248 DISEASES OF THE PARENCHYMA OF THE LUNG. 



Were it not for the very grave objections already detailed, I should 

 counsel most consumptive patients to keep the house during our North- 

 ern winter, and to maintain the utmost uniformity of temperature in 

 their chamber, in order to preserve their lungs from further harm. 

 This dilemma may be obviated by making the patient avoid the North- 

 ern winter, by sending him to some place where he can spend the 

 greater part of the day in the open air, without risk of taking cold, or 

 of inhaling a raw, inclement atmosphere. This, in my opinion, is the 

 real benefit derivable from change of climate. When a patient has 

 the means, we should never omit to enjoin upon him to make the sacri- 

 fice, but the matter must be made plain to him, so that he may not 

 suppose the air of the place to which he is sent has any special cura- 

 tive power upon his lungs. We need not expect' any benefit from a 

 residence in Nizza, Mentone, Pau, Pisa, Algiers, Cairo, or Madeira, 

 unless the patient fully understands that he must take care of himself. 

 Otherwise, it were often better that he remained at home. Acting 

 upon this principle, the patient should be sent during the autumn, and 

 before the harsh winter sets in, to Soden, Badenweiler, Wiesbaden, 

 and, above all, to the lake of Geneva, where he may try the grape-cure, 

 and where he is as well protected as he is at home during the summer. 

 None but very intelligent and prudent persons, who we may be sure 

 will stay at home in bad weather, should be allowed to spend the 

 winter at Nizza, Mentone, Pisa, or Pau. When the patients have the 

 means, it is always better to send them to Algiers, Cairo, or Madeira. 

 The comparative merit of these winter abodes is not as yet positively 

 determined, and the indications for preferring Madeira, Algiers, or 

 Cairo, in particular cases, or for certain stages of the disease, are so 

 indefinite as to be of little value. One principle, however, always ob- 

 tains : that the patient, wherever he may be, must live circumspectly, 

 and remain under the charge of an intelligent and strict physician. 



For patients who are unable to seek a milder climate, the use of a 

 " respirator," a wire gauze, warmed by the breath, through which the 

 external air is inhaled, is advisable. A handkerchief held before the 

 mouth, however, which also is soon warmed by the expired air, will 

 answer the same purpose, and, indeed, is really better than a " respi- 

 rator," as it is not, like the latter, liable to become too warm. 



When the invasion of the air-vesicles by acute catarrh, or the rapid 

 spreading of a catarrhal pneumonia, is accompanied by violent symp- 

 toms, when high fever sets in, when the sputa become bloody, and the 

 patient complains of lancinating pain upon drawing breath, and upon 

 coughing, local depletion, by means of leeches or cups, and the appli- 

 cation of cataplasms, should be resorted to. At the same time, the 

 patient must be required to keep his bed until all symptoms of the 



