PEOCEEDINGS OF SECTIOX I. 693 



Patients have three good meals a day, following on an hour's 

 complete rest. The diet is generous but simple, and the cooking must 

 be above criticism. No stimulants are given. Patients, unless their 

 condition is absolutely hopeless, steadily gain in weight, till their 

 previous maximum is surpassed. 



The third essential is — • 



Hest. — For healthy life a due apportionment of rest and exercise 

 is essential ; in a sanatorium it is of the utmost importance. When 

 the disease is active the movements of the lungs must be restrained 

 as much as possible, absolute rest in the recumbent position may be 

 required for a time, and we have to be guided much by the pulse and 

 temperature. Incalculable harm is often done by the idea that deep- 

 breathing exercises are beneficial for the lungs. Such ill-timed move- 

 ments break down adhesions, and frequently make a quiescent disease 

 active. For perfect health, good digestion, and good circulation, 

 exercise is necessary ; and one of the most difficult problems of a 

 sanatorium, and the one requiring the nicest discrimination and most 

 persistent care, is the adjustment of proper rest and exercise. Home 

 treatment must always fail in this respect. Walking is the best exercise, 

 on the flat and up gentle slopes. By watching the results of each day, 

 reducing the distance if there is any evidence of its being too much, 

 increasing it if all goes well, the patient becomes able to take longer 

 walks than in previous good health without the slightest feeling of 

 fatigue. 



I have no hesitation in saying that the whole success of the treat- 

 ment depends on the apportionment of rest and exercise. 



Many other things help to make the treatment successful. The 

 surroundings must be bright and cheerful, the life in every way pleasant 

 and agreeable, for a hopeful mental condition is a sinz qua non of success. 

 The simple routine, the increased sense of well-being, the returning 

 health and strength, the freedom from anxiety, all go to assist in making 

 this form of treatment not only the most successful, but also the most 

 agreeable. 



The sanatorium is the high-water mark of the perfect hygienic 

 life, and it must be the aspiration of the sanitary reformer to lift the 

 life of every member of the community to the same level. When this 

 is accomplished the death rate -will be reduced to a minimum, and the 

 millennium be at hand, for with the improvement in physical health 

 ^vill come an accompanying improvement in social and moral life. 



The sanatorium is a standing object lesson of what preventative 

 medicine can do by simply following the laws of perfect sanitation. 



In conclusion, I would like to draw your attention to the important 

 part the sanatorium plays in diminishing the tubercular death rate by 

 segregation and education. One of the most important conclusions 

 arrived at by the Tuberculosis Congress, held at Paris in 1905, was the 

 value of segregation in preventing consumption. 



The diminution of the death rate in England has been steady 

 during the last half-century, and has been brought about by many 



