82 SMITHSONIAN MISCELLANEOUS COLLECTIONS VOL. 63 



There was a subsequent sharp decline in May, the index dropping 

 250 points. This fall continued without interruption in June, to cul- 

 minate July II, at the low point for 1912. 



The conclusion of this study was : 



Phthisical patients are apt to lose rapidly in weight and general 

 condition in May, June, and the first two weeks in July, which season 

 constitutes an unfavorable and critical period. 



Phthisical patients make an extraordinary recovery in weight and 

 general condition in the month of August, which is a surprisingly 

 favorable time of the year. 



August, September, January and February are the most propitious 

 months for obtaining successful results in treating pulmonary tuber- 

 culosis. 



Forced feeding in the unfavorable season seems to have availed 

 very little in limited number of cases studied at North Reading. 



We have already referred to the beneficial influences of the Arctic 

 summer climate (see pages 39-42), and we attributed much of it 

 to the perpetual sunshine ; consequently we cannot agree to the 

 illogical statement that sunshine is not essential. We believe that the 

 " Fireside Cure " has no place in the treatment of tuberculosis and 

 we must admit that whereas only a few years ago the cold air 

 fiend, who slept with windows wide open in the coldest winter, was 

 considered a crank, he now has been proved to be the only sensible 

 one among us.* 



EXPANSION OF THORAX AT HIGH ALTITUDES 



Without dwelling further at this time on the efifect of cold air 

 compared with warm air on tuberculous disease (see pp. 28, 40, 

 71), we must note some of the undeniable effects of diminished 

 atmospheric pressure on physical development and especially on the 

 thorax and pulmonary tissue. 



One striking change is the expansion of the thorax in various 

 directions and a corresponding increase in the mobility of the tho- 

 racic walls. We have previously referred to one case in which the 

 circumference increased five inches during a residence at St. Moritz, 

 elevation 6,100 feet. (See page 74.) Changes of from one to 

 three inches are more commonly noted even at much more moderate 

 elevations. These changes are conveniently recorded by means of 



^ American Medicine, loc. cit. 



