Amongst the plantation pines on Flagstaff, on the far side of the hill from Dunedin, can be found the remains of the Nordrach TB Sanatorium. There is not much to see - a small pile of bricks from a chimney and a rusted square iron water tank - though the area surrounding has a profusion of rowan trees, a possible and not entirely welcome legacy of the hospital.
Tuberculosis was, 120 years ago, a mysterious thing. It was believed to be contagious. It was believed to be hereditary. One thing was known, however: if you could afford to take complete rest while stuffing yourself with food, the body might be able to heal.
OPEN-AIR TREATMENT OF CONSUMPTION.
NORDRACH COTTAGES SANATORIUM, FLAGSTAFF.
THE PREVALENCE OP CONSUMPTION.
With the view of obtaining some information with regard to the open-air treatment of consumption, a member of our reporting staff recently paid a visit to the Nordrach Cottages Sanatorium at Flagstaff, which was established about fourteen months ago by Dr R. S. Stephenson, and is now being carried on by him in conjunction with Dr E. H. Alexander.
The sanatorium is situated on the northern side of Flagstaff at an elevation of over 1200ft above sea-level, being about six miles distant from Dunedin. The establishment consists of a small block of cottages erected on a level piece of land, sheltered from the high winds by the surrounding ranges. The central block, which was formerly the homestead of Jellybrand's station, is now mainly utilised as the administrative portion of the establishment, one part of it being used as a dining room. Connected with this on the east side by a covered in corridor is a newly-added block of buildings, containing six rooms, which have been specially constructed for the open-air treatment, there being two more detached rooms of a similar description on the west side of the central block. There is altogether accommodation for eight patients in the institution, which at the present time contains its full complement. Both the doors and windows of the patients' rooms open directly on to the outside air, and remain open day and night, except in very stormy weather, when either the one or the other may require to be closed. Screens of open-wire gauze are, however, used at night in the doors and windows to keep out the moths and other insects. The air in the rooms thus remains as fresh and pure as that outside. The walls of the rooms are specially constructed to avoid dust and facilitate disinfection. For the same reason, the floors are polished, and superfluous mats, rugs, and furniture are dispensed with. A good supply of water to the sanatorium is obtained from very pure springs on the side of Flagstaff and the establishment is provided with a bathroom in which hot and cold showers can be obtained whenever required. Electric bells are also fitted up where necessary. There is a dairy farm in connection with the institution, and the patients are given plenty of milk, which is sterilised before being used so as to avoid any risk of infection from that source.
The site of the sanatorium is a very favourable one for the purpose. It is in an isolated position, standing in grounds comprising an area of 2000 acres, partly bush and partly pastoral country. It has a northerly aspect, and gets a maximum amount of sun while pine and other trees about the grounds furnish shelter from the sun and wind for the patients when reclining out of doors. The country round about has a porous subsoil, through which the moisture rapidly percolates, so that the surface of the ground soon dries after rain. From the time that a patient enters the institution until he leaves he can hardly breathe anything but the purest of air. Although it frequently rains in the locality, this is said to be an advantage, as the moisture of the atmosphere has a soothing influence over the dry, irritating cough of phthisical patients. The rain also clears the atmosphere of dust, which is irritating to the lungs. The view from the buildings extends over an expanse of many miles of mountainous country, the scenery being in its way very beautiful, while the neighbouring bush, hillsides, and gullies afford excellent opportunities for pleasant rambles.
When one becomes a patient of the institution, if he has fever, he is kept in bed until his temperature becomes normal. As he grows convalescent he is allowed out of doors, being kept at first in a recumbent position on a lounge. After a time walking exercises are prescribed, the temperature and pulse being carefully watched in the meantime. Patients are advised to walk mostly up hill at a very slow pace, this kind of exercise being prescribed for the promotion of deep breathing and the consequent expansion of the lungs. The feeding is a special feature of the treatment undergone by the patients in the institution. The Nordrach system of three meals a day is generally followed, and the fresh air enables their patients to assimilate an enormous amount of food. Two courses of meat are served at lunch and dinner, with abundant helpings of vegetables. In addition to this the patients get some nourishing kind of soup, as well as pudding and plenty of milk. They are said to eat three or four times as much as they have been accustomed to, and they are required to rest an hour before each meal, in order to aid digestion. Some of the patients who have been in the institution have a ruddy complexion, and present an appearance of robust health, which is said to be one of the first results of the treatment. There is an absence of hospital restraint about the place, and the inmates seem to be very cheerful. As there are no fires in the room it might be supposed that they feel the cold, but this is not the case. When at rest in cold weather the nurses are always very careful to see that they are kept warm with ample wraps, and also hot water bottles if necessary, but when taking exercise they are encouraged not to mind the weather, the object being to burden them so that they can stand any climate after leaving the sanatorium. Patients are not permitted to expectorate about the place, enamelled mugs being provided for them to spit into. The sputum is burnt, and the mugs are thoroughly cleansed by boiling. Handkerchiefs, which are supplied to the patients, are also burnt after being used. Since the sanatorium was established, 21 persons have been under treatment, including those at present in the institution, and there has been more or less improvement in all but three. Several have returned to work thoroughly cured, and others are continuing the open-air treatment at home. In the light of the fact that most of the patients have come to the place as a last resource, after having tried all other methods of treatment, these results are considered very satisfactory.
INTERVIEW WITH THE MEDICAL OFFICER.
Besides showing our reporter over the institution and grounds, Dr Stephenson kindly replied to a number of questions relating to consumption and to the open-air treatment of it. The following is the result of the interview: —
Reporter: "How long has the open-air treatment for consumption been adopted?"
Dr Stephenson: "'The treatment was first commenced by the late Dr Brehmer, at Gobersdorf, in Silesia, Germany, where a sanatorium was erected by him at his own expense about 10 years ago. Since then it has been adopted in every civilised country during recent years, but so far as I know our own is the first one established in the Australasian colonies."
"What are the special features of the open-air treatment?"
"The three essentials are pure air, rest (mental and physical), and abundant or even over-feeding. The greatest care is exercised to avoid over-exertion and any fatigue. Exercise is taken at a very slow pace, and usually up hill, in order to expand the lungs. Patients are only allowed to walk at the rate of about a mile an hour to begin with, and a strict watch is kept to see that there is no rise of temperature following, exercise. If so, the patient is required to remain at rest for some time longer on the couches. Fires are not allowed inside the building, but patients are given as many wraps and hot bottles are are necessary to keep them warm. There are few, or no, complaints of the cold. It is quite a mistake to suppose that patients experience any hardship in the treatment they undergo. On the contrary, after a little time they have a craving for fresh air, and object to their door or window being closed, even in the roughest weather. Diet is a very special feature in the treatment, and we try every means to get as much food consumed as possible, the object being to strengthen the constitution of the patient so that his state of nutrition will become so good that he will be able to cope with and so throw off the disease. The fact that they gain in weight shows that this food is digested and assimilated. Several of our patients have gained a stone in a month, the record increase in weight for one week being 71b."
"How do you account for sick people being able to eat such large quantities of food?"
"The explanation I believe to be that the pure air and the rest, and freedom from all the little disturbances of every-day life strengthen the tone of the nervous system, and there is no waste of nervous energy, so that all the strength that a patient has goes to help the digestive organs to do their work properly. Dr Walther, of Nordrach, in Germany, states, with regard to/feeding, that as you can educate your muscles, so you can educate your stomach to take a large quantity of food, and it is by the combination of pure air, perfect rest, and special feeding, applied in a scientific manner, that the cure of consumption is effected."
"Is consumption on the increase?"
"The disease is very widespread, and particularly prevalent amongst civilised nations. In these colonies there are few families who have not lost some near friends or relatives from tubercular disease in some form or other.
"In Victoria last year there were 1500 deaths from this cause alone, and in New Zealand 795. Statistics show that nearly two-thirds of these might have been alive and well to-day if they had received the open-air treatment. Young people are specially susceptible to consumption; it is the cause of one-third of all the deaths that occur between the ages of 15 and 25 in Great Britain, and I believe the death rate for the colonies will be the same. Then, it is not the lazy and careless who become victims, but those who are most hard-working and self-sacrificing, and often the most intelligent."
"What about the past methods of treating consumption?"
"The treatment in the past has been notoriously inefficient. The figures that I have quoted show that this is so. I remember, when I was in London ten years ago attending the Victoria Park Hospital for consumption, Robert Koch's tuberculin injections treatment was then first introduced, and great were our hopes that a cure had been found at last; while equally bitter was the disappointment of patients and doctors when, after a few weeks' trial, temperature ran up with such severe aggravation of the disease that the patients refused to submit to the treatment any longer. The history of this sanatorium treatment has, however, been very different from that of Koch's cure, instead of being a product of laboratory research, heralded all the world over as a cure before it had been tried on any sick persons, the open-air treatment has only come to the front after many years of quiet and successful working. The first special establishment for the purpose was erected at Goebersdorf by the late Dr Brehmer in 1860. The well-known sanatorium at Nordrach in the Baden Black Forest, was established by Dr Walter over ten years ago, and there are also large establishments at Folkenstein, at Ruppertshain, and in other parts of Germany; while in the last year or two the movement has extended to all parts of Europe 'and America. In Germany the Friendly and Provident Societies have found it pays them to send members who have acquired consumption to one of the sanatoria."
"What are the statistics of the open-air treatment?"
"The statistics published by Dr Brehmer show that out of 1390 cases in the first stage of the disease 817 were, cured or nearly cured — i.e., nearly 60 per cent. Out of 2225 in the second stage, 477, or 21 per cent., got better; while in the third stage only a very few recovered. The results obtained at Nordrach have not been published, but it is stated that they are even better than these. The figures I have quoted show the importance of dealing with this disease at an early stage, when the prospects of recovery are good. The sooner a patient realises his position, faces the situation, and adopts the best means of treatment available, the better. Two or three months of treatment may suffice when one is first taken ill; while four or five times that length of time may be insufficient at a later stage of the disease."
"What is the cause of consumption?"
"Consumption rises not from one, but from many causes. Over-work or excess in any direction, especially during the critical period of growth into manhood and womanhood, is one great cause. In fact, anything that produces a lowered vitality or weakness of the tissues of the body, rendering a person unable to throw off the slight cough or the obstinate indigestion he has acquired, may cause consumption. Perhaps the most consistent factor is bad air from too close confinement to the house, The ventilation, or, rather, want of ventilation, in our private houses is a disgrace to our architects, and if our private houses are bad many of our public halls are worse. The theatres are, perhaps, the worst sinners in this respect: the foul and heated atmosphere to be met with during a well-attended performance is a disgrace to the management and a menace to the public health. Pure air is the birthright of every mother's son of us, and there is urgent need of a fresh-air crusade to form public opinion on this subject and to demand an abundant supply of fresh air for every man, woman, and child for every hour of both day and night."
"What is the effect of climate on consumption?"
" The effect of climate on consumption is greatly misunderstood. It is just as prevalent in the warmer climates of Spain and Italy as it is in Great Britain, and in the treatment a cool, fresh, bracing atmosphere is much to be preferred to one that is hot and relaxing. Frequent rain showers are an advantage, as they clear the air and keep down the dust, and a fair amount of moisture in the air has a marked influence in allaying the cough. The popular idea that there are certain climates that have a magical influence in curing consumption is a delusion. Proper management and care of the patient are of far more importance than climate."
"Is consumption hereditary?"
"Consumption is not hereditary, but it certainly has a great tendency to run in families — that is to say, some families arc particularly susceptible to the germs of the disease, to which all are exposed. Where this is known to be the case, great care should be taken to select an out-door life, and to keep the general health up to a high standard, so as to resist the beginnings of disease." -Otago Daily Times, 13/10/1900.
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| Flagstaff in the background. This and other b&w photos are from the 1908 pamphlet held by the Dunedin Public Library. |
OUR DUNEDIN LETTER
From our own Correspondent
Probably few people in Otago are aware that there is a private hospital at the Flagstaff for the cure of consumption, by the Nordrach or open-air treatment. Such is the case, nevertheless, and it has been in existence for the last two years, and been most successful in curing and alleviating many severe cases of consumption. The Nordrach treatment, after having fought for some years against the conservatism and prejudice of many medical men, is now generally acknowledged as being the most curative of any, for those unfortunates who are suffering from that dire disease known as consumption. At the last meeting of the Hospital Trustees the question of starting a Nordrach hospital was discussed, and it was generally considered that that was a matter which should be taken up by the Government. In the course of the discussion, Mr Myers referring to the Nordrach treatment said it was no experiment. It had been carried on in large German towns with great success, and had been brought into use in many other parts of the world. There was an institution of this kind at Whare Flat, but only males were received there. The greatest success had been met with, every case being cured, or some relief given. There had not been a death in the two years. Of course it was too expensive for poor people, and he thought the colony should take the matter up. -Bruce Herald, 27/11/1900.
An interesting description of the Nordrach Sanitorium at Flagstaff, about six miles from Dunedin, is given in the Otago Daily Times. The sanitorium is situated at an elevation of 1300 ft above sea-level, on the northern slope of Flagstaff. The mountains which surround the site provide shelter from the prevailing winds, and the air is described as "very fresh, bracing and absolutely pure." In one block of buildings the patients' rooms have been specially constructed for the open-air treatment, and both doors and windows in these apartments remain open day and night. The floors and walls are varnished, so that they can be frequently washed and disinfected, and there is a general air of freshness and cleanliness about the whole place. The statistics furnished by Dr Stevenson in regard to the results achieved by the sanatorium are very satisfactory. Seventy patients have gone thither for treatment, and of these, all who were in the first and second stages of consumption were either improved or cured, while of the whole, number 87 per cent, have been benefited to a greater or less degree. The figures are well worth quoting: Sixtyone were unmistakable cases of consumption. Out of 18 admitted in the early stages of the disease, 11 were cured and 7 improved; out of 28 in the second stage, 2 were cured and 26 improved ; and out of 15 cases of far advanced disease, 1 was cured, 6 improved, and 2 received no benefit. "Cured" means that on leaving the sanatorium no disease was to be found in an examination of the chest, while "improved" signifies a gain in weight and general health. These figures show that under proper treatment consumption is a curable disease, and that the sooner the treatment is applied the better is the patient's chance of recovery. -Poverty Bay Herald, 13/3/1902.
The Christmas season at Nordrach Cottage Sanatorium, Dunedin, was celebrated by the presence of a number of old patients. In the course of a few remarks after dinner, Dr Stephenson commented on the healthy appearance of the latter, and their sound condition, as evidenced by the fact that they had been able to take the long uphill walk from Dunedin without any difficulty, and said that nothing was more cheering than to see patients who had been away for years returning in such excellent health. The fact was also emphasised that persevering effort on the same lines would enable the present patients to achieve the same good results. There was, he said, no royal road to cure tuberculosis, no short cut by means of drugs or patent cures; but in nearly every case would be cured if early enough placed on the right lines, and if the instructions received at the sanatorium were faithfully carried out after leaving. -Poverty Bay Herald, 5/1/1904.
Personal Items
Nordrach Sanatorium presented a very bright and pleasing appearance on Thursday afternoon. The choir of the Moemiti Bible circle visited the institution and delighted all with their excellent singing. The opportunity was also taken to present Miss Ewing, the late matron, with some acknowledgements of her long and faithful services. Mr D. Macpherson, on behalf of a few (about 20) of the old and some present patients, presented her with a set of silver-mounted brushes and mirror, saying how little he could express all that they owed to her kindness and faithful attendance at all times. Mr E. H. Reid thanked all on behalf of Miss Ewing. Dr and Mrs Stephenson gave Miss Ewing a gold chain and medallion. Dr Stephenson remarked that the old patients were now becoming widely scattered and somewhat numerous. He knew of between 60 and 70 who were keeping in excellent health, and read letters lately received from some few. Some amusement was caused by one writer, who said that he was keeping fairly well. He had just finished a job of fencing, and was next takirg on a. contract to hoe turnips. He thanked all those who had assisted and contributed to the hat harmony of the little gathering. -Otago Witness, 7/12/1904.
Nordrach Sanatorium near Dunedin affords a quiet and comfortable home, where the open-air cure for consumption is very successfully carried out. The romantic mountainous situation and bracing atmosphere afford the best facilities for the treatment of this disease. Special terms for tent accommodation. Rooms reserved for cases requiting simply complete rest and change under medical supervision, or the Finsen blue-light treatment.— Apply Dr. Stevenson, Dunedin. -Southland Times, 30/12/1904.
"Happy Hours With Great Authors" was the subject of Mr Wathen's lecture at the Nordrach Sanatorium last evening. He held that the British and other nations owed a debt of gratitude to such writers as Shakespeare, George Eliot, Thackeray, Sir Walter Scott, Dickens, and Bret Harte. Several songs were well sung. Responding to a hearty vote of thanks, the lecturer said he thought that the only pleasure worthy of the name was found in giving pleasure to others. Otago Daily Times, 30/3/1905.
Several members of the Roslyn Methodist Church choir, accompanied by the Rev. Mr Wallis paid a visit to the Nordrach Sanatorium, Flagstaff, on Saturday afternoon. Their excellent singing and playing were much appreciated by the patients. Afternoon tea was served in the dining room, and a very pleasant time was spent. -Otago Daily Times, 24/6/1907.
PERSONAL NOTES FROM LONDON
The degree of M.D. has recently been conferred upon Dr R S. Stephenson by the Edinburgh University, where the past two months have been spent in working up for the necessary examination. The months of February and March were spent on the Continent, among the places of interest which Dr Stephenson visited including the Pasteur Institute in Paris, the Schatz-Alp and other sanatoria in Davos, Switzerland, where there were no fewer than 2000 consumptive patients under treatment, and the Nordrach Sanatorium in the Black Forest, Germany, which keeps up its high reputation for thoroughness and efficiency. At Heidelberg Dr Stephenson had the privilege of meeting Professor Czerny, of the renowned cancer institute. Mrs Stephenson and her child reached England recently by the s.s. Ortona, after an excellent voyage, and now, at the conclusion of a few weeks in London, Dr and Mrs Stephenson are going north to Yorkshire and Scotland for the months of July and August. -Otago Daily Times, 8/8/1907.
Several former patients of Flagstaff Sanatorium were seen by Dr Stephenson on his recent visit to England. It is of interest to note that they were generally in excellent health. One, who is a medical student at the Edinburgh University, had broken down in the course of his studies, came to New Zealand and had a year's treatment at the above institution. He returned to Edinburgh, put in a year's hard study, and passed his final M.B. examination last year. For the past 10 months he has been resident surgeon at a provincial hospital in England, keeping in first-class health. Another former patient is now a board school teacher in London, and was one of the freshest and healthiest-looking persons met with in that city of pale-faced people. In the past nine years 300 patients have received treatment at the Flagstaff or Nordrach Sanatorium. All those in early stages of the disease have benefited by the treatment, and in many cases cures, as satisfactory as the cases mentioned above, have been made. It cannot be too widely known that, given early and persevering treatment on sanatorium lines, the great majority of consumptive patients may be definitely cured. -Otago Daily Times, 10/4/1908.
Several members of the Roslyn Methodist Church choir, accompanied by the Rev. Mr Wallis paid a visit to the Nordrach Sanatorium, Flagstaff, on Saturday afternoon. Their excellent singing and playing were much appreciated by the patients. Afternoon tea was served in the dining room, and a very pleasant time was spent. -Otago Daily Times, 24/6/1907.
PERSONAL NOTES FROM LONDON
The degree of M.D. has recently been conferred upon Dr R S. Stephenson by the Edinburgh University, where the past two months have been spent in working up for the necessary examination. The months of February and March were spent on the Continent, among the places of interest which Dr Stephenson visited including the Pasteur Institute in Paris, the Schatz-Alp and other sanatoria in Davos, Switzerland, where there were no fewer than 2000 consumptive patients under treatment, and the Nordrach Sanatorium in the Black Forest, Germany, which keeps up its high reputation for thoroughness and efficiency. At Heidelberg Dr Stephenson had the privilege of meeting Professor Czerny, of the renowned cancer institute. Mrs Stephenson and her child reached England recently by the s.s. Ortona, after an excellent voyage, and now, at the conclusion of a few weeks in London, Dr and Mrs Stephenson are going north to Yorkshire and Scotland for the months of July and August. -Otago Daily Times, 8/8/1907.
Several former patients of Flagstaff Sanatorium were seen by Dr Stephenson on his recent visit to England. It is of interest to note that they were generally in excellent health. One, who is a medical student at the Edinburgh University, had broken down in the course of his studies, came to New Zealand and had a year's treatment at the above institution. He returned to Edinburgh, put in a year's hard study, and passed his final M.B. examination last year. For the past 10 months he has been resident surgeon at a provincial hospital in England, keeping in first-class health. Another former patient is now a board school teacher in London, and was one of the freshest and healthiest-looking persons met with in that city of pale-faced people. In the past nine years 300 patients have received treatment at the Flagstaff or Nordrach Sanatorium. All those in early stages of the disease have benefited by the treatment, and in many cases cures, as satisfactory as the cases mentioned above, have been made. It cannot be too widely known that, given early and persevering treatment on sanatorium lines, the great majority of consumptive patients may be definitely cured. -Otago Daily Times, 10/4/1908.
A VISIT TO A GERMAN SANATORIUM.
By R. S. Stephenson.
I wakened this morning (February 20, 1907) in the famous Nordrach Valley, in the heart of the Black Forest, of Southwest Germany. It was stormy, wet, cold, and dark, the snow of the previous evening having given place to rain. I had to rise at 7.30 in order to get up to the Sanatorium dining room, half a mile away, by eight o’clock.
I dressed and shaved by the light of a candle and then started to walk, or rather slide, up the valley over a narrow road with no footpath, through pelting rain. It was very slippery, with streams of water wearing channels in its snowclad, half-thawn icy surface. The dining room, with the library, offices, and kitchen, is a detached building alongside the roadway. It is fifty or more feet long, by about 20ft wide. On both sides are large casement windows, with fanlights at top. There is one stove in the middle of the room. The patients, clad in warm wraps, arrive promptly at eight o’clock strikes from their dormitories on the hill-side. The windows having been kept closed until the meal begins, the room, after the wintry conditions outside, seems bright and warm. We remove our overcoats and sit down with good appetites to our allotted places. This is the signal for the maids to open some of the windows, and as the meal progresses more are opened, until a fairly rapid breeze of chilled air blows through the room. By this time, however, we are fortified by profuse libations of hot milk, coffee, Frankfort sausage, brown and white bread, rolls, marmalade, honey, and cheese. The patients number about sixty, and are seated at three tables, each presided over by a medical man, the latter serving to each patient the meat portion of his course. The maids are not allowed to remove, without the doctor’s permission, a patient's plate until its contents are disposed of.
I found myself seated opposite to a young lady with an abnormally large tumbler of warm milk in front of her (capacity half-litre — i.e., nearly one pint). She looked fresh and well, and in response to my queries informed me that she had come to the Nordrach Sanatorium from Ireland five months previously. She then weighed only six stone, now she weighed eight stone, having gained 281b. Dr Walther having told her that she would need to gain another 181b, she had still some hard work before her. She spoke very gratefully of his treatment, to which she considered she owed the saving of her life.
On my asking if her gain in weight was exceptional, she replied "No; most of the patients have done much the same.'’ Finding myself amongst a group of people speaking in my own language, I ventured to remark to my neighbor on my left that it was very pleasant after having spent several weeks in foreign countries to be amongst English people again. I found I had, colloquially speaking, put my foot in it, as I was promptly informed; “You forget that Ireland is still on the map, and about a dozen of us hail from there.” "Well,” I remarked, "you will have to talk a long time to the Germans before you will get them to cease calling you all English.”
The largest meal of the day is served at one o'clock, and the evening meal at seven. Nothing is given between, so that one has time to get up a good appetite. The following was the menu at supper: roast beef, sliced fried potatoes, bread with which butter was largely used, a salad of celery, and something like cress, which was strange to me. Large sardines followed as the fish course, and dessert in the form of biscuits, with more butter. The meal was not a heavy one, and stimulated by the cold air, it presented no difficulty to the average digestion, except for the half-litre of hot milk, which had to be taken by patients who were under weight: the others are allowed beer, etc. Dr Walther and his two assistants are all present at meals. The latter were both cured patients; one was a German, the other Scotch, and they all spoke English fluently.
The patients stay on an average from four to six months, and pay four to six guineas weekly. Each patient is visited three times daily by a medical man. Dr Walther himself sees each patient once a day. Temperatures are taken three times in twenty-four hours. A former patient acts as secretary or manager, and his wife superintends the cooking and housekeeping, the rest of the work is done by maids, there being neither trained nurses nor matron.
The doctors start on their rounds at 7 a.m and each patient is instructed what walks he or she shall take for the day. The walk is generally for two hours in the morning and less in the afternoon. There are seats to rest upon. The fir woods which cover the hills in all directions are traversed by roads which were buried in snow during my visit. These roads were probably made for getting out the timber for the numerous sawmills in the district. The roads offer a great variety of sheltered walks, at varying grades. The length of each walk is known, and they are distinguished by names. The patient starts on the up grade, and comes back down hill, going very slowly — just a crawl. Immediately on returning from his walk the patient is required to go to his room, take his temperature, and rest for one to two hours until the next meal time. Patients retire early, and spend ten or eleven hours in bed. No breathing or gymnastic exercises are permitted. Much use was however, made of an excellent dark room for photography.
I spent three days and nights at the sanatorium, and conversed with many of the patients. A good and cheerful spirit seemed to be prevalent amongst them, in spite of the strict regime. I heard no grumbling. Most of the patients took their walks as usual, although there was a violent snowstorm raging, with high wind. The gale at this time extended over the west of Europe, and caused the wreck of the S.S. Berlin at the Hook of Holland.
The patients are mainly accommodated in three villas on the steeply-sloping side of the valley. These buildings are twostoried, heated by hot water pipes, and by electricity from the sanatorium water power. The rooms are lined with plain varnished wood, which can be re-varnished when a patient leaves. The floors are covered with linoleum, which is frequently washed down. Each room has a shower bath, with a supply of hot and cold water. The rooms are not luxuriously furnished, but are comfortable, and each is provided with a lounge for rest hours.
The Sanatorium is quite in the country, about nine miles from the little railway station of Biberach Zell, at which the express trains do not stop, and where English is not spoken. There are no cabs and as my knowledge of German was limited to what I had picked up during a few weeks stay at Davos, I was somewhat at a loss to procure a conveyance to drive me to the Sanatorium. But with the aid of a little French I managed to make a bargain with the keeper of a small coffee house near by. The road leads through some primitive villages and past many quaint old farm houses. As I ascended the valley into the heart of the famous Black Forest I found that the farmer’s family, his cattle and horses, his barn and farm buildings generally, were all gathered in one big building. The Sanatorium is at the head of the valley, and elevated 1400 feet above sea level. The subsoil is a coarse red sandstone. Shelter from the prevailing winds is afforded by the hills made by forests of fir trees, the climate is that of an elevated hill district, moist and variable, rather colder in winter and hotter in summer than the south of England.
I had the privilege one afternoon of a long conversation with Dr Walther. He is a rather big man, about sixty years of age, with ruddy face and grey hair dressed in sac coat and garters, his appearance being rather that of a prosperous farmer. He has a loud voice, hearty laugh and holds decided views. Some amusing stories are told of his prompt methods of dealing with unruly patient. He told me that he prefers a patient to gain weight slowly, from 1/2Lb to 1Lb weekly over a long time, rather than to gain a large amount at first and then stop. He does not give such liberal meals as formerly, uses a lot of butter, and attaches more importance to carbohydrate than to protein food. Patients are not allowed to depart from the customary food, except for some very good reason. He keeps patients with hemorrhage from talking and at rest - not necessarily in bed - and does not put them on low diet. When I congratulated him on the success of his treatment and his courage in undertaking pioneer work of this description, he told me that for the first seven years he was doubtful whether he would not have to go bankrupt. He declares that we do not know how consumption is conveyed, but is of opinion it is probably acquired in childhood, and remains latent for a long time. He also thinks some people offer more resistance than others. Then the quality of the infection may vary: to all events, different individuals react very differently to infection. He is of opinion that what is required is something to increase the germ resistance of the human tissues, but medical science does not know of any such thing. He stated that he had given up the use of tuberculin, as, in his experience, it did no good. His views on the subject of the after-life and work of patients are interesting; e.g., for one or two years they must live quietly, and husband their strength, they are better to have something to do on leaving the sanatorium, but the work should be such as to avoid fatigue There should be no hard farming or active exercise; better to put them to office-work if they are used to that. They should live well; keep their nutrition good, and attend carefully to the everyday details of their lives. It was a popular fallacy to suppose that change of occupation meant rest.
I also learnt from Dr Leuthwaite, a former patient and now assistant physician, that some of Dr Walther's most successful cases were engaged at work in offices in London. This coincides with my own experience at Flagstaff Sanatorium, near Dunedin, where I have treated 300 patients during the past ten years. Of these 300 there are sixty odd who are cured so that they are now able to carry on their ordinary business. Quite fifty of these ex-patients of mine have stood the test of several years of ordinary life and hard work. Some since leaving the sanatorium have become mothers without relapse, several are wives who are to-day doing their own household duties, while others are in business, and others again are farming. Two are medical men in the active practice of their profession to-day.
One will have little difficulty in gathering from the above narration of plain facts that there is no one occupation specially suited to convalescents from tuberculosis. The one essential which all have fulfilled is to live well, eat, sleep, and rest well for a year or two after apparent recovery, so as to maintain a high state of nutrition and a good average weight. How to do this is a problem that has to be solved differently in each individual ease — a problem the successful solution of which depends very largely on the resolution of the patient and the cooperation of his friends and his medical adviser. I am convinced that it is an error to advise men who have never handled a shovel to go and plant trees, or to tell men who are used to shop work to go and do farming. For this reason one would expect little good — on the contrary, serious injury — to come from labor colonies for consumptives, unless they are put under very careful supervision. In this connection it is customary to quote the Frimley Sanatorium, where Dr Paterson has organised a regular scheme of manual work for patients still undergoing treatment. It is also customary to overlook the fact that these patients have been through a double process of selection. First, from a very large out-patient department at Brompton Hospital they are admitted to the wards, there watched by experts, and if considered favorable cases they arc sent on to the sanatorium. When there they are tested several times a day as to pulse and temperature, and only when these are normal are they allowed to begin work. This close medical inspection, with frequent taking of pulse and temperature, continues, and if the temperature rises to 99deg they are sent back to rest.
I have penned the above notes of a visit of observation because I find, on my return, that there is still much misunderstanding about the open-air method of treatment of chest troubles, and I trust that the perusal of them will prove of material assistance to all interested in this important matter. -Evening Star, 29/10/1908.
We have to acknowledge receipt of a booklet giving some particulars concerning the New Zealand Nordrach Sanatorium at Flagstaff, near Dunedin. Here is given an outline of the outdoor treatment of pulmonary consumption and other tubercular diseases. -Otago Witness, 4/11/1908.
OBITUARY.
DR RALPH STUART STEPHENSON.
In the death of Dr Ralph Stuart Stephenson, M.B.C.M. (Edin.), in his fifty-seventh year, which occurred at his home, St. Clair, early yesterday morning, Dunedin has lost an old and respected citizen. The deceased was born in Victoria, being the third son of the Rev. Frances Ewen Stephenson, and was educated at Horton College, Ross, Tasmania, where he secured the Tasmanian scholarship of £200 per annum, tenable at any British University for four years, and the gold medal as dux of the college. He continued his studies at Edinburgh University, taking his M.B. degree in 1890, and in 1906 he returned to Scotland and took his M.D. degree with honours, and was commended for his thesis “The Open Air Treatment of Phthisis.” He spent some time in special work in hospitals in London and Dublin. After this he studied and became convinced of the value of homoepathy, and before coming to New Zealand spent a year in the Melbourne Homeopathic Hospital as resident medical officer.
He carried on practice in Dunedin as a homeopathic physician for nearly 30 years, and some time ago established, and carried on successfully for 10 years, the Nordrach Cottage Sanatorium at Flagstaff. Many testimonies could be borne to the success which attended his efforts to relieve and cure disease. He was a man of quiet and undemonstrative but always cheerful bearing, who had a very high sense of duty and many of his patients felt that he became to them a real friend in the truest sense. He was held in the warmest esteem and affection by many in Dunedin. He took his share of war service, going Home as P.M.O. on the Turakina, and did special work at Codford and Walton-on-Thames.
Two years ago he was laid aside with a severe illness, but rallied for some time, after visiting Auckland. On Monday last he took a sudden turn for the worse and passed away quietly at his home at St. Clair yesterday. Dr Stephenson always took a keen and active interest in many phases of social life. He was a member of the Otago Institute and of the Otago Club, vice-president of the Otago Cycling Club, and a member of the Kaituna Bowling and Tennis Clubs, and of late years the St. Clair Bowling Club. In 1896 he married the second daughter of the late Mr W. A. Ewing, who survives him. He leaves two sons and two daughters, of whom the elder son (Mr Frank Stephenson, sheep farmer) and daughter (Mrs Harold Shires) reside in the North Island. -Otago Daily Times, 18/1/1924.
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| Andersons Bay Cemetery. |
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