NO. I AIR AND TUBERCULOSIS HINSDALE 85 



Patients in an acute condition should not be sent. Cases of fibroid 

 phthisis, in Dr. Knight's opinion, are not suitable. Convalescents 

 from pneumonia or pleurisy are usually well suited for elevated 

 regions. Advanced cases of tubercular laryngitis, if good local treat- 

 ment and freedom from dust can be obtained, may do no worse in 

 elevated regions than elsewhere. 



In cases complicated by cardiac dilatation we cannot advise alti- 

 tude ; but a cardiac murmur resulting from a long-past attack of 

 endocarditis with no sign of enlargement or deranged circulation 

 should not prevent. Nervous derangements of the heart are usually 

 counter-indications. 



The observations made at the United States Public Health Sana- 

 torium at Fort Stanton, New Mexico, by Surgeon F. C. Smith, of the 

 service are commended as a valuable contribution to the Relation of 

 Climate to the Treatment of Pulmonary Tuberculosis. This sana- 

 torium is open to sailors in the merchant marine and they are trans- 

 ferred from the twenty-two marine hospitals on the coasts and 

 rivers to this admirable inland sanatorium. It was found that the 

 results have been nearly three times as good in the cases which left 

 the home stations, i. e., the local marine hospitals, without fever as 

 in those who had a temperature of 38° C. (100.4° F-) or more 

 within two weeks of departure. The deaths in those leaving afe- 

 brile were to those leaving with fever as 22 to 59 ; the arrests, as 

 19 to 7>4 ; the apparent cures, as 10 to 3. Dr. Smith holds that the 

 case that should be sent to a distant climate immediately upon diag- 

 nosis is exceptional and he also adds that neglect to make an 

 early diagnosis does not warrant precipitate haste in sending the vic- 

 tim away when it is finally established. The psychologic moment 

 for a climatic change is when there is a comparative quiescence of 

 the lung process under treatment at home, when nutrition is im- 

 proved and further improvement is slow (Francine). Climatic 

 change, however, must sometimes be made, as we will see later on, 

 when the hoped for stage of quiescence does not occur. 



Before allowing patients with pulmonary diseases to go long dis- 

 tances or to make any great change to higher altitudes, some caution 

 should be given. In the first place, patients should not make any 

 physical exertion for two or three weeks after arrival. The air may be 

 stimulating, there may be sights to see and many dangerous invitations 

 given, but it is absolutely necessary that the patient should be ad- 

 justed to the new atmospheric conditions. Acclimatization is neces- 

 sary to comfort and safety. In the old days it was accomplished by the 

 slow ride in the stage-coach over the plains. We cannot go back to the 



