BY EDWARD R. BALDWIN, M.D., DIRECTOR, SARANAC LAKE, N. Y. EDITORIAL NOTE ¶ With the closing of practically all avenues of tuberculosis research in Europe, the opening of the Trudeau School of Tuberculosis at Saranac Lake is particularly timely. No more fitting or better equipped center for such a school could be found in the United States. Here, where Dr. Trudeau achieved his greatest success, will be opened an institution of learning that will do much to extend to every part of America the scientific and personal influence of the Great Pioneer. The editor has asked Dr. Baldwin, the Director of the School, to present in the accompanying article a brief outline of its purposes and methods. The suggestion was made several years ago to the late Dr. Edward L. Trudeau that a course of study at the Sanitarium in the diagnosis and treatment of tuberculosis would be very useful to physicians. Nothing definite was done about it at the time as no funds were available, yet much opportunity was given from time to time during the residency of Dr. Lawrason Brown for young physicians (themselves patients) to learn what they could. The Saranac Laboratory as well as the Sanitarium Laboratory had also been open to voluntary workers who showed an interest in research work. In fact, practically all the medical and laboratory work of these institutions has been done by tuberculous patients who had regained their health wholly or partially. Undoubtedly the opportunities thus given have been helpful to a number of physicians now engaged elsewhere in tuberculosis work. The unique place held by Dr. Trudeau himself, the institutions he created, and the spirit of sympathy for progress and research that he fostered, have made Saranac Lake especially favored in these respects. In consequence of the rapidly increasing number of institutions all over the country the demand for clinical and 33 laboratory training along institutional lines has increased. In the opinion of those who are interested in promoting the anti-tuberculosis campaign, the facilities obtainable at Saranac Lake and its surrounding institutions could be utilized to great advantage. The Dr. R. H. Bishop, Jr., of Cleveland was the means of interesting a liberally inclined friend who last year offered Dr. Trudeau means for the purpose. The steps were already taken to organize a clinical and laboratory course for graduates in medicine when his illness and death temporarily postponed it. Although too ill to have any active participation in the plans, he was very much interested and hopeful for its success. Trustees of the Adirondack Cottage Sanitarium have now made plans which provide for a six weeks' course of sanatorium and laboratory work, covering principally a thorough grounding in diagnosis of tuberculosis by physical examination and laboratory methods, including the X-ray. The sanatoria, hospitals and laboratories in the Saranac Lake and vicinity will furnish ample facilities for a limited number of students. Provision will also be made for research students who can spend more time in study of special problems There are opportunities for interneships in the various sanatoria that will co-operate in the courses to be given. Among those institutions which will join with the Adirondack Cottage Sanitarium in offering facilities for the instruction are the New York State Sanatorium at Ray Brook, the Stony Wold Sanatorium at Lake Kushuqua, and the Sanatorium Gabriels at Gabriels Station. Besides these institutions for the more favorable class of patients, there are the Reception Hospital and the Sisters' Hospital in Saranac Lake, where complications seen in the less promising cases can be studied. The instruction will be given by the medical staffs of the various sanatoria and laboratories in the Saranac Lake district, as well as by special lecturers from New York and elsewhere. It is believed that this plan will promote much more interest and enthusiasm in tuberculosis as a medical specialty, and especially give the impetus to an earlier diagnosis and a more hopeful attitude on the part of physicians in the management and treatment of this disease. Those who intend to enter institutional work will be enabled to study the organization and details of management of sanatoria. Others who may later engage in municipal dispensary work will have the opportunities supplied by the clinics in New York, Boston, Philadelphia and Cleveland, co-operating with the school, to supplement their courses at Saranac Lake. The public health work in the control of tuberculosis as carried on at Saranac Lake Village offers some points of interest for healthresort physicians. The activities of the local society for that purpose and its social-service work will also be observed during the course. Preparations are being made for the first course to be held from May 17th to June 28th, 1916. Subsequent sessions may be held annually or oftener, as may seem desirable. The expenses, including board and room, will range from $150 to $200 for the six weeks. An entire dwelling-house has been engaged provisionally at clubbing rates, for the sole use of the physicians. A few free scholarships have been offered already, for the aid of students who otherwise could not avail themselves of the course. It is suggested that a considerable number of young institution physicians on small salaries could be aided by anti-tuberculosis associations, to their mutual advantage. Full particulars about the School are set forth in a prospectus issued by the Trudeau School of Tuberculosis and can be obtained from the Secretary at Saranac Lake. A WINTER SOLILOQUY (WITH APOLOGIES TO HAMLET) That lungs are heir to, 'tis a consumption And gives us pause. There's the prospect Lights out at ten o'clock and all the spurns If one his exodus might make With just a book of mileage? Who would To grunt and fret under this simple life borne, Are many who return, puzzles the will HOME AND SANATORIUM EXPERIENCES BY MILES COLLINS, AGNES MEMORIAL SANATORIUM, DENVER, COLO. For several years I had been troubled with catarrh. Later I began to lose weight and grew weak and thin from no apparent cause. This was accompanied with a sleepiness and continuous yawning. When friends suggested that I should consult a physician, I laughed and declared the trouble was only laziness, which should be fought until overcome by more industrious habits. In the evenings my nerves felt unstrung and irritable, making it hard to concentrate my thoughts. In order to rest them I would go out of doors and cut wood for a half hour before retiring. To restore my strength I would take other vigorous exercise, but it resulted in always feeling worse. The first hemorrhage came one morning after I had run about six blocks to catch a stree car. It was not painful, consequently I felt no alarm and went on to my daily duties. A couple of days later, while driving with a horse and buggy, a second hemorrhage occurred. The blood flowed freely and I coughed up about eight ounces. Then I consulted a physician, who examined my throat and said he could see some blood trickle down the back of it, which proved that the blood came from the back of my palate; that it was nothing serious and to forget it. During the next two weeks I had about a dozen hemorrhages. These often came in the night and I would be awakened by strangling from the thick, congealed blood which coagulated in the windpipe. A little pain developed on the lower right side ribs. My physician said it was a slight touch of pleurisy and advised that I go to bed, which I refused to do, considering it a waste of time. Two days later this pain was so sharp I could hardly draw a deep breath, and a sympathetic neighbor suggested that tight straps be put over the sore place. Never having heard of strapping the ribs, I expected to see some sort of a leather harness buckled tight around them. But the physician used a small roll of adhesive cloth. Then I went to bed, stayed about a week and improved rapidly, so decided to resume my work. My coughing increased until it sounded like the deep bark of a bull dog. A friend asked if I had a summer cold, which I immediately decided was my trouble, as it was a new ailment to me. The physician said I was liable to catch tuberculosis, but did not have it, bebecause he found no bacilli in the sputum. He suggested that I go West for a dry climate. I hesitated, then consulted two other physicians. One advised that I stay home and take a few drops of creosote in olive oil daily and I would soon be O. K. The other recommended that I go to Nebraska and rough it by going onto a big ranch with a job as cowboy or herding sheep. These home physicians gave counsel according to the best of their knowledge, but their advice shows how little the average family practitioner knows about tuberculosis, that he is not able to recognize this common disease until the patient has reached the last stage, and then his verdict is that consumption is incurable. Every cured consumptive is duty-bound to admit that he had the disease and stands as living evidence to prove that it is a curable disease. Although I was opposed to going anywhere, as I could get air, rest, milk and fresh eggs at home, I was finally persuaded to buy a tourist ticket with many stopover privileges. This was the worst thing I could do. Traveling is hard work for a well person, but much of it is fatal to a consumptive, who has no energy or strength to spare in sight-seeing. He should go direct to his destination and rest when it is reached. Foolishly making many stopovers, I visited in Omaha, where the pleurisy grew so painful that I bought straps and put over the left ribs. After a stopover in Kansas I reached Denver so weak I could not take any sight-seeing trips. When I came to Colorado Springs the pleurisy was even more painful, so that every cough would double me up in a stooping position to hold my ribs firm. I was acquainted with Dr. John Crouch at the Union Printers' Home and had planned to consult him. After a few minutes' examination he pronounced the trouble tuberculosis in the moderately advanced or second stage. Extremely irritated. I de clared that since the doctors at home told me I did not have that loathsome disease I must have caught it on the train from a coughing young man who was going to the Woodman Sanatorium. Dr. Crouch only laughed and said I had had it for at least one year. Now I believe him and thank him for putting me on the right road to Wellville. He insisted that traveling be immediately discontinued and that I go at once to a sanatorium, where I should stay not less than six months. I protested, on the grounds that I could not spare the time, but finally consented to go for thirty days. Little did I realize that I would spend the next ten months in bed! The following day I went to Cragmor Sanatorium, feeling like a criminal sentenced to jail to serve an indeterminate term depending on future good behavior. I was very careful not to let the people in my home town know that Cragmor was a sanatorium. To my surprise this jail soon became a most pleasant place. The patients were cheerful and optimistic; one heard scarcely any complaining or grumbling. A few persons were, as I was, despondent when entering. One lady patient, when a newcomer, cried night and day for over a week, which, of course, did not improve her physical condition. Soon after the first shock of confinement a patient feels better. He meets other fellow sympathizers who laugh and joke about their "bugs" and even call this disease by its pet name, "T. B." When I asked how soon I would be well. Dr. F- would give me an evasive answer, such as "God only knows." Then he would advise, "Do not worry." "Sleep sound,” "Say your prayers," and "You will be all right soon." "Soon" is his favorite word. It expresses the hopefulness which is so characteristic of the sanatorium atmosphere. An old lunger told me to "Cheer up. The first five years of chasing the bugs are the hardest; after that you get the habit." In many ways a sanatorium can be compared to a college or boarding school. The president is the head physician. The trustees are the controlling body. The faculty or teachers are the nurses, while the students are the lungers who are studying a most important lesson, namely, "How to live in good health." The recitation classes are the talks with the physician and nurse, and the regular quiet hours are those spent chasing the bugs. When these students meet at dinner on the campus they always are ready for gossip or a good-natured joke with a fraternal interest in each other, and making plans of big things to be done after graduation. Since leaving the sanatorium I have met several persons who admit they have tuberculosis, but neglect or refuse to go to an institution. Each of these gives some excuse why he or she is an exceptional case and hence does not need sanatorium treatment. One young man thinks the rules would be too strict, saying it would be hard on his nerves to be held down to regular hours and habits of living. Such foolishness! The rules are made for the benefit of the patient, that he may know how to live, how to secure a more rapid recovery, and how to maintain that standard of living after graduation which will lengthen his life and prevent the spreading of this disease among the loved ones of his family when he returns to them. Another man refuses to go to a sanatorium because it is too expensive. For the sake of argument and without figuring, let us admit that six months' treatment at a sanatorium will cost more than six months at home. Yet the knowledge gained concerning the disease and the more rapid progress one makes towards recovery will offset the additional expense, if any, and by returning to his occupation able to work he will find that the best treatment is the cheapest in the end. At home one is confronted with the same old worries, problems and conditions which are partly responsible for his loss of health. Then again, at home the meals are apt to be served at irregular hours or a cold lunch is taken and eaten in a hurry. Instead of resting after eating, so that all the blood and energy may be spent on digestion and assimilation, one feels like helping the family, if only to wipe the dishes. Other members of the family do not observe rest hours, but are about their daily work and pleasures, inviting the patient to participate. Thus in one's home there is a constant temptation to overexert his strength instead of conserving it. In a sanatorium these temptations are moved. Three square meals a day are eaten, and as all other patients observe rest hours, the one who does not rest feels peculiar or like the black sheep in the flock. re The Some people say they are afraid to go to a sanatorium for fear of catching tuberculosis. Such a fear merely shows their ignorance of a well-regulated sanatorium. It is almost as ridiculous as to object to going to a dentist for fear one will catch the toothache. truth is that a good sanatorium is careful to collect and destroy the sputum, and there is much less danger of infection than in a large city where people expectorate on the streets or walls of a building. The mere fact that most patients do make remarkable improvement while taking the cure at a sanatorium is the best proof that they are not re-infecting themselves nor catching other people's bugs. The results are what count. "By their fruits ye shall know them." When you are advised to go to a sanatorium, do you make up some fictitious excuse as to why you do not need that treatment? We all want to go to the drug store and buy good health by the bottle or have a miracle performed over us. When advised to eat and rest in the fresh air, that seems too simple. We are like Naaman, the leper, who objected to washing in the river Jordan and expected some big performance. Let us admit we have the disease, put away our pride and take the best and quickest cure obtainable. |