Full credit is given by the laity to cold winds and draughts in producing catarrhs and rheumatic pains, but the effects, beneficial or otherwise, of prevailing currents have not been sufficiently studied. With the large number of accurate observations at com. mand in the records of the United States Signal Service, a careful and thorough study of this meteorological element should yield positive results. Furthermore, the progression of certain infectious diseases, especially malaria, is popularly believed to stand in a definite relation with the direction of the wind.

Sunshine and its opposite, cloudiness, are popularly credited with decided influence upon health, but inasmuch as these elements of weather are so closely related with other physical conditions of the atmosphere, no conclusions are at present permissible. The same may be said of precipitation in the form of rain or snow. While the records published by Boyden, Macpherson and others show that the advent of the rainy season in Calcutta arrests the spread of cholera, Lewis and Cunningham have pointed out that in the epidemic districts of India the rainy season causes an increase of cholera. This apparent discrepancy is explained by the different physical constitution of the soil in the different localities. Hence the great importance of a study of the sanitary relations of the soil before drawing conclusions respecting the influence of climate in the production of certain epidemic diseases.

Of chemical changes in the atmosphere, none have had a greater interest to the climatologist than the variation in the proportion of ozone. But a few years ago ozone was regarded as a great sanitary agent, and extensive observations were planned, and in some cases carried out, to determine the influence of this substance in the causation of disease. Conclusions were drawn from insufficient data and many misleading statements were made. Recently, however, Schöne has called in question the existence of ozone in the atmosphere, and ascribed the reactions supposed to be due to it to hydrogen peroxide. The latter is now being studied by a number of observers, and great hygienic and sanitary virtues attributed to it. So far as ozone is concerned, the opinion of many sanitarians is tersely expressed by Renk: "Mit dem atmosphärischen Ozon in seiner grossen Verdünnung braucht sich die Hygiene nicht weiter zu befassen."*

The question of the antiseptic action of hydrogen peroxide, and of certain volatile products of vegetation, as terebinthinate exhalations, has been recently studied by Dr. A. L. Loomis. Dr. Loomis attributes the asserted good effects of pine forests as health resorts for phthisical patients to the antiseptic virtues of the volatile constituents, or of hydrogen peroxide in the air of such places. Whether the explanation is sufficient or not, there seems to be ample testimony in favor of the remedial powers of such air in phthisis.

After having thus briefly reviewed the subject, the question may still be asked: What constitutes climate? The answer must in most cases be indefinite. While all meteorological elements must be taken into full consideration, and proper weight given to each, the subject must be studied in a broad manner, which renders it more complex and difficult. The medical climatologist must be more than a meteorologist. He must likewise be a student of medical geography and epidemiology, as well as climatosanitation and climato-therapy. To this he must add a knowledge of ethnology, for in many cases the comprehensive epigram of Sonderegger, "Der Meusch ist das Klima," seems to more than hint at a solution of the problem.

"Die Luft," in von Pettenkofer and Ziemssen's Handbuch f. Hygiene. †Transactions American Climatological Association, 1879.

THE IMPORTANCE OF THE STUDY OF CLIMATOLOGY IN CONNECTION WITH THE SCIENCE OF MEDICINE.

L'IMPORTANCE DE L'ÉTUDE DE LA CLIMATOLOGIE EN CONNEXITÉ AVEC LA SCIENCE DE LA MÉDECINE.

DIE WICHTIGKEIT DES STUDIUMS DER CLIMATOLOGIE IN VERBINDUNG MIT DER MEDICINISCHEN WISSENSCHAFT.

BY WM. THORNTON PARKER, M.D.,
Newport, R. I.

Fifteen years ago students of medicine were taught comparatively little concerning the Science of Climatology. Certain locations were considered desirable for invalids, as, for example, Florida for American consumptives, or the shores of the Mediterranean for Europeans. Italy was then recommended as a desirable resort for tuberculous patients of all nations. Physicians sent away their patients suffering from diseases of the lungs on long journeys to regions, and not to localities, but invariably to places where personal knowledge could have had little to do with the professional selection. The hasty and mistaken decision on the part of the medical adviser meant then, as it perhaps less frequently does to-day, untold suffering for patient and friends, enormous and useless expense, and even death. The great wrong perpetrated in the name of science never, perhaps, could be demonstrated. They advised to the best of their ability and according to general rules learned at the medical school or found by searching the short and unsatisfactory chapters devoted to "Climate." That was all the light they had to offer, and for their patients it proved capable only of rendering darkness visible. With the deep, imperishable hope ever present with this class of patients-for whom a good climate is imperative-they seized eagerly upon the advice of their trusted physicians, following the delusive "will-o'-the-wisp " into the swamps of death.

If the Science of Climatology had been recognized earlier in the history of medicine as one of the most important studies, it would have kept pace with other departments of medicine, where most thorough and careful attention and investigation have been rewarded with brilliant, and oftentimes wonderful, success. It is only within very recent times that the study of health resorts for invalids has emerged from its darkened corner, where it had remained so long neglected and practically ignored. Therapeutics, Surgery, Ophthalmology, Gynecology and many other departments are considered of practical importance, but the study of climate is too often thought to be only interesting for fashionable invalids, or as a "dernier ressort" for patients who are hopelessly diseased.

With all the light which patient research and brave exploration have yielded, medical men still persist in recommending places of which they have very little knowledge, even theoretically, and generally absolutely no personal information. Patients are sent to Florida, California, Texas, Italy, etc.; but the senders know little, if anything, of what will be the residence or surroundings of the unfortunates who, in the eager longing for health, leave home and friends in search of the climate cure. It would seem waste of time to repeat here the warnings so often given by faithful observers on this important subject. Briefly, they may be summed up as follows:

1. Know all that is possible to be known of the locality to which you will recommend your patients. With many invalids it is a desperate move, perhaps a last chance. If the climate does not prove beneficial, then they must die there; for many cannot possibly return. Perhaps all the means available for travel have been expended in

reaching the "health resort;" there is no money left for the return trip, and oftentimes the physical resources have been exhausted, as well as the money, by the long journey. Consider for a moment the situation: a tedious, expensive journey, during which the physical forces have been sustained and stimulated by the hope of a climate which will at least relieve; the patient arrives at some forlorn and poorly-managed house, where "home comforts" were never known. What is to be done? The very thought of a return trip is appalling. Money is gone; a small income-to be received at stated intervals-is now all that is left; but even if one had money, to return would be certain death for many; and nothing remains but to face the dangers and miseries experienced by so many, and die. What a responsibility the physician has assumed ! and if he has sent his patient without due consideration and investigation, it must be well nigh a case of malpractice.

2. In advising, the nature of the disease and the stage of the disorder must be thought of, the physical, mental and pecuniary resources taken into very careful consideration; the season of the year, which may be nearly ready to assume unfavorable influences after the patient's arrival; the chances for really comfortable accommodations. Crowding must be avoided, good food must be obtainable, reasonable amusements must be provided, and a certain amount of useful occupation, to divert the mind, is always needed.

I have heard physicians speak of sending patients, for hunting and fishing, to localities where for years none had existed except in the rosy-hued advertisements of railroad companies. Out of twelve patients sent from all parts of the country, by physicians, to Colorado, in May, 1878, by August 19th following only one remained alive. Some interesting statements in this connection will be found in Harper's Magazine, March, 1879. This is not mentioned to demonstrate that the climate of Colorado is often overestimated, but to prove how recklessly medical men of good standing, and otherwise excellent judgment, will advise or permit patients to go West on long journeys, when every vestige of hope for recovery must have ceased to exist. A statement has been made that only one patient in fifteen makes a recovery in Colorado! The question may be asked, Why is it, then, that Colorado has such a reputation for restoring consumptives to health, and why do you continue to advise that section for tuberculous patients? The answer is found in the fact that, twenty years ago, invalids seeking Colorado for its climate cure approached in wagons, ambulances and stages, slowly. They spent weeks in the journey, where now only two or three days are necessary. They began the great rise to the Rockies very deliberately, and spent the time in the open air, and slept under the most favorable chances for restoration to health-in a tent. How all this has changed! -the close carriage to the train, the overheated and badly-ventilated sleeper, the express rate of speed, the hasty meal, the tiresome noise of the journey-all these things, and many more, exhaust the invalid patient. In a comparatively short time after leaving his home, at sea level, he finds himself struggling for breath, thousands of feet above it. Unprepared for the change, the pulmonary hemorrhage, so likely to result, draws forth the last of physical resources, and the patient dies in sight of what might have been his triumph in health, if the journey had been undertaken with more caution. For invalid men in the earlier stages of phthisis, the trip across the great plains is a most excellent means of regaining health and strength. A large wagon, with horses, can be purchased at Leavenworth, Kansas. One or two men can be employed by the month to act as cook, driver and for general service in looking after the camp. For the outfit two United States regulation wall tents, a camp mess chest, camp cots, blankets, etc., also a good shot-gun and a well-trained hunting dog, will add to both health and pleasure. The best time to start from Leavenworth is the second week in May, not earlier. The daily journey can average eighteen or twenty miles. A little painstaking

in Leavenworth will enable one to secure the services of a frontiersman of experience, who will understand the route, and the old Santa Fé trail is the best for camping parties.

When the writer crossed the great plains in 1867, it was then known as a hostile country, and only well-protected expeditions could undertake such a journey with safety; but now all this is changed. Prosperous villages are found in every direction, and a safe and pleasant journey can be enjoyed. Following the old Santa Fé trail will afford comfortable camping grounds and an abundance of food and good water. This plan may seem to suggest the methods of the gypsies, and may be considered out of place in a paper for medical men, but, if faithfully carried out, will prove of the greatest value in restoring a large class of invalids to health. For those who can ride on horseback the journey would be more delightful. This plan is mentioned because all medical writers of experience in the climate of Colorado can bear witness to the injurious effects of the sudden and great change experienced by all classes in rushing west. In carrying out such a journey as I have suggested the invalid gradually approaches the high altitudes of the Rockies, and under the most favorable auspices.

This plan also illustrates the importance of attention to details in the study of Climatology. The mere statement, "Go to Colorado," may be disastrous if immediately and hastily carried out; but when the question, "How shall I go to Colorado?" is carefully answered, then an opportunity for restoration to health is presented which can be found in few sections of this country, if, indeed, elsewhere in the world. Many nights have I spent sleeping on the ground, the clear skies, star-filled, for a canopy, and the delicious atmosphere refreshing and invigorating the body. Little dew falls, and one wakes in the morning, after such a wholesome rest, with a good appetite and in a condition well suited for a twenty-mile ride before the next camp.

Occupation is a valuable remedy in connection with climate cure. Idleness will defeat the good results to be obtained from any climate. For restoration to health, the body and the mind must be actively employed. The expansion of the chest, and the reception of the pure, health-giving atmosphere, destroy the efforts of the deadly bacilli, and new life is added daily by the favoring journey.

Considering the evidence offered us in recent medical literature, we must admit that, in general, dryness, either cold or mild, is the most desirable condition sought for -other things being equal-in the treatment of pulmonary diseases. With this dryness we must have more or less elevation associated, to obtain the best results-certainly nothing under 1000 feet above sea level, or over 6000. While the careful study and investigation of Climatology will undoubtedly discover many regions and localities in Europe, Africa, South America and North America suitable for the relief, and oftentimes for the cure, of pulmonary diseases, the accumulated evidence offered by our best and most thorough climatologists demonstrate without doubt that the climate for which we have been seeking to cure our phthisical patients is to be found in what I have described in an article in the Philadelphia Medical Times, Feb. 7th, 1885, as the "Western Health Section."

Probably nowhere else in the world is such a healing zone to be found. This section comprises Western Kansas, the western portion of Indian Territory, the Texan Panhandle, New Mexico, and the southeastern and eastern slope of Colorado. The statement that American phthisical patients should be sent "west of the Mississippi" is very true, but the results would prove unsatisfactory unless "far west" were the orders given. In my experience and that of other investigators the Pacific slope is not desirable, but is, in many cases, very injurious. California, and especially southern California, is objectionable on account of the moist, warm climate and the fogs which prevail. For the same reason Florida has not of late been considered a healing climate for diseased lungs. When we search our libraries and the columns of the medical journals of this

and other countries, we find that the health resorts of real value are not very numerous, but in spite of the fact that the American climate is, generally speaking, a severe one for invalids, we have many regions suitable for winter resorts for pulmonary invalids unsurpassed in any quarter of the globe. For summer in the east, the sea coasts of Maine, New Hampshire, Massachusetts and Rhode Island. In the latter State, the climate of Newport, and more especially to be recommended, that of Jamestown, on Conanicut Island, and indeed the whole island, is a most valuable seaside resort for a large class of pulmonary invalids. The writings of Prof. Horatio R. Storer have fully demonstrated that this climate more nearly resembles that of the famous English South Coast or climate of Ventnor, Isle of Wight, than any other in America.

The atmosphere certainly possesses very remarkable qualities, both as tonic and, better still, as a real healer of diseased tissues. The coasts of Connecticut and New Jersey are not so desirable. The mountains of the Adirondack region, and certain sections of the White and Green Mountain ranges, the forests of Maine and the Adirondack region, the lakes of the St. Lawrence, portions of Virginia and North Carolina and Tennessee, west of the Mississippi, the Rocky Mountain region and the "Western Health Section" already referred to.

This list is not a large one, and yet, while I am free to confess that many other places might with justice be mentioned as health resorts, these which we have mentioned are the most important and the most promising.

If the profession of medicine is threatened with serious and lasting injury from the great number of specialists who now appear even in our smaller towns, it is equally true that the specialist devoting his time to the science of climatology has a right to exist, and will prove a valuable member of the body medical. At present we expect our specialists in diseases of the air passages to be experts in climatology. We cannot hope, at the present age of learning, to understand all the different branches of medicine, and for most men one specialty is quite enough, and certainly climatology is worthy of the most patient study and investigation. While farmers, mariners, etc., are especially benefited by Government reports and the collection of news concerning the weather, it might be well to have a bureau of Climatology, to aid the medical profession of the United States in collecting reports concerning climate from every State and territory on this continent.

Success in the study of climatology must depend largely upon attention to what may seem to be minor and unimportant details. As life is made up of little things, so we must consider minutia in the study of climatology. In sending a patient to any given place, we must know beforehand what he will find when he arrives, to insure his comfort and protection. I do not think that the plan of roughing it is always a practical one for invalids, or for those inexperienced in camping out. There is often too much danger and hardship for men to desire it very much, but I certainly do believe that to get well camping is the very best way for health's sake. Nothing can be better in summer than the canvas house, well built and well arranged, and equipped with that indispensable adjunct the most important member of the party-a really good cook. Plenty of nutritious food must follow the abundant exercise and exposure in the fresh air.

The pleasant side of the picture of camp life in the west is the constant bright sunshine, of clear skies and glorious mornings and evenings. For the investigation of climatology a great deal of actual travel is necessary and the outlay of thousands of dollars, that is for practical and really valuable information. To study climatology without traveling is like studying anatomy without dissecting, and he who recommends resorts which he has not seen and examined may be the means of making much unhappiness. It is on this account that we have considered the importance of the study of climatology in connection with the science of medicine.