well-
stocked library and numerous games are also provided.
The treatment is on the usual lines, none but con-
sumptives being admitted. Sputa . are received into
Dettweiler's flasks or into spitting cups containing water.
Linen and clothing generally are disinfected by a steam
disinfector. Whenever a room is vacated it is disinfected
by Schering*s formalin disinfector. The patients take rest
or exercise according to their medical condition. There are
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SILESIAN SANATORIA FOR PAYING PATIENTS. 157
two trained nurses in the establishment, in addition to three
male and two female rubbers. Cod-liver oil is occasionally
given in winter ; more frequently carbonate of ^aiacoU
Camphorated oil is used for external applications. The re-
sults with tuberculin have not been encouraging, so that-
it is only used where patients urgently desire it. Dr>
Rompler lays stress on the necessity of individualising in
treatment of patients. Five meals a day are provided : a
first and second breakfast, mid-day dinner of soup and three
courses, afternoon tea and hot or cold supper.
The charges are, for the room, 7 to 25 mks. per week
according to position ; for board and attendance, 30 mks. ;.
doctor's fees, 7 to 10 mks. ; entrance fee, 21 mks., or 30 for
a family. This entitles to the use of newspapers and
periodicals, the use of the park and its special arrange-
ments, concerts, eta In winter 6J mks. per week extra
are charged for heating and lighting. Other extras are
wine, drugs, the use of bedding (1 J mks.), extra milk and
baths. There is no extra charge for special diet ordered by
the doctor. Douches are provided free. Children under
ten are received at half-price, and pay no entrance fee.
For servants and attendants a reduction is also mad^.
There is accommodation for 120 patients in the sana-
torium and its annexes. For statistics see p. 53.
Both Leon Petit and Hohe speak highly of the arrange-
ments in this sanatorium. The nearest railway stations
are Friedland, which is twenty minutes' drive from the
sanatorium, and Dittersbach, which is one and a half hours
by carriage. This may be ordered from the sanatorium.
For soil and climate see the Brehmer sanatorium.
Dr. Weicker's Sanatorium,
or the ** Sanatorium of the Countess Piickler," owes ita
origin to a convalescent home for poor people foimded by
the late Countess Marie v. Puckler in 1883, at Schmidts-
dorf, less than a mile to the west of Gorbersdorf, and in the
same valley. The institution, which belonged to the village
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158 SILESIAN SANATORIA FOR PAYING PATIENTS.
of Schmidtsdorf, was acquired in 1893 by Dr. Hans
Weicker, who converted it into a sanatorium for con-
sumptives, and those suffering from diseases of the nose,
throat and larynx. It is a smaU establishment, and its
owner intends it to remain so, believing that in this way it
is possible to give more individual attention to each patient.
The sanatorium is sheltered by mountains to the north, and
At a greater distance by wooded spurs to the east and west.
The woodland belonging to the establishment amounts to
scarcely 6^ hectares (16 acres), but the patients have access
to the adjoining woods of Count Pless, according to an
4igreement with the owner; so that plenty of sheltered
walks are available, with resting places and pavilions and
l)eautiful views.
The sanatorium (fig. 16) stands at 560 metres (1837
ft.) above the sea-leveL It is an oblong block four storeys
liigh, with a receding centre portion in front of which is a
"terrace, and higher up two deep balconiea The lower
l)alcony is continued round the house to the east and west
•ends. There is a small open-air shelter or "liegehalle"
touching the eastern end of the house. The rooms are
simply furnished ; the walls being partly oil-painted, partly
Kjolour-washed, partly papered, and the floors painted or
covered with linoleum. Every room has a chimney, and is
heated by closed stoves. The lighting is at present by
petroleum, but electric lighting is to be introduced. The
closets are turf-mould closets, the waste water being
•clarified by filtration.
The treatment in the main resembles that in other
Oerman sanatoria. Patients take exercise in the grounds
And woods, excepting before dinner and after meals. Those
who are febrile or dyspeptic remain at rest on couches in the
open air. Dr. Weicker has introduced some modifications
in the couches used, to enable various horizontal or reclin-
ing positions to be assumed. A small carriage is used to
take slightly febrile patients across the park. Systematic
respiratory exercises are prescribed in suitable cases.
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SILESIAN SANATORIA FOR PAYING PATIENTS. 159
Hydrotherapy is employed, but not in the form of
douche. In the morning the patients are rubbed with a
wet glove with water at 93° F., and replaced in a warm bed
without being dried. For night sweats, sponging with
solutions of spirit or camphorated spirit is used. Another
favourite application is a hip bath at 93° F. followed by
affusion at 86°. General massage is also applied every
other day if the appetite is unsatisfactory. Moist com-
presses are used at night to counteract congestion of the
lungs. Drugs are but little used, and mainly to combat
urgent or troublesome symptoms. Cod-live^r oil is seldom
used ; very little alcohol is given, and only a moderate
amount of milk. So-called specifics are not used. Darem-
berg however states that creosote and guaiacol are often
prescribed. The physician lives in the house, and takes his
meals with the patienta Milk or soup is served in bed be-
fore the patients rise. Then follows a breakfast of coffee or
cocoa, kefir or soup with bread and butter, biscuits, etc., after
this a light lunch of milk with bread and butter, followed
hy mid-day dinner of soup, fish, meat, vegetables and stewed
fruit or pudding. In the afternoon another meal is given
like the breakfast. The last meal is a hot or cold supper.
No extra charge is made for special diet ordered by the
physician. There are two trained nurses in the house.
Sputa are disinfected with lysol, the linen by boiling, the
rooms with formalin vapour.
The charges in summer amount to from 41 to 52 mks.
per week ; in winter (1st October to 15th May), 3^ mks.
extra are charged for heating and lighting. There is an
entrance fee of 10 mks., or 15 for families. A charge of 5
mks. is made for the first medical examination. There are
A few extras. The establishment will accommodate twenty-
five to thirty patients. In 1896 it received fifty-nine
patients, with 3802 days of treatment.
For further particulars, see the Brehmer sanatorium.
Dr. Weicker is also the medical director of a sanatorium
for poorer patients, described at p. 209.
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Chapter xxvii.
SAXON SANATORIA FOR PAYING PATIENTS.
For the sake of convenience, the Saxon sanatoria of the-
Harz district are described in the next chapter. The onljr
other sanatorium which, strictly speaking, belongs to this,
group is the one at Reiboldsgriin. A short description of
Dr. Lahmann's sanatorium near Dresden is, however,,
added, although it is not specially an institution for con-
sumptives.
Dr. Driver's Sanatorium, at Reiboldsgrun,
is situated on the lower slopes of the Erzgebirge in Saxony.
These mountains, which form the natural frontier between
Saxony and Bohemia, and reach an altitude of 750 to 800-
metres (2460 to 2624 ft.), with a few peaks of 1200 metres-
(3937 ft.), consist of a number of parallel chains separated
by valleys, each containing a tributary of the Elbe. Here,,
in the little valley of the Zinsbach, in the midst of a huge
forest of pine trees, over ninety miles long by twelve to
eighteen wide, is situated the sanatorium of Dr. Driver, at
an altitude of 700 metres (2296 ft.) above the sea-level.
The district has been known and frequented since 1725
for its ferruginous waters, and had a little thermal estab-
lishment, which was acquired in 1873 by Dr. Driver, and
converted into a sanatorium for consumptives, after the
model of Brehmer s at Gorbersdorf. Dr. Driver still owns
the establishment, and lives on the spot, but has entrusted
the management since 1892 to Dr. Felix Wolff-Immermann„
formerly at the head of Brehmer's sanatorium.
(160)
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SAXON SANATORIA FOR PAYING PATIENTS. 161
The place is on volcanic soil, permeable, yet free from
dust The climate is a sheltered hill climate, with quiet
air and little variation in temperature. The sanatorium
stands in a park of seventy-six and a half hectares (about-
189 acres), provided with numerous walks, resting-places
and summer-houses, and very diversified in character. It
also contains an artificial lake, which is in winter used for
skating and sledging. The situation is a most convenient
one for a closed sanatorium, owing to its isolation, as there
is no village or health resort for miles, and pine woods
spread on every side.
The sanatorium (fig. 17) consists of a group of eight large .
buildings, arranged for the most part along the northern
and eastern sides of a large garden, and connected by
covered corridors. There are also a few more small build- •
ings for the staff and management.
The central block, or Curhaus, which was erected in 1890,
contains a dining saloon for over 100 persons, several
assembly rooms (reading, music, and billiard rooms, etc.),
and the kitchen department, and has a verandah along the
southern side. Attached to the Curhaus is another, of
which the ground floor contains the postal department and
the office ; the two upper floors containing fifteen rooms,
mostly to the south. It is in this building that the medical
director lives. The Curhaus also communicates on the other
side, by a covered corridor, with the "Villa Winterheim,"
which is the largest of the group. It contains on the
ground floor the douche and bath rooms, drug room, wait-
ing and consulting rooms, and laboratory. The three upper
floors contain thirty-four patients' bedrooms, none of which
has less than 100 cubic metres (3530 cub. ft.) air space.
There is a high tower at the eastern end, and next to it
a glass-covered verandah communicating with four large
galleries, and through them with the " Villa Wiesenhaus ".
This, like the preceding, is very comfortably furnished ; it has
twenty-six patients' rooms on two floors. A little lower
down is " Hugo's Ruhe," with fifteen rooms, some of which
11
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162 SAXON SANATORIA FOR PAYING PATIENTS.
are occupied by the assistant medical officer. Near the
Curhaus is the " Turmhaus/' containing on the ground floor
the administrative department ; on the upper floors twenty-
two rooms, mostly smaller than the others. Beside this is
the " Villa Karlsruhe," with twelve good rooms ; and Dr.
Driver's house, "Villa Mathildenruhe ". In addition to
these villas, there are stables and farm buildings, laundry
with steam disinfector, but no private dairy. About a
quarter of an hour's walk up-hill in the park is a house
(also under medical control) where patients can obtain rest
and refreshment, while they enjoy an extensive view over
.the surrounding country. Convalescents and friends of
patients are also quartered here. The sanatorium alto-
gether contains 111 patients* rooms, and will accommodate
105 to 108. Most of the rooms are 4 metres high ; the
smallest covers 15 square metres (161 sq. ft.), and most are
•considerably larger. The walls are painted with oil colours
for 1^ metres, and lime- or colour-washed above this. The
floors are mostly covered with linoleum. The Curhaus
and "Villa Winterheim*' are heated by low-pressure steam;
the other villas, partly by cast-iron stoves, partly by tiled
;stoves. The lighting is by petroleum lamps, the "re-
generative lamp '* being used in the larger rooms. There
are no special ventilating contrivances. There is consider-
able difference in the appointments of different parts of the
establishment; but the furniture is generally simple and
readily cleansable. The establishment has its own spring
of water, and, in addition, a steam pump in case of
drought.
The sanatorium is exclusively for consumptive patients,
and has been strictly so since early in 1892. Only those
are admitted who are likely to benefit from the climate.
If there are no signs of improvement within the first fort-
night, they are advised to leave the establishment, as, in Dr.
Wolff-Immermann's experience, this is a reliable test of the
suitability of the climate. Out of 366 patients who left in
1897, 11 per cent, did so before the twentieth day, and half
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SAXON SANATORIA FOR PAYING PATIENTS. 163
this number before the eleventh day. The average dura-
tion of stay is sixty-six days. Doubtless in many eases
patients leave too soon ; but some of those who benefit at
first become febrile again later on, and yet promptly recover
their health on removal to a lower altitude. This illus-
trates the fact that there must be a certain relation between
the stimulating qualities of each health resort and the re-
active powers of the patient. The number of those who
apply for admission at Reiboldsgriin is steadily increasing.
In 1892 there were 264 treated ; in 1897, 377 were admitted
The average for the five years ending in 1896 was 311
patients, with 21,874 days of treatment ; in the previous
period, 270 patients, with 19,833 days of treatment. By
far the largest number were Germans, this being a much
less cosmopolitan sanatorium than most of the other large
establishments in Germany. There are on an average
seventy in the sanatorium at the same time.
The treatment is on the usual lines. Febrile patients
rest, while others take exercise in the open air, spending
about ten hours out of doors every day. It has been in-
creasingly the custom to make use of the shelters in the
woods for rest, instead of the verandahs. The occupation
of patients is very carefully controlled. There is a good
library ; some of the more exciting books are forbidden to
febrile patients. Musical instruments and unobjectionable
games are also provided. There are periodical concerts
and entertainments. In winter, those who are fit for it go
sledging, or even skating. There are five Tneala a day, as
at other German sanatoria. The medical director is not a
believer in the excessive administration of milk, or in
unnecessary " stuffing ".
Sputa are received into spittoons containing water, and
are emptied once or twice a day into the water-closet. The
linen is disinfected by steam. As regards drugs, the chaly-
beate spring in the grounds is given when climatic treat-
ment alone does not give satisfactory results; in other
cases, symptomatic treatment is adopted, very little else
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164 SAXON SANATOEIA FOR PAYING PATIENTS.
being given excepting antisyphilitic remedies where called
for, or quinine and arsenic where there is a malarial taint.
Of those treated, 80 per cent, were "better'* when they
left. Two died, one from tubercular meningitis, the other
from severe haemoptysis, which came on while he was im-
proving in health. To appreciate the value of the treat-
ment, Dr. Wolff-Immermann*s careful report and analysis
should be studied.
There is one assistant physician in summer, two in
winter. One trained nurse is found to be sufficient.
The charges are 45 to 63 marks per week, with an
entrance fee of 10 marks, or 20 for a family, and a few
extras. Reduction is made for children, visitors, and at-
tendanta Since the opening of the Albertsberg Sanatorium
no "second-class" patients connected with insurance
societies are received.
Evangelical service is held once a fortnight in summer,
once a month in winter. A chapel is, however, to be built
for the common use of the two sanatoria. Roman Catholics
can find a church at Auerbach.
The nearest railway station is at Rautenkranz, nearly
three miles off*, on the line from Chemnitz to Aue and
Adorf. This is best for patients coming from Bohemia
and S.E. Saxony. For others, Auerbach station (about 4^
miles), on the line from Berlin and Leipzig to Hof and
Munich, is more convenient. Carriages should be ordered
from the sanatorium.
Dr Lahmann's Sanatorium,
at Weisser Hirsch, near Dresden, although not a special
sanatorium for consumptives, is here alluded to, inasmuch
as it receives cases of early phthisis amongst others, and the
methods of treatment are to some extent similar to those of
the sanatoria for consumptives.
Many of the ailments which flesh is heir to are directly
or indirectly caused by unnatural and unhealthy conditions
of life. People live in sunless and ill-ventilated rooms.
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I
5
OQ
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SAXON SANATORIA FOR PAYING PATIENTS. 165
wear unsuitable clothing, take too little exercise or ill-con-
sidered spells of sedentary work, or an unsuitable dietary,
or give themselves up to various forms of self-indulgence.
The evil results of such hygienic errors can to a great ex-
tent be remedied by hygienic means; and this is what Dr.
Lahmann*s sanatorium professes to do. Only "natural
remedies *' are employed, such ad water, light, fresh air,
massage and regulated exercise, dietetics, electricity, and
in certain cases mental suggestion. Drugs of every kind
are dispensed with, in order to avoid the possible drawbacks
incidental to their use.
The sanatorium is situated on a plateau 238 metres (780
ft.) above the sea-level, in the health resort Weisser Hirsch,
a village of about 1200 inhabitants, which in summer
receives the overflow of visitors from the sanatorium.
Sheltering the village to the north and north-east is the
extensive forest called the Dresdner Heide, which is pro-
vided by the local Improvement Society with good paths,
benches, shelters, and the like. The extensive grounds of
the sanatorium, which also include a portion of woodland,
are contiguous with the public woods.
The sanatorium consists of a main building containing
various reception rooms and dining saloons, a bathing
establishment and gjnmnasium, and a number of separate
villa residences. The reception rooms in the main building
are lighted with electricity, and communicate with the
bathing establishment by means of a covered walk. In
addition to these buildings, there are a number of open
shelters for the fresh-air treatment, fitted up for sleeping
as well as for use in the day time (fig. 18). Another
feature of the place consists in the systematic air-baths in
specially-arranged and sheltered spots, designed to restore
the lost functions of the skin, and sun-baths to stimulate
nutritive processes.
Hydrotherapy is extensively used. The ordinary dietary
consists of five meals, with a smaller proportion of meat
than is usual elsewhere in Germany. In certain cases a
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166 SAXON SANATORIA FOR PAYING PATIENTS.
vegetarian diet with eggs and milk is prescribed. Special
Attention is paid to the proportion of various salts in the
food and in the excretions, as determined in the chemical
laboratory. The buildings are heated by means of central
steam apparatus. The sewerage has been perfected at heavy
cost, and the water supply is said to be excellent and abun-
dant. The sanatorium has a private dairy farm of tested
cows. For the amusement of the visitors, in addition to
books and papers, concerts, musical evenings, dances in
summer, bowls, croquet, billiards, cycling, and pony sledg-
ing in winter, are provided.
The duration of treatment varies according to the nature
of the case — in constitutional ailments a,': least six weeks is
advised ; and in long-standing maladies as many months as
there have been years of illness. There are six doctors in
residence in addition to. Dr. Lahmann, including one lady
doctor. During 1897 over 2000 visitors (or, including the
village, over 3000) were received, of whom 221 came as
attendants or for change of air. There are on an average
300 visitors at one time in the sanatorium in summer, and
100 in winter, of the uost various nationalities.
The charges, including board, lodging, and medical treat-
ment, are from 70 to 91 marks per week, with a few cheaper
rooms for those without means. Reductions are made in
the case of children, and where two sleep in one room.
Those who lodge in the village pay 62 marks, or, for board
or treatment alone, 42 marks per week.
The sanatorium is an hour's drive from the station, which
is connected with Loschwitz by a wire-rope railway, and
thence with Dresden (Neustadt) by two electric railways
and a steamboat service. The telegraph and telephone
office is opposite the sanatorium.
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CHAPTER XXVIII.
PRIVATE SANATORIA OF THE HARZ DISTRICT.
No important closed sanatoria for paying patients exist
in this beautiful district of Germany, although there are
several for the less wealthy classes. A small sanatorium
exists at Altenbrak ; another has been built at Siilzhayn,
which, however, is being occupied by working-class patients
until the completion of the large sanatorium destined for
their use. Dra Ladendorf and Jacubasch treat patients at
St. Andreasberg by the hygienic open-air method, but their
establishments are open sanatoria, not exclusively for con-
sumptives. The ** Felixstift" of Dr. Ladendorf, however,
is a closed sanatorium for the less wealthy middle-class
patients, resembling in this respect the ** second class"
section of the Brehmer sanatorium. It is described at
p. 231.
The Altenbrak Sanatorium
is in the " Bodenthal/' which many regard as the most
beautiful part of the Harz district. It lies in a valley open
to the south and protected by mountains covered with pine
woods, which are only a few steps from the sanatorium.
It is 310 metres (1017 ft.) above the sea-level, and has
accommodation for twenty patients, unless the contem-
plated enlargement has already taken place. It is man-
aged by an assistant of Dr. Pintschovius, who is himself a
resident in the neighbouring village of Ketzin, and in
charge of an open sanatorium for the poorer classes. The
charges are 42 J to 46 marks per week ; an entrance fee of
(167)
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168 PRIVATE SANATORIA OF THE HARZ DISTRICT.
10 marks is required, or 15 for a family ; and 5 to 10
marks are charged for the first consultation. Children are
received at reduced ratea The nearest railway stations,
which are one to two hours by carriage from the sana-
torium, are Blankenburg and Thale. I have been unable
to obtain full particulars concerning this sanatorium.
St. Andreasberg
is a small town of nearly 4000 inhabitants, with a visiting
population of nearly as many more, who visit the place
chiefly for the sake of hydropathic treatment or for change
of air. It is situated partly on the side of a long hill,
partly in some adjacent valleys, the upper part being 660
metres (2165 ft.) above the sea-level, and the lower part
some 500 fi lower down. It is said to be the mast elevated
town in northern and central Germany, and has long been
known as a cool summer resort. The upper part is laid
out as a broad avenue bordered with trees, and is cool and
bracing from its elevation and its proximity to open moor
and meadow land. In the lower part the red-roofed wooden
houses are more closely massed together, and the streets
unusually steep though' fairly wide. Mining operations are
carried out in some of the neighbouring valleys, but there
are no large factories to sully the purity of the air. The
place has two hydropathic establishments, and is said to
have 700 lodging-houses,^ besides half a dozen good hotels,
a concert hall and theatre, and a "Kurpark"; electric
lighting and electric trams are, it is said, to be introduced
before long ; but with all this, it remains a quiet and unpre-
tentious little town, rather than an ultra-fashionable health
resort. The town as a whole is sheltered from keen winds
by mountains to the north and east, and by wooded hilLs
in other directions ; and from the purity of its air, the dry-
ness of the soil (which is of shale), and the absence of dust,
forms a very suitable resort for consumptives in an early
* R. W. Felkin, •* Lauterberg and St. Andreasberg," Prov. Med. Jour. ,
July, 1892.
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PRIVATE SANATORIA OF THE HARZ DISTRICT. 169
stage, who have of late years frequented it in winter as
well as summer. The winter climate is somewhat warmer
than the neighbouring lowlands. The mean temperatures
for the various months are said to be as follows : —
January, .
. - 1-2*'
July, . .
. + 160"
February, .
. - l-S**
August,
. + 18-7"
March,
. - 0'6^
September,
. + 11-8^
April, .
May, .
. + 5-4*'
October, .
. + 6-7'=
. + 12-9°
November,
. + 2'V
June, .
. + 16-9°
December,
. - 0-6°
Mean annual temperature, 6 '7''; mean bar. pr., 705 mm.; mean
humidity, 89 per cent.; prevailing winds, W. and S.W.
The surrounding country is exceedingly varied and
picturesque, with open country in some directions, and
beautiful pine-clad mountains with deeply cleft valleys in
•others. The water supply is exceedingly abundant, and is
:said to remain so even in seasons of drought. As in mast
foreign health resorts, visitors have to pay a kurtaxe.
The two hydropathic establishments — which belong re-
spectively to Dr. Laden dorf and Dr. Jacubasch — are both
in the middle of the town, in situations which are rather
.sheltered than bracing. Dr. Ladendorf receives a few con-
sumptive and other patients into his own house for treat-
ment; others are quartered in neighbouring houses. It is
scarcely to be called a sanatorium for consumptives. Dr.
•Jacubasch's sanatorium, which is close to his bathing es-
tablishment, consists of a pleasant-looking villa, which is
provided with wide covered verandahs and balconies, and
has accommodation for ten first-class patients. Arrange-
ments have also been made with a neighbouring • lodging-
house for the reception of seven second-class patients.
.Surrounding these various buildings, and the doctor s own
residence, is a large garden; and adjoining this is the
" Kurpark," with its sheltered walks and summer-houses,
and its artificial lake and fountain. Dr. Jacubasch does
not accept any advanced cases for treatment ; nor does
Jie confine him&elf to consumptives. These are treated
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172 THE REHBURG SANATORIA FOR PAYING PATIENTS.
the erection of so many sanatoria in Germany for the fresh-
air treatment, three such establishments were opened at
Rehburg, one being for the poor of Bremen, the two others
for more wealthy patients. Exaggerated notions of the
infectiousness of consumption have unfortunately injured
the popularity of Bad Rehburg, which has consequently
iallen into undeserved neglect. Those who wish for a quiet
xural retreat, with beautiful country in the immediate
neighbourhood, would do well to remember this once
fashionable health resort. It is served by a narrow-gauge
railway, which runs from Wunstorf, at the junction of the
line from Hanover to Bremen with that from Berlin to
^Cologne and Holland.
Dr. Michaelis' Sanatorium,
ivhich was specially built in 1886 for the hygienic treat-
ment of consumptives, is situated in the upper part of the
village, about 300 feet above the sea-level, and is sur-
rounded on three sides by public woods, which cover over
300 acres of ground. It stands at a distance from the road,
surrounded by a garden of about three acres, remarkable
for its lofty and beautiful beech trees.
The sanatorium (fig. 19) consists of a three-storey build-
ing, with a few attics in the peak of the roof, and veran-
-dahs to the south and east. It has a southerly aspect, and
the rooms are so arranged as to admit sunshine into every
one. The centre of the building projects in a series of
open balconies and fresh-air shelters, each of which stands
.a little farther out than the one above. The rooms behind
these are well lighted by windows in other directiona
There are a few common rooms, the dining saloon having a
•capacity of about 1000 cubic metres (35,300 cub. ft.). The
bedrooms, which are twenty in number, vary in size from
SO to 100 cubic metres (1760 to 3530 cub. ft.). They have
linoleum-covered floors, whereas in the common rooms
there is parquet. The walls are covered with shiny wash-
Able paper, and the furniture is also for the most part
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THE REHBURG SANATORIA FOR PAYING PATIENTS. 17$
readily cleansable. The heating is by low-pressure steam ;
the lighting by naphthalene lamps ; but it is proposed to-
introduce acetylene, unless a public supply of electricity is.
provided. The visitors are almost exclusively consump-
tives, of whom only those in chronic or curable stages are
admitted.
The treatment is of the usual kind. Dr. Michaelis agrees,
with Dettweiler in advocating rest rather than exercise in
the majority of patients who come for treatment. Patients,
spend much time out of doors — often 12 or 13 hours a day
— lying out on cushioned cane lounges in the garden, the-
open south verandahs, or the summer-house. There is-
seldom a day when they are obliged to use the closed
verandah. The oleander blooms freely out of doors in
most seasons; and the evenings are nearly always still
and clear. In cold weather, wraps and hot bottles are
provided. The diet is intended to resemble that of a high-
class private house rather than an hotel. Plenty of milk
is given, especially in small repeated doses in the afternoon.
During summer patients also take whey from the royal
establishment ; or, if feverish, goats' milk or kefir. The
whey is said to increase the capacity for other food. In
the morning it is taken hot. The goats, owing to special
feeding, yield milk free from the usual strong flavour.
Unlike Dr. Dettweiler, Dr. Michaelis gives very little alco-^
hoi, and never undiluted. Respiratory exercises are not
favourably regarded by him, excepting for young subjects
who are only inclined to consumption, and have good
heart action, in which case Waldenburg's apparatus may
be useful. Baths and douches are provided in the royal
bathing establishment. Dr. Michaelis is a strong advocate
of inhalations under a pressure of half an atmosphere, of
saline solution, creosote solution, pinol and the like. For
night sweats he advises a brief tepid bath, followed by
rubbing with spirit or dry rubbing ; or else an infusion of
freshly gathered oak twig bark. For excessive cough he
gives codein ; for irregular febrile outbursts, antipyrin.
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176 THE REHBURG SANATORIA FOR PAYING PATIENTS.
pastured on a field next the garden. Whey from the insti-
tution in the village and kefir are also given.
Only consumptives in the first and early second stages are
admitted. They are treated by rest and exercise in the
open air, and by the **air bath" already alluded to; by
active and passive respiratory exercises, massage, elec-
tricity, inspiration of compressed air by Waldenburg's
apparatus, followed by expiration into slightly rarefied
air ; methodical holding of the head, breathing through the
hose, and graduated walking exercises under medical super-
vision. Hydrotherapy forms an important part of the
treatment.
In the morning a wet rub at 24° R. (86° F.) is followed
by a dry rub, and this by cold affusions or gentle douches.
In the evening the patients have a tepid bath. If haemop-
tysis appears, the ice compress or icebag is applied. For
consolidation, wet compresses are employed. For fever,
cooling baths with temperature reduced from 28° to 24° R.
(95° to 86° F.), followed by ice pack. Night sweats are
treated with tepid sponging in the evening, followed by
sponging with spirit and vinegar. A few patients receive
brine baths, mud baths, pine baths, aromatic and carbonated
baths, followed by tepid douche and a rub with absolute
alcohol. Dr. Lehrecke attaches great importance to the
soundness of the nasal and pharyngeal mucosa, the mouth
and teeth. He uses inhalations, in suitable cases, of solu-
tions of mineral salts, atomised essential oils, ozone, and the
like. Drugs are prescribed rather more freely than in
some other sanatoria.
Dr. Lehrecke has two assistant physicians under him.
The charges are from 56 to 68 marks per week. Extras
are beverages, unusual remedies (such as tuberculin), baths
and douches.
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CHAPTER XXX.
PRIVATE SANATORIA IN THE RHINE DISTRICT.
Two very well-known establishments are situated in this
part of Germany — Falkenstein, in the Taunus Mountains,
and Hohenhonnef , in the Siebengebirge — as well as another
at Laubbach, recently opened by Dr. Achtermann. Other
sanatoria for poorer patients in this district are described
in chap, xxxix. ; and for poor and paying patients in the
Black Forest, in chaps, xl. and xxxi.
The Falkenstein Sanatorium
was the first of its kind erected in western Germany, being
opened in 1876 by a company of citizens of Frankfort,
under the influence and direction of the well-known Dr.
Dettweiler.
It is situated about fifteen miles north-west of Frank-
fort, on the southern slopes of the Taunus Mountains, at the
upper end of a valley which is exceedingly well sheltered
on the west, north, and east by hills of from 1500 feet to
nearly 3000 feet above the sea-level. The soil consists of
clay-slate, gneiss, and porphyry. The surrounding country
is picturesque and well wooded, with extensive forests of
beech and other trees. The climate is a moderately moist
hill climate, with plenty of sunshine in summer, but a good
deal of rain and fog during the cold part of the year.
The sanatorium has a south-east aspect, and stands about
400 metres (1312 ft.) above the sea, having an extensive
view over the little town of Cronberg and the flat valley of
(177) 12
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178 PRIVATE SANATORIA IN THE RHINE DISTRICT.
the Main, which, with Frankfort on its banks, can be dis-
tinguished in the distance.
The grounds of 5'71 hectares (about 14 acres) are partly
meadow land, partly garden in terraces, with clumps of
bushes and trees, and are continuous on the north-west
side with the extensive neighbouring public woods. Both
are provided with a number of paths at various gradients,
well supplied with seats, and in the grounds with summer-
houses of various shapes and sizes, some of which can be
turned round for shelter against wind.
The sanatorium consists of a main building with two
additional villas united to it by covered corridors. The
main building (fig. 20) has a central block and two wings,
which diverge at obtuse angles and enclose a stone terrace
with deep verandahs, under which the patients rest on cane
49ofas. On the ground floor of the central block are a large
winter garden, a rather gloomy reading room, and cloak
tooms, with a well-lighted corridor in front, looking on to
the terrace and extending to the wings. Behind are the
entrance, grand staircase, porter's lodge, and post and tele-
graph offices. At the ends of the wings are music and
conversation rooms, billiard room, and library. The hand-
some dining hall, which is placed in a separate building
over the kitchens, communicates through a vestibule with
the eastern end of the central corridor. It is 78 ft. long,
39 ft. wide, and 32 ft. high, and can easily seat 200 guests.
In front of this, diverging by an obtuser angle than the
eastern wing, is an open corridor 200 ft. long, which leads
to the eastern annexe. This is now entirely occupied by
patients' rooms. A similar but shorter corridor on the
other side of the centre leads to the western annexe, of
which the basement contains the bath and douche rooms,
the rest consisting of laboratories, consulting rooms, and
the private rooms for the three medical officers and their
establishment. The kitchen department, water-closets, and
dining rooms for servants and officials are grouped around
a small court near the dining saloon. The position of the
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PRIVATE SANATORIA IN THE RHINE DISTRICT. 179
latter near the garden might be turned to greater advantage
by bringing the windows on the south side down to the
ground, and leaving them open during meal times. At
present, however, the eastern corridor, which runs in front
of the dining saloon, interferes with such a desirable
arrangement, owing to a difference of level. The upper
part of the central block and wings, which is partially built
of wood, is occupied by bedrooms on two floors, with
smaller ones in the attics. Some of these bedrooms have
balconies, one in the centre over the winter garden being a
very large one. The bedrooms are 4 to 4^ metres (13 to 14 J
ft.) high, and are mostly of good size, excepting those in
the topmost storey. Very few have chimneys. The walls
are papered, partly with washable, partly with ordinary
paper. The floors are everywhere of polished wood, or else
covered with linoleum. Carpets are only used in strips by
the bedside. Curtains and hangings are all of washable
material. The furniture is mostly simple in character, but
varies according to the kind of room. Stufled articles have
washable covers to them. There are no special ventilating
contrivances, the air being renewed by .open windows.
Nor is there any lift. The place is heated partly by low-
pressure steam, partly by ordinary German stoves or hot-
water pipes. There are altogether six heating furnaces.
Until recently the larger rooms were lighted with oil-gas,
made in a private apparatus close to the sanatorium ; the
bedrooms, with lamps and candles. Electric lighting has,
however, now been introduced, thereby effecting a much-
needed improvement. The water supply, which is abundant
and of excellent quality, is obtained from private springs at
the top of the neighbouring hill. In case of drought, there
is a second supply from Cronberg. Hot and cold water are
laid on to each floor ; but the supply of bathrooms was far
too limited when I visited the institution. The drainage
system, which was constructed in 1883, under the direction
of an English engineer, appears to be very good and com-
plete of its kind. The water-closets, although not built
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180 PRIVATE SANATORIA IN THE RHINE DISTRICT.
out, are of good pattern. The sewage, with the rest of the
waste water, runs into precipitating tanks in a shed in the
grounds, where it is treated with acidulated aluminium
sulphate, and repeatedly clarified by a partially automatic
apparatua The sludge is mixed with peat, leaves, or earth,
and then used in the garden, while the liquid effluent
irrigates a field. There was no objectionable smell when I
visited the place. Most of the outbuildings — the stables,
cowsheds and pigsties, the somewhat primitive laundry,
the steam disinfector, etc. — are on the other side of the
road, behind the building on the north side.
There is altogether accommodation for 112 patients in
the sanatorium, without counting those who lodge in the
village. The proximity of the village inn, although in
some respects convenient, is in others a disadvantage, or,
possibly, in certain cases, a hygienic danger.
The treatment of the patients is according to Dr. Dett-
weiler's well-known methods. More stress is laid upon
rest in the open air than upon graduated exercise, for
which, indeed, the grounds are less suitable than at some
other establisliments. There is plenty of provision for
open-air treatment, the deep verandahs, balconies, summer
houses, and long covered corridors being available in all
weather& One of the corridors, indeed, is glazed, and can
be heated to any desired degree, while an abundant supply
of fresh air can be admitted. Hydrotherapy is systemati-
cally made use of, beginning with dry rubbing and passing
through spirit rubbing, cold ablutions, and the cold wet
sheet to the cold douche. The number of those who
use the latter is, however, much smaller than formerly.
Patients are somewhat unnecessarily restricted in their use
of hot baths, being only allowed to have them at intervals,
and with water below 96° F. Food is abundant and of
good quality, four meals per day being provided; the
patients can also obtain extra milk by paying for it An
attempt, which is only partially successful, is made to
suit the different requirements of the various nationalities
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PRIVATE SANATORIA IN THE RHINE DISTRICT. 181
represented amongst the patients. The milk is obtained
from a private herd of tested cows under veterinary super-
vision, and is strained through felt. Dr. Dettweiler'i^
known predilection for the administration of compara-
tively large doses of strong spirits is contrary to prevailing
medical notiona
There -is a strict rule enforcing the use of Dettweiler's
flasks, or of ordinary spittoons, many of which are placed
in'the grounds. In the latter place they seem to me calcu-
lated to lead to just those evils which they are intended to
prevent. A solution of lysol is used for disinfection. The
linen of the establishment is washed by hand in the
private laundry, after disinfection in the steam disinfector.
Patients' body linen and handkerchiefs are washed in the
village. Rooms are carefully disinfected after a patient
leaves. There are no trained nurses, unless they are speci-
allv ordered from Frankfort, in which case there is no con-
venient accommodation for them. The servants' quarters
are also, as I am informed, not quite satisfactory according
to English notions, and apt to lead to awkward conse-
quences in the event of accidental illnesa Drugs are only
sparingly used at Falkenstein. Creosote is little used ;
Koch's new tuberculin was being sparingly used when I
was there. Great attention, however, is paid to throat
complications, which are treated by inhalations and various
topical applications. Various local societies amongst the
patients help to keep them amused ; but no regularly re-
curring entertainments from outside have hitherto been
arranged. There is a Roman Catholic church in the village.
Protestant services are held twice a month in the large
board room. There is also a synagogue in Falkenstein.
The charges vary from 63 to 108 marks per week ; re-
ductions for children and servants. The entrance fee is 20
marks. Baths, douches, rubbing, drugs and instruments,
beverages, afternoon milk, lighting, and, in the main block,
heating, are extra chargea
The sanatorium is exclusively reserved for consumptives.
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182 PRIVATE SANATORIA IN THE RHINE DISTRICT.
About 160 patients are admitted for treatment. The aver-
age for the last few years has amounted to from 400 to 450
patients per annimi. The medical oflBcers, who are well
known for their courtesy and ability, are Dr. Hess, Dr.
Besold, and Dr. Adolf Koch.^ Dr. Dettweiler, the consult-
ing physician, lives in Cronberg.
In the foregoing description I have been compelled to
call attention to a few small blemishes in this historic and
most valuable institution. That they have not greatly
diminished its utility is evident from the statistics pub-
lished of patients treated there (see p. 52), and from the
high reputation which it enjoys. I have mentioned these
defects both in the interests of accuracy and in the hope of
strengthening the hands of the medical oflBcers, who are
always endeavouring to improve the institution, but have
been hampered by exceptional difliculties in introducing
some of the recent improvements. Falkenstein was for
years the only sanatorium in western Germany for the
rational treatment of consimiptives, and has had a great
influence in promoting the erection of other sanatoria, both
in Germany and in other countries. For this reason, the
names of Dettweiler and of Falkenstein will always be
held in honour by practical physicians all over the world.
To Dettweiler also belongs the credit of having brought
about the erection of the neighbouring sanatorium for the
poor, which was the first of its kind in Germany (see p. 253).
Falkenstein may be reached by carriage from Cronberg,
which is the terminus of a short railway line from Frank-
fort, and about forty minutes' journey from that city. The
sanatorium can also be reached by carriage from Soden
railway station.
The Hohenhonnef Sanatorium
belongs to a company whose shares are held by the inhabi-
tants of a large part of western Germany, and of even more
distant parts. It was opened in October, 1892, under the
^ Since resigned ; see p. 196.
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Fio. 21.— The Hohekhonnek Sanatokium. [Face page 183.
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Basement: —
Thb Hohbnhonnef Sanatorium.
1. Cloakrooms.
2. InhaUtion Room.
8. Heating Apparatus.
4. Douche Rooms.
Ground Floor : —
1. Consulting and Waiting Rooms.
2. Winter Garden.
d. Reception Room.
4. Reading Room.
5. Ladies' Room.
6. Music Room.
7. Billiard Room.
8. Cloakrooms.
9. Servants' Room.
10. Nurses' Room.
11. Hairdressing Room.
12. Office.
18. Post Office.
14. Dining Saloon.
15. Serving Room.
Upper Floors :—
1. Nurses' Room.
2. Balcony.
8. Small Kitchen.
4. Rooms for Convalescents.
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D
S
03
a
o
u
M
1
ii
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PRIVATE SANATORIA IN THE RHINE DISTRICT. 183
auspices of Dr. Meissen, who was formerly one of Dr. Dett-
weiler*s assistants, and is situated in the Siebengebirge,
236 metres (774 ft.) above the sea-level, and 158 metres
(518 ft.) above the Rhine, in a beautifully wooded and
picturesque distinct, with fine views of the distant EiflFel
mountains and the Rhine valley. The climate of this
district is mild and sunny, but is not so dry as that of
central Germany. The soil is Lower Devonian, composed
of hard rocks at a considerable angle, so that it remains
very dry. The grounds cover about 40 hectares (98f acres)
of land, consisting partly of old and newly planted pine
woods, partly of garden, partly of vineyards, and are con-
tinuous with a large extent of similar land on three sides.
The sanatorium, which is built of white stone and plaster,
makes a very conspicuous landmark above the river side.
It has a south-westerly aspect, and is well sheltered by
higher hills (from 300 to 700 ft. higher) on the north and
east, but is still somewhat exposed to south-westerly gales.
However, these are not frequent, while the pine trees will
in a few years afford better shelter.
The sanatorium consists of a five-storey building (figs. 21,
22), with two wings which diverge at a somewhat more
open angle than those at Falkenstein. Owing to the slope
of the hill, the basement is on the ground level in front,
while the entrance behind is on a higher floor. The base-
ment is occupied by cloak rooms, bath and douche and
inhalation rooms, furnaces for heating the building, and a
few bedrooms for visitors. On the same level, in front
and round the eastern wing, is a deep verandah with
cemented floor, which can be protected when necessary
with glass, and part of which can be cooled in summer by
streams of water on the roof. This is used as a fresh-air
gallery, and is provided with cane lounge chairs, electric
lights and bells, and small tables. Above it is an uncovered
balcony. On the ground floor of the building are a series
of intercommunicating handsome reception rooms, consult-
ing rooms, laboratories, and drug rooms, as well as a few
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184 PRIVATE SANATORIA IN THE RHINE DISTRICT.
bedrooms for patients, and near the entrance the bureau
and post office. The upper floors contain patients' rooms
in a single row along the centre, a double row in the wings.
There are large balconies both front and back, the northerfy
ones being specially frequented in summer during the heat of
the day. Bath rooms, water-closets, rooms for attendants
eaid nurses, and a large room for convalescents, are found on
all the upper floors, which are served by a lift for patients,
as well as staircases. The patients' rooms are nearly all on
the sunny side of the building, and are well ventilated.
Each is 4 metres (13 ft.) high, and has large windows and a
chimney ; while none have less than 70 cubic metres (nearly
2500 cub. ft.) air space. The windows are double, for
extra protection in stormy weather ; the doors are also
double, to prevent noise. Great care has been taken in
constructing and arranging the sanatorium so as to facili-
tate thorough disinfection and cleansing without raising
dust. Angles and comers are rounded, projecting cornices
and mouldings avoided. The floors are made of "gyps-
dielen," consisting of bamboo and other light materials,
incorporated with plaster of Paris, and are covered with
linoleum or parquet. The walls are papered, as it is con-
tended that this facilitates natural ventilation through
their pores. Carpets, curtains, and the like, are sparingly
used, and chosen of kinds which do not hold the dust and
are readily cleaned. The furniture also is simply con-
structed but comfortable; leather-covered chairs, cane
lounges, and the like. The whole building is heated with
low-pressure hot- water pipes, which can be separately regu-
lated in every room, and is lighted by electricity. Even
the summer houses in the woods and the fresh-air galleries
are provided with electric light and electric bells. The
dining saloon — a large, handsome, well-lighted room — is
situated in a detached block to the north, reached by a
bridge from the first floor, and has no direct communica-
tion with the kitchen department and storage rooms
beneath. The servants sleep in a separate building in the
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PRIVATE SANATORIA IN THE RHINE, DISTRICT. 185
wood behind the sanatorium. The water supply, which is
excellent, comes from a deep well in the Asbach valley,
.about half a mile behind the institution, where also are
found the steam laundry and disinfector, and the engines
for pumping and electric lighting. The sewage and waste
water are carried into the Rhine after precipitation in
settling tanks with turf and coke bottoms, the solid parts
being mixed with peat and dried in sheds, and afterwards
applied to the land. At high tide the waste water is made
to irrigate a meadow. Kitchen refuse is buried with ashes.
Sputa are received into Dettweiler's flasks and elegant
coloured spittoons, which are disinfected with solution of
5 per cent, soft soap and 1 per cent, lysol. The linen is
disinfected by steam. After each patient's departure, the
walls are cleaned with bread crumb, which is then burnt.
In treatment, Dettweiler's methods are mainly adopted,
with certain modifications — patients taking rest or exercise
According to circumstances. There are now two fresh-air
shelters in the woods, and a third is to be constructed.
Some of the walks in the pine wood are very well sheltered,
And the fresh-air galleries next the sanatorium can be used
for both rest and exercise. One portion, indeed, can be
warmed in winter or cooled in summer. There is little or
no douching of patients, but rubbing with the wet sheet or
with spirit is commonly adopted. The food is exceptionally
good, five meals a day being provided. The milk is sup-
plied from a model dairy farm belonging to one of the
directors. Creosote, tuberculin, and other reputed specifics
are not used. There are three male and three female
nurses, one of each on each floor. A small Roman Catholic
chapel is to be found in the grounds, where service is held
once a fortnight. For Protestants, service is held once a
fortnight in the ladies* saloon. There is a good library, and
in other respects patients are well entertained and looked
After. Concerts are held about once a fortnight.
Separate houses for the chief medical officer and the
managing director have been recently built close to the
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186 PRIVATE SANATORIA IN THE RHINE DISTRICT.
western wing. This has set free additional rooms in the
sanatorium, so that there are now ninety beds, and very
shortly there will be 109 beds in eighty-eight rooms^
besides six private sitting rooma During 1897, 798
patients were received, with 31,325 days of treatment.
The charges are from 66 to 91 marks per week, with a.
reduction in case of friends, servants, and children. The:
entrance fee is 15 marks, and another 6 marks are charged
for disinfection and insurance. Beverages, baths, rubbing,,
douches, inhalations, laundry, table lamps in the bedroom,,
attendance at night, and meals in the bedrooms, are extra.
The medical director is Dr. E. Meissen, formerly Dr. Dett-
weiler's assistant. There are two assistant medical oflBcers.
— Dr. Schroder and Dr. van Ysendyck. The personnel
now number seventy-nine.
This is probably the most luxurious sanatorium for con-
sumptives on the continent. There is, indeed, a little-
danger lest the internal comfort should tempt the patients,
to spend too much time indoors ; but I saw no indications,
when I was there of such mistaken conduct, which is na
doubt prevented by Dr. Meissen's watchful care. There,
are fewer facilities for uphill walks from the sanatorium,
than might be wished, and the shelter from certain winds
is not yet sufficient; but in almost every respect it is a.
model establishment, marvellously complete in its details.
It may be reached by the right Rhine railway, taking,
carriage from Konigswinter or Honnef; or by the left
Rhine railway to Rolandseck, and thence by ferry to.
Honnef; or by steamer to Konigswinter or Rolandseck.
The institution is twenty minutes by road from Honnef,.
or forty from Konigswinter.
The Laubbach Sanatorium.
About twenty-five minutes' walk southward from.
Coblenz, on the left bank of the Rhine, in a sheltered cleft,
surrounded on three sides by mountains, is situated an in-
stitution which was originally a hydropathic establishment,.
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PRIVATE SANATORIA IN THE RHINE DISTRICT. 187
but has been recently acquired by Dr. Achtermann (for-
merly medical director of the Brehmer sanatorium), and
converted into a sanatorium for consumptives. About 8^
hectares (21 acres) of land belong to the establishment^
which are mostly wooded with deciduous trees, and touch
the town woods of Coblenz. The well-known castle of
Stolzenfels is a short distance off, and the pleasure gardens
by the side of the Rhine are also close by. The soil is
rocky, and in the sanatorium grounds is free from dust.
Owing to its sheltered position the place is said to be
2° to 3° R. cooler in summer, and about as much warmer in
winter, than the immediate neighbourhood The climate
resembles that of the Rhine valley generally, and is mild
and moderately humid. The shelter against wind is ex-
tremely complete.
The sanatorium is 80 metres (262 ft.) above the sea-level,
and some 20 or 30 above the Rhine. It has been a health
resort since 1840, but was rebuilt in the eighties by Dr.
Auerbeck. Passing up the avenue of chestnut trees which
form the approach, we come to an open square with a few
smaller trees in the centre and several large blocks of
buildings to right and left. On the right is the bath
house, with various hydropathic appliances, the office and
consulting room, a winter garden, and two more large day
rooms.
On the upper floor are thirteen patients' bedrooms. On the
opposite side of the square is the main building, with lifty*
four bedrooms on the upper floors, and a handsome lofty
dining saloon on the ground floor, and near this a light and
airy kitchen. The windows of the dining saloon are large ;
in front they look on to the open courtyard ; at the back they
are semi-opaque, to shut out the sight of the cliff. Touch-
ing the main building is the ** doctor's house," which has
fourteen patients* bedrooms, and in the basement a smaller
dining saloon for the " first-class patients ". Next this is a
viUa with seventeen bedrooms, and a little higher up in the
grounds are two others with fifteen rooms, thus making a
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188 PRIVATE SANATORIA IN THE RHINE DISTRICT.
total of 113 bedrooms available for patients. The rooms
vary in size, but are all lofty, and average 80 cubic metres
<2825 cub. ft.) air space. They are furnished and decorated
in much the same style as the average hotel of the Rhine
district, and are all single bedded. The buildings are heated
by hot- water pipes and by closed stoves, and lighted by the
Coblenz gas supply. The ventilation is by open windows ;
there is usually no chimney. The sewage is carried through
the Laubbach into the Rhine. There is a chapel on the
^grounds ; also several shelters for the fresh-air treatment,
besides protected seats under the trees. The patients are
ivell provided with means of amusement, as there are a
billiard room and a bowling green, in addition to the
library of books, etc.
The establishment is not entirely reserved for consump-
tives, as those in need of change of air are also admitted.
No hopeless or advanced cases are accepted, but there are
two sick nurses in the establishment in case of need.
Treatment is on the usual lines. Laryngeal, pharyngeal,
and nasal complications are said to do better than in more
elevated districts. The usual five meals a day are provided.
The douche is freely used in all cases which are sufficiently
robust. Wine and spirits are prescribed when advisable.
No cod-liver oil or reputed specifics are employed. Sputa
are received into Dettweiler's flasks ; they are kept moist
until they can be poured into the water-closet, but are not
disinfected. Linen is boiled; walls purified by bread
crumb, which is afterwards burnt.
The charges are 6 marks per day, including attendance,
rubbings, douches and baths, and ordinary medical attend-
ance. Rooms are 1 50 to 5 marks per diem. Another 2
marks per week^re charged for the use of bedding, includ-
ing the washing of bed linen ; but patients may, if they
prefer, bring their own. There is an entrance fee of
20 marks. Beverages are extra, and in winter 6 marks
per week are charged for heating and lighting. Reductions
Are made for visitors, children, and attendants.
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private sanatoria in the rhine district. 189
Second-Class Patients
are also received into the sanatorium. Their food is some-
what simpler, but the treatment is otherwise the same.
They pay an entrance fee of 12 marks, and 145 to 160-
marks per month for board and lodging, including every-
thing excepting beverages, medicines, and bedding. For
the latter, 1*50 marks per week are charged. In winter,
an addition is made of 3 marks for heating and lighting.
There are reductions for visitors and attendants, as in the
case of " first-class patients ".
This sanatorium is at present in a state of transition, and
will in (perhaps) the near future be considerably improved.
Dr. Achtermann has been put to considerable expense in
making the absolutely necessary alterations ; but with his.
long experience at Gorbersdorf to help him, he is sure to
eventually bring the establishment into the first rank.
The first- and second-class patients are lodged in separate
buildings, but are close together. As already explained,
they have separate dining saloon&
The nearest railway station is the Moselbahnhof at
Coblenz.
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192 THE BLACK FOREST PRIVATE SANATORIA.
with large windows back and front, linoleum-covered floor^
and varnished panelled wooden walls. These windows are
taken out of their frames during the warmer part of the
year ; those in front look out upon the road, those behind
on the side of the hill. ITie dining saloon and a small
ante-room with piano and library constitute all the common
rooms in the sanatorium, so that there is every inducement
for the patients to spend their time out of doora The
houses are not connected in any way, so that the road has
to be used in going to and fro. The main building is situ-
ated on the slope of the opposite hill, some 20 or 30 feet
higher than the dining saloon. It is a plain wooden build-
ing with^a little turret at each end, consisting of a single
row of bedrooms on the ground floor, with corridor at the
back, and a similar set of rooms above. The main aspect
is south-east, and the ends of the building retreat slightly to
follow the convex face of the hill. The patients' bedrooms
are not particularly large (3*5 metres x 4'5, and 2*7 high,
or 11 ft. 6 in. X 14 ft. 9 in., and 8 ft. 10 high) ; but they
have a relatively large window space amounting to about
half the size of each room, and the windows and doors are
permanently kept open. The walls and ceilings are entirely
lined with plain varnished wood, which is revamished when-
ever a patient leavea The floors are covered with linoleum,
which is washed down every morning. In one comer of
each room is a shower bath or douche apparatus ; in an-
other is a plain iron bedstead with woollen bedclothes;
and the remaining furniture is of lacquered wood or iron,
and of equally simple character. There are no carpets or
hangings. Hot and cold water are laid on for the douche
and the washstand. The corridor is similarly built with
pinewood panelling, which here is oiled. The windows of the
corridor are opposite the bedroom doors. The water-closets,
which are built out of the corridor, are provided with a
good flush of water. Twenty patients can be accommo-
dated in this building. The rest are lodged in other villas,
farther up the valley. Dr. Walther occupies one of these*
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THE BLACK FOREST PRIVATE SANATORIA. 193
Another villa is occupied by eleven slight cases ; this is the
only existing building in the sanatorium which has a com-
mon bath-room for the patients. In all essential respects,,
the other villas are constructed and furnished like the main
building. There are no special ventilating contrivances.
The lighting throughout the sanatorium is by electricity
generated by a motor driven by water power; all the
rooms, too, have electric bells; and one entire viUa isi
heated by electricity. Elsewhere the sanatorium is heated
by low-pressure steam pipes, which can be regulated for
each building as a whole. Passages and closets are not
separately warmed. There is a good and plentiful supply
of drinking watef from springs out of the sandstone rock.
The sanatorium possesses its own farm of ten cows, which
are fed on barley and hay only. The milk for cooking
is, however, obtained elsewhere. I believe, though I un-
fortunately forgot to ask Dr. Walther about it, that he
considers it unnecessary to test the cows with tuberculin.
Patients have the milk fresh or boiled, whichever they
prefer. There is a steam laundry in the sanatorium, and
a mechanical refrigerator for meat and for ice. All meat
is kept a fortnight before being used.
Some of the descriptions of Nordrach Colonic give rather
a wrong impression of the place, as if it merely consisted
of ordinary peasants' houses and were devoid of all comfort.
No attempt is made, it is true, to provide more than ordi-
nary comfort, or to rival the luxury and sumptuousness of
a lirst-class modem hotel. But these are not at all neces-
sary, and in some respects are misplaced in a sanatorium.
The rooms, as far as I saw them, were exceedingly care-
fuUy and practically, though simply, fitted up, and were
exquisitely clean and sweet, which is more than can be
said of one or two other sanatoria that I have seen.
Opinions may difier as to particular details of Dr.Walther^s
system of management, but for all that he does or omits he
has excellent reasons to give.
Open-air treatment at all hours, weathers and seasons is
13
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194 THE BLACK FOREST PRIVATE SANATORIA.
very rigidly enforced, extra wraps being provided in bad
weather, but no other difference being made. Patients
walk about in even rainy weather without any special
protection. They take their own temperatures four times
A day in recto as a guide to treatment. Dr. Walther
regards all other methods as fallacious and misleading.
Until for eight successive days the temperature has failed
to reach 38° C. (100*4'' F.) patients are kept absolutely at
rest in bed with open windows. They are then permitted
to take very gradually increasing exercise, mainly walking,
never faster than two miles an hour, so as not to cau^e
dyspnoea or disturb the circulation. The first walk may
only consist of a few yards on level ground, followed by a
long rest on a lounge chair irfthe open; afterwards shorter
or longer uphill walks are prescribed, according to the
progress made. Patients are encouraged to do without
heavy overcoats and wraps while out walking, although
they may wrap up as much as they like while resting.
Not more than three or four are aUowed to walk together,
and visits from friends or relatives are discouraged. Even
attendance at the little chapel at Nordrach is objected to,
although there is no regular service in the institution. Dr.
Walther believes weather and season to be of no import-
ance, and does not even take meteorological observations.
Nor are any special precautions adopted against draughts.
As he himself told me, patients live in a thorough draught
from the first moment of their arrival, with absolutely no
bad effects, although no attempts are made to "harden
them" against catching cold. Hydrotherapy is not syste-
matically employed with this object, but patients bathe or
douche themselves with hot or cold water, very much as their
own instinct leads them, and in clothing are also allowed to
please themselves within certain limits. They rest every
day for an hour before the mid-day and evening meals.
Several inaccurate accounts have been given concerning
the diet at Nordrach, even by presumably trustworthy ob-
servers, and Dr. Walther was at some pains to correct these
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THE BLACK FOBEST PRIVATE SANATORIA. 195
inaccuracies. Three meals a day are provided, at 830 A.M.,
at 1 and at 7 P.M. The breakfast consists of coffee, bread
and butter, and cold meat of some kind. Dinner includes
two hot courses of meat, or fish and meat, with plenty of
potatoes and green vegetables, and sauces containing butter.
Following this are pastry, farinaceous pudding, fruit or ice
cream, with coffee to finish. Supper consists of one hot and
one cold course, together with tea. Milk is added to the
dietary until the patient's weight has reached a reasonable
standard, never more than a half -litre being given With each
meal. The meals are taken in the presence of the doctor,
who encourages the patient to finish what is given him, and
eat a reasonable quantity of every kind of food provided.
The stories about patients being compelled after vomiting
to begin their dinners over again against their will are
inaccurate. So also are the statements as to enormous
quantities of meat or food generally being given. The
proportion of nitrogenous food given is if anything less
than usual; and no attempt is made to emulate Debove
and others of the same school in hyper-alimentation. The
quantity is regulated so as to produce a steady gain in
weight during the earlier weeks of about one lb. per week.
Under this regime dyspepsia is said not to be common, and
soon to disappear, if present, with improving nutrition and
strength. The use of alcohol is kept down to a minimum,
without any absolute prohibition.
Drugs are but little used, cod-liver oil, creosote and re-
puted specifics not being employed. Sputa are disinfected
with liquor potasssB, and then poured down the water-closet.
Each patient has his own Dettweiler s flask for the pocket
and a spitcup in his bedroom, and spitting elsewhere is
strictly forbidden. Linen is disinfected by boiling; the
rooms by washing and airing and revarnishing. There are
practically no amusements, excepting walking, reading, and
occasionally a little music. Light literature is permitted,
but business communications or work of any kind are
forbidden.
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196 THE BLACK FOREST PRIVATE SANATORIA.
Monthly examinations are made of the lungs and expec-
toration. When after about twenty examinations no bacilli
are found in the sputa, and when after injection of one cc. of
the sputum into a guinea pig tuberculosis does not appear
within three to six weeks, the patient is considered fit to
return home, and to undertake moderate regular work.
Dr. C. Reinhardt writes:^ "All nationalities seem to be
represented, the whole company presenting a lively, well-
dressed, and happy appearance. I spoke with many
patients . . . and did not find one who had not gained in
weight or who had suflfered from dyspepsia or nasal catarrh
after the first month. Every case had experienced im-
provement, and several were apparently cured. The friend
of mine, a medical man, whose cure had first directed my
attention to the place, remains well and is in active pursuit
of his profession, although, before his visit to Nordrach, he
had been in an advanced phthisical condition, with a large
cavity in the right apex and much general emaciation,
whilst his sputa had teemed with bacilli/'
The charges, which include everything excepting wash-
ing, alcoholic drinks, and the services of a special nurse,
amount to 10 marks per diem ; friends pay 7 marks.
There are arrangements for the schooling of children dur-
ing their stay. Dr. Walther is aided in his work by an
assistant.
The place is nine miles from Biberach-Zell, and ten miles
from Qengenbach, on the Black Forest Railway, whence it
may be reached by carriage.
The Schomberg Sanatorium
is situated in Wtirtemberg, in the northern part of the Black
Forest, south-east of Pforzheim, and not very far from
Wildbad. A convalescent home was erected here in 1888
by Herr Rompler, which, being much frequented by con-
sumptives, was converted in 1890 into a sanatorium ex-
clusively for such patients, and placed under the care o£
^ British Medical Journal, 7th August, 1897.
Digitized by LjOOQIC
Digitized by LjOOQIC
Digitized by LjOOQIC
THE BLACK FOREST PRIVATE SANATORIA. 197
Dr. Baudach. It is now under the medical direction of
Dr. Adolf Koch, formerly of Falkenstein, Dr. Baudach
having resigned. There were originally only twenty-five
beds ; but in 1893 a large three-storey building was erected,
with forty beds, when the older building was utilised for
the reception of less wealthy patients (see p. 260).
The village of Schomberg lies in a valley on the mountain
crest, between the Enzthal ^nd the Nagoldthal, at an altitude
of 650 metres (2130 feet) above the sea-level, and surrounded
by pine-clad heights to the north, east and west. The
sanatorium is on the southern slope of a hill in the midst
of the village, but in a fairly open situation. It has about
1^ hectares (3^ acres) of ground, partly laid out as a garden.
The paths all lead uphill towards the woods, which are
distant about ten minutes' walk. The soil is of porous
sandstone, as in other parts of the Black Forest ; the climate
in summer cool and pleasant, without excessive evening
fall of temperature, and in winter is for the most part
sunny, the snow remaining the whole season on the ground.
The building (fig. 23) has a south-south-east aspect, all the
patients' rooms being on the south side. It is of oblong form,
with a deep verandah along the front, and balconies to every
other floor but the uppermost. In the basement there are
a douche room, a large steam disinfector, laundry, kitchen
and central heating apparatus for low-pressure steam pipes.
The ground floor contains the dining haU and other assembly
rooms, such as the reading room, billiard room, and ladies*
room. The largest of these contain respectively 250 and
320 cubic metres (8825 and 11,300 cub. ft.) air space. On
the upper floors are the bedrooms, and on each floor a bath
room and servant's room. The rooms have an average
capacity of 60 to 80 cubic metres (2120 to 2820 cub ft.) ; their
walls are oil-painted for 1| metres from the ground near
the beds, colour-washed elsewhere. They are ventilated by
air shafts, and by open upper hinged window panes, and
decorated simply but comfortably. The heating is by low-
pressure steam; the lighting partly by benzine incandes-
Digitized by LjOOQIC
198 THE BLACK FOREST PRIVATE SANATORIA.
cent lights or petroleum, partly by means of candle& There
is a good water supply. The water-closets lead into
settling tanks.
The treatment is much as at Falkenstein, with a large
proportion of rest in the open air. Besides the fresh-air
verandah, which is intended mainly for those whose rooms
have no balcony, there are several shelters in the grounds,
in one of which, on the edge of the wood, patients can
obtain milk, and enjoy a beautiful view of the surrounding
country. There are five meals per day, in addition to
milk before bed time. The douche and cold rubbing are
frequently used ; cod-liver oil if desired ; " specifics " are
not administered. Sputa are received into water but not
disinfected ; linen is purified by current steam ; rooms with
creolin and formalin. Only one patient sleeps in each
room. There are one male and one female nurse ; besides
which nursing sisters are obtainable in case of need. The
general management is in the hands of Herr Rompler,
himself an example of recovery from pulmonary disease.
The medical director, Dr. Koch, who lives in another house
close by, is assisted by Dr. Wehmer, formerly at Gorbers-
dorf. The latter lives in the sanatorium.
A good library, piano, croquet and other games are pro-
vided for the patients. There is a Protestant service in the
village church ; no Roman Catholic service is available.
The charges are from 32 J to 57 marks per week, in addition
to 5 marks for the first consultation, 1'50 for attendance,
1 mark for the bath attendant, and extra for beverages,
douches, baths and drugs. The usual reductions are made
for friends, servants and children.
Schomberg is a telegraph station, and is on the telephone.
It may be reached by carriage in IJ hours from Liebenzell
(on the line from Pforzheim to Calw), or from Hofen (on
the Wildbad line). Heavy luggage comes via Hofen.
Pforzheim is not far from Carlsruhe.
There is accommodation in the old and new Curhaus
together for 140 patients (see p. 260). The average number
Digitized by LjOOQIC
THE BLACK FOREST PRIVATE SANATORIA. 199
of patients treated during the four years 1893-96 was 358,
with 10,324 days of treatment (Hohe, Die Bekcumpfung
und Heilung der Lungenschwindsiicht, Munich, 1897).
Dr. Sander's Sanatorium,
in St. Blasien (Baden), was founded by Dr. Haufe, in 1878,
but has been since 1895 under the management of Dr.
Albert Sander.
St. Blasien is an ancient and picturesque little town in
the valley of the Alb, in the southern portion of the Black
Forest, famous for its eleventh century cloisters and church,
and boasting of a flourishing kursaal and hydropathic
establishment. The district is on primary rocks, and
possesses an equable climate, with fairly cool summers and
mild winters. The town itself, however, is somewhat shui
in, as, notwithstanding its elevation above the sea-level
(800 metres, or over 2600 ft.), it is surrounded on all sides
by mountains, one of which — the Feldberg — is the highest
peak in the district, and rises to a height of 4900 feet. This
circumstance renders the place unpleasantly hot in the
height of summer, although in winter it is probably much
more agreeable. The drainage is also somewhat primitive,
and spoils the charm of what would otherwise be at certain
seasons a most desirable health resort.
Dr. Sander's sanatorium is at the western end of the
town, on the pine-clad valley side, a little raised above the
main road, and nearly 100 feet above the lowest part of the
town. It has a southerly aspect, and consists of three
separate buildings, united by a glass verandah 70 metres
long, and provided with terraces, balconies, and other
verandahs for rest in the open air. Behind it rises the
forest, which is traversed with paths and has a large shelter
among the pine trees, for use in bad weather. The old
building has kitchen and disinfecting apparatus in the
basement, two dining rooms, several assembly rooms, wai ting
and consulting rooms and the office on the ground floor ;
and, above this, two floors with twenty-six bedrooms for
Digitized by
Qoogle
200 THE BLACK FOREST PRIVATE SANATORIA.
patients. The new villa has fourteen patients' rooms, as well
as those for Dr. and Mrs. Sander and family. Additional
accommodation can be obtained in a third building touch-
ing the sanatorium, but belonging to a different owner.
The rooms are four metres (13 ft.) high, and are comfort-
ably furnished, with papered walls, parquet floors, and
linoleum in the corridors. Carpets are only used as strips
by the bedside. The sofas and stuffed chairs have washable
covers, and the curtains are also washable. The common
rooms have air shafts for ventilation ; the bedroom windows
have ventilating panes above, which can be separately
opened. There are bath-rooms and covered verandahs on
every floor, and lifts for wood and food. The heating is
mainly by means of tiled stoves, in which beechwood is
exclusively burnt. The corridors and staircases have regu-
lating anthracite stoves, the closets being also warmed
The latter are mostly of a new pattern, but are connected
with cesspools. However St. Blasien is now being sewered,
so that the sanatorium will in due course profit by the
sanitary improvement. The whole establishment, including
the " liegehalle,*' is electrically lighted. The well-kept
garden is directly continuous with the pine wood behind
the sanatorium. There are two bridges from the second
floor of the building, leading directly into the woods.
Treatment is by the usual methods. Patients are kept
indoors when the thermometer falk below — 7*" C. Spwta
are collected in elegant spittoons and disinfected by three
per cent, solution of lysol. Patients' linen is washed in
the town. There are live meala a day. There is plenty of
amusement for the patients, both in the establishment and
(during the season) in the town. Indeed Dr. L^on Petit
rightly regards the proximity of the kursaal as a serious
drawback to the treatment. There is at present no douche
room in the sanatorium, so that patients have at times been
sent to that in the town. But this defect will probably
soon be remedied. There are Protestant and Roman
Catholic churches in St. Blasien.
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THE BLACK FOREST PRIVATE SANATORIA. 201
The charges are from 68 J to 82^ marks per week. Wood
for the bedroom stoves is extra, as well as beverages and
an entrance fee of 10 marks.
There is accommodation for over sixty patients, fifty-one
in the old and new buildings, and eleven in the dependance.
The average number of patients treated during the five years
1892-96 was 133, with 11,802 days of treatment. Patients
3re admitted at all stages, and stay from four to fourteen
months. An assistant physician helps Dr. Sander in his
•duties.
The place is not very convenient of access, as it is distant
26 kilom. (16 miles) from Albbruck on the line from Basel
to Constance, and 30 kilom. (over 18 miles) from Titisee
on the HoUenthal Railway (Freiburg to Neustadt). This
necessitates a drive of about four hours by omnibus or
•carriage.
Many of the foregoing particulars have been obtained
from Hohe*s book,^ as Dr. Sander was unfortunately absent
3t the time of my visit, and I was unable to wait for his
return.
Dr. Leiser's Sanatorium.
It is stated by Moller,^ L^on Petit,^ and Kuthy,* that a
:sanatorium for consumptives exists at Badenweiler. Leon
Petit refers to it as rather a boarding-house or convalescent
!home, where those in need of change of air, as well as early
stage consumptives, are received. Both he and Moller state
that it was to be rebuilt and replaced by a larger establish-
ment ; and Kuthy, who gives a fuller description, and states
that it is under the care of Dr. Leiser, also mentions the
projected rebuilding. I was unable to find such an estab-
lishment at Badenweiler itself, but was told of one being
huilt five or six miles farther east, at Marzell, on the
Blauen, which time did not permit me to visit.
1 Loc. cit
*Les Sanatoria pour le traitement de la Phtiaie Pulmonaire. Brussels ,
1894.
• Loc. ciL * Loc, cit
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204 GERMAN SANATORIA FOR THE PEOPLE AND CHILDREN.
societies, with the Empress as its patron and the Imperial
Chancellor as president. It publishes a sheet once a month
{Heilstdtten Correspondem), edited by Dr. Pannwitz. A
permanent committee for combating tuberculosis is also
being appointed by the German Society of Naturalists
and Surgeons.
Speaking in 1895 at the meeting of the German National
Health Society, Prof. v. Leyden stated that there were in
Germany only two sanatoria and two small houses where
the poorer class of consumptives could be received for
hygienic treatment. At the present time, however, there
are nearly thirty already built, or approaching completion,
while a number of others have been projected. This rapid
progress has been mainly owing to the law enforcing
compulsory insurance against sickness and old age on all
whose annual income is under £150 per annum. This Act,
which was passed in 188?, contains a clause permitting any
sickness insurance society to devote part of its funds to the
treatment of the sick in lieu of sick pay, and under this
clause large sums of money have been expended in the
erection and maintenance of sanatoria for the hygienic
treatment of consumption. Within two years of the passing
of the Act there were in Germany 11,200,000 persons in-
sured against sickness and old age, and the various societies
had collectively a capital of 162,850,000 marks. It has been
estimated that half of the applications for sick pay between
the ages of twenty and twenty-nine among the insuring
classes in Germany are because of tuberculosis, so that it is
not surprising to learn that in 1897 out of thirty-seven dif-
erent sickness insurance and friendly societies, thirty-three
had spent more or less of their funds on the hygienic treat-
ment of consumptives. Altogether 4480 such patients were
assisted by these societies in 1897, and of this number 4432
were treated in sanatoria or country colonies. In one way
or another about 1,300,000 marks were invested in sanatoria
during 1897 by these thirty-three societies ; and for this
year (1898) between three and four million marks have
Digitized by LjOOQIC
GEBMAN SANATORIA FOR THE PEOPLE AND CHILDREN. 205
been set aside for the same purpose. In some cases money
has been advanced on mortgage, in others the whole cost
of erection has been borne by the society.
Gebhard, the director of the Hanseatic Sickness and Old
Age Insurance Co., proved that if, out of 500 consumptives,
140 could be so far restored as to do without sick pay for
a year, this would recoup the company for the cost of
treatment in a sanatorium, or for the erection and mainte-
nance of one of its own. This Hanseatic Insurance Co. is
now one of several which possess sanatoria of their own.
As a rule, the first step has been to send such consumptive
patients to a suitable country viUage for treatment, or to
pay for them at an existing sanatorium. After a while,
when the numbers warranted such a step, the right to a
number of beds has been purchased, or a private sanatorium
erected by the company. Local societies for the erection
of sanatoria have usually begun by spending part of the
interest on money subscribed in maintaining a few patients
at one of the various sanatoria, while the rest of the interest
was added to the principal until such time as the funds
were suflScient for the erection of a fresh sanatorium.
The popular sanatoria which have already been erected
are for the most part described in the following chapters.
A number of others, however, have been projected. Every
large town, in fact, and every district of Germany now
has its local sanatorium society, and often already its own
sanatorium.
In the following tables the German popular sanatoria
have been placed for the sake of convenience in two groups,
one including eastern and central Germany, the other
western and southern Germany. In the description which
follows, a geographical order has been adopted which
roughly corresponds with that in the chapters on private
sanatoria.
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"206 GERMAN SANATORIA FOR THE PEOPLE AND CHILDREN.
German Sanatoria for the People.
Eastebn and Cbntbai. Gebmaky.
Feet.
Beds.
Silesia
1840
180
»f
984
87 (100)
f*
?
?100
? Brandenburg
?
?100
i»
?
80-90
»•
?
30
?
60
»»
126
80(160)
ft
102
86
? Pomerania
?
80
Saxony
2800
122
2180
?
t»
?
38
Harz
2100
115-120
?
80
f»
1880
68
ft
1850
20
?1600
120
»t
?1800
?
1470
?36
1800
40
Thuringia
?
abt.80
t>
1720
?
t»
?
?
Gorbersdorf, Krankenheim
Loslau ....
(Oberkaufungen for Cassel)
(Beelitz) .
(Belzig) .
(Bleichrdder, Belzig)
Blankenfelde ' .
Grabowsee .
Malchow .
(Stettin) .
Albertsberg
(Plauen) .
Jonsdorf, Conval. Home
Oderberg .
St. Andreasberg, Felixstift
Stiege, Albrechtsbaus
(Stiege, Marienheim)
(Sulzhayn)
Altenbrak Colony
Kdnigsberg, Conval. Home
Zellerfeld .
(Berka Emskopf)
(Manebach|
(Erfurt, Jonanniter)
North-west akd
South-west Gb
BMANY.
Feet
Beds.
Rehburg (Bremen San.) .
Hanover
?320
30
Altena ....
Westphalia
1380
100
Honnef, Philomenen
Rhenish Prussia
?260
?
(Dusseldorf)
»»
?
?
Ruppertshain .
(Hochst am Rh.)
Dannenfels
1300
88
»»
?
120
Palatinate
1300
18
(Speyer, Albersweiler)
f»
1250
?
(Worms, Felsberg) .
»i
?
?
(Saarbrdcken, St. Amual)
Alsace-Lorraine
?
?
(Metz)
„
?
?
(Wiirzburg, Lohr)
Bavaria
30
(Nuremberg, Engelthal)
»»
60100
(Planegg-KraiUing) .
114
(Harlaching)
„
200(350)
Stuttgart, Neustadtle
Wurtemberg
?
?
Schomberg, Colony .
»»
2130
60-65
Arlen
Baden
1380
16
(Marzell)
f»
2760
108
Digitized by LjOOQIC
V
german sanatoria for the people and children. 207
Seaside Sanatoria for Children.
The society for the erection" of seaside sanatoria has been
established for about eighteen years. It has four sana-
toria : at Nordemey (Kaiserin Friedrich Ho8piz\ at Wyk
on the island Fohr, at Zoppot near Dantzig, and at Gross
Muritz on the Mecklenburg coast. The Nordemey Hospiz
is the largest, and received as many as 149 visitors in 1894.
These sanatoria are not specially for consumptives, and
resemble our own convalescent homes.^
^ Brit, Med. Jour,, Ist June, 1895.
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CHAPTER XXXIII.
SANATORIA FOR THE PEOPLE IN EASTERN GERMANY.
Although Silesia was the original home of the Brehmer
system of treatment, few sanatoria for the poor have been
erected in Eastern Germany. A large open colony exists
at Gorbersdorf under Dr. Weicker, the proprietor of the
Countess v. Piickler's sanatorium for pajdng patients (see
p. 157). Another open health resort or colony for con-
sumptives may be found at Wolfelsgrund, south of Glatz^
near the Schneeberg; and this year a closed sanatorium
for the poor has been opened at Loslau.
It is stated that in Silesia alone, out of 140,000 deaths
per annum, about 11,000 are caused by consumption; so
that the supply of sanatoria for the poor is evidently in-
sufficient. A meeting was held this year at Breslau, with
Count Hatzfeld in the chair, at which the erection of such
a sanatorium for Silesia was decided upon ; and a site is
being sought in the Riesen and Eulen Gebirge. Quite
recently a legacy of 30,000 marks has been left by a lady
for the same purpose. A legacy has also been left for
the erection of a sanatorium of 100 beds at Oberkaufungen
for the Vaterldndiache Frauenverein at Cassel. Dr. Osius
will be the medical officer.
In East Prussia a similar scheme has been originated
by the local medical association ; and at Dantzig, in
West Prussia, money is also being collected for a sana-
torium.
(208)
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sanatoria for the people in eastern germany. 209
Dr. Weicker's Krankenheim,
at Gorbersdorf, is not a " closed sanatorium," but consists
of a number of separate houses in the village, devoted
since 1894 to the treatment of consumptive patients of the
poorer classes. Only one of these — the so-called doctor's
house — belongs to Countess v. Piickler*s bequest (see p.
157), and is occupied by an assistant physician under Dr.
Weicker, having been altered to suit modem requirements.
This house contains the kitchen, dining rooms, and adminis-
trative rooms, as well as beds for those who may be attacked
by intercurrent ailments. The other houses contain each a
common room, in addition to bedrooms for the patients.
Men and women are separately lodged, and have separate
collective dining rooms ; the women occupying eighty beds
in three houses. Nearly all of the villas have balconies ; but
there are also three large sun galleries for common use.
Many of the houses were built in Brehmer*s time for a
better class of patients, but have nothing very unusual
in their mode of construction. Others are ordinary village
houses altered to suit their new functions. In every case
a garden surrounds the house. The rooms are described
by Hohe ^ as being lofty and cheerful. The dining-rooms
are on the south side. Walls are colour-washed or oil-
painted. Windows have washable blinds. The heating is
by means of porcelain closed stovea Most of the bedrooms
contain each two to three beds^ some being single bedded.
The beds are of iron, on wire mattresses, and provided with
over-mattresses. The bedding is of wool, changed every
week or fortnight. Every patient haa his own wooden
washstand without drawers. Spittoons of hour-glass shape
are provided in the common rooms, placed on shelves at
a convenient height, and none in the comers. In the bed-
rooms it was found unsafe to use these, as patients amused
themselves in aiming at them from a distance, so that only
' Die Bekdmpfung und Heilung deer Ltingensckwindsuchtf Munich,
1897.
14
Digitized by LjOOQIC
210 SANATORIA FOR THE PEOPLE IN EASTERN GERMANY.
spitcups are used there which must be taken up in the
hand. Both kinds are partly filled with lysol solution.
In addition to this, every patient receives on arrival a
portable spitting flask as well as a thermometer ; and the
usual strict rules are adopted concerning random spitting
or the use of handkerchiefs.
There are at present altogether 180 beds for patients.
The increase in the numbers frequenting the Krankenheim
is very remarkable, only twelve patients having been treated
in 1894 and 510 in 1897: Patients agree to stay at least
.six weeks and usually remain twelve or thirteen. The
payment is 26 marks per week in summer, 28 in winter.
The majority are sent by the Insurance Companies and
Benefit Societies, comparatively few paying directly for
themselves. The men are under a house physician, with
two or at times three male nurses (Kraschnitzer diakonen) ;
the women have a separate house physician, sister and
female nurse. In addition to this, one patient in each
house is chosen by the rest to act as Obmdnn, He has to
i;ake the temperatures every morning and evening (in the
mouth), to see that rules are kept, and to report any breach
of discipline or any complaint, which must be made in
writing. The Ohmdnner collectively meet Dr. Weicker
every Sunday, to report progress and make or receive
suggestions.
The open-ail' treatment is carried out in the usual manner,
excepting that the lounges are collapsible iron ones ; ^ and
that, owing to the situation of the sanatorium, the patients
have to use the public roads on their way to the woods.
Patients use the same woods as those of the private sana-
torium at Schmidtsdorf (see p. 157). The patients* beds are
numbered, and each number entitles the occupier to three
hours* rest in the fresh-air gallery, according to a pre-
arranged list, thus preventing any clashing. Where longer
rest is needed, the patient receives additional numbera
^ Described by Beaulavon, Contrib, d VHude du traitement de la Tiiber^
cuhse pulmonaire dans lea Sanatoria. Paris, Bataille & Co.
Digitized by LjOOQIC
SANATORIA FOR THE PEOPLE IN EASTERN GERMANY. 211
In winter each patient receives two earthenware hot bottles,
which he fills himself. The day begins early, breakfast
being at 7 a.m. in summer, 7*30 in winter. The second
breakfast is at 10 A.M., dinner at 1 p.m., another meal at
4, and supper at 7. The food is varied as much as pos-
sible, although diflSculties are found owing to the dainti-
ness of patients and the restricted dietary of the average
German working class household. Patients of this class,
it is said, will not touch fowl, game or fish, and often object
to beef, as well as to a number of dishes commonly used in
middle class households. Much butter and milk are used
at the sanatorium, the proportions of albumen, fats and
carbohydrates in the dietary being calculated for 121, 104,
and 400 grms. respectively. The midday dinner consists of
soup, one course of hot meat, two vegetables, and fresh or
cooked fruit ; the supper of soup, one course of meat (hot
or cold), and potatoes. The whole number of patients are
brought together once a week to be weighed, and this
occasions much friendly rivalry. The weight of the naked
body is carefully estimated on entry and on leaving.
It has not been found practicable to let the patients do
any work, as their capacity for work is very unequal, and
yet each wishes to do like his neighbour; moreover, in
case of haemoptysis or other complication, the physician is
blamed for letting them work. Contrary to the experience
of some other directors of sanatoria for the people. Dr.
Weicker has not found the women any more easy to man-
age than the men. To occupy the patients, as well as to
aid their recovery, systematic bathing exercises are pre-
scribed ; courses of instruction in wood-carving, shorthand,
etc, have also been begun and no evil results have so far
been observed. Rubbing, baths and douches are prescribed
in much the same way as at Dr. Weicker's private sana-
torium.
Dr. Weicker and the senior resident medical oflScer are
responsible for the whole conduct of the establishment, both
in medical and in other matters.
Digitized by LjOOQIC
212 SANATORIA FOR THE PEOPLE IN EASTERN GERMANY.
The results of treatment have been very satisfactory.
Out of 395 patients who left in 1897 with 30,245 days of
treatment, 76*5 per cent, were restored to their full and 12
per cent, more to conditional working capacity.
For climate and other details, see also the description of
Dr. Weicker's private sanatorium, p. 157 and also p. 150.
The Loslau Sanatorium
was opened in July, 1898, by the HeUatdtten-verein filr
LungenkraTike for the district of Oppeln in Silesia, under
the presidency of Regierungsrat Dr. Both. It is a closed
establishment exclusively for consumptives of the male sex
belonging to the less wealthy classes, such as artisans, clerks,
shopkeepers, teachers and the like. Arrangements have
been made with the Silesian Insurance Society at Breslau
to receive their clients in case of need.
The sanatorium stands at an altitude of 300 metres
(984 feet), in 94 hectares (232 acres) of land, of which 91
hectares are pine wooda Touching the grounds is a large
forest, the use of which is secured by contract. The build-
ing has a southerly aspect, and is sheltered from wind to
the north, north-east and north-west. It is a somewhat
plain-looking structure of wood and iron, with a long fresh-
air gallery on the south side in front of the basement, above
which are a ground floor and two upper floors. It has a
large dining saloon and day room, balconies to the upper
floors, and bedrooms to accommodate respectively one, two,
three, and four patients each. The cubic space allowed in
these amounts to 48 cubic metres (1695 cubic feet) per head,
the ventilation being effected by open windows and air
shafts. The walls are coated with enamel paint to a height
of 2 metres (6 feet 7 inches), and above this are colour-
washed. The floors are of cement, covered with linoleum.
The building is warmed by warm-water pipes, and lighted
by electricity. Sputa are received indoors into spittoons
containing water ; out of doors handkerchiefs are used and
placed in tin boxes on entering the house. Linen is puri-
Digitized by LjOOQIC
SANATORIA FOR THE PEOPLE IN EASTERN GERMANY. 213
fied by boiling ; rooms by simply washing and airing. The
douche is employed in suitable cases, but no cod-liver oil,
alcohol or internal remedies.
There is room at present for eighty-seven, but there will
be accommodation for 100 when a separate doctor's house
is built.
None but early cases are received. Patients remain about
three months, and pay 3 marks per diem.
The chief medical oflScer is Dr. Georg Liebe, to whom I
am indebted for much useful information. It is stated that
he will take charge of the Manebach Sanatorium when this
is ready.
Digitized by LjOOQIC
CHAPTER XXXIV.
SANATORIA FOR THE PEOPLE IN BRANDENBURG,
MECKLENBURG, AND POMERANIA.
Most of the sanatoria in this section are but little raised
above the sea-level. Two of them (Malchow and Blan-
kenfelde) might be regarded as homes rather than sana-
toria for consumptives, as their position and arrangements
are not very suitable for the fresh-air treatment. To this
section belong the sanatorium at Grabowsee, the one being
built at Belzig by the Berlin-Brandenburg Society, with its
neighbour of the Bleichroder Stif tung^ and the one which
is being erected by the Berlin Insurance Co. at Beelitz.
The Brandenburg Insurance Co. also proposes to erect a
sanatorium for women at Kottbus, where the authorities
have unanimously agreed to give the land in the municipal
forest free of charge.^ The Stettin Sanatorium Society
will probably build a sanatorium at Hockendorf.^
The Beelfiz Sanatorium.
The Berlin Invaliditdts und Alters Versicherungs Verein
has purchased 140 hectares (346 acres) of land at Beelitz,
for the erection of sanatoria, convalescent homes, etc.,
at an estimated cost of six million marks. The land is cut
through by the Wetzlar Railway, on one side of which will
be a sanatorium for consumptives ; on the other, similar
establishments for those who are suffering from other
ailments. There are to be twenty-six separate houses, with
a total of 550 beds,^ of which about 100 will be for the
sanatorium.
1 Das Rothe Kreju, 1897, No. 20. ^ Heilst. Corr., Mar., 1898.
3 Das Rothe Kreuz, Aug., 1898.
(214)
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sanatoria for the people in brandenburg, etc. 215
The Belzig Sanatorium.
A large sanatorium for semi-necessitous patients is being
erected under the auspices of the Berlin-Brandenburg
Society, at Belzig in Brandenburg, about an hour and a half
by rail from Berlin. The land acquired covers If hectares
(4 acres). The building, of which the foundation stone was
laid in August, 1898, is expected to be completed in about
twelve or fifteen months, at an estimated cost of 540,000
marks. The main building is to be 150 metres long, with two
wings of 100 metres each, and will accommodate eighty to
ninety patients. Dr. Itzerott is to be the medical director.
The Bleichroder Sanatorium.
In the same grounds as the preceding a separate building
for thirty beds is to be erected with funds left by the late
banker, Herr v. Bleichroder, and this will be affiliated to
the Belzig Sanatorium. The Bleichroder legacy was origin-
ally left for the treatment of consumptives by tuberculin ;
but, in consequence of an appeal, the conversion to a sana-
torium for hygienic treatment has been permitted by the
authorities.^
The Blankenfelde Sanatorium
was originally a lying-in institution, which, being empty in
1892 at the time of tiie tuberculin craze, was converted into
a women's sanatorium for consumptives. It has since then
been gradually changed into a home for the reception of
patients with various forms of chest disease. It is situated
not far from Berlin, and has sixty beds. In 1896, 239 cases
of consumption were received, and twenty-nine cases of
bronchitis and emphysema, with 13,154 days of treatment, or
an average of forty-nine days' stay. The total cost is 3*35
marks per day. Dr. EUerhorst is the chief medical officer.'^
' Liebe, Hyg. Rundsch., Ist Nov., 1897.
« Ibid., 1896, No. 17.
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216 sanatoria for the people in brandenburg, etc.
The Grabowsee Sanatorium
is situated in the midst of a pine wood on a hill near the
Grabowsee, and is about 6 km. (nearly 4 miles) from
Oranienburg, and about 18 miles north of Berlin. It was
opened on 25th April, 1896, being the first sanatorium
erected by the Red Cross Society, through the initiative of
Geheimerat Dr. Gerhardt, who acts as consulting physician
to the sanatorium, and examines intending visitors at the
Charite Hospital in Berlin. The site covers 10 hectares
(24 acres) of land, lying about 38 metres (125 feet) above
the sea-level, on diluvial sandy soil, in a neighbourhood
free from industrial smoke, noise and dust. The land has
been obtained on a long lease at a yearly rental of 50 marka
The sanatorium is intended exclusively for consumptive
men who are likely to show decided improvement under
treatment, and who are free from infectious or disgusting
ailments. Three certificates are expected, one of which
shows the name, age, place of residence, and name of in-
surance company or benefit society concerned; the second
is a medical certificate of fitness; the third a guarantee
as to payment. Patients are requested to bring a change
of clothes, including underlinen, good socks and boots,
comb and toothbrush, goloshes, umbrella, and if convenient
sleeping jackets, slippers and the like. In case of need the
institution will lend some of these articles, upon guarantee
from the sick fund or benefit society. Bed and bedding
are provided by the institution, which also supplies hand-
kerchiefs, and washes the linen free of cost. The charge
is 3 marks per day, payable for ten days in advance in the
case of private patients, monthly in the case of insurance
societies. The daily cost is said to be 2*47 marks. Although
primarily intended for the working classes, Kuthy ^ states
that shopkeepers are beginning to insure beds for them-
selves in the institution. A committee of ladies has been
formed to look after the families of the poorer patients.
^ hoc. ciL
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SANATORIA FOR THE PEOPLE IN BRANDENBURG, ETC. 217
'There are three free beds, one of which is the gift of the
Empress.
The sanatorium consists of over two dozen buildings,
most of which are light shelters (Dockerache baracken),
with double paper walls, similar to those used in the army.
When the sanatorium was first opened the patients were
exclusively accommodated in these baracken^ but as time
went on a few more substantial structures were erected.
There are at present some eighteen or more of these light
shelters in use, one of which is utilised as a chapel, another
as a storehouse, another as the medical officer's residence,
another as a workshop, while the rest are summer sleeping
quarters for the patients, or (with one side removed) are
used as fresh-air shelters (liegehallen). They are exceed-
ingly light and portable, being entirely of wood and linen-
backed paper, everywhere covered with oil paint. The
windows are threefold, the floors a wooden framework
which may be covered with linoleum. Windows in the
peak of the roof, and ventilators round the stove pipe,
with open windows, ensure abundant ventilation. These
baracken are made of various sizes. In this sanatorium
they accommodate eight patients each, and are furnished
with beds, long lounge chairs, a table, pedestals, washstand
And stove. Ordinary tents were found to be far inferior to
these structures.^
The remaining structures consist of an administrative
block, two winter pavilions, laundry and disinfecting appa-
ratus, and the gas making and storing apparatus. The
administrative block, solidly built of timber, contains the
kitchen, scullery, larder, serving room, dining saloon, office
And library, quarters for one of the assistant medical officers
in one wing, and for the sisters and female servants in the
other. The kitchen contains a roaster, meat boiler and
milk boiler over a water bath. The dining saloon is a
large room, covering 127"19 square metres (1370 sq. ft.).
In front of this building is a large fresh-air gallery. One
^ Made by Christoph and Unmaok, of Niesky, N. Lausitz.
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220 SANATORIA FOR THE PEOPLE IN BRANDENBURG, ETC.
Malchow, about 80 miles north-west of Berlin, in the midst
of meadows and irrigation fields, on sandy soil, 31 metres
(102 feet) above the sea-level. For shelter against winds,
which is very inadequate, it is dependent upon the trees in
the park, which covers 3^ acres of land.
The building is a long low unpretentious brick building
with two floors and three in the centre. On the ground
floor are the common rooms, and next to them on the south
side two verandahs, which are used as protected walks and
fresh-air galleries, but are not suflSciently sheltered to be of
much use in bad weather. In the upper floor, which is
reached at either end by a wooden staircase from the garden,
are the bedrooms and dormitories. Four of these contain
two beds apiece, two contain twenty-four each, and two about
sixteen ; eighty-six in all being admitted, and from 35 to 40
cubic metres (1236 to 1413 cubic feet) of air being provided
per head. There is no central corridor, the rooms being
placed immediately next one another. The heating is by
low-pressure steam, the lighting by petroleum ; the ventila-
tion by the windows, none of the rooms having chimneys.
There are also a laundry and disinfection house, mortuary
and water-filtering tank. Douche and shower baths for
the patients will shortly be provided. The sputa are disin-
fected by means of hot soda solution ; the linen by boiling,
the rooms by lysol. The sewage is carried onto an irriga-
tion field. There are three trained nurses (Victoria
Sch western) ; and the institution is under the direction of a
medical man (Dr. Renter), who with the nurses has separate
quarters in the old house belonging to the place.
Most of those admitted are consumptives, all of the male
sex ; but a few bronchitics are also admitted. In 1896, 555
cases of consumption were received, and 128 cases of
bronchitis and emphysema, with a total of 26,551 days of
treatment. All stages of consumption are admitted. Cod-
liver oil, counter-irritants and so-called specifics are not much
used, but a good deal of alcohol. According to Leon Petit,
there is little or no systematic hygienic training, and very
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SANATORIA FOR THE PEOPLE IN BRANDENBURG, ETC. 221
few facilities for carrying it out. The cubic space and
means of ventilation are also somewhat inadequate. On
these and similar grounds the institution has been some-
what severely criticised by Prof. v. Leyden, L6on Petit,.
Beaulavon, and others.^
The home, which is not attached to any special insur-
ance society, was opened 24th October, 1892. The daily
charges are 2 marks. The daily cost is 316 marks. The
building was originally intended for those who had success-
fully passed through the tuberculin treatment, but" was.
thrown open in October, 1892, to consumptives without
distinction, to the number of ninety-six, although the
number admitted was afterwards reduced to eighty-six.
The Stettin Sanatorium
is to be erected by the Stettin Sanatorium Society for eighty
beds, on ground given by Stadtrat Dohm on his property,,
Hockendorf , near Finsterwalde. This is sheltered from the
north and east.
A sum of £15,000 has been given by Dr. Karkutsch to-
the fund {Heilst Corr., March, 1898).
^ Prof, V. Leyden, La solUcitude des grandes villes pour les TuherculenXy
Buda Pesth Congress, 7th Sept., 1894 ; Beaulavon, Reryue de la Tuherculose^
Dec., 1896; Leon Petit, Le Phtisiqtie et son TraitemenL,
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CHAPTER XXXV.
SAXON SANATORIA FOR THE PEOPLE.
The sanatoria included in this section are the Albertsberg
Sanatorium, the Plauen Sanatorium, and the Jonsdorf Con-
valescent Home.
The Albertsberg Sanatorium,
•or the HeiUtdtte des Vereins fii/r Begrilndung und Un-
terhaltung von Volksteilatdtten im Konigreiche Sachsen,
is situated at Auerbach, about twelve minutes' walk from
Reiboldsgriin Sanatorium (described at p. 160), in the open
country amidst hills and forests. The ground belonging to
the sanatorium is but small (6i acres), but the patients have
the use of the surrounding State forest. The soil is granite,
the elevation 700 metres (2297 feet). Woods protect it to
the east and wooded hills to the north.
The sanatorium consists of a number of buildings united
by covered corridors into the shape of a T (fig. 24), the centre
consisting of two floors, while the rest is on one floor only.
There are also several detached buildings for the dwelling
of the chief medical oflScer and inspector, the kitchen block,
ice house, coal house, stables and laundry. The main block
has a southerly aspect, and has red roofs and white walls in
the centre, flat " wood cement *' roofs elsewhere. From the
top of the T four pavilions project, containing dormitories
for ten patients each. The space between them is occupied
on each side by fresh-air galleries, in the centre by a large
library and common room 6 metres (19 ft. 8 in.) high,
(222)
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SAXON SANATORIA FOR THE PEOPLE. 223
with two cloak rooms ; over these are double-bedded rooms,
and a large balcony with side screens. Behind, forming the
central stem of the T, is the large dining saloon, which is
6 metres high, and capable of seating 100 persons. Over
it are eight single-bedded rooms. The foot of the T is
formed by a further expansion with bedrooms, etc., on two
floors ; and behind this, forming a separate block, is the
kitchen department. Baths, closets and lavatories are every-
where on the north side.
There is altogether accommodation for 122 patients, some
rooms receiving from one to four each, while a number sleep
in dormitories ten together. The cubic space allowed is 35
cubic metres (1236 cub. ft.) per head. The ventilation is
by open windows, the upper parts of which are valved ; also
by ventilating valves and chimneys, which are often com-
mon to two rooms. The heating is by closed stoves, but is
to be altered ; the Ughting by oil-gas with Auer incan-
descent mantles. The waste water is carried through
earthenware pipes to an irrigation patch. The sewage is
treated with dry peat mould.
None but consumptives are admitted, and only those in
an early stage. Sputa are poured into the water-closets
without disinfection. Linen is boiled with soap and water.
Rooms are daily cleansed with damp cloths. The cold
douche is used in all suitable cases; no cod-liver oil or
specifics being given. In addition to the fresh-air galleries
next the house there is one in the woods. For nursing
there is one sister. Dr. Gebser is the chief medical oflBcer ;
he was for five years house physician at Reiboldsgriin
Sanatorivim.
The institution was opened on 4th October, 1897. It
is connected with the Insurance Company of Saxony, the
Railway Company of Saxony and the Ministry. For the first
of these fifty-five beds are reserved, for the others twenty-
five each. Patients' payments are at the rate of 3 marks
per diem ; some pay only 2*50, a few being admitted free.
The building was estimated to cost 250,000 marks (£12,500).
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224 SAXON SANATORIA FOR THE PEOPLE.
Of this amount the Insurance Society advanced £4000 ; the-
central committee at Berlin £2500; a private gentleman
gave £12,500 for a free bed; the Railway Company pay
£125 per annum ; and a private lady £150 per annum,
besides other subscribers. The site was also given for a
low price. An annual subvention is received from the
Government.
The Plauen Sanatorium.
Another sanatorium for women is to be built in connec-
tion with the Albertsberg Sanatorium by the same society.
The chosen site is 650 metres (2130 ft.) above the sea-level,,
in the midst of thick pine woods, sheltered by mountains
to the north, east and west. It will be half an hours
walk from the men's sanatorium, but will have a common
water supply and steam laundry. The building operations
are to begin early in 1899 (Heilst Corr,, Sept. 1, 1898).
The Jonsdorf Convalescent Home
is a "closed sanatorium" for patients with various ail-
ments, including early cases of consumption, belonging to-
the union of Siidlausitzer Kranken Kaasen. It was opened
in June, 1894, on land given by the town of Zittau, in
Saxony. There are rooms for thirty-three patients, both
sexes being accommodated in two separate portions of the^
building. There is central heating by low-pressure steam,
and a private water supply.
The home is said to have cost 73,000 marka It is under
the care of Dr. Toop of Oybin. According to Hohe,^ 93
per cent, of the patients who left the institution up to the
end of 1896 were decidedly improved.
Jonsdorf is close to the frontier between Saxony and
Bohemia, and is connected with Zittau by a narrow-gauge
railway.
* Die Bekdmpfung und Heilung der Lutigenschwindsticht, Munich,.
1897.
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SAXON SANATORIA FOR THE PEOPLE. 226-
The Prinzessin Maria-Anna Heim.
According to Liebe^ a sanatorium is being erected in
Saxony by a local benevolent ^association for the benefit
of Elb'Sandstein workera
' Loc. cit.
15
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CHAPTER XXXVI.
BANATORU FOR THE PEOPLE IN THE HARZ DISTRICT.
In this section are included the sanatoria of the St. An-
dreasberg district, and those at Stiege, Siilzhayn, Altenbrak,
Konigsberg, and Zellerfeld.
The St. Andreasberg Sanatoria.
There are two closed sanatoria for consumptives in the
neighbourhood of this little town, the Oderberg Sanatorium
and the Felixstift. Consumptives are also sent by a num-
ber of insurance companies to various houses in the town,
under a common inspector, supervised by Drs. Hartung,
Jacubasch, and Ladendorf. The town and climate, to-
gether with the provision for paying patients, are described
at page 168.
The Oderberg Sanatorium
is situated 640 metres (2100 ft.) above the sea-level, on the
road from Andreasberg to Oderhaus, in the Harz Moun-
tains, on the south side of the Oderberg. The district is
scantily populated, and free from factories. The sanatorium
is protected to the north by rising ground covered with
woodland ; and to the west, and partially to the east, by
outstanding thickly wooded spurs of the Oderberg. To the
south is falling ground, partly meadow and partly wood-
land.
The sanatorium consists of a main building, doctor's
house, disinfection house, sundry stables and cowsheds, and
two cottages for some of the servants. The main building,
(226)
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SANATORIA FOR THE PEOPLE IN THE HARZ DISTRICT. 227
which has a due south front, and is built of wood on a solid
basement, consists of a central block and two wings, with
boiler and engine house at one end, all arranged in a long
line of 102 metres (335 ft.), about 100 yards from the main
road behind. Owing to the fall of the ground, the base-
ment is above ground in front. It contains the kitchen,
scullery, bath and douche rootns, cellars and store rooms,
some of the ventilating machinery, and the workshop for
repairs, and has in front of it a fresh-air gallery with
diverging ends (see figs. 25, 26). The ground floor has in
the centre the common dining room, with the inspector's
consulting rooms behind, and on either side patients' bed-
rooms, which all have a southerly aspect. There are also in
each wing a lavatory and a nurse's room, and at the eastern
end a common room 28 x 13 metres (92 x 42J ft.) in size.
The next floor has in the centre the inspector's quarters,
linen rooms, and others for the committee of management ;
those in the wings resembling the rooms on the ground
floor. Above this is an attic floor, of which the centre is
occupied by bedrooms for the women servants, linen rooms,
etc., while the sides are like those on the lower floors,
excepting that in place of the common room there are four
isolation wards. These have no direct communication with
the rest of the bedrooms, although they are approached by
a passage from the common corridor. Each floor is served
by a longitudinal corridor at the back. For security in case
of fire, a massive wall with iron doors separates the western
wing from the rest of the building. Of the bedrooms,
seven are for one patient, fourteen for two, six for three
or four, fourteen for four each. A few more can be
accommodated in other rooms in case of need. The
average cubic space per head is 35 cubic metres (1236
oub. ft.); the average floor area, 10 square metres (108
sq. ft.), the height of the rooms being 3*80 metres (12^ ft.).
The walls are boarded and colour-washed ; the floors of pine-
wood covered with linoleum, excepting in the kitchen and
scullery, where there are tessellated pavement and partially
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*228 SANATORIA FOR THE PEOPLE IN THE HARZ DISTRICT.
tiled walls, and in the bath rooms, which have glazed tiles
and a cement floor. The rooms have double windows.
The furniture is of lacquered wood or iron, free from un-
necessary dust-retaining irregularities. The dining tables
are covered with American cloth, fastened with wooden
fillets along the edges. The bedsteads are spring-bottom
iron ones ; the mattresses are of horsehair in buttoned-up
linen cases, with buttoned-up linen covers outside, and the
same system is adopted for the pillows. The washstands
and pedestals are of enamelled iron with glass tops. The
lavatories on each floor have enamelled iron basins, with
hot and cold water laid on, the plumbing resembling that
of English lavatoriea The water supply comes from
springs in a meadow belonging to the institution, to the
north of the main road, and is stored in three reservoirs.
The heating is by low-pressure steam, the lighting by
electricity. Ventilating fans driven by electricity force a
stream of air (which is warmed if necessary) into a long
channel in the basement, which in turn supplies every
room. In this way 80 cubic metres (2825 cubic ft.) per head
can be supplied every hour. Inlets exist in every room
near the ceiling ; outlets near the floor ; these communicate
with separate shafts and are covered with gratings. During
the greater part of the year the incoming air comes through
open windows ; in very severe weather the windows are
closed and warm air forced in by the ventilating machinery.
Adjoining the western wing is a boiler and engine house,
and next to it the accumulator room, with coal cellar and
ashpit outside. The boiler and engine produce steam of
7 atm. pressure for the electromotor, reduced to 2 atm.
for cooking and disinfection, and farther to ^ atm. over-
pressure for warming the building and incoming air, and
for heating the water for baths and scullery. The closets
are movable automatic earth closets, in a partially built
out and well-ventilated pavilion to the north of the base-
ment corridor. The waste waters are disposed of by irriga-
tion. Earth closet pails are also provided elsewhere for
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SANATORIA FOR THE PEOPLE IN THE HARZ DISTRICT. 229
tise during the night, and for the women servants, engine
room staff, etc. The fresh-air gallery is 3^ metres (11^ ft.)
wide by 130 metres (426^ ft.) long, with wood cement
roof, the height of which is from 2*75 to 4*6 metres (8 ft.
10 in. to 15 ft. 1 in.). It communicates directly with the
bath rooms, and with the staircase to the dining saloon, and
embraces with its diverging ends a sheltered gravelled
recreation ground. It has places for sixty patients. The
■doctor's house is about 40 yards to the south-east, so placed
as to command the fresh-air gallery. The disinfection
house, which also contains a mortuary and poet-mortem
room, is about 50 feet westward from the engine house.
The disinfector is double, with separate approaches for
soiled and disinfected linen. Owing to the altitude, extra
superheating is necessary to ensure disinfection. The
stables, cowsheds, and houses for the servants, are still
farther off (100 to 150 yards) to the west, the latter being
near the road.
The staff, which is under an inspector, consists of twenty-
five in all, and includes four male nurses (who also dean the
rooms), a female cook and three kitchenmaids ; a machine
tender and his mate ; a heater ; a steward and his wife ;
<x)achman, and messenger. Some of the lighter duties,
such as the cleansing of the spitcups, are performed by
the patients, an overman being chosen for every section
of the building (each containing about twenty patients).
He is responsible for the tidiness of the rooms, the daily
removal of closet pails, and the cleanliness of the closet of
his own section, of which he keeps the key ; for the regu-
lar use of the thermometer, the proper conduct of his
own set of patients, extinguishing of lights, observance of
rules concerning books, and the like.
The sanatorium, which was oj>ened in August, 1897,
under Dr. Liebe, is intended exclusively for consumptive
men insured in the Hanse Insurance Society of Lubeck
who are likely to recover their health or their earning
capacity for a number of years. The average stay is three
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230 SANATORIA FOR THE PEOPLE IN THE HARZ DISTRICT.
months ; but this can, if necessary, be extended. The
charges are defrayed by the insurance company. There
is accommodation for 115, or in case of need 120. Since
the 1st January, 1898, Dr. Ott has been the medical officer.
The treatment is that adopted in most of these institu-
tions — rest or exercise in the open air, good ventilation,
good food, and regular hours. There is no park belonging
to the establishment, but there is plenty of open land
around it; and patients use the fresh-air gallery and re-
creation ground, or the public pine woods near by. The
douche is used after the weekly bath, not usually at other
times. A very simple spitflask of blue glass with screw top
is in use ; only two spittoons existing in the whole establish-
ment. The sputa are mixed with peat mould and burned.
Linen is disinfected by steam ; the rooms by thorough
cleansing. In suitable cases gymnastics and respiratory
exercises are prescribed. The food is the same as in other
similar German institutions. It is served out for five at a
time, the patients helping to distribute it. The milk is
from a private dairy of twenty-three tuberculin-tested cows,
but is all boiled before being used, in order to impress on the
patients the importance of doing so at home. Beer is only
given on Sundays. Specifics, cod-liver oil and counter-irri-
tants are only used when speciaDy indicated. Newspapers
and political discussions are forbidden. Each patient is
free to attend the religious services at St. Andreasberg
with the doctor's sanction, or to abstain from so doing
if he has conscientious scruples.
The nearest railway stations are at St. Andreasberg and
OderthaL St. Andreasberg is the terminus of a branch line
from Scharzfeld.
A Sanatorium for Women
is likely to be opened in the same neighbourhood by the
Hanse Insurance Company.
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sanatoria for the people in the harz district. 231
The Felixstift Sanatorium
is intended for ladies and gentlemen of small means rather
than for the working classes, and owes its existence to the
efforts of Dr. Ladendorf , the cost of erection having been
lai^ely defrayed by a legacy, and the cost of maintenance
being guaranteed by a private society. Situated to the
west of St. Andreasberg, about half an hour's walk from
the town, it stands on a steep hillside, looking over meadowa
and a little stream to a pine-clad hill. It has a southerly
aspect and is protected on all sides from cutting winds, the
most distant view being to the south-west.
The building is a pretty structure in Swiss style, built of
wood on a granite foundation, with red-tiled roof ; and has
accommodation for thirty-two patients at present, which
number will be increased to forty when the place is com-
pletely furnished. It consists of a raised centre and two
winga In the western wing on the ground floor is a large
dining saloon, with a small serving room to the north, a
large window on the western side, and a large covered
projecting balcony on the southern front. In the centre of
the south side is the entrance hall with oflBce and matron's
and consulting rooms; and behind it the staircase. The
rest of the ground floor and first floor is taken up with
patients' rooms, some of which can be used as sitting rooms
if necessary. The centre has a few attics in the peak of
the roof. The basement, which is level with the ground in
front, contains a light and cheerful kitchen in the left wing,
with a small scullery, and near them a bath room and
douche room, the larder, and various store rooms, together
with the heating apparatus. The bedrooms, some of which
have small balconies, are cheerful and airy, the walls
painted, the wooden floor oiled and provided with a strip
of carpet n^ar each bed. The rooms are ventilated partly
by means of open windows, which are in three parts in-
dependently movable; partly by warm-air inlets near
the floor and outlets near the ceiling, which lead into
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232 SANATORIA FOR THE PEOPLE IN THE HARZ DISTRICT.
sepisirate shafta The bedsteads are of wood, provided with
feather beds and blanketa The heating is by low-pressure
steam pipes ; the lighting by petroleum lamps. There are
six well-fitted water-closets and lavatories on the north side.
The sewage is carried to six clearing tanks, where it is
treated with alum and lime, being afterwards filtered
through sand on its way to the little stream. Four meals
a day are provided, in addition to a cup of tea in the
afternoon : the two breakfasts at 7 and 9 A.BC., the dinner at
12 and the supper at 7 p.m. About 2 litres of milk per
head are used daily.
A simple and inexpensive spitfiask is used in place of
Dettweiler's pattern. There are no spittoons. The resident
staff consists of the matron, three maids and a man. There
are no nurses. Dr. Ladendorf of St. Andreasberg is the
medical officer. Patients sleep two or three together in
one room, a few single-bedded rooms being also provided.
* The charges in the common rooms are 23 marks per
week, including board, residence, medical treatment and
all other expenses. Where a single-bedded room and a
sitting room are engaged the charges are 4 to 5 marks per
diem.
There is a good road from St Andreasberg. The institu-
tion was opened in August, 1898.
The Stiege Sanatorium,
which is called Albrechtshaus, after the Prince Regent of
Saxony, has been recently erected (June, 1897) in the Harz
district by the Brunswick Sickness and Old Age Insurance
Company. It stands about 450 to 500 metres (1480 to 1640
feet) above the sea-level, near the narrow-gauge railway
from Gemroda to Hasselfelde, and a mile or two from the
little village of Stiege. The road to the sanatorium passes
through a wood, where the twin establishment, Marienheim,
is being built.
The sanatorium stands on a slope with meadow land in
front of it, and is surrounded on all sides with pine-clad
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SANATORIA FOR THE PEOPLE IN THE HARZ DISTRICT. 233
liills. It is a wooden structure on a granite foundation,
with solidly built basement and dark-tiled roof, and is 68
metres long, shaped like the letter E. Behind the centre is
the entrance, with the staircase and kitchen department
4kround it. The kitchen, which is light and cheerful but
rather small, and has tiled roof and floor, is supplied with
■ hot cupboard, food lift, a central stove, etc., and has ne^t to
it a scullery and small store room. Above it on the first
floor are the quarters of the house master, and above these
a few garret rooms for women servants. Also in the centre,
but on the south side, are the dining saloon on the ground
floor, with a verandah in front of it, and two day rooms on
the first floor, both of the latter provided with spacious
balconies. Above these, in the peak of the roof, is a drying
^pace. The lateral parts of the central block have a single
row of rooms on the south side with a corridor behind.
They comprise on the ground floor two bath rooms, two
lavatories, the cook's bedroom, the office, consulting room,
two patients' bedrooms each with four beds, and one with
two. On the first floor are four rooms with four beds each,
two with two beds apiece, a lavatory and room for the
•chaplain. In the wings on the ground floor are two large
dormitories for ten patients each, which however owing to
pressure on space have been made to accommodate fourteen
apiece. In the lavatories each patient has his own basin
•and utensils. Under the large dormitories are the chapel
in the eastern wing, a gymnasium in the west-ern. The rest
■of the basement is occupied by heating apparatus and
-cellars. The patients' bedrooms have a cubic space per
head of 27 to 28 cubic metres (9530 to 9880 cub. ft.). The
ivindows are large, of the usual pattern with three sections,
and a ventilator is present in each room. The walls are of
rough plaster on the lower floor, oil-painted in the upper
floor and the lavatories. The floors are of cement in the
basement corridor, tiled in the ground floor corridor, else-
where covered with linoleum. Most of the rooms are
lieated by closed stoves burning wood ; but three rooms, in-
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234 SANATORIA FOR THE PEOPLE IN THE HARZ DISTRICT.
eluding a bath and douche room, are heated by steam pipes.
The lighting is by petroleum. The closets are built out on
the north side of the corridors. They are six in number
and are earth closets, the user distributing peat mould withi
a spade. The waste waters are collected in a reservoir in
the centre of the terrace in front of the building. In fine-
dry weather they are allowed to irrigate the vegetable-
garden ; in wet weather they are diverted into the wood
to the east of the sanatorium. In front of the building is-
a fresh-air gallery, the roof and overhanging front of which,
are formed by a roller blind of sail cloth, the floor consisting
of the pebble-covered terrace. A Dockersche Baracke ^ in
the garden serves as a recreation pavilion. Behind the-
main building, across the courtyard, are stables, stean^
disinfector, etc.
Only men are admitted as patients, and not exclusively
although chiefly consumptives. The patients do a little-
garden work and gymnastics, and are expected to ask for-
work after three weeks unless the doctor forbids it. They
stay usually for thirteen weeks. The food consists of the?
usual five meals; beer being provided, and wine om
Sundaya
During 1897 seventy-five patients were under treatment ^
with a total of 5213 days of treatment.
The staff number nine in all, including the house master^
Dr. Kohler, who is medical officer, comes over from Hassel-
felde two or three times a week.
The Marienheim,
a sanatorium for twenty female patients, is being built a»
little lower down on the same ground, and will probably
be opened in the middle of 1899.
The SiJLZHAYN Sanatoria.
In the southern part of the Harz, where the land begins;
to fall towards Gottingen and Nordhausen, is a little niche
' See p. 217.
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SANATORIA FOR THE PEOPLE IN THE HARZ DISTRICT. 235
in the mountain side overlooking the viUage of Sulzhayn.
Densely wooded slopes rise up on three sides, forming a
sort of amphitheatre, near the centre of which, on a pre-
cipitous rock, has been built the private sanatorium " Fem-
sicht," by the side of the rising pile of the Siilzhayn People's.
Sanatorium. The foundations of this imposing structure
have been built up on massive stone pillars 18 metres
(nearly 60 ft.) high, additional room being obtained by
blasting the rock behind. On this artificial platform have
been erected three buildings: the private sanatorium, 'the:
doctor's residence, and the people's sanatorium; the first
two already occupied, while the third is rapidly approach-
ing completion. In such a situation there is almost perfect
shelter against boisterous wind from the colder quarters ;
while a lovely view is obtained of the country to the south.
There are nearly 14 hectares (34 acres) of woodland belong-
ing to the institution. The soil is of porphyry and grau-
wacke (the latter used in building the sanatorium); the
elevation about 600 metres (1600 ft.) ^ above the sea-level ;
the climate that of the Harz Mountains generally — a dry,,
bracing, equable hill climate, with a fair amount of rain
and snow at certain seasons.
The Sulzhayn People's Sanatorium
is planned somewhat like the one at Ruppertshain, with a
concave front, a centre and two wings. The dining saloon
is, however, placed behind the centre on the first floor, and
communicates by a bridge with the kitchen block still
farther to the north. The patients* bedrooms, which are
placed in a single row on the south side, on three separate
floors, contain from one to four beds apiece, with an allow-
ance of 42 cubic metres (1480 cub. ft.) per head, and a.
height of 4 metres (13 ft.). The floors are made of torga-
Toent, a patent material consisting of wood shavings incor-
porated with cement, which is capable of uniting with stone„
* According to Liebe ; Dr. Kremser gave me the height as about 1460 ft.
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r236 SANATORIA FOR THE PEOPLE IN THE HARZ DISTRICT.
iron or woodwork, and is warmer to the feet than ordinary
•cement. The walls are of colour-washed plaster of Paris,
the doors of wood without projections and very carefully
fitted. The windows are large, but have not been carried
up to the ceiling. Throughout the sanatorium all angles
Are rounded and surfaces smooth. Running in front of
the centre block on the basement, which on the south
.side is on the ground level, is a corridor 4 metres
(13 ft.) wide, which can be heated, and serves as a
promenade in bad weather. It has very large windows
which open out on to a covered strip of garden, and
boot rooms on either side. The corresponding parts
•on the ground floor form a large day room and a fresh-
Air gallery 5 metres (over 16 ft.) wide, to be used for rest
in the open air, and protected by the balcony overhead.
In both the centre and the wings balconies are placed in
front of the bedrooms. The lavatories, water-closets, rooms
for the nurses, and staircases are at the back of each wing
beyond the corridor. There are two water-closets in each
wing on each floor. The water-closet basins cover themselves
Automatically. Next the water-closets are rooms for dis-
posing of the sputa, etc. In one compartment is a boiler for
boiling the sputum, after which it goes down a special soil
pipe into the drain. In another compartment the spitcups
Are boiled and the chamber pots cleaned. The common bath
rooms and lavatories, which are also to the north, have
terrazzo floors covered with parallel wooden latha Each
patient will have his own china basin fixed to the wall,
with a box for toothbrush, etc. ; on one side of the lavatory
there is only cold water ; on the other hot and cold. The
•douche rooms, with doctor's room and dressing room, are in
the wings on the ground floor, and have the usual arrange-
ment of taps and thermometers to indicate the temperature
of the douche. Underneath are the boiler for disinfection
of sputum, the inhalation room, and some cellars. There
are also a dark room for photography and a library. Each
w^ing has also a lavatory for the nurses, and a small store
Digitized by LjOOQIC
SANATORIA FOR THE PEOPLE IN THE HARZ DISTRICT. 23T
room ; and on the lower floors a common room for the-
patients.
Behind the centre is the administrative block. This has;
in the basement the accumulator room and coal cellar, witb
the ice cellar on one side and the three heating furnaces on
the other. Above these come the laboratory and consulting-
room, the porter's room and office, on each side of the*
entrance. On the next floor is the large dining saloon,
with a room for the sisters on one side and a couple of
committee rooms on the other. This communicates witb
the kitchen block by means of a serving room on the
bridge. The kitchen block, which has its entrance behind,
contains in the basement the larders, store rooms, cellars
and engine room. There is also a passage under the road
to the main block. On the ground floor is the laundry-
department with disinfecting apparatus and linen rooms,
on either side. The disinfector has two approaches; the-
linen rooms are for storing and mending respectively. The
laundry has an electric mangle, and rolling and ironing
rooms. An electric lift carries the washed linen up to the
drying loft. Above the laundry department is the kitchen
department, with scullery, crockery room, vegetable kitchen,,
and dining room for the servants. The kitchen is separated
from the serving room by a passage, and has a special
ventilating shaft. On the next floor are the quarters of
the engineer and his wife, together with a separate portion
for the women servants, and a drying loft. The kitchen
department has its own staircase, douche and bath rooms,
and water-closets.
The sisters are lodged in separate quarters in the roof
of the main building. The sanatorium is heated by low-
pressure steam pipes, and by closed stoves in addition. It
is lighted by electricity. There is an abundant supply of
good water, which works a turbine, and has a pressure of
5 or 6 atmospherea The staircases are of stone, let into-
the thickness of the walls, without other support
There is altogether accommodation for 100 patients, but.
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238 SANATORIA FOR THE PEOPLE IN THE HARZ DISTRICT.
twenty more could be lodged in the attic floor if necessary.
Only men are admitted ; the sanatorium having been built
by the N. German Knappschafts Pensions Kasse in Halle-
•on-Saale, chiefly for the miners of the district.
Dr. Kremser is the chief medical oflBcer. He has under
him a matron and female nursing staff*. The assistant
medical officer is also appointed on his recommendation,
subject to the assent of the matron. All the other officials
are directly appointed by the chief medical officer. They
consist^ of an engineer, female cook, two kitchen maids,
two male nurses, messenger and night watchman. No
inspector will be appointed. The male nurses clean the
«pitcups. The building is to be cleaned daily by women
from the village.
During the building operations the poor patients have
•been lodged in the private sanatorium " Femsicht," and
before this was built an open colony existed in the village.
The Fernsicht Sanatorium
lies to the west of the miners' sanatorium, and is attached
to Dr. Kremser s residence, which is between them. Owing
to the rapid fall of the ground it has a deep basement
^hich is above ground on the south side, whereas the
doctor's villa has one floor less. There is accommodation
for ten patients on the ground and first floors, all being to
the south and provided with balconies. Between the two
T^uildings is a deep fresh-air gallery on each of these floors.
The basement contains in front a reading room and billiard
room, and behind a bath room and consulting room. Over
the latter on the two upper floors are bath rooms and
lavatories, together with rooms for the attendant& The
J30uth-eastern corner is occupied by the furnace room, above
which is the kitchen, and above this the dining saloon,
iwrith a, large winter garden in front of it (fig. 27).
The charges will be probably 6 marks per diem.
* Liebe, loc, cit.
Digitized by LjOOQIC
Fio. 27.— Db. Krbmser's Sanatorium "Fbrnsicht,"
SULZHAYN IN THE HaRZ.
[Face page 2SS,
Digitized by LjOOQIC
Digitized by LjOOQIC
•sanatoria for the people in the harz district. 239
Another Sanatorium
under the charge of Dr. Kremser' s brother-in-law exists in
the village of SiiJzhayn, about 160 to 200 feet below the
rSiilzhayn miners' sanatorium. There is accommodation
for nine patients, who pay from 4 to 6 marks per diem.
Additional beds can also be obtained in other houses in the
-village.
Altenbrak Sanatorium
is situated in the Bodenthal, which some consider to be
"the finest part of the Lower Harz district. It consists of
the Villa Emma and other houses in the village, where
patients are received from various insurance societies, and
is managed by an assistant of Dr. Pintschovius of Ketzin,
who also owns a small private sanatorium in the same
•neighbourhood (see p. 167).
The Konigsberg Convalescent Home
is situated about 3^ kilom. (2 miles) from Goslar, in the
northern part of the Harz district, in the midst of beautiful
pine woods, and is 450 metres (1470 ft.) above the sea-level.
It was originally a private villa, but was converted into
ia sanatorium by the addition of a large dining saloon.
Opened in May, 1895, by the Hanover Sickness Insurance
Company, purely as a convalescent home for men, it was
after a time devoted chiefly to consumptives, owing to the
number of other convalescents attached to the insurance
company being insuflBcient to keep it full. The building
has a south-east aspect, and has a meadow in front of it
with a rapid downward slope. Across the valley in front
is a wooded hill; on each side of the meadow and the
sanatorium are pine woods. The ground also falls to the
south-west, and rises to the north. Owing to the height
of surrounding hills, and the neighbouring pine woods,
there is good shelter against cutting winds.
The building is of wood, in the Swiss style, with a turret
in the middle. The chief entrance is at the south-west end,
Digitized by LjOOQIC
240 SANATORIA FOR THE PEOPLE IN THE HARZ DISTRICT.
which leads into a corridor running parallel to the fronts
with rooms on either side. At the opposite (north-east) end
is the new wing, containing the kitchen and dining saloon.
From the latter a door leads on to a broad verandah, and
thence to the garden. The bedrooms for patients are on the
ground floor and first floor. They are placed on all sides of
the building excepting the north-east, and hold from two ta
four beds each. They are light and cheerful, with linoleum-
covered floors, washable paper on the walls, varnished
wooden wainscots, large French windows (mostly with
balconies), and plain, dean-looking furniture. The bed-
rooms on the second floor are for the staff. There is a
reception room on the ground floor near the entrance.
Hot and cold water are laid on to every floor. There are
three earth closets, but only one bath room. The basement
contains heating apparatus, engine and dynamo room^
small accumulator room, four cellars, and a larder ; and in
the added wing a cheerful kitchen with tiled walls and
floor, and windows on three sides. Near this are a disin-
fecting room, laundry, and stables, and over these a drying-
space and the quarters of the farm manager. These are all
separated from the rest of the house by a mtrrow passage.
The lighting is by electricity, the heating by low-pressure
steam. A two horse-power engine supplies a 36-celled
accumulator; these suffice both for heating and lightings
and for pumping water from the meadow to a cistern under
the roof.
There is accommodation in the house for thirty-six
patients, and fourteen more are lodged in a Dockersche
Baracke ^ in the meadow. Ninety per cent, of those
admitted are consumptives. The usual five meeds a day
are provided ; the food is said to be excellent Beer and
Bordeaux wine are allowed. Patients do light work for
wages if the doctor permits, and also the lighter house-
work. Spitcups are disinfected with corrosive ublimate.
The institution is managed by a sister of the Hermitten-
' See p. 217.
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SANATORIA FOR THE PEOPLE IN THE HARZ DISTRICT 24 '.
stift in Hanover, and is under the care of Dr. Andrae of
Goskr, who comes over twice or three times a week.
During 1897, 178 patients left the institution, of whom
107 were tuberculous. Eighty of the latter (or 75 per
cent.) regained their full working capacity, and 17 per cent,
were apparently cured. ^ The daily cost is said to be 2*23
marks, or, with interest on capital, 2*71 marks.^
The Zellerfeld Sanatorium,
which was opened by the Hanoverian Sickness and Old
Age Insurance Company in August, 1898, for the reception
of women, is situated in one of the most elevated and open
parts of the Harz district. Leaving Goslar by rail the
train goes panting and puffing up a steep incline through a
winding river valley skirted by dense pine woods, until it
reaches the bare and open mining country near Clausthal.
Adjoining this important mining village is the more purely
residential village of Zellerfeld, which climbs the hillside
on the way to an elevated plateau consisting chiefly of
meadows and cultivated land. About a mile from the
village, near a small lake and stream, is a pine wood, by the
side of which the sanatorium stands. Originally a restaurant
and brewery going by the name of " Zur Erbprinzentanne,"
it is next the main road opposite a village inn. This circum-*
stance is probably less disadvantageous in a women's sana-
torium than would be the case in one for men. Altogether
6^ hectares (13 acres), mostly woodland, belong to the insti-
tution, which with the exception of the above-mentioned inn
has no other buildings near it. The elevation is 550 metres
(1800 feet) above the sea-level, the soil being of sand or rock.
The sanatorium consists of an old wooden structure and
a brick-built house to which have been added a new one of
timber and plaster on a brick foundation, and some stables.
These form three sides of a square, and surround a courtyard
wrhich will be partly covered with grass, partly paved with
^ Report of the Inv. and A. Versicherungs Anstalt of Hanover for 1897.
' Liebe, loc. cit.
16
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242 SANATORIA FOR THE PEOPLE IN THE HARZ DISTRICT.
granite blocks — asphalt not standing the severe cold met
with in this district in winter. Across the road to the north-
east is a sheltering line of pine trees, and beyond them a
sudden fall to the stream ; behind the sanatorium, and to
the sides, a thick belt of trees. High pine-dad hills may be
seen on the horizon in most directions ; but the pine trees
around the building form the only efficient wind screen.
Each part of the sanatorium consists of a basement,
mostly occupied by cellars, and of a ground floor, first floor,
and second floor under the roof. On the right of the court-
yard at the north-west end is the original wooden building,
the ground floor of which is partly occupied by the con-
sulting room and administrative rooms. At the junction
between this builcUng and the centre block are the quarters
of the nursing stafl*. The centre block has a large day room
and the dining saloon on the ground floor, and behind these
a wide verandah which also extends along the north-west
end. The corridor serving these rooms is next the court-
yard, and leads to the closets, of which there are two on
this floor, one.for the staff and one for the patients. The
kitchen, which is also on the ground floor, has a central
stove and tiled walls. At the extreme end of the centre
block are two bedrooms separated by a short passage from
the rest for cases requiring isolation. On the next floor
are most of the bedrooms ; there are nine of these, accommo-
dating from two to five apiece, or a total of forty. The
walls are painted, floors covered with linoleimi. The bed-
steads are of iron, the mattresses partly stuffed with vege-
table fibre. The washstands are of enamelled iron with
drawers and .glass tops. The pedestals are also of open
iron work with glass topa There is one bath room with
two fixed baths. The heating is by means of closed stoves.
The staircases are of cement. The further wing is com-
posed of stables and cowsheds, together with the farm
manager s house.
The sanatorium is connected with the telephone system.
Dr. Plumecke is the medical officer.
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CHAPTER XXXVII.
SANATORIA FOR THE PEOPLE IN THURINGIA.
These include the colony on the Harth, the new Berka
Sanatorium, and the Manebach Sanatorium. An open
colony exists at Gross Tabarz, near Friedrichroda, on an
elevated hill-girt plain 1300 feet above the sea-level. At
Erfurt (which although not in Thviringia is surrounded by
it) a sanatorium is to be built by the Johanniter Knights
out of the proceeds of a legacy.^
The Colony in the Harth Forest,
which is a few miles from Bad Berka, near Weimar, in
the midst of beautiful pine woods, was opened on 27th
May, 1896, and consists of Schloss Rodberg, with twenty to
twenty-live beds, the Restaurant Sophienhohe, which has
eight to ten beds for summer use, and a number of huts in
the woods which are also only habitable during the warmer
parts of the year. The colony is in charge of a nursing
sister ; and consists mainly of patients from the Thuringia
Insurance Company. Dr. Miinsel of Weimar comes over
frequently to supervise the treatment.
Of eighty-three patients who left the institution in 1896
(six months) seventy were phthisical or suspected to be so.
Of this number seven presented no traces of disease on
leaving ; twenty-five showed traces, but were fully capable
of work ; twenty-five more were capable of working, but
were less likely to remain so ; eleven were only capable of
light work, and in twelve no good result was obtained.
Three did not complete their treatment.^
^ Brit, Med, Joum,, 2l8t ]VIay, 1898. * Liebe, loc. ciL
(243)
Digitized by LjOOQIC
244 sanatoria for the people in thuringia.
The Berka Sanatorium,
which is being built by the Red Cross Society of Weimar,
and is rapidly approaching its completion, will probably
take the place of the above-mentioned colony in the
Harth Forest. The site is on a picturesque headland in
the midst of the pine woods, overlooking the little town
of Tannroda with its ruined castle, and the valley of the
Ilm. The soil is a beautiful red sandstone, which has
heen utilised in building the institution.
The building, which has a southerly aspect and is well
protected to the north and east, is in the form of a central
block with wings projecting back and front. It will accom-
modate men only, and will have about eighty beds, each room
<x)ntaining from two to four beds and having a southerly
aspect. The larger bedrooms are in the wings in front.
Behind the east wing are the bath and douche rooms ;
behind the west wing the sisters' quarters. There are
altogether two bath rooms and a large douche room. In
the centre of the middle block is a large and lofty dining
.saloon, and next it a day room. The kitchen is behind,
separated from the dining saloon by the corridor. The
windows are all large, but do not reach the floor or
the ceiling. The walls are lime-washed ; the floors of wood
in the bedrooms with fillets to fit into the angles ; in the
corridors they are of torganient (see p. 225). There will
be central steam heating, with two heaters under the
kitchen, and long, large steam-pipes under the windowa
A ventilation shaft containing a central steam-pipe is placed
in the middle of the building. The place will be lit by
electricity. There will be eight water-closets with a good
water flush. Behind the main block is a courtyard, on
the far side of which are being erected stables, disinfecting
rooms, etc
Dr. Miinsel of Weimar is to be the resident medical
officer. The institution will be utilised by the insurance
association of Sachsen-Anhalt in Merseburg, as well as by
the Thuringian Insurance Company.
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sanatoria for the peopiie in thuringia. 245
The Manebach Sanatorium.
A sanatorium is also being built for women at Manebach,
near Ilmenau, 626 metres (1720 ft.) above the sea-level.
There is already a recently built Curhaus, which, with an
adjoining house, will accommodate forty patients. The new
building is to be still larger ; and when it is completed the
Curhaus will be devoted to a different class of society.^
^ Liebe, he, cit.
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CHAPTER XXXVIII.
SANATORIA FOR THE PEOPLE IN HANOVER, WESTPHALIA,
OLDENBURG AND LIPPE DETTMOLD.
In addition to the open colonies at Wissen-on-the-Sieg and
Uckerath, near Oberpleis, and those of Lippspringe and
Salzuflen in Lippe Dettmold, there is a sanatorium at
Rehburg and another at Altena. Another is projected at
Hagen in Westphalia, which is to be called the Kaiser
Wilhelm Sanatorium, and for which 270,000 marks have
been subscribed.^ There are other projects for the establish-
ment of sanatoria for Aix-la-Chapelle, Oldenburg, Altona,
and Hamburg respectively. For the latter a legacy has been
left of 250,000 marks ; and the State of Hamburg will con-
tribute 60,000 marks per annum.^ A sanatorium is also
projected at Lippspringe for the consumptives of Minden.^
There is already a Johanniter Hospiz there.
The Rehburg Bremen Sanatorium
was opened on 1st June, 1893, by the Bremen Heilstdtten-
Verein fur bedilrftige Lungenkranke at Bad Rehburg, a
little to the north of the Royal Bathing Elstablishment. It
was the third of those opened in Germany for the poor,
being preceded by the one at Malchow and the small one at
Falkenstein, now replaced by the Ruppertshain Sanatorium.
Originally containing twenty-four beds, it was enlarged in
1894 by the addition of wings, raising the number to thirty,
1 Heilst. Corr., July, 1898.
2 Deutsches Central KomiU- zur Eit, von Heilst, /. Lungenkr. Ann. Rep.
for 1897.
3 Das Rothe Kreuz, Ist Sept., 1898.
(246)
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Digitized by LjOOQIC
SANATORIA FOR THE PEOPLE IN HANOVER, ETC. 247
twelve for women and eighteen for men. It is under the
medical care of Sanitatsrat Dr. Michaelis, the owner of the
private sanatorium, who with his assistant attends the
Bremen Sanatorium gratuitously. It stands in a very
sheltered position on the hillside, and owing to the slope
of the ground the western half of the building has been
built on a slightly higher level than the eastern. Close to
it are com fields ; a small garden lies to the south, and
densely wooded hills protect it to the north and west, and
the high beech trees of Bad Rehburg to the east.
The building consists of a centre and two wings, which
form a nearly unbroken line facing south. In the centre
are a dining room, day room, doctor's room and matron's
room, and in the projecting bow a room with four beds.
The east wing, which is for men, contains two largo rooms
with four beds each, and two smaller with two beds each,
and under the roof another room with two beds. The west
wing, for women, has two rooms with four beds each, and
two rooms with two each. The rooms are 4 metres (13 ft.)
high, the larger being 7x9 metres (23 x 29^ ft.), the smaller
3 J X 7 metres (11 ^ X 23 ft.). The walls are colour-washed ;
and in the dining room there is also linoleum to the height
of the shoulders. Floors are everywhere covered with
linoleum, which is daily cleansed with damp cloths. The
place was beautifully clean when I visited it, simple, homely
and practical. The heating is by means of close (Lonhold)
stoves ; the lighting with petroleum. The furniture is
simple ; bedsteads of iron, with spring and horsehair
mattresses. Beds are disinfected when necessary by steam
heat in the public disinfecting oven. The rooms are simply
cleansed and aired. Sputa are poured down the water-
closets. Patients are instructed to use spittoona
The sanatorium is managed by a matron (a sister of the
Red Cross), who does what nursing, rubbing, etc., are needed.
She has under her a cook and kitchen maid, housemaid, and
a man.
Treatment is by hygienic methods. Five meals a day
Digitized by LjOOQIC
248 SANATORIA FOR THE PEOPLE IN HANOVER, ETC.
are provided, the mid-day dinner being a substantial meal
with several courses. Beer is provided at supper. Patients
who are medically fit help in the lighter household duties,
such as making the beds, cleaning their own boots, and
cleaning the spitcups.
They pay 2 marks per day if connected with the Bremen
insurance societies ; 3 marks if from other towns. A few
gratuitous beds are provided whenever the finances permit.
No charge is made for medical attendance, drugs, or in
some cases for personal washing. There is a fund in Bad
Rehburg for the assistance of poor people who come .
for treatment, baths and other means being gratuitously
provided.
Up to the end of 1896, 334 patients were treated at the
sanatorium, with 27,287 days of treatment, or an average
of 81 J days. Only 297 were certainly consumptive, 43^
percent, being seriously affected. Excluding the doubtful
cases, 86 per cent, improved in general health. 8 per cent,
lost ground. The lung condition improved in 21 per cent.,
grew worse in 13^ per cent. In 1897, 106 patients left the
institution. Of these 44'3 per cent, appeared to be per-
manently able to work ; 32*1 per cent, were thoroughly
capable of working, but with less certainty of a lasting
result.
The climate of Bad Rehburg is described at p. 171.
The Hanover Sanatorium Society,
which was originally connected with the Bremen Society,
also sends patients every year to various houses in the
village of Bad Rehburg as well as to the convalescent
home at Konigsberg and the Zellerfeld Sanatorium. These
are described at pp. 239, 241.
The Altena Sanatorium
for the district of Altena, in Westphalia, was opened on •
Ist August, 1898, in the open country between the villages
of Hellersen and Briinninghausen, about 4 kilometres (2^
Digitized by LjOOQIC
SANATOBIA FOR THE PEOPLE IN HANOVER, ETC. 249
miles) from the town of Liidenscheid. It stands 420 metres-
(1380 ft.) above the sea-level, in about 38^ hectares (nearly
96 acres) of land, on the south side of a hill which is wooded
with oaks and pines and sheltered to the north-east by more^
distant hilla The grounds are partly wooded, but in front
of the building consist of a large open grass plot, with
gardens and little ponds.
The sanatorium buildings consist of a main block, aa
administrative block, doctor's villa, and open-air galleries.
The main block has a basement, ground floor, and three
upper floors, all the patients' rooms being to the south.
Behind it is the administrative block, which is united to-
it by a covered bridge, and contains the kitchen, scullery,
store rooms, dining saloon and nurses' dining room, and
quarters for the second medical officer and the female
staff*. The open-air galleries are not placed in front of
the main block, but form a curve on each side of it,
the western gallery leading to the chief medical oflScer'a
residence. It is intended to build a chapel at some future
time.
There is accommodation for 100 male patients. The
bedrooms are of various sizes, and contain from one to
eight beds each. They are furnished with iron bedsteads,,
steel and horsehair mattresses, iron pedestals with glass,
plate, and a clothes cupboard for each patient. The lava>
tories are. separate from the bedrooms, and have water laid
on over each fixed washbasin, and shelves above for wash-
ing utensils. There is also a large bath room with three
fixed baths and a dressing bench of xylolith plates. Next
to this is a douche room, with various douche and spray
apparatus, and a compartment provided with two water
cocks and a thermometer for the medical oflBcer to regulate
the temperature of the douche. Another bath room is pro-
vided for the staff". The water-closets have porcelain basins,
with oaken seats and automatic waterflush. The urinala
also have automatic water supply ; their walls are of
polished granite, the floors of terrazzo. The sewage and
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•250 SANATORIA FOR THE PEOPLE IN HANOVER, ETC.
waste water are carried into settling tanks, and purified
"by filtration. The water supply, which is said to be good
and abundant, comes from special springs in the neigh-
l)ouring mountain, and is pumped by a benzine motor
from a reservoir near the administrative block to another
in the woods 4 metres higher than the roof. There are
two day rooms in addition to the. dining saloon. Every
room is provided with ventilation shaft, and with special
ventilation for winter. The building is heated by low-
pressure steam. It is at present lighted with petroleum,
which will, however, probably be replaced by electric light-
ing. There are electric bells in every room, with pushes
near each bed. All the patients' rooms and the corridors
Are covered with linoleum ; the bath rooms being tiled. A
special room for boot cleaning is on the ground floor. The
kitchen has a tiled floor, and is provided with two steam
boilers and a roaster, with a food lift to the serving room
Above. The dining saloon is 13 x 7 metres (42^ x 23 ft)
and 6 metres (19 ft. 8 in.) high. There are a steam dis-
infector with two approaches, and a laundry with ironing
and drying rooms. The washing is done by machinery,
driven by a benzine motor. The sputa are disinfected
with lysol solution.
The whole staff is under the control of the medical
superintendent, who will be aided by a second medical
oflScer. There are at present three Red Cross sisters from
Cologne, one of whom acts as housekeeper, another as
secretary, while the third sees to the nursing. When more
patients are under treatment there will be one or two more
nurses. There are also a bathman, a porter, a female cook
with two kitchenmaids, and two women for the laundry
work. The medical officer is Dr. Stauffer, to whom I am
indebted for most of these details.
None are admitted but consumptives who have a reason-
Abl^ prospect of recovery. There is an arrangement at
present with the Westphalian Old Age and Sickness In-
-surance Company, but patients will probably also be sent
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SANATORIA FOR THE PEOPLE IN HANOVER, ETC. 251
from the Hanover Insurance Company and from the
Rhine province.
Patients pay 3^ marks per diem, or 5 in a single-bedded
room, and stay at least twelve weeks, unless otherwise ^^
determined by the medical officer.
Ludenscheid station may be reached vid Hagen and ^
Brugge. The sanatorium is connected with the telephone
.system.
Other iNSTrruTioNs at Altena.
There is also at Altena an " Isolation Establishment " for
consumptives in connection with the Johanniter Hospital in
the same town. Treatment lasts from one to three months ;
the payment is at the rate of 3 marks per day.
Two or more funds exist for the support of the families
of patients who are under treatment in sanatoria, and who
are in reduced circumstances. One of these has a capital
of 140,000 marks (£7000), and will also be applied to the
improvement of patients' dwellings. Another of 10,000
marks has just been started in memory of the late Count
Bismarck, who was an honorary citizen of Liidenscheid.^
1 Heilst. Can:, July, 1898.
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CHAPTER XXXIX.
SANATORIA FOR THE PEOPLE IN THE RHINE DISTRICT.
Excepting the Ruppertshain Sanatorium in the Taunus.
no large sanatorium for the poorer classes has yet been built^
in this district, although several are projected. A society-
has been formed for this purpose with branches at Duisberg,.
Essen city and district, and Ruhrort.^ Another union of
local societies, which is called Gesellschaft Gemeinwohl,
and includes Barmen, Dusseldorf city and district, Elber-
feld, Mettmann, Solingen town and district, Lennep and
Remscheid, has made greater progress. A Dusseldorf firm
has promised 20,000 marks, and an Elberfeld banking firm
10,000 marks ; and it is hoped that building operations may
be begun in the autumn of this year.^ Barmen at present,
sends its consumptives to an open health resort at Godes-
berg near Bonn. The insurance company for the Rhine
province will probably support the new sanatorium.
Cologne has a Verein zur verpjlegung Oenesender, with
five convalescent homes, and sends its consumptives to two-
of these (at Wissen an der Sieg for men, and at Uckerath
near Oberpleis for women) ; but proposes to build a closed
sanatorium as well.* There are a few beds for consumptives
at the Philomenen Hospiz at Honnef. On the opposite bank.
Dr. Achtermann receives patients of the poorer classes,
into the "second-class section" of his sanatorium at Laub-
bach (see p. 189), but this establishment was not originally
built for such a purpose. A society has also been started at.
1 Heilst, Corr,, July, 1898. ^ Das Rothe Krem, Ist Sept., 1898.
•'' Liebe, loc. cit,
(252)
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FlO. 28. — ViBW OP RUPPERTBHAIN SaNATOBIUM.
FIRST af 5CCONO FLOORS
FlO. 30.— RUPPBRTSHAIN SANATORIUM.
1. Dining Saloons. 2. Large Donnitories. 3. Single-bedded Rooms. 4. Larger Bedrooms.
5. Nurses' Rooms. 6. Small Kitchen. B = Bathrooms.
[Face page 25^
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SANATORIA FOR THE PEOPLE IN THE RHINE DISTRICT. 253
Wiesbaden for the erection of a sanatorium of fifty beds
for the lower middle classes of Wiesbaden, the Rheingau
and the Unter Taunns.^ At Hanan 30,000 marks were
subscribed for a sanatorium fund, to commemorate the
300th anniversarj'^ of the town ; and half of the interest
will be us^d to send patients to existing sanatoria, the rest
being added to the principal/^ There is also said to be a
sanatorium for 120 beds in course of erection at Hochst am
Rhein. The districts bordering on the lower part of the
Rhine will be included in another chapter.
The Ruppertshain Sanatorium
is the successor of a small establishment at Falkenstein,
founded by Dr. Dettweiler for the consumptive poor in
1892 with the help of the Frankfort Ck)nvalescent Associa-
tion. This earlier sanatorium, which was merely an ordinary
village house, was replaced in 1895 by a specially con-
structed building near Konigstein in the Taunus Moun-
tains, about forty minutes* drive from the older institution.
The new sanatorium is at the head of a wide valley, with a
south-easterly aspect, and is sheltered on three sides by
mountains, for the most part covered with trees of various
kinds. The soil, as at Falkenstein, consists of slate, gneiss,
and porphyry ; the climate is that of the Taunus district
generally. The elevation is 400 metres (1300 ft.) above the
sea-level. The grounds of 4 J hectares (11 acres) are partly
wooded with newly planted trees, partly meadow and
cultivated land.
The sanatorium is built near the road in the form of part
of a circle, with thickened ends (fig. 28), and has a base-
ment, ground floor, first and second floors, and an attic floor
within a steeply pitched and lofty roof. Projecting from
the ends are two fresh-air galleries on the basement level,
leading on to a terrace in front, with a view over the Main
valley as far as the Odenwald. Behind the galleries on
each side is a built-out pavilion, connected with the main
1 Heilst, Corr,, July, 1898. « Ibid,
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254 SANATORIA FOB THE PEOPLE IN THE RHINE DISTRICT.
block by a short corridor. The western pavilion contains
the kitchen department ; the eastern, the stables and wash-
house.
The basement (fig. 29) of the main block is occupied by
cellars, heating apparatus, and bath and douche rooms on
either side. The ends, which project slightly, contain twa
common rooms next the fresh-air galleries. On the ground
floor in the centre are the rooms for the chief medical
oflBcer and the matron. Corresponding parts in the twa
next floors (fig. 30) are occupied by two large dining
saloona There are also a nurse's room and a small ward
kitchen on each side and on each floor. The rest of the-
building on the south side is occupied with bedrooms.
These open into well-lighted corridors, two metres wide,,
which have no other rooms to the north, excepting at
the ends, which contain lavatories and closets, and in
the basement also a mortuary.
The building was originally intended for seventy-five,,
the rooms being arranged for one, three, and five beda
respectively. Owing to the pressure on their space, how-
ever, extra beds have been put in to the number of eighty-
eight, so that there are now ten single-bedded rooms, the
rest each containing four or six beds. Both sexes are ad-
mitted, the men being housed in the western half, the women
in the eastern half, with separate sun galleries and dining
rooms. There are large verandahs in front of the latter.
The building is heated by low-pressure steam. For ven-
tilation, the windows are constantly left open, day and
night. There are ingenious wooden shutters attached to-
the windows, worked from inside, which admit air while
they exclude rain, and can also be arranged as sun blinds.
Only early cases are supposed to be admitted, but the-
medical oflScers, in their report, complain that many un-
suitable cases are sent in. Sputa are received into Dett-
weiler 8 flasks, which are provided free of cost. The use of
handkerchiefs for this purpose is forbidden. Sputa are-
afterwards mixed with peat powder and burnt. Linen is.
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Digitized by LjOOQIC
SANATORIA FOR THE PEOPLE IN THE RHINE DISTRICT. 255-
disinfected by steam. Patients have the use of the public
woods on the other side of the road. Their treatment is as
at Falkenstein in all essentials (see p. 177). Smoking ia
forbidden.
Patients stay at least twelve weeks, if suitable. They^
pay 5 marks in the private rooms, 3 in the common rooms,
or 2^ when they come from one of the Frankfort sick bene-
fit societies. They have five meals per diem. They are
expected to make their beds, brush their clothes and boots,,
etc., or else pay 3 marks per month for attendance. There
is a good water supply. Sewage is treated with peat
mould ; waste water disposed of by irrigation. The daily
cost is 2*77 marks, of which 1*22 is for food. The average
receipts are 2*50 marks, so that a deficiency remains,
to be made up by voluntary subscriptions, in which the
Falkenstein patients share.
Dr. Nahm is the chief medical oflBcer, Dr. Fohrbrodt the^
second medical oflScer.
In 1895-6, 249 men and 64 women were received. Of
these, 179 men and 26 women came through various
societies. The percentage of improvement amongst those
who left the institution was 77*6.
The nearest station is Eppstein on the line from Frank-
fort to Limburg.
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CHAPTER XL.
SANATORIA FOR THE PEOPLE IN SOUTH-WEST GERMANY.
Several large sanatoria are being erected in this part of
Germany, some of which are nearly completed Nuremberg
is building a sanatorium in the Engelthal, near Hersbriick,
for sixty patients ; it is so planned as to be capable of exten-
sion to 100 beds, and is estimated to cost 276,000 to 280,000
marks.^ Stuttgart has a convalescent home {Neustddtle)
which receives consumptives amongst other patients, but is
planning a separate sanatorium for 100 beds.^ There is an
open colony for consumptives at Reichelsheim in the Oden-
•wald, utilised by the Hesse Darmstadt Insurance Company.
A sanatorium is projected at Miihlhain in Rhenish Hesse
Darmstadt.^ According to Kuthy* a. sanatorium is pro-
jected at Felflberg in the Odenwald for the city of Worms.
Another sanatorium, for the city of Wiirzburg and Lower
Franconia, is being built at Lohr in the Spessart. In the
Palatinate there is a small sanatorium at Dannenfels for
a large manufacturing firm of Ludwigshafen ; and another
for Speyer is being erected near Abbersweilftr.^ In Alsace
and Lorraine there is a project for the erection of a sana-
torium for the city of Metz, rendered possible by a legacy
of 150,000 marks from a lady.^ Saarbriicken is negotiating
for the purchase of a site of 10 hectares (24 acres) in the
Btiftswald at St. ArnuaL" In the Black Forest Dr.
Baudach has for some years had a sanatorium of this kind
1 Das Rotfie Kreuz, 1897, No. 12. * Liebe, he, ciL
3 Heilst. Corr,, July, 1898. * Loc. cit. « Loc. cit,
« Das Rothe Kreuz, Sept., 1898. ' Ibid.
(256)
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SANATOBIA FOR PEOPLE IN SOUTH-WEST GERMANY. 257
under his care at Schomberg, in addition to his private sana-
torium. Another sanatorium was opened last year at Arlen
by a local manufacturer for the benefit of his workmen,
A large sanatorium is being built at Marzell on the Blauen
for the Baden Insurance Company. Another is projected
for " semi-necessitous " patients at Freudenstadt in Wurtem-
berg. Four gratuitous beds are said to exist at the Nor-
drach Sanatorium (see p. 190). In Bavaria a large sana-
torium has just been completed at Planegg Krailling, and
another of still larger proportions is being built for the
Munich Town Council at Harlaching. There is also a
project for the establishment of a sanatorium for Lower
Bavaria at Maxhof en near Deggendorf ,^ and another is to
be erected in the Bavarian forest for the poorer middle
classes.^
The Dannenfels Sanatorium.
The Badiache Anilin und Soda Fabrik at Ludwigshaf en^
on the Rhine, are remarkable for the care which they take
of their large staff of workpeople. They have over 4000
workpeople, whom they have provided with a number of
model dwellings, a large restaurant where they can obtain
meals below cost price, another dining hall where those
who receive their meals from home may eat them in com-
pany of their wives and children ; baths, lavatories and
dressing rooms, with soap and towels gratis ; a large free
bath for the ^ves and children (who are not employed in
the factory) ; a lying-in cottage ; a school of cookery and
household management for the daughters; a cottage hos-
pital for women and children, and another for men; a
convalescent home in the country, and a sanatorium for
consumptives. In addition to this they have a system of
premiums for long service from five years upwards; a
savings bank ; a sick fund, also open to those who are
called out on military service; a fund for widows, orphana
^Das Rothe Krews, Sept., 1898. ^Heilst, Corr,, March, 1898.
17
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258 SANATORIA FOR PEOPLE IN SOUTH-WEST GERMANY.
and invalids ; and a pension fund for those over sixty years
of age.
The convalescent home and the sanatorium for con-
sumptives are both near Kirchheimbolanden in the Pfalz.
We need only describe the latter.
It is situated at Dannenfels, at the foot of the Donner-
l>erg, 400 metres (1312 ft.) above the sea -level, on 25
liectares (62 acres) of land, which is partly meadow and
^rden, partly covered with chestnut woods. It is on the
eastern side of a hill, and is protected by woods to the
north. The eastern end is a three-storey pavilion (%. 31),
with a ground floor, first and second floors and attics.
From this extends a long two-storey prolongation, con-
sisting of a single row of rooms on each floor, with a cor-
ridor along the northern side, and surrounded on the east,
.south and west by a balcony with two fresh-air resting
places on a level with the first floor. One of these resting
places (which has no roof) extends southwards over a built-
out pavilion near the eastern end, 10 metres long by 6
wide (32' 9" x 19' 8"). Under it is another shelter open
to the west, and with windows to south and east, for use
in cold weather. The other first floor shelter is somewhat
larger, and occupies the western end of the building, on a
level with the garden. The ground floor contains, in ad-
' dition to the cold weather pavilion, a large dining room at
the eastern end, a day room, bath room, doctors room,
ironing room and cellars ; and on the northern side, the
kitchen and administrative rooms at either end of the
house. The first floor contains patients' rooms along the
south side ; office, staircase, lavatories, closets, and nurses'
rooms on the northern side. In the second floor of the
eastern end are two rooms for the matron and a reserve
room ; the attics being occupied by additional admiuistra-
tive rooms. There is altogether room for eighteen patients,
six in one room, three each in three other rooms, and three
in single-bedded rooma There is also an outbuilding for
cows, pigs, hens and laundry.
Digitized by LjOOQIC
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FIBST TLOOPL
^M*
^^EI
L 3
1 1 Ji .an "
^ 1
'^
—' 4-. nu r
■ m
1
GROUND FLOOPw
Fig. 31.— Thb Danitinfxls SAKATORinif. [Face page 258.
Digitized by LjOOQIC
The Dannbnfbls Sanatorium.
Oround Floor : —
1. Fresh-air Gallery.
2. Dining Saloon.
3. Sitting Room.
4. Bathroom.
5. Consulting Room.
6. Ironing Room.
7. Cellars.
N.E. comer, Kitchen.
First Floor .—
1. Fresh-air Gallery.
2. Open Platform.
3. Room for six Beds.
4. Rooms for three Beds apiece.
5. Single-bedded Rooms.
6. Norses' Room.
7. Lavatory.
8. Office.
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SANATORIA FOB PEOPLE IN SOUTH-WEST GERMANY. 259
The sanatorium was opened in September, 1892, and
remains open the whole year. It is under the care of a
sister of the Bavarian Frauenverein vom Rothen KreuZy
and of Dr. Boye of Kirchheimbolanden. Up to the end of
1895 fifty patients had been received, of whom ten were
still in the establishment. They had received 7230 days
of treatment, making an average of 144J days apiece.
Patients now usually stay six months ; and the results are
stated to be notably better than with only thirteen weeks.
Of forty who left, eight remain perfectly well, fifteen much
better and able to work ; sixteen were no better, and one
died. About ^ per cent, of the workpeople become con-
sumptive. The building cost £7000 to erect; the daily
cost is 4*15 marks per head, food alone 2*20 marks, doctor
and drugs 55 pf.
Patients are treated on the usual lines. They do some
of the light work when fit for it.
The Wurzburg Sanatorium
has been founded by the Verein zur Orilndung von Curan-
stalten fur unbemittelte Lungenkranke for Lower Fran-
<»onia and Aschaffenburg, in the Lichterwald, near Lohr, in
the Spessart, a district famous for its extensive forests of
oak and beech trees, and will have thirty beds. Kuthy
gives a description and plans in his book,^ from which it
appears that the sanatorium will have a basement, ground
floor, first and second floors. The basement will contain
various cellars and store rooms, together with kitchen and
laundry. On the ground floor will be a dining room for
the men at one end and one for the women at the other,
with laboratory, consulting and drug room between, and
bath rooms and rooms for servants behind. The fresh-air
verandahs will diverge from the ends next the dining
rooms, each forming an obtuse angle with the front of the
building. On the upper floors there will be nurses' and
* Loc, ciL
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260 SANATORIA FOR PEOPLE IN SOUTH-WEST GERMANY.
linen rooms behind, and bedrooms in front, some single-
bedded, some for three, others for four beds each.
The site is said^ to have cost 20,000 marks, the esti-
mated cost of the whole sanatorium amounting to 225,000
marks, of which the Insurance Company for Lower Fran-
conia advance 70,000 marks for ten years at 2 per cent.
There are at present twenty-two branch societies in the
Sanatorium Society, with an income of nearly 120,000
marks.
The Speyer Sanatorium
is shortly to be built on a wooded hill, 380 metres (1245 ft.)
above the sea-level, near Albersweiler in the Palatinate.
The society (Verein fiir Volkaheilstdtten in der Pfalz)
has about 100,000 marks in hand, besides which the
Insurance Society of the Palatinate will lend two-thirds
of the estimated cost at low interest.^
The Schomberg People's Sanatorium
was originally founded by Dr. Baudach, the owner of the
private sanatorium described at page 196. It consists of
the old sanatorium, together with a number of other houses
in the village with which arrangements have been made.
It now accommodates from sixty to sixty-five patients,,
mostly from the Wurtemberg and Baden, Alsace-Lorraine,
Pfalz, and Hesse Darmstadt Sick Assurance Societies.
There is an experienced married manager in charge. The
patients are kept quite separate from those of the private
sanatorium both in the woods and fresh-air galleries, but
are otherwise treated in much the same way. Never
more than three sleep in one room. The charges are 3 to
3 J marks per diem, or 4 in single-bedded rooms; there are
also a few gratuitous beds. In 1896, 297 patients were
received.^ For other particulars, see description of the
private sanatorium (p. 196).
^ Das Rothe Kreuz, Ist Oct., 1898.
^HeilsL Corr., Ist July, 1898. ^Uebe, loc. cit.
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SANATORIA FOR PEOPLE IN SOUTH-WEST GERMANY. 261
«
The Arlen Sanatorium.
In the south-west comer of the Black Forest, in the Grand
Duchy of Baden, to the south of Hohentwiel, is a small
sanatorium for male consumptives in connection with the
Heinrichs Hospital, both of which were founded by the
factory owner, Commercienrath Carl Ten Brink, for the
benefit of his workmen, the hospital in 1888, and the sana-
torium in 1897. Both are under the care of Dr. Weibel, and
are chiefly intended for the cotton spinning and weaving
operatives of Arlen, although others can also be received.
The sanatorium stands about 400 metres (1300 ft.) above
the sea-level, in open country, at the foot of a mountain
running from north-west to south-east, which shelters it from
north and east winds. It has a fine garden of 1*2 hectares,
and is surrounded by other gardens. It consists of one storey
on a high ground floor, arranged in two symmetrical halves,
for eight male and eight female patienta On each side are
a large day room, one dormitory for four beds, two rooms
with two beds apiece, and a lavatory. The bedrooms have
an average space of 48 cubic metres (nearly 1700 cub. ft.)
per bed. There are a common dining room, kitchen, matron's
and doctor's rooms, and two bath rooms. On the south side
of each half is a large verandah, and smaller ones to east
and west, besides a long covered walk in the garden. The
building is heated by warm-water pipes and lighted by
electricity. Every room has a chimney for ventilation.
The walls are enamel-painted. The sewage is carried into
a neighbouring stream. Sputa are poured into the water-
closets without disinfection. Linen is purified by steam
disinfection.
Although mainly intended for consumptives, it is not
reserved exclusively for such patients. The . douche is
not used, but other forms of hydrotherapy are employed.
Specific and stimulating remedies are administered when
advisable, but no cod-liver oil. Five meals per day are
provided; alcohol being given when specially ordered by
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262 SANATOBIA FOR PEOPLE IN SOUTH-WEST GERMANY.
the doctor. There are two female and one male nurse.
Patients pay 2| marks per day.
The nearest station is Arlen-Rielasingen, on the line from
Singen to Winterthur. Singen is a junction on the line
from Cassel, and that from Basel to Constanz.
The Marzell Sanatorium.
A sanatorium is projected for the Baden Invaliditdts
Versicherungs Anstalt at Marzell on the Blauen, 840
metres (2750 ft.) above the sea-level, at an estimated cost
of £33,000, exclusive of electric lighting, and of £4200 for
the furnishing. Of this amount the State gives £2500, and
an annual subvention of £500.
The projected building will be 87 metres long and 10
metres deep. Bath and inhalation rooms, ironing room
and laundry, and the heating apparatus will be placed on the
ground floor. There will be 108 beds, for men only, on three
floors, eighteen rooms containing four each, sixteen being
double-bedded, and four single-bedded ; the cubic space for
each of these sets of rooms being 27*60, 28, and 56 cubic
metres (975, 989, and 1978 cub. ft.) respectively. On the
north side will be lavatories, closets and a day room ; and in
the outbuilding, cellars with the porter's rooms. On the first
floor will be rooms for the medical officers, laboratory, the
office and the kitchen. On the second floor, rooms for the
matron and linen maid, linen rooms, dining saloon and bed-
rooms for the staff! On the third floor, chapel, library and
guest rooms for the officers of the insurance society. In
front of the ground floor will be a deep verandah for 100
places. The building is to be solidly built, and provided
with central heating and electric light. The soil pipes will
end in iron receptacles accessible on all sides. The floors in
the rooms will be covered with linoleum, in the corridors
paved with ** Mettlacher Flatten '\ There are also to be a
doctor 8 house, laundry, stables and an ice cellar.^
^ Liebe, loc, cit.
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I
2
1^
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SANATORIA FOR PEOPLE IN SOUTH-WEST GERMANY. 263
The Baden Sickness Insurance Company in 1894 had 1398
cases, of which 546, or 39 per cent., were phthisical or
threatened with consumption.^
The Krailling Sanatorium,
which has just been built by the Sanatorium Society of
Upper Bavaria to the west of Planegg, is intended for the
reception of consumptives of the male sex. Besides work-
ing men belonging to the sickness insurance societies
(especially that of Upper Bavaria), it will receive private
patients of the industrial and commercial classes — shop-
keepers and the like — at low fees ; and a number of separate
rooms with one or two beds each have been provided with
this object. The Sanatorium Society itself, which is under
the protectorate of H.R.H. Prince Ludwig of Bavaria, was
mainly established through the efforts of Prof. v. Ziemssen
in 1895. Amongst the most prominent supporters has been
the Baroness Hirsch, who gave a donation of £5000.
The sanatorium stands in a wooded neighbourhood on
gravel soil 557 metres above the sea-level, and has an area
of 16^ hectares (40 acres) belonging to it, laid out in a
variety of patha It consists of a main building with
diverging wings, connected by a subterranean passage
about 200 feet long with a subsidiary block. The main
building has a basement, ground floor, first and second
floors. In the basement on the north side are the kitchen,
scullery, and larder. Next to the latter, in the angle of
junction between the centre and the western wing, is the
ice cellar. Electric ventilation shafts go from the kitchen
to the highest point of the building, and lifts to the serving
room and to the tea kitchens on the upper floors. To pre-
vent the entrance of cellar air into the upper floors there are
no cellars under the parts occupied by the patients, and the
cellar stairs do not lead into the shaft of the main staircase
but into the open air. In the middle of the ground floor on
the south side is the large dining saloon, with a serving room
^ Kuthy, loc. cit.
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264 SANATORIA FOR PEOPLE IN SOUTH-WEST GERMANY.
and servants* dining room to one side and a reading room
to the other. The dining saloon is also used as a day room.
In the wings are two fresh-air galleries, with room for forty-
couches. Behind the western wing is a corridor with a
number of rooms for the sisters ; and in the angle above the
ice house is the Catholic chapel. The corresponding angle on
the eastern side is occupied by a Protestant chapel. Behind
the eastern wing is a corridor with laboratory, consulting
and waiting rooms, and separate bath rooms for the patients,
the medical staff and the sisters, as well as a douche room.
Part of the corridor is used as a dressing room. To the
north of the centre block, behind the dining saloon, is the
main entrance, with a visitors' room on one side and two
rooms for the house master on the other. Outside these are
water-closets, and outside these again, rooms for clean and
dirty linen, separated from the two chapels by the main
staircasea
The first floor contains patients' rooms on the south side,
and at the back of the centre block a committee room,
lavatory, tea kitchen, and another large room, besides the
water-closets and linen rooms, as on the floor below. The
second floor is somewhat similarly arranged. The patients'
rooms have an average air space of 38 cubic metres (1340 cub.
ft.). Those in the second floor in the wings have mansard
windows. As originally planned, there were two rooms
with five beds, fourteen with four beds, four with three
beds, fourteen with two beds, and eight with one bed
apiece ; but 120 can actually be accommodated in the build-
ing. The linen rooms are so arranged that dirty linen can
be sent down from each floor on one side of the building by
a lift into the basement, and clean linen be drawn up by
another lift on the opposite side. The building is heated
by low-pressure steam, and lighted by electricity. The
outbuilding contains in the basement the disinfector with
two approaches and bath, another bath room for servants,
heating apparatus and cellars. On the ground floor are the
washhouse, stables, cowsheds, workshop, tool-house, laundry.
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SANATORIA FOR PEOPLE IN SOUTH-WEST GERMANY. 265
engine and djrnamo for electric light, mortuary, and common
room for men servants. Above are the servants' bedrooms,
in addition to hay loft and dry room, the latter with lifts
to the disinfecting room and the laundry.
The treatment is on the usual lines. The douche is
regularly employed, cod-liver oil and specifics when re-
-quired. Sputa are destroyed by burning.
There are ten nursing sisters. Dr. G. Krebs is the medical
officer. Patients pay 3^ marks per day.
The sanatorium is twenty minutes' walk from the Planegg
43tation on the line from Stamberg to Munich, which is
distant two hours by rail.
The Harlaching Sanatorium
is being built by the Munich Town Council for convalescents
of both sexes, including consumptives, and will probably
be opened early in 1899. Situated in 10 hectares (24
acres) of ground, it is surrounded by woods to the south,
west and east.
It is to be a large two-storey building, 350 feet long,
and nearly 130 wide, with a southerly aspect, and separate
administrative block to the north. The latter has been
arranged to provide for 500 patients, but the sanatorium
will at first accommodate from 200 to 250. The sexes are
^separated by a division through the building, garden and
park, with separate open fresh-air galleries and resting
places. The entrance is behind ; in front will be a large
lawn, and vegetable gardens to the sides of the grounds.
Next to the entrance are rooms for the porter and the
physician on duty. There will be a separate staircase on
-each side, as well as one in each wing ; also a couple of
lifts for patients and others for food. On either side of
the main entrance will be a dormitory with twenty beds. In
the first and second floors will be other dormitories for
twelve beds apiece, besides single-bedded rooms and large
open covered balconies well protected from wind by the
projecting wings. A chapel and a saloon for Protestant
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268 NORWAY AND SWEDEN.
•cent, of the visitors, so that it has been somewhat altered
in character to suit their requirements. The climate is
very good for this purpose, being cool and sunny in summer,
•dry and cold in winter. It is less pleasant in April when
the snow melts, and in autumn which is foggy ; but the
true winter and the months of February, March and June are
■especially pleasant. The temperature ranges in winter
between 28' and 12" F., with a daily variation of S** to 11°,
And occasional drops below zero. The summer temperature
ranges from 46*4'' to SS^**, with a very regular daily varia-
tion of 3** to S**. The usual maximum is about 68** in June
or July ; the lowest recorded temperature was — 16*6°, the
highest 80°. The relative moisture is from 85 to 95 per
<5ent. in winter, 70 to 85 per cent, in summer ; with more
in March and April. There are about 135 rainy or .snowy
•days, and thirty to forty cloudy or foggy days per annum.
There is very little wind, especially in winter. The climate,
.as a whole, has been compared by Dr. Andvord to that of
Wildbad ; April, May and June he likens to the winter of
Meran ; the rest of summer and the autumn to the winter
of Pau ; the winter to that of Davos. There are six months
of continuous snow. The sanatorium lies in a hollow in
Tonsaassen Mountain, which separates Valders from EtnedaL
The mountain rises to a height of 2625 feet, the sanatorium
being 625 metres (2050ft.) above the sea. The ground forms
part of a plateau which is surrounded to the west, north and
•east by heights of 4900 to 6500 feet, and gradually drops to
the south and east towards the great lakes and sea coast.
The soil belongs to the Cambrian system, and consists of
slate and blue quartz. The latter is somewhat barren, and,
being much fissured, dries rapidly after heavy rain.
The sanatorium owns 3250 acres of land, mostly pine woods
provided with paths at various gradients and many seats.
It consists of a curhaus, six other buildings, doctor's house,
bath house, bakery, outhouses, etc. (fig. 32), mostly arranged
round the head of the little valley. The chief building has
.an external staircase, and contains a dining room, music
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s
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NORWAY AND SWEDEN. 26?
room, conversation room, etc., on the ground floor; it is.
heated by open fires burning wood. The dining room ia
11 X 10 metres (36 x 32 ft. 9 in.) and 3i metres (11^ ft.) high ;
the drawing room of the same size, but 6 metres (19f ft.)
high. There is accommodation for ninety patients in summer,,
thirty-five to forty in winter. Very few of the summer rooms,
have stoves ; the others have closed stoves. The bedrooms*
are in four different buildings, so that four tariffs can be
observed. In one of the buildings no tuberculous patients,
are admitted ; in the other buildings some rooms are used
exclusively for tuberculous, others exclusively for non-
tuberculous cases. The rooms in one building are 4*5 x 4'1
metres and 3*3 high (14J x 13 J x 11 ft.). The rest are about
4-4 X 3-5 X 3 metres high (14J x 11 x 10 fi). There are
verandahs or balconies on every floor. The furniture ia
simple. The lighting is by electricity. Ventilation by
open windows, day and night, summer and winter. There
are said to be good water-closets and baths. The waste
water is carried into a brook. In winter the sewage ia
covered with earth.^
The establishment is open throughout the year. It waa
built in 1881, and has been a winter station since 1885.
No advanced cases are admitted. Treatment is by open air,
in the verandahs or balconies, or in the pavilions in the
woods. Patients who are fit for it take plenty of exercise.
There is a very complete apparatus for hydrotherapy, with
vapour baths, needle baths, ferruginous, hot and cold baths,
etc. Patients in summer have friction with water at 15° to
20"* C, or douches. In winter, dry friction and partial
ablutions are substituted. Five or six meals are provided
daily, with alcohol in great moderation. Cod-liver oil and
specifics are little used. The sputa are put into a cask
with sol. of ferrous sulphate, and after a month are burnt.
Patients bring their own bedcovers and pillows. Mat-
tresses are disinfected by brushing with 2 per mUle corr.
subl., followed by solution of washing soda. Rooms are
* Mdller, Les Sanatoria.
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^'
CHAPTER XLII.
RUSSIAN SANATORIA.
Up to 1892 there were two sanatoria in Russia for con-
sumptive paying patients, one at Halila in Finland and
another at Lindheim in Livonia. The first of these how-
ever was transformed by the late Emperor Alexander III,
into a popular sanatorium, and two others built in the same
grounds respectively for girls of the upper classes who show
consumptive tendencies and for military men. There are
at present, in addition to the above, sanatoria for paying
patients at Slawuta in Volhynia ; at Yalta in the Crimea ;
at Oranienbaum near PeterhofF, opposite Cronstadt, for
patients with but moderate means ; and a number of
koumiss stations on the Volga and near the Steppes ; while
a new sanatorium for paying patients is to be erected under
Dr. Masing at Willmanstrand on the Saimansee in Finland.^
The sanatorium of Slawuta is near Ostrog on the Goryn,
and has 100 beds, but is only open in summer. For the
poorer classes a sanatorium has been founded at Taitzi on
the Baltic by the present Emperor ; consumptive patients
are also received at the Obouchowsky Hospital at St.
Petersburg (for 100 men and fifty women), the Alexandre
Hospital in the same city (for fifty men and fifty women), the
Alexandrina Hospital (for fifty women) ; and " House Sana-
toria " have been established for the fresh-air treatment of
consumptives at the Military Hospital of Zarskoje Selo
under Dr. Unterberger, at the Hospital of the Grand Duke
Nicholas at Kief, and at Wola near Warsaw under Dr.
Natanson ; while other sanatoria are to be erected near
1 See Liebe, Hyg, Rundsch., 1896, No. 20.
(272)
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RUSSIAN SANATORIA.
27a
Moscow and at Mustamakki in Finland.^ The Duodecim
Society of medical men in Finland has recently decided to
erect a sanatorium for fifty to sixty patients. It is esti-
mated to cost 50,000 to 75,000 rb., to be covered by shares-
of 100 rb. each.2 The Rachmanow family in Moscow has.
made a donation to the city of 200,000 rb, part of which is:
to be for the erection of a sanatorium of at least 100 beds,
while the interest on the rest is to be spent in the support
of free beds in the sanatorium. The city of Moscow is
expected to pay for the maintenance of the institution, and
to provide a suitable site.^
A society has been formed in St. Petersburg for the erec-
tion of sanatoria for tuberculous children ; 22,000 rb. have
been collected.* Countess Bariatinsky has recently founded
a gymnasium or school in Yalta for sixty children who have
to live in the south owing to delicate health.^
Collections are to be made twice a year in all the churches,
of St. Petersburg for the erection of sanatoria. The first
collection yielded 1200 rb.
Russian Sanatoria.
, Lindheim
Quisisana, Yalta
I Alexander, Halila
Maria ,,
I NikoUj
I (WiUmanstrand)
I Slawuta .
Oranienbaum .
Taitzi
(Moscow) .
Zarskoje Selo (House San.)
Kief
I Wola (Warsaw)
Obouchowsky Hospital .
Alexandre „
Alexandrina „
Feet.
Beds.
Livonia
800
12
Crimea
200
?36
Finland
82
i»
—
26
>»
—-
100
Volhynia
100
Baltic
—
—
>?
—
40
"^
100
St. Petersburg
—
160
If
—
100
»»
—
60
^ Kuthy, loc, cit. ; see also L^on Petit, loc, cit. ; Sonderegger, Heilstdtten
far Brustkranke in der Schweis, St. Gall, 1894.
' HeilsL Carr,, Aug., 1898. A rouble is worth about 2s.
^Ibid. *Ibid. »IWd.
18
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274 KUSSIAX SANATORIA.
LixDHEiM Sanatorium,
in Livonia, was originally a boarding school, but was
acquired by Dr. Armin Treu in 1895, and opened as a
sanatorium for middle class consumptivea It consists of
two wooden buildings, with one and two floors respectively,
standing in a garden of 5 hectares (12 acres), nearly 100
years old, and wooded with oaks and other deciduous trees.
There are altogether 75 hectares (185 acres) of land belong-
ing to the sanatorium. The soil is of granite and sand
without any admixture of clay, so that it rapidly dries
after rain.
The sanatorium stands 300 feet above the sea-level, in a
plain traversed by the little river Waidau, and surrounded
by pine woods to the west and south, and by mountains
to the north and east The sanatorium is said to be warm,
and comfortably though not luxuriously furnished, heated
with Russian stoves, lighted with petroleum, and provided
with special ventilators. The dining and reading rooms
-cover an area of 96 square metres (1033 sq. ft.), and are
5 metres (9 ft. 10 in.) high. The bedrooms, which are
mostly in the two-storey buildings, are 34 metres (11 ft.
6 in.) high, and vary from 16 to 48 square metres (172 to
516 sq. ft). For open-air treatment there is a large
verandah open only to the south. There is at present
accommodation for twelve patients, but Dr. Treu intends
to buy the property and completely transform the establish-
ment, increasing the accommodation to twenty-four.
The sanatorium is intended for consumptives in remedi-
able stages; but healthy attendants or friends are also
admitted. The treatment is by hygienic methods. The
food is said to be abundant, with good plain cooking.
Wet and dry rubbing are practised, but the douche is not
employed. Sputa are received into Dettweiler's flasks.
The contents are disinfect^ with FeSOi, and poured into
the water-closets. The sewage goes into a cesspool Linen
is purified by boiling ; rooms by thorough washing, rubbing
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RUSSIAN SANATORIA. 275
with bread, and application of corrosive sublimate solution.
Creosote, Kleb's antiphthisin and Kochs' tuberculin are
employed in suitable cases. Cod-liver oil is not given.
There is a nurse in the building who has been trained by
Dr. Treu.
The charges are 50, 60, and 75 roubles per month. If
two persons share one room, the first pays the full price,
the second 50 roubles per month. For healthy attendants
there is a reduction of 10 roubles. For extra nursing 40
roubles are charged in addition. Other extras are beverages
and expensive drugs. Patients bring their own bedding
and body linen ; also a rubbing glove, a fur covering for
winter, with fur cap and felt boots to the knees. They
buy their own Dettweiler's flask and thermometer.
The sanatorium may be reached by carriage from Werro,
which is connected with St. Petersburg by rail.
Kuthy (loc. cit.) mentions a sanatorium at Lindenhof for
thirty patients. This is probably the same as the above
described establishment.
QUISISANA.
This is a sanatorium not specially for consumptives, but
admitting such patients in early stages. Situated in a
suburb of Yalta, in a bay on the Black Sea coast, it is pro-
tected to the north, west, and partially to the east by the Yaila
Mountains, which rise to a height of 5000 feet. The soil is
slate, quartz, crystalline limestone and marble, mixed with
clay, diorite, etc. The sanatorium is 200 feet above the sea-
level, with a view of the sea to the south. It stands in a
terraced garden of one-third acre, next to a wood of 7 acres ;
and all the neighbouring houses are also surrounded by
gardens. The grounds are on the mountain side, and are
laid out with paths of various gradienta
The sanatorium, which was founded in 1886, consists of
several buildings, one of which is a wooden structure with
seven rooms and four verandahs and balconies, the others
being solidly built of stone. Higher up is the main block,
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276 RUSSIAN SANATORIA.
which is built in two storeys and contains twenty-four bed-
rooms with seven verandahs and balconies, the dining room
and drawing room. Still higher is the doctor s residence,
which contains the bath room, laundry and kitchen depart-
ment, in addition to ten bedrooms with three verandahs and
balconiea A little way off are the stables, cowsheds, etc.
The verandahs have for the most part glazed sides and open
fronts. The average air space in the bedrooms is 1104 cub.
ft. ; the common rooms collectively contain 7000 cub. ft.
There are no ventilating chimneys, but double ventilation
for winter and summer, admitting fresh air through open
windows or warmed air next the heating apparatua This
consists of Warsaw porcelain stoves with hermetical seal
and chimney. Throughout the winter every window is
opened while the patients are at meala The lighting is by
stearine candles and petroleum. There is room for thirty
patients. As a rule only one sleeps in each room, but
exceptionally two or even three may sleep together.
The sputa are disinfected with carbolic solution and then
poured down the water-closet. Linen of healthy patients is
washed at home ; of those who are ill by the public laundries,
which also disinfect by steam. Rooms are disinfected on
the departure of each patient by the public health authori-
ties, and repapered and repainted of a different colour,
mainly to give confidence to the visitors, the floors being
washed and disinfected with sublimate solution and then
treated with beeswax and turpentine. The solid sewage
and kitchen refuse are removed every day and carried out
to sea by a special steamer. The liquid sewage is carried
along the seashore in ventilated sewers.
Patients in the third stage are not admitted, nor as a rule
any which require nursing. The treatment is by open air,
good food and the like, but not by the Brehmer methods.
Dr. Weber seeks to make the place a home, and to banish
everything suggestive of a hospital or sanatorium. He is
present with his family at all meals, and treats patients
more as members of the family. He constantly endeavours
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RUSSIAN SANATORIA. 277
to impress upon them the very feeble infective power of
tubercular consumption, and organises concerts, private
theatricals, etc., in which both patients and the members of
his own family take part. A masseuse lives in the house ;
other nurses are obtained from the Red Cross sisters in case
of need.
The charges are 70 to 90 roubles per month, and 10 roubles
for medical attendance.
Yalta may be reached from Sebastopol by steamer and
carriage.
The Sanatoria at Halila.
A sanatorium was founded in 1889 by Dr. Dittmann at
Halila in Finland for the reception of paying phthisical
patients. It was however bought by the Russian Govern-
ment by command of the Emperor Alexander III., and con-
verted in 1892 into a popular sanatorium for the same
purpose. Two other sanatoria have since been erected on
the same ground. These three sanatoria are called re-
spectively the Alexander, the Maria, and the Nikolaj.
The ground belonging to these sanatoria consists of 1000
hectares (2471 acres) of wood and moorland near the Halila
lake ; and has no large towns or factories near it. Walks
have been laid out at various gradients provided with seats
at every 50 metres. There are already a great many such
paths, but the number is being added to every year. There
are altogether some twenty buildings on the. ground,
including the three sanatoria, which are under common
management.
The Alexander Sanatorium
consists of a pine-wood structure on a granite foundation
in the shape of a T, with ground floor and first floor, and
contains thirty-eight rooms for thirty-two patients. Most
of these rooms are east and west of a wide corridor which
leads on to an open verandah on the sotith side, or on to
balconies above it. The bedrooms are 4J metres (14f ft.)
high and 8 x 5J metres (26 X 18 ft); and have chimney
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278 BUSSIAN SANATOBIA.
shafts for ventilation. Their walls are of varnished pine-
wood, the floors covered with linoleum. The furniture is of
white enamelled pinewood. There are also common rooms,
a music room, a reading room, billiard room, and winter and
summer dining rooms, as well as two bath rooms, douche
room, consulting room, and a laboratory with chemical,
bacteriological, histological and microphotographic appa-
ratus. The kitchen department is united by a warm cor-
ridor with the rest of the building. There are balconies to
the north as well as south. Heating is by Swedish por-
celain stoves ; lighting by electricity. There is an abundant
water supply, which is mostly pumped up by a steam engine
from the Halila lake into two highly placed reservoirs, the
drinking supply being stored in a third reservoir. This
water supply is common to all three sanatoria, and is cap-
able of supplying from 60,000 to 90,000 litres per diem, or
from 400 to 600 per head. The water-closets are of
English pattern, with powerful spiral flush, and carry the
sewage through earthenware pipes to a small lake adjoining
the property, where it is purified by filtration through
sphagnum, the solids being put on to the fields.
Patients receive four meals a day, in addition to milk or
other supplementary food. They spend most of the time
out of doors from 8 a.m. till 10 p.m. Morning and evening
they are treated with douches, baths and massage. Wet
compresses are much used. Sputa are received into Dett-
weiler's flasks, random spitting being strictly forbidden.
Spittoons containing water are also used. The bed and
body linen, which with handkerchiefs, etc., is provided by
the patient, is disinfected by steam before being washed.
There is a good library with newspapers, etc ; patients also
amuse themselves with piano, chess, photography, etc. ; and
in winter there is sledging. They are also encouraged to
do light work in the garden ; and a bookbinder's apparatus
is to be set up for them. Dr Gabrilowitsch is the chief
medical oflScer.
In 1895-6, 109 patients were treated, 43 per cent, being
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BUSSIAN SANATORIA. 279
in the first and 47 '7 per cent, in the second stage. Of
these 19*3 per cent, were apparently cured, an additional
541 per cent, were improved ; in 18'3 per cent, there was
no result, and 8*3 per cent. died.
The mean duration of stay was 219 days. The results in
winter were on the whole more favourable than in summer.
The charges are from IJ to 2 roubles per day.
The Maria Sanatorium,
which was founded in 1893, is intended for children who
have a predisposition to consumption, and especially for
the girls of the schools for the nobility who may show such
tendencies. The sanatorium contains thirty-five rooms, for
twenty-five patients, all placed on the south side of the
building, a long, wide, airy, glazed corridor being placed to
the north and used in bad weather for walking exercise.
The rooms resemble those in the Alexander Sanatorium,
but are rather more luxuriously furnished. They have air-
shafts for the foul air, and also means of warming the
incoming air. The flooring is of parquet. Heating is by
Swedish stoves, lighting by electricity, and the sanitary
arrangements are like those of the Alexander Sanatorium,
but rather more complete. The walls in the kitchen and
bath rooms are tiled, the kitchen being placed in the
ground floor. The lower floors and the walls have been
built with damp-proof courses.
The Nikolaj Sanatorium
was built in 1895 by the Grand Duchess Alexandra Jossef-
owna for the military classes. It is built on the plan of
Hohenhonnef (see p. 182), in three storeys, and has 120
rooms for 100 patients. The front has a southerly aspect,
and is provided with three tiers of fresh-air galleries and
diverging wings. The large dining saloon is over the
kitchen in a separate block to the north, united to the main
building by a vestibule and winter garden. The walls and
ceiling are of varnished wood, the floors covered with
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280 RUSSIAN SANATORIA.
linoleum. For ventilation there are separate air-shafts and
fans, with electromotor. The heating is by low-pressure
warm-water pipes. The foundations have a damp-proof
course, the electric lighting, water supply, and sewerage
being part of the same system as in the other two sanatoria,
And the rooms of the same size. Dirty linen is put into
numbered sacks and sent down a linen shoot into the base-
ment to be disinfected and washed.
This establishment is not far from Novajakirka, on the
branch railway from Viborg to St. Petersburg.
The Taitzi Sanatorium.
Early in 1896 the Society of Medical Practitioners in St.
Petersburg made a report on the need for sanatoria for
the consumptive poor, and appealed to the public for funds.
Plans and estimates were prepared, and ultimately a society
was formed under the presidency of Countess Woronzova-
Dashkova, and the high protectorate of the Empress Maria
Theodorovna. Soon after the Emperor Nicholas II. sent a
contribution to the society of 467,000 roubles (nearly £50,000)
for the erection and maintenance of a sanatorium in memory
of the Empress Maria Alexandrovna, who was herself a
victim of consumption. He also made them a gift of his
property of Taitzi, near Qatschina, on the Baltic coast,
about twenty-five miles from St. Petersburg. This place
has long been famous for its magnificent park and its
sheltered situation, and contains 22 dessiatinen (630 acres)
of arable land, gardens, meadows, and woods. In 1896
extensive alterations were made at the cost of the Depart-
ment of Imperial Properties, the land being drained, the
mill removed, a pond filled in, water-courses cleansed,
and their banks turfed. The old stone castle has been
fitted for the accommodation of twenty patients, while
other buildings have been altered to receive the doctor,
nursing staff, and servants. Verandahs have been con-
structed on every side of the sanatorium, and there is also
to be a solarium on the roof. A new building is also being
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RUSSIAN SANATORIA. 281
built for twenty female patients ; and a laboratory, disin-
fecting chamber, electrical apparatus, laundry, and chapel
Are also being added. The china has been sent from the
imperial factory.
Military House Sanatoria.
These have been chiefly advocated by Dr. S. Unter-
%erger, who was the first to establish one at the Military
Hospital of Zarskoje Selo, near St. Petersburg. Dr.
Unterberger is not a believer in the common causation of
phthisis in all its forms by the tubercle bacillus, but is of
opinion that many scrofulous inflammations of bones, joints,
glands and lungs are non-bacillary, and due to inherited
predisposition: **a constitutional disease, and a specific,
still unknown ailment of the lymphatic system; just as
hsemophilia and arteriosclerosis are special ailments of the
muscular system ". Unterberger believes this tendency to
be greatly encouraged by defective nutrition, noxious micro-
K)rganisms, such as the streptococci, staphylococci, micro-
•coccus tetragonus, etc., and that the tubercle bacillus may
secondarily attack such lesions. This view is, it appears
io me, of more theoretical than practical importance, as in
Any case treatment would be directed against constitutional
•debility, and sputa disinfected by the usual methods.
Dr. Unterberger started his House Sanatorium as follows :
A large airy room was chosen with a southerly aspect, and
A number of rooted young fir trees placed in it in tubs
of wet sand. These were sprinkled daily with pulverised
solution of ol. pini sylvestris, ol. terebinth and water. The
fir trees retain their needles for about six weeks, when
they are replaced. Patients sleep in these rooms, and in
other respects are treated according to the Brehmer-Dett-
"weiler methods.
Dr. Unterberger has published statistics showing that
out of 128 patients 86 per cent, were restored to compara-
tive health, while 383 per cent, more were improved ; a
Jesuit which he states is much better than is obtained
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284 swiss sanatoria for paying patients.
The Arosa Sanatorium.
Arosa is a small hamlet in the Upper Engadine, in the
canton of Grisons, about six hours' drive from Chur. The
road ascends the valley of the Plessur in an easterly direc-
tion as far as Langries, where it takes a sharp turn to the
south-west as far as Arosa. The Arosa valley itself forms
a long oval, surrounded on all sides by snow mountains,
and rises from 1760 to 1892 metres above the sea-level. It
is divided by the Tschuggen mountain on the north into
an upper and a lower part; and its sides are clothed to
a height of about 1900 metres (6200 ft.) by pine woods,
broken by two fine lakes.
The climate is Alpine, with a dry diathermanous atmo-
sphere, much sunshine, little or no dust, and a low baro-
metric pressure. Owing to its position among high
mountains, it is little affected by strong winds ; but is
kept fresh and clear by local winds of great regularity.
The prevailing day wind in winter is westerly, at other
seasons easterly ; while at night the cool mountain air
flows down into the valley from the north. Excepting
when the Fohn blows, however, there is no strong wind,
so that low temperatures can be comfortably borne. As
in all Alpine climates, there are considerable daily and
seasonal differences of temperatures; although these are
diminished by the abundant vegetation. In winter the
minimum and mean temperatures are about 2** C. higher
than at Davos ; while the amount of sunshine is greater.
In summer Arosa is a little cooler than Davos, but has a
larger proportion of cloudy days. Altogether the climate
of Arosa is regarded by Dr. Ewart as more stimulating
than that of Davos.
The sanatorium is situated on the northern side of the
Arosa valley, and is sheltered to the north by the Tschuggen,
to the east by pine woods and the approximation of the
mountains ; while it is open to the south and west, and so
receives a large proportion of sunshine. It is 1866 metres
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Fio. 33.— Thb Arosa Sanatorium. [Face page 2S6,
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SWISS SANATORIA FOR PAYING PATIENTS. 285
(6090 ft.) above the sea-level, and 120 metres above the
bed of the Plessur, and was built in 1887, and extended
in 1895. It is isolated from other buildings by private
grounds, which are provided with a few horizontal paths
and a larger number at gentle slopes, all plentifully pro-
vided with seats. Some of these walks are over sunny
meadows, others through the woods. The view to the
south is over meadows which rise to naked peaks in the
distance ; to the west are wooded mountain sides. Owing
to the steepness and the permeable soil, the ground soon
dries after rain and during the melting of the snows.
The sanatorium consists of an old and a new curhaus
side by side, and a separate building for laundry and dis-
infection. The ground floor of the old curhaus (fig. 33) is
mainly occupied in front by drawing room, music room
and reading room, behind by the kitchen department. In
front of it is a deep verandah, protected at the eastern end
by the projecting music room, and ending at the western
end in a pavilion. On the ground floor of the new curhaus^
which stands back about 10 metres, are a ladies' room,
oflBces, vestibule, waiting room, consulting room and labora-
tory ; and on the south front another verandah. Uniting
the two buildings is a large dining saloon, which covers
160 square metres (1722 sq. ft.), and is 6 metres (19 J ft.) high.
Eiach building has a terrace in front of it, and at a lower
level a liegehalle. The united south front measures 105
metres There are two upper floors in the new kurhaus,
and three in the old, which are occupied by bedrooms.
Originally opened with thirty-two beds, there are now
sixty-five. Most of the bedrooms have at least one window
to the south, and are of good size; some have separate
balconies Every room is lined with wood, and has linoleum-
covered floors. The electric light is used throughout the
establishment. Heating is by solid closed stoves in the old
building, by low-pressure steam in the new. There is a
private water supply, and good flush to the water-closets,
which are placed in built-out pavilions near the staircases
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288 SWISS SANATORIA FOR PAYING PATIENTS.
disadvantages which inevitably exist in a fashionable health
resort, where many consumptives congregate together with
a mixed population of tourists and invalids. Facilities
abound for skating, tobogganing, sledging, snowshoe run-
ning and the like ; also for more objectionable concerts and
entertainments in crowded places. Many of the consimip-
tives there are scarcely, if at all, under medical control, and
are apt to disregard the directions of their medical advisers,
to their own hurt and possibly to the disadvantage of others.
There are a number of hotels and pensions, some of them
very well arranged, and possessing many of the structural
features of medical sanatoria, but without their medical
control and attention to details of management. Most of
these hotels charge from 7 frs. 50 c. to 14 fra per day ; in
the pensions the terms are from 1 to 2 frs. lesa The sana>
toria proper consist of (1) Dr. Turban's sanatorium, (2) Dr.
Philippics new sanatorium at Davos Dorlli, (3) a sana-
torium for the poor of Basel, (4) one for poor consumptives
of Dutch nationality ; we may perhaps add (6) the Diako-
nissen-Haus, a private nursing home for advanced cases,
and (6) the Villa Pravignan, which is a similar institution
exclusively for Roman Catholics.
Dr. Turban's Sanatorium
is situated on the south-west of Davos Platz on the moun-
tain side at an altitude of 1573 metres (5160 ft.) above the
sea-level. Sheltered by mountains and forest to the north, it
has a fine view to the south and south-west over meadows
and the town of Davos to the mountains beyond. It has
a garden of 7 hectares (17 acres) with walks at gentle
gradients, adjoining the grounds of the Kurverein, to
which patients have access on payment of a subscription.
In these grounds '* the paths are somewhat steep, and
insufficiently provided with seats, while in summer there
is too little shade ".^
^ v. Jaruntowsky, Sanatoria for Consumptives ^ trans, by E. 0. Beale
London : Rebman Publishing Co.
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SWISS SANATORIA FOR PAYING PATIENTS. 289
The sanatorium, which was built in 1887 and enlarged in
1894, is situated at the lower or south-east corner of the
garden, and consists of four buildings (tig. 34) united by-
covered passages, and an isolated villa for the chief medical
oflBcer and the managing director. The main building is a
long erection on four floors, with a basement, having a covered
verandah in front of the ground floor, and open balconies to
the other floors. In the basement are the administrative
rooms and cellars, the laundry, disinfecting and heating
apparatus. On the ground floor is a large dining saloon,
15 X 10 metres (49 ft. x 32 ft. 9 in.) and 5 J metres (18 ft.)
high, with room for 120 guests ; a drawing room, reading
room, billiard room, oflBce, doctors' rooms and laboratories,
gymnasium, douche and bath rooms. Above these are
patients' bedrooms on three floors, all on the south side,
and opening into a well-lighted corridor, the staircase being
also to the north. The largest of the (jjbher villas is to the
east, the remaining two being at the upper or western end.
There is altogether accommodation for eighty patients. The
bedrooms average 57 cubic metres (2013 cub. ft.) in capacity.
They are heated in the main building by low-pressure
steam pipes, the rest of the establishment being served by
porcelain closed stoves or hot- water pipes. In each bedroom
of the main building is a radiator which can be regulated,
and which has a ventilating inlet next to it. On the oppo-
site wall is an outlet leading to a chamber under the roof.
In addition to this, the windows, which are French windows
with an upper hinged pane, are always kept partly or en-
tirely open. There is a similar arrangement over the doors
of the balconies. The walls are of wooden panels with
rounded angles. The floors are covered with linoleum.
The lighting is by electricity, the bedrooms having bed and
table lamps which can be shaded. The water-closets have a
good flush. There is a very good water supply.
The diet is varied, with six meals a day, including much
mijk and butter. One day it is recherche, the next it is
simple in character.
19
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290 SWISS SANATORIA FOR PAYING PATIENTS.
The patients are exclusively such as are likely to benefit
by an Alpine climate, no advanced cases being admitted.
The contra-indications are much the same as at Arosa
{which see). Davos, being 300 metres lower than Arosa,
has a correspondingly less stimulating climate ; the summer
is finer, and is better suited to patients with chronic anaemia.
The neighbourhood has been carefully mapped out in quar-
ter-hour walking distances, also showing the steepness of
the paths.
Treatment is mainly on the lines indicated by Dr. Breh-
mer. There are fresh-air galleries 80 metres in length ;
but patients who are not febrile mostly take a good deal of
exercise. They spend as a rule from eight to ten hours a day
out of doors. Hydrotherapy is applied in the form of dry
and wet rubbings, and in about 25 per cent, as a divided
douche, applied by the physician himself. Respiratory
exercises with Qifiprd's apparatus are employed where the
lung is little affected. Dr. Turban uses tuberculin where
patients are willing to have it, and where the case is
suitable. The sputa are thrown down the water-closeta
The spittoons and spitting flasks are disinfected with
solution of corrosive sublimate and sodium chloride.
Linen is disinfected by boiling; rooms by being washed
with soap and water.
The sanatorium belongs to a company, but is under the
control of Dr. Turban and his assistant, Dr. Wunsch. The
charges for single rooms are from 2 to 6 frs., for double-
bedded rooms 5 to 7 frs. Board is 11 frs., including
medical attendance, baths, douches, rubbings, attendance,
heating and lighting. There is an entrance fee of 20 frs.
for all (excepting servants) who stay more than fourteen
days. Other extras are beverages and drugs. There is a
reduction in the case of medical men and their families,
children and servants ; and in summer time 1 f r. per day is
deducted from the charges for bedrooms.
Davos is reached by rail from Landquart, which is in
connection with Basel and other centres.
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swiss sanatoria for paying patients. 291
The New Davos Sanatorium,
which was recently opened under Dr. Dannegger, is now
under the care of Dr. Philippi, formerly at Dr. Turban's
sanatorium. It is situated in the English quarter, on the
boundary between Davos Platz and Dorf, on the highest
part of the road, where it is surrounded by open meadows
free from other houses.
From its position it receives a large proportion of sun-
shine. It has a southerly aspect, and consists of a stone
building erected in 1896-7, and a chalet in Swiss style,
both connected by a covered walk with the fresh-air gallery,
which is over 60 feet long. The main block, which has
a basement ground floor, and four upper floors, on an
approximately square base, contains in the basement the
kitchen department and heating apparatus. In the ground
floor the eastern side is occupied by the dining saloon,
which is 12-80 x 4-25 metres (42 ft. x 13 ft. 9 in.). To
the south are the drawing room and reading room ; the
entrance is on the north side, as well as the water-closets
and office and porter's room ; the staircase at the western
end of the central corridor. The consulting and waiting
rooms are on the first floor over the office. The patients'
bedrooms are placed on all sides of the house, but mostly
to the south and east. Many have balconies. They all
have wood-panelled walls and linoleum-covered floors ;
electric lighting, and heating by low-pressure steam pipes.
The doors and windows are double, the latter having an
upper hinged pane. The water-closets are of a modem
pattern, with abundant water flush. The water supply is
of excellent quality. In addition to bath rooms in both
buildings, a douche room has been fitted up.
The ch&let, which has two upper floors, contains twelve
rooms, ten of which are patients* bedrooms. These have
parquet floors, but are in other respects like those in the
main building. Dr. Philippi sleeps in this part, and has
arranged a small laboratory above his room.
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292 SWISS SANATOBIA FOR PAYING PATIENTS.
The patients admitted, who number forty, or with two in
some of the rooms, fifty-live, are mainly consumptives in the
more hopeful stages, although others who suffer from
anaemia, scrofula, pleurisy, asthma, or bronchial catarrh
are not refused. The treatment is after Brehmer's and
Dettweiler's methods. Hydrotherapy consists of rubbing,
packs and douches, applied before the first breakfast. The
douches, which are only applied in suitable cases, last but
a few seconds, while the water is cooled by a special mixing
apparatus from 68° F. to 47° or 50°. The meals consist of
a first breakfast at 7*30 to 9 (half an hour earlier in
summer), second breakfast at 10'30, dinner of five courses
at 1, a light meal at 4, supper of four courses at 7, and extra
milk at 9. The milk comes from cows under veterinary
supervision. Patients rest from 12 till 1, from 2 till 4, and
from 5*30 till 7, as well as after supper. During the after-
noon strict silence is observed, to allow those who need it
to sleep. The couches have removable horsehair cushions.
The patients who are able go for walks before the second
breakfast in the morning, and before supper. Creosote
preparations and tuberculin T.R are administered in certain
cases. Respiratory gymnastics are only employed in
pleuritic adhesions and the like, where no crepitations are
audibla In suitable cases patients go up the mountain
side through the woods belonging to the Kurverein, about
five minutes' walk from the establishment. The place is
very thoroughly ventilated day and night. Rooms are
rubbed down daily with a damp cloth, disinfected on
departure with Schering*s apparatus (formalin).
The charges are 10 francs per day for inclusive board
and treatment, with 1 to 6 francs extra for the room.
Where two sleep together, 4 to 7 francs are charged for
the room. Patients buy their own woollen bedcover at
cost price, and bring their own rugs, furs, and a new pouch
for their napkin ; a f ootbag reaching up to the chest should
be bought in Davoa
The sanatorium is on the telephone, and close to post
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SWISS SANATORIA FOR PAYING PATIENTS. 293
and telegraph oflBce. It is ten minutes from the station
at Davos Dorf, twenty minutes from that at Davos Platz.
The Maison de Diaconesses,
founded in 1882, receives advanced cases which are not
suitable for treatment in hotels and not admissible to sana-
toria. Their charges are a little below those of the hotels.
The Villa Pravignan
is a similar institution exclusively for Roman Catholics,
and under the charge of a sisterhood.
The Leysin Sanatorium,
Leysin, which has the highest parsonage in the Canton de
Vaud, is situated above the lower part of the Valine des
Ormonts, on a wide plateau 1264 metres (4150 ft.) above
the sea-level, at the foot of the Tours d'Ai. The valley,
which has long had a reputation for the cure of scrofulous
children, runs from north-east to south-west, the sana-
torium being on its northern side, at an altitude of 1460
metres (4760 ft.), which is above the usual fog and cloud
level for this part of the Alps. The soil is dry and calca-
reous, the climate resembling that of other Alpine resorts,
with rather more sun than Davos.
The establishment is protected to the north and west by
pine woods and mountains, and by high peaks four or five
miles farther east. Its aspect is south-south-easterly. It
has a fine view across the valley to the snow mountains, of
which the most conspicuous is the Dent du Midi, with Mont
Blanc in the extreme distance, while Aigle and St. Moritz
are visible in the Rhone valley. The forest behind, which
extends 300 metres above the sanatorium, has numerous
paths, some steep, some nearly level, with sheltered kiosks
and seats in abundance.
The sanatorium (fig. 36^, which is of stone, consists of five
storeys and a basement served by a lift, and contains 110
rooms for patients, of which eighty are on the southern side.
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294 SWISS SANATORIA FOR PAYING PATIENTS.
Each of these is at least three metres high, and is provided
with a chimney for ventilation, and with double windows,
the tops of which can be separately opened. There are
roomy balconies in front of most of these. The kitchens,
store rooms, servants' apartments, and staircases are on
the north side. The dining saloon, drawing room, winter
garden, and glazed galleries for exercise indoors, are on the
ground floor and basement. There is also a large liege-
halle, thirty metres long, on the eastern side of the build-
ing, and another is being made farther off The second
floor communicates with the forest by meanff of a foot-
bridge. The building is heated by low-pressure steam, a
few rooms also having independent fireplaces. Lighting is
by electricity. Furniture is simple and readily deansable.
There is an abundant water supply from the Tours d'Ai, by
an aqueduct from a height of 125 metres (410 ft.) above the
establishment. There is also a large dependance (fig. 36).
Patients of all stages are admitted, provided there is any
probability of their benefiting by the dimate. Treatment
is on the usual lines, but patients take much rest in the
open air and only a moderate amount of exercise, as at
Falkenstein. They spend on an average ten hours out of
doors. Respiratory gymnastics are not employed. Three
meals a day are provided. Not much alcohol is given, and
this mainly in the form of wine. Spv^ta are received
exclusively into Dettweiler's flasks and spittoona The
former are disinfected with lysol, the latter with corrosive
sublimate solution, a special male nurse attending to this
every day. The skin is stimulated daily by dry frictions,
occasionally by rubbing with cold, fresh, or salt water. The
douche is not employed. As regards amusements, skating
is recommended for those who are fit for it. There are
two skating rinks. Professional musicians and conjurers
are not admitted ; but a caf^ casino has been built at a
short distance, which is of very doubtful advantage.
Smoking is not encouraged, but is allowed in the billiard
room.
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Fig. 35.— Thb Lbysin Sanatorium.
[Page 293.
Fig. 86.— Thb HdrsL du Mont Blanc, Lbysin.
[Page 294.
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SWISS SANATORIA FOR PAYING PATIENTS. 296
The building is connected with the telephone and tele-
graph systems. Two rooms are used for regular religious
services, which can also be found in the village for both
Protestants and Catholics. Leysin is connected with Aigle
by a good road. Diligences run at least twice a day each
way and take about three hours. A railway line is also
to be made.
The charges are 9 to 15 francs per diem, including service,
light and warming. Extras are medical fees, massage, baths
and douches, private sitting rooms, meals in private rooms,
■ open fires in the patients' rooms, and a small charge for
the use of the open-air gallery. Special diet is charged
a la carte. Reductions are made for families, children,
and servants.
The sanatorium was built in August, 1892, by a company,
and is managed by Dr. Exchaquet, with the help of a
managing director.
The Montana Sanatorium.
Montana is a small village in the Swiss Valais about
three hours by road from Sierre, which is itself half an
hour by rail from Sion. Some 300 metres above the village
of Montana, and 1515 metres (4970 ft) above the sea-
level, is the Hotel du Pare, which until 1st October, 1897,
was visited mainly by tourists, but was then reorganised
by Dr. Stephani to suit the needs of consumptive patients.
The present proprietors are M. Louis Antille and M. Michel
Zufferey, the latter of whom also owns a flourishing hotel
at Sierre; but Dr. Stephani is endeavouring to form a
company to buy the hotel, in which case it would be used
exclusively as a sanatorium for consumptives, instead of
(as at present) admitting tourists as well as invalida
The hotel stands on a plateau of over 4 kilometres square,
consisting mainly of meadows, the rest being pine woods
together with live small lakes. The surrounding country
is very mountainous, and mostly covered with pine woods.
The Wildstrubel mountain protects the sanatorium to the
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296 SWISS SANATORIA FOR PAYING PATIENTS.
north, the pine woods belonging to the hotel to the east.
The most frequent winds, which are seldom strong, are
from the east; those from the west, on which side there
is less protection, being rare. There are 4 hectares (9f
acres) of more or less level wooded land to the north-east
of the sanatorium. The soil is schistose, covered with
sand.
The climate is very dry, especially in winter, when the
hygrometer often records 10 per cent. Fogs are very rare.
The winter minimum in 1897-8 was — 14"* C. at night,
the maximum shade temperature in January, 1898, being -
+ 14-5° C, that in the sun + 47° C.
The sanatorium (fig. 37) faces south on a southerly slope,
with an extensive view over the Simplon, Mont Cervin, Mont
Blanc, eta, and receives eight hours' sunshine even on the
shortest days of the year. The establishment consists of a
single building in Swiss style, with high pitched over-
hanging roofs, balconies and verandahs ; the basement and
ground floor and walls of corridors and staircases are built
of stone, the rest being of wood. The basement contains
the kitchen at the north-east angle, the store rooms, linen
room, billiard room, etc. On the ground floor are a large
central hall, two drawing rooms, dining saloon, oflSce and
two bedrooms for patients. Above this are four floors of
bedrooms, the three lower containing each six rooms to the
north with areas of 13 to 17 square metres (140 to 188 sq. ft.),
and nine rooms to the south with areas of 16 J to 25 square
metres (17S to 269 sq. ft.), a corridor running between
the two sets of rooms. The fourth floor has one room to
the south for visitors, the rest being for the staff*. The
principal staircase, which is at the back, has leading off* it
separate water-closets for ladies and gentlemen with water
flush on every floor, and on the ground floor and first floor
baths and douche rooms. There is a separate staircase for
servants at the north-east comer of the building, one room
on each floor being for servants. There is no lift. In front
of the house is a large glazed verandah, and above it large
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Fio. 37.— Montana Sanatorium, Rhonb, Switzerland. [Face page 206,
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SWISS SANATOKIA FOR PAYING PATIENTS. 297
balconies for the first-floor bedrooms. Most of the other
rooms on the south side also have balconies. There are
altogether four galleries on the south side for rest in the
fresh air. There is electric light throughout, and central
low-pressure steam heating. There are very few chimneys,
and ordinary windows, without any special ventilators.
Every window has a wind screen or sun blind. The walls
are papered on the ground floor, elsewhere of pine wood ;
those of corridors and staircases being lime-whited. The
floors are of pinewood on most floors, of hardwood on the
ground floor, of red bricks in the corridors. The corners
Are not rounded. There are carpets and curtains. The
sewers end on a special meadow 300 metres below the
hotel. The drinking water is from springs 1 kilometre
(I mile) from the establishment, and conducted to it by a
subterranean conduit
There is room in the building for fifty patients, who are
received all the year round. As many as eighty tourists
liave in former times been lodged in the place. Patients
are received at every stage of illness, although as far as
possible only curable cases are accepted. There is a trained
nurse from 1st October to 1st May.
The treatment is mainly hygienic, by good food and a
regulated life in the fresh air. Three raeah a day are pro-
vided, with plenty of good milk. Where purely hygienic
means do not appear to suflSce, Dr. Stephani prescribes cod-
liver oil, phosphates, creosote, inhalations of eucalyptol or
menthol, or any other indicated remedy. Febrile patients
are not allowed to indulge in tobogganing, skating, rowing,
walking, riding, or billiards ; but these and other amuse-
ments, such as croquet and lawn tennis, are open to such as
Are fit for them.
Sputa are exclusively received into spittoons in the rooms,
•or into Dettweiler's flasks, which the patients buy, both
being daily disinfected together with their contents by boil-
ing. Linen is boiled in the establishment ; bedding disin-
fected by a Zurich steam disinfector. Booms are disinfected
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298 SWISS SANATORIA FOR PAYING PATIENTS.
by formo-chloral under pressure (Trillat's apparatus) ; the
corridors are lime- washed.
The charges for rooms, board and attendance vary from
8 to 13^ frs. per diem. Medical fees are from 30 to 50 frs.
per month ; the use of the fresh-air gallery, etc, 3 fra per
week ; in winter 1 fr. extra is charged for heating. Other
extras are baths, douches, and meals taken in the bedroom.
The hotel is connected by telephone with the telegraph
and telephone office at Sierre. Dr. Stephani, who waa
formerly at Leysin, has no medical assistant.
The Weissenburg Curhaus,
in the Simmenthal, is also frequented by consumptive
patients amongst others ; but is scarcely to be regarded as
a sanatorium for such patients. It stands 890 metres above
the sea-level, and has a mild mountain climate wiih great-
relative humidity. It is mainly frequented for its thermal,,
sulphated and saline waters.
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CHAPTER XLIV.
SWISS SANATORIA FOR POORER PATIENTS.
There are several sanatoria for consumptives of small
means in Switzerland. The earliest of these was the one
at Heiligenschwendi near Thun ; there are also sanatoria
at Davos for the inhabitants of Basel, and for those of Dutch
nationality ; an Elnglish invalids' home, and two institutions
(Diakonissen-Haus and Villa Pravignan) where seriously
affected patients are nursed at a lower charge than in an
hotel or ordinary sanatorium. At St. Moritz there is also
an English home. Sanatoria are being built at Stachelberg
for Glarus, and on the Faltigberg for Zurich ; and others
are projected at Leysin, Montana, Basel town, and other
placea It is expected that in a year or two there will be
eight or ten popular sanatoria for consumptives on Swiss
soil. There is also an institution for scrofulous children at
Aegeri near Zurich. For table of altitudes see p. 283.
The Basel Sanatorium "in der Stille,*'
at Davos Dorf , was founded by the Gemeinniitzige Gesell-
schaft of Basel, on the initiative of the medical profession,
and with the help of public subscriptiona This society in
1893 formed a committee to consider the advisability of
such an institution for the working and the poorer middle
classes, and to decide upon a suitable site. After searching
the Jura, they came to the conclusion that the Engadine
was preferable, and a site was obtained at the foot of the
Seehorn, near the entrance to the Fluelathal, 1600 metres
(5250 ft.) above the sea-level. The sanatorium is in a very
sheltered situation, with a south-westerly aspect, being
protected to the east and west by pine woods. The ground
(299)
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300 SWISS SANATORIA FOR POORER PATIENTS.
amounts to 2 hectares (4f acres), half of which was given
by the Huntsmen's Society. The building was begun in
June, 1895, but, work being interrupted by the winter snow,
was not completed until December, 1896.
In order to expose as little surface as possible to the cold
air, the sanatorium was built on a concentrated plan, in-
stead of the extended one-sided arrangement common in
the lowlands. It was also placed as far as possible to the
north-west of the ground, to allow of future enlargement,
and the administrative portion prepared for 100 patients,
whereas the bedrooms would only at first accommodate
seventy. It consists of an oblong block 48*2 metres long,
20 deep, and 25 high, with a projecting wing behind the
south-east end, to accommodate kitchen and dining room.
The main block consists of a basement, ground floor, and
four upper floors, including the attic storey ; the kitchen
pavilion only goes as high as the second floor, and has a
flat roof, which can be reached from the third-floor corridor,
whereas the main block has a rapidly sloping roof to shed
the snow, with lozenge-shaped metal tiles, gutters which
do not project, and chimneys which come up to the roof-
ridge. The basement (fig. 38) contains in the centre the
heating apparatus ; next this the wine cellar, laundry, dis-
infecting oven, workroom, and store rooms; and in the
wing, the kitchen department and servants' hall. On the
ground floor are the oflSce and manager's rooms, porter's
room, waiting and consulting rooms, laboratory, bath and
douche rooms, a large vestibule on the north side, and two
large common rooms on the south side, for men and women
respectively. At the junction with the wing is another
large common room, and in the wing itself the large dining
aaloon over the kitchen. Along the southern side extends
the open verandah with room for fifty couches. The floor
of this verandah is sunk a few steps ; it is of wood over
cement, and rests on a projecting part of the basement.
The first floor (fig. 39) contains ten patients* bedrooms on
the south side and the chief medical ofiicer s rooms at the
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GRouMo ruoon
£>A5tMtHT
Fio. 38.— The Basel Sanatorium at Davos.— Ground Floor and Basement.
Ground Floor : —
1. Dining Saloon.
2. Serving Room.
3. Conuuon Sitting Room.
4. Men's Sitting Room.
5. Office.
6. Porter's Rooul
7. Women's Sitting Room.
8. Nurses' Room.
9. Waiting Room.
10. Consulting Room.
11. Laboratory.
12. Bathrooms.
13. Dressing Room.
14. Douche Room.
14 (centre). Vestibule.
Basement:
1. Larders.
2. SooUery.
8. Kitchen.
4. Servants' HaU.
S.E. comer, behind Balcony, Workroom.
6. Heating Apparatus.
10. Mortuary.
7. Wine Cellar.
8. Laundry.
9. Disinfector.
[FaeejMi^«aOO. ,
DigiWuuy^^Ogle
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/
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SCCONO rLOOR
FIRST PLOOB
Fig. 39.— The Basel Sanatorium at Davos.— Uppbr Floors.
First Floor: —
1. Medical Officer's Quarters.
2. Vestibule.
3. Nurses' Room.
4. Cloak Room.
Second Floor :—
1. Manager's Quarters.
2. Assistant Medical Officer's Quarters.
3. Reserve Rooms.
4. Nurses' Room.
5. Cloak Room.
Centre of North side, Vestibule.
[Fa(x page dOl.
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SWISS SANATORIA FOR POORER PATIENTS. 301
junction with the wing. In the latter there is no accom-
modation on this floor, owing to the greater height of the
dining saloon.
In the second floor are thirteen patients* rooms on the
south side, the assistant medical officer and manager being
accommodated over the dining saloon. The next floor is
similar ; in the attic floor is a large drying room, an ironing
room, and a clothes lift to the laundry in the basement ;.
also a workshop for the use of the patients at times. On
every lower floor there is a large vestibule on the north
side for the use of the patients, and a bath room for such
as cannot safely use the ones in the ground floor ; the
closets, lavatories, attendants' and nurses' rooms and main
staircases being also at the back.
There are altogether seventy beds, seven rooms con-^
taining four each, ten rooms two each, and twenty-two
being single-bedded. The cubic space is 40 cubic metres
(1413 cub. ft.) in the bedrooms, and at least 28 cubic metres
elsewhere. The height of the ground floor is 3*25 metres
(10 ft. 8 in.) ; of the first, 290 metres (9 ft. 6 in.) ; second,.
2-85 metres (9 ft. 4 in.) ; third, 2-80 metres (9 ft. 2 in.). The
dining room is 5 metres (16 ft. 5 in.) high. It should be
remembered that in an Alpine climate ventilation is much
more rapid than elsewhere.
The sanatorium is built of stone, with an inner lining of
hollow tiles ; stairs and foundations of cement ; main stair-^
cases of oak; floors in the patients* quarters of oak or
boxwood, or else of pine covered with linoleum ; in the
kitchen, " terrazzo *' ; elsewhere in the basement of cement.
The window frames are of unpainted red pinewood ; the
windows are double, with upper panes which open inwards
together. The inner walls are smooth and free from
mouldings, with rounded comers and angles, and covered
with oil-coated and washable linen paper. In the labo-
ratory, douche rooms and bath rooms there are enamel-
painted walls; in the common rooms and dining saloon
breast-high wooden panelling.
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304 SWISS SANATORIA FOR POORER PATIENTS.
were severely affected, 32*98 per cent, moderately affected^
27*57 per cent, were in an early stage, 18*91 per cent, in a later
stage but only slightly affected. Of all these collectively
25*38 per cent, left apparently cured, 42*31 per cent,
decidedly better, 23*10 per cent, somewhat better, 3*84 per
cent, stationary, 3*84 per cent, worse, 1*53 per cent. died.
This gives a total improveiiient of nearly 91 per cent.
The sanatorium is a quarter of an hour from the rail-
way station of Davos Dorf . Dr. Kiindig is chief medical
officer ; he is aided by Dr. Buser.
It is intended to establish another sanatorium of
sixty beds in the neighbourhood of Basel town, in the
Budenholz, for such as cannot be usefully sent to Davos.
Cliniques are also to be established in connection with
the City Hospital.
For climate, etc., see p. 287.
The Dutch Sanatorium at Davos
for poor people was founded in 1897 by a private society,
and is maintained chiefly by voluntary subscriptions from
residents in Holland, including the Queen, and is intended
exclusively for consumptives of both sexes of Dutch nation-
ality. It is situated 1560 metres (5120 ft.) above the sea-
level, in a private house which has been recently leased for
the purpose. It has no private garden, but its patients
have the right to use the Curgarten and parks and woods
of the place.
The building is on the hillside, sheltered from the north
and west by mountains, and receives on an average seven to
eight hours' sunshine in the winter. It was built about
ten years ago in the usual Swiss style, and consists of a
basement, three upper floors and attics. The bedrooms are
200 to 250 square metres in area, with one to three beds
each ; those with three having a cubic capacity of 400 to
500 cubic metres. The walls are of varnished wood, or
covered with washable paper. Each has a closed stove,
and wooden furniture, no stuffed furniture being used and
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SWISS SANATORIA FOR POORER PATIENTS. 305
but few curtains. The floors are everywhere covered with
linoleum. The lighting is by electricity. The windows,
are " French windows," with an extra hinged pane above^
which opens inwards. There is also a dining room, drawing-
room with piano, and a suitable bath room. Most of the
rooms on the south side have balconies. In addition to this
there are three large verandahs at the western side of the
house, of which the lower is glazed, the upper ones being
provided with solid roofs and thick curtains to draw down
on the windy side. The water-closets have a good flush.
The sewage is carried into the Landwasser through the
town sewers.
There are thirty beds. Patients pay 4 francs per diem>
including board, lodging and medical attendance.
They spend, as a rule, from 9 A.M. till 9*30 p.m. in the
open air, and an hour or more in walking abroad, morning
and afternoon. The cold wet rub is frequently employed,
the cold douche but seldom. Cod-liver oil is exceptionally
given, but no "specifics," and no stimulants. Random
spitting is strictly forbidden, as also the use of handker-
chiefs for the sputa, which are received into the spitting-
flasks and spittoons, and emptied into the water-closet.
Linen is disinfected in the public steam disinfector. Rooms
are washed with soda solution, and in the case of death
also disinfected with formalin vapour.
There is a trained nurse in the house. Dr. A. Schnoller
is the resident medical officer. The sanatorium is to be
open all the year round. There is some talk of affiliating
the institution to the recently formed public society in
Holland.
During the first four months (1st Sept., 1897, till 1st
Jan., 1898) thirty-five patients were received, and a profit
of about 550 francs was made, which was used in bujdng
more furniture. The sanatorium cost 12,500 francs for
furniture and installation. When sufficient funds are
forthcoming, the society intend to enlarge the institution to
fifty beds, and eventua)ly to build a sanatorium of their own.
20
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306 swiss sanatoria for poorer patients.
The Davos Invalids' Home
is intended for ladies and gentlemen of limited means who
are in need of treatment in an Alpine climate. It was
founded in 1884 by three English ladies (Mrs. Lord and the
Misses Crothers), and carried on by them for eleven years,
Tintil Mrs. Lord's ill-health compelled them to reb'nquish the
work. It has since been carried on by a committee with the
aid of public subscriptions. The institution is managed by
An English lady, and without any denominational restric-
tions. The charges are 4 to 4'50 frs. per diem, including
board and residence, medical attendance and nursing, the
only extras being medicine and personal washing. The
hoa secretaries are Mr. Arthur Herbert, 6 Finch Lane,
London, E.C., and Dr. Wm. Ewart.
A benevolent society exists at Davos to secretly assist
those whose funds are exhausted before the end of their
course of treatment in one of the paying sanatoria.
The St. Moritz Aid Fund
is also intended to provide those of limited means with
treatment at an Alpine health resort The president is
Princess Christian. Applications may be made in the first
instance to Lady Jeune, 79 Harley Street, London, W., or
to Lady Bancroft, 18 Berkeley Square, W.
The Heilioenschwendi Sanatorium
was opened in August, 1895, to commemorate the 600th
anniversary of the Swiss Confederacy and the 700th of the
City of Bern, mainly on the initiative of various members
of the medical profession. It stands, about 1^ hours' walk
from Thun, on an elevation overlooking the Lake of Thun,
1160 metres (3800 ft.) above the sea-level, with a lovely
view across the lake to the Niesen, Jungfrau and the Alps.
The situation is sheltered, and not subject to the Fohn. To
the north is the Blume, to the west are wooded hills. There
is a fairly large garden in front, and .although there is very
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SWISS SANATORIA FOR POORER PATIENTS. 307
little ground behind the institution, patients are able to use
the public woods close by.
The sanatorium, which faces south-south-west, consists of
a central building (fig. 40) united by covered corridors with
two slightly projecting lateral pavilions. Behind the eastern
pavilion is a separate dipendance. In front of the central
block and the connecting corridors are the fresh-air galleries,
which were originally open, but have since been glazed. In
the central block is the dining saloon, and on either side of
it a common room. The former is for both sexes, but in
other respects they are kept apart. The northern part of the
central block contains the kitchen, etc On the first floor
are a few single-bedded rooms to the south, and over them
a number of attic rooms. Both lateral pavilions have on
the ground floor two large rooms with eight beds each and
windows on three sides, and a few smaller rooms for one
or two beds apiece, and the same on the first floor. The
dipendance contains the manager's and doctor's quarters.
There is also an outbuilding behind the western corridor
with laundry, disinfector, stables, etc The inner walls are
painted with glossy oil paint ; the floors are of simple
washable parquet. The building is heated by low-pressure
hot water pipes, and lighted by petroleum, although
electrical lighting is to be introduced in future. There
are no special ventilating contrivances ; but the windows
Are very large, reaching down to the ground, the lower part
being guarded with a grating. There are good baths, a
good water supply, and ** Unitas " water-closets, the house
drain leading to a cesspool with an overflow. The furniture
is simple. The lounge chairs are in two pieces and can be
used as armchair or couch.
There are at present fifty-two beds, including four for
children ; but there will eventually be 100 or 120 in four
separate blocks. None but consumptive patients are ad-
mitted, and no serious cases are supposed to be admitted ;
but a good many such have been sent in notwithstanding, so
that on an average one-third have been in bed, and nineteen
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308 SWISS SANATORIA FOR POORER PATIENTS.
died out of 186 in 1895-6. Patients on arrival have a bath,
during which their clothes are disinfected. There is a fine
of 1 fr. for spitting on the ground. Patients buy their own
Dettweiler's flask, which is disinfected with carbolic solution.
In the bedrooms they may use spitcups of glass, which are
emptied into the water-closet. Special handkerchiefs are
provided by the institution for mouth-wiping in bed. These
are collected twice a week $ind disinfected, with the other
linen, by boiling.
Patients send a menu daily to the manager, who provides
accordingly if it seems advisable. They have about two
litres of milk per day. They take walks according to the
advice of the medical officer, Dr. Glaser of Steffisberg, who
comes over twice or three times a week, and is in communi-
cation with the building by telephone. In winter some are
allowed to sledge on the mountain side. Patients do a little
work for the establishment, both out of doors and in the
kitchen and elsewhere. So far there has been no haemop-
tysis in consequence of this regulation. Some difficulty has
been experienced in entertaining the men, games and read-
ing being insufficient, so that the erection of a small work-
shop is contemplated.
The staff consists of a manager, a matron, two nurses,
two maids, a helping maid, and a man to attend to the
disinfection and heating. Thanks to good means of com-
munication, this staff has been found quite sufficient.
There is no resident medical officer.
Patients stay at least two months. Up to 1st July, 1896,
there were 186 patients, ninety-eight being men. Their days
of treatment amounted to 12,843, or an average of forty
days ; but most of the patients stay three months. The
average daily number was forty ; but the building is now
nearly always full. The daily cost amounts to 1*90 frs.
Patients pay from IJ to 4 frs., according to their means.
Those who come from subscribers, parishes, hospitals or
societies in the canton of Bern have the preference in
admission. The total cost of the building was under
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SWISS SANATORIA FOR POORER PATIENTS. 309
200,000 frs. without the land, or, with road-making,
280,000 frs. This is about £216 per bed.
The Zurich Sanatorium
is being built near Wald, on the Faltigberg, a little north
of the southern end of the lake of Zurich, 900 metres (2950
ft.) above the sea-level. The ground amounts to 30 hectares
(74 acres), with woods and meadows. There will be from
ninety-two to 100 beds.
ITie building will have a southerly aspect, and will have
an administrative block in the centre, and a three-storey
pavilion on each side, for men and women respectively,
with open-air corridors between. It will be opened on
1st October, 1898.^
The Sanatorium of Braunwald,
for the canton of Glarus and other neighbouring cantons,
has just been opened on an elevated terrace near the baths
of Stachelberg, in the valley of the Linth, 600 metres above
the stream and 1160 metres (3805 ft.) above the sea-level.
Although intended for the poor, it will also receive paying
patients.
Surrounded by woods and meadows, it has a south-
south-westerly aspect, and is well sheltered by mountains
from north-east winds. It has a dining room, work
room, fresh-air gallery, and rooms for gymnastics and
games in bad weather, as well as beds for thirty patients,
from one to three in each bedroom. There are two
windows to each bedroom, and good ventilation by means
of hinged upper window panes, about 30 cubic metres
(1060 cub. ft.) air space being allowed per head. The
walls are wainscoted to a man's height, and all corners
rounded. The heating is by hot water pipes, the lighting
by electricity. Furniture is simple, of varnished wood.
A trained nurse is in charge of the establishment, which
* Liebe, loc. cit. ; Correspondent Blatt filr Schweizer Aei'zUy Ist July,
1898.
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310 SWISS SANATOBIA FOR POORER PATIENTS.
has no resident medical officer, but is visited two or three
times a week by a doctor from Glarus. There is a good
water supply. A plentiful but simple dietary is provided.
The douche is used for convalescents, but no cod-liver oil,
" specifics," or counter-irritants. Sputa are disinfected by
lysol, linen by boiling with soda ley, rooms with corrosive
sublimate.
Patients from the canton of Qlarus pay 2^ frs. per day,
or 4 fra in a single-bedded room. The sanatorium is 1^
hours by road from Linthal and Riiti ; Linthal is 3^ hours
by rail from Glarus. According to Kuthy, another sana-
torium will later on be built on the same site by a neigh-
bouring canton, when a resident medical officer will be
appointed.
The Aegeri Sanatorium.
A sanatorium for scrofulous children has existed since
1885 at Aegeri near Zurich, at an altitude of 820 metres
(2690 ft.) above the sea-leveL^
^ Liebe, Ilyg. Rundschau, 1896, No. 14.
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CHAPTER XLV.
PROJECTED SANATORIA IN OTHER FOREIGN COUNTRIES.
SoiiE other countries, both in Europe and elsewhere, are
beginning to bestir themselves in the campaign against
tuberculosis, although up to the present they have done but
little in establishing sanatoria.
BELGIUM.
At the Congress of Hygiene and Medical Climatology, held
in Brussels in August, 1897, a resolution was unanimously
passed that a league against tuberculosis should be formed
on the model of the French Ligue contre la Tuberculoae.
Another resolution was passed urg\ng the foundation in
Belgium of sanatoria for consumptives of the poorer
classea Several seaside convalescent homes for children
already exist — such as the one at Middelkerke with 300
beds, that at Venduyne with 200, and that at Ostende.
Another convalescent home for children exists at Esneux^
about half an hour's rail from Liege, and at Bockryck-
Genck-lez-Hasselt and Bonsecours for adults, while a third
is to be built at Crainhem-Tervueren. All three are inland
at a low altitude. A hydropathic establishment like the
French one at Divonne is to be erected at Venaimont in
the Belgian Ardennes.^ Some of these might possibly be
utilised for the open-air treatment.
BULGARIA
has also a project for the erection of separate sanatoria
for consumptives in each district. A medical man has
1 Brit. Med. Joum,, 9th April, 1898.
(311)
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312 PROJECTED SANATORIA IN OTHER FOREIGN COUNTRIES.
been sent by the Government on a journey of investi-
gation.^
DENMARK.
For some time past consumptives have been boarded out in
various farms in the country with satisfactory results.
Sanatoria exist at Refsnaes with 130 beds for scrofulous
children, and at Heidschloss, near Ploen, in Holstein. Dr.
Schepelem is in charge of the former. More recently a
society has been formed for the erection of sanatoria for
paying consumptive patients, the subscribers binding them-
selves to receive no more than 4 per cent, interest, all
further profit to go towards the maintenance of free beds
(Liebe, Hyg. Rundschau, November, 1897). Over £10,000
have been subscribed, and it is stated that the first sana-
torium will be opened this year.^
EGYPT.
Several hotels exist in various parts of Egypt with
. resident medical oflBcers, and almost entitled to be called
sanatoria. They are, however, by no means exclusively
devoted to consumptives, and the climate does not permit
of an open-air life throughout the year. Among the best
known hotels which might safely be visited are two at
Helouan, where Dr. Page May lives; Mena House, near the
Pyramids (Dr. Bentley) ; three at Luxor ; and one at
Assuan.
HOLLAND.
A society for the erection of sanatoria for consumptives
of Dutch nationality was formed in 1896 by a number of
medical men, with Prof. Reisz, Rector of the University of
Utrecht, at their head, and Dr. Saugman as secretary.
They succeeded in raising over 300,000 frs. in shares and
donations, and the State voted an additional 138,000 frs.
{Rev. de la Tvherculose, December, 1896). In May, 1897,
it was decided to form a number of local sub-committees to
^Da$ Rothe Kreue, 1897, No. 16.
* L6on Petit, Tuberculosis Congress, Paris, 1898.
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PBOJECTED SANATORIA IN OTHER FOREIGN COUNTRIES. 313
raise more money, and to erect two sanatoria, of which
one was to be on the coast. In September, 1897, a private
society leased a house at Davos and converted it into a
sanatorium for thirty patients (see p. 304). Two convalescent
homes for children also exist on the coast of Holland at
Zaandvoort, near the Hague, and at Wyk van See ; but
these are not exclusively for tuberculosis {Heilst Gorresp.y
January and July, 1898).
ITALY
has about twenty seaside hospitals for tuberculous diseases
•of the bones and joints, but up to the present no sanatoria
for consumptives.
JAPAN.
It is stated that a sanatorium for consumptives is to
l>e erected in Japan under the patronage of H.I.M. the
Empress.^
PORTUGAL.
At a recent Congress of Hygiene resolutions were passed
in favour of the establishment of sanatoria for consump-
tives, and of the adoption of other measures for the preven-
tion of tuberculosis.
ROUMANIA.
The Council of Hygiene of Bucharest recently appointed
A committee to prepare a handbook of advice as to the
means of preventing phthisis. The committee has recom-
mended, among other things, that persons suflFering from
.the disease be excluded from workshops and placed in
.sanatoria where they should be treated and maintained at
-the cost of the municipality. Steps have already been taken
to obtain buildings for transformation into a sanatorium.
A special medical inspector is appointed to discover cases of
Jbuberculosis in workshops and factories.'-^
1 Das Rothe Kreuz, 1897, No. 17.
^Brit Med. Jown., 2nd July, 1898.
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316 BRITISH COLONIAL SANATORIA.
In Queensland *^ arrangements have been made for the
•establishment of a ward for consumptives at the hospital at
Boma, and also at Dalby. According to Dr. Hardie, Dalby,
Boma, and CharleviUe in S.W. Queensland are admirably
suited for the treatment of phthisis during the hot months
from October to April, as also a high altitude station, Stan-
thorpe on the Dividing Range, while Mount Tambourine in
S.E. Queensland" is the best for early cases during the
<XK)ler months from May to September.^
CANADA.
It is proposed to erect a sanatorium for consumptives on
Trembling Mountain, overlooking the village of Ste.
Agathe. The Government intend to set aside sufficient
•Crown land (100,000 acres) to form a natural park, to be
•called the Trembling Mountain Park ; and it is here that
the sanatorium will probably be built, at an elevation of
2500 feet above the sea^level. The district resembles that
of the Adirondacks (see p. 84), and is situated among the
Laurentians, north of Montreal.
The Mvskoka Cottage Sanitarium, for incipient phthisis,
has been recently founded in a region abounding in pine
trees, about 100 miles north of Toronto and 800 feet
Above the sea-leveL There is shelter from mountains
and forests to the north and west, whence come the colder
winds in winter. The grounds, which embrace seventy-five
Acres, are on Lake Muskoka. The present establishment,
which accommodates forty patients, consists of a large and
well-planned main building, surrounded within easy dis-
tances by a number of small cottages.*'^
CAPE COLONY.
A sanatorium, founded by the Right Hon. C. J. Rhodes
At Kimberley, in Cape Colony, near the Orange Free State,
was opened on Ist September, 1897.
1 Lancet, 15th May, 1897.
^ Pres. Address by Dr. Roddick, at the annual meeting of the Brit. Med.
Assoc, at Montreal, 1897.
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BRITISH COLONIAL SANATORIA. 317
Kimberley is on the high inland plateau of South Africa,
650 miles from Capetown, with which it is connected by
rail
The climate is dry and sunny : the rainfall being 18 in.
per annum, the mean annual humidity 55 per cent, of
saturation ; the mean summer temperature (October to
March) 72°, the mean winter temperature (April to Sep-
tember) 56^
The sanatorium is about 4100 feet above the sea-level,
about half a mile from the town, on the tram-line to
Beaconsfield. It stands on seven or eight acres of ground
on the brow of a hill, overlooking the town and the
neighbouring Free State hills, and has well laid-out tennis,
and croquet courts.
It contains about thirty bedrooms, several of which can
be arranged en suite; large dining-room, drawing-room,
ladies' morning-room, smoking and billiard-rooms, together
with the appointments of a first-class hotel, and excellent
sanitary arrangements.
It is intended for early and curable cases of consumption.^
The charges, which are intended to render the institution
self-supporting, are from 15s. to £1 per diem according to
room. There are special rates for the week or month.
Applications to the secretary, Kimberley Sanatorium,
with a banker's reference.^
> Lancet, 26th March, 1898.
20»
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CHAPTER XLVII.
BRITISH INSTITUTIONS FOR CONSUMPTIVES OP THE
POORER CLASSES.
In reviewing the provision for the poorer classes in this
country, it is advisable to remember the definition of a
sanatorium given in the first chapter of this book, and to
distinguish them from institutions where the treatment is
an indoor treatment, or where the situation or the lack
of adequate supervision or other circumstances render the
open-air methods of little value. Judged by this standard,
England appears to be rich in urban chest hospitals and
in convalescent homes, but poor in sanatoria and nursing
homes; rich in institutions for the patching of consump-
tives, poor in those for efiectually mending theuL Some
efforts have, however, been recently made to supply the
deficiency by the opening of country sanatoria, and the
partial or complete transformation of some of the more
favourably placed chest hospitals. Indeed, all the Scotch
and Irish chest hospitals and several of the English ones
are now managed on open-air lines.
London Chest Hospitals and Sanatoria.
There are in London four chest hospitals with 645 beds ;
while in the country, including those in provincial towns
and cities, there are 6 hospitals and 7 homes or sanatoria
for the poor, with a present total of 532 beds. There are
also over 150 convalescent homes which do not exclude
consumptives in an early stage, and which have collectively
(318)
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BRITISH INSTITUTIONS FOR POORER CONSUMPTIVES. 319
between 7000 and 8000 beds ; as well as twelve homes for
advanced consumptives (five in London), with altogether
over 250 beds.
London Hospitals for Consumptives.
Founded.
Beds.
Brompton Hospital for Consumption and Diseases of
the Chest
City of London Hospital for Diseases of the Chest,
Victoria Park
North London Hospital for Consumption and Diseases
of the Chest, Hampstead
Royal Hospital for Diseases of the Chest, City Road
1841
1848
1860
1814
321
164
100
80
For the treatment of out-patients there is another special
institution in London, the Infirmary for Consumption and
Diseases of the Chest, which has no beds, but has an
affiliated convalescent home (Richmond Home) at Worthing.
Consumptives are also occasionally admitted to the general
hospitals for hasmoptysis or some other urgent complication,
but are not welcomed there, and are transferred as soon as
possible to a special hospital or poor-law infirmary. In
advanced stages they are ineligible for admission to the
London general hospitals, two of which refuse to admit
them in any stage.
Phthisical patients also attend as out-patients at the
London general hospitals ; but such treatment, whether at
a general or a special hospital, cannot be regarded as
satisfactory so long as the faulty conditions of home life
are ignored. The poor-law infirmaries of London and the
suburbs have collectively over 13,500 beds for the recep-
tion of poor people suffering from a variety of more or
less chronic diseases. Like the London general and chest
hospitals, they have large and well- ventilated wards ; but
few of them are ideally placed for open-air methods of
treatment, which, moreover, their medical officers are far
too busy to supervise. A deputation was recently sent
from the Poplar and Stepney Guardians to the Local Gov-
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320 BRITISH INSTITUTIONS FOR POORER CONSUMPTIVES.
eminent Board, asking for power to erect a sanatorimn.
They were informed that such a sanatorium should be
under the management and control of the metropolitan
authority, rather than of a single board of guardiana A
circular was subsequently issued, asking the co-operation of
other boards of guardians in the metropolitan area. A new
infirmary is being erected for Camberwell, in which the top
storey of three of the large pavilions is occupied by large
wards, each to hold twenty-four beds, constructed so that
on the two sides and one end the whole length is composed
of windows made to open ; and on one side there is a balcony
for the whole length. Immediately over these wards is a
flat roof with brick parapets surmounted by iron railings,
available for patients. The four-bed wards of this infirmary
have the windows occupying the whole of one side.
It should be noted that nearly all our special hospitals
and homes for consumptives also admit sufferers from
other complaints, such as heart disease, aneurysm, pleurisy,
pneumonia, bronchitis and asthma. This is apt to hinder
efficient sanatorium treatment and diminishes the number
of beds available for consumptives.
The following London institutions admit advanced cases
of consumption from amongst the poorer classes : —
Home for Consumptive Females . . London 26 beds
Friedenheim (not exclusively for consumptives) „ 44 „
St. Luke's House, N. W „ 16 „
St. Peter's Home, Kilbum ... „ 80 „
Free Home for the Dying, Clapham . . „ ? n
The Brompton Chest Hospital
is well known for its large and luxurious wards and the
excellence of its arrangements for the treatment of its
patients ; but its position and the relatively small size of
its garden make it by no means an ideal spot for open air
treatment Two small wards, however, have been recently
set aside for such treatment, and are said to have yielded
good results.
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Fig. 41.— North London Consumption Hospital.
[Face 2Xff/f 32U
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british institutions for poorer consumptives. 321
Brompton Hospital Sanatorium.
In addition to the above, a scheme has for some time past
been under consideration for the erection of a sanatorium
in the country. Twenty acres of land have recently been
secured for the purpose at Heatherside near Bagshot. The
building is to be built in tae form of an X, with a court to
the north separating the patients' quarters from the adminis-
trative block. There are to be one hundred beds, seventy-
two in single-bedded rooms, the rest two and three together.
Part of the building is intended for convalescents who are
not tubercular. There will probably be two storeys in the
patients* portion. The cost is estimated at £50,000.
The Royal Hospital for Diseases of the Chest
is placed by the side of a busy main thoroughfare, the City
Road, and is unsuitable for open-air treatment.
The City of London Chest Hospital,
although in the midst of a densely populated district, has
the considerable advantage of being near a large open space
(Victoria Park). I understand that open-air treatment has
been carried on there with satisfactory results for nearly
a year.
The North London Chest Hospital
at Hampstead is the only one of the London chest hospitals
whose position really lends itself to the open-air treatment.
Situated 300 feet above the sea-level and near the top of a hill,
capped with Bagshot sand, which dominates Western London^
it has around it a residential district consisting chiefly of
houses with large gardens and of extensive open spaces, in-
chiding the well-knowii Hampstead Heath, parts of which
rise to 400 feet above the sea-level, and help to protect the
hospital from the north and east winds. The ground falls
rapidly to the south-west and west, and being sandy soon
dries after rain.
A fair-sized garden lies on the slope of the hill, which
21
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322 BRITISH INSTITUTIONS FOR POORER CONSUMPTIVES.
forms a terrace next to the hospital, and is laid out lower
down with a large lawn, paths and flower-beds, and provided
with several shelters. Owing to its position the hospital
escapes most of the fogs which settle over the lower parts of
London in autumn and winter, and enjoys a more bracing
climate and a larger amount of sunshine. Its chief draw-
back is that it is somewhat exposed to south-westerly gales
and does not possess sufficient ground for long walks during
convalescence.
The hospital, like most of the existing British chest
hospitals, was originally built for indoor treatment, and
was provided with only a few small balconies ; but in the
summer of 1900 an extension was completed which consists
of large open-air wards or balconies, one for each floor, but
the uppermost, of the hospital. In the basement, which is
almost entirely above ground on the south-western side,
are situated the out-patient rooms, together with store-
rooms, mortuary and dispensary. On the ground floor are
the large dining-room, the board-room, and rooms for the
matron and resident medical officers, and in the newer part
a wide balcony and a winter garden. Higher up are two
more floors consisting of large and small wards on either
side of the corridors, and fresh-air balconies on the south-
west side of an extension of these corridors. Under the
roof are quarters for nurses and servants, together with
the kitchen, which is connected by a food lift with the
dining-room, while a hydraulic lift for patients serves the
wards. The latter are lofty, with washable walls, polished
floors, and large triple windows, consisting of sash windows
below, and hinged fan-light windows above. The fresh-air
galleries have no windows in front, but are provided with
blinds of waterproof material above the balustrade. The
hospital is heated with open fires, and lighted by elec-
tricity. The number of beds has been increased to 100.
A further extension and further developments are projected.
Treatment is by rigidly fresh-air methods; plentiful
feeding without compulsion ; rest in bed or on cane lounges
in early stages, later on by graduated exercise. Drugs are
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BRITISH INSTITUTIONS FOR POORER COrSUMPTIVBS. 323
freely used wherever indicated ; hydrotherapy is scarcely
employed; baths given periodically for cleansing only.
Patients are admitted free by letter from a subscriber, and
if suitable receive extension up to nine or twelve weeks.
The staff includes visiting and consulting physicians and
surgeons, a throat specialist, dentist, and two resident
medical officers, the senior of whom acts as pathologist.
The nursing staft* is under a matron ; the general manage-
ment under a lay committee with medical representatives.
There is a separate out-patient department in Fitzroy
Square, in the heart of Western London.
Provincial Chest Hospitals and Sanatoria.
aouTH OF England.
Founded.
Bed».
Bournemouth .
Bagshot .
St. Leonard's .
Torquay .
' Ventnor .
1 Worthing .
Clare, Suffolk .
National Sanatorium for Consump-
tion and Diseases of the Chest
Bromptou Hospital Sanatorium
Eversfield Hospital and Home for
Consumption and Diseases of the
Throat and Chest ....
Western Hospital for Incipient Con-
sumption
Royal National Hospital for Consump-
tion and Diseases of the Chest
Richmond House Convalescent
Home
Richmond Hou^e Cottage Sana!
toriura
1855
being built
1891
1850
1868
1891
1900
62
100
65
40
155
15
10
North op England.
Horn Hall Sanatorium, Stanhope .
Temporary Sanatorium
Liverpool Hospital for Consumption
and Diseases of the Throat and
Chest
Sanatorium for the above in Dela-
mere Forest
Sanatorium for the Poor of Liver-
pool, Heswall, Deeside .
Hospital for Consumption and Dis-
eases of the Chest, Bowdon, Cheshire
Sanatorium for the Poor of Man-
chester, Halkin, N. Wales .
Northern Counties Hospital for Con-
sumption and Diseases of the Chest
Open Sanatorium ....
Closed Sanatorium in Sherwood
Forest
Sanatorium at Kirkby Lonsdale
Durham .
Leeds
Liverpool .
» •
Manchester
»»
Newcastle • on -
Tyne .
Nottingham
II
Westmoreland .
1900
1899
1864
being built
being built
1875
projected
1878
1900
projected
1900
20
10
44
50
25
50
?50
5
50
25
16
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324 BRITISH INSTITUTIONS FOR POORER CONSUMPTIVES.
In addition to the above institutions, sanatoria are pro-
jected for tlie counties of Devon and Cornwall, of Wiltshire
Gloucester and Somerset, Worcester, Hampshire, Suffolky
Oxfordshire, Cumberland, and the cities of Leeds, York,
and Bradford. The Hampshire Sanatorium scheme origin-
ated with the. Portsmouth Board of Guardians, who »re
seeking to obtain a site on the southern slope of PortsdoWTi
Hill.
Special wards or arrangements for the treatment of
consumptives exist in the Seamen's Hospital, Greenwich ;
the Sheffield Royal Infirmary^ the North Staffordshire
Infirmary at Stoke-on-Trent, the St, Andrew's Hospital
for Convalescents and Incurables at Clewer, Windsor ; the
Hull and Withernsea Convalescent Home ; Addenbrooke's
Hospital, Cambridge ; the Walsingham Union, Norfolk, etc.
In most of the above institutions the open-air treatment is
said to have been adopted with good results. An open
sanatorium is being organised for the county of Notting-
hatn.
Two experimental sanatoria in the eastern counties at
Cromer and at Downham — described in the lirst edition of
this book, are no longer open.^ The Royal Sea-bathing
Infirmary for Scrofula at Margate does not admit eases of
pulmonary tuberculosis.
The following provincial institutions admit advanced
cases of consumption:—^
Firs Home
St. Catherine's Home
Mildm*y GoBSumptive Hom«
Home of Comfort for the Dying (not exclusively
for consumptives^
St. Michael and All Angels' Home . . . .
Home for the Dying
Town.
Bournemouth
Ventnor
Torquay
Southsea
Cheddar
Wimbledon
Beds.
20
12
10
12
iO
?
1 See LanceU Match, 1898 ; British Medical Jourmal, 25th M«iy, 1898 ;
Practitioner, iune, lfe98.
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O
^
I
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3BITISH INSTITUTIONS FOB POORER CONSUMPTIVES. 325
In the St. Michael and All Angels' Home, opeu-air treat-
ment hfts been recently introduced by Dr. Tatham with
wonderfully good resulta
south of england.
The National Sanatorium for Consumption and
Diseases of the Chest
at Bournemouth is nearly the largest institution of the
kind on the south coast of England, coming next in size to
the Consumption Hospital at Ventnor. Like the latter, it
does not admit cases of advanced disease, and (nominally
at all events) does not exclude the sufferers from asthma
and chronic bronchitis. At the time of my first visit many
defects were noticeable in its plan and administration ; but
so many improvements have since been effected as to place
it on quite a different footing.
It is situated in a valley at the back of Bournemouth,
close to the Mont Dore Hotel, the grounds of the two in-
stitutions touching one another. The sanatorium has fairly
extensive grounds, which are partly laid out as kitchen
garden, partly as flower garden and shrubbery, with a fine
lawn to the south of the institution, beyond which is a
rapid descent to the bottom of the valley. The place is ex-
tremely well sheltered, both by the neighbouring hill-sides
and by large trees, and shares in the climate of the less
bracing parts of Bournemouth. The sanatorium is built of
stone, and consists of a ground floor and first floor, the former
for men, the latter for women. The aspect is south-south-
west, the entrance on the northern side. At the eastern end
is a large chapel attached to the institution. Behipd the
building near the centre is a yard, with various domestic
offices shut off from the garden, and ending in a small
mortuary and post-mortem room. Corridors run from
end to end of the building ; the patients' rooms are to the
south of these, including on each floor a large dining-saloon
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326 BRITISH INSTITUTIONS FOR POORER CONSUMPTIVES.
and day-room, a ward for five patients, eight with three
apiece and two single-bedded. The dining-saloons are both
cheerful and light, with a good view of the grounds; and
the same may be said of the day-rooms and wards. The
furniture is plain and simple, but suitable ; walls painted,
floor covered with linoleum, windows large. The corridors
are used after dark and in bad weather as promenades.
Special ventilating windows have been introduced at the
eastern end, where otherwise the chapel would block the
current of air. The lavatories, bath-rooms and water-closets
are now placed in a projecting pavilion on the north side, as
also are the staff-rooms. The building is heated by open
fire-places and hot-wator pipes, the water supply, sewerage
and electric lighting being that of the town of Bournemouth.
Shelters have been erected in the grounds for men and
women respectively. These are used in rainy weather for
open-air treatment. At other times the patients place their
deck chairs on the lawn. Since the reorganisation of the
sanatorium, which was entrusted to Dr. Pineo, the resident
medical officer, open-air methods have been thoroughly
carried out in all but a few cases ; and the results are said
to have been much better than formerly The average stay
of patients during the fifteen months ending April, 1900, was
eleven weeks, varying from four to thirty-nine weeks.
The Bournemouth Sanatorium is closed during July and
August, when in such a situation the heat would be op-
pressive. It would be well if during these months patients
could be transferred to an affiliated sanatorium in a more
bracing place. The sanatorium is much used by various
provident and friendly societies. There is room for sixty-
two patients, an equal number of each sex. A projected
extension at the western end would accommodate eight or
ten more. Admission is by governor's nomination (which
is available for twelve weeks, and can be renewed if ad-
visable) and payment of Ts. 6d. weekly. There are some
endowed beds in which weekly payments are not required.
The physicians are Drs. Snow, Frazer and DaviscMi.
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BRITISH INSTITUTIONS FOR POORER CONSUMPTIVES. 327
There are also a consulting physician, consulting surgeon,
surgeon and dentist attached to the institution, as well as
a resident medical officer, and a nursing staff consisting of
a matron and three nurses.
The Sanatorium at Bagshot
for the Brompton Cheet Hospital is described at p. 321.
The Sanatorium for Gloucester, Somerset and
Wilts
is to be erected close to Winsley Common, between Bradford-
on-Avon and Limpley Stoke. The site is a plot of fifty
acres situated about 430 feet above the sea-level, and
consisting of arable and pasture land together with a
disused quarry of nearly twenty acres. The place is
well wooded with firs and beeches. There is to be accommo-
dation for sixty patients. The estimated cost is £20,000
including the land, the annual cost being reckoned at
£4,000.
The Western Hospital for Incipient Consumption
at Torquay was originally a private house, which was
transformed in 1850 into a chest hospital, day-rooms being
added for men and women respectively. The walls are
whitewashed, floors boarded, stained and polished, rooms
fairly lofty and airy, but varying in size. Recently two
verandahs have been added for open-air treatment. Heating
is by open fires ; lighting by gas, although it is hoped that
electric lighting may be introduced.
The Ventnor Consumption Hospital,
or, more correctly, the Eoyal National Hospital for Con-
sumption and Diseases of the Chest, was founded by the
late Dr. Arthur Hill Hassall in 1869 on the underclifi*, less
than a mile west of Ventnor. Originally formed of a
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328 BRITISH INSTITUTIONS FOR POORER CONSUMPTIVES.
single block, it now consists of eleven, together with a
handsome chapel (fig. 44).
The site of this hospital is in many respects an admimble
one. Protected to the north by a thickly wooded slope
which rises to the green-sand cliffs surmounted by the lofty
chalk downs, to the east by a rising patch of underclitf in
front of Steephill Castle, and to the west by tall trees, it
is separated from the sea by about 300 yards of undulating
undercliff, part of which, near the hospital, has been con-
verted into garden and shrubbery. The soil is of sand,
the elevation inconsiderable (80 feet) but sufficient to en-
sure a dry situation. About twenty-two acres of ground
belong to the hospital. In the meadow to the east are
several shelters, and others will probably be added in the
course of time.
The climate of the undercliff is known for its mildness.
The winters are warmer than in most other English health
resorts, and the summer slightly cooler than further inland.
There is a large proportion of sunny weather, with a com-
paratively small number of rainy days in the year. The
mean humidity, although greater than that of Bournemouth,
Brighton and Weymouth, and of the stations on the Riviera,
is less than that of most British health resorts, the annual
mean being 81 per cent., and that of the winter months
84'3 per cent.^ Ventnor is probably less bracing than the
Kentish and east-coast seaside resorts, the German hill
sanatoria, and some of the inland districts of England.
The separate blocks composing the hospital are of brick
and stone, with slated roofs, and are only united by an
underground passage which runs the whole length of the
building. They form a uniform line facing south, the four
eastern blocks being for women, and the six western ones
beyond the chapel being for men. Owing to the slope of
the ground, the ninth and tenth blocks have an additional
storey, while preserving architectural uniformity; they
* Ths Climates and Baths of Great Britain, vol. i., p. 212. London, 1896.
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BRITISH INSTITUTIONS FOR POORER CONSUMPTIVES. 329
•are also larger in other ways. EUch block has a separate
entrance behind, a covered verandah along the ground floor,
and covered wooden balconies to all but the topmost storeys
•above. Patients occupy without exception a separate room
on the south side ; the north side containing all the stair-
cases, nurses and servant's quarters. On the ground floor
on the southern side are sitting-rooms (some provided with
billiard tables, bagatelle boards, etc.), mostly for the use of
patients, a few of the rooms being reserved for nurses, and
one for the chaplain and the hospital library. The eight
smaller blocks consist of ground floor, first and second
floors, and contain about twelve patients' bedrooms each.
In the first block at the back is the superintendent's office ;
but in other respects these blocks are almost identical.
No. 9 block is much larger, containing the administrative
department, as well as eighteen patients' bedrooms. It is
deeper as well as wider, and has, on the south side of the
ground floor, a handsome dining hall, 70 x 48 feet and 32 feet
high, with parquet flooring, walls panelled for some distance
and painted above, and handsome painted ceiling. It is
provided with large windows, and lighted with incandescent
gas mantles. At one end is a stage which is utilised for
periodical concerts and dramatic entertainments. At the
other is a large orchestrion, and portrait of the founder,
Dr. Hassall. There are six long tables, two being for
women. This and the chapel are the only parts where
male and female patients meet. In the grounds there
is a dividing line which they are not allowed to cross.
On the north side of No. 9 block are consulting rooms,
dispensary, board-room, bath-rooms, and quarters of the
resident medical officers, as well as the kitchen depart-
ment on the second floor. No. 10 block in many respects
resembles the smaller blocks, although in a few details it
is more modem. No. 11 block, which has been recently
opened, has twenty-one bedrooms. Its floors and staircases
are of teak, and are beeswaxed and polished ; the walls of
Parian cement with rounded angles, the doors and windows
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330 BRITISH INSTITUTIOKS FOR POORER CONSUMPTIVES.
sunk flush with the walls, the balconies of iron and wide
enough to permit of the beds being wheeled out on to
them. Throughout the older blocks the walls are painted,
the floors of deal with painted borders and linoleum in the
centre except- in the dining-saloon. In the bedrooms the
windows are alternately bow and flat; the top floor has
mansard windows. The dimensions vary from 1200 to
1400 cubic feet in the older, and 1(>00 to 1800 in the newer
blocks. The ventilation is partly by open windows, partly
by the introduction of warmed air from the corridors
through an aperture above the door. There are in addi-
tion ventilating shafts which are collected under the roof
and exhaust the impure air, steam pipes being placed in
the main shafts. By these means 5000 cubic feet of air
per head per hour are admitted, at a uniform temperature
of 62° F. The heating is by means of steam pipes, with
radiators in the corridors and bedrooms. Electric lighting
has recently been introduced into all parts of the building.
The furniture in the bedrooms is simple : white painted
washstands, dressing-tables, and chairs, and wire-wove
spring iron bedsteads. Excepting for food, coals and the
like, there are no lifts ; but as far as possible the more
robust patients are placed in the upper storeys. The total
accommodation is for 155, of whom 104 are men ; but this
includes two north rooms, which are seldom occupied by
patients. On the other side of the approach at the back,
sunk below the road level, is the engine-house for heating
and pumping water. There is a large softening tank which
has recently been added ; and it is proposed to make a
reservoir on the hillside at a higher level. The water
supply comes from a private well.
Like other British chest hospitals, the Ventnor Hospital
nominally receives cases of bronchitis as well as phthisis,
but practically the patients are all consumptives in an early
or remediable stage. The irksome rules in force in most of
the general hospitals are not adopted at Ventnor, patients
rising at 8 o'clock and going to bed at 9 or 9*30 according
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BRITISH INSTITUTIONS FOR POORER CONSUMPTIVES. 331
to the season. The meals are four in number, at 8 30, 1, 5
and 8. The distance which the female patients have to
walk is inconvenient in the case of feeble subjects. Those
who are too weak to come to the dining-saloon have some
(or all) of their meals in the sitting-room of their own
block. At one time all used to dine in their own block ;
but this system proved to be wasteful. Sputa are received
out of doors into special Turkey-red handkerchiefs supplied
by the institution, which are collected daily and boiled ; in-
doors, spitcups are used which contain a little water ; these
are emptied into the drain without special disinfection, but
the adoption of an incinerator is under consideration.
Open-air treatment is now systematically carried out at
the Ventnor Hospital. Shelters have been erected in the
grounds ; and the balconies of the new block as well as the
verandahs on the ground floor, are well adapted for rest out
of doors.
There is no systematic hydrotherapy. Cod-liver oil is
largely prescribed, as well as drugs of various kinds ac-
cording to necassity. There are sixteen nurses and two
resident medical officers. Since the lamented death of Dr.
J. G. Sinclair Coghill, the visiting physicians have been
Drs. Robertson, Whitehead and Williamson. There are
also a surgeon, an analyst, and consulting and examining
physicians and medical referees in varioas parts of the
kingdom. Admission is by letter and payment of 10s.
per week, the latter being occasionally remitted.
The Richmond House Convalescent Home
at Worthing is connected with the Infirmary for Con-
sumption and Diseases of the Throat and Chest, Margaret
Street, London, W. It is an ordinary house, with accommoda-
tion for fifteen or sixteen patients, surrounded by a garden ;
and has been latterly managed on open-air principles. Ad-
mission is by subscriber's letter and payment of lis. 6d.
per week, or 15s. without a letter. During 1899 the average
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332 BRITISH INSTITUTIONS FOR POORER CONSUMPTIVES.
length of stay was three and a half weeks ; so that it oannot
be regarded as a sanatorium.
Richmond House, Clare,
in Suffolk, is a cottage under the medical supervision of Dr.
Jane Walker (medical director of the East-Anglian Sana-
torium). It is intended for a limited number of women
of the hospital class who can be maintained at a cost of
15s. to £1 per week. The cottage is under the charge of a
trained nurse. The resident medical officer of Brookside,
Clare (p. 378), visits the patients.
the northern counties.
The Durham Sanatorium.
At a meeting of the Society for the Prevention of Tuber-
<;ulosis in the County of Durham, held in December, 1899, it
was decided to open a sanatorium for twenty men and
women. Horn Hall, Stanhope, with two and a half acres
of ground, was subsequently acquired for the purpase on a
seven years' lease at £40 per annum, and another plot of
ground in the same neighbourhood on a 999 years* lease at
£5 per annum for the erection of a more permanent build-
ing. Subsequently, however, it was decided to enlarge
Horn Hall and to retain it as a permanent sanatorium.
A promise was therefore sought and obtained for an eighty
years' lease at £35, terminable at shorter periods.
Horn Hall is in the valley of the Wear, some distance
west of the coal-fields and away from noise, smoke and dirt.
It stands on limestone soil, 700 feet above the sea-level, and
is sheltered from the north by a spur of the Pennine
Chain, points of which rise to 1400 feet above the sea-leveL
The district is well wooded with pines and other trees. The
rainfall is 36 inches. The sanatorium has a fine view, and
is surrounded by moorland with abundant opportunities
for walking exercise. The grounds are surrounded by a
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BRITISH INSTITUTIONS FOR POORER CONSUMPTIVES. 8SS
high wall which protects them from prevailing winds. The
building is substantially built in stone, and has accommoda*-
tion for twelve male patients, all the bedrooms, but two,
being on the south side. Among the alterations effected were
the substitution of French windows for the original ones
on the south and east sides. The walls were painted with
duresco, the floors covered with cork carpet and varnished,
and additional bath and lavatory accommodation provided.
Lighting is by gas. The sanatorium was opened on 15th
May, 1899, and from this time until 30th April, 1900, there
had been fifteen men under treatment. Most of them had
remained from ten to nineteen weeks, the shortest stay
having been four weeks. An arrangement was made with
Dr. John Gray of Stanhope to act as deputy medical oflBcer
at a salary of two guineas per week, for which he was also
to supply drugs.
The treatment is based on that at Nordrach. Patients
sleep with windows wide open, and spend on an average
eleven and a half hours out of doors every day. According
to the first interim medical report of the society, issued 30th
September, the results have been very satisfactory.
The sanatorium is maintained by subscriptions from
workmen of various shipyards and works in the district at
the rate of threepence per quarter per man ; annual sub-
scriptions from the wealthier classes ; and weekly payments
by in-patients who do not subscribe regularly. Regular
subscribers amongst the working classes have the first claim
on the beds for themselves and their families to the full
extent of their total subscriptions. The cost per bed is.
estimated at £Y8 per annum ; with twenty beds it would
probably be £65 per annum. It was therefore decided to
enlarge the sanatorium in the spring of 1901 by the addi-
tion of a wing with eight beds for women, and at the same
time to add another kitdien, a large dining-room, two large
lavatories with baths, and another staff bedroom. At
some future date the accommodation may be increased to
forty.
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334 BRITISH INSTITUTIONS FOR POORER CONSUMPTIVES.
Dr. Wm. Robinson and Dr. Scurfield took a prominent
part in establishing this sanatorium.
The Leeds Sanatoria.
A temporary sanatorium for the poor of Leeds was
started in 1899, at a farm house at Ask with near Otley.
This was subsequently given up for another farm house
at Famley in the same district. There are ten beds for
patients. It has quite recently been proposed to establish
a permanent sanatorium, at first for twenty, later on for
/ seventy-five to one hundred patients, at Gateforth Hall,
where some 2000 acres have been bought by the corporation
/^ for the disposal of the city sewage. It is intended that the
hall and the use of the grounds shall be given free of cost to
the Tuberculosis Committee and a small subsidy paid yearly
from the city funds. A free bed will be provided for the
use of every board of guardians or other body subscribing
£50.
At a meeting of the Holbeck and Hunslet Social and Sani-
tary Association, last year, Dr. Woodcock delivered an address
on suitable employment for consumptives. A patch of land
in Norfolk was put at his disposal for experimental work
in this direction ; but it was not taken up, as the grounds
at Gateforth Hall can be used for the same purpose.
The Liverpool Hospital for Consumption
is in the midst of the city, in a situation quite unsuitable
for open-air treatment. It consists of two blocks for women,
and men respectively, united by a third which forms the
dining-room ; and of an out-patient department in which
from 4000 to 5000 patients are seen every year. There are
forty-four beds, but usually no more than thirty-six are
used, to prevent overcrowding.
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british institutions for poorer consumptives. 335
The Liverpool Hospital Sanatorium
is being built at Roughhill, in Delamere Forest, one of
the highest points in Cheshire. Roughhill is in the parish
of Kingswood, three or four miles from Frodsham Station,
and commands a view of the village of Molesworth and of
Eaton Hall, the seat of the Duke of Westminster, as well as
of the city of Chester, the river Mersey, and, on a clear day,
Snowdon and Moel Fammau. Surrounding it is prettily
wooded, undulating country. The site has been secured on
a long lease from the Crown, and has been planted with
3000 young fir-trees by a generous supporter.
The sanatorium will consist of a main block and a
number of small detached blocks. In the main block will
be placed, on the ground floor, the medical officer's and
matron's quarters, and behind the corridor (which ends in
the lavatories) the consulting-rooms and laboratory. On
the first floor will be a limited number of bedrooms for
patients; in the attics, quarters for the staff*. In front of
the building, with a south or south-west aspect, will be
verandahs and balconies. Running back from the centre of
the building will be a passage leading to the dining-hall,
and beyond it the kitchen department, with servants' bed-
rooms.
Most of the patients will be accommodated in small
detached blocks, each containing from four to six bedrooms,
with bath-rooms, etc. All the rooms will be built with
rounded angles and comers, and without projecting mould-
ings. There will be no fire-places in the bedrooms, heating
and lighting being by electricity. The Vyrnwy water main
of the Corporation of Liverpool runs within a mile of the
sanatorium.
The sanatorium, which is intended for the patients of
the chest hospital in Liverpool, owes its existence to the
generosity of Lady Willox and Mr. W. P. Hartley, who
between them subscribed £15,000 for the purpose. It will
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836 BRITISH INSTITUTIONS FOK POORER CONSUMPTIVES.
eventually have fifty beds, but at first only fourteen. The
foundation stone was laid by Lord Derby on 6th October,
1900.
Liverpool Parochial Sanatorium.
A sanatorium is also to be built for the poor of Liverpool
by a joint committee representing three of the boards of
guardians of the city. A site has been purchased at a coBt
of £4200 at Heswall, at a height of 650 feet above the
sea-level, on the slope of a hill overlooking the river Dee
and the Welsh mountains. There will be twenty-five beds.
The City Council is not contributing. This 'useful scheme
is largely due to the exertions of Dr. Nathan Raw. Ad-
vanced consumptive cases in the infirmaries are now received
into special wards.
The Manchester Hospital for Consumption
has its out-patient department in the heart of Mandiester,
the in-patient department at Bowdon in Cheshire. Early
cases of consumption amongst the out-patients are put on
the list for admission to Bowdon. This used to be in the
country, but is now a small commercial and manufackiring
centre. Round the hospital is a large garden of about three-
quarters of an acre, in which for a year past there have
been " Liegehallen " for open-air treatment. The hospital
has fifty beds in all, in four wards, two of which are for
men and two for women. Each ward is 24 x 50 feet,
the cubic space per bed being 2000 feet. Ventilation is
effected by means of hot pipes, open windows, and an ex-
tractor, the air being changed about three times per hour.
Heating is chiefly by fresh air passed over hot pipes ; l^ht-
ing by electricity. Large verandahs have been built round
the building for open-air treatment. Patients stay on an
average twelve weeks, and are treated by hygienic and
medicinal remedies, creosote and cod-liver oil being largely
used. They pay what they can aflbrd ; some 2s. ©A or 5b.
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BRITISH INSTITUTIONS FOR POORER CONSUMPTIVES. 337
per week, some nothing at all, the average being about Is.
6d. per week.
The Manchester Sanatorium.
A sanatorium is projected for the poor of Manchester by
W. J. Crossley, Esq., at a cost of £100,000. It will probably
be on the south-west slope of Moel Gaer near Halkln in
Flintshire. The sanatorium is intended to be a three-storey
building with 100 beds, some in single rooms, some double,
others in wards with four to six beds ; all rooms to face
south, and to have behind them a corridor two feet wide.
There will be a few small balconies and verandahs in the
grounds for groups of patients. Probably, in the first
instance, there will be only fifty beds provided.
The Northern Counties Hospital
for consumption and diseases of the chest at Newcastle-^
on-Tyne is in the town, with no ground attached to it, so
that it is quite unsuited for open-air treatment. In-patients
are admitted for three weeks, at the end of which a fresh
letter is required. There are only five beds, but many
out-patients are annually relieved.
Nottingham Sanatorium.
An open sanatorium is projected for convalescent con-
sumptives in the county of Nottingham. A number of
suitable houses in the country have been selected, and
accommodation can already be provided for fifty or sixty
patients. These will be chosen from among those who have
improved under hospital or other treatment, and have no
active disease, but require prolonged rest in fresh air with
abundance of nourishing food before they return to their
work. It is estimated that a patient can be kept three
months for ten pounds.
The above sanatorium is distinct from the projected county
sanatorium, for which a site has been offered by the Duke
of Portland at Ratchers Hill in Sherwood Forest. This
22
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338 BRITISH INSTITUTIONS FOR POORER CONSUMPTIVES.
site comprises fifty acres of moorland and pinewood on
sandy soil, standing 470 feet above the sea-level, with a
southerly aspect and a good water supply. It is intended
to build here a long narrow building with wide verandahs,
and a central block of two storeys. The estimated cost is
£5000 ^ for twenty-five beds.
The Westmoreland Sanatorium
at Kirkby Lonsdale, near Kendal, was opened in March,
1900, in a building previously used for a convalescent home.
Dr. Paget-Tomlinson was one of the chief subscribers, pajdng
the rent (£70) for five years, as well as the cost of furnishing.
The sanatorium stands on a sunny hill, 210 feet above the
sea-level, on limestone soil, in a well-sheltered situation,
about three miles on the Kendal side of Grange-over-Sands.
The building consists of a two-storey house of stone, with
two large wards respectively for seven men and seven women,
and two small isolation rooms. The heating is by hot water
pipes, A large wooden dining-room has been added. Small
wooden shelters, which can be opened on every side, stand
in the large garden. A subscription of £50 gives the right
to a bed for one year. The staflT consists of a resident
medical officer, a matron, two nurses and two servants.
SCOTLAND.
There are at present two sanatoria for the poor in Scotland
A third is being built, and one or more projected.
Founded.
Beds.
Aberdeen
Dundee
Edinburgh
Glasgow
Perth
Projected Sanatorium ....
Sanatorium at Auchterhouse
Victoria Hospital for Consumption,
Craigleith
Consumptives' Hospital for Scotland,
Bridge of Weir
Projected Sanatorium ....
Projected
Being built
1894
1898
Projected
34
23
38
16-90
1 Brit. Med. Joum., 22nd December, 1900.
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british institutions for poorer consumptives. 339
The Aberdeen Sanatorium
was first proposed afc a joint meeting held on Slst May,
1899, of representatives from the Public Health Committee
of the city, and others from the local branch of the British
Medical Association. Dr. Matthew Hay informs me that no
definite step has yet been taken to erect the sanatorium.
A new wing is however to be erected at the Convalescent
Cottage Home near Aberdeen, with sixteen beds for con-
sumptives, a separate kitchen and dining-room, and facilities
for open-air treatment.
The Perthshire Sanatorium
was projected in November, 1900, by the Committee of
Management of the Society for the Treatment and Relief of
Incurable and Chronic Ailments and Care of Convalescents
in Perthshire. A well-sheltered site has been secured on
the Barnhill slope, 300 feet above the sea-level. Sir Robert
and Lady PuUar have provided the building fund. The
funds (£10,000) for endowment are being raised by public
subscription. Nearly half has been subscribed.
The Victoria Hospital for Consumption
at Craigleith, Edinburgh, which was for a time the only
hospital in the United Kingdom for the gratuitous treat-
ment of consumptives, managed strictly on open-air prin-
ciples, was opened in 1894 in connection with a free
dispensary in the centre of Edinburgh under the care of
Dr. R. W. Philip. It was originally a private mansion
standing in seven and a half acres of ground about a mile
to the north-west of Edinburgh; but another nine and a
half acres have been recently acquired, and the accommoda-
tion increased by the erection of a wooden annexe. The
hospital is surrounded on all sides by fields and open spaces.
The soil is sand overlying rock ; the elevation 150 feet above
the sea-level. The hospital is placed on a gentle slope, facing
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340 BRITISH INSTITUTIONS FOR POORER CONSUMPTIVES.
south, and is sheltered by a splendid belt of trees. The
grounds are laid out with fine lawns and winding paths,
and afford shelter in one part or another from every possible
wind. There are at present twenty-three beds, seven for
men in two rooms on the ground floor, eight for women in
three wards on the first floor, and eight more for men in
four rooms in the annexe. The rooms have a cubic capacity
of about 1000 feet per head, some having nearly double
this amount. Elach has at least one large window which
is open day and night, the larger wards having three.
There is no special protection against rain outside the open
windows. Heating is by open fires, the temperature being
kept as near as possible 60° F. The floors are plain and
polished, the walls distempered. The wards of the annexe
have panelled walls. There are no balconies, but a piazza
in front of the main block, and numerous sun boxes in the
grounds. There is a bath-room to about every four patients.
The furniture is of the simplest. The bedsteads have an
open spring mattress, covered with a horse-hair mattress.
The reclining couches are made very narrow to promote
absolute repose. The bed-tables are of glass and metal
with open shelves, one of which is protected by a thin strip
of cotton.
The treatment is mainly by hygienic measures. Every
patient spends many hours out of doors every day. Those
who are febrile or have much circulatory disturbance are
carried out to reclining chairs and couches, or remain in
bed. In other cases graduated exercise is adopted, such as
walking, gentle cycling, mild golfing, quoit throwing, dumb
bells, Indian clubs, or gentle breathing exercises, according
to the condition of each patient, and the ettect on the pulse.
Patients rest before and after every important meal. Every
patient is either sponged or bathed in more or less cold
water. Occasionally systematic massage is applied. The
clothing is simplified as far as possible, Shetland woollen
materials being much used. Five meals a day are given,
two consisting of soup or warm milk. Stimulants are given
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BRITISH INSTITUTIONS FOR POORER CONSUMPTIVES. 341
to pyrexial cases as a rule, and to those with much disturbed
circulation. Sputa are received solely into spit-cups contain-
ing 1 in 20 solution of carbolic acid, or into a modification
of Dettweiler's flasks. These are cleansed with boiling water,
and the contents poured down the water-closets. Handker-
chiefs are not used for sputa, but occasionally rags are used for
wiping which can afterwards be burnt. Of drugs cod-liver
oil and arsenic are the most used. Formalin inhalations
and those with some of the late Dr. Coghill's formulce are
much employed.
Dr. Philip reports that he has seen nothing but good
from the treatment, even in cases with considerable phural
effusion. The climate is that of Edinburgh, temperate but
changeable, with a fair amount of mist and wind ; but the
weather is seldom allowed to keep suitable cases indoors.
The main results have been an improved colour, better
appetite, disappearance of night sweats, diminution of fever,
increase of body weight and diminution in cough. The
patients at present are seldom able to stay more than two
months, but Dr. Philip considers from four to six months
desirable.^
The Bridge of Weir Consumption Sanatorium
is an outcome of the manifold philanthropic labours of Mr.
Quarrier of Glasgow, who was struck with the good results
of open-air treatment of tuberculous children from his
orphanages, and decided in 1897 to extend the benefits to
adults.
Bridge of Weir is a village on the G. and S. W. Railway
about sixteen miles from Glasgow. Two miles farther by
road, nestling amongst the Renfrewshire hills, is a small
group of buildings consisting of an old and a new patients*
block, an administration block, with laundry, engine house,
etc., and the secretary's residence.
iSee Brit. Med. Jouni., 23rd July, 1898; British Sanatoria (Bale &
Son), ♦•Edinburgh Hospital Reports," vol. iii., 1895.
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342 BRITISH INSTITUTIONS FOR POORER CONSUMPTIVES.
The old block is a handsome stone building on two floors,
with an additional storey in the centre. Patients' rooms
are nearly all on the south side, the corridor to the north,
with a handsome marble vestibule in the centre and lava-
tories at the ends. The bedrooms are floored with polished
boards, the angles next the walls being rounded with a bold
curve. Walls are washable, furniture simple, and fittings
fairly free from dust-retaining ledges, although the whole
building is beautifully and almost luxuriously fitted up. The
walls are double and the windows were also double, the
heating being originally by means of warm air by propul-
sion. It was, however, soon discovered that this was a
hindrance to treatment, so that the inner windows have
everywhere been removed, and ventilation by open windows
substituted, together with heating by open fires. The ground
floor was originally intended for a number of day-rooms ;
but these have been mostly transformed into wards. There
are now beds for about twenty-six patients in this block,
twelve on the ground floor and fourteen on the next floor.
The dining-room is on the first floor, the kitchen above.
In the basement are bath-rooms, and space for the heating
and ventilating apparatus, which will presently be replaced
by a cloak-room for the patients. This block was opened
for patients in April, 1898.
The second block, which has recently been finished, is
built in the same style as the first, but with some modifica-
tions and improvements, and will accommodate about forty
patients. A new kitchen department is placed behind the
centre of the corridor. On the roof is a Mann*s extraction
flue. In the bedrooms the concave skirting next the floor
has been replaced by one which ends above in a convex
border ; but in other respects there is little difference from
the other building. When this block is finished, further
alterations will be made in the first block, which will bring
up the total accommodation to about eighty.
The treatment is modelled on that at Nordrach. Food is
weighed out and served by the medical oflScer (Dr. Camp-
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OS
S
OS
pq
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BRITISH INSTITUTIONS FOR POORER CONSUMPTIVES. 343
bell), who presides at each of the chief meals. Couches are
but little used, febrile patients resting in bed
The existing blocks are reserved for women and children.
When another women's block has been built, it is proposed
to erect three more for men on an adjoining piece of land
with a somewhat more westerly aspect. A doctor's house
is also projected. There is a dispensary in Glasgow from
which patients are drafted.
The staff consists of a resident medical officer, matron and
three nurses, as well as servants. All doubtful points are
submitted to an advisory board of five distinguished medical
men.
The Dundee Sanatorium
is being erected at Auchterhouse, on a site of about twenty-
one acres granted by the late Earl of Airlie, 800 feet above
the sea-level, and well sheltered from north and east winds.
The cost of erection, which is estimated at £13,000, has been
met by a generous donation of £15,000 from ex-Provost
Moncur, and an anonymous donor has promised £500 per
annum for five years for maintenance.
The sanatorium will comprise three or more blocks, a
main residential block, a second block to the north-west, for
dining-hall and kitchen department, connected with the first
by a covered corridor, and a laundry block to north-east.
The main block has a frontage of 200 feet, on two floors
with attics, consisting of single rows of rooms with straight
corridors to the north. On the ground floor will be accom-
modation for eighteen men, including ten single-bedded
rooms and two wards of four beds apiece. Each room will
have an oriel window giving access to the terrace and
grounds. Behind the corridor are pavilions at the ends for
lavatory accommodation, etc., and in the middle for doctor's
room, laboratory, consulting and waiting rooms. On the
first floor are the sitting-rooms for doctor, matron and nurses,
together with rooms for sixteen women patients, eight of
these being single-bedded rooms. In the attics are bedrooms
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344 BRITISH INSTITUTIONS FOR POORER CONSUMPTIVES.
for the matron and staff. All the patients* rooms will face
south, and be heated by radiators. The dining-hall will
seat forty persons. The laundry block will have attached
to it a boiler house, and another which will accommodate
the accumulators when electric lighting is installed.
IRELAND.
There are two special hospitals for the consumptive poor
in Ireland. Consumptives are also admitted to the Throne
Hospital, Belfast, and to other general hospitals, as well as
to the Royal Hospital for Incurables at Dublin.
Belfast
Dublin
Foreter Green Hospital for Consump-
tion, Fortbreda
National Hospital for Consumption for
Ireland, Newcastle, Wicklow
Founded.
Beds.
1897
40
1896
34
The National Hospital for Consumption for Ireland,
at Newcastle, in the Wicklow Hills, is situated three
miles from the sea, on the southern slope of a hill, which
shelters it from the north and to a less extent from the
east. The hospital is 270 feet above the sea-level : to the
south-west and west, at a distance of a mile or two, is a
chain of hills 700 or 800 feet high. The soil is gravel, in
the deeper parts of which are many springs of water. The
climate is mild, humid, and equable, with from 77 to 84
per cent, mean daily humidity, about 40 inches rainfall,
and 195 rainy days per annum. The prevailing winds are
north-west and south-west.
The hospital, which is shortly to be enlarged, consists of
an administrative block connected by glass shelters with
two other blocks for men and women respectively. The
latter have each three floors, the two upper provided with
balconies on the south side, the lower looking on to a terrace.
The present accommodation is for thirty-two patients, an
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BRITISH INSTITUTIONS FOR POORER CONSUMPTIVES. 345
equal number of each sex ; twenty-four in single-bedded
rooms, the rest in wards with four beds apiece. It is
intended to add a block on either side, each to house thirty
more patients. The ventilation of the original blocks was
at first on the plenum system ; but this has been abandoned,
open windows and open fires being depended upon. The
heikting is still by the plenum system, hot air being pumped
into the rooms. Lighting is by electricity. There is a
liberal supply of baths on each floor, but hydrotherapy is
not employed systematically. The sewage passes into a
closed cesspool, the overflow of which passes into a branch-
ing drain deep in the soil, which it permeates in every
direction.
Treatment is by open-air methods, and has been very
satisfactory, judging by the reports already published.
The food is abundant; rest is taken in bed or in one of
three shelters in the grounds ; exercise to a moderate
extent, not exactly graduated but under medical super-
vision. The sputa ai*e burnt in the furnace ; spit-cups
being used at night and Dettweiler's flasks by day, and
disinfected with antiseptic solution. There are two visiting
physicians. Dr. Parsons and Dr. Coleman, who live in
Dublin, and a resident medical oflScer, Dr. Steede. Ad-
mission is by subscriber's letter. The hospital is supported
by voluntary subscriptions. The average duration of treat-
ment is ten weeks. In each of three years the average
gain in weight has been greatest in autumn and winter.^
The Forster Green Hospital for Consumption
and Diseases of the Chest, was opened on the 30th October,
1897, at Fortbreda on the Castlereagh Hills, a short
distance from Belfast, but suflSciently far removed to
ensure a pure atmosphere and a healthy situation. Erected
> See Annual Reports ; also paper by Dr. Steede at the Dublin Congress
of the Royal Institute of Public Health, August, 1898.
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346 BRITISH INSTITUTIONS FOB POORER CONSUMPTIVES.
through the munificence of Mr. Forster Green, who con-
tributed over £13,000, it has been amalgamated with the
Belfast Hospital for Consumption and Diseases of the
Chest, which has existed in the city since 1880.
The hospital stands in its own well-wooded grounds of
forty acres, on a sandy subsoil, on the western slope of the
Castlereagh Hills, 200 feet above Belfast Lough, of which
a magnificent view is obtained. The hospital was originally
a private mansion, and has seven or eight villa residences
within half a mile. The grounds contain sheltered walks,
and are provided with a shelter with shifting panels and
room for five lounge-chairs. There is also a large conserva-
tory for the patients' use, and a verandah 12 feet deep and
70 feet long along the south side of the building. The
latter consists of a ground floor and three upper floors ; it
was heated and ventilated by the plenum system, fans
propelling 5000 cubic feet per head per hour of filtered and
if necessary heated air into the rooms; but this method
has been abandoned for natural ventilation. There is elec-
tric lighting and an electric lift for patients. The water
supply is pumped up by an electric motor. The windows
are extra large, of the usual guillotine variety. The walls
are distempered ; the floors covered with heavy linoleum,
excepting in the recreation pavilion, which is floored with
polished pine, and in the passages which are paved with
stone. The wards contain from two to five patients each^
the total number of beds being forty. On the ground floor
is a dining-saloon 30 feet x 16 feet ; the kitchen depart-
ment, a staff dining-room, smoke-room and store-room.
On the first floor on one side is a large board-room, and
on the other four large wards, each 23 feet x 17 feet.
On the next floor are sitting and bedrooms for the nurs-
ing staff* and matron, together with seven wards. The
top floor contains bath-rooms and servants' bedrooms.
Treatment is stated to be by open-air methods. A large
apparatus is kept for sterilising milk ; and a set of meteor-
ological instruments has also been presented to the hospital.
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BRITISH INSTITUTIONS FOR POORER CONSUMPTIVES. 34T
Admission is by subscriber's letter, the patient or his friends-
also paying what they can afford towards the cost of treat-
ment. There are a few free beds. There are three visiting
physicians : Drs. Purdon, Simpson and Sinclair, as well as.
a visiting surgeon, laryngologist, and pathologist.
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CHAPTER XLVIII.
BRITISH SANATORIA FOR PAYING CONSUMPTIVES.
During 1899 and 1900 many sanatoria of various descrip-
tions for paying consumptive patients hav^e been opened in
this country. They mostly profess to model their treatment
on that of Nordrach in Germany, which appears to be much
better known and appreciated in England than in Germany.
The following is a list of such institutions : —
Aldemey Manor Sanatorium.
Altadore
Bellevue
Brinklea
Brookside
Cotswold
Crooksbury
Dunstone Park
East Anglian
Grampians
Hailey
Harboume
Holne Chase
Inglewood
Knocksualtach
Liniord
London
Maitland House
(348)
Mendip Hills Sanatorium.
Moorcote „
Mundesley „
Nordrach upon Dee.
Nordraoh upon Mendip.
Ochil Hills Sanatorium.
Overton Hall
Pendyffryn Hall
Bossclare
Rostrevor
Budgwick
Stourfield Park
Swiss Villa, Swanage.
Sunny Nook Sanatorium.
The Firs.
Timbercombe.
Whitmead Hill Sanatorium.
Woodbum ,,
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BRITISH SANATORIA FOR PAYING CONSUMPTIVES. 349"
Inland Sanatoria in the Southern Counties.
Name.
Nearest Town.
Medical Director.
No. of Beds.
Orooksbury Sanato-
rium^
Hailey Sanatorium ^
Harbourne Sanatorium
Liinford Sanatorium ^ .
London Sanatorium * .
Maitland House Sana-
torium' .
Moorcote Sanatorium .
Rudgwick Sanatorium ^
Whitmead Hill Sana-
torium ' .
Famham .
Reading
Ashford
Ringwood .
Reading
Reading
Reading
Horsham
Farnham .
Dr. F. R. Walters .
Dr. C. Reinhardt
Peter Paget, Esq.
Dr. Mander Smyth .
20*
12
20
15
(64)
8
12
12
19
Dr. Esther Colebrook
W. Langworthy Baker,
Esq.
Dr. Annie McCall .
Dr. Hurd-Wood .
The Crooksbury Sanatorium
has been specially built in the lovely tract of country to
the south of the Hog's Back, near Famham in Surrey.
This district forms the widest part of the southern outcrop
of the Lower Greensand formation, which is covered mainly
by open moorland with pine woods, stretching for over
twenty miles to the south-west. This extensive sandy
region appears to modify the climate, rendering it re-
latively dry, while in the higher parts, such as the Hind-
head and around Crooksbury Hill, it is distinctly bracing
with a large proportion of sunshine. The district has a
large amount of common land, and possesses some of the^
finest scenery in the South of England.
The grounds of the sanatorium cover thirty-two acres of
land. They have been laid out with several miles of
walks of the most varied character, level and sloping^
through grass and heather, or under the pine-trees which
cover much of the surface. Numerous specially designed
* Specially built.
3 Special block added.
^ Sleeping huts and mansion.
* 12 open.
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350 BRITISH SANATORIA FOR PAYING CONSUMPTn-ES.
shelters have been erected in different parts of the grounds.
The soil — Folkestone beds — is mainly sandy for several
hundred feet below the surface, so that it rapidly dries
after rain. Pine-clad hills lie to the north, east, south-
west, and west, protecting a shallow valley trending south.
At the head and sides of this valley are well-wooded,
pine-covered ridges. Beautiful and extensive views
may be obtained from many parts of the grounds,
northwards towards the Hog's Back and the Aldershot
hills, to the south over a semicircle extending from
Leith Hill and the Charterhouse to the Hindhead and
the Hampshire hills. The nearest towns are Farnham
(three miles), Guildford (eight miles) and Godalming (seven
miles).
The sanatorium stands on a sheltered situation about
400 feet above the sea-level, on Crooksbury ridges, im-
mediately to the east of Crooksbury Hill. The ground
rises rapidly to the north of the building, and falls
gently to the south. The main building contains twelve
bedrooms on one floor, all looking south, and served by
a common corridor, behind the centre of which lies a
large dining-saloon, attached to the two-storey kitchen
block. It is built of brick covered with white rough cast,
and has a red-tiled roof. The centre of the latter forms a
nurses' bedroom, the rest being used as box-rooms. Lava-
tories with needle - bath, etc., and earth - closets project
northwards from either end of the corridor. Walls and
ceilings are of hard cement covered with washable dis-
temper, all angles being rounded and dust-retaining ledges
avoided. Floors are waxed and polished, covered with a
few detachable carpet-strips. Most of the bedrooms are
12 X 10, a few being larger, and are fitted with corner
cupboards with sloping roofs and specially designed tiled
washstands. The large French windows surmounted by
fanlights look on to a garden with large lawns, and open
on to a tiled terrace protected by glass screens. From each
bedroom an airshaft leads across the corridor to the open
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Fio. 47. — Crooksbdky Sanatorium. — In the Gkolnds.
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Fio. 49. — Crooksbury Sanatorium.— In the Grounds.
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BRITISH SANATORIA FOR PAYING CONSUMPTIVES. 351
air behind, so that a current of fresh air passes through
the room even if the door be shut. The furniture and
fittings of the rooms are both practical and artistic and
have been specially designed or chosen so as not to retain
the dust and to be readily cleaned with a wet cloth. Each
room is finished a little different from the rest, in order
to make it more home-like and less like an institution.
Heating is by hot-water pipes; lighting by electric light,
produced by an oil engine in a distant part of the grounds.
The water supply is from the Wey Valley Water Company's
mains. All drinking water is purified by a Pasteur-
Chamberland filter. There is a large storage tank for rain-
water behind the building. The waste water is purified on
the principles advocated by Dr. Vivian Poore. A new
building with eight south rooms on two floors is being
built a little higher up the hilL
The treatment agrees in all essentials with that adopted
at Nordrach in Germany, but with modifications to suit
British patients. It includes a rigidly enforced open-air
life, personally superintended by the medical director ; abso-
lute rest or graduated exercise, according to the degree of
fever and other circumstances ; moderate forced feeding ;
drugs and hydropathic measures whenever indicated. The
windows in the bedrooms, corridors and dining-rooms, are
never completely closed, and as a rule are wide open
day and night, except during dressing and undressing.
The dietary is varied and abundant, a high-class British
standard being adopted, with three chief meals a day. and a
relatively large proportion of butter, cream, fresh meat, and
milk puddings. On the other hand, patients are not com-
pelled to eat dishes which appeal solely to the German
palate ; nor are they compelled to remain in wet clothes, or
to abstain from the use of woollen underclothing, or of a
reasonable amount of extra covering in cold weather. The
" Liegehalle " system is not adopted ; visitors are not encour-
aged, but are allowed to see their friends with the medical
director's permission at reasonable intervals. Sputa are
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352 BRITISH SANATORIA FOR PAYING CONSUMPTIVES.
received into spit-cups, spit-flasks, or Japanese handker-
chiefs, and are destroyed by burning. Cleaning is done
every day by special methods which do not raise the dust ;
and after the departure of a patient the bedroom and its
contents are systematically disinfected.
The stafl* includes a lady superintendant, housekeeper,
two nurses, and two resident physicians. The medical
director, Dr. F. Rufenacht Walters, lives in a house to the
north of the sanatorium connected with it by telephone.
The second medical officer, Dr. C. G. Higginson, lives in
one of the sanatorium blocks.
* Terms are from four and a half guineas upwards, including-
all excepting personal laundry, beverages, special medicines,
and special nurse (if required). A reduction is made for long
residence.
Railway stations: Farnham (three and a half miles,
L.S.W.R.); Tongham (two and a half miles, L.S.W.R.) ;
Ash (four miles, S.E.R). Connection with the Great Western
Railway at Reading. Distance from London thirty-six
miles.
Telegrams : Sanatorium, Farnham.
Hailey Sanatorium,
•
on the Chiltern Hills, consists of an old country house,
with out-buildings, on about thirteen acres of land, together
with a detached thirty- five-acre patch of breezy upland a
quarter of a mile away. Dominated by the highest chain
of the Chilterns, which form a sort of amphitheatre to
north, east and west, the sanatorium is surrounded by open
fields which extend to the valley of the Thames, and enjoys
beautiful and extensive views in many directions. Roimd
the house is a well-kept old-fashioned garden, with good
lawn, lofty ivy-clad elm-trees and ornamental pines, and
farther ofi" a productive orchard and grassy meadows which
fall to the westward. The upland patch consists of open
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Fio. 52.— Hailey Sanatoricm.— In the Grounds.
[Face page B53
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BRITISH SANATORIA FOR PAYING CONSUMPTIVES. 353
fields reaching to the top of the hill, surrounded on three
sides by a narrow belt of beech-trees.
The soil of the district is chalk, covered with brick earth
or gravel. The altitude near the house is about 350 feet,
but the grounds rise from 250 to 600 feet, so that there is
plenty of scope for graduated hill climbing.
The house itself has been somewhat remodelled for its
present purpose. Over the entrance and the eastern side is
a large glass verandah, which can be used for some of the
meals. On another side is a small glass conservatory com-
municating with the basement. The rooms throughout the
house have been provided with extra large windows, and in
some cases a second window has been put in. The walls are
of the ordinary kind, with paper and skirting board ; floors
covered with linoleum or cork-carpet. Heating is by open
fires, lighting at present by lamps and candles. Sewage is
carried into a cesspool. Earth-closets are also provided.
The house is supplied with water from its own well, sunk
into the chalk. Four of its rooms are at present available
for patients ; but the house will be used in time solely as
an administrative block, surrounded with wooden sleeping
chalets. Each of these is raised on piles, and has windows
on all sides, a space for ventilation just below the roof, and
a narrow covered verandah in front. An outlying cottage
has also been utilised for the reception of patients, so that
twelve patients can at present be received. Another iso-
lated cottage is to be used for laundry and disinfector.
The nearest large town is Reading, fifteen miles away.
The medical director, Dr. Reinhardt lives at Goring, five
miles off. There is also a resident- medical officer, as well as
a matron and nurse who have both had personal experience
of open-air treatment. Dr. Reinhardt was probably the
first British physician to publish a description of Nordrach
in Germany.
Railway stations : Goring or Wallingford (G.W. Railway),
the latter four and a half miles distant
Terms from four to seven guineas per week.
23
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364 british sanatoria ro]^ paying consumptives.
Harbourne Sanatorium,
High Halden, Ashford, Kent, is under the care of an experi-
enced trained nurse, Mrs. Stansfield, and of Peter Paget,
Esq., M.R.C.S., L.R.C.P., the visiting medical officer. Two
other institutions are under the same proprietorship and
management: the St. John's Nursing Institution for the
Aged and Afflicted, Upper Holloway, N., and the Invalid s
Country Home, Tenterden, Kent.
Harbourne is about four miles from Tenterden Station on
the South- Elastern Railway, and was described by G. P. K.
James in his novel The Smugglers.
The soil is dry, the elevation satisfactory. From the top
of the house on a clear day the sea can be distinguished
at a distance of ten miles. Surrounding the house are
some twenty acres of land, partly wooded with fir-trees.
The neighbourhood is remote from any town, and abounds
in walks of the most varied character. Harbourne Wood is
close by; and good protection is given against northerly
and easterly winds by the surrounding hills and woods.
The house is on two floors, built of brick. The main part
is squarish, with a tower on one side and a projecting wing
with greenhouse on the other. The bedrooms are all lofty,
and vary in size from 25 x 18 feet to 12 x 9 feet 6 inches.
There are four large day-rooms, each 25 x 18 feet or more.
There are also two bath-rooms, three lavatories, three
kitchens, etc. The floors are mostly of polished oak, the
windows large sash windows. The house faces south-east>
the bedrooms and corridors in various directiona Ventila-
tion, sewerage, and water supply are all described as excellent.
The heating is by hot pipes, the lighting by oil lamps.
The treatment is on the usual lines. Patients are seen
once a day by the medical officer. Terms from four guineas,
including all excepting laundry, alcoholic beverages, drugs,
and special nurse if required.
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Fk;. .'>.*3, -Linfohd Sanatoisil'm.— IIesidential Block.
[/V(r /unje 355.
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BRITISH SANATORIA FOR PAYING CONSUMPTIVES. 355
LiNFORD Sanatorium
was one of the first in England to be specially built for
" Nordrach " treatment, being opened in May, 1899.
It is situated in the open country, two and a half miles
from the little town of Ringwood. Surrounding it on all
sides is the heather-covered moorland which forms a large
part of the New Forest. Hills and woods protect the sana-
torium from north and east winds. Within a stone's-throw
to the north-east are some 1500 acres of woodland, covered
chiefly with pines and oaka But little cultivated land, and
but few isolated houses are found in the district. The sub-
soil is mainly gravel, with here and there patches of clay^
overlying the Bagshot sands at a depth of about 12 feet.
The sanatorium buildings consist of a residential portion, a
refectory, and a farm. The residential portion stands 160
feet above the sea-level, near the top of a hill facing south-
south-east in three acres of garden ground. The refectory or
dining bkx;k, which includes kitchen and oflSce, together with
bedrooms for the stati', is separated from the residential
portion by the garden and road, together with a certain
amount of common land through which runs a small stream
of water. Around this block are two acres of garden and
meadow. The farm has attached to it twenty-eight acres,
making thirty-three acres in all. Near the refectory is the
engine house for production of electric light.
The residential block is a two-storey brick building with
attics. The bedrooms are all on the south side of the corridor,
and have each two large casement windows, wood panelled
walls, floors of maple, floraxed, and specially designed furni-
ture. Each room has a douche in one comer, and a fixed
wash-basin, both supplied with hot and cold water, and is
heated by hot- water pipes with an American radiator. In
size each room is 13 x 15 feet, and 9 feet high. The only
hangings are washable curtains, and a few strips of carpet.
The bedrooms in this block, available for patients, are
thirteen in number, including two in the roof. In addition
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356 BRITISH SANATORIA FOR PAYING CONSUMPTIVES.
there are two rooms in the farm, a trifle smaller, and with
douche-room in common, but in other respects nearly the
same as the rest. The dining-saloon is a large room resem-
bling the one at Nordrach in Germany, placed on the south
side of the kitchen and offices. It has large removable
windows on the two longer sides, which look east and west.
There are two shelters in the grounds, one of which is
temporarily used as a sleeping shelter. An extension is
projected. There is no " liegehalle " or covered verandah.
The water supply is from a well 40 feet deep, sunk into
the Bagshot sands, from which water is pumped on to the
roof of each building. The water-closets are built out to the
north of the corridor in the residential block. Sewage is
purified by filtration tanks and the effluent applied to the
land. At the farm there are earth -closets. Waste water,
like the sewage, runs into tanks.
The treatment is strictly modelled on that at Nordrach
in Germany, where the medical officer. Dr. Mander Smj^h,
was at one time patient, and later on assistant physician.
The milk supply is not sterilised, and is from cows which are
not tested with tuberculin, but are specially fed to provide
uniformly rich milk, the butter being obtained elsewhere.
There is a refrigerator for meat and ice.
The terms are five guineas, including board, lodging,
medical attendance and medicine. Extras are personal
laundry, alcoholic drinks, and special nursing if required.
The beds at the farm are a little cheaper.
Applications to Dr. R. Mander Smyth, Linford, Ringwood^
Hants. Station: Ringwood(L.S.W.R.).
The London Open-air Sanatorium
is being built at Pine wood, Wokingham, near Bracknell
in Berkshire, about eleven miles from Reading. The dis-
trict is hilly, with picturesque scenery, and consists largely
of pine woods and open heather land. Eighty-five acres of
land have been acquired, on sandy soil consisting of Bagshot
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Fio. 54.— LiNFORD Sanatorium.— The Refectory and Doctor's Quarters.
[Face jpage 95Q.
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BRITISH SANATORIA FOR PAYING CONSUMPTIVES. 357
sand. The altitude of the sanatorium is about 280 feet
above the sea-level. It is placed in a forest glade which
stands in a sort of amphitheatre of pine-trees, well sheltered,
with clear open space to the south.
The buildings consist of a central block, a dining-room
block with kitchen behind, and a laundry block.
The central or administrative block will have on either
side a large pavilion on two floors, with accommodation on
ground and first floors for thirty-two patients, and provided
with bath- and douche-rooms, lavatory, hot-water plant etc.,
on the north side. Every patient's room will face approxi-
mately south, and will have behind it a long well-ventilated
corridor. The windows will be large, with fanlights up to
the ceiling.
The total accommodation will be for sixty-four patients.
The whole place will be lighted by electricity.
The funds have been advanced by a member of the firm
of Wernher Beit & Co. The sanatorium is intended for the
less wealthy middle-class patients. The charges will be
made " as moderate as possible ".
Applications for admission will be made to the London
oflSce at 20 Hanover Square, W. Dr. Alf. Hillier is the
hon. secretary.
Maitland House,
Kidmore, on the lower slopes of the Chiltem Hills, is about
five and a half miles from Reading. Surrounding it are
grassy meadows, open commons, and farther oft' beautiful
beech woods. The district is bracing ; the soil, gravel over- >
lying the chalk.
The house itself is small but airy, and has four rooms for
patients, with others for the staff*. Adjoining it is a large
wooden dining-room. In the garden are several shelters,
and a wooden building with a nan'ow covered balcony.
This building accommodates four more patients and two of
the staff* As this is a temporary sanatorium, little alteration
has been made beyond the provision of shelters in the garden.
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358 BRITISH SANATORIA FOR PAYING CONSUMPTIVBS.
A large building is projected, but arrangements are not yet
completed.
Dr. Esther Colebrook, the medical director, lives half a
mile away, but spends most of her time at the sanatorium.
Hastings Gilford, Elsq., F.R.C.S., of Reading, is consulting
surgeon.
Access: Railway to Reading (G.W.R or S.E.R.), thence
by carriage.
Terms : Three guineas per week ; in winter three and a
half, with bedroom fire. In some cases a reduction is made
with the help of a special fund.
MooRcoTE Sanatorium
was opened at Eversley, near Winchfield, Hampshire, in the
summer of 1899. The district is richly wooded with pine>
trees, the soil being gravel, overlying sandy tertiaries. The
house is four miles from the nearest railway station, and is
surrounded by its own grounds. It faces south, and is
sheltered from the north and east.
It consists of a two-storey building with roomy corridors
and large hall, and has accommodation for ten patients.
There is a good water supply.
The sanatorium is under the care of Mrs. Godfrey, who
was herself under " Nordrach " treatment, and is aided by a
trained nurse. Dr. W. Langworthy Baker is the resident
physician.
Terms : four to five guineas, including medical attendance ;
extras : wines and laundry.
Railway stations : Reading (G.W.R.), Winchfield or Wok-
ingham (S.W.R.), Wellington College (S.E.R.).
Applications to Mrs. Godfrey, the proprietress.
RroGwicK Sanatorium
is situated about 240 feet above the sea-level in beautiful
country near the borders of Surrey and Sussex, on a hill
which gives distant views over the Sussex Weald and the
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BRITISH SANATORIA FOR PAYING CONSUMPTIVES. 369
South Downs and Surrey hills. A house standing in four
acres of garden and meadow-land, one of a long straggling
line of country cottages, has up to the present been used to
accommodate the patients, but will in future be chiefly used
as an administration block. The grounds slope down to
the south and west ; higher hills protect the place to the
north. The soil is a light clay (Horsham clay) ; the climate
is mild, figs ripening in the open air. For shelter there are a
large walnut-tree, a large glass conservatory, used for meals ;
a small green-house and two wooden shelters ; others are
to be added soon. Halfway down the western slope is a
newly built brick house on two floors, designed for twelve
patients The corridor runs north and south, the rooms
being placed symmetrically on either side. Eight have
two windows apiece, two have French windows and will
lead on to a balcony. Over the porch on wooden pillars is
a bath-room and closet. The water supply is from a well
in the grounds.
The matron is a fully trained nurse ; another nurse is
also kept. Dr. Annie McCall, the medical director, lives
in London and attends about once a week, a local doctor
being called in when necessary.
Rudgwick Station (on the L.B. & S.C. Railway line from
Horsham to Guildford) is about five minutes* walk from the
sanatorium.
Terms: two guineas; bedroom fires- and special medical
visits are extra.
Whitmead Hill Sanatorium
was originally a private house built for Sir Henry
Cunningham, but has been altered and added to by Dr.
Hurd-Wood with a view to its present purpose.
It is situated at Tilford, near Famham, on a small plateau
overlooking a large expanne of open country, with the
Hindhead in the distance, and is sheltered to the north by
Crooksbury Hill and to the east by a well- wooded slope, but
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360 BRITISH SANATORIA FOR PAYING CONSUMPTIVES.
is rather exposed to the south and south-west. It is on
sandy soil (Lower Greensand), has a southerly aspect, and
stands about 300 feet above the sea level.
The grounds, which cover about eighteen acres, are cleft
on the east side by a deep sloping valley, -running south,
and wooded in part with large beech- and pine-treea
The original building is a picturesque house in cottage
style, containing on the ground floor the dining-room, draw-
ing-room, consulting-room and kitchen department, and on
the first and attic floors rooms for seven patients, mostly to
the south and west This portion presents no special advan-
tages for open-air treatment ; but like other parts of the
establishment is lighted by electricity. It is comfortably
furnished like an ordinary gentleman's residence ; and has
very fine views from many of the rooms and from the terrace
in front, over Leith Hill on the east, to Hindhead, and the
Hampshire hills on the west.
The new building, which was completed in August, 1900,
lies to the west of the older house, and consists of twelve
bedrooms on two floors, connected by a staircase at the
eastern end which unites the two corridors. In front of
the lower floor is a deep glass verandah, 63 x 15 feet,
which will in suitable weather be used as a dining room.
In front of the upper floor is a shallow balcony. This floor
is reserved for ladies. The rooms are all 12 x 8 feet,
with a projecting fire-place. The floors are covered with
linoleum, the walls distempered. Each bedroom has half-
glazed French windows with fanlights, and is furnished with
washstand, bedstead, chest of drawers, but no wardrobe.
There is a bath-room on each floor.
Altogether nineteen patients can be received, including
seven in the old house.
The whole building is lighted by electricity. The corridor
is heated by hot pipes, the rooms by open fires. The water
supply is from a private well. To the north of the sana-
torium a house has been built for Dr. Hurd- Wood, and farther
east are the stables and a small cottage.
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BRITISH SANATORIA FOR PAYING CONSUMPTIVES. 361
The treatment is based on the usual lines. Three good
meals are provided per diem, with milk and other extras
according to need.
The staff includes a trained nurse -matron, a secretary,
and Dr. Hurd-Wood, the medical director.
Fees : from five guineas, including all, excepting personal
laundry, alcoholic liquors, or special nurse if required.
Station : Famham (L. & S.W.R.), three and a half miles.
Applications to the secretary, Whitmead Hill, Tilford, Farn-
ham.
SOUTHERN SANATORIA ON THE COAST.
Name. Nearest Town.
Medical Director.
No. of Beds'.
Aldemey Manor (
Sanatorium * . j Bournemouth .
Dr. Johns
26
Brinklea Sana- ;
torium-^. . Bournemouth .
Dr. Kinsey Morgan
10
Holne Chase . Bexhill-on-Sea
Dr. Wills
8
Ingle wood Sana- '
toiium'^ . . 1 St. Lawrence, I. W.
Dr. Chowry Muthu
20
Overton Hall 1
Sanatorium . Bournemouth .
Drs. Pott and Stein
16
Stourfield Park-
Sanatorium* . Bournemouth .
Dr. David Thomson
45
The institutions in the south-western counties are de-
described at pp. 370-378.
Although Bournemouth has 40,000 inhabitants, it is less
" towny " than most other places of the same size, owing to
the large area over which it is scattered and the large propor-
tion of private and public gardens. It lies on the Bagshot
beds (mostly sandy), which rest upon the London clay, and
has a warm and equable (in hot weather somewhat relaxing)
climate. The climatic advantages of the Isle of Wight are
too well known to require mention. Bexhill is sunny and
moderately bracing and has a dry soil.
' Sleeping huts.
^Sleeping huts and mansion.
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362 british sanatoria for paying consttmptives.
Alderney Manor Sanatorium.
When Dr. Denton Johns severed his connection with the
Stourfield Park Sanatorium, at Bournemouth, in December,
1900, he acquired Alderney Manor, an estate of 600 cu^res
of pine woods and heather in the same part of Boscombe,
but a little higher up the hill, for the purpose of erecting
thereon a new sanatorium. The place is 210 feet above
the sea-level, and is near the sea and the valley of the Stour.
In addition to natural shelter there is a large garden sur-
rounded by a 7 foot wall which protects against wind.
The buildings coasist of a wooden administrative bungalow
and a number of wooden sleeping-huts provided on all sides
with windows. The drainage is connected with a uewly
made main sewer ; the water supply is from the Poole Water
Supply Co. There are no verandahs or " liegehallen ". For
those who are fit for it, shooting and fishing can be obtained
on Lord Wimborne's preserves, and rabbit shooting on the
estate itself. An arrangement has been made with an estate
Agent to give instruction in the management of landed
property to those desiring to be trained for the profession.
The treatment is based upon that adopted at Nordrach in
Germany. Visits of friends are only exceptionally permitted.
There is accommodation for twenty-five patients.
The fees are from four guineas per week ; extras : personal
laundry, wine or spirits, medicine and special nursing.
The sanatorium is about two miles from Parkstons Station.
Brinklea
is situated close to Alum Chine in the western part of
Bournemouth. Surrounding it is a large piece of ground,
for the most part thickly wooded, which stretches down hill
into the Chine. The sea is within a few minutes* walk, but
the place is sheltered by trees and rising ground against the
boisterous south-westerly breezes, as well as against north-
erly and easterly winds. The immediate neighbourhood
is occupied on two sides by villa residences with gardens
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BRITISH SANATORIA FOR PAYING CONSUMPTIVES. 863
Attached. Not far off is Branksome Park, which provides
extensive walks amongst the pines. The house is about 100
feet above the sea level, and like the rest of Bournemouth
is on sandy soil. It has at present accommodation for ten
patients, but an extension is projected which will raise the
number to thirty-five.
The entrance on the west side opens into a comfortably
furnished and softly carpeted vestibule, from which a corridor
and a staircase lead to the part occupied by patients. The
rooms vary in size, but are mostly large and sunny, the
majority facing south. The walls are covered with HalPs
washable distemper or with washable paper, the floors with
linoleum; the furniture is simple; heating by open fires;
lighting at present by lamps and candles. In the grounds,
across the well-kept lawn and flower garden, are several
well -constructed shelters, communicating with the house by
electric bells and available as sleeping shelters for suitable
patients.
The sanatorium is in charge of a matron who was herself
a patient at Nordrach in Germany. Dr. Kinsey Morgan,
the medical director, is in practice in the centre of the tow;n
and attends daily. His son, also a qualified practitioner, lives
in an adjoining house and acts as resident medical officer.
The sanatorium is within two miles of West Bournemouth
Station, and is on the telephone system.
Terms, payable to the secretary, are from four to six
guineaa Extras are, personal laundry, medicines, stimulants,
and special nurse if required. Applications to the matron.
HoLNE Chase,
Bexhill-on-Sea, consists of part of a terrace of houses
facing the sea with gardens at the back, in which for the
last two years patients have been treated by sanatorium
methods under Dr. Wills and his sister. Miss E. O. Wills, a
trained nurse. The house consists of a basement, a raised
ground floor, three more floors and garrets, the rooms on
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364 BRITISH SANATORIA FOR PAYING CONSUMPTIVES,
first floor being provided with balconies. There are eight
beds for patients. The garden has a revolving shelter, but
no trees. Electric lighting in bedrooms, balconies and shelter.
A special feature in the treatment is the gradual and careful
exposure of patients to the open air. Salt-baths are mudi
utilised, and graduated exercise by means of Whiteley^s
apparatus. A rigid scale of dietary is not attempted. The
milk supply is from the Duchess of Cleveland's Home
Farm at Battle, from tuberculin-tested cows. Bexhill is
known to possess considerable climatic advantages, being
bracing and sunny. The hills behind Holne Chase shelter
it against north winds, and the Sackville Hotel shelters it
to the east.
Terms : four to six guineas ; extras : stimulants, drags,
and special nurse if re(iuired.
Inglewood Sanatorium,
St. Lawrence, Isle of Wight, is about two miles west of
Ventnor, and shares its climatic advantagea Mild and
equable in winter, with a large average of sunshine, it has
a somewhat lower mean humidity than Bournemouth, and
is less relaxing in summer. The soil of the district consists
of chalk and lower greensand, which form an underditF at
the base of the high chalk range traversing the island from
east to west. On the sandy undercliff, about a quarter of a
mile from the coast, 150 feet above the sea-level, surrounded
by twenty acres of park and undulating woodland, is a
substantially built stone mansion, which has been converted
into a sanatorium. The place is isolated by its grounils
from public roads, and is well protected against northerly
winds by the cliffs which rise to a height of nearly 800 feet
above the sea, and from east winds by wooded hills. In
the grounds are numerous walks of various gradients,
provided here and there with revolving shelters, and com-
manding fine views over land and sea. There are at
present four sleeping shelters, and four more are being
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Fig. 55.— Inglewood S.\natorium.
[Face jxige 264^.
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Fi»;. .'(ti. - Inclewood Sanatorium.
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BRITISH SANATORIA FOR PAYING CONSUMPTIVES. 306
erected. One of the two lawns is used for playing croquet.
The house is somewhat U-shaped, round a central court
open to the north, with a small projecting wing at the north-
west end. The ground floor is occupied by two dining-
rooms and the vestibule on the south side, and by the
kitchen department, nurses' rooms and lavatories to the
north- A corridor is next the central court on each floor,
the bedrooms being in a single row, five facing south, three
west and four east. They are all thirteen feet high and vary
in size from 10xl3to25x20 feet. They are provided
with casement windows and ventilators, warmed with hot-
water pipes, walls coated with duresco, floors covered with
linoleum. The house is plainly furnished without any
carpets, curtains or ornamentation. The chairs and loungas
are of bent wood and cane, woollen materials, stuffed chairs
and the like being avoided. The bedroom furniture is
mostly of satin wood, and is all raised on wooden blocks to
facilitate cleansing. Both building and shelters are provided
with electric light.
The treatment is on the usual lines. Three meals a day,
taken for the most part in the common dining-room under
supervision of the physician ; from three and a half to four
pints of sterilised milk per diem ; no alcohol The food
taken by each patient is daily weighed and recorded.
Sputa are received into Dettweiler's flasks or into
Japanese paper handkerchiefs. Rooms are mopped out
daily.
Dr. Chowry Muthu is the resident medical director ;
he goes to London for consultations once a fortnight. He
was until recently in charge of a similar establishment at
Ventnor (Mount Pleasant).
Inclusive terms : three and a half guineas.
Ventnor can be reached from London by the South
Western Railway or by the London Brighton and South
Coast Railway. Average journey, three and a half to five
and a half hours, including forty minutes by sea.
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366 british sanatoria for paying consumptives.
Overton Hall,
Bournemouth, is planned like a specially built sanatorium,
although originally intended for a different purpose. It
lies on the north side of the Poole Road, separated from it
by a garden of one and a half acres, but in full view of its
traffic. The road runs parallel to the coast, from which it
is separated by other roads, houses and gardens, and by
open common land In the garden are several revolving
shelters, specially designed by Dr. Pott.
The building, which lies 120 feet above the sea-level,
is in the shape of a hollow square with the north side
omitted. It has a long south front, 70 feet long, with short
wings diverging from the two comers. Between these a
verandah has been built out, which is 12 feet deep, with
two large glass windows in the roof. In front of this a wire
netting has been stretched, covered at times with large strips
of transparent canvas to increase the privacy, and ward off
the stronger southerly gales. Comfortable cushioned couches
with wire bottoms are placed in the verandah for rest in the
open air. Over the verandah is a balcony, partially roofed
over. Eight of the patients' bedrooms occupy the south
side on the ground floor and first floor. Behind them are
the corridors, of which the lower forms a fine hall from side
to side of the house, with windows at each end. This is
furnished with chairs and other furniture, so that it can be
used for rest or exercise by the patients in stormy weather.
The main staircase leads off one end of this corridor. The
dining-room is on the side of the house to the north of the
corridor near the kitchen. There are no other sitting-rooms
for patients, who are expected to spend most of their time
out of doors. In the wings on the first floor are eight other
patients' bedrooms, somewhat smaller than the south rooms.
The rest of the wings together with the attics are devoted to
administrative and staff rooms.
The southern bedrooms are all of good size, the smallest
being 14 x 12 and 12 feet high, with a capacity of over
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Fks. 57.— Overton Hall, Bournemouth.
[Face page 3(56.
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BRITISH SANATORIA FOR PAYING CONSUMPTIVES. 367
2000 cubic feet, and some beinjif considerably larger. The
floors are painted along the border, with linoleum in the
middle ; the walls painted with duresco (a silicate paint) ; the
windows next the balcony and verandah are large "French "
windows down to the ground ; in other rooms they are of
the ordinary English pattern, but provided with special
catches. There is an open fireplace in every room. Mould-
ings and ledges have been for the most part removed.
Carpets and rugs are only sparingly used. In the lower
corridor cork matting in squares is employed, presenting a
washable warm surface, while it prevents noise. The fur-
niture is all arranged with a view to proper cleansing,,
standing away from walls, and being raised above the
ground, or else easily movable, dead space and awkward
ornamentation beipg largely avoided. In the bedrooms the
furniture is mostly of white painted wood, the bedsteads
being of iron. These are placed away from the wall, with
the head towards the window, a tall screen being placed
round the head of the bed.
The heating is by means of open Hres, the lighting by
electricity. No special ventilating contrivances are found
necessary. The water-closets, lavatories and bath-rooms are
all next outside walls on the north side.
The rooms are rubbed down daily with a damp cloth.
The sputa are received into red hour-glass shaped vases
containing weak carbolic solution, with plain glass covers
fastened on with gummed paper. To be used this must be
torn, so that those which need cleansing can be recognised.
They are collected daily, and treated with strong carbolic
solution, the sputa being then poured down the water-closets.
The patients also use Japanese handkerchiefs, which are
afterwards destroyed.
None but consumptives are received, and no hopeless or
seriously affected cases. They are treated continuously
with fresh air, in and out of the house ; spending seven or
eight hours out of doors on an average. Hydrotherapy is
not much used, excepting in the form of hot or cold baths.
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368 BRITISH SANATORIA FOR PAYING CONSUMPTIVES.
Four meals a day are provided, including two of three or
four courses each. Extra milk is also given on waking.
Patients take as a rule about three pints of milk per diem,
all of it being sterilised by the dairy which supplies it.
Dr. Pott was one of the first to carry out systematic
sanatorium treatment in England. Owing to ill health he
has latterly taken a much less active part in the manage-
ment, which is chiefly in the hands of his partner, Dr. Stein,
aided by a resident matron and aasistant matron. Dr. Stein
lives in a separate house acroas the road.
The sanatorium is a few minutes' walk from West Bourne-
mouth Station. The charges are seven guineas per week
for board, lodging and me<lical attendance ; drugs, wine
and laundry being extra. A reduction in price is made for
the rooms in the wings.
Stourfield Park Sanatorium
was for a time under the medical direction of Dr. W.
Denton Johns, who began treating consumptives by sana-
torium methods in 1897, in another part of Bournemouth,
and moved into Stourfield Park in 1899. In December,
1900, however, Dr. Johns severed his connection with the
institution, owing to a ditference of opinion with the lay
manager, and started another sanatorium at Aldemey
Park.
Some ten minutes' walk from Pokesdown Station at the
eastern end of Bournemouth, and not far from a densely
populated district, the Stourfield Park Sanatorium is im-
mediately surrounded by large open spaces, and stands on
an eminence commanding distant views to the south-east
and east over Christchurch and the valley of the Stour.
The grounds, of ten acres, are laid out in park-like fashion,
with lawns, shrubberies and flower-beds, and here and there
groups of handsome tall trees, partly coniferous, partly
deciduous. Rising ground with pine-trees lies to the south
and west, warding oft* the stronger gales from the sea. The
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BRITISH SANATORIA FOR PAYING CONSUMPTIVES. 369
subsoil is stated to be of sandy flint gravel, but probably
overlies the clay at no great depth. The height above the
sea-level is inconsiderable, but sufficient to ensure proper
drainage. Dotted about the grounds are a large number
of shelters each provided with windows on every side, and
some fitted up as sleeping shelters with electric lighting
and electric bells.
The building consists of two parts of different age, stand-
ing at right angles to one another. The newer part, which
faces south-west, is a handsome pile of three storeys, the
ground floor of which consists chiefly of reception rooms,
the upper floors being occupied with bedrooms, surmounted
by attics for the servants. The other part of the building
contains on the ground floor the kitchen department, above
this, adjoining the newer part, is the dining-room, and
higher still patients' bedrooms on either side of the corridors.
The rooms vary in size, but are for the most part large.
The reception rooms and central corridor are stylishly deco-
rated with lincrusta and oil-paint. Most of the patients'
rooms are prepared with washable paper, the floors being
covered with linoleum and a few strips of carpet. The
windows are everywhere large, many on the south-west
side opening on to balconies.
Ventilation is aided by electric fan extractors. The water
supply is from the Bournemouth Water Company ; the light-
ing from the public electric supply. An electric lift serves
the upper floors. Shower and douche baths are found on
the north side of each corridor. Heating is partly by open
tires, partly by hot-water pipes. The sanatorium possesses
its own laundry and disinfector, and is connected with
the town sewers. There is accommodation for forty-five
patients.
Treatment was on " Nordrach " lines when Dr. Johns was
head of the establishment. Patients take their meals either
in their own kiosks or at separate tables in the public
dining-room. Dr. David Thomson is now the medical
officer.
24
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370 BRITISH SANATORIA FOR PAYING CONSUMPTIVSa
Terms are from four to six guineas, inclusive of medical
attendance. Elxtras are, personal laundry, alcoholic bever-
age, medicines, and special nurse if required.
WESTERN COUNTIES.
Nune. Nearest Town. Medical Officer.
No. of
Beds.
Cotswold Sanatorium » . Cheltenham | Drs. Pruen and Braine-
Hartnell ....
37>
Dunstone Park Sana- '
torium . . . , Paignton
Dr. Alexander
8*
Mendip Hills Sana-
torium . . Wells . . Dr. F. Hudson Evans .
20*
Nordrach upon Mendip^ ' „
Drs. Thumam and Gwynne
37
Pendyffryn Hall . . ' Conway
Dr. G. Morton Wilson
15
Timbercombe . . Taunton
1
Dr. Brown ....
10
A boarding school (St. Hilary School) at Wallasey,
Cheshire, receives children requiring open-air treatment ;
reference permitted to Dr. Walther, Nordrach.
The Cotswold Sanatorium
was opened in the summer of 1898, on the top of the Cots-
wold Hills, not far from the sources of the Thames and
Severn. Nearly equidistant (seven miles) from Cheltenham,
Gloucester and Stroud, and a mile from the nearest village,
it enjoys the advantages of relatively high elevation, atmo-
spheric purity and isolation from the world, together with
scenery of a very high order. The Cotswold Hills are
mainly composed of oolitic limestone, and rise to 900 feet
above the sea-level. Their sides are partially covered with
fine woods of beech interspersed with firs. Some 50 feet
below one of the highest parts, in a slight depression, sheltered
by woods and rising ground to north and east, the sana-
torium has been built at an elevation of 800 feet. It has a
* Sj)ecial blocks built and a pre-existing house remodelled.
2 Thirty-three in winter. ^ Ten more being added. * Six in chaletB.
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^
^
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X
c
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BBITISH SANATORIA FOR PAYING CONSUMPTIVES. 371
southerly aspect, overlooking the Painswick Valley and
Minchinhampton Common, whilst from the grounds behind
a view of the entire Severn Valley is obtained, stretching
from the Shropshire Hills in the north to the commencement
of the Bristol Channel in the south-west. The entire range
of the Malvern hills is seen in the north-west, with the
Welsh hills beyond. The soil is dry, the climate bracing,
the rainfall moderately heavy, which keeps the place green
and free from dust.
The grounds cover sixty-seven acres, and provide a large
extent of sheltered walks in the garden and woods. These
are mostly fairly level, while hilly walks abound outside
the grounds. In the latter are numerous shelters facing in
different directiona
The buildings consist of residential blocks for the patients,,
a dining and kitchen block, blocks for the staff and the
servants, and a block for the electric-lighting installation.
Most of the buildings are on one floor, and are built of
wood ; but one (which was originally a private mansion)
is of stone on three floors. In this latter the ceilings and
inside walls are covered with petrifying fluid in varioua
colours which gives a brilliant enamel-like surface, and can
be readily washed. A corridor runs along each floor, and
the rooms open on to it, a few on the north side, bUt the
majority on the south. The rooms vary in size from 20 x
16 and 11 feet high, to 12 x 8 and 10 feet high. The
windows vary from 8x6 feet to 6^ x 3^, starting mostly
1^ to 2 feet from the ground. They consist of French
windows, some with a hinged upper transverse pane. Out-
side are louvre shutters. The one-storeyed blocks are built
of wood on a stone foundation. The walls are boarded
inside and out, with felt between. The inside walls and
ceilings are covered with canvas overlaid with oil-cloth in
light-coloured designs. The floors are covered with linoleum.
The bedrooms are nearly all on the south-west side ; behind
them runs a corridor, and behind this two other bedrooms,
two bath-rooms and a passage leading to the back verandah.
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372 BRITISH SANATORIA FOR PAYING CONSUMPTIVES.
In front of each wooden block runs a glass-covered verandah
9 feet 6 inches wide, and to the sides and back a narrower
one of the same kind. The ends of these verandahs are
protected by screens of wood and glass. E^ch bedroom is
12 X 8 and 10 feet high (960 cubic feet). Windows are
5^ X 3| feet, starting 1^ feet from the ground. In the
wooden blocks earth-closets are built on the small back
verandahs, after Dr. Vivian Poore's plan ; they are emptied
daily.
The heating, lighting, furnishing and water supply are the
Bame in all the blocks, whether one or three storeyed. Tliere
are radiators fed by low pressure hot- water supply in every
bedroom, corridor, bath-room and closet. The dining-rooms
are warmed in the same way, and hot-water pipes under
the tables keep the patients comfortable on the coldest day.
The verandahs are warmed by large hot- water pipes. These
verandahs in the three-storeyed house are 15 feet wide
and 15 feet high, and extend half round the house, and have
special provision for ventilation. Lighting is by electricity
throughout, the main garden walks as well as the inside of
the houses being lit in this way. There are electric bells
in every room, communicating with the doctors and nurses
or servants ; similar bells in the verandahs, sheltera, closets
and bath-rooma The bath-rooms are supplied with hot- and
cold-water baths and douches, there is also a needle bath.
Several of the bedrooms have hot- and cold-water douches,
and all of them have hot- and cold-water basins.
The furniture of the rooms is specially made, neither to
easily catch nor to retain the dust.
Ventilation is by open doors and windows. The windows
are never shut, except for dressing and undressing and
during gales. The water supply comes from two springs
in the private grounds. These supply two or three gallons
a minute. The water is pumped up to the sanatorium, 200
feet above, by a water-wheel run by a stream which flows
through the grounds, supplemented by an electro-motor.
The quality of the water is excellent and not too hard.
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BRITISH SANATORIA FOR PAYING CONSUMPTIVES. 373
The dairy produce is from Brockworth Park Farm, near
Gloucester, which has been opened by Mr. Collings Walhch
under the sanitary supervision of the sanatorium. All the
cows have been purchased as young animals, after having
been carefully examined for their general health and then
tested with tuberculin. They are kept as much as possible
in the open air, and during cold nights in cow-sheds, which
in regard to cubic contents, floor space, central passages,
ventilating spaces between the stalls and the side walls,
and in every other particular more than comply with the
requirements laid down by the Royal Commission in their
rules for the construction and working of farm buildings.
An arrangement has been made with a steam sanitary
laundry to disinfect all the linen in a properly fitted
disinfector.
Sputa are received into Dettweiler*s flasks, and the con-
tents mixed with sawdust and burnt in the furnace.
Treatment is on the Nordrach model. Three rather
heavy meals per day are provided, and also afternoon tea.
Hydrotherapy is provided for by baths, of which there are
an ample supply and variety. Temperatures are taken in
the rectum. The medical stafl* consists of Dr. S. T. Pruen,
Mr. C. Braine-Hartnell, and an assistant medical officer,
two of whom live at the sanatorium, as well as a head sister
and nurses.
There are thirty-seven beds for patients in the sanatorium,
fourteen in the mansion, nineteen in the wooden blocks, and
four in sleeping shelters.
The inclusive charges are five guineas weekly, extras
being alcoholic beverages, personal washing, and a special
nurse should one be required.
Applications should be sent to the secretary, 2 Ormond
Place, Cheltenham.
DuNSTONE Park Consumptive Home
was opened this year at Marldon Hill, Paignton, South
Devon, about one and a quarter miles from the town, in an
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374 BRITISH SANATORIA FOR PAYING CONSUMPTIVES.
open situation 550 feet above the sea-level, commanding
beautiful and extensive views of the sea, the river Dart
and Dartmoor. The soil is sandstone, the aspect south-
western. Higher hills shelter it from the north and east.
The house is on two floors, well provided with balconies
and verandahs. The grounds, of seven acres, consist of
garden and field, and have a number of shelters or sunbox^,
as well as large croquet courta
There is at present room for eight patients ; but a new
wing is to be added with ten more rooms.
The sanatorium is in the charge of Miss Hayes, for five
years matron of the Dorset County Hospital, and of Dr.
Alexander of Paignton, who is connected with it by tele-
phone and pays daily visits. The treatment is modelled on
that of Nordrach. Visits from relatives or friends are only
allowed by special permission.
Terms from three to five guineas, exclusive of medical
attendance, stimulants and personal laundry.
The Mendip Hills Sanatorium
is on the south-eastern slope of the Mendip Hills, about two
and three quarter miles from Wells. The sanatorium stands
850 feet above the sea-level and is surrounded by extensive
and beautiful grounds.
There are fourteen beds •in the main building, and six
more in sleeping chalets. Lighting is by electricity, heating
by hot-water pipes. The sanatorium is managed by a
resident secretary, aided by a medical oflScer, Dr. F. Hudson
Evana
Postal address : Hill Grove, over Wells, Somerset.
Terms on application to the secretary.
Nordrach upon Mendip.
This sanatorium was opened in January, 1899, on the
top of the Mendips in a house which was formerly Wood's
Convalescent Home. The Mendip Hills are composed partly
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Fig. 60.— Nordrach upon Mendip.— Main Block.
[Face puf/e 375.
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Fig. 61.— Xorduach upon Mendip.— A Sleeping Shrlter.
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BRITISH SANATORIA FOR PAYING CONSUMPTIVES. 375
of limestone, partly of sandstone, and are for the most part
covered with moorland, although copses of beech and fir are
to be found here and there. Coming from Yatton Station,
eleven miles distant, the road leads through undulating
country freely sprinkled with farms and hamlets, to a cleft
in the hills, through which a long steep ascent leads to a
sort of tableland between 800 and 900 feet above the sea-
level. Magnificent views are obtainable from this tableland,
while Cheddar cliffs and other beautiful spots are within
walking distance.
The approach to the sanatorium is through a fine avenue
of beech-trees which form a curved belt protecting it against
north-east winds. To the north-west the chief protection is
afforded by a slight ridge of hills ; but the place is decidedly
bracing and a trifle exposed to wind. Notwithstanding the
elevation, the place has a green and smiling aspect, largely
due to the heavy dews and the mountain mists which gather
around it. Near the house is a well-kept lawn and flower
garden. In one corner of the grounds (which cover sixty-
five acres) is a dell which is warm and protected in all kinds
of weather. Just outside the gates is a pine wood, much
used for hammocks in winter.
The house, which is 862 feet above the sea-level, is of
stone with unusually thick walls, and has two floors. The
corridors run from north-east to south-west, the patients'
rooms being exclusively on the sunny side. The floors are
covered with linoleum or polished boards, the walls colour
washed with an ordinary skirting, or in some places panelled
and varnished. Heating is by hot- water pipes, lighting by
electricity.
Adjoining the house, looking south-east, is an elegant
wooden dining-saloon, which is a reproduction of that at
Nordrach in Germany, with a raised portion for books and
writing materials, the lower portion being provided on three
sides with detachable panels which are removed in temperate
weather. The food is brought from the kitchen department
through a covered way.
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376 BRITISH SANATORIA FOR PAYING CONSUMPTIVES.
In a field beyond the lawn is a little colony of woo<len
houses, forming two sides of an angle looking south. The
largest is for twelve patients, and consists of small bedrooms
with a narrow verandah in front instead of a corridor,
wooden panelled walls, polished floors, and large windoiws
oppasite the doors. A common bath- and douche-room
serves this little colony ; others are found within the main
block. There is room at present for thirty-seven patients,
including four in a house just outside the grounds. The
water supply is from springs at the junction of the limestone
and sandstone rocks, pumped up into storage tanks.
The treatment is strictly modelled upon that of the Ger-
man Nordrach ; rigid rest and quietude during fever, which
is determined by rectal thermometry ; persevering stuffing
with suitable food, taken for the most part at three meals
daily; a rigidly out-of-door life, with utter disregard of
weather and season ; avoidance of visits from friends, of the
infection from " colds in the head," of the dusty and con-
taminated air of towns, and of all kinds of unreasonable
unrest and excitement
The medical directors, Drs. Thumara and Gwynne, have
themselves been successfully treated at Nordrach in Germany;
one of them was for some time in charge of Dr. Walther's
sanatorium during his absence.
Terms: five guineas, including all excepting personal
laundry and alcoholic drinks, or special nurse if required.
During convalescence there are a few beds at lower price
in a house just outside the groimds. These are not avail-
able for new-comers.
Railway stations: Wells or Cheddar (each about eight
miles) or Yatton (eleven miles), thence by carriage. Tele-
grams: Nordrach, Blagdon, Bristol.
Pendyffryn Hall,
or Nordrach in Wales, is a stone-built mansion standing in
100 acres of well- wooded land between Conway and Pen-
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Fig. 62.— Nordrach ui-iJN Menuii'. -The Drive.
[Face pof/e 37H.
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BRITISH SANATORIA FOR PAYING CONSUMPTIVES. 377
maenmawr. This part of the country is exceedingly
picturesque, and is well wooded with pine-trees and decidu-
ous trees of various kinds. The soil is of sand and gravel ;
the climate mild in winter and cool in summer, with an
annual rainfall of about 31 inches and a fairly large pro-
portion of sunshine.
The sanatorium has fifteen beds for patients, and stands
at a very moderate elevation above the sea-level, most of
the walks in the grounds being arranged to run uphill
Mountains protect it to the east and north-east.
The physician is Dr. G. Morton Wilson, who was himself
a patient at Nordrach in Germany, and who (with his wife)
is present at all the meals.
Terms : five guineas ; extras : personal laundry, alcoholic
drinks, and special nursing if required.
Access: rail to Conway or Penmaenmawr, thence by
carriage. Postal address : Pendyffryn Hall, Conway, North
Wales. Telegraphic address : Pendyfiryn, Penmaenmawr.
TiMBEROOMBE,
Spaxton, near Bridgwater, Somerset, is a private house
under the care of two ladies, one of whom was for some
time a patient at Nordrach in Germany. It is intended for
patients suflering from incipient phthisis, for whom daily
medical supervision is not necessary, but who would benefit
greatly by " Nordrach treatment ".
The house is situated on the Quantocks (which are chiefly
composed of slate rocks), 750 feet above the sea-level, in
the midst of beautiful scenery. The house is sheltered to
the north and east; it is a two-storey building, provided
with verandahs on two sides, and has been specially furnished
and arranged for its purpose. It stands in several acres of
ground, laid out in part as garden with large lawn, etc, and
is six miles from a town. In the immediate neighbour-
hood are many walks over moorland or through woods of
beech and fir.
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378 BRITISH SANATORIA FOR PAYING CONSUMPTIVES.
The number of patients is limited to ten. Each patient
has a separate bedroom; meals being taken in common.
Visits from relatives or friends are only exceptionally per-
mitted. The visiting physician, Dr. Brown of Taunton,
-examines patients once a month.
Timbercombe is seven miles from Bridgwater, six from
Taunton.
Terms : three guineas, inclusive of all excepting pei^sonal
laundry. Further information on application to Miss Gara-
way or Miss Coates.
Telegrams : Timbercombe, Kingston, Somerset
EASTERN COUNTIES.
Name.
1 I '
Nearest Town. , Medical Director. No. of Beda. I
Brookside, Clare . Colchester j Dr. Jane Walker 9
East Anglian Sanatorium * ,, „ 35
The Firs . . . Mundesley Dr. Burton Fanning ' 8
Mundesley Sanatorium ^ . „ i „ I ^^
The first two are in Suttblk, the last two in Norfolk.
These counties have a relatively low rainfall, with a large
proportion of sunshine. The climate is bracing, especially
Along the coast, and is cold and bleak in winter and spring.
Brookside, Clare,
in Suffolk, is under the care of Mrs. Wilson and Miss Amy
Wilson, and is managed in much the same way as the East
Anglian Sanatorium, though on a less expensive scala Dr.
Jane Walker is medical director, Miss Sharp, M.B * resident
medical officer.
The terms, inclusive of all but wines, drugs and laundress,
are two guineas per week.
^ Specially built.
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british sanatoria for paying consumptives. 379
The East Anglian Sanatorium
was built to replace the sanatoria directed by Dr. Jane
Walker successively at Denver in Norfolk and at Boxted,
near Colchester, each of which was unequal to the demand
made upon it. The present building, opened in December,
1900, is situated at Nayland, near Bures, on land belonging
to a farm of ninety-four acres, from which comes the milk
and cream for the sanatorium. Six acres, well sheltered
by trees and hedges, have been converteil into flower and
kitchen garden, with a number of flat and sloping paths
for patients, and shelters in various places. The sanatorium
is on light sandy soil, overlying the London clay.
The sanatorium, which has two floors and attics, is in the
shape of an inverted Y with very diverging limbs, one
looking south-south-east, the other east-south-east. These
limbs are but one room and corridor deep, and consist
mainly of patients' bedrooms. At their junction is a central
open-air shelter, behind which is the main staircase. Still
farther north, in the stem of the Y, are, on the east side, two
lavatories, the oflSce, a visitors' room and a servants' hall ;
a nurses' room, the entrance hall, lady superintendent's
room, and an open-air gallery on the west side. The foot
of the Y is formed towards the west by the dining-room
and billiard-room, towards the east by the kitchen depart-
ment. The corridor behind the patients' bedrooms has on
the north two projecting pavilions containing earth-closets
and bath-rooms, and at the ends two rooms on each floor for
the nurses. A central open-air gallery is found on the first
floor as well as ground floor. Two rooms near the centre
on the ground floor are set apart for the medical oflScers.
There is no verandah in front of the patients' bedrooms.
These are 14 x 10 feet in size. There is accommodation
for thirty-five patients. The building is heated by low-
pressure steam, and lighted by electricity produced by its
own plant. The water supply is from a deep well.
The treatment is based upon Nordrach lines. The resident
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380 BRITISH SANATORIA FOR PAYING CONSUMPTIVES.
medical officer, Miss Paine, sees patients several times a day.
The medical director, Dr. Walker, lives in London, and pays
visits to the sanatorium as may be necessary. The staff in-
cludes in addition a lady superintendent and several nurses.
Terms : four to six guineas, including all excepting per-
sonal laundry and wines.
Applications to Miss Walker, M.D., 62 Gower Street, W.C.
Railway Station : Bures (G. E. R.), three miles distant
Bures is fifty-three and a half miles from London. Aver-
age train journey one and a half to two hours.
The Firs
is a detached house on the cliffs about ten minutes' walk
from the Mundesley Railway Station, surrounded by a small
garden. It was opened in June, 1898, for the reception of
eight patients. There are three revolving shelters in the
garden, and a conservatory next the house which can be
opened along the whole south side.
There is a resident trained nurse, but no resident medical
officer, patients being seen periodically by Dr. Burton
Fanning and Mr. W. J. Fanning.
Terms : three and a half guineas. Applications to Miss
Downe.
The Mundesley Sanatorium
is about half a mile from Mundesley Station on the Great
Eastern Railway, and seven miles from Cromer. The sub-
soil of the district is deep sand lying on chalk. About
a mile from the north coast of Norfolk, running parallel
with it, is a ridge somewhat sparsely covered with pine-
trees, commanding extensive views southward over agri-
cultural land, and northward over cliffe, and the sea in
the distance. Immediately to the south of this, and about
200 feet above the sea- level, is a good-looking wooden
building on two floors, surrounded by twenty-five acres of
land, part of which has been recently planted and laid out
with walks, lawns and flower-beds.
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BRITISH SANATORIA FOR PAYING CONSUMPTIVES. 381
Running along the south front is a glass-covered verandah.
The entrance is at the eastern end. On the ground floor
are three bedrooms for patients, a large dining-room and
drawing-room, all facing south. A wide corridor behind
these runs the whole length of the building. Behind it at
the western end is the kitchen block, and the office, but
very little else. On the first floor are twelve bedrooms, all
on the south side. The bedrooms are fairly large, with
casement windows surmounted by fan-lights. Above each
bedroom door is another fan-light opening into the corridor,
behind which are only bath-rooms and lavatories. The
walls are plastered, and washable with rounded angles.
The floors covered with linoleum. Furniture is simple and
of a kind likely to catch little dust. Heating is by hot-
water pipes (in some rooms also by open fires) ; lighting
throughout the building and in the shelters by electricity,
which is produced in an engine house farther east. There
are water-closets on each floor. The water supply comes
from a well 223 feet deep extending into the chalk.
Special shelters are found in the grounds, with removable
sides of glass and wood and provided with awnings. Each
shelter holds two patients, and can be turned round accord-
ing to direction of wind There is accommodation for fifteen
patients.^
The treatment is based on that of Nordrach. Two or
three heavy meals per diem for most patients ; rest in the
bedroom or in the shelter ; graduated exercise, including
gentle bicycling in some cases; very free ventilation in-
doora The milk is from tuberculin-tested cows. Sputa
are received into mugs, or into Dettweiler flasks, and in-
cinerated twice a day. When a patient leaves, the room is
disinfected with formalin.
The staff includes Dr. Burton Fanning (who lives in
Norwich), Mr. W. J. Fanning (resident medical officer), a
matron and two nurses.
^ Soon to be increased to eighteen.
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384 british sanatoria for paying consumptives.
The Grampian Sanatorium.
Since May, 1899, Dr. de Watte ville has been treatino; con-
sumptive patients by " open-air methods " in a private house
(Sonnhalde, Kingussie) modified for the purpose. This
is now to be replaced by a specially built sanatorium in the
same neighbourhood which was expected to be ready in
June, 1901.
The new sanatorium stands in its own grounds of ten
acres, 850 feet above the sea-level, sun'ounded by a large
extent of woods and open moorland. Behind it to the
north are woods of Scotch fir with a few larch- and birch-
trees, and a range of mountains (Monadh Liadh) ; on one
side a mountain stream ; in front of it the Grampian Range
six miles distant. It is sheltered on nearly all sides by
trees, and is on a soil of gravel and sand, overlying solid
rock. The aspect is south-south-east. For graduated exer-
cise there are paths within the grounds, rising 100 feet
above the building and higher hills beyond. For rest in
the open there are revolving and other shelters in the
woods.
The building has two floors and will accommodate twenty
patients, all on the south side of the corridors. Most of the
rooms are 13 x 11 and 11 feet high. The end rooms on
the ground floor are 24 x 20 feet and serve respectively as
dining- and drawing-rooms. Above these are two pairs of
narrow, long rooms, one of each pair facing to the sides of
the house. The corridors are 80 x 7 feet. Behind it on
the ground floor are the kitchen department at one end ;
the doctors' quarters, gentlemen's bath-room and a store-
room at the other ; and centrally the entrance, two stair-
cases, lavatories, bath-rooms and water-closets. On the
upper floor are the servants* quarters above the kitchen,
the matron and nurses' rooms at the other, bath-rooms,
lavatories and staircases centrally. Two gaps are left
between the rooms on each floor for ventilation.
The patients' bedrooms have floors of stained and
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• BRITISH SANATORIA FOR PAYING CONSUMPTIVES. 385
polished wood, walls painted with duresco, rounded angles,
and furniture specially designed to carry little dust and be
easily cleaned. The windows are mostly sash windows,
7 feet 6 inches x 4 feet 6 inches, with a rounded revolving
fan-light above and similar ones over the doors. In the
centre are a few with covered verandah or balcony and
these have French windows. The rooms and hall are
heated by open fires, the fire-places in bedrooms occupying
part of the south side; the house is lit by electricity.
Ventilation is by natural means. Sewage goes into the
Kingussie main drain. The water supply which is stated
to be very good is from springs three miles above Kingussie.
Treatment is modelled on the usual lines as in other good
sanatoria.
The staif includes a resident physician, matron, two
nurses and a male attendant. Dr. de Watteville and his
family live in a separate house.
The sanatorium is half a mile from Kingussie Station,
110 miles from Edinburgh, 120 from Glasgow, 90 from
Dundee and 46 from Inverness.
Knocksualtach Sanatorium
is at Kirkmichael in Perthshire, twelve and a quarter miles
from Pitlochry and thirteen from Blairgowrie, in a moorland
district, standing about 700 feet above the sea-level. The
climate is dry and bracing, the soil sandy. The house is
on a slight elevation above the village, in an open situation
commanding a fine view, and slightly sheltered to the north
and east by rising ground. The building is of stone, on
two floors, and has accommodation for six lady patients.
Wooden shelters have been erected in the grounds. Treat-
ment is strictly on open-air principles, with liberal diet.
Dr. Mary F. Nannetti lives in the sanatorium and person-
ally supervises all details. A trained nurse is in constant
attendance.
Charges : four to five guineas per week, inclusive of
all excepting personal laundry and stimulants.
25
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386 BRITISH SANATORIA FOR PAYING CONSUMPTIVES.
Postal and telegraphic address: Knocksualtach, Kirk-
miehael, Blairgowrie, N.B. Railway station: Blairgowrie.
NORDRACH ON DeE
is the first sanatorium in Scotland which was specially
planned and built on a carefully selected site for open-air
treatment, and enjoys many advantages from this fact. It
is situated to the westward of Banchory, eighteen and a half
miles from Aberdeen, in the same district as Balmoral
Castle. This district was chosen for the royal health resort
by a Royal Commission in 1851, and enjoys a mild winter
climate, a relatively low rainfall for Scotland (29 inches), a
large proportion of sunshine (29*7 per cent.) and pure air
of dry, bracing character, rich in ozone (over 2 per cent).
South-west winds prevail there during nearly nine months
of the year. The sanatorium is built in the middle of
a pine forest on a southern slope, and is protected to the
north by a range of hills rising in one part to 1545 feet
(Hill of Fare), to the south by the Goch Hill (1104 feet),
while to the far west lie the peaks of the Grampian Range.
The grounds are laid out with a large number of walks
of known gradients, indicated by colour bands on the trees ;
they are furnished with shelters and command beautiful
views.
The soil is of red gravel and rapidly dries after rain.
The building is on three floors, with a central higher
tower, and is only one room and corridor deep. The ground
floor contains a large drawing-room with ten windows, for
use during stormy weather, another similar room for use
as library and writing-room, and a number of rooms for
the use of the medical, nursing and general staff, but no
patients' bedrooms. In front of it is a glass-covered
verandah. This will not be used as a "liegehalle" or
provided with seats.
There are thirty-six patients' bedrooms all on the upper
floors. Occupying over two-thirds of the outer- wall space
are French windows with fan-lights above and louvre
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Fig. 67.— NoRDRACH upon Dee. [ /ace /;«//e 386.
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I
2
Q
O
I
•rxj «:
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BRITISH SANATORIA FOR PAYING CONSUMPTIVES. 387
shutters outside. Similar windows are found along the
corridors and similar fan-lights over the bedroom doors.
Each bedroom has a douche bath and two fitted-in basins,
all served with hot and cold water. As a protection against
damp and fire, a four-inch thickness of silica wool has been
placed in every wall. All comers are rounded ; walls
painted in colours ; floors of polished wood. There are two
steam lifts, for servants and for patients respectively. The
heating of the building is by steam pipes carried from the
engine block. In some rooms these are supplemented by
Dowsing electric radiators. The lighting is everywhere by
electricity. Electric bells communicate with the doctor and
staff. The water-closets, lavatories and bath-rooms are in
projecting pavilions to the north of the corridor. The water
supply is of exceptional purity and comes a distance of
four miles.
The dining-room, together with kitchen department and
servants' bedrooms form a separate block about 50 or
60 feet to the eastward, connected with the main building
by a continuation of the corridor, which has in front of it
an open glass-covered verandah. The dining-room, 56 x
24 feet, has on three sides walls with large removable
windows.
The engine block with dynamo stands over 100 yards
from the sanatorium, shut off by densely wooded ground.
A special feature of this sanatorium is the provision of
a fully equipped laboratory under a trained assistant. It
is at present placed on the ground floor of the main block,
but will eventually form a separate block. The sanatorium,
including land, has cost £660 per bed.
The treatment is based on that at Nordrach in Germany.
The milk and butter are supplied from a tuberculin-tested
herd of cows. The physicians are Dr. David Lawson and
Dr. Noel D. Bardswell. Besides matron and trained nurses,
a masseur and masseuse live in the sanatorium.
Terms: five guineas weekly; extras: personal laundry
and alcohol.
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338 BRITISH SANATORIA FOR PAYING CONSUMPTIVES.
Mode of access : by rail to Aberdeen and Banchory.
Telegrams : Nordrach on Dee, Banchory. The sanatorium
is on the telephone system.
The Ochil Hill Sanatorium.
A company has recently been promoted for the erection
of a sanatorium for paying consumptive patients on the
southern slopes of the Ochil Hills, about four miles from
Kinross. It is being erected on a gravelly plateau, 800 feet
above the sea-level, with well-wooded and picturesque sur-
roundings. There will be accommodation for sixty patients,
each occupying a separate room on the south side of the
house. The foundation stone was laid on 27th October,
1900, by Sir Thomas Glen Coats. Dr. Ebenezer Duncan of
Glasgow is one of the directors.^ The estate consists of
462 acres of land, well wooded with pine-trees. Behind the
selected site the land rises north-east to a height of 1050
feet, whence distant views are obtained of the Grampians
in one direction, and Loch Leven, the Lomonds, the valley
of the Forth and the Pentlands in another. A stream on
the estate will furnish power for electric lighting.
WooDBURN Sanatorium
is situated at Morningside, a suburb of Ekiinburgh, just on
the outskirts of the open country. Originally a private
mansion standing in six acres of garden, it has been
completed by the addition of a detached wooden pavilion
containing bedrooms for ten patients, the original building
containing the dining-room and administrative portion.
The soil is of red sandstone ; the climate that of the
outskirts of Edinburgh. Standing under the shelter of
Blackford Hill, the sanatorium faces the Braid and the
Pentland Hills, the former being one mile distant, the
latter three miles. The garden is well wooded with fine
trees, and has been provided with a few shelters.
^Brit. Med. Joum., 3rd Nov., 1900.
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Fig. 70 — Woodburn Sanatorium.
[Face page SS9.
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Fk;. 71.— WooDHLiix San ATORICM.— Wooden Pavilion.
[Fare fMiffe *]S0,
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BBITISH SANATORIA FOR PAYING CONSUMPTIVES. 389
The mansion is substantially built in stone, with two
floors and attics. The corridor runs east and west from
the entrance hall, and has to the south a few large rooms,
including a drawing-room 40 x 30 and 22 feet high, open
on two sides and freely ventilated on a third. The dining-
room is open on three sides. The pavilion, which is raised
on brick piers 4 feet from the ground, is built of wood, covered
with oak shingles, lined with felt, and internally faced with
match-boarding. The rooms are 15 x 11 and 11 feet high,
and have extra large casement windows surmounted by
fan-lights. They are all to the south of the corridor, and
have similar fan-lights over the doors. The floors are waxed
and polished, the walls varnished ; the furniture simple and
readily cleansed. To the south of the corridor are a small
kitchen, lavatories and water-closets. The roof is ventilated
all round, so that it is cool in summer, warm in winter.
Heating is by hot- water pipes. A few extra large bedrooms
are reserved in the mansion for cases requiring special
nursing. There is room for twenty patients. The treat-
ment is modelled on that of Nordrach. Patients are super-
vised by Mrs. Mears, L.R.C.P.I.,* and by Dr. J. J. Galbraith.
Dr. R. W. Philip is consulting physician.
Terms: five guineas; the only extra charge being for
stimulants.
IRELAND.
There are three sanatoria in Ireland for paying patients,
at Rossclare in Fermanagh, at Rostrevor near Dublin, and
Altadore in Wicklow.
Name. Nearest Town.
Medical Officer.
No. of Beds.
Altadore . Greystones, Wicklow
Rossclare . Irvinestown, Fennanagh .
Rostrevor . ' Rostrevor, Down
J. C. Smyth .
Dr. P. S. Hichens .
Dr. F. H. Sinclair .
18 2
17
20
1 Dr. W. P. Mears died March, 1901.
2 9 open.
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390 british sanatoria for paying consumptives.
Altadore Sanatorium
is situated amongst the Wicklow mountains, 750 feet above
the sea-level, and is well sheltered to the east, north and
west, by woods and mountains, sgme of which reach the
height of 2000 feet above the sea. To the south the sana>
torium commands a view of the sea, five miles away. The
soil is of gravel and sand, the rainfall below the average,
the climate that of Eastern Ireland, but relatively dry. The
grounds, of 480 acres, include a beautifully wooded glen, and
a large variety of lovely walks. Farther oft are the Dargle,
the Glen of the Downs, Powerscourt and other places of
interest. The building consists of a squarish mansion on
two floors, with turrets at the four comers, and has rooms
for nine patients. Bungalows are being prepared for nine
more. There is a turbine worked by water power which is
about to be used for electric lighting.
The sanatorium, which was opened this year, is under
the care of J. C. Smyth, Esq., L.R.C.P., M.R.C.S., and his
wife, the former of whom was for a time at Nordrach in
Germany.
Treatment is according to the methods of Dr. Walther of
Nordrach. Visitors only allowed by special arrangement
Terms : four guineas per week, or for a few rooms five
guineas. Extras are personal laundry, alcoholic drinks,
medicines, and special nursing if required.
Altadore is five miles from Greystones, eight miles from
Bray. Carriages can be sent to meet the trains from
Dublia Postal address, Altadore, Kilpedder, Co. Wicklow.
RosscLARE Sanatorium
was opened on 1st August, 1899, at Rossclare, Fermanagh,
under Dr. R. C. Macfie and Dr. L. Kidd of Enniskillen,
being the first of its kind in Ireland. Since April, 1900, it
has been under the management of Dr. P. S. Hichens, who
was himself .previously under treatment at Nordrach in
Germany. The sanatorium stands on a hill about 125 feet
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BRITISH SANATORIA FOR PAYING CONSUMPTIVES. 391
above the northern shore of the Lower Lough Erne, and
274 feet above the sea-level, and commands a fine view of
the lake and the mountains of Donegal, Fermanagh and
Leitrim. It is three Irish miles from the nearest town,
Irvinestown ; and seven from Enniskillen. The soil of this
district is of limestone, and dries rapidly after rain. The
climate is rainy but very equable, and bracing for Ireland.
The house stands in the midst of meadows, with only a few
trees about it. Immediately below is a sort of undercliff
overlooking the lake; on the south-west there is a thick
wood with sheltered graduated paths. The drive is also
well sheltered ; and from a distance of half a mile the
surrounding country is richly wooded. The ground rises
to the north behind the sanatorium. In the garden just
outside the house is a large shelter 45 x 14 feet, with
raised floor and movable shutter.
The house was originally built for an hotel, and forms
two sides of a quadrangle facing respectively south-east
and south-west. There is a large dining-room with three
windows facing south-west, and a large sitting-room. Most
of the bedrooms look south-west or south-east, but a few
are on the north-east side. The bedrooms are plainly
furnished, and have linoleum on the floor, a cushioned
wicker-work couch, and muslin curtains to the lower halves
of the windows. The seventeen patients' bedrooms vary in
size from 12 x 13 x 10 to 18 x 18 x 10 feet. The smaller
ones have a large window 3x5 feet 6 inches, the bigger
ones have mostly two. All the rooms have fire-places,
although these are little needed.
The treatment is the same as at Nordrach, excepting that a
more substantial breakfast is given, and rather less at dinner.
Terms : three and a half to four guineas, including every-
thing excepting laundry, stimulants, and special nurse if
required.
Stations: Ballinamallard and Irvinestown. From Lon-
don patients travel via Holyhead and Greenore to Ballina-
mallard, which is four miles from the sanatorium.
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392 BRITISH SANATORIA FOR PAYING CONSUMPTIVES.
RosTREvoR Sanatorium
stands on the slopes of the Moume Mountains, about 350
feet above the sea-level, and is two and a half miles from
Rostrevor, and one and a half from Carlingford Bay. The
climate of this district is mild and equable; the rainfall
heavy ; the s6i], gravel overlying granite. The place is well
sheltered against wind, the Moume Mountains rising to a
height of 2700 feet to the north and east
The sanatorium, which was opened in August, 1899, con-
sists of two parts at right angles to one another ; a large
picturesque wooden building on two floors, with a covered
verandah at the ends and a balcony to the upper floor ; and
a solidly built mansion. The rooms are of fair size, pro-
vided with casement windows, some having French windows
opening on to the terrace. There are thirteen patients' bed-
rooms and seven sleeping bungalows. Lighting is through-
out by electricity ; heating partly by open fire-placcys, partly
by hot-water pipes, which also pass under the terrace. The
water supply is from a deep well bored through the granite.
In the grounds (which are well wooded) are five sleeping
huts and two revolving shelters. Part of the garden ia
protected by a high hedge, and forms a specially sheltered
spot in rough weather.
The treatment is based on that at the larger German,
sanatoria. Three chief meals are given, and four inter-
mediate ones, including much milk from a tuberculin-tested
herd of cows. A nurse attendant is kept for massage, baths,,
etc., which form a special feature of the treatment. Wash-
able pockets are provided for the patients' handkerchiefs.
Dr. Howard Sinclair is the resident physician. Terms:
three and a half guineas; special drugs or special nurse
(if required), personal laundry, and alcoholic dtinks, are
extra.
Access : by the Great Northern Railway from Belfast or
Greenore to Warrenpoint, thence a drive of three miles to
the sanatorium.
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\
CHAPTER XLIX.
BRITISH NEEDS AND BRITISH RESOURCES.
There has been a steady and considerable reduction in the
mortality from consumption during the last sixty years
in this country. In 1838 the death rate from this disease
was over 38 per 10,000 living, in 1899 it was only 13, or
a diminution of 25 per 10,000 living. This has been
attributed with good reason to the establishment of special
hospitals for diseases of the chest, and to the general
sanitary improvements in house construction, drainage
of land, ventilation of workshops and factories, and the
like. A vast amount of money has also been spent in the
erection of convalescent homes, which no doubt have helped
to stave off the decline of many a consumptive, although
such patients are not welcome or desirable visitors to these
institutions, nor indeed adequately provided for in them.
Great Britain was probably the first country in the world
to establish special hospitals for the treatment of consump-
tives. Her first seaside sanatorium for scrofula (which
however does not admit consumptives) was founded at
Margate as early as 1791, and the Royal Hospital for
Diseases of the Chest in London in 1814 ; while the
Brompton Hospital for Consumption and Diseases of the
Chest, with its 321 beds, is almost the largest of the kind in
the world.
Eight years ago, when Germany *s first sanatorium for
the poor was erected, England was unrivalled in her pro-
vision for the consumptive poor. There were at the time
no such institutions in any other part of the continent,
(898)
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396 BRITISH NEEDS AND BRITISH RESOURCES.
home ; but there would be no objection to the transformation
of a number of these institutions into sanatoria under medical
supervision. Every large town and district of Germany
has its own sanatorium, ready or in process of erection ; and
a similar arrangement should be made in this country.
Many relapses are occasioned by the return of consump-
tives to an unsuitable occupation or neighbourhood. To
prevent this, model villages should be established under
medical supervision Many occupations known to be injuri-
ous to consumptives might be rendered harmless by altering
the conditions under which they are performed. In order to
prevent the soiling of materials by smoke and dust, trades
and occupations are carried out behind closed windows
which might equally well be done in clean houses with open
windows in the country ; and even short of the erection of
model villages, much could be done (and, indeed, has been
done) by persistent medical pressure to improve the condi-
tions of life.
To ensure a reasonable amount of uniformity, it would be
advisable to appoint a few medical men (preferably such as
are acquainted with public health as well as with sanatorium
treatment), each to supervise a district and regularly inspect
the various sanatoria and model villages within it Such
supervisors would confer with the local medical officers and
advise them, while i*eporting to some central authority.
To prevent disobedience in hygienic matters on the part
of convalescent patients, certain privileges might be con-
tinued after their leaving the sanatoriuhi (as with members
of benefit societies), which would be forfeited on breach of
rules. As in the case of convalescent homes, the railway
companies would, no doubt, allow special reductions in fare
to those going to a sanatorium.
For the children of consumptive parents, it would be
advisable to establish special schools for delicate children,
where the laws of health were more S-crupulously obeyed
Tradesmen abroad frequently subsidise a sanatorium in
order to secure a bed for themselves or their families in case
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BRITISH NEEDS AND BRITISH RESOURCES. 397
of need. In several instances, too, large manufacturing
firms in Germany have erected sanatoria as well as con-
valescent homes of their own for the benefit of their
workmen.
Turning to the arrangements for middle-class consump-
tives, Germany was until recently even farther ahead of
this country than as regards the poor. This was partly
because of a feeling here that the middle-class patient can
afford to pay for home treatment ; partly because our climate
was regarded in many quarters as unsuitable; partly also
because the disadvantages and diflSculties of home or hotel
treatment were not sufficiently realised. Even where
patients can afford to go abroad, there are often grave
objections to their doing so. That our climates are suitable
for the treatment of consumptives is sufficiently proved by
the results already achieved in existing British sanatoria,
and by the long list of distinguished physicians who have
publicly and privately advocated the hygienic treatment in
our country.^ Home treatment of consumptive patients
during febrile or complicated stages is far more expensive
than is usually realised. Allowing for the salary and keep
of a trained nurse (who is needed during febrile stages for
a part of both day and night, unless relatives can attend to
the nursing), and for an average of two visits a day from the
medical man, it will not be safe to reckon the cost of treat-
ment during critical stages at less than £5 per week, exclusive
of rent and ordinary household expenses, or of the cost of
rooms in lodging-house or hotel, if the patient is away from
home. And as the physician in such cases does not live
under the same roof, he is quite unable to exercise efficient
control over the hygienic details which so often make the
difference between recovery or the reverse, and in which
consists the special educational value of a sanatorium.
1 Among these may be mentioned Sir Richard Douglas Powell, Dr.
Theodore Williams, Sir Hermann Weber, Dr. Ransome, Dr. Kingston
Fowler, Dr. J. A. Lindsay of Belfast, Dr. Philip of Edinburgh, and nearly
every physician attached to the London chest hospitals.
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398 BRITISH NEEDS AND BRITISH RESOURCES.
Patients who pay from £4 to £6 per week, as at most of
the continental sanatoria, have a right to expect not only
proper sanitary conditions, good medical attention available
at any moment, a good and suitable dietary and efficient
nursing, but also an atmosphere of unexceptionable purity^
free from boisterous winds, and grounds which are of such
a size and character as to allow of graduated walking exer-
cise, as well as rest in the open air.
Owing to the rapid multiplication of full-price sanatoria
in this country there are now nearly 600 beds available for
this class of consumptives, or nearly half as many as in
Germany. Very few however of these have been specially
built, and many are not very suitable, owing to their con-
struction, their situation, or for other reasons.
There is still great need of good sanatoria which will
provide adecjuate facilities for treatment at cost price. There
are many patients not properly admissible to institutions
for the poor who yet cannot afford to pay more than an
inclusive charge of from two to three guineas per week.
The poor curate, the briefless barrister, the struggling doctor,
governess, teacher, actor, artist, the bankers* or mercantile
clerk, is utterly unable to afford more than a very modest
fee, and has frequently been driven through lack of other
resources to one of the consumption hospitals which are
neither intended for such a class nor able to provide sana-
torium treatment. There is, in fact, no adequate provision
for this class of patient, who is often worse off than the
artisan or domestic servant. Such provision at low cost
can only be made by a sanatorium with accommodation for
fifty or more patients ; for in many respects it costs as much
to provide for two or three patients as for twenty or thirty.
The administrative department, the efficient cook, the house-
keeper, the trained nurse, the resident medical officer, the
grounds and shelters, have tcT be provided for one patient
just as much as for a dozen, and it is only by dealing with
a number that economy can be effected, variety introduced,
and dulness prevented.
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(
BRITISH NEEDS AND BRITISH RESOURCES. 399
The establishment of the National Association for the
Prevention of Tuberculosis and of other kindred societies
is but one of many signs that Great Britain is at last waking
from her satisfied slumbers and preparing to again take her
place in the van of the nations. Our country's sanitary
past has been great and fruitful ; and there is every reason
to hope that with growing consciousness of the possibility
of destroying this dread scourge of humanity by the abolition
of town smoke, the improvement of our dwellings, the better
ventilation of rooms and streets, the admission of sunshine
into our midst, the inculcation of more rational habits of
life, the destruction of sputa, the erection of sanatoria, and
in many other ways, she will gradually prepare for herself
a still more great and glorious future.
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APPENDIX.
AMEEICA, UNITED STATES.
The following Sanatoria and Chest Hospitals should be added
to the list given in the first edition : —
Asheville Sanitariuniy North Carolina.
Chicago Sanitarium for Tuberculosis, Illinois.
Chicago Hospital for Consumptives, to be built at the
expense of Mr. Otto Young.
Chico Springs Sanitariurrhy New Mexico, hitherto a ranche-
belonging to Ex- Senator Dorcey.
Consumptives' HomCy Eoxbury, Massachusetts, for the poor.
Convict Campf Alabama, for tuberculous prisoners of the:
State.
Cook County Hospital for Consumptives, Dunning, Illinois,
for the tuberculous poor of the county. Beds, 380.
Hill Crest, Santa Clara, Franklin Co., New York. A
home for incipient cases, maintained by the Working
Girls* Vacation Society of New York. Stands 1700
feet above the sea level Charge 7 dollars per week.
Latta Sanitarium, East las Vegas, New Mexico. Under
the charge of (Protestant) Sisters Latta. Beds, 15.
Trained nurses. For paying patients.
Ladies' Home Sanitarium, East las Vegas, supported by
the Ladies' Local Relief Society. Beds, 16. Visiting
Physician, Dr. Atkins. Free to the poor. Others pay
5 to 8 dollars per week.
Pasteur Sanitarium, Suflfem, New York.
Pennsylvania Sanitarium, Whitehaven, projected by the
Society for Prevention of Tuberculosis.
26 (401)
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402 APPENDIX.
Saint Anthony's Sanitarium, near East las Vegas. Under
the care of Roman Catholic Sisters. Charges 6 to 12
dollars per week.
United States Sailors' Sanitarium, Fort Stanton, Lincoln
Co., New Mexico.
United States Army Sanitarium, Fort Bayard, New Mexico.
At first 100 beds, later on 200.
The AshbviliiE Sanitabium
was opened on 1st March, 1898, in the neighbourhood of the
same city, on a wooded eminence 2350 feet above the sea-
level, commanding a fine view of the surroimding country. It
has attached to it fifteen acres of park land, wooded with oaks
and pines, and has its own supply of spring water. The build-
ing has rooms for seventy-five patients, and contains eighty
rooms. It consists of a handsome pile with three storeys and
basement, provided with lift and electric light, and numerous
verandahs and porches. In the basement (which is above
ground) is the bathing department with swimming bath and
gymnasium.
It is under the management of Dr. S. W. Battle and Dr.
Boss, one of whom lives in the building. It is intended for
paying patients.
The Free Home for Consumptives
in the City of Boston was opened by the Young Ladies'
Charitable Association at Dorchester, Massachusetts, in March,
1892, in a dwelling-house which was altered for the purpose.
It has recently been enlarged by the addition of a new block,
and now has accommodation for 125 poor patients. Both
buildings are of wood, the new one having brick walls and fire-
proof doors every fifty feet as a protection against fire. One
building is used for administration. The other has wards on
two floors on the south side of the corridors ; the dining-
hall, sewing-rooms, toilet-rooms, reading-rooms, linen-rooms,
and cloak-rooms being to the north of the corridors. In the
centre is a large recreation hall, communicating with the wards
by sliding doors. Grouped about the entrance hall at the eastern
end are consulting-rooms and reception-rooms. Large balconies
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APPENDIX. 403
run along the south side of the building. In the basement are
laundry, inhalation- and disinfecting-rooms, and the kitchen
department. At the extreme west are some isolation wards.
The ventilation is by heated air forced into all the rooms and
corridors.
Drs. E. O. Otis, Merrick and Watts are the visiting
physicians.
The Sanitabium Gabriels
was opened on Sunrise Mount on 26th July, 1897» on land
given by Dr. Seward Webb and Mr. Paul Smith. It consists
of detached cottages built of hard wood, heated by one central
boiler house about 800 feet from the main building. Pure air
is forced into the buildings through a shaft, and heated on its
way by radiating pipes. The air can in this way, it is said, be
changed every five minutes. About seventy patients can be
admitted. Dr. J. C. Lamb is house physician. Both rich and
poor are admitted, the fees of the former helping to, support the
latter, and the nursing sisters receiving no personal remunera-
tion. Medical attendance is free. Weekly charges, 7 to 12
dollars ; extra for laundry, medicine, and attendance in the
bedroom.
The Htgeia,
Oitronelle, Alabama, is now under the management of Dr. J.
G. Michael, with Dr. Keith Fond^ as house physician, and is
open all the year round.
The Massachusetts State Hospital
for Consumptives and Tuberculous Patients, which was opened
on 10th October, 1898, was described by the author in an article
published in the Lancet for 19th August, 1899, from informa-
tion kindly furnished by the resident physician, Dr. Walter
Marclay.
It stands 1200 feet above the sea-level in the open country
about one and a half miles from a small village, one hour and
three quarters* journey by rail from Boston, and one hour by
rail from Worcester. The place is just sufficiently near the
coast to have '* a suspicion of sea air" after several days of east
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404 APPENDIX.
wind ; but otherwise it has an inland hill climate. The soil is
sandy and rocky and contains much mica schist. There are
2JX) acres of land belonging to the institution, which covers the
greater part of a hill with a southerly aspect and extends east-
wards to a lake a mile long, from which comes the water supply.
A hill rises to the north-west, behind the institution, about
100 feet higher than that building, which is further sheltered
to the north by a grove of pine-trees.
The hospital, which might even more properly be called a
** sanatorium," consists of a number of one-storey paviHons
radiating from the convex side of a semicircular corridor (fig. 75).
Behind the centre of this is the kitchen block, with servants'
dining-room, and in front of it the nurses' dining-room. Behind
the kitchen block are the laundry and disinfector, and still
farther ba<^ the dynamo- and engine-room. The western
pavihons are for men and the eastern for women ; and the
latter also have separate dining-rooms. The pavilions are
alternately long and short, the former having dining-rooms
attached to them behind the circular corridor. The part of
the pavilion immediately in front of the latter consists on one
side of private wards, and on the other of bath-rooms, lavatories
and a nurses' room. Then come in succession a large ward for
eight beds, a circular ward with from four to six beds, and
another ward with eight beds, terminating in a sun-room and
a piazza. The shorter pavilions have only one large ward
instead of two, and no circular ward. Alternating with the
above-mentioned pavilions, but radiating northwards from the
circular corridor, are two pavilions on either side, each consist-
ing of small wards, nurses' room, bath-rooms, etc. Some dis-
tance in front of the centre of the semicircle is an administrative
block with offices and separate kitchen. The nurses sleep in
another block at the north-eastern comer of the ground ; a
corresponding block to the north-west consists of a mortuary,
stables and coachhouse. The wards have large windows and
have an air space of over 1200 cubic feet per head. Every
room has an inlet for warm air and an outlet for foul air, the
former being supplied by four fans and engines in the basement.
Ventilation is, however, mainly effected by open windows.
These are only shut when patients are getting up or going to
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n
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APPENDIX. 405
bed. The walls of the rooms are finished in hard plaster, all
comers being rounded. The outer walls are rough cast. The
roofs are finished with tar and gravel.
The hospital is intended for hopeful cases of phthisis drawn
from the class of poorer wage-earners. A charge of 50 cents
per day is made, without any extras. There is room for 175
patients, and the average stay is expected to be about a year,
unsuitable cases being dismissed after a probationary period of
a few weeks. Private wards are set apart on purely medical
grounds for those who are specially in need of them, no dififer-
ence being made in the charge.
The treatment consists mainly in good food and rest in the
open air, together with whatever accessory medical or hygienic
measures may be required. Patients spend at least eight hours
a day out of doors, and in rainy weather they sit in the sun-
rooms with open windows. Daily cold baths are largely em-
ployed. Disinfectants are not used and sanitary cuspidores
take the place of handkerchiefs. Most of the patients make
their own beds and walk to the dining-room for meals ; but
there are trained nurses in the institution for those who need
them. The medical staff consists of two visiting physicians
(Dr. Bowditch and Dr. Clapp), a resident medical superinten-
dent and two resident assistant physicians.
The hospital was founded partly by a State subvention and
partly by private munificence. The payments of patients cover
about one-third of the cost, the rest being annually made good
by the State.
The Pasteur Sanitabium
had been built by Dr. Paul Gibier, Director of the Pasteur
Institute of New York, at Suffem, a little village about an hour's
rail from New York. Situated 500 feet above the sea-level,
at the foot of the Eamapo Mountains, near a grove of pine and
other trees, it has attached to it some 250 acres of land. The
building is solidly built with ground floor, two upper floors, and
attics. A deep verandah runs opposite the first floor along the
south and west sides, transformable by glass shutters into a
solarium. On the ground floor are the laboratories and hydro-
therapeutical department; on the first floor the dining-room
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406 APPENDIX.
and a number of other day rooms. The kitchen^ laundry,
servants' quarters, and machinery are in an annexe connected
by a corridor. Heating is by hot water, lighting by electricity.
Windows are of the ordinary double-hung variety. There ia
at present room for about thirty patients. Some pay from
twelve to twenty-five dollars per week. There are, however, a
number of free beds for poor physicians of any nationality,
school, or religion.
The medical director lives in a cottage 1000 yards from the
building, connected with it by telephone. A house physician
hves in the sanatorium. There is a model farm on the ground.
The Philadelphia Hospital fob Consumptives
at Chestnut Hill now has eighty beds.
Bhode Island.
A hospital for consumptives is to be erected at Providence by
the Rhode Island State Board.
The Rush Hospital
for Consumptives, Philadelphia, has been recently enlarged. It
is a solidly built structure of three floors and basement, accom-
modating forty patients in two large wards. It receives an
annual grant from the State of Pennsylvania.
The Seton Hospital
was erected in 1894 opposite Spuyten Duyvil Parkway, within
Greater New York, and stands 250 feet above the sea-level,
overlooking the river Hudson. The institution is amder the
care of the Sisters of Charity, and can accommodate 160
patients in wards of twelve each. An even temperature is
maintained by a system of fans and ventilators. There is also
a large solarium for bad weather. From 1898 onwards this
hospital took charge of the consumptive poor of New York,
selected by the Board of Health, one dollar per diem being paid
to the hospital for each patient. Drs. Jackson and Shrady are
visiting physicians. There is also a house physician.
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appendix;. 407
The Winyah Sanitarium
is to be replaced by a large new building with two or more
cottages, laboratory, etc., situated in a patch of twenty acres
adjoining the city of Asheville.
The United States Sailors' Sanitarium
at Fort Stanton, New Mexico, has recently been projected for
the reception of tuberculous patients from the Marine Hospital.
Ten thousand acres of land have been set apart for the purpose,
at an average elevation of about 6000 feet above the sea-leveL
The soil consists of new red sandstone and magnesian limestone
covered by black alluvial deposit with a subsoil of gravel and
volcanic stone. The river Bonito runs through the selected
tract, from which rolling hilly ground, covered with grass,
extends to the mountains. Higher up is a belt of trees, mostly
pines and cotton wood. The rainfall is 20 inches, the clear
days average 300. A deep artesian well supplies abundant
water. Sewage will be by irrigation channels. The buildings
will be heated by wood in closed stoves and open fires. There
is some idea of encouraging patients to settle in the district, and
devote themselves to sheep and cattle farming, light gardening
and agriculture. Goal is to be found six miles off.
AEGENTINE EEPUBLIC.
During 1899 a league was started for the prevention of
tuberculosis in this country. It was proposed in Congress to
erect sanatoria for the poor.
AUSTRALIA.
There are now several private sanatoria in Australia. I have
only been able to get information about one of them.
The James Brown Sanatorium
at Belair, South Australia, is situated on the Mount Lofty
Range, seven miles from Adelaide. The situation is described
as excellent, 1100 feet above the sea-level, very dry and bracing.
In summer the temperature is stated to be several degrees
Digitized by LjOOQIC
408 APPENDIX.
below that of Adelaide and seldom oppressive, in winter rarely
below 45^ The climate is " almost an ideal one, allowing the
patients to live outside all the year round ".
'* The buildings consist of three blocks, a central one for the
staff, one for male, the other for female patients, with a large
dining-hall (40 x 26, and 20 feet high), all buildings connected
by covered passages. There is a plentiful supply of veran-
dahs with comfortable lounges. The grounds extend over thirty
acres ; and patients can wander about over the hills in all
directions. Accommodation is provided for twenty-five patients,
and as the beds are fully occupied this number will shortly
be added to. Patients are expected to pay 15s. per week
towards the maintenance, the rest of the expense, as well as
the cost of the buildings (£8000), being met by the legacy of
the late James Brown. The open-air treatment is fully carried
out, with very encouraging results." I am indebted for this
information to the medical oflScer, Dr. A. H. Gault.
AUSTRIA AND HUNGARY.
Beyond establishing the sanatorium at AUand very little
seems to have been done in this direction in Austria proper.
In Bohemia there are two societies, one German and one Czech,
each of which proposes to erect sanatoria for the poor. There
is also a sanatorium projected in Styria.
At the Alland Sanatorium one-third of the beds are allotted to
women.
BELGIUM.
A society or league against tuberculosis was founded in 1897
as an offshoot of the Royal Society of Medicine.
It is stated that a sanatorium for paying patients has been
started under Dr. Hottly at Limburg.
CANADA.
There are two sanatoria for Consumptives now in working
order in Canada : —
The Laurentian Sanitarium at Ste. Agathe des Monts,
Montreal.
The Muskoka Cottage Sanitarium at Gravenhurst, Ontario.
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APPENDIX. 409
The Muskoka Cottage Sanitarium
^as opened in September, 1897, and is the first of a series of
sanatoria to be erected by the National Sanitarium Association
of Canada.
It is situated on the shores of Lake Muskoka, 125 miles from
Toronto, about 800 feet above the sea-level, and is protected tp
the north and west by rocky hills and by a neighbouring wood of
deciduous and coniferous trees. The soil consists of Laurentian
rock ; the climate is dry, bracing and free from dust.
The buildings consist of an administrative block and a number
of cottages. The former has a central tower and diverging wings.
It contains bedrooms for twenty patients, and has a deep verandah
in front of the ground floor, which forms three chief solaria
facing respectively south, south-east and south-west. It has
also a number of reception-rooms. Over the verandah is an
open balcony. The building is heated by steam pipes.
The cottages contain each from four to six bedrooms and a
large sitting-room with an open fire-place. The verandahs can
be enclosed by glass screens. The cottages are heated by hot-
water pipes, and are finished in hard wood. Every building has
a southerly aspect, and is Ut by electricity.
There are three chief and three intermediate meals.
Only patients in early stages are admitted.
The physician is Dr. J. H. Elliott.
The charges are six doUars per week, including medicine.
There is at present accommodation for fifty patients, all in
separate rooms. During the first three years of its existence
371 patients were admitted. The average stay has risen to 129
days.^
A Sanitarium for the Poor
of Toronto will shortly be built under the auspices of the
National Sanitarium Association in the same neighbourhood
as the Muskoka Cottage Sanitarium. It will contain fifty beds,
and is expected to be ready in about a twelvemonth. An allow-
ance of forty cents per patient per diem will be made by the
municipality. Easy terms has been granted for the transport
1 Lancet, 8th Dec, 1900.
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410 APPENDIX.
of patients over the Grand Trunk Bail way to and from the-
sanatorium.^
The Laurbntian Sanitarium
stands on the mountains of that name, nearly 2000 feet above
the sea-level, about a mile from Ste. Agathe des Monts and sixty-
four miles from Montreal. The district comprises innumerable
lakes and forests, and is dry and bracing. The sanatorium i&
fairly well protected from the north by distant hilla The
building is square and unpretentious, with three floors and
attics, a verandah on the ground level and a covered balcony
above it ; the verandahs can be enclosed with glass screens^
and are provided with fire-places. The sanatorium is in charge
of trained nurses and a stafif of visiting physicians, and has beds
for twenty-five patients. It was built in 1898.
THE CANARY ISLANDS.
A sanatorium on the model of Falkenstein has been in exis-
tence since 1890 at Santa Oatalina, about one and a half miles*
from the town of Las Palmas in the north-east part of Grand
Canary. Designed by Mr. A. J. McLaren, himself originally
a sufferer from pulmonary tuberculosis, it has been managed
up to the present as a sanatorium and hotel combined. The
south wing is now to be devoted to patients who will be treated
more strictly on Nordrach lines.
The sanatorium stands in about eighteen acres of ground,,
reaching from the sea to an altitude of 250 feet above the
sanatorium. At this height is a bare tableland with golf links,,
which extend to a height of 500 feet above the sea-level. North,
and south of the grounds is farm land with very few roads or
habitations. Excepting on the public roads which are dusty
in hot weather, but which can easily be avoided by patients,
the air is pure and free from dust and laden with ozone. For
240 days annually the north-east trade winds blow direct on
to the sanatorium. No rain falls between May and October ;
during this period the climate is moderately warm and very
sunny, with a mean temperature of 74*5° F. and a maximum of
1 Lancet, 5th Jan., 1901.
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APPENDIX. 411
79**. In winter it is dry acd bracing and rather cooler than an
average English summer. The soil is rocky and dry.
The sanatorium is planned like that at Falkenstein with
diverging wings, but with three storeys instead of five, and a
less cramped kitchen department. The concavity of the build-
ing looks east-north-east.
The dining-room, billiard-room and smoking-room occupy
the northern wing on the ground floor. In the central part of
the building are a large entrance hall and reception-rooms in
front of the corridor and smaller rooms behind it. Verandahs
and balconies surround both wings on the two lower floors and.
line the eastern side of the central part. The top floor leads to
large terraces over the wings which are partially covered with
roofing. The servants are quartered in a separate block to the
north-west. The south wing, containing twenty out of the
eighty bedrooms, will in future be devoted to the ** Nordrach '*
treatment. Patients in this part will take their meals in
common in a separate dining-room without windows which has
been built on the south side of the south wing.
The internal arrangements of the sanatorium are mainly on
the usual lines. Polished floors, no carpets beyond small slips
in the bedrooms and on the staircase, a narrow strip of cocoa
fibre matting in the corridors, whitewashed walls ; simple fur-
niture ; French windows, with large square fan-lights ; extra
large windows to all the common rooms ; louvre shutters to all
outside doors and windows.
The water supply and electric hghting are those of the town
of Las Palmas. Sanitary engineering has been done by a first-
class English firm. The milk, which is from herds living in
the open air, and therefore seldom infected with tubercle, is
sterilised before use.
Sputa are received into cups or Dettweiler's flasks containing
bleaching solution or corrosive sublimate solution.
The sanatorium, which belongs to a company, is managed by
Mr. and Mrs. Sauerbrei, the latter of whom was an Enghsh-
trained nurse and hospital sister. Another trained nurse is kept
in the place and a third during the winter months. The medical
officers are Dr. Brian Melland and Dr. Fleming Baxter.
Terms for Nordrach treatment : five guineas or less ; extras :
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i
41S APPENDIX.
persdct&I laundry, alcoholic beverages, extra nursing and medical
AU(*nd&nce. Lower terms in the general part of the sanatorium.
!*'urUidr |mrticulars from the Canary Islands Company, Lau-
refloe Pauntney Hill, E.C.
The HdTEL Metbopole,
Tmb Fftltnas, also professes to provide facilities for open air
tr«tttQietit. It IS situated outside the town, overlooking the
barbtiur, and has a resident trained nurse. Meals in English
style.
Gl'iMAB Hospital,
for opeti air treatment, has been opened in Teneriflfe,
1300 fe*3t above sea-level, twenty miles south of Santa Cruz.
Physicians : Djs. Stanford Harris and J. Campbell Graham.
Terms five guineas. Further particulars from Messrs. Squire
4k Son, 413 Oxford Street, W.
CAPE COLONY.
}tlh% BletinerbaBsett and Miss Sleeman opened a home for
eousumptives at Middleburg, Cape Colony, in June, 1895.
Middlebur^ was then a picturesque village, well planted out
with gardens, 4000 feet above the sea-level, on the railway from
Pott Eli/iiheth and East London, eighteen hours by rail from
the foriiit^r*^
An hotel at Lemonfontein, Beaufort West, and a sanatorium
at Claiemont, about two miles from Wynberg, are also recom-
mended. At the former the charges are about £3 10s. to £4 per
week;-
DENMAKK.
A st>oiety for the promotion of sanatoria for consumptives
was formed in 1895 under the auspices of Prof. Reisz of Copen-
hagen. The fit'st of its sanatoria (Vejlefjord) is described below.
BosERUP Sanatorium
has lieen built by the city of Copenhagen, not far from Roskilde
in Zealand , for the tuberculous poor of the city. It contains
110 beds, mostly for men, the two portions being separated
^ Dr* 8heen. Brit, Med, Joum., 27th Oct., 1900.
'Lt.^CoL BAttfsrahy, ibid., 15th December, 1900.
I
Digitized by LjOOQIC
APPENDIX. 413^
by the administrative block and the medical officer's quarters.
It is intended later on to raise the number of beds to 200.
The daily charge is Is. 3d. for most patients, half this amount
for members of sick benefit societies, but considerably more
for those from outside Copenhagen.^
Vejlepjord Sanatorium,
a pay sanatorium of ninety-four beds, was opened in February^
1900, under Dr. Saugmann, on the northern coast of the fjord
not far from the open sea. Attached to it are forty-two
hectares of land with a sea-front of about 900 metres. The
sanatorium is thirty metres above the eea-level, 400 metres
from the coast, sheltered to the north-west and to the east
by wooded hills, which rise to a height of eighty-five metres.
Of the ninety-four beds sixty are in single-bedded rooms, the
rest in pairs. The sanatorium has it own water supply,
sewerage, hot-water heating, electric lighting, electric lift
for patients, and steam laundry. There are several common
rooms ; the '* liegehallen " are placed at the sides with only
the corridor behind them. The medical officer's house is at a
short distance. The total cost amounted to nearly £40,000.
The profit is limited to 4 per cent, the rest being devoted to
lowering the charges, which at present stand at 6s. 9d. per
diem. 2
EGYPT.
Several sanatoria are now stated to exist in this country.
One of these is under the care of Dr. Arthur Bentley, at
Helouan, in the palace of the late Khedive Teufik. Another is
at Mena Hotise, near Cairo, formerly under the care of the same
physician. A third is at the Cataract Hotel, Assouan^ where
Dr. H. E. L. Canney resides.
The Tbupik Palace Hotel
at Helouan stands about 140 feet above the valley of the Nile,
in the highest part of the town, which is three miles from the
river, at the fort of the Mokattam Hills, and can be reached by
train in half an hour from Cairo. The sanatorium is sur-
rounded on all sides by desert.
* Liebe, Der Stand der VolksheUsUitten Bewegung (Munich, 1900), p. 49.
^ Zeitschr. f. Tuberk, i., 2, p. 167.
Digitized by LjOOQIC
416 APPENDIX.
four laboratories, under the care of Prof. Arloing and Dr.
Guinard. Curable oases of both sexes are received mto th&
sanatorium.
Havre, — An isolated block at the Hdpital Pasteur has been
transformed by Dr. Frottier into a sanatorium with twenty- two
beds.
Lille. — Dr. Ausset is collecting subscriptions for a sanatorium
at Avesne. The Ligne du Nord Centre la Tuberculose are pro-
jecting a sanatorium with 100 beds for the same city.
Mentone. — Dr. Malibran has opened Les Villas Sanatorium
for the consumptive poor, who are taught bee-keeping, silkworm
rearing, olive gathering, flower gathering, etc. The patients
stay indoors at sundown and shut the windows for an hour
or more.
Nancy, — Drs. Spillmann and Haushalter are building a
people's sanatorium at St. Christophe-en-Laye, near Nancy.
Orleans, — There is a similar movement here for the erection
of a sanatorium of twelve beds in the neighbouring woods.
Paris, — An influential body of Parisian physicians has raised
a large sum of money for the erection of a popular sanatorium.
The scheme has been adopted and supported by the municipality
of Versailles and various local mutual aid societies.
All the above are the result of private initiative.
Paris. — Of the Parisian hospitals where special blocks were
opened for consumptives, the Hopital Boucicaut, with fifty beds
in a new and well-appointed building under Dr. Letulle, has
been fairly successful ; the block at the Hopital Lariboisi^re,
with 156 beds, has been shunned by patients owing to the
heavy mortality.
Angicourt. — The sanatorium here, intended to have 200 beds,
has taken fourteen years in building. One hundred and thirty-
four beds were completed at a cost of £60,000, but funds were
not forthcoming to furnish them. It is now shortly to be
opened.
See also Monaco,
Orniesson and VillierS'Sur-Mame. — There are now three agri-
cultural colonies connected with these sanatoria : at Tr^miUy,
Noisy and Le Menillet, comprising in all seventy-seven hectares,
of land.
Digitized by LjOOQIC
APPENDIX. 417
EASTEKN GERMANY.
Gorbersdorf. — The Brehmer Sanatoriwm is now under the care
of Dr. J. Petri, for sixteen years assistant to Dr. Brehmer. The
** second class sanatorium '* has been increased by the addition
of six houses with 110 bedrooms, formerly called the " Ej^one
Sanatorium ". Dr. Weicker's Krankenheim now has 275 beds.
Patients are systematically trained to do suitable work.
Konigsberg. — A site has been offered free for a sanatorium
here.
Loslau Sanatorium is now under the care of Dr. Schrader,
who will have a second medical officer under him.
Oberkaufungbn.
A sanatorium for both sexes was opened 11th April, 1900 ^
by the National Women's Union of Cassel. It stands on the
side of a wooded cliff with a south-west aspect, and has two
**hegehallen '' at the sides. The dining-saloon is to the north,
with kitchen beneath. There is a separate doctor's house.
The main block is of several storeys and contains 100 to 120
beds (seventy-six for men). The rooms have each from one
to seven patients, ten being single-bedded. There are separate
lavatories and day-rooms for the two sexes. Heating is by low-
pressure steam, lighting by electricity. The management is
under the Bed Cross Sisters of Cassel ; Dr. Pickert is medical
officer. The cost was nearly £24,000.
Another sanatorium is planned for fifty female patients be-
longing to Silesia.
In Posen a society has been formed to erect a sanatorium,
and £15,000 has been promised towaids it by the local insur-
ance company.
The August Hospital in Slawentzitz (Upper Silesia) has now
a pavilion for consumptives.
At Neudorfy near Friedland, a private sanatorium has been
opened by an engineer's wife. The medical officer, Dr. Kirch-
nest, lives some distance off, at Friedland.
27
Digitized by LjOOQIC
418 * APPENDIX.
BRANDENBURG, MECKLENBURG AND POMERANIA.
Belzig Sanatorium was opened on the 8th of March, 1900. It
stands in a pine-wood and possesses its own springs of water
and irrigation fields. A chain of mountains, of which the
highest peak is the Hagelsberg, shelters it from the north.
There are ninety-two beds.
The Bleichroder Sanatorium, which has twenty-five beds for
the less wealthy middle-class patients of both sexes, uses the
same kitchens, laundry and grounds, as the Belzig Sanatorium.
The Berlin CharitS Hospital is to have a pavilion set apart
for forty consumptives.
The Blankenfelde Sanatorium now has sixty-four beds.
Birkenbusch. — A home for consumptive men has been pro-
jected on the irrigation fields at Birkenbusch, near Berlin.
Another is projected for 100 men in a similar situation at
Buck,
The Cottbus Sanatorium
of the Brandenburg Insurance Company was opened on 13th
July, 1900. It contains 100 beds, one to six in each ward,
all to the south of the corridors. Large day-rooms are placed
at the ends of the wings, from which " liegehallen " run
obliquely, each for twenty patients. The doctor's house is
at the end of the one, the inspector's at the end of the other
^'liegehalle". To the north of the central portion are two
pavilions of one storey, for the chapel and dining-room re-
spectively. Under the latter is the kitchen ; and adjoining
are the engine-house, laundry and disinfector, and staff bed>
rooms. Still farther off are the stables and ice-house. The
institution, which is for women, cost £28,750. Dr. Bandelier
is medical officer.
The Gbabowsee Sanatorium
now consists of a wooden building with twenty-six beds, a
solidly built block with fifty-one beds, together with baths
and day - rooms and doctor's quarters ; an administrative
block, with dining-room, kitchen department and rooms for
the doctor, sisters and staff ; a laundry, with disinfector and
Digitized by LjOOQIC
APPENDIX. 419
quarters for the inspector; a gas factory for the production
of acetylene ; engine-house, with quarters for the engineer ;
a pneumatic sewage station ; and a number of Docker baracken,
ten of which contain beds. A new pavilion has been built,
which raises the total number of beds to 200. A visit to
this institution leaves a very favourable impression behind it.
A country colony is to be added to the sanatorium for the
patients who leave it, who will be trained in arboriculture and
fruit raising.
Jungfemheidey near Berlin. — A sort of convalescent home was
opened here in April, 1900, for the use of those waiting admission
to a sanatorium, or threatened with consumption. Patients
come down by train to spend the day in the open air, meals
being provided at low charges, but no sleeping accommodation.
Malchow Sanatorium now has eighty-eight beds.
Prussian-Hessian Railway Friendly Society has planned two
sanatoria, one of which is to be in the Riesengebirge, near
Krummhiibel and Schreiberhau.
Rostock. — A sanatorium is projected for the poor of Mecklen-
burg. There will be 100 beds in summer, seventy in winter.^
Stettin. — A legacy of £17,500 has been left to the town for a
sanatorium. The local society will, therefore, probably devote
its funds to supporting likely patients in existing sanatoria.
A Children's Sanatorium for tuberculous children is projected
by the Berlin Brandenburg Society. An anonymous donor has
promised 200,000 marks, and 12,000 marks have been collected
(April, 1901). The building is to be of one storey in two divi-
sions with fifteen beds each for boys and girls respectively.*
SAXONY.
Albert sberg Sanatorium now has 140 beds, two baracken
having been added. Steam heating has been substituted for
close stoves, and water-closets for earth-closets. Here as in
many other sanatoria patients are expected to do a little work.
Dr. Schultze is chief medical officer.
Carolagrun Sanatorium, for women and children, was opened
on 16th October, 1900. It contains 120 beds and will have a
1 Heilstdttenhote, Jan., 1901. « Rothe Kreuz, April, 1901.
Digitized by LjOOQIC
420 APPENDIX.
church in the woods in common with the Albertsberg Sana-
torium. The heating is by low-pressure steam. Dr. Gebser
is chief medical officer. Qualified clinical assistants will be
attached to these two sanatoria.^
Reiboldsgrcn.
In 1898 this sanatorium, which had since 1892 been leased
by Dr. Wolff-Immermann from Dr. Driver, was bought by
the former, who has since made considerable alterations and
additions. A number of small villa residences are to be
added for the wealthier patients at higher fees, and at the
same time the fees are to be reduced for the poorer ones.
The ** upper houses " have been styHshly refurnished and pro-
vided with additional day-rooms. In this portion, which forms
a separate sanatorium by itself, there are now nearly seventy
bedrooms. The ** lower houses," which have for the most part
smaller rooms, have a completely separate organisation, with a
less expensive menu. For the present there are only thirty
beds in this section. Central heating, acetylene gas lighting,
and water-closets to every block are being provided. There has
been a considerable increase in the number of patients, which
amounted to over 500 in 1899.
Vogelsang,
Gommern, near Magdeburg. A sanatorium for women and
girls, was opened on Ist July, 1899, by the Patriotic Women's
Union of Saxony. The main block is solidly built and has
accommodation for the medical officers, the dining-room,
etc., and forty beds for patients. Another block accom-
modates the male staff. A third contains the steam laundry
and eighty beds. Eighty beds are contained in fifteen baracken.
Nearly one-third of these beds were used all the winter 1899-
1900. Dr. Schudt is medical officer. As in some other similar
institutions corsets are forbidden.
^ Heilstattenhote, Jan, 1901.
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APPENDIX. 421
THE HAKZ DISTEICT.
The Oderberg Sanatoriimi at St. Andreasberg has been im-
proved by the addition of a summer-house, sputum disinfector,
drying-room for wet clothes, pumping station and fire-engine.
The Gliickauf Sanatorium has been opened by the Hanse
Insurance Company in the same neighbourhood for women.
It was not specially built but adapted and added to. It con-
tains quarters for the doctor and matron and a few beds for
patients. A new building will be placed to the eastwards,
and between the two a third for the bath-rooms, day-rooms and
in the roof more bedrooms for patients. To the west yet
another block will be built for the kitchen department and
dining-rooms. Dr. Servaes is medical officer.
The Albrechtahaus at Stiege now has eighty -six beds, several
baracken having been added of which one is to be used as a
" liegehalle ".
The Marienheim was opened in June, 1899, and has thirty
beds.
■Sulzhayn Sanatorium was formally opened on 15th October,
1898. Two free beds have been retained for patients who are
competent to act as teachers or ministers. The private sana-
torium Fernsicht is therefore now devoted to full -price
patients. Three other open sanatoria exist in the village of
Siilzhayn, the Waldhaus Sulzhayn of the EvangeUcal Diakonal
Society (charges 35 to 50 marks per week) ; the Pension Son-
nenhof, which has ten rooms and a " liegehalle " (charges 31| to
42 marks, pltis medical fees and extras) ; and the Villa Elisa-
beth, All three are under the supervision of Dr. v. Hahn.
The Konigsberg Sanatorium, near Goslar, now has fifty-seven
" beds. A teacher comes twice a week from Goslar.
The Zellerfeld Sanatorium near Clausthal now has fifty-eight
beds.
SCHWARZENBACH SANATORIUM
in the same district was opened on 9th May, 1899. It stands
576 metres above the sea-level, and consists of a main block,
with seventy-six beds, and a Docker baracke with fourteen
more. The main block consists of a basement, ground floor,
first and attic floors. The kitchen is in the basement, to-
Digitized by LjOOQIC
422 APPENDrx.
gether with heating and disinfecting apparatus and three
bath-rooms. There are nine bedrooms on the ground floor.
Lighting is by electricity. There are earth-closets. The place
was originally an institution for nervous diseases belonging to
Dr. Appenrodt of Clausthal, and was bought by the Hanover
Insurance Company and converted into a sanatorium, under
the care of the same medical officer, at a cost of £7850.
The Sachsen-Anhalt Insurance Company intends to erect a
sanatorium near Diiben.
The Saxony Insurance Company has also a project for a
sanatorium.
Other sanatoria have been projected for Leipsic and for
Dresden. The former will be at Adorf ; the ground is stated
to have cost £4350.
THURINGIA.
The Sophienheilsttitte at Berka, built by the Patriotic Institu-
tion of the Women^s Union of Saxe-Weimar, was opened on
the 10th of October, 1898. Dr. Koppert is stated to be the
medical officer.^
At Bomhild a sanatorium for forty to fifty women is pro-
jected by the Thuringian Insurance Company, and a site has
been bought for the same on the southern slope of the great
Gleichberg.
A sanatorium is projected for Eisenach.
HANOVER, WESTPHALIA, OLDENBURG, LIPPE
DETTMOLD AND SCHLESWIG HOLSTEIN.
Altena Sanatorium. — Compulsory technical instruction in out-
door work is given here to the patients.
Edmundsthal Sanatorium
at Geesthacht, for the city of Hamburg, was opened on 4th
May, 1899, in a little pine wood about 90 feet above the river
Elbe, where it is sheltered on three sides by wooded hills.
1 Liebe, HeilstdtUnbewegung, 1900.
Digitized by LjOOQIC
APPENDIX. 423
It consists of a main block, engine-house, doctor's house and
out-buildings. The main block is H shaped, and consists
of a basement and two upper storeys. The whole of the
southern long building, and the ends of the northern, are
wards for patients, the connecting piece consisting of kitchen
department below, and dining-hall above. In the basement of
the southern building are baths and lavatories. Adjoining the
wards are wide corridors which form day-rooms ; and outside
these are verandahs. The total accommodation is for 103 beds.
Four large wards contain twenty beds apiece. These wards
are each divided into five divisions by partitions reaching half
way to the ceiling. Four smaller rooms contain each four beds,
besides which there are seven single-bedded rooms. All but
three of the latter are on the south side. Hot and cold water
are laid on everywhere; heating is by low-pressure steam,
lighting by electricity. The place is intended for men who are
not insured in the Sickness Insurance Companies. The charges
are 2 marks per diem. The site was given by the city of Ham-
burg, as well as £3000 per annum for five years. The total
cost of the building, etc., amounted to nearly £17,600, two-
thirds of which was given by Herr Siemers. Dr. Bitter is
medical ofiicer.
The second Johanniter Hospiz at Lippspringe has been con-
verted into a sanatorium with twenty-five to thirty beds.
The Bonusdorf Sanatorium for 100 men is expected to be
ready this year, after which the above will be devoted to
women.
Another sanatorium is to be built for the Minden district at
Lippspringe in a pine wood. It is to consist of two blocks, each
with fifty beds, one for evangelical, the other for Eoman Catholic
patients. Each block has a separate kitchen, but the adminis-
trative block and disinfector, douche and bath-room, isolation
hut and mortuary are to be in common. The site has been
given free by the parish. The building is expected to cost
£17,600 and to be ready this year.
The Schleswig-Holstein Insurance Company has plans for a
sanatorium, for which a site has been offered.
Digitized by LjOOQIC
424 APPENDIX.
EHINE DISTRICT.
Alberschweiler, — The " Franzosenmiihle " has been converted
into a sanatorium for Lorraine with forty to fifty beds. Further
additions will be made.
Braunfels, near Wetzlar, was conducted for a time by Dr.
Liebe (formerly of Loslau) as a provisional sanatorium for pay-
ing patients, but was converted in November, 1899, into a
popular sanatorium, as another private sanatorium was being
prepared at Waldhof-Elgershausen.
The Braunfels Sanatorium consists of a main block, in which
the doctor lives, with two gardens provided with shelters, and
of thirty-two beds distributed among six neighbouring houses.
Cohlenz. — A sanatorium is projected for this city.
Cologne, — The Lindenburg Hospital now receives consump-
tives.
Crefeld, — A sanatorium is projected for this town.
Naurod Sanatorium is being built near Niedemhausen in
Hesse-Nassau. There will be beds for thirty men and twenty
women ; a separate doctor's house, manager's house and dining-
room.
Lamje7ibergy near Olsberg on the Ruhr. A sanatorium of 150
beds has been planned for the Bochum Trades Union.
Eohrbacher Schldsschen. — A convalescent home for consump-
tives and others was opened here in January, 1899, by a
Heidelberg Benevolent Society. Dr. HoU of Heidelberg is
medical officer.
Buppertsham Sanatorium has been considerably enlarged.
A new wing has been added, raising the number of beds to
ninety for men and thirty-two for women. A new kitchen and
dining-rooms have been built between the two wings, and
engine-house at the back, and a separate house for the doctor.
Water-closets have been substituted for earth-closets.
Rossbach, on the Sieg. — A sanatorium is being built here for
100 men.
Soden. — There is a sanatorium here for poor Jews, the
majority of whom are consumptives. Dr. Hughes and Dr
Rothschild are medical officers.
Digitized by LjOOQIC
APPENDIX. 425
Sonnenberg, — A sanatorium is being built here for the Saar-
briicken district.
Treves is to have a sanatorium near Wittlioh.
Werden, on the Ruhr. — A sanatorium is to be built here.
Liebe states that £30,000 has been collected for the purpose.
Waldhof-Elqbbshausen.
A new sanatorium for paying patients has been opened here
in a country house which belonged to the late Prince Albrecht
of Solms-Braunfels. Situated on the south-eastern slope of the
Westerwald, on the watershed between the little rivers, Dill and
Ulm, with distant views of the Taunus, Feldberg and Alt Konig,
the sanatorium stands 375 metres above the sea-level, on similar
soil to the well-known Falkenstein Sanatorium. It consists of a
main building which was originally an abbey attached to a large
church, a small administrative block, formerly a hunting lodge,
a new residential block and various out-buildings. The main
block contains on the ground floor a kitchen, staff-rooms and
dining-room for second-class patients ; also reading-room, dining-
room and two bedrooms for private patients. On the upper
floor are a ward with fourteen beds, the doctor's rooms and
two rooms for private patients ; and in the attic floor a ward
with thirteen beds, and rooms for nurse and servants. Next
to the entrance is a room for changing dirty boots. The
administrative block consists of consulting- and waiting-rooms,
laboratory and office. The new block contains two wards on
groimd floor and first floor, respectively ; each with seven beds.
In another building are benzine motor, dynamo and accumula-
tors, laundry, bakehouse, bath- and douche-rooms, disinfector
and mortuary. The stables and cowsheds are in another out-
building. Surrounding the place are pine woods, on the edge
of which are three '' liegehallen " and an air-bath. A pond
serves for boating and skating.
The total accommodation comprises fifty-five second-class
beds for men who pay twenty-nine to thirty-one marks per
week, and four first-class rooms for patients of either sex at
fifty to sixty marks. Further additions to the latter are con-
templated. The rooms are painted with enamel and oil paint,
Digitized by LjOOQIC
428 APPENDIX.
WiLHELHSHEIH SaNATOKIUH
in Wurtemberg, in the Black Forest, at Schiflbrain, was opened
in September, 1900. It stands 435 metres above the sea-level,
on the south side of the fairly steep slopes of the Lowenstein
Mountains, overlooking the Murrthal. It is well protected by
woods and hills to the north and east, and fairly well to the
west. The building, which has three storeys and attics, stands
on a terrace surrounded on three sides by woods, the ground
rising 50 metres behind it, and falling in front about 260 metres
to the bottom of the valley. A separate doctor's house stands
a little to the north-west. The sanatorium, which is intended
for men, contains sixteen rooms for three apiece, and eighteen
with fifty-two, or 100 in all. The capital, which amounted to
300,000 marks, was borrowed at 1 per cent, for ten years from
the Wurtemberg Savings Bank, and was met partly by the
State, partly by the Wurtemberg Insurance Company, partly
by the Central Sanatoriimi Committee in Berlin, and partly by
boards of guardians, sick benefit societies, manufactories, private
donors, etc. Dr. Knapp is medical ofl&cer. The Oppenweiler
Railway Station is four kilometres distant.
HOLLAND.
Most of the Dutch consumptives who undergo sanatorium
treatment go to the German or Swiss sanatoria. The Dutch
sanatorium in Davos has been already described. There isi
however, now a sanatorium for paying consumptive patients in
Holland.
The Sanatorium of Putten op de Veluwe
was founded mainly through the exertions of Dr. P. K. Pel.
It consists of a solidly built house in the usual style of Dutch
country houses, with basement, ground floor and first floor. A
verandah, festooned with creepers, runs along the south and
west side of the ground floor. The floors are covered with
linoleum ; the furniture is fairly simple and cleansable. The
windows are of the ordinary English kind, provided with louvre
blinds to keep out rain. Surrounding the house are gardens
Digitized by LjOOQIC
APPENDIX. 429
and woodland, with sheltered paths and a large reversible
**liegehalle". Sputa are treated with hetol. Disinfection is
done with formaldehyde. Heating is by closed stoves. Light-
ing by gasoUne glowlights.
The charges, including everything excepting personal laundry
and beverages, are from 3^ to 6 francs per diem.
There is a railway station within a short drive.
The physician is Dr. Haentjens.
Sanatoria fob the Poor
are being built at Hellendoom (Province Overgssel) and at
Orange-Nassam-Oord (Province Gelderland). The former will
have fifty beds. The latter resulted from a popular subscription
of 300,000 florins given to the Queen-Eegent on the accession of
her daughter, Queen Wilhelmine, to the throne. The greater
part of this sura was given by the Queen- Regent for the erection
of a popular sanatorium, together vdth one of the royal parks
for a site. This sanatorium will contain 100 beds, and be prob-
ably ready for use this year.
ITALY.
A national league with more than fifty branches has been
established in this country. In addition to the private sana-
torium of Prof. Maraghano at Nerviy and a special block at
the New Hospital at Monza, a number of sanatoria are projected
or being erected. Amongst those projected are, one at Ariz-
zano ; one of thirty beds for Padua in addition to an asylum of
100 beds for incurable consumptives ; a sanatorium for paying
patients near the Cascade della Marmore in Umbria ; one for
Naples, to receive both poor and paying patients ; one for Sicily ;
one for Tarentum ; one for the poor at the foot of the Alps of
Cadore; one at Palermo; one for Novara Pisa and Salerno,
and one for Milan, Prof. Cozzolino informs me that a large
sanatorium for full-price patients has been built on the coast
at Palermo. They are treated according to Prof. Cervello's
methods (inhalation of formalin and iodine).
Digitized by LjOOQIC
432 APPENDIX.
Sanatoria are projected at Moscow^ Kieff, Warsaw, and else-
where. For the one at Moscow a gift of £20,000 has been
received. At Kieflf the town has granted a free site. In Finland
an organisation has been formed to erect a number of sanatoria.
The State is to find the cost of erection and part of the cost of
maintenance, the commune of the patient paying the balance.
In addition to this, a society of Finnish doctors in Helsing/ors
are building a sanatorium at Numela, near Lojo, between
Helsingfors and Hango. Land to the extent of sixty hec-
tares has been given by the State. The houses are to be
of stone, and to accommodate fifty to sixty patients.
Another sanatorium is being erected by the Finnish Medical
Society, Duodecim, in Helsingfors, at Pungaharju, near Nyslott,
on the Saima Lake. The sanatorium is to contain beds for fifty
patients. A grant of thirty to forty hectares of land has been
received from the State.
In Russian Poland a sanatorium for the summer months
existed from 1879 to 1882 in Mienia, about an hour's journey
from Warsaw. Twenty patients were poor, the rest being
paying patients. The head of the movement was Dr. Dobrzycki.
The treatment was according to Brehmer's teaching. In 1899
the Hygienic Society projected a sanatorium with 160 beds for
poor patients, estimated to cost £30,000. Dr. Chrostowski of
Warsaw has an independent scheme for a sanatorium for sixty
patients four miles from Warsaw. A temporary pavilion for
the open-air treatment has been set aside at the hospital at
Lodz in the outskirts of the town. It has a garden and ''liege-
hallen ".
SPAIN.
According to Cortezo ^ a sanatorium is being erected at Las
Navas, 1200 metres above the sea-level and two hours by rail
from Madrid.
Porta Coeli.
A sanatorium has also been opened at Porta Coeh near
Valencia, mainly through the exertions of Dr. MoHner. The
Qiieen Eegent has accepted the Protectorate and help has been
^ Berlin Tuberculosis Congress, 1899.
Digitized by LjOOQIC
APPENDIX. 433
obtained from Spanish students, workmen's unions, etc., with a
state subvention. The place, which was formerly a convent
belonging to the Carthusians, dating from the thirteenth cen-
tury, covers 14,000 square metres of ground. It consists of two
large sleeping pavilions with a southerly terrace, standing on a
small hill surrounded by an amphitheatre of pine-clad moun-
tains. Behind it is the Sierra de Naquera. The soil is Trias ;
the altitude 360 metres above the sea-level. The sea is nine
kilometres distant. The mean annual temperature is 22"^ C,
the mean winter temperature 14*". Some beds are for paying
patients. Ten free beds are reserved for Germans.^
SWEDEN.
The large sum of money given by the people of Sweden to
the King in 1897 to celebrate the twenty-fifth anniversary of
his accession has been set aside for the erection of three sana-
toria, one in the south, one in the centre, and one in the north
of the country. Each is to have 100 beds in winter, 120 in
summer, and is estimated to cost £25,000 for erection and a
capital sum of £33,000 for maintenance. The Eeichstag con-
tributed over £47,000 and offered the necessary sites on State
domains as well as large quantities of timber. The first of
these sanatoria is stated to be nearly ready for use. The
charges are to range from under 4s. per week to nearly 27s.
per week.
The northernmost sanatorium will be in 63° north latitude,
higher than any other in Europe. The mean temperature here
is 2° to 3° C. Snow lies on the ground 155 days in the year.
The central one, Holahali, lies between 59** and 60° north lati-
tude, where the mean temperature is 4° C, and snow lies on
the ground 100 days in the year. It will be 100 metres above
the sea-level. The southern sanatorium is at 5T to 58° north
latitude, 225 metres above the sea-level ; the mean annual
temperature here is 6° G. In every case the selected site is on
gravel, on a southerly slope covered with pine forests, with
mountains to the north. As regards rainfall, at the northern it
averages over 400 mm. ; at the central one, 600 mm. ; at the
^ Domini, Und.
28
Digitized by VjOOQIC
434 APPENDIX.
southern, 550 mm. yearly. The two southern sanatoria will
be on three floors, sohdly built. The northern will consist of
four one-storey wooden buildings, each with twenty-five to
twenty-seven beds, united by a corridor. ** Liegehallen " will be
placed in front of the cellars, or some distance from the house.
At least 7*5 square metres floor space and 30 cubic metres will
be allowed per bed, and in single-bedded rooms much more.
The floors are to be of concrete covered with linoleum. The
sexes will be separated excepting in the dining-rooms. The
other common rooms can be thrown into one. The kitchens
and farms will be quite separate from the patients' quarters.
The doctor's house overlooks both the entrance and the " hege-
hallen ".i
SWISS SANATORIA FOR PAYING PATIENTS.
Aboba.
Dr. Jacobi's Sanatorium has been enlarged by the addition
of a west wing. The number of beds is now eighty. The
whole establishment is heated by low-pressure steam pipes.
Davos.
The Platz and Dorf are now continuous, with Dr. Turban's
Sanatorium at one end, and Dr. Dannegger's Sanatorium at
the other. High up on the Schatzalp a new sanatorium baa
been built for Dr. Spengler, the son of a well-known physician
recently dead. A number of other sanatoria are advertised^
some of which are probably more correctly to be called hotels
or pensions. Among these are the Hotel BelvdcUre (Dr. Douty)>
the Eeilanstalt (Dr. Michel), the International Sanatorium (Dr.
Humbert), the Kurhaus Clavadel (Dr. Frey), the Kurhaus
Seehof (Dr. Philippi), the Schulsanatorium for Girls (a sort
of model day-school) and the Sanatorium for Girls (Dr.
VoUand).
The New Davos Dorf Sanatorium is now under the care of
Dr. Hafeli, formerly at Heiligenschwendi. Proprietors, Frei
and Neubauer.
^ Linroth, Berlin Tuberculosis Congress, 1899.
Digitized by LjOOQIC
APPENDIX. 435
The Scmatorium Davos Dorf was erected in 1898. It stands
back from the road in an elevated position, enjo3ring plenty of
sunshine. The building is of stone, and has four floors, includ-
ing the basement There is a verandah on the south side of
the latter, and balconies are found on every other floor, the
two lower being continuous from end to end of the building.
Hydraulic lifts serve every floor. Long corridors run from east
to west, nearly all the patients' bedrooms being to the southi
and offices to the north. Heating is by low-pressure steam
pipes, lighting by electricity. Attached to the main block by
a passage is an annexe, the Villa Maria. The proprietors are
Hvalsoe and Henrichsen, Danes by birth. The medical
director, Dr. Dannegger, with an assistant physician, lives on
the premises. Dettweiler's flasks are compulsory. The sputa
are washed down a special sputum sink. Disinfection of rooms
is done with formalin. Hydrotherapy is employed. Five meals
a day are provided. There are sixty-five beds.
The Schatzalp Sanatorivm is a large building 300 metres
above Davos Platz, 1866 metres above the sea-level, connected
with Davos by a funicular railway. Behind it to the north is
the mountain, spread out in front are the pine woods over-
hanging Davos.
Attached to the sanatorium are over forty hectares of land.
The building stands on a large terrace, and enjoys an extensive
view over the Davos Valley, while its relatively open situation
gives it the advantage of plenty of sunlight. The ground floor
contains a number of large day-rooms, as well as laboratory and
consulting-room and the doctor's quarters. In front of it is a
long covered way, leading at the sides to the two " liegehallen ".
The three upper floors consist mainly of bedrooms placed north
and south of the corridors, with here and there a solarimn.
There are in all about 120 bedrooms ; about seventy-five of these
are on the south side, mostly provided with covered balconies.
Bath-rooms, staircases, water-closets, liDen-rooms, and those for
servants, are entirely on the north side. The kitchen is on the
groimd floor to the north-east, and projects beyond the other
floors. The heating is by low-pressure steam. There is also a
steam disinfector and a complete douche and bathing department
on the ground floor. Lighting is by electricity ; electric bells and
Digitized by LjOOQIC
436 APPENDIX.
telephone connect varions parts of the building. The rooma
are roomy, with painted panelled walls and floors covered with
linoleum over felt. Wardrobes are let into the walls, and
furniture is washable. Doors are double, and walls specially
constructed to hinder passage of sound. Windows are double^
provided with ventilators which can be regulated, and with
outside blinds. There is a covered way to the railway station,
and telegraphic and telephonic communication with Davos.
Dr. Neumann, the house physician, lives in the building. Dr.
Spengler, the medical director, visits the sanatorium from
Davos every day.
Charges for medical attendance, 12*50 francs per diem, extra
for medicines, beverages, massage and night nursing. Booms
are from 2 to 15 francs per diem. A charge of 7 francs is made
for disinfecting the room on departure, as well as an entrance
fee of 20 francs.
Tlie German Sanatorium at Davos is being built near the
Davoser See not far from the Wolfgang Station. It is intended
for middle-class patients, but the fees will be moderate. There
will be forty beds for ladies and forty for gentlemen. The
situation in the pine woods is good and sunny. The building is
elongated with rooms to south of the corridors, and oflices^
bath-rooms, etc., behind. In front of the rooms are verandahs
and " liegehallen ". It is expected to be ready in autumn, 1901.
Leysin.
At Leysin the sanatorium has remained unaltered from the
description given in our first edition. But the Mont Blanc
Hotel is now much enlarged and is called a sanatorium, the
newer portion having been specially built for the purpose. It
contains about 120 beds. The charges are from 11 to 19
francs per diem. East of the Mont Blanc Sanatorium is a
cheaper sanatorium of 120 beds, built by the same company
as the other two. The charges will probably be about 8
francs per diem, and the sanatorium is likely to be ready for
the coming winter. Dr. Mayer is the medical director. For
the three sanatoria there will be seven resident medical ofl&cers.
The electric rack-and-pinion mountain railway connecting Aigle
with Leysin is now complete and in full working order. The
Digitized by LjOOQIC
APPENDIX. 437
Casino mentioned in our first edition has been bought in by the
company and abolished.
Montana.
The building described as a sanatorium in our first edition is-
now an hotel, into which consumptives are not adi^itted. Dr.
Stephani has built a sanatorium with seventy beds in the same
neighbourhood, and proposes to add another eighty beds.
SWISS SANATORIA FOR THE POOR.
The Basel Sanatorium at Davos now has eighty-six beds and
has been provided with a lift. The medical officers are Drs.
Nienhaus and Hosslin. The total cost is said to have been
650,000 francs, the daily cost 3*50 francs per diem.
The Heiligenschwendi Sanatorium has been enlarged to 110
beds. The medical quarters are still insufficient, leading to
frequent changes in the staff. The medical director is Dr.
Schwab in Bern. The daily cost in winter is 2*25 francs.
The Zurich Sanatorium was opened in November, 1898, and
has eighty-eight beds in three pavilions, one of which is for
men, one for women, and the third for the administration and
dining-room. These are united by glazed corridors and ** liege-
hallen". The daily cost is 3'03 francs.
The Braimwald Sanatorium has twenty-nine beds, and now
has a resident medical officer. Both sexes are admitted. The
daily cost is 3*82 francs.
The Asile pour les femmes^ Feydey, Leysin, was opened in
1894. It stands 1450 metres above the sea-level, and contains
fifteen beds.
The Asile pour les hommes at Leysin, opened in 1897, is 1263
metres above sea-level, and has fifteen beds.
Both of these were due to private initiative.
Leysin, — The foundations have been laid at Leysin of a new
sanatorium for the poor. The medical attendance will be given
by the doctors of the existing sanatoria ; the founders and
supporters are a Vaudois Charity Organisation Society aided
by private subscriptions and a cantonal subvention.
Digitized by LjOOQIC
438 APPENDIX.
The Sanatorium Malvilliers at the foot of the Tete de Ban,
Neuchatel, was opened in 1899. It stands 860 metres above
aea-level, and has twenty-two beds.
A sanatorium is projected for Geneva at Glairmont sur Sierre,
In the above sanatoria the charges vary from 2 to 5 francs
per diem.
THB ABEBDBSN UNiyEBSITT PBES8 LIMITED.
Digitized by LjOOQIC
INDEX.
Aberdeen Sanatorium 338, 830
Acbtermann, Dr. 67* 150, 177, 186
Addenbrooke's Hospital 32 ^
Adirondack Cottage Sanitarinm x8, ao, 33,34,
61,65,77,79.83,84
„ Mountains 84, 87
Administration 59
Admission of patients i, 49, 57, 60, 63
Adorf Sanatonnm 422
Aegerl Sanatorium for children 383, 999,
310
Africa, South 412
Agnetz Sanatorium 12S
Agricultural Colonies 62, 141, 313, 416
Ar2le2m
Aiken Cottages 84, 06
Aix*la*Chapelle 2|6
Alabama— se< Hygeia, Convict Camp
Albersweiler 206, 424
. Albertsberg 22, 46. 75, 78, 206, 922, 419, 420
Albrecht, Archduke X2i
Albrechtshaus Sanatorium 206, 382, 421
Alcohol 4^
Aidemey Manor Sanatorium 348, 361, 882
Alexander Sanatorium, Halila 273, 277
Alexander, Dr. ^70, 374
Algiers Sanatorium i2j
Alland Sanatorium 120
Alps of Cadore429
Alsace-Lorraine 206, 260
Altadore Sanatorium 348, 389, 890
Altena Sanatorium 7S> 77t 206. 2|6, 248, 422
„ Johanniter Isoliranstalt 78, 251
Altenbrak Sanatoria. 148-9, 167, 206, 280
Alteration of existing buildings 73
AlUtude 5, 13, 14, 54. 73
Altona Sanatorium 7St 346
America-^M Canada, United SUte8
Angicourt Sanatorium 128, 4x6
Angney, Dr. 07
Arcachon, 129
Ardennes, Belgian 31 x
Ardes 136
Area required 16, 93
Argentine Republic 407
Arizxano 429
Arlen Sanatorium 78, 206, 961
Arosa Sanatorium tq, 283, 284, 434
Asheville (su also Wlnyah) 401, 402
Ashford 349. 354 , .
Asile pour les femmes, Leysin 437
Asile pour les hommes, Leysin 437
Askwith 334
Aspect 13, 21
Assistance Publique 80, 127-8
Assouan (Egypt) 312, 413
Atmospheric purity 14
Auchterhouse 338, 343
Aufrecht Dr. 63
Augusu-Viktoria Heim 426
Aussee(Styria)ia6
Australia 315, 407
Austria-Hungary, Sanatoria In x 90, 408
Avants, Les 283
Bacilli, Tubercle 28
Baden 48, 190, 199* 30X, flo6, 26x-«, 427
,. (Vienna) 121
Badenweiler Sanatorium I2i,201
Badische Anilin und Soda Fabrik 2)7
^rT^m.
108
Baker, Dr. R. Langworthy 358
Balconies, 19
Baltic Coast 207, 2x4, 277, 2S0
Banchory 383, 386
Baracken, Dockersche, 73i 3i7, 334
Bardswell, Dr. NoSl D. 387
Bariatinsky, Countess 273
Basel Sanatorium— s«c Davos
„ Gemetnnutzige Gesellschaft 399
„ Hilfsverein fur Lnngenkranke 303
Bathrooms 20
Baths 36
Batthyani, Count X30
Battle Creek Sanitarium X09
Baudach, Dr. 197
Bavaria 206, 263, 265
Beaulavon, Dr. 52, 112
Beds 45. 58, 88, 54I
Beelitz Sanatorium 206, 214
Belsium 311, 408
Bellevue Sanatorium (Durham) 348
„ Sanitarium (Colorado) 84, 112
BeUis Sanatorium 76, so6, SMi 216, 418
Beneke, Dr. 13
Bentley, Dr. 312, 413
Berck-sur-Mer 128-9
Bergen Sanatorium 430
Berka, Bad 206
„ Sanatorium 206, 211, 432
Berlin 216, 219
„ Brandenburg Sanatorium Society
203-1.214-15,419
„ Charitd Hospital 418
Bexhill-on-Sea 361. 363
Birkenbusch 418
Black Forest Sanatoria «, x8, 148^ 190, 196,
X99, 301, 260, 26f-2, 428
Black Sea. sm Quisisana
Blairgowrie 38), 385
Blankenfelde Sanatorium 76^ 206, 314, 216^
Blanlcenhain X48
Bleichrdder Sanatorium 306, 3x4, 216, 418
Blumenfeld, Dr. F. 14, 35
Boarding Houses 2, 18
Bockryk-(2enck-les-Hasselt 311
Boeme— se< White Gables Sanitarium
Bohemia 120, 408
Bonsecours Convalescent Home 3x1
Boots and Shoes 27
Bordeaux 4x5
Boston 91, IIS, 40X-3
Bonlder-^sr< Colorado Sanitarium
Bournemouth 5. 323-5, 361, 366, 368
Bowditch,Dr.V.Y.66,92
Bracknell 356
Bradlbrd-on-Avon 327
., (Yorkshire) 324
Braine-Kartnell, Dr. 370, 373
Brandenburg 203, 206, 9t4—su Berlin
Braunfels ^24
Braunwald Sanatorium 309, 437
Brecke, Dr. 2x9
Brehmer Sanatorium— sre G5rbersdorf
Bremen Sanatorium 75, 203, 206, 216
Breslau2o8
Br^vannes 120
Bridge of Weir Sanatorium 338, 841
Bridgwater 377
Brinklea Sanatorium 348, 361, 862
British Colonies 315. 408, 412
Brompton HospitalSanatorium 321
Brooklyn Home for Consumptives 1x5, 1x8
Brookside, Clare. 348, 84*8
Brown, Dr. 370, 378
Browne, Sir J. Ciichton, 30
Bruckenau 148
Brunswick Sanatoria 303, 232
Bnch4i8
Budanest X20
Buildings in relation to climate 35
Bulgaria 31X
Digitized by LjOOQIC
440
INDEX.
BnrtOD-Faimlng, Dr. STOf 378
Baser, Dr. 304
C«UfomU84t 112
Camberwell Infirmary sso
Canadian Sanatoria 316, 408
Canary Isles 410
Canigou Sanaiorimn 34, 60, ity; ngflSO
1415
Cape Coloby 3x6. 4x3
Carolagr&n Sanatorium 4x9
Carolina, North, jA 66. 79, 83-4. 97
„ South, 84, 98
Carpathians, 124
Carpets, 36
Cascade della Marmore 4J9
Cassel~M« Oberkauiungeo
Castlereagh Hills 343
Cataract Hotel 414
Cauldwell, Dr. xiy
Ceilines as
Cervello, Prof. 439
Chalk Downs. 15
Channlng Home (or Consumpdves 1x3
Charees at Sanatoria 78
Charieville, Queensland 316
Chateau de la Tisnire 414
Chaumler, Dr. 145
Cheddar 324
Cheltenham 370
Chestnut Hill Hospital 84,96
Chicago IIS, 401
Chico Springs Sanitarium 40X
ChUdren, Sanatoria for 3, 47. 79. 9h "9. »39.
X45, 307, 373, 379, 383, 399, 3x0,
370, 419, 134
,, Schools for delicate, 370, 396
Chlltem Hills 35a. 357
Chimneys 23
Christiania 430
Chur 387
Cimiez 415
Citronelle-jrr Hygeia
Clairmont sur Sierre 438
Clar, Dr. Conrad 120
Claremont (Cape Colony) 413
Clare (SuflFolk) 323
Cleansing and Disinfection 24, 38» 30
Chermont-Ferrana 133
Climates, cool, bracing 4
„ esHcntial factors s
„ for consumptives 4-6, 9, 33-3
„ mountain 5, 6, 13, 383-310
Climate only one factor 6, 0, 33
„ The building in relation to 83
Cloak-rooms 20
Closed or open sanatoria a
Closets 30, 30. 31
Clothing 36. 46
Coblentz 186. 424
Colchester 323, 378. 379
Cold-catching 11,36
Colebrook, Dr. Esther 358
Cologne 424
Colonial sanatoria 315
Colorado 9. 25, 4'>. 62. 79. 84. 102-3, io9t "i-xt
„ Sanitarium 40, 79, 84, 108
Common rooms 25
Construction of a sanatorium 18
Convalescent Homes— see Homes
Convict Camp. Alabama 40X
Conway 376
Copenhagen 412
Corners 24
Comet on Altitude 14
Corridors 18, 23, 34
Corsica 128
Cost of a Sanatorium 71, 73
„ Home treatment 69
Cotswold Sanatorium 348, 870
CotUge Sanatoria, 18, 19, 73, 77, 84, 88, 9s,
98-9, 190, 309, 216, 236, 360, 316
CoCtbos Sanaioricm 418
Qmh^ or town X4, 73. 394
Ctainliem Tervoeren 311
Ci«field,434
Cromer 33, 334— «r« also ICundesIey
Crooksbnnr Sanatoriam 348, 849
Crouaet, Dr. 134
Cubic space 23
CayU Homak Boalott xis
Cumberland Saaalorlam 8M
Curtains 3s4S
Csirfaas, Dr. Desaoe X33
Dalby. QoeeDslaiMl 316
Danish Saaaieria 413
Danoegser, Dr. 391, 434
Dannenlsls Sanatorium, 76, 306
Dantxigao7-8
Davos 10, M, 60, 75, 70, 80, 383, f87, 388, 434
„ Basel Sanatoiium 3S, 60, 73. 73. 7^ 8*^
383, 388, 299, 477
„ Benevolent Society 388, 306 '
„ Dr. TurlMm's Sanatorium 383. 288
„ Dutch Sanatorium 80, 383, M, J99,
»M, 438
„ English Invalids* Home 383, aS8, 506
„ Goinan Sanatorium 486
„ Bfalson des Diaconesses 383, 3S8, S93,
„ New Sanatorium 388, 291, 434
„ Villa Pravignan 383, 388, 393. *99
Death-rate from Consumption 393
Debove, Dr. on forced feeding 43
Decoration xs, 18
Deeside Sanatorium 33^ 333
Definition of a Saaatonum x
Delamere Forest Sanatorium 323, 335
Denver, The Home, 25, 63, 79, 84, lOfr— «m
also Downham
De Peyster Hospital for Children 79, 84, 91
Deiecq. Dr. 140
Dettweiler, Geli. Dr. 10, 16, 35, 43, 53, 55, xyy,
803
Devon and Cornwall Sanatorium 324
Diaconesses, Maison des— sm Davos
Diet 8, 41
Differences in treatment 49
Dlllenbnrg 148
Dining Saloon 19
Dirt 13
Disinfection 36, 38, 30, 31
Diver, Dr. 383
Dlvonne Hydro. 31 x
Dockersche Baracken— Me Baracken
Doctor, the Family 64
Doors 33
Douche 30, 33, 36
Douty, Dr. 434
Downham Sanatoria 324
Dresden 164, 422
Driver, Dr. 53, 160, 164
Dublin Sanatorium 344
Duncan, Dr. Ebenezer 388
Dundee Sanatorium 338, 848
Dunstone Park Sanatorium 348, 370, 87S
Duodecim Society, Finland 273, 432
Durham Sanatorium 323, 882, 382
Durtol Sanatorium 127, 129, 182
Dusseldorf 206
Dust s, 12, IS, 34, 36, 27
Dutch Sanatoria 304, 438
Dyspepsia and other complications 44
Eastern English Sanatoria 378
East Anglian Sanatorium 348, 378, 879
Eberswald 426
Edinburgh 338, 339, 383, 388
Edmundsthal Sanatorium 422
Education of patients 47
Eggs 44
if^.
ibachthiu 436
Digitized by LjOOQIC
JNCBX.
441
Blbeandstein Workers 225
Aleetrielty 33
BUcershaiisen Sanatorium 424, 425
BUaabeth,VUU43i
EUerfaorst, Dr. 215
Bms 148
Binskopf«)6
Engehhal Saoatorlom 206, IS6
Ennui 63
Brfnrt Johanniter 206
„ Sanatorlam 243
Brzgebirge 148-9, z6o, 222
Asnenz 3x1
BnlengebirM 208
Bvans, Dr. F. H. 370, 374
Bversley 358
Ewart, Dr. Wm. 284, 336
Bzcbaqoet, Dr. 29s
Bxerciae 12, 16, 38, 40
Extension of Sanatoria 73
Factory i^
Failcenstein Sanatorlam xo, s8-o, 34-6, 5s, sSi
^. 67, 76, X48-9, 177. 246
Faltigberg Sanatorium -set Zurich
Fanning, W. J. 381
Farnham 349. 359
Famley 354
Feeding, forcible 43
Feketebegy 125
Fellxstift 59, 78. 206. 211
Fclkin. Dr. R. W. 168
Felsbers 206
FemslcEt. Sulzbayn 421
Finland 273, 431*2
Firs Home 324
Firs. The—ue Mundeslev
Fletclier Convalescent Home, Cromer 3S4
Floors 24
Florence. New 99
Fod6r6 13
Fdhr207
Food, preparation of 41-3
Foodstuffs, proportion of 41
Fosses Mouras 302
Foundations 20
Fox, Dr. Wilson 65
France, Soutb of 4
Franconia. Upper 426
Fr&nlcel, Dr. 10, xi8
Franlcfort 177, 303
Fran«Menmuhlei24
Free Home for Consumptives, Botfton 1x5,
402
.( for the Dying 320
French Agricultural Colonies 144
Fresh air treatment 33
Fri«denheim 330
Friedrichroda 241
Friedrichsheim Sanatorium 426
Fruit and Vegetables 42
Furniture 12. 18, 26. 46
Furth436
Gabriel's Sanitarium 83, 84. S7
Gabrilowitsch. Dr. 278
Galbraith, Dr. 383, 389
Games— SM Recreation
Garfield Memorial Home xi8
Gateforth Hall 334
Gausdal Sanatorium 370
Gebbard, Dr. 501 56. 203
Gebser, Dr. 323
Geissler, Dr. 431
Gelderland 429
Gerhardt. Dr. 10, 204, 207. 2 to. 2x6
German Insurance Law 80, 204
G*^rmany compared with England 393^
Ghitsman. Dr. J. W. 97
Giresse. Dr. 60, 133
Giants. Sanatorium for 399, 309
Glaser. Dr. 308
Glasgow Sanatorium 338
Glcckner Sanlurium 70, 84, i03
GkMcester. Wilu and Somerset, Sanatorium
for. 324, 827
GliickaufSanatoriimi, 421
Gdrbersdorf, Brehmer Sanatorium. 16. X7, 53,
55. 58. 7x. 79. 148^
1 0. 4x7
„ „ and class, 149. 15% 306
„ R5mpler's Sanatonum, 18. 66.
149-50. 155
„ Weicker's Sanatorium, 53-3*
149-50, 167, 308
Krankei * '
kenheim, 53,
149,206,206.200
GorMo Sanatorium, 414
Grabowsee Sanatorium. 76. 78. 206, 3x4. 216,
4x8
Grampians Sanatorium 3x8, 881
Grange over Sands 338. 382, 383
Graz, Styria zao
GrefiMn sanatorium 430
Gross Muritz 207
'Gross Tabarz 243
Grounds, The Sanatorium z6
Guimar Hospital, Teneriffe 412
Gwynne. Dr. 370. 376
Hifeli. Dr. 434
Hague, The 313
Halley Sanatonum, 348, 349. 85 1
Halila. Sanatoria at 23, 273, 277, 279, 431
Halkin Sanatorium 323, 837
Halle 75
Hamburg 346, 422
Hampshire Sanatorium 324
Hampstead Chest Hospital ~5M "North
London
Hance, Dr. 66
Handkerchief 29
Hanover 148-9, X7x, 303, 206, 246, 422
Harbourne Sanatorium 348. 349, 1:54
Harlaching Sanatorium 206. 265. 427
Harrogate 382
Hanh. Colony on the 243
Hannell. C. Braine 348, 370
Hassall, Dr. Arthur HUl 337
Hatzfeld, Count 308
Haufe. Dr. 33. 199
Haupt. Dr. 68, 69
Hauteville Sanatorium 4x5
Havre 416
UeaUh Resorts 3, X4, 68, X48
Heatherside Sanatorium 321
Heating of Rooms is. 33
Heidelberg (Germany) 424
„ (Australia) 315
Heidschloes (Holstein) 312
Heilanstalt Michel 434
Heilieenschwendi Sanatorium 39, 73-6, 79,
383. 399. »0«, 437 .
Hellstitten Correspondenz 204
Hellendoom Sanatorium 429
Helouan 312. 413
Helslngfors 432
Heron. Dr. 63
Hersbruck Sanatorium 426
Hess, Dr. 183
Heswall Sanatorium 323, 8S6
Hich-ns, Dr. P. S. 389, 39)
Hill Crest (Santo Clara) 40Z
Hillier. Dr.Alfr«-d3s7
Hdchst am Rhein 206
Hdckendoi f sx 1, sax
Uoff-nreich, Dr. 12 1
Hohenhonnef Sanatorium 19-30. 33. 35, 30. 34,
« ,5^ 7X. 75:^X18.% 177. IW, 379
Holieolobe, Countess 2 3
Digitized by LjOOQIC
442
-INDEX*
HdUhall Sanatorium 43
Holland \i2, 428
„ Queen of 304
Holne Chase Sanatorium 34I, 361, 161
Home^su Denver, Evenfield Hoaplta],
Fletcher Convalescent, Firs, MUdmay
Consumptive. Richmond, St. Ifichael*t
and AU AngeU, St. Catherine's
Home eomlOTts 63
„ for consumptive females sso
„ for the dying 394
„ of comfort for the dying, 324
„ treatment, expense of 6^
Homes Convalescent 2, 3, 906, 214, 3ix-i3,
3»8, 324
Nursing 1, 61, 318
for advanced consumptives 319, 324
for consumptives, American 84, kc3,
I1& 117-18, 401 '
„ Belgian 311
„ British 32), 324
BritUh Colonial 3x3
„ Danish 312
„ Dutch 313
„ French 1271 '44
„ German 169, 203,
207-8, 21S, 219, 224,
«39. 243, 252. 256
„ Hungarian 123
„ Italiau 313
„ Russian 27s
„ Spanish 314
„ Swiss 293, 306
Honnef 186, 2-6- ue also Hohenhonnef
Hopeless cases 61, 293, 319, 324
Horn Hail Sanatorium 323, 3a
Horsham 349, 338
Hospital, Alexandre 272-3
Alexandrina 272-3
August, 47
Austin 315
Belfast- ^e* Forster Green
Bellevue 66
Belvedere 414
Berck-sur-Mer 128
Bergen 271
Bicfiat 129
Boucicaut ?29, T46
Bowdon 323, tiSS
Bridge of W#>lr 338. JMl
Brompton Chest ^6, 65, 319, 8i0,
o 393 ,
Broussals 129
Charity 216, 418 •
Charity 66
City or London— s^tf Victoria Park
City Road— sr« Royal Hospital
Clewer— s*# St. Andrews
Cochin 12)
Consumption, for Ireland 344
Cork Co., for Consumptives 4 .1
Craigleith - stt Victoria
Dc Peyster 79. 8a, M
Edinburgh set victoria
Eversfield (St. Leonards) 323
Forster Green (Belfast) 344, 816
Gulmar 4 2
Hampstead—M« North London '
Kief2?2-3
Laennec 129, 146
Laribolsiire 129, 147
Liverpool, for Dls. Chest, 323, 9U
Loomis 115
Magdeburg 65
Manchester, for Consumption 3,
323. 336
Massachusetts State, for Con-
sumption 79, 8^4,-92, 91, 403
Metropole, Las Palmas 412
Montpelller 129
Mount Vemon^j^f North-London
Hoq^tal, National Cmisnmpdoo, far Iretond,
344
„ Newcastle-on-Tyne— s«r Northen
Counties
„ Newcastle (Ireland)— Me Nattooal
„ Northern Counties, for Consomp-
iion332
„ North London, for Coosmnption
• 319, asi
„ Ormesson 14, 80, 129, 110, 4x0
n Obonchowsky 272-3
„ Philadelphia 84, 95, 9^ 406
„ PiU< 129
n Rhode Island, for Consmopdvet
406
„ Royal, for Diseases oi the Cheat
319
„ Royal National— <re Ventnor
„ Roma (Queensland) 316
„ Rush, for Consumptives 1x3, 406
„ St Andrew's (Windsor) 324
„ St Antoine im
„ St lorgen's (Bergen) 271, 430
I, ~ St Joseph's xis
„ St. Leonard's— «« Eversfield
„ . Seamen's, Greenwich 324
„ Tenon 129
„ Torquay— s«e Western
„ Ventnor 46, 77, 80, 323, 324, »27, 3/64
„ Victoria (Cndgleith) 338f 8J0
„ Victoria Park 319, 9U
„ Villiers-snr-Mame 14, 22, 24, 62, 83,
129, 141
„ Western, for Incipient Consamp-
tion 323, 8lf
„ Windsor— 5^e St Andrews
., Wola272j,j8J
„ Zarskoje Selo 272-3. 981
R0qHt>lSi Comparison with Sanatoria, 2, 36
62,76-7
„ for Consumptives 2, 74-77
Costof74. 76, 177
„ American 84, 91, 94-9^ ^^ ^^7
„ British 318
„ British Colonial 315
„ French 129, li6
Irish 344
„ Itahan 313
„ Russian 2ii
., Scotch 338
Hotels 2, 8. z8
Hotel du Pare, Montana 29s
House of Rest, New York 115, 117
., Mercy, Philadelphia 84, 95
Hull and Witbernsea Convalescent Home
- -324
Humbert, Dr. 434
Hnrd-Wood, Dr. 359
Hydropathic EstablishmenU 2
Hydrotherapy 2, 36
Hygela Sanitarium 79, 83 4, 9), 403
Ilmenau 245
Inder StUle-^ve Basel Sanatorium
Individual peculiarities 43
Infection 28-31, 6s €t seg.
Infirmary for Consumption 3x9
Inglewood Sanatorium 348, 361, 884
Insurance Companies 50, 56, 59, 78, 204^5,
2x0, 2x2, 214, 210, 223-4, 229-30, 232, 238^9,
241, 244, 246, 248, 250-31, 256 7. 260, 262
Insurance Co., Baden 257, 262, 425
„ Bremen— sfc Insurance Co.,
Hanseatic
„ Berlin Brandenbung 2x4
„ Brunswick 232
„ Hanover 241, 251
„ Hanseatic 50. 56, 59, 75. 205.
226, 229-30, 246
„ Hesse Darmstadt 256, 260
^' P£alz26o
„ Sachsen-AxJMlt 244, 412--
Digitized by LjOOQIC
INDEX.
443
Insurance Co., Saxony 12a
„ Schleswis-Holstein 423
„ Westpballan 250
Intelligence aids recovery 49
International Sanatorium, Davos 434
Invalids' Home, Davos 83
Isle of Wight 327, 36X, 364
Isplation Rooms 26
Italy 6, 3x3, 429
Itxerott, Dr. 215
. iackson, Dr. 92
, acobi, Dr. 286
, acoby, Dr. 35
^ acnbasch, Dr. 149, 167, 169
ames Brown Sanatorium 407
aoul. Dr. 141
apanese Sanatoria 313
onanniter Hospital 423
„ Society 206, 243, 427
Iohns' Sanatorium, Dr. 3)1, 362, 368
onsdorf Convalescent Home 206, 224
ossefowni, Grand Duchess 279
oumeys 8
ungfernhelde4i9
Kaatser, Dr 174
Karlcutsch, Dr. 221
Kaurin, Dr. Edv. 271
Keresztenysziget, 123
Kidd, Dr. L. 390
KieflF432
Kiel 273
Kimberiey Sanatorium 316
Kingussie Sanatorium —su Grampians
Kinross Sanatorium 383. 888
Kirlcby Lonsdale— see Westmoreland
Kissingen 14S
Kitchens 19, 20, ^
Klebs, Dr. loc-i
Knocksualuch Sanatorium 348, 383, 885
Knopf, Dr. 9, 10, $6
Kobert, Prof. Dr 150
Koch, Dr. Adolf 190, 196-7, 4*7
Kohler, Dr. 214
Kdnigsberg Sanatorium fS, 2:6, S89, 4i7r 421
Koranyi, Prof. lao
Kottbus2i4
Kiallling Sanatorium so5, 263, 427
Krankenheini, Dr. Weicker's 149, 206, 903
Kraus, Dr. 120
Kremser, Dr. 238
Kundig, Dr. 3 ^4
Kurhaus Clavadel 434
„ Seehof, 434
Kttthy, Dr. 74 et *eq. ; 124 et ug.
Laboratory 25
Ladendorf, Dr. 149. x67, X69, 231
Ladies' Home Sanitarium 40X
Lahmann's Sanatorium, Dr. 149, 161
Lamotte Beuvron 414, 415
Laneenberg. Dr. 424
Las Navas Sanatorium 432
Las Vegas Sanitarium 79, 84, 108
Latta Sanitarium 4 ix
Laubbach Sanatorium 79, 14^9, 177, 188
., „ 2nd class, 189
Laundries 30
Laurentian Saiutorium 408, 410
Lavatories 23
Lawson, Dr. 383
Leeds Sanatoria 323, 324, 881
Lehrecke, Dr. 149, 174
Leis^r, Dr. 193. 201
Le Menillet 4x0
Lemonfontein 412
Letulle, Dr. 14$
Leudet, Dr. 69
Leyden, Prof, von xo, 72, 203-4, t2x .
Leysin Sanatorium x8, 79* S83, 896, 609, 436,
Llebe, Dr. 76 et uq.^ 2x3, 414
Light tx, M
Ligne centre la Tubsrculose French ity
„ „ „ Belgian 31 X, 3xa
LiUe4x6
LiUehammer 430
Limburg Sanatorium 408
Limpley Stoke 3x7
Lindhelm Sanatorium 273, i74, 43X
Linen ^o, 31
Linfbrd Sanatorium 348, 349, 365
Lippe Dettmold 245, ^z
Lippert, Hofrath Christian xao
Lippsprinae 246, 4^3
Liverpool Hospital Sanatorium 323, 885
„ Sanatorium for the poor 323, 886
Livonia— s«< Lindheim
Lohr am Spessart 2o5
London Sanatorium 348, 349, 856
„ Chest Hospitals and Sanatoria 3x8
Loomis, Dr. Alfred 88
„ Hospi:al and Dispensary X15
,, Sanitarium 18, 23, 79, 83-4, 88, xxy
Lord, Mrs. 306
Lorraine 424
Loslau Sanatorium 78, 2o5, 2o3, SIS, 4x7
Luxor jX2
Lyon, Sanatorium for X28, 4x5
Lysterfjord 433
Macfie, Dr. R. C. 390
Magdeburg Sanatorium 420
Macny 128
Maitland House Sanatorium 3^, 349, 867
Malchow Home for Consumptives 76, 78, 206,
2XA. S19, 246, 41Q
Malviiiiers Sanatorium 438
Management of a Sanatorium 58, 2x0
Manasse. Dr. 52
Manchester Sanatorium 323, 837
Manebach Sanatorium 206, 2x3. 243, 24)
Manitou Park ixi
Margate, Royal Sea-bathing Infirmary 324,
Mari^'
193.
Sanatorium (Halila) 25, 273, S79
- - ■ In
Anna Heim, Prinzessfn 22s
Marienheim (Stieg^) 206, 2^1, 421
Married couples, Phthisis in 69
Marty-Martineau, Monsieur 136
Marzell Sanatorium 75, h8-9< 201, 2o6i 26S, 426
Massachusetts State Sanatorium 79, 33-4i 92,
94.403
May, Dr. Page 3x2
McCall, Dr. Annie 339
Meals, number of 42
Mears, Dr. 383, 3^9
Mecklenburg 207, 2x4, 418
Medical Ownership 00
„ Staff IX, ^8
„ Supervision 9, xx, 58
Meissen, Dr. 182
Mena House (Egypt) 312, 4x3
Mendip Hills Sanatorium 348, 370, 874
Mental influence xi
Mentone 416
Meran X26
Merseburg 214
Mesna (Norway) 430
Metz 236
Meung-sur-Loire 414
Mexico. New 84, xo6
Michaelis, Dr. 68, X49, 172, 174, 2|6
Michaelis' Sanatoria, Dr. 172, 246
Middelkerke 3x1
Middleburg 4x2
Mienia 432
Milan 429
Mildmay Consumption Home 324
Milk Stipply 40
Miller, Dr. Wm. 1x3-14
Minden 246
Mokle27o
Monaco 430
Digitized by LjOOQIC
INDEX.
Ifoatana Suuitoriiiin 27, za/, IJ9, 111
Moot. ^Bomnoiin Saiutoniim 97, 127, tag,
l9o
Mont. PacanacU* Sanatoritim xt7. iflo, IIB
Moote6ortt Home Conatrj Sanltarinm 7S» 84,
91
„ Home for Cbroolc Invalids 115.
, "7
Montrenz 383
lfon2ft439
ICoorcoce Sanatorioin 348. 349. 866
Morgan, Dr. Kiotey 361, ^
Mortality from coiuumpuoD 393
Mortuary a6
Moscow 373. 433
Mountain Sanatcnia in France 14^
Mundesley Sanatorium 348, 378. 880
„ The Firs 348. 378, 880
Munich, Sanatorium for 75. 3o6» 163, K6
Muslcolca Sanitarium 408, 400
Mustamaklii 373
Muthn, Dr. Chowry.361, 365
Nabm. Dr. €7
Nancy 416
Nannettl, Dr. Mary 383, 38s
Naples 439
Nathanson, Dr. 383
National Tastes and Customs to, 35, 4Z-3, 63
„ Sanatorium for Consumption and
Diseases of the Chest, Boome-
roouth 333, ^25
„ Hospital for Consompdon (Vent-
noT)—ue Hospitals
H Hospital for ConsumpUoo (Ireland)
—SM Hospitals
Naunyn, Prof. 10
Naurod. Sanatorium 434
Nervt Sanatorium 439
Neuchatel Sanatorium 438
Neudorf4i7
Neuschmecks Sanatorium 134
Newcastle, Widclow HllU— sm NaUonal
Hospiul for Cons. (Ireland)
Newcastle-on-Tyne 333
New Florence 63, 99
,. Forest 348. 349. 355
„ Zealand 313
„ York 83-4. 87^ 91.3, X15, 117418, 401,
H York Hospital and Dlspensai^ for
Consumptives 1x7
Nice 138
Nicolaj Sanatorium (HaUla) 373. 179
Niedemhausen 434
Noise 3s
Noisv-ie-Grand 144, 416
Nordemey 317
Nordrach Colonle, 18, 33, 34-5, 30, 34, 40, 60,
S, 1*8-9. »9o. 4*7
ettinxer's Sanatorium 437
„ upon Dee Sanatorium 148, 383, 886
,. upon Mendips Sanatorium 348, 94
North London Hospital for Consumption 3x9,
„ Stafibrdshlre Infirmarr ^34
Northern Counties Hospital for Consump-
tion 333, JI87
Norway 367, 430
Nottingham Sanatorium 333, 334, 887
Novara 439
Nuremberg Sanatorium—Me Engellhal
Nursing Y^mes — ^re Homes
„ Stair XX, 38
Oberkaufungen 306, 308. 17
Oberdlkofen 437
Oberpleis 346
Objections Answered 63
Obm&nner 310
Obouchowsky Hospital (St. Petersburg) ^73
Occupation 39, 46
Ochil HiUs Sanatoriom 348. 383,888
Odenwald^
Oderberg Sanatorium as, 30, 47, 31, 59* >o^
8t7, 431
CBuvre de la tnbercoloae w
u des enfanis tubercoleax 137, 1 "9
N des ieunes fiiles poitrinaires X97
„ des Hopitanx Maxins, 137
., des Hopitaux de Montagne 127
Oldenburg, Sanatoria in 346, 42a
Ontao43i
Open-Au- Treatment 33, 33X
Orance— Nassaus— Oocd 439
Oranienbufig 316
Orteans 415, 416
Ormesson— M» Ho^rftals
Osius, Dr. 308
Ostend3ii
Ott, Dr. 330
OuibulkUngs, PocUioo of tj
Overman 47. 3x0
Overton Hall Sianatorinm 348, 36X, 868
Oxfordshire Sanatorium 334
Padua 439
Paget, Peter 354
Paignton 373, 373
Palatinate so6
Palermo 430
Pannwitz, Dr. 303
Panxeri, Dr. 3x4
Paris 416
„ Mnnidpal Coondl so
Parramatta 3x5
Pasteur Sanatorium, New Yoric 401, 4tB
Peodynryn Hall Saxiatorlum 348, 370, 878
awr377
Petmsylvania 84, 95, 96, 401
Penxoldt, Dr. 46
Perthshire Sanatorium 3)8, 889
Petit, Dr. L^on 4. 14. 33. 58^. 7*
„ Dr. Georges, 140
Pfalx~-M» Speyer, Dannenfels
Philip, Dr. R. W. 389
PhiUppl, Dr. a9x, 434
Pine Trees 15
Plnewood Saxiatorinxn— ^« London €aan-
Pintschovius 1G7
Pitkej&rvi Sanatorium 431
Pitlochry 385
Planegc Saxiatorium— m# Kraillixig Ssnn-
twium
Plauen Sjmatorium 306, 333, ttA
Ploen, Holstein. 313
Pneumatic Cabinets 40, 390
Poland, Russian 433
Pollock, Dr. J. E.I4
Pomerania 306, 314, 4x8
Poole Road Sanatorinm-^s<« Overton JIaU
Poore, Dr. Vivian 8
Poplar and Stepney Guardiaxis 3x9
Portsmouth Board of Guardians 334
Porta Coeli Sanatorium 433
Portugal 3x3, 430
PosenAiy
Potu' Sanatorium, Dr.^sr* Overton iisU
Powell, Sir R. Douglas 6
Pravignan. Villa— ««< Davos
Prinsessin Maria Anna Helm 333
Prtien, Dr. 370, 373
Prussia, East 308
„ West 338
„ Rhenish 3 6
Prussian Hessian Railway Sanatorium 4x9
Pitekier, Sanatorium of the Coonteit— sr«
Weicker's Sanatorium
Puebla XI 3
Putten op de VeluweilS
Digitized by LjOOQIC
INDBX.
445.
Qtuuitock«377
Quarrier's Ho rn — — f rg Bridge of Weir
Qaaensland 3x6
Qoisitana Sanatoriam 373, 275
Rachmanow Familj S73
Railways 15
Raltt5»34.
Raotome, Dr. A. 7, 13, si, 67
Reeling 349, 35a. 357
Recreadoo 33* 39
RecambencT zo, 13. 16, 34-3, 38
Red Cross Sanatorium Society 903. S16, tai,
344
Refsnaes Sanalorlam 3x3
Rehborg Sanatoria 31, 59, 69, 7<>, 78, 148^;
171. 303. 236, 8I«
Relboldsgrun Sanatorium 7, x8, 40, 59* 6a,
Z48-9, 16 \ 430
Reicben berg ISO
Relnbardt, Dr. C. 196, 353
Reitz. Prof. 3ta
Reknaes Sanatorium 367, 179
Relapse, Danger of xo
Renfrewshire 34 x
Resident Medical and Nursing Staff xx, 58
Rest and Exercise 10, 13, z6, 34, 38
Results of treatment 48, 55
Reuter, Dr. sto
Revue de la Tnberculose 80
Rhine District Sanatoria 148-9, X77, x83, x86,
<S<. 4?l
Rhodes, Rt. Hon. C. J. 3x6
Richmond House Cottage Sanatorium 333,
8J1
„ „ Convalescent Home 333,
811
Riesengebirge iso, X48-9, 150, 153. xS5i >S7i
307-8
Riley, Dr. ixo
Ringwood— s^e Linford Sanatorium
Rivtera 4, 6, 7. 68
Roads IS. 16
Rocky Mountains xo3-3, 10^ >09
Rodberg, Schloss 343
Roddick. Dr. u6
Rohrbacherschldsschen 434
Roma (Queensland) 3x6
Rdmhitd Sanatorium, 433
Rompler's Sanatorium, Dr. x8, 67, 149-50, 185
Ronusdorf Sanatorium 413
Roosa. Dr. St. John 88
Rossbach on the Sieg 434
Rossclare Sanatorium 348, 389, 89)
Rostock 4 19
Rostrevor Sanatorium 348, 389, 891
Rougemont 144
Roumania 3x3, 43X
Royal Sea-Bathing Infirmary 394, 393
Ruck, Dr. K. von 56, 97
Rudgwick Sanatorium 348. 349, 869
Ruppertshain Sanatorium 30-1, 46, 74-6, 78,
906, 346, 16i, 434
Russian Sanatoria 171, 43X
Saarbrucken 306
Sabourin, Dr. 43, X30, 133
St. Andreasberg, SI, 1(8, 3a6
„ Dr. Jaarbasch'a Sanatorium
X49, 167, x6o
, , Dr. Ladendorl ^s Sanatorium
X49. 167, 169
„ Felizstift Sanatorium 59, 78,
X67, 306, 3S1
„ Oderberg 306, tM, 327, 4^1
St. Anthony's Sanitarium 403
St. Aroual 306
St. Blasien Sanatorium 30, 53, X48-9, 170, 196,
lfr9
St. Catherine's Home 334
St. Lawrence (I.W.) 364
St. Luke's Home 330
St Martin Lantosque xso, X38
SL yary's Sanitarium (Caltfbmia) 84, 113
„ „ (Texas) — SM White
Gables
St. Michaels and All Angels Home 334, 323
St. Moritz 80, 283, 309, 306
„ Aid Fund 306
St. Peter's Home 330
St. Petersbvrg 373. 375
St. Radeeonas 144
St. Symphorien X38, 14J
Saious* Co-operative Viilage, Dr. 98
Salerno 439
Salzuflen 346
Sanatoria for rich and poor 8x
„ for children— SM Children, saaatoria
for
„ for external tuberculoaes 3
Sanatorium des Pins 413
Sandbach Sanatorium 427
Sander, Dr. 89, X90, 199
Sanitarium or Sanatorium 83
Sanitarium, Gabriel's 403
Santa Calallna (Canary Isles) 4x0
Saugmann, Dr. 313
Schatralp Sanatorium 434, 486
Schepelem, Dr. 313
Schiffrain^
Schleswig-Holstein 433
Schloss hdteln 427
Schmidtsdorf— si'c Weicker Sanatorium
Schndller, Dr. 303
Schdmberg Sanatoria 78, X48-9, 190, 198, 306,
280,437
Schools— ser Children
Schreiber's Alpenbeim, Dr. X36
Schrdder, Dr. 186, 437
Schrdtter, Prof, von 130
Schulsanatorium (Davos) 434
Schwarzenbach 431
Screens 36
Scrofula, Infirmary for 334
Sea Coast 13, 13, 145, 307, 313
Sea Voyage 8
Seaton Sanitarium 84, 92, 406
Senator, Prof. 10
Sewage. Disposal of 31— 5/# also Closets
Sharon Sanitarium 79, 83-4, 92
Sheffield Royal Infirnmry 334
Sherwood Forest Sanatorium 333, 887
Shelter 13-11, 16, 34
Shotley Bridge— «^< Bellevue (Durham)
Sicily 439
Siebengebirge 148-9 X77, 183, x86
Sierre 39s
Sileslan Sanatoria IJ0-9, 308-13, 4x7
Sinclair, Dr. F. H. 389, 390
Sites for Sanatoria 13, 73
Size of Rooms 33
„ „ Sanatorium 18, 38
SlawuU Sanatorium 273
Sleeping accommodation 37, 45
Smyth, Dr. T. C. 389, 390
,. Dr. Mander 336
Societies for combatting Tuberculosis 127,
302-3, 308, 313, 314, 221-3, 344, 246, 248,
239-60, 263, 380, 399, 302, 3»i-i2. 407i 408,
409, 412, 4141 429. 430. 431
Soden 69, 424
Soil 13. 15
Solly, Dr S. E. 9. 49i 54. 85, 87, 98, xi3
Somerset Sanatorium 324
Sonnenberg Sanatorium 425
Sonnenhof Pension 421
Sophienbad 148
Sophienheilstfttte— s«« Berka
Sorge 427
Spengler, Dr. 287, 434
Speyer Sanatorium 306
Sputa, Reception and Disinfection ot 38-31
Stachelberg Sanatorium 383, 399, 309
Staff of a Sanatorium 38
Digitized by LjOOQIC
446
INDEX.
Stage of ninets x. a8
Stanbope Sanatortom— Mr Durham Sana-
tornun
Scanthorpe (Qnaensland) 3x6
StatltUcs 48-9, 53-4
Stain, Dr. 361
Stephanie, Dr. 905. 4^7
Stettin, Sanatormm for 206, 314, m. 419
Stiege Sanatorium S9. 75. ^03, 906, iSS, 421
Stolcie>apon-Trent— SM North Staffordshire
Infirmary
Stooax las
StomteldPark Sanatorium 348, 361, 868
Stroud 370
Stubbert. Dr. J. E. 89
Statteard Nenttftdtle 306
Suffolk Saratorium 324
Sulahayn Sanatoria 30. 59, 148-91 X70,906,S34,
_ 235, 239. 4ai
H Femsicht 144, 170, 886
Summerhouset 35
Sunny Nook Sanatorium 348, 883
Sunfnine 17, 18, a i, 34, 67
Swiss Villa. Swanage 348
Szontagh, Dr. von 124
Taltd Sanatorium 27^. 980, 431
Tambourine Mount. Queensland 316
Tannroda 244
Taunton 370
Taunus Bffountalns 148-0, 177, 425
Tewfik Palace Hotel, Helouan 413
Texas 84, 112
Thirlmere, N.S.W. 315
Thomson, Dr. David 361, 369
Thorenc4i4
Tbun29Q,3o6
Tburingia 243,422
Thumam, Dr. K. 191, 370, 376
Tilford 359
Tirobercombe •48, 370, 877
Tirmann, Dr. 154
Toop, Dr. 224
Torgament 24, 133, 244
Torquay 313, 324. 327
Tours, Sanatoria for 128, X44
Town or Country 14. n
Transformation of Old Houf as 73
Treatment at Home 61, 69
„ in Sanatoria n
H results of 48
„ duration of 49, 60, 64
Trelat, Dr sa
Trembling Mountain Sanatorimn 3x6
Tremilly 144, 416
Tref poey Sanatorium 127, X29, IM
Treu, Dr. 274
Treves 425
Trudeau, ur. E. L. 86
Tuberculosa Infsntile, La 127
Turban, Dr. 250, 434
Uckerath 246
Uj Tatra FQred Sanatorium xt4
Umbria 429
Unxer. t>r. 887
United States Army Sanitarium 402
., Sailors' Sanitariimi 40a
Unterberger, Dr. 68-9, 147, 281
Valencia 43a
Vaquier. Dr. 144
Vegetables, Fruit snd 4a
Veaetation 15
Vejlefjord Sanatorium 413
Veuaimont Hydro. 311
Venduyne 311
Ventilation it, 21, 23
Veninor Consumption Hospital, 46,' 77, 80,
„ 3»3.3t4. *7,364
Verandahs 12, 19, 20, 34, xxa
Vernet les Bains 130
Victoria. Anacralla 3x3
„ Park Hoapital-M» Hoapitals
„ Cralgleltb— M» Hospitals
Vf w in a xso
Village, Dr. Sajous' Co-operadTe 98
Villagea, Model 63, 98. 39^
Vlllepinte Sanatorium 129
VUliera«iir-Manie Hospital-see Hospitals
VlaltorB40, ^
WaM Sanatorium— SM Zmich Sanatorium
Waldhaua Snlxhayn 421
WaMhof filgershauaen 424. 4»
Waldshot 427
Walker, MIm Jane. M.D. 24, 3;^. 379
WalU24.25
Walabe, Dr. 13
Walslngham Unloo Infinnary 324
Walters. Dr. F. R. 349
Waltber, Dr. 5, 37, 40, 192
Warsaw. 431 -a
Water Supply 32
Watteville, Dr de 383t 3^4
Weather 3
Weber, Sir Hermann 13, 33
„ Dr. F. 276
Wehmer, Dr. 198
Weicker's Sanatorium, Dr. 35, 52, IST,
se§ also Gorbersdorf
Weimar 243
Weir-Mltcbell treatment 40
Weissenburg Kurhaus 298
Weisser HIrach, Sanatorium at the 164
Weissmayr, Dr. Alex RItter von 123
Wells 370
Werden on the Ruhr 425
Westmoreland Sanatorium 333, 888
Westphalia 306, 246, 422
Wetxlar424
White Gables Sanatorium 79, 84, IIS
Whitmead Hill Sanatorium 348, 349. 860
Wicklow Hills^-«M Hospital Coos, for Ireland
Wllhelmsheim 428
Williams, Dr. C.T. 7, 15.65
Wlllmanstrand Sanatorium 373
Wilte, Dr. 360, 363
Wilson. Dr. G. Morton 370, 377
Wiltshire Sanatorium 324
Wimbledon 324
Winchfield 358
Windsor 324
Wind 14, 34. 35
Windows 2x, 23, 123
Winsley Common 327
Winyah Sanitarium 56. 66, 79. 83-4. VT, 407
Wissen on the Sieg 246
Wokingham 356
Wola 273, 282
Wdlfelsgrund 308
Wolff Immermann, Dr. 7, 53, 55. 'SO. i6o»
aF6
Woodbum Sinatorium 348, 383, 8(8
Worcester Sanatorium 324
Work 46. 144, 21X
Worms 74. 206
Worthing Chest Hospital 323
Wunsch. Dr. 290
Wurtemberg 196, 206, 428
Wurxburg 75, 206C
Wyk van Zee 207, 213
Yalta— «^« Quisisana
York Sanatorium 324, 382
Ysendyk. Dr. van 186
Zaandvoort3i3
Zarskoje Seio Sanatorium 273, 181
Zellerfeld Sanatorium 2c6, 421
Ziemaien, Prof, von xo, 69
Zlttau 224
Zoppot 307
Zurich, Sanatorium for 299, 309, 437
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