THE OTAGO DAILY TIMES THURSDAY, September 21, 1905. THE WHITE PLAGUE.

Otago Daily Times, Issue 13394, 21 September 1905, Page 6

THE OTAGO DAILY TIMES THURSDAY, September 21, 1905. THE WHITE PLAGUE.

Among the papsrs that were read at tTic recent intercolonial Medical Congress, conosrning which Dr Colquhoun furnishes some interesting particulars in the interview we -publish this morrijhg, there was nope of 'greater practical moment to New Zealand than those that dealt with the treatment of consumption. It is, indeed, a. matter of the highest importance in this colony, which has suffered'an average annual loss of 766 lives from tubercular diseases in the past ten years, that we should have presented to us, for our information and profit, the available results of the efforts that aro being made in other colonies to cope with this class of malady. The paper which was contributed by Dr G-. Burden Stoney, superintendent of the Consumptives' Sanatorium at Echuca, was, in this aspect, of considerable interest, forofc supplied five, years' records of the experience in that Victorian institution. The sanatorium treatment of consumption in Australia, was described by Dr Gault in another paper as being still on its trial, and it may be that conclusions based on an experience limited to five years should not be viewed, as altogether reliable. But the results which treatment extending over that period produces must at least be held to be suggestive and distinctly useful. And, if in some case's they haw proved to be less satisfactory, than- was hoped for, it is necessary that due allowance be made for the fact, upon which Dr Gault laid stress, that the average patient entertains.a prejudice against sanatoria. The general advice to the early consumptive, he says, is to have as much fresh air as possible— to go for a change or sea. trip, to reside in the north or in a tent, and, when these have failed, to try a sanatorium. The experience of Br Burdon Stoney .corresponds precisely with this. It is, he has found, generally when the patient is given up by the chemist, by the- family physician, and by the specialist that he is thrown upon the sanatorium. Under these conditions, which probably give a. year's start to the disease before the patient submits himself to treatment in a sanatorium, the value of an institution of the kind cannot ho said to be fairly tested. It is exceedingly important, as Dr Burdon Stoney insists, that cases should be recognised in the incipient stages and that, no time should be lost, either in purely medicinal treatment or otherwise, or else the disease may become so far advanced as to "render recovery impossible. "Of all the factors in the treatment of consumption, fresh air and sunpjiiue, according to Br Stpgey, are

the*riiosb"lra|)orl;irril,' good nutritious diet 'and' rest coming second, and medicine being reserved for the purpose, of arresting complications. Dr "Gault, on the other hand, regards the enforceinenfc of rest and the regu-lation-of exercise as of the-most vital consequence; and it is in this regard, he holds, thathome treatment, is most decidedly' incomparable with instihitional treatment.•'.."lt is veiy difficult ,to get people, to realise tho importMiea'of this; matter; —one so frequently comes across patients with actwe disease who are'practising deep breathing, and thereby unknowingly doing their best 1 to extend their trouble. "When active disease is present the quieter the lung can be kept the .better, .provided that perfect oxygenation of blood is taking place. AVo must remember, that laughing, coughing, or forcibly inhaling disinfectants .causes a great increase in chest movements, and ought'to be limited as much as possible. ■. . . The perfect pure air of the sanatorium, combined with perfect rest when lying down, enables a- patient to reduce the amount of tidal air, and, therefore, the chest movements to a. minimum.;' As. the 'disease becomes quiescent,'veiy.slowly and gradually, and wider constant supervision, the patient is permitted to increase the respiratory movements up to the normal." That'is a process, Dr Gault considers, which only admits of being properly carried out in a sanatorium. The regulation of exercise seems to be a factor of hot less importance than.' that of tho supervision of rest. It has sometimes happened, in, Dr Stoney's experience, that patients who have been sent away from Echuca. as hopeless cases have subsequently, picked'up strength, returned to work, and become comparatively well, while cases that appeared likely to yield satisfactory results have "gone to pieces'" as soon a? they got out in the world again. The reason assigned by Dr Stoney for this j failure of promising cases is that the j patient has had such an easy, lazy time in the sanatorium that his muscles have become quite nnfit for work: "He gets among .companions and drinks, perhaps, a little more than Iho ought;—or, even when he takes caro of himself, the worries of this world, and the fact of his br:in<» tied down to , his work, of having to do his daily round, whether ho likes it or no, whether.he feel; fit or no, of weather and climate and such like, which he lias to put up - with when he goes back to work; and a large number break down before they have been at home long." Prom this we infer that the condition of a patient at the time of his discharge from a sanatorium affords no dependable criterion of the real effect upon him of the treatment he has received. Consequently the statistical record of the- work of the institution may probably have to be accepted with a certain amount of reservation. The mortality returns are, however, necessarily reliable, and, in the case of Echuca Sanatorium, these show that the known deaths for the five-yearly period,-in which 552 patients were treated, represent 441- per cent.- of the total number of cases. Of those who are alive, tho report concerning 4G per cent, of them is that they are well and able to do their work well; of 16 per cent, it is said that they can with difficulty struggle'along, and of 26. per cent, that they are invalided; while as to the remaining 12 psr cent, of the cases that are alive there is no recent information. Thess results may be regarded as fairly encouraging, and it is a cheering circumstance that an analysis of the records ' shows, year by year throughout-the five years, a gradually decreasing death rale. Incidentally Dr Stoney's experience does not accord l with what is a- somewhat common impression, for which, in fact, there is definite authority, that a. patient who increases a stone in weight under treatment, is safe. But the records of the Echuca Sanatorium actually show that .patients . whose weight increased from 51b to 141b have produced the smallest percentage _of deaths, while among those who " put on " less than s)b or lost in weight there was a very heavy Mortality. It is inadvisable, probably, to regard the results, thus stated by Dr Stoney, as other ■than suggestive, the truth probably being that the influence of the sanatorium form of treatment of consumption has not yet properly asserted itself. We gladly welcome, however, the note of confidence that marks DVGault's prediction that in another decade the tubercular death rate in Australia will, as the result of institutional treatment, decline as it has elsewhere.