Combined Physical have now reached the considera tion of the method of treatment by combined physical therapy. In an emergency we restrict ourselves to only one of the many natural and easily accessible healing agents. For instance, association with other children, or the stimulation of natural surroundings, will often be the means of inducing a child to enter into the spirit of exercise, so that it will be engaged in sufficiently, and with especial pleasure. At the same time, the association with individuals of the same age is of great value, excepting during the first two or three years of life, as it tends to develop and educate the child's mind, and neurasthenic disorders, for instance, are forced into the background. The freedom of the exercise amid natural surroundings permits these powerful influences for health to become efficient. To these influences we shall now for a short time turn our attention.
It is impossible here to bring out in detail the value of the individ ual points of climatotherapy; the cleanliness and the humidity of the atmosphere, its temperature, and motion; the sun, the terrestrial radia tion, the barometric pressure, etc.. The subject will be considered from an essentially practical point of view.
It is not always borne in mind that the greatest harm which modern culture has brought about is the restriction of life in the open, amid the surroundings of nature, with the evil results directly due to this restric tion. Rickets and tuberculosis in all their forms are in great part caused by this. From earliest youth air, light, warmth, and dryness are re quired by the human body. Since little children cannot wander far from the homes which protect them against the inclemency of the weather, they must, if they are doomed to grow up among the stone piles of a large city, search for dust-free playgrounds. Older children can and should take plenty of exercise, and for this purpose the open spaces in the outlying districts of the city should be made use of for play and exercise. The summer camps answer this purpose for school chil dren during their summer vacations.
When travelling in the interest of health, the drawbacks of the trip must be borne in mind (dust, trains, irregular and improper nourish merit, the jarring, and the excitement incidental to a journey), and it is necessary to decide whether the existing disease may not become indirectly aggravated, or whether the ultimate results, particularly in regard to a cure, may not he more readily attained in suitable home surroundings, under proper conditions. Little children should not travel far, or often: older children only mulcr proper guidance and with out being overtaxed. Travelling is to be forbidden in acute diseases. In the same way, subacute diseases of the respiratory tract, of the intes tines, of the sensory organs; even ninny chronic diseases (e.g., chronic
enteritis) may often be cared for to greater advantage at home, owing to better medical and dietetic treatment. travel under the re straint and care of members of the family is very desirable as a rule, in cases of hysteria or degenerate conditions, especially the neurasthenia and scrofula which so often exist together in the same individual, sepa ration from the family and admission to an institution are followed by much more favorable results. In this xvay, too, the cure can often be carried on for a longer time. In fact, four to five weeks usually serve only to refresh weakly children, not to cure sick ones. In chronic condi tions, it is necessary to extend the treatment (Kur) over many months; or, if this is not possible, courses of treatment for periods of from five to eight weeks should be repeated yearly.
A prescribed course of treatment in a health resort must not be permitted to endanger the health of the child by causing intestinal catarrh, typhoid fever, or children's diseases generally (especially whooping-cough). For this reason, in choosing the health resort, it is necessary to take into consideration the milk and water supply, the condition of the dwellings and baths, and the possibility of obtaining satisfactory medical attention. In a precipitous country a young child may easily stumble, and poor roads whose surface does not drain well owing to the impervious nature of the ground, may interfere with exer cise in the open. The discrimination between watering places and climatic resorts (mountains and seashore) is only theoretical, since the prescription of baths and of drinking spring waters may be combined with climatic and other hygienic and dietetic factors. with the happiest results. In the choice of a proper climate. it may be stated that for children during the first two or three years of life, extremes are to be avoided, and even with older children residence in such a place may be recommended only for trial. Finally, the experience obtained in previous cases must not be forgotten and must be taken into consider ation in making selection of a resort. The limits given for particular ages may be extended in certain diseases: e.g., the true ana'mias (we do not mean the regional ana'mia of skin and raucous membranes) require a place where the climate is warm, without marked variations in the temperature, and without the temptation to long walks. Altitudes of 900 to 1200 feet for children during the early years of life, and of about 3000 feet for older children, should not be exceeded. Living at such a resort may be combined with baths (of carbonate of iron or other mineral waters, or of carbonic acid brine).