34 SMITHSONIAN MISCELLANEOUS COLLECTIONS VOL. 63 



Dr. W. E. Fisher, for many years surgeon to the Pacific Mail 

 Steamship Co., while observing that patients affected with chronic 

 diseases, such as phthisis, dyspepsia, etc., are not so liable to seasick- 

 ness as others, states that a large percentage of tuberculous patients 

 stand the sea voyage badly. Dr. Fisher's experience relates to the 

 trip from New York to San Francisco by way of Panama. During 

 the first part of the voyage until the Bahama Islands are reached, 

 the invalid experiences bracing weather. From that point to the 

 Isthmus and thence up the coast during the long voyage of three 

 weeks or more, a distance of nearly three thousand miles, the tem- 

 perature averages 90° in the shade and on many days rises as high 

 as 95° or 96° F. This occurs during the winter months and is 

 the direct cause of deaths on the voyage or shortly after arrival on 

 the California coast. 



Dr. R. W. Felkin, of Edinburgh, says :^ " Fifteen years ago I used 

 to advocate sea voyages in my lectures on Climatology in Edin- 

 burgh, with great confidence; now I am more cautious. I do not 

 send phthisical patients to sea as I once did. The risk of spreading 

 infection is, to my thinking, too serious to be incurred. I well 

 remember once sending two sisters to Australia ; the elder suffered 

 from phthisis ; the younger was healthy. The elder certainly did 

 gain some temporary benefit, but the younger sister and also a cabin 

 companion became infected, and all three girls were in their graves 

 within a year of their return to this country. I am sure that occupy- 

 ing a joint cabin as they did caused the mischief." 



Dr. F. Parkes Weber, of London, takes a more hopeful view."" He 

 says that sea voyages are often useful in the milder and quiescent 

 forms of pulmonary tuberculosis, provided the patient's general con- 

 dition be such as otherwise to fit him for life on shipboard. " Long 

 voyages are to be preferred to all other methods of treatment in the 

 case of male patients who have a taste for the sea, who are strong 

 physically, or who possessed an originally strong constitution and 

 were infected by * chance ' or when weakened by overwork, worry, 

 improper hygienic conditions, or acute diseases." 



In pulmonary tuberculosis complicated by syphilis, or syphilitic 

 phthisis, as it was formerly designated, a marine climate seems to 

 be particularly suitable.^ 



^Journal of Balneology and Climatology, January, 1906. 

 'F. Parkes Weber: System of Physiologic Therapeutics, Vol. 3, p. 87, 

 Philadelphia, 1901. 

 ' See Roland G. Curtin, Trans. Amer. Climatological Ass., Vol. 4, p. 31. 



