NO. I AIR AND TUBERCULOSIS — HINSDALE 11/ 



as we prescribe medicines. Thus we had walks radiating from the 

 dispensary round the meadows, walks over the Bruntsfield Links 

 and walks in various directions on the slopes of Arthur's Seat. The 

 patients reported, at successive visits, their experience in carrying out 

 such instructions and notes were made of the effects produced." 

 Here we see the germ of the class method so well developed and 

 practiced by Pratt, of Boston, although he is an apostle of rest 

 rather than labor. 



The results in Philip's hands were eminently satisfactory. " The 

 patients did remarkably well and no accident was traced to the 

 adoption of active movement instead of rest. The experience led to 

 a change in my outlook in relation to the meaning of treatment in 

 tuberculosis." Philip came to the conclusion that by the establish- 

 ment of hospitals or sanatoria for patients in the earlier stages of 

 tuberculosis " we might hope to achieve permanent cures to a degree 

 not dreamt of, by elaboration of the principle of regulated exercises 

 and graded activity of all kinds." These conclusions were justified 

 by the results obtained " in the home treatment undertaken for so 

 many years at the Victoria Dispensary and in the systematized 

 regime of work at the Royal Victoria Hospital and the recently 

 opened Farm Colony." 



Sir Robert Philip lays great stress on the well-known fact that 

 there is a progressive intoxication in tuberculosis and the toxins pro- 

 duced by the tubercle bacillus appear to exert their vicious influence 

 particularly on the neuromuscular apparatus. The toxin is especially 

 a muscle poison.^ There is a visible and palpable progressive wasting 

 of the muscles, both of the trunk and the extremities, with advancing 

 flaccidity and increased myotatic irritability. It is an expression of 

 malnutrition, a muscular dystrophy dependent on intoxication. The 

 obvious conclusion is that by the institution of natural movements 

 the physiologic cure of " recreation " is assisted and health gradu- 

 ally returns. 



Sir Robert's scheme of physical treatment at the Royal Victoria 

 Hospital is worthy of mention. On admission each patient is placed 

 at complete rest. During this stage, in addition to minute examina- 

 tion of every organ, the patients general condition is carefully ob- 

 served. According to the estimate which is made the length of the 

 resting period is fixed. Thereafter, in the absence of counter-indica- 

 tion, the patient is gradually advanced through the other stages. 



^R. W. Philip, Trans. International Med. Congress, Washington, 1887, 

 Vol. I, p. 205. 



