Home sanatorium treatment has almost completely removed the highly reprehensible practice of sending patients away in the advanced stages of the disease to perish in a foreign land, far from friends and removed from the comforts of home life.
A long journey when the patient is suffering from a continuously elevated temperature is a decidedly dangerous procedure even in the early stages of phthisis.
It cannot, however, be denied that there are more suitable climates than that of Great Britain for the treatment of phthisis, but the drawbacks as regards travelling and sanitation must always be considered, as already mentioned.
Sea Voyage.—A long journey in a good sailing-vessel was considered to be the ideal climatic treatment, and doubtless it would remain so but for the fact that steam as a motive power has almost rendered the sailing ship obsolete. It is seldom possible to arrange that the patient can spend his nights on board ship otherwise than in a small confined space, which it may be impossible to ventilate properly. Thus the unrivalled benefits obtainable on deck during good weather by day are vitiated during the sleeping hours, and the noiseless, dust-free atmosphere of a good sailing ship is now replaced by an environment in which the cea Bless throbbing of powerful machinery and occasional clouds of coal-dust are frequently perceptibly blended with the characteristic odours peculiar to modern marine propulsion.
It is, moreover, worse than cruelty to consign a phthisical patient to a long voyage when previous experience of a marked tendency to seasickness causes him to dread the trip.
Sea-Coast Resorts.—These are often most advantageous, and by careful selection a bracing or a sedative atmosphere of great purity and equability suitable to the individual wants of the patient may be provided. At home, Bournemouth, Ventnor, Torquay, Rothesay, Nairn, Rostrevor and Glengariff are much appreciated. Of these, Torquay affords a moist sedative atmosphere well suited to those cases exhibiting marked bronchial irritability, and it may, like Rostrevor, be selected as a winter resort. The sanatorium in the latter resort, situated on an elevation sheltered by high surrounding hills, is one of the most favoured spots in the British Isles, being cool in the summer and equally warm in winter and free from sand-storms. The dry sandy soil of Bournemouth, which is sheltered from
the prevailing winds, and the advantages of its surrounding plantation of pines make it a valuable substitute for the more tempting climates farther afield.
Arcachon and Biarritz are excellent autumn resorts which can be vacated as winter sets in, when the patient may with advantage move on to any of the sheltered sites on the Riviera; Taormenia, Algiers, Mentone and San Remo are probably the best resorts for winter in the Mediterranean, the first-mentioned being the most sheltered and freest from the dry biting mistral wind. Madeira and the Canaries are easily reached, and by some patients are much prized as havens of winter rest, the former being especially valuable for its moist sedative atmosphere when extensive bronchial irritability is present, which is often aggravated by the more bracing climates.
In California, Los Angeles is an ideal winter resort, and the writer has often been able to save the lives of patients whose means have been limited by sending them out in a vessel plying to Mexican ports, from which they can reach the orange groves of California, where open-air work is easily procurable.
High Altitudes.—The treatment of phthisis by residence in regions situated at great elevation above the sea-level is one of the many modern adaptations of the open-air method. Such resorts arc to be found in various parts of the globe, as Denver and Colorado Springs in the Rocky Mountains, Bloemfontein and Pretoria in South Africa, Davos Platz and Saint Moritz in Switzerland, where the altitude ranges between 4,000 and 6,000 feet.
The extraordinary purity of the air and the low barometric pressure tend, with other considerations, to produce a most beneficial effect upon the lung tissue, which is the seat of disease, as well as to produce hyper trophy, and even vzsicular emphysema and expansion of the chest, as believed by Williams.