84 SMITHSONIAN MISCELLANEOUS COLLECTIONS VOL. 63 



should not afford the slightest ground for controverting the general 

 proposition that life at altitudes of from 3,000 to 6,000 feet favors 

 immunity from tuberculosis and the cure of the disease in suitable 

 cases. 



CHOICE OF CASES FOR HIGH ALTITUDE 



The question then arises, what are suitable cases for altitude treat- 

 ment? What kind of patients may be sent to stations of lower 

 barometric pressure? 



In choosing a location, the late Dr. F. I. Knight, of Boston, for- 

 mulated some opinions based on his long experience.' He limited 

 the age of those resorting to altitudes to fifty years. In temperament 

 he preferred the phlegmatic to the nervous, with an irritable heart, 

 frequent pulse, and inability to resist cold ; and with the latter we 

 must be careful not to include those who show nervous irritability 

 from disease, not temperament, as they are generally benefited in 

 high places. As regards disease, he first considered cases of early 

 infection of the apices of the lungs with little constitutional disturb- 

 ance, and, although these generally do well under most conditions, 

 yet considerable experience assured him that more recover in high 

 altitudes than elsewhere. 



It is best to begin with low altitude in patients with more advanced 

 disease showing some consolidation but no excavation ; also when 

 both apices or much of one lung is involved and the pulse and tem- 

 perature are both over 100. 



Hemorrhagic cases, early cases with hemoptysis and without much 

 fever are benefited by high altitudes. Patients with advanced dis- 

 ease, those with cavities or severe hectic symptoms should not be 

 sent to high altitudes. A small, quiet cavity is not a counter-indica- 

 tion ; hectic symptoms are counter-indications. 



This accords with the latest report from the U. S. Public Health 

 Service Sanatorium at Fort Stanton, New Mexico, altitude 6,231 

 feet. Dr. F. C. Smith reports 56 deaths from pulmonary hemor- 

 rhage in a total of 524 patients since the hospital was opened in 

 1899. His conclusion is that pulmonary hemorrhage is not more 

 frequent at high altitude than at sea level, but the results are perhaps 

 more often serious, especially in those with impaired circulation." 



' Trans. Amer. Climat. Ass., 1888, p. 50. 



'Public Health Reports, U. S. Public Health Service, No. 51, by F. C. 

 Smith, Passed Ass't Surgeon, Washington, 1910. See also Report No. 93, 

 Washington, 1912. 



