294" Dr. H. "t, Bidstrode [May 15, 



this matter of sanatoria, in order that we may be in a position to 

 improve our methods, if necessary. I shall confine my remarks 

 exclusively to the poorer classes. 



What are known as the immediate results of sanatorium treatment 

 amongst the poor are, in a large percentage of the total number 

 of cases admitted, decidedly good. The poor react well to the 

 abundance of good food, the relative rest, the pure air, and the 

 discipline of sanatorium life. In all these matters the poor have, as it 

 were, a large margin to work upon. 



Consequently, a large number of the cases admitted leave the 

 institutions in conditions which are described by somewhat hetero- 

 geneous terms, such as " cured," " arrested," " greatly improved," or 

 "improved ;" and could the circumstances which have brought about 

 this improved condition be maintained, a larger number of patients 

 than is at present the case would retain such improvement more or 

 less indefinitely. 



The hard school of experience, however, after some years trial, 

 compels us to face the fact that under stress of work, along with 

 persistence in selecting unwholesome environments, a large proportion 

 of the cases relapse. The proportions vary in different sanatoria 

 according mainly to the success or failure to secure for treatment 

 early and suitable cases of the disease, but there is at the present 

 time no useful purpose to be served by attempting comparison 

 between the results of one and another institution. 



The usual method of presenting the " after-results " is to ascer- 

 tain the condition at some given time of all the cases which have 

 been discharged, thereby including cases discharged only a few weeks 

 with those discharged perhaps three or four years or more. This 

 method tends to present the after-results in a too optimistic fashion ; 

 in effect it amounts to confounding and mingling the after-results 

 with the immediate results. 



Sometimes, however, the figures for the last year are excluded 

 from the after-results, and in this fashion the actual after-results are 

 more nearly approached. 



In this matter of sanatorium statistics, much may be learnt from the 

 German methods, by means of which the after-results relative to 

 patients discharged in any given year are kept quite separate from 

 those relative to patients discharged in other years, and by this 

 means it is possible to determine when a suificient period has elapsed, 

 in what manner the patients discharged year after year are {a) main- 

 taining tliemselves, {h) surviving. 



Unfortunately, the data as regards after-results in English sana- 

 toria have not, as a rule, been so collected and arranged as to allow 

 of grouping by the German method, but the figures for the Durham 

 Sanatorium and also for the Kelling Sanatorium enable this to be 

 done, and they are herewith presented in this fashion. 



