808 
PROCEEDINGS OF SECTION I. 
examinations of cases of tuberculosis has not been called upon for a 
long time to sustain any more than the minimum circulation which is 
required for the body while at rest; the lungs in consequence have 
not been ventilated sufficiently, and the stagnation of air and the 
growth of tubercle bacilli are favoured in these parts of the lungs 
which partake least in the respiratory excursions of the thorax. The 
effect of physical out-door work, commensurate to his strength, as 
prescribed by the medical director (I should like to emphasise on this 
occasion that I am by no means inclined to recommend heroic remedies 
like physical over-exertions) is an extremely favourable one on the 
constitution of the consumptive patients; the muscles of the body 
become firmer, the heart and circulation improve alike, both inspira- 
tions and expirations become deeper ; stagnating secretion, swarming 
with tubercle bacilli, is expectorated, assisted by the increasing 
strength of the heart and the respiratory muscles (m. intercostales, 
sternomnstoid, rectus, pectoralis major, &£.). The patients should be 
employed in ordinary farm work — for above everything this improves 
their appetite — ploughing, fencing, digging up trees, or gardening, Ac. 
It is quite necessary for the success of the undertaking that the medical 
director and his assistants should have supreme command of the place, 
so that he be able to enforce strict discipline amongst the patients, 
and to punish offenders eventually with expulsion. Every patient 
should go out riding every day for at least two hours ; those who have 
not been in the habit of riding will have to learn it. Lawn tennis, 
cricket, and other games serve to vary the monotony of the daily 
routine. The hot hours of the summer day can be spent by the 
patient lying under shady trees, either reading or sleeping or chatting 
with other patients. The daily tasks set to the patients are increased 
with the increasing strength in the same ratio. An especial feature 
of the plan is the formation of an orchard. As regards women, 
light gardening work, gymnastic exercises, lawn tennis, riding, 
driving, Ac., will have to be allotted to them. The arrangement as 
proposed above has a double advantage. While on the one side it 
is eminently calculated to improve the health of the consumptive 
patient, it lessens on the other side the cost of maintenance very con- 
siderably. Nearly the whole daily bill of fare can be produced on the 
farm — meat, milk, butter, eggs, vegetables, all kinds of fruit, ali of 
which it would be very expensive to purchase. It would thus be 
possible to make the place almost self-supporting. How considerable 
the saving effected by it would be, anybody familiar with hospital 
management will see at once. Even wine, which is indispensable in 
the treatment of consumption, could be made on the premises. 
The whole management of the sanatorium should be vested in the 
medical director, who is to have absolute command over his patients. 
He examines every person that is admitted to the institution, and 
maps out the daily routine for him, as described above. Special 
attention has to be given to the diet, since over- feeding is the most 
important factor in the successful treatment of the consumptive. The 
diet has to be regulated according to the principles laid down by the 
recent researches of Voit, Pettenkofer, E. Hirschfeld, and von Noorden. 
Another important point, which must not be neglected, is the regu- 
lation of dress and the daily bath, which both tend to place the skin 
of the consumptive patient under .the most advantageous conditions. 
