Davos Platz is the most desirable of these mountain resorts, with its splendid sanatoria and the excellent hygienic arrangements of its modern hostels and pensions. The stillness of the cool air, its great purity, rarefaction and dryness, the absence of fogs and the prevalence of ozone and warm sunshine, renders Davos a favourite resort of the victims of phthisis. Even in the depth of winter the patient can safely sit or lie out in the still pure atmosphere in bright sunshine, when the thermometer is below freezing-point, and at night he can sleep with windows widely open in safety.
The appetite increases, the lungs expand, night sweats and fever subside, hremorrhage is less likely to occur, and many patients return without any symptoms of the disease, having also left their physical signs behind them. The rarefaction of the air is, of course, a most important factor in producing these good results. Professor Lindsay lays great stress upon the inadvisability of sending patients to Davos who are not capable of supporting and responding to the highly stimulating climatic conditions prevailing there. Where sedative measures are indicated, low-level climates should be selected.
By the majority of authorities, the following classes of cases should not be sent to high-level resorts:—Patients with serious cardiac or valvular lesions, much bronchitis or emphysema; where the symptoms are acute or the fever high; where there is laryngeal or intestinal ulceration; where the disease is so far advanced as to prevent exercise. Also the old and very young had better remain in low-level regions. Those of very excitable temperaments, in whom insomnia is marked, and those suffering from albuminuria, should not try the high altitude unless they have had previous experience of it.
September is the best period for reaching Davos, and it is often expe dient that the ascent should not be abrupt. After the expiration of six months the patient may safely move towards the sea-level, to return to Davos again in the early winter, if necessary; he may spend his summer with great advantage in the Engadine, or in some of the districts above the Lake of Geneva. • Camping out in the Peruvian Andes, in Santa Fe de Bogota (Granada), zunongst the Blue Mountains in New South Wales, as well as in various parts of the Rockies, Transvaal and Orange River Colony, may be resorted to by male patients whose strength and vigour are but slightly impaired by the early inroads of the disease.
Inland value of each must be estimated by the above mentioned law regarding the amount of daily time which the climatic conditions permit of comfortable outdoor life in the particular district. To these should be added the great advantages which sometimes can be obtained by living in the midst of plantations of different coniferie where the air is purified and saturated with aromatic, resinous or terebinthinate products exercising a most beneficial action upon the diseased bronchial surface. Many such spots are available in the Austrian Tyrol and Black
Forest. The dry warm climates whei e the clear pure air is flooded with sunshine and where the rainfall is so slight as to interfere little if at all with outdoor life are most beneficial, and when the patient can travel, Egypt about Assouan and Luxor is highly prized as a winter resort. Such privileged invalids whose means will permit them to spend the winter in the vicinity of the Libyan or Nubian deserts can on the approach of summer have the benefits of a long Mediterranean cruise amongst the islands of the Greek Archipelago or a summer residence in any of the cooler resorts on its northern shore.
Drug may be safely affirmed that no antiseptic can be safely administered by the mouth in such quantites as will exercise a lethal action upon the bacillus in the tissues of the body, and it is scarcely necessary to emphasise the fact that drug treatment must take a very subordinate place in the routine treatment of phthisis. But when this has been said a plea must be put in against the abandonment of many useful agents, since the open-air treatment has obtained such a firm position in the minds of the profession and of the laity. Unfortunately in many sanatoria the idea seems to prevail that to resort to any form of drug administration is to belittle the virtue of the open-air method of treatment.
To mention the innumerable local methods of reaching the diseased pulmonary tissue by the routine means of inhalations, sprays, &c., must be to condemn them. It is idle to imagine that the bacillus can be destroyed in this way. But it must be conceded in some cases that where the benefits of a pure atmosphere are not obtainable, sterilisation of the air breathed by the phthisical patient must prove beneficial, especially in early cases, and in some advanced cases where there is extensive bron chial mischief and mixed infection. The old form of oro-nasal respirator containing a space for cotton-wool or a sponge saturated with alcoholic solutions of Menthol, Creosote, Phenol, &c., is now seldom employed. One objection to its use is that it interferes with the full inflation of the lungs with air. Coghill's fluid consists of Creosote 1, Phenol 2, Ethereal Tincture of Iodine 2, Rectified Spirit 3. The Brompton formula is Creosote i, Spirit of Menthol (2o per cent.) i, Spirit of Chloroform r.