Some simple cereal food at bedtime may aid in producing sleep. Heat to the abdomen, warmth to the feet, and giving the patient an extra pillow may all aid in causing sleep.

The diagnosis of hysteria probably means, very frequently the inability of the physician to determine what ails the patient. There is generally some functional disturbance which causes real symptoms in our hysterical patients, often some glandular disturbance, most frequently of the thyroid. Hysterical conditions can generally be dissociated from neurasthenic conditions, but sometimes the conditions are associated. While neurasthenic patients are markedly benefited by the rest cure, hysterical patients may become more introspective and greater invalids, and acquire the sanatorium habit.

For a rest cure to be of benefit to a hysterical patient, she must be under the care of a forceful physician, and under the care of a nurse with a large amount of common sense, and while every disturbed function is righted, if possible, the patient should be treated psycho-therapeutically. While the mental attitude of these patients is awry, as just stated, there is frequently endocrine disturbance present, and perhaps generally of the glands that are associated with the sexual functions. The so-called Christian Scientist has not discovered a new therapy. Mental cures, and cures by mental impression are as old as the world, and unusual treatments, unusual methods, unusual apparatus, unusual sanatoriums, and unusual distances to go for treatment will all impress these patients, and many times aid in the cure of the mental part of the disease.

The need for physical and mental rest for patients who have become heart- and brain-weary should be taught the general public. Neither the patient nor his family should think that because he senses his heart for the first time, and because he is found to have heart weakness, and must have a rest, that he has heart disease, or that he must die because his heart is disturbed. Also, both the patient and his family should understand that the brain may become weary, like any other part of the body. Hence if he becomes mentally a little warped, and gives evidence of some mental peculiarities, and has signs of brain tire and his physician advises a complete mental rest, it is no reason for

thinking that he is partially insane, or that he will become insane, or that he always will be "queer.

If a patient has signs of mental derangement, or even shows some symptoms of insanity, it is rarely justifiable to send him immediately to an insane asylum. There should be developed in every city psychopathic wards in the hospitals for the treatment of these mentally sick patients. Many a patient will completely recover, and he need not then return to his home and to his work with the stigma of having been an inmate of an insane asylum. Many a patient whose brain is not apparently working along normal lines will become mentally normal under the rest cure and the proper treatment of his physical debilities. The value of rest in preventing serious developments in simple infections, and in preventing infection in simple injuries should be recognized and utilized. Also persistent fatigue removes the normal immunity and the normal ability of the individual to prevent and combat infection, and also allows heart tire and kidney irritation from the accumulation of the waste products of metabolism.

CLIMATE

The study of the benefits obtained from a change of climate becomes more important each year as the systemic changes caused by different climates are better understood. Also the accessibility of regions once considered remote, and the development of hotels and sanatoria, for the comfort and care of individuals who are sick and of those who need a "rest cure," have made it possible to send patients to regions which were previously unavailable.

A discussion of the climate means a comparison of the temperature, the moisture, and the altitude. The latitude more or less constantly determines the temperature; the altitude not only more or less determines the temperature but also the dryness of the atmosphere, and the purity of the air. The moisture is determined not only by rain and melting snow, but also by the proximity of bodies of water. Pure, clean air may be obtained at even slight elevations, provided that the air is not contaminated by the dirt and dust of cities and towns. A region that is subject to frequent high winds is objectionable, although a hotel,

sanatorium or other building may be so located and so protected against the prevailing high winds as to make the region available for a health resort. However, it is unwise to send an individual who needs a change of climate where he will be exposed to strong and cold winds every time that he leaves his sanatorium or hotel.

Dust from germ-laden streets; smoke and dust from the burning of soft coal; noxious vapors from the burning of any coal; leaking illuminating gas pipes; and vapors from factories where chemicals are used are all recognized as subjects for sanitary science to abolish, if possible. It is also recognized that stagnant air and vapors from low lands, and emanations from stagnant waters (to say nothing of the opportunity for the production of mosquitoes) are unhealthful, and individuals breathing such an atmosphere are liable to illness, and if ill must be removed to more healthful regions to promote recovery.

Most individuals residing in cities and towns, to-day, have more or less irritation of the mucous membranes of the nose, throat, and often larynx and bronchial tubes, because of the irritant dust which they must inhale. The irritants are largely sharp particles from cement or other hard roads, or the particles of dried oil, where roads have been made dustless by applications of crude mineral oil. Also the emanations from this crude oil causes irritation of the upper air passages. The exhaust from the poor gasoline burned in motor cars pollutes the atmosphere and causes irritation when inhaled. The result of these constantly repeated irritants is more or less increased mucus in the upper air passages, or actual catarrh.

It is obvious, then, that removal to any location that has a clean pure atmosphere must be advantageous for any individual, well or sick.

Ocean air contains elements that inland air does not, and perhaps one of the principal differences is an increased amount of iodine, and iodine is needed by the human body and is more or less stimulant. Ocean air is always clean and dustless, although at times it is loaded with humidity. Generally on clear days the wind will blow on the coast toward the land, a sea breeze, while generally at night the wind will blow toward the sea, a land

breeze. The climate is that of a low altitude, i.e., sea level. Ocean air may be obtained at any seacoast, on islands, and on ocean voyages. The temperature of the ocean climate of course depends upon the latitude, but islands even in the tropical regions may not be uncomfortably hot in summer. Some of the islands of the West Indies, especially Jamaica and Porto Rico, as well as the Bahamas and Bermudas, are especially pleasant resorts in winter.

Inland climates vary not only with the latitude, but also as to altitude. The latitude will determine the prevailing temperature, and the region will determine whether there is much or little moisture. The altitude, varying many thousand feet, will determine the temperature and also the dryness. From one to three thousand feet high is generally considered to be a medium altitude; over three thousand feet is termed high altitude, and, from the standpoint of benefit to one who is sick, above six thousand feet should rarely be considered for a health resort.

From three thousand feet upwards, the circulation is at first much disturbed in most individuals, and one who is ill ordinarily cannot tolerate the height of altitude above the sea which a well individual can. As we increase the altitude the atmospheric pressure is lowered, and the blood-pressure is lowered unless the cold is sufficiently intense to cause contraction of the surface vessels and thus counteract the lowering of pressure. The heart and the respiration become more rapid as the oxygen exchange becomes disturbed by the high altitude. The peripheral blood shows an increase in the red blood corpuscles (nature rushing more into the general circulation on account of the oxygen shortage) and the rapid breathing is to cause the necessary oxygenation. The least exertion causes an increase in the heart rate, an increase in the respiration, and a feeling of dyspnea. After a quiet sojourn at an altitude that is at first disturbing to an individual, he may acquire a tolerance, and his heart and respiration become normal under a normal amount of exercise, although exertion may still disturb him.

The circulatory disturbance caused should preclude an individual with a very high or with a very low blood-pressure,

or with a weak heart, or with valvular disease (even with good compensation) from going to these altitudes. Individuals who have a tendency to hemorrhage from any part should not ordinarily go to an altitude over three thousand feet. Tuberculous patients with a tendency to hemoptysis should not travel rapidly to a higher altitude, if it is well for them to go to a high altitude at all. If it is desired for them to have that kind of a climatic change, they may sojourn for a time at a medium altitude, and later go higher.

Many patients are made very nervous and irritable after a short sojourn in a high altitude, even though they remain there but a few hours. This nervousness lasts for hours or for several days. Sometimes when the sojourn is longer at a high altitude, on returning to a lower altitude, the individual may be excessively nervous and irritable for many days. High altitudes, therefore, are not conducive to sleep, unless the individual remains long enough to become used to the conditions. The cold of a high altitude is also very stimulating, which, while perhaps of advantage in low blood-pressure, is a distinct disadvantage in high blood-pressure, and in nervous tension. A patient who has a simple catarrhal condition of the nose and throat may be benefited by this dry, high air, but if he has nasal obstruction, or cannot breathe well through his nostrils, he will not do well at a high altitude.

A cold mountainous climate will interfere with the functions of the skin, and for this reason patients who have chronic nephritis, or even a tendency to imperfect action of the kidneys, should not be subjected to the cold of a high altitude, and should not be sent to a cold climate. Also patients who have gout, arthritis, or neuritis should not go to a cold climate. Tuberculous patients who react well to cold, and feel stimulated by cold, those who have profuse expectoration, and those who have night sweats, are quite generally benefited by a mountainous climate.

An inland climate may be dry, even if not very high, as we have the desert air of New Mexico and Arizona. Southern Florida has a low altitude, is warm, is likely to be moist, and is enervating and not stimulating as are either the high