Change of environment is advan tageous in itself, but of more impor tance is the selection of a resort at an altitude which seems to be indicated in individual cases. Very little can be said in favor of an altitude less than fifteen hundred feet; the experience of some seems to indicate that many patients do well at heights of five to ten thousand feet. The majority of the tuberculous, however, as they appear before the phy sician for advice, seem to do best at ele vations of two to three thousand feet.
A few years ago the majority of pa tients sought warm climates in the winter and returned home during the summer; the result in the majority of instances was eventually fatal. To-day it is a recognized fact, that if a given patient is possessed of ordinary resisting power, it is better for him to winter in a cold, dry climate rather than a mild one: for example, the Loomis Sani tarium at Liberty, _New York, is situated on the top of a mountain-range exposed to rigorous, northwest winds at an eleva tion of twenty-three hundred feet above sea-level, and the winter temperature ranges between ten above and ten below zero. F., yet the percentages of good re sults attained are higher in the winter than in the summer months. It is un doubtedly a mistake to send to cold cli mates patients who have passed into the third, or far-advanced, stage of the dis ease,—in other words, hopeless cases,— first, because they do not possess suffi cient vitality to be comfortable, and, secondly, because it is the inalienable right of a doomed man to spend his dying hours among his friends and kindred.
Having selected the locality in which it is hoped to effect a cure of the pa tient's disease, it is imperative to impress upon him the necessity of remaining continuously there until the desired end is accomplished. It is difficult for pa tients to realize the danger they incur by short visits to their homes or lower altitudes.
To obtain the full benefit of climatic influences, patients should remain out of-doors from seven to ten hours a day during the entire year. It is astonishing how soon they become accustomed to such an out-door life; after having ex ercised sufficiently, they rest in chairs on verandas with the temperature ten below zero and the snow often blowing around them; such a length of time out of-doors is not easily attainable among private patients located in boarding houses or hotels, their environment and associations tending more directly toward an in-door life, and it must be acknowledged that the percentages of good results are proportionately lower than among sanitarium patients.
Patients should pass their sleeping hours in a room with the windows widely open; it is of no moment if the cold air blows directly upon the bare head, pro viding the body and limbs are warmly covered.
At lower altitudes, those below fifteen hundred feet, the proper way to venti late in damp weather is to have the win dows open in the room adjoining that of the patient and have an open fireplace in the room the patient occupies; in clear weather, the room should be ventilated as described above.
There is among the tuberculous a fear of cold sponging; two or three hot baths should be taken each week and a tepid plunge-bath every morning, followed by a cold sponge and brisk rubbing.
The dirty and unsanitary spit-cloths so much in vogue and, unfortunately, advised by physicians, should never be employed; they are potent sources of contagion, soiling the clothing and hands; whenever it is possible, sanitary sputum boxes with close covers and com bustible linings should be used and the linings burned daily. For use on the street and other public places nothing is better than the Dettweilcr sputum-flask.
Diet.—Diet, in the treatment of tuber culosis, is a much abused and poorly understood term. It is a difficult thing to persuade many an incipient case that he must not, of necessity, stuff his stom ach with concentrated nourishment from four to six times daily. In advanced cases at all times, and in a very few in cipient cases when they first come under observation, specially-arranged diets are necessary. In 90 per cent. of incipient cases nothing is better than three sub stantial meals a day.
The appetite of convalescing tuber cular patients is something extraordi nary. Climate, out-of-door life, and tonic treatment all tend to increase the powers of digestion; nevertheless, in most cases, periodically there will arise ' disorders from overfeeding, which will require treatment. Nothing is more simple to overcome than these so-called bilious attacks, and, after a rest of a few hours, the patient will recover his ap petite and power of digestion.