86 SMITHSONIAN MISCELLANEOUS COLLECTIONS VOL. 63 



old methods, and therefore we must exercise greater caution. No fe- 

 brile case should be sent on these journeys or to any elevated resort. 

 Hemorrhage is not a counter-indication to a change of altitude, and 

 it is not any more liable to occur at five to six thousand feet than 

 at sea-level. However, no advanced case of pulmonary tuberculosis 

 should be sent away. Financial considerations are highly important. 

 Expenses are usually underestimated, and the want of sufficient 

 means, the need to economize as regards the necessities, not to speak 

 of the luxuries, of life, is a dreadful handicap, and should bar out 

 many a case that succumbs for want of the very comforts he had 

 left behind. It would be far better for such patients if they should 

 enter some special hospital or sanitarium for consumption, such as 

 are found in most of our Eastern States. 



No one should be sent away without definite and satisfactory 

 knowledge of the place to which he is sent, and without a letter of 

 introduction to some favorably known practitioner containing a state- 

 ment of the main points in the case. 



In matters of climate, as in many other fi.elds, it is the man behind 

 the climate who will help the patient, save him from errors and in- 

 discretions, advise him and direct him as to local surroundings, and 

 enable him so to live that his disease shall be arrested. 



Some localities favorable for tuberculous patients have already 

 been mentioned. Taking the country as a whole we naturally look 

 to the elevated, sparsely settled regions of Colorado, New Mexico, 

 Wyoming, Montana, Nevada, Utah, Arizona and California. The 

 slopes of the Rocky Mountains and the Great Basin are justly en- 

 titled to first choice, provided always that other safeguards than 

 climate are to had for the protection, the comfort and nutriment 

 of the patient. Texas, especially the central and higher western por- 

 tion, must be included in this great area. Life in Texas was for- 

 merly rather too rough and food and accommodations were too 

 primitive for fastidious people, but now at places like San Antonio 

 and El Paso, these defects have been remedied. The winter climate 

 of Texas is very agreeable, except when the Texas norther descends 

 and holds everything in an icy clasp. However, this is not alto- 

 gether a disadvantage, if not too severe. 



Florida suits some cases of phthisis. The interior of the state is 

 sandy and the winter and spring climate is excellent. The culti- 

 vation of orange groves and other agricultural features of the state 

 have given many a patient a profitable occupation that he would 

 never have found elsewhere. 



