Remarks on the Universal Applicability of the Open-Air Treatment of Pulmonary Tuberculosis
Authors: R. W. Philip
Journal: BMJ (1898)

IN view of awakening interest in relation to tuberculosis, it seems opportune to record the conclusions I have been led to form as the result of ten years' observation with regard to the prevention and treatment of pulmonary consumption in connection with the Victoria Hospital for Consump- tion, Edinburgh, which was established especially for the treatment of poor patients on the open-air principle.A description of the origin and scope of the hospital has already been published in the Edinburgh Hospital Reports, vol.iii., and more briefly in the well-known works on Sanatoria for Consumption of Drs.Knopf, L6on-Petit, and Kuthiy.At the Tenth International Congress at Berlin (1890) I ventured to maintain the view that hospitals for the open-air treatment of pulmonary tuberculosis should be founded in relation to all large centres, and might, in my judgment, be as effectively arranged in Scotland as in any part of the world.This view was based on observation of the extremely varying characters of recognised resorts for consumptive patients, and the highly satisfactory results which had been obtained by the adoption of the fresh-air treatment in the practice of an extensive outdoor department for consumption at Edinburgh.Continued observations during the eight years which have elapsed since that date have confirmed and intensified that belief.These include observations made at a large number of the leading sanatoria and health resorts for tuberculous disease at home, on the Continent, and in North Africa, and results obtained at the Victoria Hospital for Consumption at Edinburgh, which was formally opened for the residence of patients four years ago, and where the cure a l'air libre has been the basis of treatment throughout.REPUTED CLIMATIC FACTORS.In the earlier discussions on the climatic treatment of pulmonary tuberculosis many factors were admitted and rightly emphasised, which cannot, however, be regarded as essential.The recognised fact that tuberculous disease is combated effectively at the sea level and at all elevations to over6,ooofeet, goes far to show that elevation, as such, has little to do with determining the successful result.Similarly the varying mean of temperature recorded at various stations makes us dis- card temperature as a factor of direct importance.For like reasons we may exclude mere dryness or moisture of the atmosphere, both of which are of significance in particular cases.Comparative stillness of the atmosphere, or, at least, some provision for protection against boisterous or piercing winds, is certainly a powerful adjuvant, usually eminently grateful to the patient, but cannot be regarded as essential in view of the fact that excellent results are attainable on shipboard, and at many sea coast and island resorts with full measure of wind.The nature of the soil is a factor worthy of much consideration in selecting the residence of tubercu- lous patients, but in the light of the geographical distribution of phthisis cannot be regarded in the category of essen- tials.Phthisis occurs in all countries where,the disease has obtained a footing, and can, I believe, be treated with ap- proximately equal success, or want of success, in all cli- mates, according as the larger indications for treatment are fulfilled or overlooked.It is a comforting doctrine, and eco- nomically reassuring, that the tuberculous patient, of what- ever country or race, can be suitably treated not far from Ilis own home.