134 SMITHSONIAN MISCELLANEOUS COLLECTIONS VOL. 63 



the late Dr. Alfred L. Loomis, in the Medical Record and formed 

 a part of a paper read before the Medical Society of the State of 

 New York in 1879, a paper which we commend to your attention. 

 Dr. Loomis says: 



At the age of twenty-five this patient, being of good family history, began 

 to lose his health in the winter of 1872. His symptoms were rapidly becoming 

 urgent; he was examined by several physicians. Extensive consolidation at 

 the left apex was found, extending posteriorly nearly to the angle of the 

 scapula; on the right side nothing was discovered save slight pleuritic ad- 

 hesions at the apex. 



He was ordered south, but returned in the spring in no way benefited. 

 On the contrary, night-sweating had set in, and his fever was higher. In 

 the latter part of May he started for the Adirondacks, the ride in the stage 

 being accomplished on an improvised bed. His condition at this time was 

 most unpromising; he had daily fever, night sweats, profuse and purulent 

 expectoration, had lost his appetite and was obliged constantly to have 

 recourse to stimulants. Weight about 134 pounds. He began to improve 

 at once, his appetite returned, all his symptoms decreased in severity, 

 and after a stay of more than three months he returned to New York 

 weighing 146 pounds, with only slight morning cough, presenting the appear- 

 ance of a man in good health. A few days after his arrival in New York 

 he had a chill, all his old symptoms returned and he was advised to leave 

 for St. Paul, Minnesota, where he spent the entire winter. He did badly 

 there ; was sick the greater portion of the winter. In the spring of 1873 

 he again went to the Adirondacks. At this time he was in a most debilitated 

 state, was anemic, emaciated, had daily hectic fever, constant cough, and pro- 

 fuse purulent expectoration. 



The marked improvement did not commence at once as it did the previous 

 summer, and the first of September found him in a wretched condition. I 

 then examined him for the first time and found complete consolidation of the 

 left lung over the scapula and suprascapular space, with pleuritic thickenings 

 and adhesions over the infraclavicular space. On coughing, bronchial rales 

 of large and small size were heard over the consolidated portion of the lung. 

 Over the right infraclavicular region the respiratory murmur was feeble, 

 and on full inspiration pleuritic friction sounds were heard. I advised him 

 to remain at St. Regis Lake during the winter, and although he was repeatedly 

 warned that such a step would prove fatal, he followed my advice. 



From this time he began slowly to improve. Since that time he has lived 

 in this region. At the present time his weight is 158 pounds, gain of 22 

 pounds since he first went to the Adirondacks in 1873, and ten pounds more 

 than was his weight in health. He has slight morning cough and expectora- 

 tion, his pulse is from 72 to 85 and he presents the appearance of a person 

 in good health. In his lungs evidences still remain of the disease he has so 

 many years combated. 



Although he has made three attempts to live in New York, at intervals 

 of two years, each time his removal from the mountains has been followed 

 within ten days by a chill, and a return of pneumonic symptoms — symptoms 

 so ominous that he has become convinced that it will be necessary for him 

 to remain in the Adirondack region for some time to come. 



