XVII ON CLIMATE “Of natures or temperaments some are well- or ill-adapted for summer, and some for winter." TUBERCULOSIS is found from pole to pole. No people, no land, no climate is free from the disease though in some lands it is more common than in others. The Indians about Hudson Bay, the Eskimos of Greenland, the African in his native land, all suffer severely; while in the temperate zone it is a scourge. Tuberculosis is found in every climate and at every altitude though less frequently in arid or semi-arid lands, on mountains and in the higher altitudes. Brehmer, the founder of the sanatorium treatment of pulmonary tuberculosis, believed in immune zones, districts where tuberculosis was very infrequent or did not occur. Today, however, it is recognized that it is not climate, but sparseness of population, and difficulty of frequent communication with the outlying world that produces such zones, while density of population with the accompanying overcrowding under insanitary and poor economic conditions plays a far more important part in reducing the individual resistance to the disease than any possible climatic condition in the temperate zone. The relation of climate to health is very complex but a few facts do stand out. Warm or hot moist climates depress many of the bodily functions, the stomach and the intestines are less active, evaporation from the lungs is slight, perspiration is profuse, the kidneys overexcited, all of which produce at times torpor of body and mind. That such a climate is bad for patients with pulmonary tuberculosis is very evident. The severe cold within the Arctic circle with the many unpleasant symptoms produced, render it a climate to be avoided except in summer. The temperate zones again have marked changes of temperature, which today are looked upon as beneficial to patients who can stand them and meet them intelligently. Strange as it may seem more severe changes are of daily occurrence in the deserts of Arizona and of Sahara at sunset than occur in colder climates. The most vigorous race of men, some hold, is that which lives far enough north to have to combat a vigorous winter and yet not far enough north to experience scarcity of food. Such cold acts like a healthy stimulant upon body and mind, and the feverish activity of the American people has been attributed to our variable climate. The value of climate in the treatment of pulmonary tuberculosis rests today largely upon personal belief and experience, for much has been stated and little proved. Such widely divergent climates as the desert, the mountaintop or the mid-ocean, are all good climates and certain patients thrive wonderfully well under their influence. But it is now clearly recognized that proper treatment is more important than climate and, further, that there is no specific climate. Rainy winds or bad weather may exert some influence upon the onset of tuberculosis, but it is an open question whether by preventing an outdoor life they do not reduce the individual's resistance and so bring about the disease. Change of climate when it involves change of residence, food, habits, freedom from care and worry, accompanied by properly regulated rest and exercise, is of influence as a preventive or restorative, but such action must not be attributed solely or even largely to change in atmospheric conditions. That climate is best which tempts us most to be outdoors, especially when we expect to reside in it permanently, but to return from a lovely warm exhilarating sunny climate where one has spent many hours out of doors to one which is bleak, dreary and sunless is depressing and makes an outdoor existence more difficult. There are certain localities in all climates which by experience many individuals have found to be stimulating. Such localities are frequented by numbers of people and become known as summer, winter or health resorts. The benefit derived from these places is to be attributed largely to change of environment and in some instances to a more properly regulated life. Even change from a "good" to a "bad" climate may produce this benefit, and a sojourn in any climate for more than eight or nine months without change is often inadvisable. But here again many factors enter which only the physician can pass upon. Any patient who seeks a change of climate should make inquiries about the place he selects and obtain a letter, if possible, from his physician to some medical man located there. On arrival he is often stimulated and for this reason should remain quiet for some time until his physician permits him to walk. He must not expect to alight upon the platform of a health resort and to have "package" of good health handed him with an insurance against relapse attached to it. There, as at home, the rules mentioned elsewhere in this book and his physician's advice must be conscientiously followed. XVIII ON HOW AND WHEN WE CONTRACT "Knowledge comes but wisdom lingers.” WHEN through knowledge the time comes that we fear not for the pestilence that walketh in darkness, nor for the sickness that destroyeth in the noonday, then the need for sanatoriums and for such books as this will be done away with. Until that time, however, we must ceaselessly strive to increase our meagre knowledge of the spread of disease, and having acquired a little more, must put it as soon as possible into practical use. The idea of contagion is centuries old, and 100 B. C. we find it suggested that animalculæ, invisible to the naked eye, may bring about disease. Everyone has no doubt heard many times of infectious and of contagious diseases. An infectious disease is one in which the cause of the disease gains entrance into the body and multiplies there, giving off poisons. Contagion relates to the method of transmission of the disease from the infected person to the well. From this it can be readily seen that a contagious disease is a communicable disease. While I |