NO. I AIR AND TUBERCULOSIS HINSDALE 133 



and at the same time a moderately low temperature the general 

 effect is tonic and it is beneficial in conditions of irritability of the 

 respiratory mucous membrane; but if the temperature is very low 

 this may be rather irritating. We find atmospheric conditions like 

 this from Minnesota to the Rockies and through Manitoba and 

 Alberta. 



The combination of high relative humidity and low temperature 

 certainly favors catarrh and we have such conditions all winter 

 long in the region of the Great Lakes and in New York and New 

 England. Probably the best combination is a low humidity and a 

 moderately cool temperature ; the average tuberculous patient makes 

 his best gains after August first and in subsequent cold, dry weather 

 when such conditions prevail. But of course there are exceptions 

 and some do better with a high relative humidity and a warm tem- 

 perature ; these are not numerous and probably include more of the 

 patients in later stages when expectoration is profuse and vitality is 

 low- 



The old idea about equability of temperature, at least between the 

 temperature of midday and midnight, is not of great importance;* 

 all mountainous stations show great variations in this respect. Some 

 variability tends to stimulate the vital activities, but in older people 

 and those who are feeble great variability is a disadvantage. 



As far as altitude is concerned it probably has not, per se, any 

 great influence ; certainly to my mind not so much as we used to 

 think. However, altitude is incidentally associated with mountain 

 life or life on the plains, with more sun, less moisture, and scattered 

 population. We should not forget that surgical tuberculosis is al- 

 ways favorably influenced by a seashore residence suitably chosen. 



I never shall forget the wonderful impression made on visiting 

 the Sea Breeze Hospital for Tuberculous Children on Long Island, 

 New York. Constant outdoor life in all weather works miraculous 

 cures after the most formidable operations for bone tuberculosis and 

 in many cases renders them wholly unnecessary in patients whose 

 physical condition on admission was most unpromising. All the 

 great French and Italian sanatoria for tuberculous children are 

 located on the seashore. 



Among the numberless histories of the climatic cure I will give 

 only one and I think I may safely let it stand as a good example by 

 which to let the argument rest. The history is that of a physician 

 whom we all love and respect. It was published, together with 

 twenty other carefully recorded histories, by that prince of clinicians, 



