Popular Science Monthly/Volume 47/July 1895/Climate and Health

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CLIMATE AND HEALTH.[1]

By Dr. CHARLES FAYETTE TAYLOR.

IN the divisions of land and water, the situations of the continents, the seas, and the islands in the seas; the mountain ranges and the rivers which have their sources in them; the elevations and depressions of the more even surfaces, together with procession of the seasons and the earth's diurnal revolutions, we have some of the conditions for a great variety of climates. Proceeding from the equator toward the poles or moving along the surface of the earth in any direction, man, who seems to be the toughest animal on the face of the earth, can so adjust himself to varying climatic conditions as to exist in fairly good health almost anywhere, from the steaming equatorial jungles to the regions of perpetual ice and snow, as well as in intermediate locations where often heat and cold vary from one extreme to the other in rapid succession. And yet men live and thrive in nearly all lands and under the most diverse conditions, and with intelligent self-adjustment to their environment they may live well and live out their allotted times as a general rule. While the human race is exceedingly flexible, and can adapt itself rapidly to very diverse conditions, such adaptations, be they rapid or relatively slow, are not accomplished without an expenditure of energy to correspond with the functional modifications thus brought about. We call the process acclimatization, and the person, after subjection to the process, we say is acclimatized. That is to say, the functional activities of such a person have become adjusted to his environment; his functions have learned to harmonize with the 3 H THE POPULAR SCIENCE MONTHLY.

temperature, food, humidity, and other influences affecting him. The effect on the individual varies according to his susceptibility and the degree and intensity of the factors acting on him. In some cases sluggish functional activities are energized with a tonic effect. But when that is the case it does not follow that the new climate is necessarily intrinsically better than the one from which he came. In other cases the effect of climate change often proves atonic, depressing, and injurious ; but a bad effect on an in- dividual does not prove that the climate is necessarily worse than the one to which he was formerly accustomed. It may happen that influences, good in themselves, may be injudiciously employed : as, if a person requiring a cooler climate, such as that of the coast of Maine, for instance, should try Labrador, and it should be more than he could bear ; or, if one needed a milder climate and should find Para too depressing. Even the relatively slight difference between the European and American sides of the Atlantic often proves serious to the immigrant during the process of acclimati- zation, and many succumb, though it is probably true that the majority of immigrants find themselves invigorated in their new conditions of life on this side of the Atlantic.

My object is to call your attention strongly to the well-known fact that change of climate and its attendant circumstances, even when not of any extreme character or degree, does produce an impression more or less profound on the vital processes, and that the nature, degree, and general therapeutic or pathological char- acter of these influences should be more carefully studied than they have thus far been studied, so that when consulted by our patients we may have some definite advice to give in regard to locations best suited to the inquirer's special needs ; or, if we can not do so much, we ought at least to be able to give our patients some very positive ideas as to the kind of climate to seek, and especially what to avoid. For instance, California is seven hun- dred and seventy miles long. It embraces, according to Dr. Re- mondino, at least seven climates, distinctly different from each other, and all very different from the climatic conditions existing on this side of our continent. What is the sense in telling a patient with a hole at the top of his lung to " go to California " without instructing him in regard to the location to which he should go, or at least what kind of climate he should look for ? Without some specific information such a patient is likely to drop into a place better calculated to shorten than to prolong his days. To be sure, all the climates of California are characterized by a dryness exceeding what is known in the east, and this fact gives some relative advantages. But unquestionably the air may be too dry in certain localities for certain cases. Is it not too much to expect a patient to find out what the doctor who sends

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him away from home and friends himself does not know ? Be- sides, there are many constituent elements which enter in to make up what we call " climate." The first of these to be mentioned is usually the thermometrical readings, and the " mean " tempera- ture is generally quoted as proof positive of superiority when it varies a few degrees one way or the other from that of another locality with which it is compared. Now, the truth is, that to know the mean temperature of a place, and to know only that, is to know very little about its climate. The physiological effects of a climate must necessarily include the degree of humidity, the force and direction of the prevailing winds, the sunshine and cloudiness ; the fogs and their characteristics whether thin or dense, high or low, whether coming down from the mountains or rolling in from the sea ; besides other unmeasurable influences not seen though felt : all these and more must be appreciated in order to give the single factor of relative temperature any positive quality whatever. For instance, the mean temperature of the seven hundred and seventy miles along and near the coast of California varies but a few degrees, though the extremes vary much. But the physiological effects of the climates of different areas vary greatly. There are stiff northwest winds from off the Pacific, carrying a thin, swift-moving fog that chills an invalid to the bone, during July and August in San Francisco. To correspond to the sensations, the thermometer there lies like a cheap watch, and should be twenty degrees lower. A few miles back from the coast, with less wind and little fog, one's bodily comfort is perfect, and life is worth living, though the unlucky thermometer persists in recording nearly the same average as when you had been shivering on the coast. I conclude that the physiological influence of a given temperature below a certain degree, say below sixty, with the wind ten or fifteen miles an hour, is equal to at least ten or fifteen degrees lower in scale. On the other hand, a thermometrical showing of 90 and over is not uncomfortable if there is a gentle breeze and little humidity, but with a strong wind becomes a sirocco, when prostrations are numerous, and, if long continued, many aged and feeble die under its influence. In one of the interior valleys of California I have seen the thermometer indicate 100 to 110 F. for days and weeks together, and no one complained of the heat as excessive, while all labor of man and beast went on as usual, and prostrations are unknown. I refer to the temperature in the shade. In the sun, where men work, it must be ten or fifteen degrees higher. In New York, when summer heat approaches 90 we expect many prostrations and some deaths. I am not trying to show that 110 of heat in California with no prostrations is a better climate than New York at 90 and many prostrations, but to illustrate the

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principle that we must know much more about a climate than what the thermometer can tell us before we know very much about it. I kept a record of the temperature in Martinique, one of the Windward Islands lying in 14 north latitude, and it never went above 86 F., nor so high but two or three times during a residence of three seasons, and once so late as the 1st of July. But no sensible person would dare to expose himself to the mid- day sun with the same impunity that he could in this latitude and a corresponding temperature. The ever-present humidity, bordering on saturation, in the tropics is an important modifying element to be taken into account.

Again, temperature may depend on latitude or on altitude ; but it is not a matter of small moment which the cause may be. Sixty degrees of heat at the level of the sea and on the seashore are very unlike in physiological effect to 60 in the dry and rarefied air of an elevated inland situation. There is no doubt that considerable moisture in the air favors the growth of minute organisms, and decomposition of matter takes place rapidly under the influence of heat and moisture. On the other hand, a dry air retards de- composition, and, if sufficiently dry, prevents it entirely, no matter how hot it may be. The Sacramento Valley is very hot in the summer, but it is also dry, so that friends of mine would kill a beef and elevate the carcass by means of rope and pulley to the top of a tall pole, let it down from time to time to cut from it, and it would keep perfectly sweet until it was all eaten up. A good illustration of conditions retarding or favoring the growth of minute organisms may be seen during the orange harvest in por- tions of California. The altitude of Redlands, California, aver- ages about fifteen hundred feet above sea level. Fogs seldom reach there, the sun shines clear more than three hundred days of the year, and there is not a speck of mildew on any fruit. But go forty miles nearer the sea and seven or eight hundred feet down nearer the sea level, and at every station you will see many people washing oranges. More fogs, denser air, less sunshine, more humidity favor fungous growths. On the high table lands of the central portions of the continent, at an altitude of six or eight thousand feet, as in Wyoming, where a friend lives, milk does not " sour " or change under a week or ten days, and the carcasses of dead cattle, of which there are many, give no offen- sive stench, but slowly dry up and waste away, showing that comparatively few organic germs exist there, and that the con- ditions for their rapid propagation are unfavorable. From the facts just stated and they are representative facts it would be too hasty to conclude that the higher and drier locality is es- sentially more healthy than the lower and moister locality, even for consumptives, until we have mastered and estimated the

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quality and energy of the other meteorological influences. There is another fact which has come under my personal observation which must be taken into consideration. It is that life in those elevated nonmicrobian regions is not without its drawbacks. Whether it is due to the increased action of the heart in the rarefied atmosphere, the constant hammering of the nerves by the winds and the fierce sunshine, or all these and other causes, people in those regions have a thin and tired look, and it is found useful and often necessary, especially in cases of women and children, to visit lower, damper, and more germ-laden regions in order to recuperate. It is important that the air we breathe should contain as few disease germs as possible ; but it is still more important that we should breathe an air and live under such climatic conditions as shall most conduce to such general bodily vigor as will resist the entrance of disease germs into the organism, or destroy them if an entrance is once effected. It is quite conceivable that a dry atmosphere containing few microbes may be too dry for an irritable mucous membrane, and set up catarrhs which may furnish nesting places for disease germs ; while a moister, softer air, though holding many more microbian elements, may be more advantageous, at least in certain cases. In these latter days, in the wonderful strides which have been made and are constantly being made in bacteriology, perhaps we are in some danger of losing sight of meteorology in its relations to health and disease. It seems to me that climatology has here- tofore to a large extent resolved itself into a search for some place where consumptives can not die. There is no such place. There is no place where the ever-present bacillus may not get in its deadly work. The chief question in climatology in its rela- tion to health should be, " In what climate, or by what changes and influences of different climates, can we be best invigorated for good existence in the location where we are obliged to live the greater portion of our lives ? " Many other causes besides tuberculosis men die of. Among civilized people, especially among our pushing Americans, debility, nervous exhaustion in one form or another, from overactivity of brain or body, render multitudes asthenic and vulnerable to the invasion of disease. We say that such cases need to be "toned up." This is un- doubetdly true, but there are many cases in which the first step in " toning up " should properly be to tone them down. By that I mean that it is necessary to diminish the unnecessary expendi- ture of energy which has become a fixed habit of life. We all, as a rule, are too prodigal of our resources, and squander vast quan- tities in excess of what the occasion requires. It is amazing to see people, intelligent about ordinary things, traveling for their health at a rate that suggests that they have been shot out of a

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gun. Many do, of course, get a limited benefit in the change of subjects of thought, but they often mistake change of feeling due to excitement for recuperation. "We need to learn how to stop. Instead of rushing across the face of the earth in the delusive hope of finding health on the other side, we need to learn how to sit down and make ourselves comfortable where we are. A man who had lived to a great age in health and contentment was asked to give some simple rule of life out of his experience. In reply, he said, "The only rule I can give is, 'Always keep com- fortable/ " I feel confident that a well-selected residence in the tropics from time to time will prove helpful in acquiring habits of reposefulness. Tropical heat is not oppressive, as many who have not tried it seem to suppose. It is very different from the same -temperature as indicated by the thermometer during a northern summer. One does not fret about the tropical heat as he is apt to do here, but is inclined to keep quiet, lie down and sleep a good deal during the daytime as well as profoundly all night. Wakefulness is a rarity. The relief from nervous tension and irritability is inexpressibly delightful. The increased action of the skin relieves and gives needed rest to overworked kidneys, the air passages are bathed by a moist, bland, nonirritating, warm air, no chilly draughts scourge the nerve centers into activities wasteful of energy, morbid appetites are allayed, digestion is im- proved in sympathy with increased skin activity, and the poor invalid begins to feel that, after all, life may be worth living. It is a delusion, born of constant assertions of the advocates of negro slavery before the war, that white people can not work in the tropics. The island of Porto Rico was originally settled by Catalonian peasants, and the major part of the farm labor has from the beginning till now say for approaching four hundred years been done by white men. True, negro slavery was intro- duced there, but of a milder type than in the other islands ; and the blacks never amounted to much more than one third of the population, and they rapidly mixed with their Spanish colaborers beside whom they worked. The facts are still more startling in regard to the Spanish Main. Along the coasts of Central Amer- ica the mahogany cutters, called " Indians/' are mostly of mixed negro blood ; and along the unhealthy shores of the Magdalen a River, or wherever the sugar cane is cultivated, negro slaves were introduced, and their descendants, largely mixed with the Indian race, still remain. Even in Brazil the negroes and their descendants are confined to a few provinces, and never to exclude white labor ; and in numbers the African blood constitutes but a small proportion of the ten or twelve millions in that country certainly not enough to influence the following statement : From the southern border of the United States through Mexico, the

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republics of Central America, Colombia, Venezuela, Ecuador, Peru, Bolivia, Chili, Paraguay, Uruguay, the larger part of Brazil, Argentina, down to Patagonia, with the exceptions above mentioned, there is not now and there never has been any farm labor but white farm labor since the settlement of that vast con- tinent ; and the widest portion is directly under the equator. I do not include the Indians in this statement, because when wild they do not work in the sense here meant, and when brought under the influence of the Spanish and Portuguese civilization they immediately mix with and become essentially one with their white coworkers. I do not deny that there are pestilential lagoons which are more pestilential than any similar territory to be found north. But I do not believe that, shunning local conditions which would be bad anywhere, and worse in the tropics, well-selected locations are unhealthy because of tropical heat and moisture, except in certain cases. On the other hand, I believe that almost all elderly people and a large number of over- worked and tired-out persons would find that tropical life costs a largely diminished outlay of energy with a corresponding hus- banding of nervous .and metabolic forces. In illustration of the foregoing statement I give the following facts :

The island of Dominica lies in fifteen degrees north latitude and contained twenty-nine thousand people in 1885. Dr. Nicholls, the chief medical officer of the island, whom I personally know, made a report to the managers of the Colonial Exhibition held in London in the year 1886, in which he stated that the death rate of the preceding year was fifteen and a half per thousand of the population that is to say, the death rate in this small island, deep in the tropics, was less by ten per thousand than the average for New York city. The people are mostly blacks. Further in- quiries revealed the fact that there were, at that time, three hun- dred and ninety-one white people men, women, and children and that there had been two deaths among them during the pre- vious year : one from apoplexy and one, a nun, died from phthisis, which she had brought from England, she having come to the island in the hope of benefit to her health. In fact, there was not one death among the whites from any disease generally supposed to be especially tropical. The death rate is higher in some of the other islands, but not higher, according to the best information I could get, than in northern communities from the same classes of diseases. It should also be remembered that many of the West India Islands are in a deplorably bad sanitary condition, exposing them to be scourged from time to time by importations of yellow fever, smallpox, and such like epidemics, when, of course, the death rate is largely increased. The foregoing applies more espe- cially to the Windward Islands, which possess some conspicuous

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advantages over the Greater Antilles, in that they lie in the path of the northeast trade winds, and, being small, the winds sweep over them as over the deck of a ship. There is no alternating sea breeze and land breeze, because there is not sufficient land to be heated by day to form an upward current, and to cool by night and form a downward and outward current ; but there is always a gentle movement of the air toward the west, without the inter- vals of calms which characterize the Greater Antilles. But any of the West India Islands, no doubt, furnish many locations in good sanitary condition where the intelligent invalid may find bodily and mental repose, and let his muscles relax and take com- fort, while his enfeebled skin, long constringed by cold and de- bilitated by clothing, is stimulated by genial warmth to doing its long.-neglected duty, for a time at least, while the kidneys, heart, and lungs are given a much-needed rest.

It should be understood that I do not think all cases would be benefited by a sojourn in a tropical climate, but I feel assured that for a large number of carefully selected cases no resource of climate can be so promotive of improved metabolism as a well- selected location and suitably regulated life during several win- ter months in the tropics, from time to time, especially if closely followed by a change to a higher latitude or altitude and cooler locality during the following summer.

Not least among the advantages of a tropical climate for a temporary sojourn in certain cases is the change of food which is, or at least ought to be, always effected. It would be a very un- wise proceeding to subsist upon a diet essentially the same as one is accustomed to at home. In the first place, there are not many of our American stomachs that do not need a rest, and one of the objects to be sought in living in a warm climate is to give the overworked stomach a chance to recuperate ; not only because there is no necessity for the same amount and quality of food to be digested, but we can find in the fruits of a country food which is not only very easily digested, but which supplies nearly all the requisites for wholesome nutrition under the changed conditions. The best fruits of the tropics are very perishable so much so that we never see them in New York. Now, I am not advocating an exclusively fruit diet ; but I think when people from the north go to the tropics for " climatic therapeutics " they should make it a point to eat very sparingly of meats and even farinaceous food, and endeavor to supply Nature's wants by using largely of the fruits of the country especially those soft, sweet, and perish- able fruits which do not last more than a day or two. Thus we have, besides the influences of steady warmth and moisture, the added advantage of a change of diet, which is no small factor in modifying the metabolism which we seek.

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I have spoken of the Windward Islands as being especially desirable during the three or four months of the so-called " dry season," or from December to May, and of the whole West India Islands as furnishing desirable locations for climatic rejuvena- tion. The West Indies are especially interesting because commu- nication is so easy and constant and relatively cheap ; they are practically at our door, and it seems to me that they should be studied more. The Spanish Main also furnishes a great variety of especially desirable locations which can be used for the same purposes ; but in speaking to the question of climate in " thera- peutics" my object is not to advocate any particular point, but to illustrate the general subject.

When one has become rested by a some months' sojourn in a tropical region, and, as the season advances, goes north instead of sweltering in New York or other corresponding place, it would be well to go to the seashore or to the mountains, where he would receive another form of tonic to his already partially recuperated energies. In that way we should be using the climate as an essentially " therapeutic means." *

The larger number of invalids and tired- out people will con- tinue to go to Europe for their change, and undoubtedly that is the better course for the majority, and, when properly managed, the "therapy of climate" may be sufficiently realized in that manner in most cases. I do not include those people who travel for pleasure only, or where change of climate is the secondary object, though in many instances even those persons do reap real advantage from the considerable change in food, air, and the surrounding conditions of life. There are many advantages to Americans in visiting Europe, not the least of which is the change of interests which new and different objects for contem- plation furnish, and that fill the mind without taxing it to the temporary displacement of the business, political, domestic, or other cares and anxieties which are apt to hold our American mind in a tenacious grip from sheer force of habit. With three thousand miles of ocean behind us, it is not easy to talk "shop" with the neighbor at our elbow during the ten minutes some people devote to their lunch or dinner, and we are almost obliged by prevailing custom to take a reasonable time at meals and be quiet about it. I believe that the climate of Europe is no better than ours, and in some respects not so good. I am told that life-insurance statistics the most reliable of all show that the life expectation is somewhat longer among American risks

��* For more detailed information in regard to the West Indian climate, I refer those interested in the subject to several articles in The Times and Register, by Dr. William F. Hutchinson, beginning in the number for September 6, 1890.

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than in European; and there seems to be no evidence among athletes or race-horses that bodily vigor is not equal here, to say the least, to anything across the water. But there is a difference in meteorological conditions, and this difference may be very effectually used to invigorate and improve the metabolism in a large number of cases if we keep this object steadily in mind and manage toward the accomplishment of this end. There is not only the mental relaxation not possible here in the midst of ordi- nary pursuits, but the change of climatic conditions, though not so great as a change to tropical lands, is still considerable quite enough, when properly utilized, in connection with mental and bodily rest, change of food and cooking, change of many habits, and the gentle but quite positive mental tonic of new scenes and new interests. With some important exceptions to be presently noticed, I do not think it makes very much difference where our American tired- out or half invalids go, provided they actually get rest and always keep comfortable. Of course, I do not include those thousands who are always on the rush, "doing" Europe. Among other influences there is no doubt, in my mind, of the great therapeutic value in many cases of well-regulated courses of mineral waters, when the cases and the waters are carefully selected and as carefully directed to the peculiarities of each case. Nothing could be more reprehensible, from the therapeutic point of view, than for an American family to turn itself loose in Carls- bad, for instance, and drink haphazard of these powerful waters powerful for harm as well as for good without the advice of a competent physician, experienced in their use and effects, as I have been told our brethren sometimes do. My experience with physicians at some half dozen European spas has been very satis- factory, and leads me to believe that the local doctors are gen- erally capable, honest men, and that their advice ought to be generally sought and followed with confidence in the use of the waters. But we, on this side, ought to be able to give clear advice, if not as to the particular mineral spring, at least as to the general character of the waters to be sought ; and especially it is always important to urge our countrymen not to overdo the matter. I am speaking more especially of that vast horde of tired-out health- seekers who annually cross the Atlantic and for whom there can be no better therapy than judicious change of climate, including mineral waters for a certain number as an added and potent alterative. Taking Carlsbad as perhaps the representative spa of the Continent, I am of the opinion that there are few middle-aged or elderly persons who are not decided- ly the better for having their capillaries physicked and their emunctories cleaned out once in a while by a course of Carls- bad water sufficient for that purpose ; and it is astonishing what

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��a small quantity of the water will sometimes do it to the extent here contemplated.

There is some danger to the novice in going into semitropical regions in being unacquainted with and unprepared for the de- gree of apparent cold which he is likely to find to his great sur- prise. And when he looks at the thermometer he is further sur- prised to see it so high while his feelings indicate a much lower temperature. He is still more astonished to notice that the natives do not mind the cold that makes the novice shiver. The fact is that without his accustomed fire and housewarming facilities, and subjected to air currents, the practical temperature in its physiological effects is much lower than the thermometer registers. In Spain, Italy, and in general along the Mediterra- nean shore, they have a semitropical climate during eight or nine months of the year, during which time the native inhabitants hold their calorifacient function in reserve, and when they reach their short and moderately cold season they have no difficulty in drawing sufficiently on their reserve heat-making power. The man from the north has no such reserve, and what he has the temperature is not sufficiently stimulating to call into full ac- tivity. He has used up his caloric in the greater cold of the north. People from the extreme south enjoy their first north- ern winter. I met, in Teneriffe, an intelligent captain of a whal- ing ship who had several times fished in the Bering Sea. He said it is customary for whalers to make up for loss of men from desertions by taking on South Sea islanders. He said they bear the cold and hardships of the north as well as New Bedford whalemen, and in proof related the following incident: One morning, when far north, he noticed on coming on deck one of his South Sea islanders entirely naked taking a bath. There was a strong wind blowing, and it was so cold that the water he dashed over him froze as it struck the deck. The man seemed to enjoy it, though he had never seen frozen water or snow before. There are good reasons why people of the north with impaired stamina should not expect to bear exposure so well as natives of semitropical regions and should make themselves, in regard to temperature, more comfortable than would be sufficient for the natives.

Northern people should be particularly careful in going to a climate with a temperature too low for comfort without a fire and too high for comfort with a fire. Even the increased sun- shine is not sufficiently constant, and all rooms do not face the south. No matter what natives may say, Americans ought al- ways to have the means for heating when occasion requires, and a southern aspect to their rooms everywhere in southern Europe, if they are at. all sensitive to cold, irrespective of the thermometer,

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or else travel north till they come to fireplaces, stoves, ovens, or other means for artificial warmth. Inquiry into the sanitation not only of residences but of the towns should never be neglected. I suppose the climate of the southern and southeastern coast of Spain is perhaps the most genial on the Mediterranean, and equally the most dangerous for Americans to abide in on account of the lack of proper drainage and other attention to sanitation. But the same may be said of much of the coast except on portions of the Riviera, where in certain places much improvement has been and is being effected in that respect.

There are generally good reasons for many of the customs and habits of the natives of any region, and there will be found ad- vantages in adopting many of their ideas and methods so far as practicable. Along the Riviera people flock indoors with the going down of the sun : and there is good reason for it. At Nice, I have seen the thermometer register a fall of 25 F. within an hour as the sun neared the horizon. Such sudden cooling might be dangerous to an American dyspeptic with his limited power of reaction. Going indoors reduces this difference of temperature. Right across the Gulf of Lyons, in Barcelona, Spain, in nearly the same latitude and about the same mean temperature, the habit of the people is to be out of doors in the evening, promenad- ing, visiting theaters and cafes, and the ladies doing their shop- ping till midnight and after. They find evening the best time for many purposes because there is very little change between the temperatures day and night. My thermometer was hung in an alley which the sun never reached, and all I could make it do was to record the extreme difference of two degrees between six o'clock in the morning and two o'clock in the afternoon during a week. I was still a thermometer dupe at that time. I have since broken my thermometers, and they will never endanger my sanity any more.

But it is not always convenient or even possible for one needing the therapeutic advantages of change of climate to go to Europe, nor is such a change necessary or even desirable in many cases. There is a great deal of as good climate as the world affords in our own country ; and almost any change from low to high temperature, from damp to dry, from low to high altitudes, from seashore to mountains, from regions of high cultivation to the balsamic air of primeval forests or the reverse, can be had with- out the fatigue and expense of long sea voyages and wide stretches of turbulent sea between the traveler and anxious friends at home. The " sunny south " offers much that is admirable both in quality and variety of climate suited to various conditions. The main idea should not be the search for the perfect climate which does nowhere exist, but the question should be, "What

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change is indicated for the case in hand ?" The question, to be properly answered, necessarily includes a knowledge of the region in which the individual has been living. Shall an inhabitant of Virginia go south or north for the winter ? Or, had he better go west, or northwest, or southwest ? Shall a New-Yorker go to Florida, and, if to Florida, shall it be into the tonic Atlantic breezes of the eastern shore, or the milder and softer air of the Gulf coast ? Does this person's condition and meteorological surroundings indicate a change to the rarefied air of Colorado or to the denser atmosphere of Tennessee, Michigan, or Minnesota ? Ought the change to be to the moist breezes and frequent rains of Washington in the northwest or to the constant sunshine and more even temperature of southern California in the semitropical southwest ? If the Pacific slope seems indicated, shall it be in the coast cool winds or the warm and calm interior valley ? Or, had we not better make a new climate of our own ? The bosom of great Ocean furnishes a variety of climates all its own. In former days a sea voyage was much resorted to for chronic invalids, and with decided advantages in many cases. A life at sea, if at all prolonged, has the disadvantage of leaving too many comforts behind to be recommended for any but the young and compara- tively robust. It is said that three hundred miles from land the air is free from living germs. Many persons have returned from long voyages in health entirely restored.

But we need not go to sea, or go abroad, or even to the south, or to the wide west. We can make a climate of our own if we properly work for that end. It is not even necessary to rattle over ten miles of pavement in order to get a change of air. We have it right there on the veranda ; we can have it fresh from the outside grand air, by opening the windows and opening them wide till all the stale air in the room is blown out and all the room is filled with ozone. We can change our food at home if we like. I know a man who almost rejuvenated himself by living on little else than fish, oysters, and clam juice for three months. We can regulate the temperature and take a sun-bath whenever the sun shines. And we can stop fretting if we are sufficiently determined to do so. Actions are but the evidence of a pre- determination. Why not determine to change our climate, when there is benefit to be derived from such change ?

It has always been the unsolved puzzle of my professional life that so many people insist on reaching out to a distance for much that can be had better right at hand if they would but open their hand and take it. This is especially so in regard to climate and changes of climate. Notwithstanding positive directions to the contrary, many a child in pain with joint disease has been taken out miles over rough pavements " for the air," while every jolt

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was agony, when the same air could be had in his bedroom, with pleasure and safety, by bundling him up and opening the windows and keeping them open. It is against the law to live in cellars, but we make cellars of our rooms by keeping them filled with impure air. I do not inveigh, as it is the fashion to do, against the temperature at which our American houses are kept; a higher temperature is a necessity of our climate ; but some one has yet to secure a fortune and the blessings of mankind by devising a system which will keep our houses always filled with living, moving, fresh air, and that will oblige everybody to attend to this matter as he ought.

And here I wish to enter an earnest protest against the prac- tice of sending patients, often far gone with consumption or other wasting disease, away from friends and the comforts of home, without knowledge of what would be best for them, in a fruitless search for health, when, in their enfeebled state, better conditions could be instituted at home where at least they could die in peace. Some, not too far gone, do recover, it is fortunately true, but many lie buried there, and more are sent east in long boxes. On my last trip east, a young girl sat in front of me, whose mother's body accompanied her, and opposite me sat a gentleman and his wife whose daughter's body was also in the baggage car. In neither of these instances had the invalids been more than a short time west. Too many such things are happening for the credit of our profession. Send patients, in time, with a definite intention in the change of climate sought, or do not send them at all.

My object has been to call attention to the many and often difficult questions involved in the therapeutics of climate in its wide and varied significance. Probably no one now lives who is capable of answering all the questions relating to " therapeutics of climate," but they will be answered some day and correctly answered; and when answered it will be found, I believe, as a general thing, that the best climate for consumptives is also the best for other persons in like general physical conditions. Twenty years after our profession more fully realizes the immense value of " climate in therapeutics " and hundreds of capable men have been studying the subject from that point alone, and valuable material has been created to draw upon a climato-therapy may be formulated which will give the divine art of healing a new up- lifting, not less glorious than that which in our day has attended the labors of Pasteur, Koch, Lister, and others whose immortal services have so enriched the world.

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  1. Read before the New York Academy of Medicine, October 4, 1894.