THE CLASSES OF INVALIDS MOST BENEFITED AT ATLANTIC CITY. Read before the Congress of Medico- Climatology in Chicago, June 3, 1893. BY BOARDMAN REED, M.D., ATLANTIC CITY, N. J. REPRINTED FROM THE THERAPEUTIC GAZETTE, JANUARY zj, 1894. DETROIT, MICH. : GEORGE S. DAVIS, 1894. The Classes of Invalids most benefited at Atlantic City. NERVE exhaustion, or, in popular parlance, nervous prostration, is, in its various forms, the disease most certain to be benefited at Atlantic City. Probably a prolonged sea- voyage or a sojourn at some of the other sea- shore resorts might be equally helpful. I can- not say as to this, but confine myself to a report of facts carefully observed during a residence of more than fifteen years. Sea air, as exemplified at Atlantic City, is a nerve tonic of the utmost value. Whether the unfortunate victim of an overtaxed nervous system chances to arrive in a rain which confines him to his hotel (as will sometimes happen, especially in the winter or spring), or whether he finds all sunshine and brightness, he-or more often it is she, since the majority of neurasthenics are women-will nearly always begin at oncg to eat and sleep better. Fine weather, though helpful, is not essential, and most cases will gain even in spite of it. With quickened appetite and sounder sleep come an enriched blood and refreshed nerve-centres. All the vital processes are heightened, and health is usually and often rapidly restored. True, there are exceptions. Occasionally a nervously - depressed patient, who considers himself merely run down from overwork or other cause, comes to Atlantic City, puts up at one of the best hotels, and sets out to get well by doing as he sees others do, yet fails utterly, returning home after one or two weeks worse, perhaps, than before. There are usually excel- lent reasons for these failures. One of the most common is the existence of derangements of the stomach or liver, which are suffered to go with- out proper treatment. Sea air is simply a tonic, -a powerful and effective one in most cases, but still only a tonic and not a corrective of faulty secretions. The patient who has been trying to overcdme an increasing debility by forcing larger quantities of food-often very unsuitable food at that-upon an unwilling, because unhealthy, stomach, with the help, per- haps, of an unaccustomed amount of stimulants, until his tongue has become foul and his entire digestive apparatus on the point of revolting, will not recover by the mere fact of sojourning at any sea-side place. If he has gone on in this way until his urine has become loaded with urates, his joints stiffened, his temper moody and despondent, and his sleep considerably impaired, the sea air, though a most valuable aid in the task of curing, will do next to noth- ing until the way has been cleared for its proper action by a judicious course of mescal treatment instituted either by the physician at home or by some competent local practitioner at the shore after the patient has arrived there. Fortunate is it for the poor neurasthenic if he or she has not let matters drift along until insomnia has developed into a chronic condition and the habit of taking some narcotic drug has become 2 fixed. These are the cases which try the souls of physicians everywhere; but even these will do well and usually recover at Atlantic City, if placed under proper conditions, and especially if they can have the benefit of the Weir Mitchell "rest-cure" (or some modification of it in the less severe cases), under the guidance of a physi- cian and nurse experienced in such special treat- ment. Closely allied to neurasthenia is simple atonic dyspepsia, and this rarely fails to respond to the healthy stimulus of the sea air, especially when the diet and exercise have been properly regu- lated. In the worst cases the aid of medicine, as well as of electricity and massage, is some- times necessary, but many recover with only the simplest hygienic treatment. Convalescents from operations, as well as from fevers or other acute prostrating diseases, will also derive the greatest benefit in nearly all cases from a removal to Atlantic City. Like the nervous cases, these may be expected to gain rapidly even if still confined to their rooms. It is a constant experience to see them taking on flesh and growing stronger at a surprising rate even before it is possible to get them out of doors. The chronic diseases peculiar to women are generally improved and often markedly so by the invigorating properties of the climate. It tends to bring up the nutrition and nerve tone, thus indirectly relieving congestion and ca- tarrhal states of the pelvic organs. Many of the diseases of childhood are promptly and often remarkably benefited. Persistent cases of sum- mer complaint, as well as nearly every form of malnutrition in children, including especially 3 scrofula, rickets, chronic joint-disease, and chronic bronchitis, find in the atmosphere of the locality a positive and decided adjuvant to other therapeutic resources. In some of these cases the air alone proves rapidly curative with- out further medical intervention. In adults, as well as children, chronic bron- chitis, chronic pleurisy, and delayed resolution of pneumonic exudations may usually be ex- pected to do well at the same place. In most of such cases it is advisable to persist at the same time with the usual therapeutic measures in order to insure the promptest results. Anaemia, chlorosis, and struma are benefited by sea air, and, under proper regulations and restrictions, even more markedly so by sea- bathing. But it is highly important to see to it that patients afflicted with these or other maladies shall exercise caution as to the length and frequency of their baths. For some only the very briefest dip in the ocean will be needed to obtain the curative effect or can be safely borne; others should be prohibited altogether from ocean-bathing. At least equal care is needed as to the manner in which the warm or hot sea-water baths are taken. Patients are prone to look upon these as entirely safe for anybody at all times, and to suit their own in- clinations as to the temperature of the water and the length of time they remain in it; but no experienced physician need be told that delicate invalids cannot all bear safely a pro- longed soak in hot water, whether salt or fresh. The above-mentioned diseases form only a small part of the many which are benefited by the climate of Atlantic City, but they include those in which I have ob;erved the most 4 marked and constant improvement. Sufferers from asthma and from hay-fever often have an entire immunity here, but this is by no means always the case. Patients in the early stages of pulmonary phthisis usually do exceedingly well, -quite as well, according to my experience, as they do in the lowlands of the South,-always provided they persist with a rational treatment and can and will spend most of their time out of doors in the open air. Chronic malarial cases may be cured by a long sojourn at Atlantic City. There is no doubt whatever as to the entire exemption of the place from malaria in the proper sense of that word,-i.e., the miasm which produces ague or intermittent fever. The town has an excellent underground sewerage system,-one of the best on the coast,-and is supplied with an abundance of pure and wholesome drinking- water, so that invalids need not incur the dan- gers which lurk so often in resorts where the sanitation is bad. 5 JANUARY 10, 1893. WHOLE SERIES. VOL XVII. No. I. I THIRD SERIES, VOL. IX. ' THE ' Therapeutic Gazette A MONTHLY JOURNAL, - OF- General, Special, and Physiological Therapeutics. f T GCNENAL THKRAFKUTie*. / H. A. HARE, M.D., of Therapeutic* <■ ths Jefferses Medical ColWfa ' OPHTHALMIC ANO AURAL TH I RAPtVTlCC, SURGICAL .<• Q tRITO-U Rl* ART Th t RARC UTICd. Q B. DK BCHWBlNtTB, M.D.. KIWAID MARTIN. 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