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54
THE MODERN TREATMENT OF PULMONARY CONSUMPTION.
In the sixth monthly report, 1905, under the heading "Life in a Sanatorium," reference was
made to a report in The Times of a visit paid to the Brompton Hospital Sanatorium, near
Frimley, Surrey, in which it was stated that "the aim [of treatment] is to educate patients into a
condition of real bodily vigour and capacity for work; " the patients being " put through a graduated
course of exercise adjusted to their physical condition." Three years having elapsed since the
sanatorium was opened, by the Prince and Princess of Wales, it was satisfactory to learn from
a further article in The Times (July 15th), on a then recent visit of inspection, that the experimental
treatment adopted by the medical superintendent has been justified by results. The
present ideas on the proper method of treatment of the disease are in remarkable contrast with
those that prevailed, almost universally, not so many years ago. It is stated in the article referred
to that—
"The distinctive feature of the treatment "is" the graduated system of outdoor employment to which the
patients are subjected "; this being the" first sanatorium for consumptives in which work ha3 been introduced
into the regular routine, as an integral and prominent part of the treatment on a methodical plan of
systematic adjustment of occupation to the condition and capacity of the individual." Patients are not set to
work " until they are fit for it* carrying light baskets of stones or mould being the first grade in the outdoor
works of utility carried on by them. Gardening operations follow in an ascending order, until the strongest
met) arrive at quite heavy work. Thus, while the active mischief in the lungs is healing, their frames are
built up into a robust condition which renders them at the same time fit to do regular work when discharged,
and more resistent to the attacks of recurrent disease to which they may be exposed in ordinary life." A
number of old patients had been brought down to Frimley for the occasion: all were very much better; many
were perfectly restored to health, " including some who had been discharged for two years, and bad gone back
to their former employment." The men attributed their improved health to the treatment the regular
life, the outdoor work and the fresh air having, moreover, applied at home, so far as possible, what they
had learnt at the sanatorium—a regular life and the open window having become habitual with them all."
The patients enjoy the work, and besides "the direct effect upon their bodies it has an indirect [good]
effect through their minds. It is a cure for listlessness and ennui. The results of their work are visible and
tangible, and the men are interested in what they are doing they have transformed the place: the extensive
grounds were a wilderness; they are now beautiful; and heavy work of a more utilitarian character
has been carried out. The Sanatorium spends nothing on labour ; " the grounds would require twelve gardeners
if the patients did not work: the household work is performed by two ward maids with their help." Instances
are given of the economical conduct of the establishment; e.g., all the soap used is made from the refuse kitchen
fat, and the exhaust steam from the engine house is used to heat the water for the laundry and the baths."
The committee of Management of the Brompton Hospital issued last year a report on the sanatorium,
its work and its results, in which it is stated that—
"No male patient has been considered to present total arrest of the disease until all bacilli have disappeared
from the expectoration, and medical examination has failed to detect any sign of active mischief, nor
until he has performed the highest grade (of five or six grades) of exercise for a fortnight or three weeks, without
rise of temperature or loss of weight. Such hard work (it is added) will rarely be required from the
patients in after life, and there is thus a strong probability that the arrest of the disease will be permanent."
Of the cases transferred (from the Brompton Hospital) to the sanatorium in 1906, "110 were discharged with
'total arrest' of disease; 21 were ' much improved ' and 25 were ' improved.' On discharge the patients are
invited to report from time to time as to their condition ; and it appears that of 110 cases of total arrest, 93
are at work, 5 are not at work, 12 have failed to report; of 21 ' much improved ' cases, 10 are at work, 7 are
not at work, 4 have failed to report, whilst of 25 'improved ' cases, 10 are at work, 7 are not at work, 7 have
failed to report, and one has died."
The Secretary of the Brompton Hospital informed me that the "average daily number of beds
occupied at the sanatorium during 1906, was 102, and the average weekly cost per patient twentyseven
shillings." This includes" provisions, drugs, fuel and light, wear and tear, cleaning, rates,
ordinary repairs and salaries." This moderate cost the Secretary attributes to the smallness of the
official staff, " very little nursing being required," so that "a staff of 4, with a Sister-in-Charge is
found to meet all requirements for 108 patients. The domestic staff, moreover, is relatively
small, for the reason that the patients at the sanatorium are able to give assistance in light duties
which are found beneficial as an occupation."
*It is stated that patients "in a weak state, or with serious or active mischief going on in the lungs, are not allowed to
work": they " remain in bed and are attended as in hospital"; whilst those "who are fit to leave their beds, but are not
strong enough for any exertion, rest on couches in the open air and merely occupy their hands with some light work such
as making wool mats or sewing " ; work proper being applied later to building up their physical strength by degrees."