36 



NATURE 



[March 9, 191 1 



are all treated of, and the special and general condi- 

 tions under which tuberculous infection may be car- 

 pied, and the conditions of the patients who may most 

 readily be infected by that infective material are all of 

 them laid down. The precautions to be taken against 

 infection, the necessity for home treatment, and for 

 the carrying of it out in a rational and intelligent and 

 persevering fashion are insisted upon strongly. The 

 following quotation might well be written up in large 

 letters wherever men congregate : — 



"The education of all consumptives to this view, 

 that in the warfare against tuberculosis, the arrest of 

 the disease, and the prolongation of life depend upon 

 the care with which home treatment is carried out 

 by the patient would materially aid in diminishing 

 the death rate from the disease." 



It is, of course, obvious that any such patient, if 

 he be wise, will report himself at intervals to his 

 doctor for examination and advice. 



The various rules laid down as to observation of 

 temperature, rest, exercise, diet, and the like, simple 

 and readily followed out, are exceedingly valuable. 

 The concluding paragraph of the book is perhaps a 

 good type of the advice here given : — 



"Too frequently the consumptive spends on useless 

 nostrums money which would be far better employed 

 in purchasing good food and procuring fresh air. 

 All the so-called cures which are advertised for con- 

 sumption will avail little in checking and curing the 

 disease, compared with an intelligent effort on the 

 part of the patient to carry out the principles and 

 practices pf open-air home treatment." 



(3) Mr. Stanley H. Bates, in this brochure, give? 

 a very succinct and clear account of his own experi- 

 ence in post-sanatorium treatment of consumption. 

 Mr. Bates defines his purpose as being 



"to give, in as clear a manner as possible, practical 

 advice in the home-treatment of consumption drawn 

 from three years' actual experience. It is written 

 for the benefit of those who find themselves placed 

 as I was three years ago, when, after six months at a 

 sanatorium, I was advised to continue the treatment 

 at home; and is an attempt to pass on to them the 

 knowledge I should have been glad of then, but had 

 to learn by experience." 



After outlining the advantages of an outdoor sleep- 

 ing shelter, the author gives a series of most practical 

 details as to site, construction, and ventilation, pro- 

 tection from rain, materials, cost, and general con- 

 struction and furniture, of an outdoor shelter. It is 

 interesting to note how the ideas of the author gradu- 

 ally developed, and how at very small cost he has 

 been able to evolve an open-air shelter that has prac- 

 tically all the advantages of a sanatorium shelter. He 

 is a good example of the man who fights the disease 

 whole-heartedly, and he certainly has deserved his 

 victory. 



"Wage continuous war with it," he says, "allow it 

 no respite, and your victory will be accomplished the 

 sooner. Sorne amount of moral courage and per- 

 severance will be required for the purpose of your 

 recovery. Energetic measures, however, and a deter- 

 mination to get well without delay, will go far to- 

 wards rendering it sure and speedy. It is far better 

 NO. 2I';8. VOL. 861 



to make your recovery complete before returning to 

 your occupation, than to run the risk of having to 

 leave it again for the purpose of a further course of 

 treatment. If your illness has upset your plans, make 

 others; if a change of occupation is necessary, resign 

 yourself to the form of life it will be best for you to 

 follow. You will find more than sufficient compensa- 

 tion in the exuberance of health which you will enjoy 

 as the result of your open-air principles." 



This is good philosophy and sound common-sense. 

 Mr. Bates's book should be in the hands of everyone 

 who wishes to obtain the best results possible in his 

 or her own care. 



(4) Dr. Bardswell, in a concise abstract of the cases 

 that have come under his observation in King 

 Edward VII. Sanatorium, directs attention to the fact 

 that it is now possible to obtain some indication as 

 to the expectation of life of the consumptive, especially 

 when based on a careful classification of a series of 

 patients, living under favourable conditions, examined 

 before and after treatment. He shows that this 

 double classification is of importance because at the 

 one extreme the patient is observed under what may 

 be looked upon as the most unfavourable conditions, 

 whilst at the other the course of the disease and the 

 condition of the patient may be assumed to be con- 

 sidered in their most favourable aspects. How com- 

 plicated and varied are the symptoms in cases of 

 tuberculosis may be gathered from the classifications 

 given by Dr. Bardswell, but it is obvious that with- 

 out the data on which the classifications are based it 

 would be impossible to give any intelligent and trust- 

 worthy prognosis, the classification on discharge being 

 as important as is that on admission in so far that it 

 offers additional ground for prognosis. 



Marked differences persist at the stage of treatment, 

 at which the cases leave hospital. This is evident 

 from the fact that they are divided into "apparently 

 cured," "arrested," "improved," "unimproved," or 

 " progressive." Examining these cases at later in- 

 tervals — that is, after periods of from one to five 

 years — Dr. Bardswell gives the results of the open- 

 air treatment of 241 cases discharged between the 

 years 1901 and 1905, taking as the time basis of his 

 report the year 1909, and points out that of these 

 patients there were 62 suffering from incipient 

 phthisis, of whom 46 were still alive, 6 of these dating 

 back to the year 1901, 12 to the year 1902, 14 to the 

 year 1903, 11 to 1904, and 3 to 1905, so that all of them 

 were alive and well for at least four years after they 

 had been discharged, and some of them for nine 

 years. In only one case was the disease active when 

 the patient was discharged, and he is now dead. Of 

 the other cases of incipient phthisis 10 of the 62 were 

 dead and four could not be traced. 



Such results are certainly very satisfactory. In 

 cases where the diseases was moderately advanced 

 on admission the results were far less satisfactory. 

 Of 95 treated 47, or 49*4 per cent, against 74 per 

 cent, in the first group were well in 1909, 10 were 

 alive, but were still suffering from the disease, and 

 35 or 36'8 per cent., against 176 in the first group 

 were dead, and three patients had been lost sight of 

 entirely. In the group in which the disease was far 



