By J. Henry Hallock, M.D., Saranac Lake, N.Y.
It is with pleasure that I comply with Dr. Smith’s request for a paper upon the above subjects, and though “there is nothing new under the sun” and it seems doubly true of the threadbare subject of tuberculosis, yet located as we are at Saranac Lake, where hundreds of patients are under observation at all times during the year, a few ideas gained from such experience may be of interest to some less favorably situated to study the disease.
Advantages of the Adirondack Climate
This climate is perhaps no better than that of other mountain countries, but that a moderately high, well drained, forest covered mountain region offers advantages that cannot be secured in an ordinary farming district is too obvious to need discussion. Add to this a location like Saranac Lake, which has complete drainage, a good elevation, yet is entirely surrounded by many miles of forests and mountain peaks which fill the air with ozone, break the wind and moderate the force of all storms and you have not only a summer resort, but an all year round resort, good in summer and even better in winter.
If there is no thing that experience has taught me well it is this, that the patient must choose a climate where he can stay both winter and summer, and not one very pleasant in summer, or one very fine in winter, with the expectation of going elsewhere as soon as the weather changes.
Why so many of these patients do badly after what promises in the beginning to be a most perfect cure I cannot explain, I only know it to be a fact.
An elevated mountain climate is very stimulating to the appetite, the cutaneous functions and the nervous system. It also increases the red blood corpuscles. Wolff claims that a complete revolution in the construction of the blood takes place every eight or ten days in the proper altitudes. Be this as it may, the air is clear and sterile, devoid of dust and acts as a general tonic. Prof. G. Cornet, of Berlin, in his elegant work on tuberculosis gives a list of the factors necessary for a good health resort everyone of which Saranac Lake possesses. He further says: “The so-called summer or winter resorts which are characterized only by the beauty of their situation are usually unsuited for consumptives.
“By good lick results are occasionally beneficial. The advantages of these summer places is their nearness, cheapness and the absence of other consumptives. Modern traveling facilities have shortened distance and the slight saving does not compensate for the diminished chance of recovery. It is also an error to believe that the chance of infection is any smaller since any other patients will resort thither for the same reasons.
“The difference from a health resort lies in the neglect of precautionary means against infection, hygienic arrangements, drainage, protection from wind, etc. And often there is no physician near at hand who is experienced with these cases.”
The methods used in the outdoor treatment of consumptives I am sure are familiar to every practicing physician. The results obtained perhaps could be best illustrated by giving a case, and I for this purpose will choose one of recent date:
Mr. M., sent me by Dr. J. D. Zwitsch, of Gowanda, N. Y. Patient was 19 years of age, from healthy German parents. He contracted pneumonia during the winter of 1994, which left him with a cough from which he could not get relief. A few weeks before starting for the Adirondacks he had an attack of pleurisy with effusion. Dr. Zwitsch had punctured a couple of times, drawing off considerable fluid. When he came to me, March 1st, 1905, he was twenty pounds under his normal weight; was coughing hard and expectorating a large cupful of characteristic tubercular sputa daily, which contained tubercular bacilli. His temperature was running from 1010 to 1030, his pulse was usually over one hundred. Examination showed solidification at the apex and over middle portion of upper lobe of left lung and pleuritic effusion which extended in the axillary line from the fourth to eighth rib.
He was placed in a private cottage where he could be kept under careful supervision. He was instructed regarding his clothing, expectoration, diet, ventilation of room, exercise (which was forbidden until temperature should become normal), and told to remain out of doors as many hours daily as he could without fatigue, and when too tired to spend one hour in his room on his bed with all windows opened.
He was given a generous and nutritious diet without over crowding. For remedies he received one dose of Bacillinum and three doses a day of Ars. iod. This, of course, was changed from time to time as his digestion and other symptoms demanded, and with this I used a Chattanooga vibrator. He began to gain after the first week, could eat and assimilate more, which produced a steady gain in weight. His cough and expectoration gradually decreased, and his temperature and pulse began to drop. He has now been under my care seven months, and his cough and expectoration have decreases two-thirds. His, temperature is rarely above normal. He has gained eighteen pounds in weight. The consolidations have nearly all cleared up. The effusion, which was the last symptom to improve, is now rapidly disappearing, reaching only up to the sixth rib.
And while this case is only an ordinary one and is not yet well, it shows what may be accomplished with the outdoor treatment and should he do as other cases have done he will become entirely well.
I had a case from near Boston who returned home last month, apparently well after a three months’ stay here, and I have two others under treatment now who promise as well and they are all at private cottages but these are all exceptional cases, all coming in the first stage and making more than ordinary progress.
The sanitarium treatment I need not dwell upon as others at this meeting will give their methods. Surely it is the ideal treatment in many ways, especially in immature and unformed characters, which can be more easily advised and controlled, but there are not sanitariums enough so as to have an ideal sanitarium for all the people. Those existing at present accept mostly, those who are able to pay but a small amount to partly pay their board. These are only taken for a limited time, and only those in the early stages are accepted. Many physicians send their patients to the sanitarium not realizing what constitutes the first stages of the disease.
In the July Chironian Dr. Pryor, who was at the head of the State sanitarium here, was quoted as saying that during his term of office nine (900) applications for admission were made to the institution and out of this number only one hundred and eighty-three were accepted.
From a report of the Cottage Sanitarium, Which was the first institution in this section, it was reported that only fifteen per cent. Of those applying were found to be in the first stage of the disease and there was not room for all applying in the first stage.
This shows the little chances the cases as ordinarily sent have of gaining admission. Whereas there should be sanitariums enough to accommodate all stages, not but what the patients can and are treated in private cottages quite as successfully but those who need it most are those without means who are in the second or the beginning of the third stage, who have some chance of again becoming a bread winner if under proper treatment, but who from lack of means or lack of charity, must remain at their unsanitary and poorly ventilated homes until the end. Think of the menace such a case is to the public health. They work as long as possible, exposing all other workmen, When unable to work they visit among their relations and friends and possibly infect their homes, and after they become confine to the house or bed neighbors take the part of nurse, and I have known cases where such have contracted the disease.
But I see the light beginning to dawn, and from every State comes the cry for more institutions, better instruction of patients and more care among physicians regarding an early diagnosis.
Many large and instructive meetings, like the one you are now holding, devoting an entire session to tuberculosis, means something.
Last April I had the honor to be appointed by the American Institute of Homeopath as delegate to the American Anti tuberculosis League, held at Atlanta, Georgia. A most enthusiastic meeting was held, lasting for three days, and the quality of the papers and the men who took part are positive evidence that the South means to be well in the lead in ridding the nation of this, the “Great White Plague.”