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Climate and

disease, tuberculosis, amount, patients, climatic, conditions and temperature

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CLIMATE AND DISEASE.—The relations between the effects of climate and the treatment of disease are very complex for at least two reasons : in the first place, because it is extremely difficult to define climate ; and secondly, because the reaction to climate may vary within wide limits in different individuals. Thus, of two patients suffering from the same disease one may be benefited by a certain 'definite climate, and the other rendered worse.

The most ideal type of climate for a great majority of sick people may be said to be one in which there is a maximum amount of sunlight, a moderate amount of moisture, and one in general in which the atmosphere is free from dust. Much, however, depends upon the disease under consideration. For a climate might have all the ideal conditions that the mind of the physician might desire, and yet, by reason of difficulties of transportation and of obtaining food, proper housing, and protection, it might be badly adapted to the individual case. Thus, in many cases of tuberculosis, in which the disease is not advanced too far, certain arid regions of New Mexico and Arizona have shown themselves to be very desirable as regards climate ; but until such places shall have been placed within the region of civilisation, and provided with good facilities for food supply, transportation, and nursing, they offer little hope except for those who can command all of the resources in spite of the difficulties.

A classification of climates is difficult to lay down. So many factors— such as pressure of the atmosphere, prevailing temperature, prevailing winds, average humidity, amount of electrification in the atmosphere, amount of sunlight, amount of rain, etc.—all contribute to the estimate of the general problem. There is no definite system for the classification of climates, since no region of the globe has an unvarying series of climatic conditions ; and at best one can only approximate the general average. So that when one has to take into consideration not only the adaptability of the climate to the individual and the disease but the economic features as well, it often becomes a very perplexing problem.

There are practically no individuals, either sick or well, that are not benefited in some degree at least by change of residence under different climatic conditions. This applies particularly to those afflicted with certain

disorders which are in part due to, or largely aggravated by, unhygienic climatic surroundings, such as tuberculosis, and by the various neuroses and neurasthenias so largely incidental to city dwellers. The most important diseases that can be benefited by climate are tuberculosis, neuroses, mild mental disturbances, chronic Bright's disease, chronic heart-disease, and, chronic bronchial disease. In tuberculosis, as has already been outlined, no general rule can be laid down. Patients with incipient tuberculosis can recover even in a London street, if they can be made to live twenty-four hours a day in the open air ; and, on the other hand, patients die of tuberculosis even in the most favourable climatic surroundings and with all the aids and accompaniments that a munificent purse can afford. In general, however, it may be said that patients with incipient tubercu losis should avoid the cities, where fierce winds are common, where draughts are rendered more acute by the flue-like character of many of the buildings, and where dust is extremely prevalent, particularly dust that contains many septic micro-organisms.

Tuberculous patients should avoid those climates where extreme changes are rapidly brought about, where the temperature falls so or 40 degrees in two or three hours and does it very often. They should seek a climate in which the sun shines much of the time, and where the humidity is not very marked ; in certain cases, complicated by bronchial conditions, the presence or absence of humidity may, however, be of service in allaying irritation of the bronchial mucous membranes. Having found such a climate, where increase of weight and decrease of temperature and cough are secured, every attention should be given to further the cure of the malady by the observance of hygienic and dietetic measures. Whether a patient should choose high altitudes or low, whether plains, forests, or lake regions, is a matter that should be determined for each and every individual by a physician who 'has paid particular attention to such climatic details. The following of general rules is often disastrous.

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