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results have been observed, such as the reduction of temperature, the disappearance of tubercle bacilli, the relief of cough, and the increase of weight. This is mentioned as an illustration, and because it is only fair not to overlook any credit attaching to a first experiment. Its originator would probably be the last to claim that in its present stage it contains more than the germ of a great movement.
Let us examine very briefly the possibilities that lie within the range of a more complete and organised development of this great reserve of our natural resources. The cure of consumption is among the hardest of our tasks, and more than we could venture to hope for as a result of any one system of treatment. But it is less difficult to realise the protection that might be afforded against rheumatism, heart disease, and kidney disease by mitigating certain properties in the atmosphere that surrounds the patient. If treated air should prove, with the co-operation of other hygienic factors, of great value in these and other ailments, it would solve the economic or social difficulty inseparable from a population like ours, of which only a small percentage of sufferers can visit other climates. It would meet another difficulty which attends the Open Air treatment at home. It is applicable to London and other great towns, where the great majority of the sick cannot, for want of means, be sent to open air sanatoria in the country. As a form of treatment it could find its domicile in every town hospital. It would not remove the patient from the centre of science and medicine, but would place the best resources of these at his disposal, and enrich and develop them by the opportunities afforded for observation and study.
Mention has already been made of the variety of diseases, widely prevalent in this country, which might be brought within the range of a systematic investigation of the possibilities of treated air. When we consider how numerous and diverse those possibilities are, we are justified in saying that at present little is known and little has been done in this direction, and in asking if we can calmly contemplate a continuance of our inactivity and ignorance. We have purified water; distilled, aerated, and medicated it. We use it for purposes of cure in every variety that nature can provide or science can apply. What has been done for air, beyond mechanical ventilation, modifying or increasing the abundance of its supply without any improvement in its quality ? Compressed air and rarefied air have been used. Establishments exist for the inhalation of steam and medicinal vapours. Oxygen, too, has been summoned to the aid of the sick. But these have been casual expedients of the nature of sittings.' Nowhere, save in the instance already mentioned, have the means been provided of continuous application by enabling the patient to live for a given time in treated air.
The main constituents and the main qualities of air are well known. Its finer constituents and qualities are only now.gaining recognition.
The temperature, the moisture, and the pressure of the atmosphere have already been submitted to control ; and it might even now be possible to provide within a limited cubic space a succession of artificial atmospheres differing in their value for purposes of treatment. But the finer characters of natural climates—for instance, their tonic or their relaxing quality, are not wholly to be explained on so simple a basis. As the proportion of oxygen, nitrogen, and carbonic acid is known to show hardly any local variations, these subtle climatic properties possibly depend upon the more variable influence of light, of electricity, of magnetism, and of the latest of our additions to the attributes of air, radio-activity. The recent observations made in Switzerland that the air at a moderate altitude is several times more radioactive than in the valley favour the hope that a future elucidation of the mysteries of climate may result from a study of the physical agents already known to us, and of others yet to be discovered.
Is it not clear from this brief survey that the field of investigation before us is vast and varied, and that the treatment of air may become at least as important as the Open Air treatment? The two subjects are closely connected, and it is a question whether the Open Air treatment, in this country at least, can have the fair trial its great possibilities demand, without being complemented by an efficient control of the condition of the air itself. Extremes of cold or heat, of damp or dryness, mists and fogs, constant changes of wind, cannot be regarded as a helpful part of the treatment, and need to be eliminated. The relative quality of local climates is another important consideration. Above all, it must not be forgotten that the suitability of the climate is an individual question. It is well known that even Davos does not suit all cases of consumption, and the best of health resorts would be the better for facilities for modifying its local atmosphere to meet individual indications.
No inquiry into this matter can fail to open up an important question affecting the construction both of our sanatoria and our town hospitals. In the former provision for suitable air is not a care of the future, but of the present. Sanatoria must live up to their name. With cure as their object they must follow every advance, if they cannot lead it, and provide for each condition the best air that science can produce. Have they been planned with this progressive end in view ?
The suitability of our older hospitals for the Open Air method, including all the improvements in it which are within sight, is another anxious matter. From this aspect alone, irrespective of any new departure which further discoveries may at any time force upon us, there is a certain responsibility in planning monumental hospitals of a durability' worthy of the Romans' instead of lighter buildings not intended to survive so long their inevitable obsolescence. Within the near future our ideas as to the internal distribution of space and of wards
may undergo modification in connection with the necessity for extending an improved application of the Open Air principle, and of supplying not damaging but healing air. Have our hospitals been designed to include this purpose ?
To elucidate all these problems and satisfy their requirements, prolonged and systematic investigation and patient observations are necessary. The result may bring us to the strange conclusion that after all the best treatment for our climatic diseases is the only one possible to the vast majority of those who suffer from them, to stay at home; and the best sanatorium one where every facility for aërotherapy may in the future be obtainable.
If, by sufficient study, we could ultimately learn to treat the air so as to fairly reproduce for practical purposes of treatment the virtues of various climates, a great advance would have been made. And, besides imitating climates artificially, we might in the future be able to create climates to suit the individual requirement just as we regulate the dose of medicine or of electricity, by varying the supply of the normal constituents and qualities of air and by adding beneficial agents. To analyse the factors in the air of a climate might enable us to compound it as we compound a chemical body. That this treatment of the atmosphere is a practical possibility is becoming known to men of science; that it is worth doing will be obvious to physicians ; that it is being tried has already been shown. How soon it shall be tried on an adequate scale is a question for the nation. The range of investigation which in the future is open to us in this direction is boundless.
It remains to suggest and, not without hesitation, to formulate a scheme by which the conclusions arrived at might be embodied in a great national enterprise.
It is strange that in an age illuminated by its discoveries pure science has as yet done so little for health. Though we may not be so enthusiastic as Metchnikoff about prolonging life, still we may hope for some improvement if we know how to earn it. Hitherto medicine has gleaned rather than reaped in the fields of science, or has caught here and there a casual seed which was to fructify under its own care. There is an illimitable harvest, if only men of pure science are secured as practical associates in our work. They are the explorers fully equipped. Agents of progress themselves, their collaboration with its other agents should be a direct one. A new organisation is needed, in which pure science should be given the place it alone can fill. This should include scientific men in working combination with the men who have practical experience in the actual treatment of disease. To assist the cure of the sick and suffering might then become a welcome function of the man of science, as it is the professional duty of the medical man.
The practical requisites for such a scheme would be
1. A Hospital for the treatment of disease with the help of atmospheric as well as other agents ; not necessarily a very large or costly hospital, for special construction and equipment would be more important than size. A hospital is the only place where clinical and therapeutical methods can be applied with systematic thoroughness, so that the results can be identified with the factors of treatment, and the knowledge thus gained diffused far and wide with authority.
2. An Institute for the study of atmospheric hygiene in relation to (a) the treatment of disease, (b) the improvement of the health and strength of the healthy. The institute would be worked in connection with the hospital, and would represent on a large scale the functions of the clinical and pathological laboratories attached to an ordinary hospital. The staff of the institute might consist of (a) a consulta-, tive board, including, in addition to physicians and surgeons, men eminent in each branch of science : physicists, chemists, physiologists, electricians, radiographers, architects, engineers, and others; (6) a smaller group of experts to collaborate with the medical staff.
Need we ask what would be gained by such a combination ? All problems of treatment involving chemistry or physics would be studied and worked out in their various aspects, including the practical side of finance, by the highest authorities of the institute, and, if judged practicable, their final elaboration carried out by the joint scientific and medical staff of the hospital. In this way, for the first time, pure science would be handling the practical work of healing.
A résumé of these ideas, which are probably novel to most, may be of service to the reader.
No new cure for consumption or for any other diseases is contained in these pages. Their object is to reveal the extent to which our knowledge and our use of curative agencies available in a promising direction have been unnecessarily delayed.
Open Air, the greatest of all modern advances in the treatment of consumption, can never be superseded; it only needs to be improved and, if necessary, supplemented. Its application extends far beyond consumption. But our open air does not always suit our chief ailments so well as open air elsewhere at selected stations.
The advantage of climate as a protection or as a cure should not remain the exclusive privilege of the few; some equivalent at least should be provided for the many.
This national duty is specially a London duty, for in London, with its millions of breathers of used-up air and with its miles of contaminated atmosphere, it is combined with another national duty —that of stopping the deterioration of the race, and of providing for the healthy development of the young. This necessarily involves as a first essential a progressive study how to improve the air we breathe in the sick-room, in the sleeping-room, in the school-room, and in the workshop.
The difficult task of producing special atmospheres for the prevention or relief of some of our climatic diseases, for which special climates are distinctly beneficial, is beyond the unaided powers of medical art. It could not be successfully attempted without a systematic collaboration between the representatives of pure science and practical engineering and those of medicine. This calls for an institute for the experimental study of atmospheric hygiene in all its aspects, combined with a hospital for practical observation and treatment, not limited to any one system, but capable of readjustment to every future advance. Under such a combination problems relating to the construction and plant of hospitals and sanatoria, as well as those of medical treatment, which have not hitherto been submitted conjointly to comparative study, would be continuously worked at, and the results made available for all charitable institutions throughout the land.
Labour and delay are inseparable from the attainment of practical results in the treatment of disease, and still more in connection with atmospheric hygiene as relating to the ventilation of houses and towns. This twofold necessity strengthens the claim for prompt action. For solid clinical results, however, we may not have to wait so long. A hospital duly equipped would from the first be fulfilling an urgent work of relief, on those less complicated lines which have already been found successful, and any other simple lines to come. To generous supporters of the scheme this would be an immediate reward. It would encourage and sustain those engaged in the weary work of research, and provide the first fruits of that matured and systematic co-operation between medicine and science for which this article is an earnest appeal.