NO. I AIR AND TUBERCULOSIS HINSDALE 83 



the instrument known as the cyrtometer which gives accurate trac- 

 ings for recording the progress of the patient/ 



Inasmuch as tuberculous patients in whom the disease is actively 

 progressing show a shrinking of the perimeter pari passu with the 

 advance of the disease, and those who are recovering show an in- 

 creasing circumference, it is a fair inference that the physiologic 

 increase in thoracic measurements due to residence in the higher alti- 

 tudes is an advantage in the prevention and treatment of pulmonary 

 tuberculosis. Man is not adapted to live permanently at altitudes 

 above 13,000 to 16,000 feet (4,000-5,000 meters), but at somewhat 

 lower elevations as, for instance, at 10,000 feet we have some thriv- 

 ing cities such as Leadville and Cripple Creek in Colorado, and Quito 

 in Equador, elevations 10,000 and 9,350 feet (3,000 and 2,850 

 meters). The altitude of the permanent habitations in the Ortler 

 Alps is about 5,450 feet (1,640 meters), and that of the highest 

 health stations from 5,000 to 7,000 feet (Arosa). It is a well-known 

 fact that the Indians of the Andes, the Swiss guides, the Tyrolese 

 hunters and other mountain dwellers have a large thorax with corre- 

 spondingly deep inspiratory power and remarkable endurance.' The 

 increased respiration and the quickening of the circulation promote 

 health and vigor in mountain races and comparisons between the 

 highlanders and those in deep and flat valleys are always in favor 

 of the former. All observers have remarked on the immunity from 

 disease, and especially scrofulous and tuberculous disease, charac- 

 teristic of mountain races, provided they live in the open, avoid over- 

 crowding, have sufficient and suitable food and observe ordinary 

 hygienic methods of life. Failure in this respect provides an opening 

 for tuberculosis which, as we well know, is the scourge of the 

 North American Indian and his relatives in Mexico and South 

 America. Even in Quito, that city of remarkable equability, where 

 it is perpetual spring, tuberculosis has effected an entrance, and 

 enters largely into the mortality lists.' In Bogota, South America, 

 in La-Paz, Mexico (elevation 11,000 feet, 3,360 meters) and in other 

 densely populated towns in these countries, the later records show 

 increasing numbers of cases of tuberculosis. This fact, however, 



' See Minor, Charles L. : The Cyrtometer ; A Neglected Instrument of 

 Pulmonary Diagnosis and Prognosis (Trans. Amer. Climat. Ass., 1903, p. 

 221). 



' " Mexican Indians, though of medium height, have unusually large and 

 wide chests, quite out of proportion to their size." Jourdanet. 



""Jacoby: These de Paris, 1888. Quoted by Huggard. 



