THE 
COMPARATIVE IMPORTANCE 
OF 
DIFFERENT CLIMATIC ATTRIBUTES 
IN THE TREATMENT OF 
PULMONARY CONSUMPTION. 
BY 
VINCENT Y.JETQ.WJXLTCH, M.D., 
VISITING PHYSICIAN TO THE CARNEY HOSPITAL, BOSTON; INSTRUCTOR IN 
BOSTON POLYCLINIC. 
FROM 
THE MEDICAL NEWS, 
October 13, 1888. [Reprinted from The Medical News, October 13, 1888.] 
THE COMPARATIVE IMPORTANCE OF DIFFERENT 
CLIMATIC ATTRIBUTES IN THE TREATMENT 
OF PULMONARY CONSUMPTION.1 
By VINCENT Y. BOWDITCH, M.D., 
VISITING PHYSICIAN TO THE CARNEY HOSPITAL, BOSTON ; INSTRUCTOR 
IN BOSTON POLYCLINIC. 
In offering my views upon this subject, I shall 
not presume, even were it possible in the limited 
time allowed, to give statistical evidence of the 
results of my own experience in the climatic treat- 
ment of phthisis. From the protracted nature of 
the disease satisfactory data can be given only after 
years of close observation of cases, and it is more 
with the hope of exciting discussion which shall lead 
to more thorough investigation of this most impor- 
tant subject than of giving new or valuable facts, 
that I have prepared this paper. 
There can be no physician, I imagine, even of 
many years' experience, who does not feel, at times, 
a sense of helplessness when asked if a change of 
climate will be beneficial to his patient, and, if so, 
what climate shall be chosen. It is then that our 
1 Read at the meeting of the American Climatological Associa- 
tion, Washington, September 19, 1888. 2 
BOWDITCH, 
lack of proper knowledge on the subject comes over 
us; it is then that the apparent difference of view, 
held by equally eminent authorities, makes us feel 
that the science of climatology is in its infancy only, 
and that from its very complexity it must have a 
slow growth. 
In taking a broad survey of the different methods 
of climatic treatment in the last half century, we 
Can say that, regardless of possible differences of 
detail in treatment of incipient phthisis, the modern 
method is strongly in favor of selecting cool or even 
cold invigorating climates by which the general 
system may be assisted in its efforts to resist disease, 
as opposed to the former custom of selecting the 
warmer, more debilitating regions with their gener- 
ally depressing effects. Even when taking into 
consideration the greater attention paid now to 
hygienic matters, which has its favorable effect, yet 
the results of the modern method show it to be a 
decided step, in the right direction, for a large class 
of cases. 
Let us now ask: 11 What in the opinion of emi- 
nent authorities are the most important attributes of 
a climate for the treatment of incipient phthisis ? 
At the outset we must pause, being brought face 
to face with the fact that in all tabulations of results, 
the word phthisis covers a variety of pulmonary 
affections, and herein lies one of the chief difficulties 
of our coming to accurate and definite conclusions. 
By accepting the presence of this well-nigh insur- 
mountable difficulty, and keeping it in mind, we 
can, nevertheless, draw general conclusions with TREATMENT OF CONSUMPTION. 
3 
safety, and judge if the number grows less of those 
who die from wasting pulmonary diseases, be they 
of tubercular nature or otherwise, and, if so, what 
are the reasons of the decrease ? 
In Dr. Denison's admirable paper of last year, 
which gives us the key-note of the discussion to-day, 
he places at the head of the list the quality of dryness 
as opposed to moisture. Under this head we may 
include both dryness of the air and of the soil, and 
without discussing the question as to how these are 
largely dependent upon each other, it will be suffi- 
cient to say that the researches and opinions of 
many authorities justify Dr. Denison in placing this 
attribute at the head of the list. 
The investigations of my father, about thirty years 
ago, as to the cause of consumption in Massachu- 
setts, and shortly afterward, of Buchanan and Simon, 
in England, point most strongly to soil moisture as 
a cause of the disease, and, furthermore, show that 
removal from a damp soil to a dry one has frequently 
been followed by arrest of the disease. More recent 
researches in other regions (for instance, those of 
Dr. Pepper in Pennsylvania two or more years ago) 
have lead to the same result. Jaccoud, Hermann 
Weber, and others quoted by them, while they lay 
the greatest stress upon altitude, yet speak of the 
dryness of the air which accompanies a rarefied 
atmosphere and the rapid drainage of the soil due to 
elevation as most important factors in the cure of 
consumption. 
Jaccoud, in his enthusiasm for altitude as the most 
important factor in the treatment of incipient 4 
BOWDITCH. 
phthisis, lays much stress upon the mechanical effect 
of expansion, which residence in a rarefied atmos- 
phere has, upon the human chest, and in this view 
he is supported by Hermann Weber, C.B.J., and 
C. Theodore Williams, Denison, Solly, and others, 
and from their observations there is little reason to 
doubt that the frequent and deep inspirations made 
by patients upon arriving in mountain regions, to 
obtain the requisite amount of oxygen from the 
rarefied air, tend to expand the chest and to dilate 
the collapsed or obstructed alveoli of a phthisical 
lung. The full-chested appearance of children in 
the mountainous regions of Colorado, as noticed by 
the two authors last named, goes to prove this fact.1 
Apart from the mechanical effect upon the chest, 
authorities very generally agree that in altitudes, 
properly selected, varying from 1500 to 8000 or 
10,000 feet, we find a combination of attributes 
favorable to the cure of incipient phthisis, and in 
addition to the one already mentioned, viz., dryness 
of the atmosphere and soil, we have the advantage 
of a cool or cold bracing temperature, clearness and 
purity of the atmosphere, with a large percentage of 
sunshine. 
1 That these effects of altitude have a decidedly beneficial 
influence on the pulmonary condition there is little reason to 
doubt, even though Jaccoud persists in saying that the rarefac- 
tion of the air causes an anamia of the lungs in conjunction with 
the other viscera, although other eminent authorities maintain 
that the lungs share with the skin the increased circulation due to 
removal of atmospheric pressure, which seems the more rational 
view. (Lubbock's translation of Jaccoud's "Curability and 
Treatment of Pulmonary Consumption,'' p. 293.) TREATMENT OF CONSUMPTION. 
5 
While fully acknowledging the weight of the 
opinions of those who regard altitude as one of the 
most, if not the most important element in the 
climatic treatment of phthisis, yet I must confess to 
being as yet unwilling to accept this without reser- 
vations. It is doubtless true that we find, as Dr. 
Denison says, at certain high altitudes a greater 
number of what we now consider the most important 
attributes combined than in less elevated regions; 
but I think we must be guarded in accepting this, 
lest from the result of future investigations we find 
that we have gone too far in this direction. 
With my present conviction that dryness of soil 
and atmosphere are the most important factors in 
the climatic treatment of phthisis, I am much struck 
by the experience of Dr. Geddings, who for many 
years has studied the climate of Aiken, in South 
Carolina, and the results of phthisical patients who 
have been sent there. The town is situated between 
500 and 600 feet only above the level of the sea, 
not high enough to exert any special mechanical 
influence on the chest by rarefaction of the air (on 
which Jaccoud lays so much stress), yet the atmos- 
phere and soil are both very dry, and the bracing 
quality of the air is a marked feature. 
From the results which Dr. Geddings has noticed, 
and from the experience of a few patients with whose 
histories I am acquainted, I find myself questioning 
as to how7 far the element of altitude per se is neces- 
sary, and whether other regions resembling the posi- 
tion and climate of Aiken are not to be found, where 
equally favorable results can be expected. In this 6 
BOWDITCH, 
connection, moreover, the facts spoken of by several 
authorities must not be lost sight of, viz., that in 
certain countries of decidedly low altitude there 
seems to be an entire immunity from phthisis ; for 
instance, the Kirgheez, in Asiatic Russia, who live on 
vast steppes, one hundred feet below the sea-level, 
and the inhabitants of the Faroe Islands and of Ice- 
land, living at a very slight elevation, and under the 
most unfavorable hygienic conditions, are nearly, if 
not entirely, free from the disease. So far as I know, 
these countries have never been used as health resorts 
for phthisical patients, but probably the depressing 
effects of living in such communities would far out- 
weigh any possible benefit. 
As to the attribute of temperature, or, in other 
words, coolness or coldness, as opposed to warmth, 
in the climatic treatment of phthisis, there can be 
little doubt that, in the majority of cases of incipient 
disease, the former has the more favorable effect. 
The good effects of a low temperature lie chiefly in 
its bracing quality, its tendency to cause dryness of 
the atmosphere, and its unfavorable influence on the 
growth of the bacillus outside the human body, a 
fact which, to those who believe in the theories of 
Koch, is of marked importance. (The contrary is 
true of warm, moist, relaxing climates.) The im- 
portance of clearness and purity of the atmosphere, 
with the presence of sunshine, is so self-evident that 
one need scarcely discuss it. The effect of the lack 
of these elements upon healthy human beings is suffi- 
cient proof of the necessity of their presence in the 
treatment of disease, more especially in phthisis. TREATMENT OF CONSUMPTION. 
7 
In connection with the comparative importance 
of different climatic attributes, a word must be said 
as to the difference between seashore and inland 
climates. Of necessity, no general law can be laid 
down on this point, but the weight of opinion may 
be said to be distinctly in favor of dry, inland 
climates for the treatment of incipient phthisis. The 
shores of the Mediterranean are famous as health 
resorts for consumptives, and although, in the 
opinion of Jaccoud and Hermann Weber, they are 
inferior to the inland and mountainous climates, yet 
a residence in that region is doubtless of great 
benefit to many ; the dryness of the atmosphere, and 
a large percentage of sunshine being two most 
noticeable features of the climate. 
Opposed to the idea of preference being given to 
inland climates, is the fact that most of the health 
resorts for consumptives in England are situated near 
the sea, where the climate is decidedly moist, and 
soft. As to the results in the cure of phthisis in these 
places, compared with those in mountainous regions, 
I am unable to make any statement, but the prefer- 
ence shown by English physicians, in. sending their 
patients to such dry, mountainous regions as Davos, 
in Switzerland, speaks strongly in favor of the latter 
resorts. 
Speaking for New England, it can be said that, 
while exceptional cases may do well, the moist, harsh 
climate of our northern coast is distinctly bad for 
consumptives, and it is my custom, as it has been 
my father's for years before me, to advise removal 
from the coast, if only to retreat to some compara- 8 
BOWDITCH, 
tively dry region eight or ten miles inland, where 
the rigor of our harsh, damp winds may be avoided. 
Very different are the effects of a sea voyage or its 
equivalent, residence upon an island several miles 
from the shore. The reason of this difference is not 
satisfactorily explained, but doubtless the purity of 
atmosphere, and absolute freedom from dust, have 
much to do with it. As a cure for phthisis, however, 
either method may be said to hold a decidedly 
secondary position. 
By comparing these facts again, we find strong 
evidence in favor of the attribute of atmospheric 
dryness in the treatment of phthisis. 
To state briefly my present views: I believe that 
properly selected altitudes possess a combination of 
climatic attributes which, according to our present 
knowledge, form the best means of cure for cases of 
incipient phthisis in which there are no symptoms 
that would contraindicate residence at a great height 
-e. g., cardiac weakness, excitability of tempera- 
ment, marked feverishness, or a pronounced emphy- 
sematous condition, all of which symptoms are, 
according to the authorities mentioned, apt to be 
unfavorably affected by altitude. 
At the same time, I believe we have much to learn 
as to the possibilities of cure in less elevated regions, 
like Aiken, South Carolina, where the quality of 
dryness is present with a bracing atmosphere. 
Still further, we have a great field before us in the 
investigation of the effect of residence in compara- 
tively favorable regions near our homes, where, by 
the establishment of sanitariums, we can combine Treatment of consumption. 
9 
climatic, hygienic, and medical treatment in such a 
manner that exile from home and family may not be 
thought, in the future, of such paramount necessity. 
In accordance with my father's and my own 
custom of recommending, in certain cases, a resi- 
dence in towns favorably situated within a few miles 
of Boston, I have, for some time, felt that much 
more could be accomplished by the establishment of 
sanitariums for phthisical patients in these regions. 
I determined to make the attempt to get some suit- 
able institutions for those who cannot afford to go 
far away from home, in Sharon, Mass., a town situ- 
ated between 300 and 400 feet above sea-level, 
about eighteen miles southwest of Boston. The soil 
is of a very porous nature, the atmosphere of a 
markedly dry, bracing character, pine forests abound, 
and a line of hills, moreover, shelter the town from 
our harshest winds. Through the generosity of one 
interested in the scheme, a farm favorably situated 
has been bought, and, relying upon the assistance of 
wealthy citizens of Boston, I hope, with the assist- 
ance of Dr. R. W. Lovett, to show, at some future 
time, that much can be accomplished in this way. 
I was much pleased to find that Dr. Kretzschmar, 
of Brooklyn, several months ago, had called the 
attention of the profession in America to the grati- 
fying results of Dettweiler, in his sanatorium at 
Falkenstein, in Germany; of Brehmer, at Gbrbers- 
dorf, in Silesia ; and other now well-known establish- 
ments, situated in not especially salubrious climates. 
The experience of these physicians in Europe, as well 
as that of Dr. Trudeau, in the Adirondacks, should 10 
TREATMENT OF CONSUMPTION. 
give us reason to hope that, by means of similar 
establishments near our homes, even at a compara- 
tively slight elevation above the sea, we can do a 
great deal toward arresting the present death-rate 
from pulmonary consumption. 
I cannot conclude better than by quoting Hermann 
Weber, who, in the fourth division of his exhaustive 
work on climatology, says: "By erecting well- 
arranged establishments, under medical supervision, 
in well-situated places near at hand, a great many of 
the advantages of more distant climatic health 
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