December 3, 1914] 



NATURE 



375 



properties of atmospheric air in connection with the 

 welfare of man." From this fund a prize of 300Z. was 

 offered in 1908 for the best treatise on the relation of 

 atmospheric air to tuberculosis. Numerous essays 

 were submitted to the adjudicators, and Dr. Guy Hins- 

 dale, of Hot Springs, Virginia, was one of the success- 

 ful competitors. His essay, enlarged and more fully 

 illustrated, has now been printed in vol. l.xiii. of the 

 Smithsonian Miscellaneous Collections, Publication 

 No. 2254. It is necessary to recite these details; 

 otherwise it would be difficult to understand the raison 

 d'etre of such a work as that now before us, which 

 is that of an enthusiastic specialist. It has its faults 

 — many of them — it also has the virtues of its kind. 

 It is an expanded essay. It contains an enormous 

 amount of information ; facts and figures abound, and 

 anyone studying questions of climate, the eflfect of 

 elevation, the condition under which moisture is pre- 

 cipitated, the action of sunlight and the like, will here 

 find ample data for consideration. One cannot but 

 feel, however, that to it might be applied with pro- 

 priety the Scotsman's description of a "haggis" as 

 ■fine confused feedingf." This is to be regretted, as 

 one is constantly coming across evidence that if the 

 author could only leave his authorities severely alone 

 now and again and let us have the result of his own 

 cogitations, a far more stimulating and quite as in- 

 formative a book would have been the result. 



Starting out from the Adirondack Forest, whither 

 Dr. A. L. Loomis, of New York, sent patients in order 

 that they might have the benefit of the purest and 

 most invigorating air obtainable, and where Dr. E. L. 

 Trudeau, who himself had benefited from the treat- 

 ment, founded a cottage sanatorium in 1884, Dr. 

 Hinsdale, after indicating the success of Dr. Trudeau 's 

 experiment, takes his institution as an example. He 

 maintains that the condition of the atmospheric air 

 may be of great importance in the successful treat- 

 ment of tuberculosis, and that such pure air is to be 

 obtained in the midst of an evergreen forest of more 

 than 10,000 square miles. It was " common know- 

 ledge " in the days of Pliny that forests, especially 

 those which abound in pitch and balsam, are beneficial 

 to consumptives, or to those who do not gather 

 strength after long illness, and that they are of more 

 value than the voyage to Egypt (C. Plin'ii, Hist. Nat., 

 lib. xsiv., cap. 6). Such forests are to be found in 

 the Hartz Mountains and the Black Forest of Ger- 

 many, in the Ardennes, the large American and Cana- 

 dian forests, and in our own New Forest areas. Here 

 the air is pure and moderately moist — an important 

 feature, though one to which too little attention is 

 paid — and the rainfall averages not too high, in order 

 that patients may get out of doors during a consider- 

 able part of the year. 



It appears that there is a slight excess of ozone in 

 the air of forests, and this, of course, may be a factor 

 in the treatment of consumptive patients, though it is 

 maintained by some that ozone which, even in great 

 dilution, irritates the lungs, the throat, and the frontal 

 sinuses cannot be of much value in the treatment of 

 such cases. The author ventures no opinion on this 

 point, but quotes Lorrain Smith to the effect that 

 oxygen which at the tension of the atmosphere stimu- 

 lates the lung cells to active absorption, at a higher 

 tension acts as an irritant and sets up inflammatory 

 processes. 



Perhaps the most important points brought out by 

 Dr. Hinsdale in connection with forests and afforesta- 

 tion are that the work of raising, transplanting, and 

 caring for trees is specially adapted to the strength 

 of convalescent consumptives and that various forms 

 of woodcraft, such as basket-making and the manu- 

 facture of small rustic articles, may easily be carried 

 on under healthful conditfons in the forest. 

 NO. 2353, VOL. 94] 



The site of a model sanatorium for consumption 

 may, with advantage, be above the snow-line for some 

 part, if not for the whole, of the year. Here there is 

 less organic matter in the atmosphere, and, as demon- 

 strated by Boycott and Haldane, it is the organic 

 matter in the air and not an excess of carbon dioxide 

 that gives rise to the discomfort, headache, etc., 

 suffered in badly ventilated rooms ; moreover, the 

 anaphylactic phenomena corresponding to those noted 

 in "horse asthma" or "stable asthma," may be 

 avoided by changing the air even when considerable 

 quantities of carbon dioxide are allowed to persist. 

 I It is interesting to learn that the consumptive daughter 

 of the discoverer of oxygen, Dr. Joseph Priestley, was 

 condemned to pass a considerable time in a cow-house 

 I in order that the diminished oxygen and increased 

 [ carbon dioxide " might lower the inflammatorj- action 

 ! associated with the disease." Dr. Beddoes, who had 

 ! charge of the patient, thought that this treatment 

 i would not be acceptable to all his patients, " as it 

 seemed to me hopeless to propose residence in a cow- 

 I house, I advised that the patient should live during the 

 i winter in a room fitted up so as to ensure the com- 

 I mand of a steady temperature. This advice was fol- 

 i lowed. Double doors and double windows were added 

 1 to the bedroom, the fireplace was bricked up round 

 ; the flue of a cast-iron stove for giving out pure air." 

 Dr. Hinsdale's comment on this note is that the 

 doctor persisted in his plan of treatment until the 

 patient died. Dr. Hinsdale, from his own experience, 

 makes a further point on which sufficient attention 

 had not been concentrated. It is not the expired air 

 of tuberculous patients that carries infection, but the 

 sputum and the tiny drops of moisture coughed by the 

 patient that carry the bacilli and communicate the 

 disease to others, but, be it remembered, that many of 

 the bacilli carried into the nose, mouth, and upper air 

 passages soon lose their activity or are extruded. 



In his chapter on the influence of sea air the author 

 mentions that Aretaeus, about 250 B.C., recommended 

 sea voyages to the patient strong enough to endure 

 them, for the cure of consumption, and that about 

 three hundred years later Celsus prescribed a voyage 

 from Italy to Egypt, or, failing this, that the patient 

 should pass a large portion of his time sailing on the 

 Tiber. Such treatment has fallen out of vogue, 

 probably because long distances are now covered in 

 such short periods that changes in temperature and 

 atmospheric conditions occur far too rapidiv, and the 

 patient is unable to accommodate himself to them 

 sufficiently rapidh'. Patients who are fond of the sea 

 and who have the opportunity of travelling in a sailing 

 ship in roomy, well-ventilated cabins, and under medi- 

 cal super\'ision, even now receive great benefit from 

 this treatment which, however, should not be used 

 indiscriminatel}'. 



It would be difficult to follow the author through his 

 disquisitions on warmth, moisture, fog, and the like, 

 but it may be accepted that he favours quiet, bracing 

 atmospheres, through which the sun's actinic rays can 

 pass but little obstructed. These, he thinks, are' to be 

 found on high ground, where also expansion of the 

 thorax almost invariably occurs, though, following 

 our own surgeons who send their cases of surgical 

 tuberculosis to Margate, he recommends sea air for 

 such cases. High grounds, he maintains, are natural 

 gymnasia where patients living out in the open air can 

 graduate their exercise and form and absorb their own 

 tuberculin. Dr. Hinsdale insists that rest is essential 

 to the well-being of the patient during the febrile 

 phases of phthisis, and that a patient must never 

 over-exercise, as he is greatly tempted to do in clear, 

 bracing climates. Finally, he comes to the ver^• 

 common-sense conclusion that when all is said and 

 done it is the man behind the climate who is able to 



