im. i^^. W: 7/^ CORNELL UNIVERSITY. ^&s THE THE GIFT OF ROSWELL p. FLOWER FOR THE USE OF THE N. Y. STATE VETERINARY COLLEGE. 1897 Cornell University Library RA 793.S68 A handbook of medical climatology.Embody 3 1924 000 293 872 Cornell University Library The original of tiiis bool< is in tine Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924000293872 A HANDBOOK MEDICAL CLIMATOLOGY. EMBODYING ITS PRINCIPLES AND THERAPEUTIC APPLICATION WITH SCIENTIFIC DATA OF THE CHIEF HEALTH RESORTS OF THE WORLD. BY S. EDWIN SOLLY, M.D., M.E.C.S., LATE PRESIDENT OF THE AMERICAN" CLIMATOLOaiCAL ASSOCIATION". ILLUSTRATED IN BLACK AND COLORS. LEA BROTHEES & CO., PHILADELPHIA AND NEW YOEK. 1897. \ -Lr\AJJl\-^^- - Solly« 92 91 78 87 89 73 48 80 58 Total 63 Altitudes — total 1971 76 430 89 503 1 ''' 1 '' 1 C. B. Williams and 0. T. Williams: Med.-Chir. Trans., 1871, vol. liv., table p. 108; also Trans., 1872, vol. Iv., table p. 241. Dr. Wilson Fox extracted from tbese two reports all the cases that had remained in England of which the results were known— 700 cases. See p. 902 Treatise on Disease of the Lungs, Wilson Fox, M.D. Churchill, London. 2 Brompton Hospital, first report. This is the only report which is divided into stages ; the other report given by Wilson Fox could not be used in this table. 3 Voyages: (C. T. Williams) see p. 907, Wilson Fox. ^ Voyages: (Austin Flint) Flint on Consumption. ' Voyages: (Hermann Weber) Braun's Curative Effects of Baths and Waters, p. 566. ' Voyages: (Faber) Practitioner, 1877, vol. xix. p. 275. ' Madeira: (C. T. Williams) Med.-Chir. Trans., vol. Iv. ' Madeira : (Lund) from White's Madeira ; also British Medical Association Journal, 1883 : also Theodore Williams's Influence of Climate in Pulmonary Consumption. " It must be noted that, of the arrests of the first stage, relapses occurred in two. In the second stage, of five 134 MEDICAL GLIMIATOLOGY. cases of ' arrest,' relapses, followed by sabsequeat arrest, occurred In tvro ; two were much ameliorated, and in two more, though the disease progressed to the third stage, it was then arrested, and the general health remained good. I have placed the four last named among ' marked improvement.' In the third stage it is stated of three cases that on leaving after one winter their only symptoms were moderate cough and expectoration. I have placed these among ' relief or slight improvement.' " Note 17, p. 907, Wilson Fox. » Madeira : (Mittemaier and Goldschmidt.) " Madeira, seine Bedeutung als Heilungaort. 37 cases,|flrst stage, all recovered ; 244 second and third stages. 83 recovered, 2 relapsed, 49 were living with a mean of fourteen years subsequently, 14 lost sight of, 8 died later of other dis- eases, having lived for a mean (?) of fifteen years ; 12 died later of phthisis, having lived for a mean of ten and a half years. These all, with the exception of two relapses, are reckoned as 81 cures : 39 died after living variable periods up to fourteen years. These are reckoned as 'islight improvement,' but are also included in the total of 173 deaths, which includes also the 12 before referred to among the cures." Note 18, p. 903, Wilson Fox. lo Madeira : (Brompton Hospital report, 1866) 20 patients were especially selected and sent out for the winter, but on their return the results were considered so discouraging that the experiment was not repeated. " Madeira : (Renton) Edinburgh Med. Surg. Journ., 1827. 12 Tenerifife, St. Helena, West Indies : (Williams) Med.-Chir. Trans., vol. Iv. 18 Corsica, Sicily, Malta, Corfu, and Cyprus : (Williams) Med.-Chir. Trans., vol. Iv. w Riviera : (Sparks) note 10, p. 902, Wilson Fox. IS Riviera : (Bottini) Walshe, Diseases of the Lungs, see p. 619. Bottini gives 21 arrests in the first stage, and 55.3 per cent, improved ; taking the mean between them, as in Williams's cases, it yields 26 cases improved in both local and general condition. M Riviera : (H. Weber) Klimato-therapie, Ziemssen's Handb. AUg. Therapie. 1' Riviera : (C. T. Williams) Aiirotherapeutics, p. 47. Williams gives a table on page 51 of Aerotherapeutics, with the number of first stages 123, but 3 were lost sight of, leaving 120. He states that these improved in the proportion of 41 to 30 per cent, more than the cavity cases, but the table and text do not make it clear, and there are some typographical errors. I have taken the highest number of improved possible, viz , 77 cases. 18 Aiken : (Geddings) Trans. Amer. Climatol. Assoc. 1' Southern California : (H. A. Johnson) Trans. Amer. Climatol. Assoc, 1891 ; see, also. Hare's System Therap., vol. i. p. 4'27. 20 Rome : (C. T. Williams) Med.-Chir. Trans,, vol. Iv. 21 Pan : (C. T. Williams) Med.-Chir. Trans., vol. Iv. 22 Sharon: (V. Y, Bowditch) Med.-Chir. Trans., Amer. Climatol. Assoc, 1893. 28 Adirondacks : (E. L. Trudeau) from ten annual reports, the last being for 1894, Adirondack Cottage Sanitarium. The only reports obtained of first stage were for the years 1890-'92-'93-'94. Those who remained less than three months are not included, as they are in the all-stage tables, because they are not separated in Dr. Trudeau's report. He recently writes to me that the cases are selected before admission, and again picked out after three months' trial, only hopeful cases being retained, 2'i Asheville : (Karl von Ruck) Medical News, September 16, 1893. 25 Egypt : (F. M. Sand with) Egypt as a Health-resort. 2« Egypt and Syria : (C. T. Williams) Aerotherapeutics, p. 28. 21 Egypt and Syria : (H. Weber) KUmato-therapie. 28 Alps : (H. Weber) Klimato-therapie, 29 Davos : (Spengler) Wilson Fox, note 13, p. 903. 8» Davos: (C. T. Williams) Aerotherapeutics. p. 111. 81 Davos : (CUfford Allbutt) Lancet, 1878, vol. ii., and 1879, vol. i., and also Wilson Pox, note 15, p. 903. 82 Davos : (Carl Ruedi) Dr. Ruedi very kindly gave me extracts from his case-books. He had noted his cases at the end of each season as improved or not ; he had not divided the cases Into separate individual cases, but reported the same persons as often as they passed a season at Davos. Dr. Euedi's report covered twelve seasons, with 1270 cases (an unknown number being repeated), 953 oases of these improved, thus making the benefited 75 per cent. 88 Colorado : (C.iDenison) Rocky Mountain Health-resorts. Houghton, Mifiain & Co., Boston 3* Colorado: (S. Fisk) Trans. Amer. Climatol. Assoc, 1891. 85 Colorado: (H. A. Johnson) Trans. Amer. Climatol. Assoc, 1890. 8« Colorado : (S. E. Solly) Trans. Amer. Climatol. Assoc, 1890. TREATMENT OF PHTHISIS BY CHANGE OF CLIMATE. 135 Eepoets not used in the Tables. 1. The second Brompton report of 6001 cases is referred to by Dr. Wilsoa Fox, but, as it is not divided into stages and does not make evident the total percentage of improvement, I have not used it. The extent of improvement was apparently only 15 per cent. (Wilson Fox, p. 902). 2. Pollock's Brompton report of 641 cases, improvement 25.6 per cent., was not used, as apparently some of the cases appear in the last Brompton report (I'ox, p. 902). 3. Williams reported 235 cases who had some climatic change, but as it is not defined I omitted these. The improvement was 38.7 per cent. 4. Champouillon reported 78 cases who tried various changes of climate. This is omitted for the same reason, and because the percentage of improvement is not given (Fox, p. 902). 5. Hameau reported 110 patients treated at Arcachon; improved, 13.6 per cent. This was not used, as Arcachon could not be ranged with the Riviera group (Fox, p. 902). 6. Leeson sent 29 patients to the districts of Buenos Ayres ; improved, 48.2 per cent. These were omitted, as they could not be put in any group (p. 904). 7. Leeson sent 23 patients to Montreux ; improved, 48 per cent. Omitted for the same reason . 8. Dettweiler reported 1022 patients treated at Falkenstein Sanitarium ; improved, 25.7 per cent. The report does not show the stages, and I thought it fairer to omit it as the percentage seems too low (Fox, p. 904). 9. Thaon reported 151 cases treated at Nice ; improved, 55 per cent. Omitted because appar- ently included in Spark's report (Fox, p. 904). 10. Williams reported "10 cases treated in India generally." Much too indefinite climatically to be used. The improvement was 90 per cent. He reported four treated in New Zealand. 75 per cent, improved ; also nine cases who went to the Cape and Natal, 68 per cent, improved. Both these are omitted for the same reasons as the first (Fox, p 904). 11. Brehmer reported on 700 cases treated in bis sanitarium at Gijrbersdorf, with 13 per cent, cured in all stages, and 53 per cent, cured in the first stage. As he does not give the total benefited, I could not use this report (Hare's System, vol. i. p. 423). 12. Von Ruck reports 511 cases treated at Asheville and other places ; 45 per cent, improved. These are not included, as they could not be put into any one group. I bad previously sup- posed that they were all treated in Asheville at his sanitarium (Hare, p. 429). It will be seen that if these omitted reports bad been added to the tables given, they would have somewhat increased the percentage of improvement in the high over the low altitudes, and would also have obscured the main features of the statistics. If we extract the percentages of results for all stages of each group and put them in order, progressing from the ocean up to the high altitudes, we see an almost steady rise in the percentage of improvement as we proceed toward the highlands, as illustrated by the chart on page 136. It will be observed that the rise would be uniform were it not that the results from ocean-voyages run 2 percent, higher than those from the sea islands, and that the results from the low inland resorts drop back 2 per cent, below the seacoast climates. As has been before remarked, the selection of the ca.ses sent on sea-voyages is usually more carefully made, and their living more out of doors in a purer air than they would do on shore may account for this slightly better result. The total percentage of the low inland results is lowered by those of Rome and Pan, otherwise they probably would not have shown the slight dropping back of 2 per cent, below the Eiviera reports. It is very much to be regretted that the physicians of Southern California give no reports, and also that none can be had from 136 MEDICAL CLIMATOLOGY. Thomasville nor from many other good inland places. The few cases reported from Southern California were not on the coast, or they would have been classed with the Riviera group. Analysis of 7795 Cases of Phthisis. P.C. Home Sea Lowland Highland England Ocean Island Coast Loirland Desert Altitude Ti > > 70 / 65 / 60 /^ 55 / '— Y 50 1 ^ /- 45 « 1 35 / 30 / 25 t i Influence of Sea-air. In making a further analysis of the reports it will be seen that two chief climatic factors exert appar- ently the greatest influence upon the results, namely, sea-air and mountain-air. If we arrange the reports into three groups, the first consisting of the ocean, the island, and the coast climates (England being omitted, as it does not illustrate climatic chauge) ; the second group, composed of the low inland climates, with the sanitariums and the desert climates ; and the third, formed of all the high alti- tude reports, and then compare their total percentages of benefit, we find they range in the following order : All stages. 1st stage. 2d and 3d stages. Sea climates, 57 per ct. 71 per ct. 38 per ct. Inland climates, 63 " 92 " 57 " Climates of high altitude, 76 " 89 " 63 TREATMENT OF PHTHISIS BY CHANGE OF CLIMATE. 137 This shows improvement as the sea-influence diminishes. There is an exception in the first-stage cases in the second group, which is doubtless due to the special selection of the cases before admis- sion to the sanitariums and to the extra care taken of them while there. These results of the influence of sea-air upon the treatment of phthisis by climate are confirmed by the statistical facts concerning the mortality from phthisis as shown in the tables of mortality in cities, the phthisical death-rate per 1000 diminishing with the dis- tance from the Atlantic and Pacific coast to the Gulf of Mexico. Dr. E.. H. Curtin, in a paper^ entitled " The Influence of Sea-air on Syphilitic Phthisis," states that he has observed that most cases of phthisis improve in sea-air during the first month after they are brought under its influence, but run down more rapidly afterward. He reports five cases of syphilitic phthisis which were all much better on the ocean than on land. An interesting discussion fol- lowed, in which Drs. Bruen, Bowditch, Knight, Shattuck, Musser, Ingalls, and Donaldson took part. The consensus of opinion was that sea-air was usually injurious; that pulmonary tuberculosis sometimes improved on sea islands or on ocean-voyages (either being better than the coast) ; but that the improved cases were those in which the catarrhal element was prominent. In a paper which followed this discussion Dr. Boardman Reed said that incipient phthisis usually did well up to a certain point at Atlantic City, but that the second- aud third-stage cases did badly. Advanced heart-cases, he thought, also did badly there, because of over-stimulation. On sea-voyages the diet cannot be varied, and sea-sickness is sometimes a most serious complication. Influence of Altitude. In order to show the influence of high altitudes as compared with that of low altitudes I have combined all the low altitudes, viz., ocean, island, coast, inland sanitariums, and desert, together and contrasted the total percentage with that obtained in high climates. The result is as follows : All stages. 1st stage. 2d and 3d stages. ow climates, 59 per cent. 75 per cent. 47 per cent. igh climates, 76 " " 89 " '■ 63 " " This inquiry has clearly demonstrated two things, viz. : that the majority of consumptives do belter, other things being equal, the 1 Transactions of the American Climatologlcal Association, 1887 . 138 MEDICAL CLIMATOLOGY. further they are removed from the sea, and that they do better in high than in low altitudes, wherever situated, the difference in pro- portionate improvement being here exhibited. Influence of Sanitarium Treatment on Phthisis. I have been much disappointed in my efforts to gather statistics of the results of treatment in sanitariums. The only reports I received in answer to my requests, which were in such form as to be available for fair comparison in a table, were those of Drs. Trudeau, Von RucIj, and Bosvditch. No statistics of Gorbersdorf and Falkenstein of recent date and giving the information required could be obtained, nor could I gather any statistics from the many other excellent sanita- riums now well scattered over the European continent and the few new ones recently established in America. In order to make a fair comparison of results obtained in cases treated in open or closed resorts — that is, between patients who resided in sanitariums under supervision, and those who lived in hotels, boarding-houses, or private dwellings without much supervision, where the surroundings were not especially adapted to their peculiar requirements, and their general life and personal conduct were not systematically controlled by a physician — it is necessary to consider briefly the various modifying factors. The quality of the cases is the first factor of importance. Dr. Hermann Weber, in replying to my request for assistance in ob- taining reports from European sanitariums, writes that in his opinion reports of such results are not satisfactory, because sanita- riums are largely a last resort for desperate cases, and it is most difficult to get incipient cases to enter them ; therefore, a fair com- parison with open resorts cannot be instituted. This objection would to a great extent be removed if the reports of results were grouped under the three stages of phthisis. In the cases entering the Adirondack and Sharon Sanitariums the conditions, according to the statements of the physicians in charge, are exactly the re- verse, the patients being picked out from a number of applicants as likely to recover. In the Adirondack Sanitarium, Dr. Trudeau writes me, patients are again examined after three months' residence and only those are retained who have shown an encouraging tendency toward recovery. In his published reports the patients who remained only three months, some of them leaving for pecuniary reasons or causes other than failing health, are classed as a separate group, but the results TREATMENT OF PHTSISIS BY CHANGE OF CLIMATE. 139 are not given under each stage. Thus the results at Saranac, in the first stage, as shown in my own tables, are limited to those cases which had passed the second weeding out, and are therefore perhaps abnormally high. The quality of the cases taken into the Asheville Sanitarium appears to be not so good as at Saranac and Sharon. Dr. Von Ruck recently wrote me concerning this, as follows : "My admis- sions are all more or less advanced cases, and we do not get more than about a dozen of an early stage in the course of the year. Now, if an institution can discriminate and admit nothing but favorable cases, that institution must necessarily get better percent- ages." Again, the conditions of life of the patients admitted to the Adir- ondack and the Sharon sanitariums are much improved by the change of circumstances, and this may further account for the particularly favorable results obtained. The patients are usually persons of narrow means, formerly engaged in a sedentary city-life, who, having been transported into the countryj are compelled to lead an outdoor life and enabled to enjoy comparative luxury under improved hy- gienic conditions. Tuberculin was used in a certain proportion of eases at Saranac, but not at Sharon, and the results are given separately (I have com- bined them in my tables). The percentage of improvement was slightly greater iu the cases treated with tuberculin. Dr. Trudeau writes me that he inclines to the opinion that, given the proper conditions, tuberculin is an aid in specially selected cases; but he believes that it is only of service where the patient could tolerate without fever a slight but gradual increase of dosage, and he used it in only such cases. He goes on to say: "You can see, how- ever, readily, that it may be just because these are insusceptible to tuberculin that their cases turn out well, and not because the tuberculin brings about in them an improvement in their disease or a more or less marked degree of immunity." Dr. Von Ruck used tuberculin on 36 out of 90 cases treated in his sanitarium at Asheville, and these cases, according to his report, did extraordinarily well, the benefit in all stages being 95 per cent., while in those not treated with tuberculin it was 65 per cent. He, also, does not give it to cases with fever, and in any case administers it only in cautiously increased doses. The greater improvement in bis tuberculin cases may therefore be due to the circumstance that 140 MEDICAL CLIMATOLOGY. the cases upon which it was used were of better material, as sug- gested by Dr. Trudeau with regard to his own cases. It is certain that when febrile cases are omitted the most unfavor- able element is eliminated ; and if those who do not tolerate tuber- culin are also removed, we have, in the tuberculiu cases, a highly selected class. Acting on this assumption, I have combined the cases treated with and without tuberculin. I am inclined to the opinion that the results were not materially changed by this moder- ate use of tuberculin, either for better or worse. The results at Sharon, while not so good as those in the Adiron- dacks or at Asheville, are probably better than any which could be obtained outside the sanitarium in the same climate. In the Sharon reports it is evidently the lack of elevation and the proximity to the sea that account for the slight deficiency, as my visit to this sanita- rium convinced me that the institution and the treatment were quite up to the best standard. In my inspection of both Sharon and Sarauac I was much struck with the admirable mauner in which the patients were made to live outdoors, and this doubtless helped to account for the good results obtained. Drs. Trudeau, Von Huck, and Bowditch all believe that they obtain better results, other things being equal, in the sanitarium than outside, though they have no figures for comparison. My personal experience in sanitarium treatment, while not sufficient to furnish statistics, confirms this opinion ; and I believe the great hindrance in all climates to getting better results is due to the mis- taken repugnance of most well-to-do patients to enter sanitariums, and the criminal apathy of the State in neglecting to furnish them for the poor, so that their use is extremely limited. The statements of Drs. Trudeau and Bowditch, then, may be said to show that in sanitariums which are designed for the use of the poorer class of consumptives, and in which the charges are less than the cost of maintenance or merely cover it, the patients are selected with a view to doing the most good by admitting, as far as possible, only curable cases ; therefore, the results of treatment are above the average attained under otherwise similar conditions. The statements of Drs. Von Ruck, Weber, and others show that sanitariums in which the charges are higher and a profit is made are resorted to by the desperate rather than the hopeful cases, and the results are not so good as in the purely benevolent institutions. My observations as to the influence of prudence upon the progress of TREATMENT OF PHTHISIS BY CHANGE OF CLIMATE. 141 phthisis, as detailed on page 123, corroborate these opinions of the value of sanitariums. If we contrast the results of treatment in these sanitariums with that in open resorts in both high and low altitudes, we see that the sanitarium results occupy an intermediate position, as shown in the appended table, except that the results in the first stage exceed those obtained in high altitudes. All stages. 1st stage. 2d and 3d stages. Lowland climates, 58 per cent. 71 per cent. 28 per cent. Sanitariums, 63 " " 95 " " 58 " " Highland climates, 76 " " 89 " " 63 ■' " The Stage of Phthisis as Influencing- Results. It will be observed, in looking at the first-stage column in the tables, that while the altitude results exceeded all others, except those of the sanitariums, yet the first-stage columns in all the reports were much better in proportion than those of the combined stages or of the second- and third-stage columns. This seems to indicate the correctness of the common opinion that the majority of incipient cases are benefited more or less by any climatic change as they usually are by any change of treatment. As to the relative permanency of the benefit, the evidence here produced shows nothing, nor was I able to secure sufficient reports of arrests and cures to make a fair comparison. In a sense it may be considered as unfortunate that first-stage cases are so easily improved, for these reasons. On dropping their pursuits and changing their environment, by taking rest and fresh air, and by cultivating better habits, their general constitution is very apt to improve and the local signs recede or remain in statu quo. As a consequence they, and often their physicians also, look lightly upon the attack, and the patients return prematurely to their former life, believing themselves cured. Accumulated evidence, however, both clinical and post mortem, proves how slow a process is the cure of a tuberculosis, at least of one that has given clear signs, either local or general, to the physician in charge. There are probably quite a number of persons who pass through a tuberculous infection with so little cough or other disturbance of the general health that they do not even come under the notice of a physician, and no phthisis follows, but local signs may be discovered later during life or after death. 142 MEDICAL CLIMATOLOGY. If a patient goes away, gains flesh, feels strong, loses his cough and other symptoms, and his local signs disappear or remain quiescent, it is very hard for the physician, even if he has sufficient wisdom to attempt it, to persuade the patient to change his life or remain longer away, and especially to go to a distant or unknown country. Thus the tide in the affairs of phthisis, which, taken at the flood, leads on to health, is lost, and the next catarrh or other accident starts up the smouldering tuberculosis, and from the lodgement it has already gained it advances with much increased activity. These second attacks are very frequently the beginning of that sad and tedious progress to the grave which is made by the health- seeker in various climates and under varying treatment. This progress, alternately chequered with hopeful improvement and de- pressing decline, is beyond the skill of the physician or the benign influence of climate. It is as impossible to arrest the disease as it is to avert its inevitable termination. There are incipient cases of phthisis for which a comparatively short and slight change of climate is all that is needed ; but these must be carefully selected, and after a return home they should be watched for several years, all their departures from health promptly attended to, and their daily hygiene raised to as high a standard as possible. In considering the length and character of climatic change for a consumptive, not only the arrest of the disease but also the perma- nent raising of the standard of the patient's health demands our attention iu order that recurrent attacks may be warded off. Diagnosis. "With reference to the question of the importance of an early recognition of phthisis and of constant watchfulness after the diagnosis has been made, I analyzed the last 100 first examinations I had made just previous to instituting the inquiry,' aud I found that in 52 per cent, of the cases diagnosis and treatment had been de- layed beyond the time when the symptoms were clearly developed, while in 48 per cent, the disease had been promptly recognized and treated. The total average of delay was two years. In those in whom the diagnosis was made and treatment begun in good season the proportion of first-stagers was 48 per cent., while in those in whom there had been delay and neglect the proportion of those in the first stage was only 29 per cent. The difference in the percent- 1 Neglect of the Early Diagnosis and Treatment of .Pulmonary Tuberculosis. S. E. Solly, M.D., in Medical News, February 4, 1893. TREATMENT OF PHTHISIS BY CHANGE OF CLIMATE. 143 age of cures between the first stage and the combined second and third stages, in the high altitudes to which these cases came, is as follows: first stage, 62 per cent.; second and third stages, 15 per cent. This negligence has very serious results. In fact, it means that out of every hundred consumptives who are allowed to drift into advanced disease only fifteen recover, instead of sixty-two, as would be the case if there was no neglect. Indications and Contraindications in the Climatic Treat- ment of Phthisis. If the foregoing pages have been studied, the general principles by which one should be guided in selecting a climate for a case of phthisis will be apparent; but as a change to a high altitude is most desirable for the majority of consumptives and most dangerous for those who are unsuited for it, it is best to review briefly the indications and contraindications for the use of high altitudes in phthisis. After studying these it is easy to deduce the approximate climate for those unsuited to high ground. They have been most admirably put by Dr. F. I. Knight, and, as he is without prejudice in the matter, and has also had a remarkably successful and large experience in the use of high altitudes for phthisis, I believe I cannot do better than give an epitome of his views •} " 1. He limits the age of those resorting to altitudes to fifty years. In temperament he prefers the phlegmatic to the nervous with an irritable heart, frequent pulse, and inability to resist cold; and with the latter, he says, we must be careful not to include those who show nervous irritability from disease, not temperament, as they are gen- erally benefited in high places. As regards disease, he first con- siders cases of early apical affection with little constitutional disturb- ance, and, although these generally do well under most conditions, yet considerable experience assures him that more recover in high altitudes than elsewhere. "2. Patients with more advanced disease, showing some consoli- dation, but no excavation nor any serious disturbance. When both the apices or much of one lung is involved, and the pulse and tem- perature are both commonly over 100, it is best to begin with a low altitude. "3. Hemorrhagic cases, early cases with haemoptysis and with- out much fever or much disease, are benefited by high altitudes. ^ Transactions of the American Climatological Association, 1888. 144 MEDICAL CLIMATOLOGY. 'i . ■4. Patients with advanced disease, those with cavities or severe hectic symptoms, should not be sent to high altitudes. A small, quiet cavity is not a contraindication ; hectic symptoms are contra- indications. "5. Patients in an acute condition should not be sent. " 6. Cases of fibroid phthisis are not suitable. " 7. Convalescents from pneumonia or pleurisy are usually well suited to elevated regions. " 8. Advanced cases of tubercular laryngitis, if good local treat- ment and freedom from dust can be obtained, may do no worse than elsewhere. " 9. In cases complicated by other diseases much care is needed. Cardiac dilatation precludes high altitudes ; so also does hyper- trophy for the most part, though with exceptions. A cardiac murmur resulting from a long-past attack of endocarditis with no signs of enlargement or deranged circulation should not prevent. Nervous derangements of the heart are usually contraindications. In renal disease and in chronic hepatitis the local physicians claim that benefit is often obtained. Intestinal ulceration does not bar out, but benefit is doubtful. Heredity to phthisis is no bar to high altitudes, but diabetes renders them objectionable. Syphilis is no contraindication, though in phthisis the combination always makes the prognosis bad." In the paper read by me before the American Climatological Asso- ciation, 1889, entitled " Invalids Suited for Colorado Springs," I expressed very similar views. In closing this chapter upon phthisis I will repeat some remarks I made in addressing the Arapahoe County Medical Association, December, 1892: It must especially be remembered that all sorts and conditions of men may become tuberculous, and you must study the individual and his circumstances as well as the type and stage of the disease before you can plan a rational and systematic scheme of treatment for him. All this enters particularly into the question of change of climate. The well-to-do, whose domestic ties permit it, are most safely advised to seek at once the climatic changes best suited to their case; and where such luxuries as have become necessities to them can be obtained, providing that they are or can be brought into a condition to stand the change. There are many, however, who, on account of their circumstances, cannot leave home, and should not be forced to do so unless home-treatment is not succeed- TREATMENT OF PHTHISIS BY CHANGE OF CLIMATE. 145 ing. Hereditary cases should always be sent away. In cases arising where the conditions of life, except the climatic, are good, the neces- sity for change is clearly indicated. Cases resulting from pneumonia, pleurisy, or bronchial catarrh, which is slow in clearing up, should also have change. In the hereditary the change must be permanent; in the second group it must often be so; there are a certain number of cases that have arisen under peculiarly unfavorable conditions of life, in which removal would be a hardship, and which, if they can be placed under good hygienic conditions at home, may often be safely left, at all events until the physician has gained a clear knowl- edge of the tendencies of the case. Those also in whom the tuber- culosis is not advanced or active, and whose depression of health appears to be due to digestion or other causes which can be equally well treated at home, may remain if they are carefully watched for a time. Often a change to a different house or soil or different surround- ings, physical or social, will start a patient on the road to recovery, if conjoined with other wise measures. The choice of climate must be made, not on the usual happy-go-lucky methods, nor from the results in a single case, but by studying the general principles of climatology and then obtaining reliable information concerning the particular resort that is likely to be suitable. Climatology (in which the profession as a whole is little learned) is not the pure empiricism that many think, but is a science founded on natural laws and strengthened by rational experience. 10 CHAPTER IX. FOEMS OF DISEASE OTHEE THAN PHTHISIS AS INFLUENCED BY CLIMATE. Tubercular Laryng-itis. The only reports which I could find of the influence of climate upon tubercular laryngitis are those of Dr. Robert Levy, of Den- ver, and my own, which deal with the effect of the Colorado climate upon this disease. Various opinions have been expressed on the subject, and most of them advocate a mild, equable climate and especially condemn high altitudes. Dr. Clinton Wagner, however, after some experience in Colorado Springs, wrote as follows: "I think that cases of laryngeal phthisis may safely be permitted to remain at high altitude resorts, provided improvement in the pul- monary trouble and general conditions has already taken place." ' Dr. Levy, from an extensive experience of several years as a laryngologist in Denver, reports upon seventy-two cases of tuber- cular laryngitis; thirty cases were reported to the Colorado State Medical Society^ and forty-two cases to the Pueblo County Medical Society, May, 1895.^ Both reports are extremely interesting and valuable. They did not admit of tabulation with my own, but the results show a close resemblance. His conclusions as here quoted are also very similar. "While agreeing with Heryng that climatic change cannot supplant local treatment, and advocating surgical procedure when possible and suitable, he says : ' ' Still, judging from these seventy-two cases and many others treated in hospital and dispensary of which records have not been kept, I cannot but believe that under proper treatment laryngeal improvement will go pari passu with that of the lungs." Feeling that the relative efEect of the treatment of tubercular laryngitis could only be estimated when the quality of the cases and their relation to lung-tuberculosis, which almost invariably accom- panies this sort of laryngeal disorder, are taken into consideration, I 1 Transactions of the New York Academy of Medicine, October 20, 1887. "- Transactions, 1891. s New Yorli Medical Journal, July 20, 1895. OTHER FORMS OF DISEASE INFLUENCED BY CLIMATE. 147 reported before the Pan-American Congress, 1893/ upon the cases of laryngeal tuberculosis occurring among 250 cases of phthisis treated by me in Colorado. Of these, 45 exhibited unmistakable tubercular laryngitis. 25 of the laryngeal cases showed clear signs of tuber- cular infiltration, \Yhich had not, however, proceeded to the stage of ulceration at the time of the first examination, though some of them did subsequently, while 20 cases had ulceration as well as infiltration when first seen. Average Duration. The average duration of the non-ulcerated cases, from the date of their first symptoms up to the present time or until death, was six years; while of 17 of these cases which im- proved and are living the average duration is thirteen years, and of the 8 which are worse or have died it was but three years and ten months. The total average duration of the 20 cases with ulceration was three years and two months. Of 5 cases which improved and are living the average duration was eight years and five months; while of the fatal and deteriorated cases it was two years. Of the dete- riorated cases, with and without ulceration, the average duration was two years and seven months. This is somewhat longer than the two-years' limit given by Bosworth. Non-laryngeal. 78 cured, 38 greatly improved, 30 improved, 59 worse. Laryngeal. Xon-ulcerated : 6 cured, 7 greatly improved, 4 im- proved, 3 worse, 5 died. Ulcerated: 2 cured, 2 greatly improved, 1 improved, 15 died. Total laryngeal: 8 cured, 9 greatly improved, 5 improved, 3 worse, 20 died. Grouping together the cured, the greatly improved, and the im- proved, under the head of ' 'improved," we find that of the 205 non- laryngeal cases 72 per cent, improved; but of the 45 laryngeal cases only 49 per cent, improved. The non-ulcerated cases, however, showed 68 per cent, and the ulcerated only 25 per cent, of improve- ment. Taking the condition of the throat, without regard to the ultimate fate of the patient, the results were much better, there being local permanent arrest of the disease in 64 per cent., beside 5 cases which healed temporarily. Among the non-ulcerated alone 68 per 1 Therapeutic Gazette, November 15, 1893. 148 MEDICAL CLIMATOLOGY. cent, showed a return to a normal appearance in the larynx, while among the ulcerated cases 50 per cent, healed permanently and 3 additional cases temporarily. With regard to the position of the ulceration, the results were : commissure, 33.3 per cent, improved; true chords, 30 per cent.; epiglottis, 17 per cent. ; while of the arytenoids and false chords none improved. To recapitulate, it may be said that of the whole number of cases, viz., 250, rather more than two out of three improved. Of the 45 which had laryngeal disease, one out of two improved. Of the 25 cases in which there was laryngeal tubercular in- iiltration without ulceration, rather more than two out of three improved; while of the twenty in whom there was laryngeal tuber- cular ulceration, only one in four improved; but of the 205 cases without laryngeal disease there was improvement in nearly three out of every four cases, the exact reverse of the laryngeal ulcerated cases. This shows, as was to be expected, that the laryngeal complication reduces the chance of improvement, and, when it has proceeded to the stage of ulceration, does so to the extent of three to one. But even so, according to the opinions expressed by laryngologists practising in low altitudes, these are far better results than have usually been obtained, and show, I believe, that similar effects, beneficial, retard- ing, and often curative, which have been demonstrated in pulmo- nary tuberculosis treated in Colorado and other high altitudes, are exhibited in laryngeal tuberculosis. It is, of course, to be expected that the results are not actually so good as in cases of simple pulmonary tuberculosis, though relatively they are so, because in all these cases — and I have never seen a laryn- geal tuberculosis without an accompanying pulmonary tuberculosis — there was the double disease and therefore the double burden to bear. Moreover, it is hardly to be doubted that these laryngeal compli- cations almost always indicate a tendency to a free dissemination of tubercle and generally an absence of any self-limiting features. There are undoubtedly some cases in which the laryngeal tubercu- losis is derived from an inoculation caused by the lodging of the sputum upon the abraded laryngeal membrane; but clinical obser- vation leads me to believe that in the great majority of cases the infection starts from within and not from without. OTHER FORMS OF DISEASE INFLUENCED BY CLIMATE. 149 Taking the results upon the laryngeal disease alone, irrespective of the ultimate recovery or deterioration of the patient on account of the accompanying lung-disease, we find that in 64.2 per cent, there was arrest; and if we consider also the five in whom there was temporary healing, which broiie down again under the strain of the last weeks of fatal pulmonary suppuration, we see that the percentage of improvement in the local laryngeal symptoms is'not very far short of that in the simple pulmonary cases. "While I believe that, generally speaking, high altitudes are really beneficial to tubercular laryngitis (contrary to an impression once commonly received that, as regards that disease, they were positively injurious), it is nevertheless true that no such results as I report could be reached, in the majority of cases, without careful local treatment. " This remark especially applies to those cases which show ulceration. As Bosworth truly writes, after advocating topical measures, "in no ulcerative process, probably, are we able to detect in a less degree any reparatory effort on the part of nature than in tubercular ulceration, and yet instances of spon- taneous cicatrization have been reported by Bouveret, Yirchow, Jarvis, and others." In conclusion, it may be said that the foregoing facts indicate that while tubercular laryngitis is always a grave complication, at an altitude as elsewliere, and that when advanced it is almost inva- riably fatal, yet in the earlier and medium cases high altitudes, with appropriate treatment, afford relatively, though not actually, as good a chance for arrest or delay in laryngeal as in pulmonary tuberculosis. With respect to the influence of low altitudes, I be- lieve that where most relief is afforded to the accompanying pul- monary tuberculosis the lesions are most likely to heal under appro- priate treatment. Tuberculoses other than those of the Respiratory Tract. My experience leads me to believe that the question of climatic change for all other forms of tuberculous disease must be answered upon the same grounds as that of change for pulmonary tuberculosis. There are, however, certain modifications to this statement which will be discussed under the head of Scrofulosis. Scrofulosis is a diathesis which renders its victims peculiarly liable to tuberculosis and induces chronicity of inflammatory pro- 150 MEDICAL CLIMATOLOGY. cesses and inflammation of the adjacent glands. It tends to produce hyperplasia and caseation of the lymphatic glands. The object in the treatment of a scrofulous person, whether child or adult, is to increase the vital resistance, especially to bacillary invasion and con- sequent tuberculosis. The open lymph-spaces and feeble vitality allow the bacilli to spread readily through the body, and where hyperplasia or caseation has occurred a peculiarly congenial soil is presented for the development of tuberculosis. Some years ago, during my visits to the Infirmary for Scrofula, at Margate, England, a resort possessing a beach with a good sand and gravel soil and endowed with a mild, sunny climate, I was much struck by the remarkable improvement in scrofulous children, particularly in those cases where the disease had attacked the bones. Later experience has confirmed me in the opinion tliat a warm seaside-resort, where much outdoor life and sea-bathing can be ob- tained, is the best for counteracting the scrofulous habit and early tuberculosis ; but when the tuberculosis is advancing an elevated climate is generally more beneficial. Sea-bathing. With regard to its benefits for the scrofulous. Dr. D'Espine' writes that of 308 children, from four and one-half to fifteen years old, who were sent to the Mediterranean coast of France because of various scrofulous affections, 48 cases were cured, 215 improved, 44 were unimproved, and 1 died. They each had about forty-five sea-baths during a stay of six weeks. Jacobi and Casse and many French authorities are favorable to sea-bathing. Treves thinks the effects are chiefly mental. Dr. Walter Chrystie^ writes as follows : " The writer is convinced that salt-baths stimulate nutrition, and is in the habit of directing scrofulous persons to add a small amount of sea-salt to the bath once or twice a week." Sea- and Mountain-air. With reference to climate, Dr. Chrystie goes on to say : " The efficacy of sea-air in eradicating the scrofu- lous diathesis and its manifestations is admitted by all writers, and is especially dwelt upon by Deliguy, who made a large number of observations upon scrofulous children treated in L'Hopital de Berck on the coast of France. Frederick Treves also writes that the records of the INIargate Infirmary for Scrofula support the fact that sea-air possesses a curative influence upon scrofula by show- ing a large number of cures and a still larger number of cases of ' Revue m«d. de la Suisse Eomande, September, 188S. - Hall's System of Therapeutics, vol. 1. p. 930. OTHER FORMS OF DISEASE INFLUENCED BY CLIMATE. 151 marked improvement. But he adds that ' the greatest advantage is observed in instances of acquired struma, in cases where the disease has developed in the purlieus of a great town, and in those patients, in fact, to whom sea-breezes and outdoor exercises offer the most striking possible contrast to their previous surroundings.' " Cases will occasionally be met with which do not improve in a coast climate or which improve exceedingly slowly, notwithstanding the utmost care in the selection of diet. Such cases will often im- prove rapidly if removed to a dry, moderately elevated, mountainous region. It is extremely difficult and often impossible to determine which climate will be the most beneficial in a given case. Treves thinks that the cases which do not improve at the seaside are usually those with a "phthisical tendency," also many cases of eczema, some cases of strumous ophthalmia, and a few cases of lupus. The author's experience has been that cases in which there is marked anaemia, muscular debility, or exhaustion from the presence of complications, such as glandular suppuration, bone-disease, etc. — in other words, cases with well-marked tubercular disease, excluding pulmonary phthisis — usually improve more rapidly in sea-air, and that cases with the scrofulous diathesis alone are better in mountain-air. Many cases gain in weight and appearance in a coast climate for a few months, and then come to a standstill or even retrograde. Under such circumstances a removal inland is usually followed by renewed improvement. Indeed, in some cases frequent change of climatic surrouudings is necessary in order that the improvement may be continuous, and, in all cases, a week or two at the seashore can do no harm if it be preparatory to a more prolonged sojourn in ■a mountain climate. Affections of the Respiratory Tract other than Phthisis. Croupous Pneumonia. In this affection the use of climate has only to be considered during the stage of convalescence. Resolu- tion of the pneumonia and a return to health are frequently assured, and generally hastened by change of air. The climates most convenient to the place in which the sickness has occurred and which afford the most opportunities for the invalid to rest in the open air without danger of catching cold, are usually the best. A warm seashore, or a dry, sunny, inland spot with a sandy soil, is generally the most suitable choice for the early days 152 MEDICAL CLIMATOLOGY. of convalescence, and when strength has been sufficiently regained to allow of taking exercise it is wise to seek the more bracing air of the uplands to complete the cure. When, in spite of these mod- erate changes, resolution is delayed or tuberculosis supervenes, the high altitudes should be resorted to, as there the anaemia, which is the most common cause of delay in recovery, is most quickly and surely combated/ On the other hand, if the disease has occurred on high ground, a change to a lower climate is indicated. In deciding the question of sending a patient with an unresolved pneumonia to elevated ground the condition of the heart and breathing should be carefully considered, the heart being examinfed not only during rest, but after exercise, and especially after climbing stairs. A moderate degree of weakuess can be taken care of in those under thirty-five years of age, proper precautions concerning exercise being taken. For those who are older it is wisest to select elevations under 3000 feet until experience shows that the patient may safely be advanced to higher ground. In all cases the amount of unused lung of course enters into the problem, obstruction in the left lung being more detrimental than the same amount in the right. If the lungs are seriously involved or the heart manifestly weak, it is always best for the patient to go to bed immediately on arriving and to send for his physician before taking any exercise. The late Dr. A. L. Loomis dwelt upon the injurious effects to the heart in certain cases sent to the Adiroadacks at an elevation of 1600 feet, and in Colorado Springs (6000 feet) I have seen such serious injury result to patients whose hearts had been considered normal, from their walking, on first arrival, a few hundred yards up a slight incline from the station, as to make it necessary to send them back in a short time to sea-level. However, when the cases are wisely selected and properly warned as to exertion there is little risk, and the results, in cases of retarded pneumonia, whether simple or tuberculous, are generally much more brilliant in high altitudes than elsewhere. Catarrhal Pneumonia. Convalescents from this affection are often given moderate change of air with benefit at an earlier stage than the croupous cases. In these, as a rule, warmer and more 1 In selecting a bigh climate, it must be remembered that the drier atmosphere is generally the better, and, if the invalid has progressed to the point of taking exercise, and evinces fair powers of reaction, the climate chosen should also be moderately cool on account of the greater tonic effect. OTHER FORMS OF DISEASE INFLUENCED SY CLIMATE. 153 equable climates of moderate elevation are best. Those cases in which the tendency to fever and irritability of the membranes is slight are better suited to higher and drier ground, even though the climate is neither so warm nor so equable as that lower down ; while for those with the contrary tendencies the sea or a slight elevation, such as is to be found on an upland or hillside, or a moorland, is better than such an altitude as that of a mountain or high plateau. When the patient is also tuberculous higher ground can more often be sought with benefit than in cases of simple ca- tarrhal pneumonia, the other considerations referred to being allowed due weight. Pleurisy. When the convalescent stage is reached, the fluid having been absorbed or removed by tapping, it sometimes happens that recovery is unduly delayed owing to anaemia or to a bound- down lung, or both, and that a moderate chauge of air is not suffi- cient to complete the cure. In such cases a visit to the higher altitudes is nearly always the most effective and speedy remedy; but here, again, the condition of the heart, especially if that organ is displaced, must be as carefully considered as in a case of pneu- monia. If the patient goes to an altitude, the direction of his exer- cise must at once be intrusted to a physician. Empyema. Cases of delayed recovery do remarkably well on high -ground, as they do also on a warm, sheltered seashore. The climate to which the patient is sent should be, as far as is possible, a contrast to the one in which the disease arose ; and each case, whether tuberculous or simple, must be decided with a proper con- sideration of the same principles referred to as being applicable to pneumonia. Bronchitis, unless tuberculous — and a majority of the cases of chronic bronchitis become so — is usually soonest cured in a dry, warm, inland clitnateof very moderate elevation where there is little wind. Asthma, which is generally either bronchial or nasal (hay-fever), and at times both, may be defined as a spasm of the bronchial tubes, which has a predisposing, a determining, and an exciting cause. The predisposing cause is a peculiar neurotic habit. The determin- ing cause is some disorder or disease of the respiratory tract which can generally be classed as bronchial or nasal. The exciting causes 154 MEDICAL CLIMATOLOGY. are very numerous, and are either intrinsic or extrinsic. The in- trinsic cause may be an ordinary catarrh or inflammation of some portion of the respiratory tract, or indeed of any other portion of the body, or organic disease, such as that of the heart, indepen- dently of true cardiac dyspnoea; or it may be simply a derangement of function, as in dyspepsia, or a nerve-storm, or other disturbance, physical or mental. The extrinsic causes are also various, being generally, for bronchial asthma, changes in atmospheric conditions, and, for nasal, the inhalation of the pollen of a particular plant, or of dust, or of some animal exhalation. Bronchial Asthma. In selecting a climate for an asthmatic it must be determined which of the causes it is most important to remove, as one climate excels auother in its influence over one or more of these causes. It is impossible, in actual practice, to separate these causes and to treat each in its appropriate climate; but it will perhaps be well to try to explain why so many different climates and conditions are good for asthmatics, and to assist in making the best possible compromise when a climate is finally chosen, thus causing the selection to be less empirical and experimental than it usually is. We must presume, in the first place, that the physician or surgeon has done all that lies in his power to remove or modify one or more of the three causes. Let us suppose that the neurosis is the cause to be especially remedied; the climate must then be chosen for its quality of sedation or stimulation. If the hypersesthesia is appar- ently innate in the individual and customary to him, and is not brought about, or largely aggravated, by anaemia or some other depressing cause, a sedative climate is generally most beneficial, because it modifies the neurotic habit. Further, as the catarrh or chronic inflammation of the respiratory tract is, in what is termed a born neurotic, usually of the irritable or inflammatory type, a climate of a sedative character, in which the air is warm, humid, and equable, would be the most beneficial ; but the climate selected should also possess tonic qualities in proportion as the respiratory condition permits a lessening of this warmth and humidity and consequently of climatic equability. If there is chronic anaemia, a stimulating climate, cooler, drier, and more vai-iable, would be pre- ferable. The one meteorological element, however, which has the most marked effect upon the neurosis of asthma is barometric pressure, either markedly inureased or decidedly decreased. Both conditions OTHER FORMS OF DISEASE INFLUENCED BY CLIMATE. 155 are of the greatest benefit, as is shown by laboratory experiments and also by the actual experience of asthmatics in depressed parts of the earth's surface, such as the valley of the Dead Sea and the sink of California; and at great elevations, such as the high plateaus of the Alps, the Eockies, and the Andes. With regard to the use of increased barometric pressure, while its effects at the time are striking, they are seldom lasting, because, if it be used in the laboratory, its application is necessarily intermittent, and a residence in depressed climates is almost unendurable from heat during the summer and is monotonous and depressing at all times. On the other hand, life at an altitude is pleasant and can be continued without interruption. It is possible to vary the locality, and in many places the pursuit of business or amusement may be carried on profitably and agreeably. The height, latitude, and exposure of the elevated region can be selected in accordance with the tempera- ture, humidity, and variability best suited to the particular con- dition of the respiratory. tract, and a locality which is free from the pollen, dust, or animal exhalation peculiarly obnoxious to the in- dividual asthmatic may be more readily found. I believe it may be said that, other things being equal, an altitude is best for the cure of the neurosis ; but if, for special reasons, the diminished baro- metric pressure is unsuitable, the next best climate for the neurotic habit is in a sink. In deciding upon a climate with a special view to the cure of the determining cause — that is, the disorder of the respiratory tract — the choice must be made according to the principles dwelt upon in discussing pneumonia, bronchitis, etc., and a sedative or stimu- lating climate selected accordingly. If, however, the exciting cause appears to be the most important, that must be especially considered. For instance, in a cardiac case the elevation of the resort is the prime factor ; but in the case of a dyspeptic the ability to obtain appropriate food is an absolute essential. If, again, the exciting cause be pollen, dust, or animal exhalations, pure air must be sought, and this will be found, first, on the ocean, and next on the mountain-side or desert-plain. Cases of chronic bronchitis without marked emphysema and with a heart in which permanent dilatation or other lesion is not ajopar- ent, are usually most benefited by a change to high ground. Before sending to a high altitude any cases in which the condition of the heart is questionable, it is well to try the effect of a moderate eleva- 156 MEDICAL CLIMATOLOGY. tion, such as is found between 1000 and 2500 feet, where the air and soil are fairly dry and the skies sunny. A.S is well known, an adult asthmatic is rarely permanently cured ; but, to modify Sydney Smith's remark about a Scotchman, " Much can be done with an asthmatic if he is caught young." It is in youthful asthmatics that I have seen nearly all of the compara- tively few permanent cures, and among these the use of high alti- tudes had been the most successful element. This is probably due to the breaking up of the neurotic habit and to the cure of the ansemia generally present in young asthmatics. Dr. Denison, of Denver, reported^ 52 cases of asthma treated in Colorado, of which 72.5 per cent, were more or less improved. Of those that got worse or remained stationary all but one had em- physema. This agrees with the experience of my colleagues and myself. Hay -fever {Nasal Asthma). With respect to this form of asthma, I may say, without entering into a full discussion of its causes, that my observations in Colorado have convinced me that vegetation, in some form or other, is the most frequent exciting cause, although we know that in a few cases certain animal exhalations and inorganic dusts play the most important part. The particular kind of vege- table growth, the pollen or dust of which excites an attack of hay- fever, is different for different individuals. While it is probably true that a larger number of eases of hay -fever are benefited by a change to a high altitude, such as the Alps or Colorado, than to lower climates, yet many cases at altitudes have to shift their ground at certain flowering-seasons, and the relief thus afforded is probably due to the amelioration of the neurosis by diminished pressure, to the general purity of the air, and to the comparative sparseness of vegetation. Geographical Distribution. The following reinarks concerning the geographical distribution of hay-asthma are well worthy of attention : "One thing that markedly distinguishes hay-fever from other catarrhal maladies of similar nature is its geographical relations. It does not exist over the whole of the United States or of Great Britain, yet it would be a difficult task to define its exact limits. Numerous portions of England are immune, especially the high- land and seacoast, and all or nearly all of Wales and Scotland. 1 Transactions of the American Climatological Association, 1890. OTHER FOBMS OP DISEASE INFLUENCED BY CLIMATE. 157 In America it obtains to the north of Lake Ontario in a limited degree, but not on the upper side of the St. Lawrence; scarcely at all in the provin'ce of Ontario north of the "Welland Canal until the Detroit River is reached, and it is wholly unknown to regions above the outlet of Lake Huron. In Michigan, however, it follows Lake Huron to above Saginaw Bay, finding victims even at Alpena, though residents of Buffalo, Cleveland, Detroit, and Cincinnati are here usually immune. On Lake Michigan its effects are lost above Ludington, while over the Mississippi, in Wisconsin, it is felt as far north as the junction of the Chippewa, and in some seasons extends in a mild form to St. Paul, Minn. To the south it extends to the latitude of Memphis in the west, Knoxville in the central area, and Cape Henry on the Atlantic. In all this area there are immune districts at high altitudes, such as the Green, White, Adirondack, Allegheny, and Catskill Mountains, and the southern New York region. Isolated spots where the malady prevails are found about Galveston, Texas; St. Augustine, Florida; Mont- gomery, Alabama; and Milledgeville, Georgia. Beyond the Mis- sissippi evidence and data are almost wholly lacking; but several persons have suffered at Denver, Colorado Springs, and Golden City, though denizens of cis-Mississippi regions here find relief."^ Where the attacks are chiefly dependent on vegetation the surest remedy^ is naturally a sea- voyage; but if the noxious plant be known, the flora of the proposed resort should be studied before changing a land climate.^ Where the chronic catarrhal condition is prominent as a cause and cannot be removed by treatment, the climate, with respect to its humidity and temperature, must be selected as the experience of the individual or a general inference dictates. Nasal and Pharyngeal Catarrhs. The surgeon, on the one hand, and the physician, on the other, have so narrowed the field of treatment by climate of these affections that there is very little to be said specifically. Change of air is often of benefit, especially as a supplement to surgical or medical treatment; but its selection must depend upon the general or local condition of the patient, one being usually of greater importance than the other. 1 Medical Age, Detroit, 1896. = Ibid., September 10, 1896. ' It has been noticed in Colorado Springs and Denver that, when the weeds are allowed to grow freely, cases of hay-fever are less often reUeved, and perhaps the greater amount of watering done in cities has an influence. 158 MEDICAL CLIMATOLOGY. For instance, a stimulating air may be best for the general health, while the mucous membrane may be more benefited by a sedative climate. Nasal and pharyngeal catarrhs are coinmbn in all climates where there is much variability, whether they be warm or cool, moist or dry, high or low, and the greatest benefit is usually derived from the climate which is in sharpest contrast to that in which the catarrh was contracted. Chronic Laryngitis. When this affection is not entirely amenable to suitable treat- ment at home it is usually benefited by a change of air opposed in character to that in which the condition first arose, and the question has to be considered on the same principles as those referred to con- cerning nasal and pharyngeal catarrhs. Tubercular laryngitis is discussed in the chapter on Phthisis. Diseases of the Heart and Great Vessels. We can all remember the time when a patient who was pro- nounced to have heart-disease was warned to avoid all exercise, and was hardly considered to be fulfilling his natural destiny unless he died suddenly. Fortunately, the study and treatment of the under- lying causes of heart-lesions or irregularities have done much to prolong the life of patients and have led to more frequent cures. There are two points of view from which change of climate for a heart-case must chiefiy be looked at : the first is the general con- dition and tendencies of the patient; the second, the mechanical condition of the lieart or pump. In the heart the strength and resiliency of the cardiac muscle are of the greatest importance, and the quality of the climate and the amount of exercise allowed should be determined by these conditions rather than by the nature of the valvular lesion. The diagnosis can often be aided by experi- menting cautiously with different exercises before leaving home. Cardiac cases are often slightly affected by a moderate change of air even when this is unaccompanied by an increase in elevation, and they are generally very much affected when climatic change and increase in altitude are united. It is therefore of the utmost im- portance that, after the resort has been selected with due care and the journey properly planned, the patient should be advised, from the first hour of his arrival, by a local physician especially as to his exercise, habits, and diet. OTHER FORMS OF DISEASE INFLUENGED BY CLIMATE. 169 When a heart-case is to be sent to an elevated resort the tem- perament of the patient enters into the question ; for, if he be heed- less and likely to neglect the advice of his physician, he is certainly safer on low ground. Again, if the patient be of the erethic type, he is apt to have an irritable heart, in which case a sedative climate is more suitable. The age of the patient has much to do in the selection of a climate. In the young, moderate dilatation, a frequent accompaniment of phthisis, does not prevent a patient's being sent to an altitude if it is otherwise expedient ; for, when great care is exercised or absolute rest prescribed for the first month, such cases generally recover more quickly and completely than at sea-level. On the other hand, when the dilatation is well marked or if the invalid is approaching middle- life, a high altitude is dangerous. Hypertrophy generally, though not necessarily, contraindicates a change; but this depends upon its extent and duration and the attendant circumstances. Any disease or irregularity of the heart or great vessels in elderly per- sons, particularly if there are indications of atheroma, should be treated at sea-level and in a sedative, warm, equable climate. Cases of aneurism in the aged or in prematurely old persons should be treated in the same way; but I have observed in Colo- rado that most patients suffering from aneurism enjoy a greater sense of well-being and apparently improve more than when living at sea-level. Several cases now residing in Colorado have remained in a stationary condition far longer than I expected. The observa- tions of Weber and other clinicians, and particularly those of Arch- ibald Smith in the Andes, agree with this opinion.^ In choosing a climate for a case of cardiac or vascular disease it has first to be determined whether it is reasonable to expect cure or arrest, or only palliation. In the first case the more tonic and stimulating climates may be cautiously tried, beginning with the bracing air of a seashore-resort and advancing, first, to a dry, desert climate like Egypt, then to a slight altitude, and then to a high one through the intermediate climates, and choosing from these accord- ing to the degree of stimulation thought to be safe or found by experience to be so. On the other hand, when the disease is of such a character as to make it unwise to attempt to level up the patient's health and to 1 The physiological causes for this are dwelt upon on page 114. 160 MEDICAL CLIMATOLOGY. put extra work upon the peccant organ, levelling down must be carried out and the ship of life made to sail on an even keel. Again, in choosing a climate for cardiac and vascular cases, not only does the condition of the kidneys, skin, and lungs demand the gravest consideration, but also the effect of the proposed change upon them. If there be one organ which, more than another, requires the most careful scrutiny before an invalid is sent from home to any positive climate whatever, it is the heart, and this scru- tiny must iDe something more than auscultation while the patient is calmly sitting in a chair. Some attempt must be made to reproduce temporarily the climatic conditions to which it is proposed to subject him. The examination of the kidneys is next in importance to that of the heart, and is a necessary adjunct of it. Both of these inquiries are too frequently neglected, or are at most passed over in a perfunc- tory manner, often to the injury of the patient and the discomfiture of the health-resort physician. Again, in choosing a resort for a heart-case the effect of the climate upon the liver requires some thought, for it is well known that through the portal circulation the hepatic functions influence the cardiac very markedly in some cases. As a change to a high altitude is the most extreme that can be made for these cases, I will quote from the opinions expressed by two of the leading authorities — Dr. Hermann Weber, of London, and Dr. Frederick I. Knight, of Boston. Dr. AYeber^ writes: " The diseases which are unfavorably influ- enced include most cases of organic disease of the heart and vessels, though a heart moderately enlarged, with a weak muscle, even with a bruit, is often improved, and generally much more so than on the coast. Even cases of aneurism are often relieved. Atheroma and senile affections generally contraindicate a high climate." Dr. Knight, after prefacing his statements by saying that he refers particularly to altitudes from about four to six thousand feet, writes thus: "1. Cases of valvular disease with sufficient cardiac enlargement or derangement of the circulation to make the diagnosis certain. While a great difference in risk in such cases must be admitted, dependent upon the compensation, the age of the patient, etc., it is safer to forbid the change to such patients, for we know that in 1 Ziemssen's Handbook of Therapeutics. OTHER FOBMS OF DISEASE INFLUENCED BY CLIMATE. Igl aay case, even at sea-level, compensation, for some unknown and unexpected reason, may suddenly cease, and of course this may be precipitated by such a change of pressure as would be experienced by a change in altitude of five thousand feet. I say this, knowing that Dr. Solly and others have had young cardiac patients with good compensation who have been not only uninjured, but invigorated and improved by residence in Colorado. " 2. Cases of chronic myocarditis or fatty degeneration. These should be rigidly excluded, and these are the cases about which more care should be exercised. They are the cases among which there is such sudden fatality, caused apparently by slight variations from a dull routine of life. A sudden change of conditions under which the heart is laboring stops it altogether. This change may be one of atmos- pheric pressure, a change of nerve-influence, a sudden excitement of joy or grief, a fall, a shock of any kind, mental or physical. There may or may not have been symptoms calling attention to the heart, or the symptoms may have been wrongly interpreted — as, e.g., calling an attack of angiua pectoris ' gastralgia.' Many cases have been declared sound on superficial examination chiefly because no cardiac murmur was discovered, when a more careful examination would have re- sulted in the probable diagnosis of one of the above-mentioned con- ditions. A careful examination should be made of the area of car- diac dulness. It will often be found enlarged in cases of chronic myocarditis. The character of the first sound at the apex should be carefully studied. A very valvular first sound, an almost entire loss of the booming or muscular quality, with a weak and irregular pulse in a man no longer young, especially in connection with any subjective symptoms, points to myocarditis or fatty degeneration. Breathlessness on slight exertion and a feeble, irregular pulse are strong confirmatory signs. It is much more important to keep this kind of a case out of high altitudes than those of valvular disease. A person over fifty years of age with marked cardiac symptoms or any of the signs mentioned al)ove must not be allowed to make the change. " 3. Cases which present a murmur anywhere in the cardiac area, but who have never had any symptoms, and who on physical exami- nation show no further evidence of disease. The murmur is fast losing the undue importance which was attached to it for many years, and is falling into its proper place as only one link in a chain of evi- dence. Even life-insurance companies accept some applicants with 11 162 MEDICAL CLIMATOLOGY. cardiac murmurs. Patients with systolic murmurs which are known to have existed for many years without any enlargement of the heart or any alterations of its normal sounds may be allowed to go into high altitudes. Patients with murmurs in diastole must be advised much more cautiously, as these murmurs are more surely indicative of serious organic disease. " 4. Cases of nervous palpitation. Patients with functional pal- pitation cannot be considered in one class. In many such palpita- tion is quite temporary, due to errors in diet or mode of life, which can be easily set right. When these errors have been corrected, of course there can be no objection to the patient's going to a high alti- tude. Affections of this kind, due directly to some morbid condi- tion of the nervous centres, may be divided, as by Eskridge, into two classes — that of patients who have inherent nervous temperaments and that of those who are nervous from malnutrition. The latter, as is pretty generally conceded, are likely to be improved, and conse- quently the trial of a high altitude may be recommended to them ; but the former, those of inherent nervous temperament, are usually made worse by it, and consequently should be forbidden the high altitude." I will close this subject with some remarks of my own.' The de- cided eifect of a high altitude in exciting and disturbing the action of the heart in sensitive persons, even without disease, is shown by many who, after living comfortably for several years at Colorado Springs (elevation, 6000 feet), ascend to the summit of Pike's Peak, 8000 feet higher. These persons, while there, except for a feeling of light-headedness, are all right so long as they do not attempt to walk, but even a few steps will sometimes bring on rapid and often irreg- ular beating of the heart, generally slight headache, often nausea and diarrhoea, and in some slight precordial pain; the headache and pain over the heart often persist more or less for twenty-four hours after the descent to lower ground. Nervous Disorders. Organic disease, when progressive, requires a sedative climate at or near sea-level, with a humid air and a moderate rainfall, where warmth and equability are present. When the disease is stationary, mildly stimulating climates may be cautiously used, and in some exceptional cases even the high altitudes. I have, for instance seen » Article upon Climate in Hare's System of Therapeutics. OTHER FORMS OF DISEASE INFLUENCED BY CLIMATE. 163 improvement in some stationary cases of progressive locomotor ataxia, brought into Colorado, and also in certain cases of other chronic paralyses. It is always risky to send cases with well-marked organic lesions to high ground, particularly where the patient is of full habit or inclined to inflammatory or irritable nervous conditions. It is only when the destructive processes are arrested that an accom- panying anaemia can sometimes be best treated at an altitude; as a rule, however, such cases do better during summer months at eleva- tions of from 1000 to 2500 feet. Meningitis is especially unsuited to treatment in high climates, and even a seacoast air is apt to be too stimulating. I find in medical literature very few references to the influence of climate upon nervous diseases, and these are of the most general character. Dr. J. T. Eskridge, of Denver, from the standpoint of a neurologist enjoying the opportunities of a large practice of several years in Colorado, wrote a valuable and conservative paper^ which throws much light upon the influence of a high altitude in nervous disorders, and indirectly explains by inference the effects of lower climates. I will therefore give the gist of some of his remarks: According to Eskridge, numerous careful observations which he has takeu of the temperature of the surface of the body, and espe- cially of the head, show that the surface-temperature averages half a degree higher than at sea-level. Insomnia. A larger percentage of overworked people, Eskridge states, sleep better in mountain climates than near the sea. The cases which do best at high altitudes are those who sleep well from the time of their arrival, and they are the majority. But there is truth in the popular belief that the influence of the Colorado climate ceases to be effective in this respect after a few years of continued residence, especially if tiie individual be either too little occupied or overworked. A change to sea-level for a short time results in re- newed improvement on returning. Eskridge also states that stimulants usually produce their eilects more readily, and with this I agree ; but I believe he should have added that when the vitality is depressed, and alcohol is suitable, larger amounts are needed and can be safely taken. Patients with active hypersemia of the brain, with insomnia or sleeplessness from organic brain-changes, do badly, whereas those with passive hypersemia are benefited. 1 Transactions of the American Climatological Association, 1891. 164 MEDICAL CLIMATOLOGY. Inherent nervous irritability is increased, especially in women. Hysteria is apparently as frequent and severe as at sea-level. Chorea, Eskridge believes, yields as readily to treatment in Colorado as elsewhere. The movements ou first arriving are per- haps exaggerated; he is uncertain about their frequency. My own belief is that they are less frequent. Neuralg-ia, he states, is, on the whole, less frequent because of the absence of malaria. I think, however, that the pain is more severe in proportion to the conditions. Migraine. The first effect of a high altitude upon this disorder is benericial; but it frequently returns, in which case a change to lower ground is advisable. Epilepsy. Eskridge refers to 21 cases, 5 of which originated in Colorado ; 16 were improved. Treatment seemed to have about the same effect as at sea-level. In all he noticed some improvement, on first coming, if they kept quiet. The writer has seen several epileptics very much improved in Colorado, and a few apparently recovered who were doing badly before they came; others have be- come worse. My impression is that where there is no local condi- tion beyond the reach of climatic treatment, and the case is one for which an elevated climate is otherwise suited, the strong tonic and alterative qualities of altitude are often of the greatest service. Possibly one leason of improvenjent is the fact that epileptics are better able to take bromides with less depression. Insanity. He says that the opportunities for observation have not been sufficient to form an opinion as to whether Colorado is generally beneficial or otherwise. Acute mania is apparently aggra- vated by the climate, and he has known such cases benefited by being seut to sea-level. Insanity originating in Colorado is more apt to be of the depressive than of the expansive type. In a recent conversation he said that he found from his own experience and that of other practitioners in Colorado that the proportion of melancholia to mania is about three to one, while Spitzka and other writers state that elsewhere it is about equal. Inflammatory Lesions of the Brain and Cord. So far he could not say whether there was any difference or not. Infantile paralysis is rare. Meningitis, tubercular and non-tubercular, is also rare, the latter in proportion to the number of tuberculous persons. Chronic degenerative conditions of the cord are perhaps in- directly improved. OTHER FORMS OF DISEASE INFLUENCED BY CLIMATE. 165 Chronic degeneration of the brain is quite as frequent in old- time settlers as it is in Wall Street men, and is in both cases prob- ably due to the exciting lives led by them, to which, in the case of the Colorado men, was added much physical hardship. This explanation is reasonable, as their wives, who are under the same climatic influence, rarely develop such diseases. Autopsies reveal arteritis as the usual cause, and this was several times found asso- ciated with slight chronic meningitis. Apoplexy, while apparently not frequent, is certainly more likely to occur when the vessels have been previously weak. Sunstroke, Esk ridge states, is practically absent. This agrees with my own observation, and I found the same thing true in Egypt, at least south of the Delta. I conclude that this immunity is due to the dryness of the atmosphere in both climates, which favors evaporation and gives relief to vascular congestion. Leaving these interesting observations concerning altitude and nervous diseases, we will take up the subject of neurasthenia at greater length, as this nervous disorder oftenest demands climatic change and is most frequently benefited by it. Neurasthenia. The definition and etiology of this affection, so clearly and concisely given by Osier, are as follows : ^'Definition. A condition of weakness or exhaustion of the nervous system. The term, invented by Beard, covers an ill-defined, motley group of symptoms, which may be either general and the expression of derangement of the entire system, or local — that is, limited to certain organs. Hence the terms cerebral, spinal, cardiac, and gastric neuras- thenia. In certain respects it is the physical counterpart of insanity. As the essential feature in the latter condition is the abnormal response to stimuli, from within or without, upon the higher centres presiding over the mind, so neurasthenia appears to be the expression of a morbid, unhealthy reaction to stimuli acting on the nervous centres which preside over the functions of organic life. No hard-and-fast line can be drawn between neurasthenia and certain mental states, particularly hysteria and hypochondria. "Etiology. Although the causes are apparently varied, they may be classified as hereditary and acquired. " (a) Hereditary neurasthenia. We do not all start in life with the same amount of nerve-capital. Parents who have been the subjects of nervous complaints or of mental troubles transmit to their children an organization which is defective in what, for want of a better term, 166 MEDICAL CLIMATOLOGY. we must call ' nerve-force.' Such individuals start handicapped and furnish a considerable proportion of our neurasthenic patients. So long as they are content to transact a moderate business with their capital, all may go well; but there is no reserve, and in the emergencies which constantly arise in the exigencies of modern life these small capitalists go under and come to us bankrupt. " (b) Acquired neurasthenia. The functions, though perverted most readily in persons who have inherited a feeble organization, may also be damaged by exercise which is excessiw in proportion to the strength — i.e., by strain. The cares and anxieties attendant upon the gain- ing of a li'^elihood may be borne without distress, but in many persons the strain becomes excessive and is first manifested as worry. The individual loses the distinction between essentials and non-essentials, trifles cause annoyance, and the entire organism reacts with unneces- sary readiness to slight stimuli, and is in a state which the older writers call irritable wealiness. If such a couditiou be taken early and the patient given rest, the balance is quickly restored. In this group may be placed a large proportion of the neurasthenics whom we see in this country, particularly among business men. Other causes more subtle, yet potent and less easily dealt with, are the worries attendant upon love affairs, religious doubts, and the sexual passion.'" After the due regulation of rest and exercise for a given case of neurasthenia, the essentials of climatic treatment are the degree of stimulation or sedation needed, the removal of the patient from the rut into which he has fallen, and keeping him in pure, open air. One of the most common and distressing symptoms of neurasthenia is insomnia, and it may be stated, as a general rule, that where the neurasthenic sleeps the most he does the best — at least till that symptom is overcome and he is thoroughly rested.^ In deciding where to send such cases a close inquiry must be made into their past experience in changing air, whether they have recuper- ated best at the seashore or on the hillside, in the woods or among the lakes, on the warm, dry desert-plains, or at high altitudes, warm or cool. Eest for both body and mind is the first essential until the anemia 1 Osier : Practice of Medicine. 2 Ttiere are exceptions to this, as it is not infrequent to And neurasthenics living In malarial districts who sleep too heavily, and who, while they improve in an elevated climate, yet sleep more liglitly because the malarial poison is being eliminated. OTHER FOBMS OF DISEASE INFLUENCED BY CLIMATE. 167 is fairly overcome. The ideal rest to both mind and body for those with whom the sea agrees is obtained on a well-found sailing-ship in a warm latitude or on placid waters/ This necessitates a good digestion for monotonous and simple food, a non-susceptibility to sea-sickness, a pleasant tolerance of the general boredom of ship- board-life, and a philosophy sufficient to overcome the difficulties sometimes encountered in a forced companionship with uncongenial spirits. Possessing these qualities, the neurasthenic can vegetate in great security from the irritation of contiguity to the busy life or worrying circumstances among which his malady began, and he is also free from the temptation to overexertion. Again, with those to whom the sea-air is beneficial, but who prefer a shore-life and can endure more exercise, a quiet island in the ocean, where steamers rarely stop and which is free from the requirements of fashion, allows a pleasant alternative, with more varied interest and opportunities for social intercourse and exercise. If a more stimulating sea-air is needed, it is next best obtained on a pleasant seacoast, because there is less equability of tempera- ture and more mobility of atmosphere, owing to the change from sea to land breezes and to the difference in radiation from the sur- faces of earth and ocean. Here, again, both exercise and amuse- ment can be more diversified than on the island or the ship. To those with whom sea-air does not agree, and who chiefly re- quire rest, a camp-life in the woods or among the lakes is most desirable, with hunting, fishing, and boating or pursuits connected with the study of natural history, according to the individual's strength. Again, in such cases as are unsuited to the sea, but who cannot, owing to expense or inconvenience, or because of some physical con- traindication, visit high altitudes, the anaemia will be more speedily removed by a change to moderately high ground than by one involv- ing no change in altitude. Inland places of medium elevation are best suited to those for whom the seashore or the higher altitudes are too stimulating. Where, however, anaemia is the prominent symptom or the under- lying cause, and where the nervous susceptibility is acquired, not inherent, and there is no cardiac disorder, an altitude between 4000 and 8000 feet affords the surest, speediest, and most permanent cure. ^ See extract from Robert Louis Stevenson, Section III. 168 MEDICAL CLIMATOLOGY. A few years ago I reporied^ certain cases of neurasthenia, in some of which the trouble had been continuous, while in others it had taken the form of recurrent attaclss. All of these had previously tried low altitudes or the ocean, and in all the improvement was much more rapid and lasting in Colorado than elsewhere. When we consider the blood-changes induced by the diminished pressure, the greater dryness, and the increased brilliancy of the sun- light, this is not surprising. All writers on the eiFects of altitude have noted this ; therefore, where the other physical conditions are favorable, and opportunity offers, a neurasthenic should be sent to a high climate. The cooler climates are the more bracing, the warmer more seda- tive. Patients seeking climatic change must be especially warned against over-exercising and neglecting to obtain at once the advice and guid- ance of a local physician. In the case of those who cross the sea with a view to finding diversion in foreign travel, much harm is done by an excess of sight- seeing, especially indoors in galleries and chilly churches. In no malady more than neurasthenia is the advice of Dr. Julius Braun pertinent, that "you must consider not only the individual sickness, but the sick individual."^ Kidney Diseases. Prevalence of kidney diseases. This subject has been studied very carefully by several writers, especially by Hirsch, Davidson, Hjaltelin, Martin, Chambers, Morehead, and Dickinson. Dickin- son, availing himself of the British Government reports, both civil and military, and of the researches of other physicians, has given, in his valuable work upon Albuminuria,^ a digest of the literature upon the prevalence of kidney diseases. He shows very clearly, and in this he has the support of other authorities, that renal dis- eases are most prevalent in temperate climates, least so in cold climates, and comparatively rare in warm climates, if lardaceous cases be eliminated. There are several factors other than the climatic which tend to 1 Influence of Colorado upon Nervous Diseases. S.E.Solly. Transactions of the Colorado State Medical Association, 1870. 2 See chapter on Personal Equation. ' A Treatise on Albuminuria. By W. H. Dickinson. OTHER FORMS OF DISEASE INFLUENCED BY CLIMATE. 169 cause this greater prevalence in temperate climates, such, for in- stance, as the greater use of alcohol, the fact that the inhabitants lead more sedentary aud more anxious business-lives, and that a larger proportion of them are syphilitic and gouty; but, neverthe- less, a thorough inquiry into the facts clearly shows that the influence of climate is marked. As an explanation of this, Dickinson states the axiom that the liability of an organ to disease, particularly of an inflammatory character, bears a proportion to its functional activity. The kidneys have to do most work in a temperate climate, the skin, liver, and bowels in hot countries, and the lungs in a cold climate. Statistics of eight years for the British army show that the most prevalent diseases are tubercular and kidnev troubles in temperate climates; in the tropics, malarial affections and diseases of the bowels and liver ; and in the arctic regions, catarrhal disorders of the res- piratory tract. Dickinson further demonstrates, by a table' and by other evidence, that where the temperature of two climates is the same, the least renal disease will be found in the one which has the lowest humidity. Influence of the Several Climatic Factors. Weber writes on this subject as follows : " The separation of water by the lungs and skin is diminished in great dampness, and more work devolves upon the kidneys, while their activity is less called upon when the air is dry and warm, and we must always pay great attention to this in affections of the kidneys." Elsewhere he says : "As cold air con- tains less vapor than warm, therefore there is more loss of water by the lungs when the air is cold than warm." ^ In warm air there is more secretion from the skin and less from the lungs, and in cold air the reverse holds true ; and the drier the air is, whether cold or warm, the more secretion there is from one or the other of these organs. As cold air is always proportionately drier than warm, the secretion from the lungs in a cold air would be relatively greater than that from the skin in warm air; but how the greatest possible amount of water excreted through the lungs compares with the greatest possible amount excreted through the skin has not been determined. Again, as the action of cold in contracting the cutaneous vessels increases the action of the kidneys and the amount of urine passed,^ it may be assumed, theoretically at least, that the kidneys have 1 Albuminuria, p. 281. - Ziemssen's Cllmatotherapy. 3 Landois and Sterling : Physiology, p. 426. 170 MEDICAL CLIMATOLOGY. somewhat more relief in their work in a warm, dry, than in a cold, dry air. Climatic Treatment. From the clinical knowledge at command, it would seem that while the difference in value between the two varieties of climates is not great, yet if a warm, dry climate is other- wise suitable, it should be preferred, as a general rule, for the relief of renal disease. Cases may occur, however, in which the bracing effect of dry cold is so desirable for the cure of an accompanying anijemia that, in weighing the advantages, a dry, cold climate is preferable. In both warm and cold climates the question of wind is of the utmost importance, it being the one meteorological element most harmful to a kiduey-case. While any sudden change of temperature is attended with risk, those expected and customary differences between sunlight and shadow, and day and night, which are always present in dry climates, hot or cold, according to their degree of humidity, are of less consequence, as they can be prepared for ; indeed, they are often beneficial through their general tonic effect. Chauges of tem- perature in warm, damp climates, however, even when much less extreme, are more dangerous, and, being more subtle, they are not so easily guarded against ; and such changes in cold, damp climates are the most dangerous of all. With respect to the influence of elevated climates upon kidney diseases, there has been very little recorded. Dickinson does not refer to them at all ; and most physicians, when mentioning alti- tudes in this connection, condemn them utterly, as did Dr. J. C. Wilson in his otherwise excellent paper upon " Climate and Bright's Disease. " Analyzing briefly the physical elements of elevated climates likely to influence the development and progress of kidney diseases, we begin with diminished atmospheric pressure. While it cannot be positively asserted that this element decreases the flow of urine, it may reasonably be inferred, for we know that there is a general tendency of the blood to flow to the skin and lungs and thug lessen the blood-pressure upon the kidneys ; and that lowering of blood- pressure reduces the urinary secretion. Further, it is stated by Jaminet, Foley, Lange, Pol, Pravazy, and others that increased barometric pressure has the opposite effect.^ Also the general 1 A. H. Smith : Compressed Air, p. -lO. OTHER FORMS OF DISEASE INFLUENCED BY CLIMATE. 171 equaliziog and lowering of the blood-pressure caused by dimin- ished barometric pressure, in addition to the effects before men- tioned, warrants the belief that diminished barometric pressure directly lessens the work of the kidneys. Again, the improved quality of the blood and the increased tissue-change brought about by the same climatic factor should be favorable to combating the dyscrasia accompanying renal disease. The increase of sunlight should also be of benefit to the general ill- health. The dryness of the air, which is usually a marked feature of such climates, should, as shown before, be of especial value, and might to a great extent obviate the objections which could otherwise be urged against high climates if cold, or their depressing effects when warm. It must be admitted that wind is generally a feature of elevated climates, except at special seasons or in certain favored resorts (such as Davos) situated in valleys. As most valleys, how- ever, are theoretically and practically uusuited to renal cases, it fol- lows that the benefits ascribed to altitudes are usually offset by the presence of wind, even if it be dry and therefore as unobjectionable as possible. It may be inferred that, if an elevated climate is determined upon, one should be selected which is in all respects medium — that is, neither very cold nor windy. The altitude should not be very great, the resort should be situated on open, sloping ground, where the soil is dry, and the storm-shelters must not lie so near as to cut off the sunlight nor to surround the locality on all sides. These theoretical conclusions agree with my clinical experi- ence in Colorado and other elevated climates. Colorado Springs is often too cold and windy in the winter to be free from danger to these cases, and the ideal elevated climate for them is to be found further south and somewhat lower down ; but my experience, even in Colorado Springs, has convinced me of the benefit of an elevated climate iu certain renal cases. Some years ago I reported a few cases which had resided both in Colorado Springs and at sea-level, and the results were by no means adverse to the altitude.^ Later experience has confirmed the conclusions I then formed, which were as follows : First. Acute nephritis, like all acute inflammations, is not infre- quent in Colorado, especially in the mountains, where the inhabi- tants, not being natives, are careless of climatic extremes. When 1 Bright's Disease of the Kidneys as Influenced by the Climate of Colorado. S. E. Solly. Transactions Colorado State Medical Society, 1884. 172 MEDIQAL CLIMATOLOGY. nephritis occurs it is, moreover, like all inflammations at an altitude, more than usually acute. Acute nephritis is not especially induced by the climate, but once established, it is, at the beginning, apparently aggravated by the altitude. Second. The direct tendency of altitude in chronic nephritis, as in most chroaic diseases, is toward its cure. This beneficial influ- ence is doubtless mainly exerted through the increased action of the lungs, and, to a smaller extent, of the skin, which lessens the work of the kidneys and diminishes the renal congestion by the general stimulating and equalizing of the circulation. The late Sir Andrew Clark stated to me that he found that kidney affections frequently developed among consumptives residing in the high Alps. Lardaceous Kidney. I have been unable to ascertain the aver- age percentage of cases of lardaceous kidney among consumptives generally, therefore I cannot say what is the comparative influence of climate upon the disease. In 150 cases of phthisis which I treated in Colorado and traced up, there were 4 witb this compli- cation — 2 who were affected before coming to Colorado and 2 in whom the trouble developed after their arrival. In all of the patients the urine was frequently tested. It is quite common in Colorado to find in fatal cases, toward the end, more or less oedema, but the test-tube and microscope generally fail to show any renal afifection ; doubtless the cedema is usually caused by the weakening heart. Where no test is made this cedema is often attributed to the wrong cause, and I believe this to be the explanation of the some- what prevalent opinion that lardaceous kidney is frequent in Colo- rado. In the scrofulous cases, and cases with bone tuberculosis, lar- daceous disease is perhaps at least as frequent here as elsewhere. With respect to nephritis, acute or chronic, among the 150 cases referred to, there were three cases ; two began in Colorado — one acutely, the other slowly. The former, who showed unmistakable evidence of a tuberculous kidney, is still in Colorado and much improved, though his urine contains a little albumin and a few casts. The latter case died of his pulmonary disease and before his death the renal symptoms were more marked. In the present state of our knowledge it is undoubtedly safest to try first a warm climate which may have a high humidity, but must have a moderate rainfall. The age of the patient as well as the stage of the disease should greatly influence the choice between OTHER FORMS OF DISEASE INFLUENCED BY CLIMATE. 173 a warm and a cool climate; and, again, it is essential to know whether one may anticipate a cure or only an alleviation of the malady before deciding the matter. With regard to the effect of the Colorado climate upon healthy kidneys, persons during the first few days after their arrival have frequently called my attention to the "thickness" of the urine, which, upon examination, proved to contain an excess of solids, especially the urates. These persons have usually thought also that they perhaps passed less watei', but certainly more frequently. This phase usually disappears in a few days, and the urine returns to a normal condition. This would suggest that at first the excre- tion of water by the lungs and skin was much increased at the ex- pense of the kidneys, and the condition of the mucous membranes and the parched skin bear out this opinion. My friend, Dr. S. A. Fisk, of Denver, informed me that from quantitative and qualitative analyses made by him upon specimens of urine taken from healthy persons who were permanent residents he found the urine usually normal, except that the specific gravity was slightly higher. This would indicate that in healthy persons the balance between the excreting orgaus is in time regained. " Certain life-insurance reports gave to kidney diseases in all deaths occurring on the Rocky Mountain plateau and Pacific slope a percentage of but 1.6 per cent, against nearly 9 per cent, of all deaths occurring in New England or the same in New York." Thus writes Dr. Francis Atkins, of Las Vegas, New Mexico. He believes that early albuminurics do well on the Rocky Mountain plateau. He finds that the specific gravity of urine ranges from 1024 to 1030 in the life-insurance examinations he made in Las Vegas.^ Dr. Fisk^ says that he was told by the vice-president of the Santa Fe Road that at the stock-yards in Chicago it was rare to find diseased livers or kidneys in cattle coming from the Rocky Mountain region. Scarlatinal Nephritis. "I have frequently examined the urine during convalescence from scarlatina, but only remember three cases of Bright's disease as a sequel of the fever. In one case there had been exposure and neglect, and there was much dropsy. All the cases, however, made a good recovery while remaining in this climate. In practice in London previously I found albuminuria 1 Transactions of the American Climatological Association, vol. vii. pp. 250, 251. 2 Ibid., p. 253. 174 MEDICAL CLIMATOLOGY. a common sequel of scarlatina. In our county society the opinion of my colleagues was that scarlatinal nephritis is decidedly rare in this district."^ Hepatic Complications. Sir Henry Thompson, some years ago, drew attention to the importance of taking the condition of the hepatic functions into practical consideration in the proper treatment of chronic renal diseases. This, I believe, is an especially important factor in the choice of climate. Diabetes. My views with regard to this disease remain what they were when I expressed them in Hare's System of Therapeutics.^ " Diabetes, both mellitus and insipidus, would appear not to be dis- eases pe?- se, but symptoms resulting from disturbance of the func- tions, or change in the structure of some portion of the nervous system or of one or more of the digestive organs, notably the liver. Change of climate, though not usually of the first importance in the treatment of this disease, is often of use in aiding other therapeutic measures." The choice must then be determined by the primary causes of the affectiou ; thus when, in a full-blooded person, the disease appears to have resulted from high living, a low, unstimulating climate at a spa, such as Carlsbad, where the waters are rich in the salts provo- cative of increased metabolism, is indicated. When, again, digestive or excretory deficiencies are at the root of the matter, and the patient is of the anaemic type, a mountain climate is more beneficial. Where the nervous system is most involved, and when an actual lesion is suspected, a warm seashore climate is generally indicated ; while in cases in which the nervous symptoms are functional, and more or less anaemia is present, an altitude will probably do more to retard or cure the disease. In the statistics compiled by Purdy' the rate of mortality from diabetes was very much higher in cold, moist, than in mild, dry climates, and it also increased with the altitude. I have watched with interest the progress of several cases of diabetes during their residence in Colorado, but have been unable so far to come to any positive conclusions as to the influence of alti- tude upon the disease. I have seen some cases of diabetes which had not advanced far, 1 Author's article upon Climate in Hare's System of Therapeutics. = See page 448. 3 Purdy on Diabetes, Philadelphia, 1890. OTHES, FORMS OF DISEASE INFLUENCED BY CLIMATE. 175 and with whose hepatic and nervous systems the dimate seemed to agree, do well in Colorado ; but a diabetic should be carefully exam- ined before being sent to a high altitude, as the lack of equability in the climate increases the risk of intercurrent attacks, and any nervous lesion may be aggravated. Conclusions. While my experience leads me to prefer warm, low, inland climates, such as those of Egypt and Arizona, for the majority of cases of chronic renal disease, yet I have found that in some a warm seashore, and in others dry, elevated regions, both cool and warm, are better suited, and I believe this is often because the climate insures a more perfect working of the liver. The instruc- tions of the physician at the health-resort must be very deiinite and should be strictly followed, for iu no disease is personal prudence of greater importance. Diseases of the Liver. Organic Disease. In serious cases any change must be made with caution and extreme climates should be avoided, except when the patient is in a particularly bad climate, such as that of a tropical country or malarial district, in which case the needed change may be to a climate which offers the sharpest possible contrast. In functional disease, on the other hand, a radical and extreme change is usually of the greatest benefit, as, for iustance, one from mountain to seashore, from land to ocean, from a cold climate to a warm one. As pertinent to the subject I will make use of an address which I read before the Colorado State Medical Society : In estimating and recording the effects of Colorado upon the various organs it is necessary to take into consideration the race and tem- perament of the individual, and it is probable that these will gener- ally explain apparent contradictions. Take the liver, for example. It is frequently asserted, on the one hand, that the climate of Colo- rado causes biliousness, and, on the other, that it relieves it. I have formed the impression that what is called a bilious person, one who at home frequently exhibits signs of functional hepatic irregularities, is, while resident in this climate, less subject to them, and his skin is apt to lose its yellowish tinge ; but persons of a sanguine or nervous temperament, in whom such attacks had previously been rare, are, in Colorado, not uncommonly subject to such disorders. The explanation for this assumed fact appears to me to be briefly as 176 MEDICAL CLIMATOLOGY. follows : Iq the individual of bilious temperament the cause of the derangement was mainly from lack of sufficient stimulus to the liver through its circulatory or nervous supply, or both, and the ac- knowledged activity of these two systems, induced by the climate, was the cause of the better working of the organ. In the individuals of sanguine or nervous temperament the circulatory and nervous supply of their livers was already sufficieutly active, and the climatic stimulus would be, for them, excessive and induce a condition in which slight exciting causes would readily give rise to congestion of the liver and subsequent derangement.' In a dry climate, such as Colorado, the rapid and constant loss of moisture from the tissues, while beneficial and stimulating to the action of the liver in one class of individuals, would probably be irritating and hampering to it in another class, unless especial care were taken to compensate for this by drinking water freely. Again, while a dry, warm air induces free perspiration, yet the evaporation of the water of the sweat, as soon as it reaches the sur- face of the skin, is so rapid that the sweat is seldom noticeable; but it is probable that, unless the skin is kept in an active condition by more than usually frequent washing, rubbing, and general exercise, the salts of the perspiration clog the pores, and elimination through tlie skin becomes lessened instead of increased. Consequently waste- products which should be excreted in this way may be returned by the circulation to the liver and so interfere with its action. Dr. Weber and other writers on climatology have spoken of the favorable influence of elevated climates upon sluggish circulation in the abdomen generally, and it has been my observation that passive congestions in angemic persons were usually benefited at an altitude which failed to agree with the full-blooded or those in whom there were active congestions or marked nervous irritability. The direct influence of climate is perhaps more marked upon the functions of the liver than on those of any other organ. Speaking broadly, persons may be divided into those who become bilious when they go to the seashore and those upon whom the mountain- air has a similar effect. It will be found, as a rule, that with fair and full-blooded persons the liver acts best at the seashore, while with the dark-skined and antemic the hepatic functions are most regular in mountain-air. 1 Presidential address. S. E. Solly, M.D. Transactions Colorado State Medical Society, 18S7. OTHER FORMS OF DISEASE INFLUENCED BY CLIMATE. 177 Attacks of Gallstone. To remove the conditions upon which the formation of gallstones is dependent certain drugs are usually required, notably sulphate or phosphate of sodium ; and clinical experience indicates that these are most effective when taken in mineral water. A suitable spa should therefore be sought ; but to get the best effects one should be selected which possesses the climatic conditions most suited to the patient upon the general principles already laid down. The success of treatment at Carlsbad largely depends upon a proper consideration of these general princi- ples, and its failure is often directly traceable to an ignorance of, or lack of regard for, them. As balneotherapy does not lie within the range of this treatise, I cannot pursue this subject much further ; but I will add that I have been gratified by the beneficial results in the treatment of gallstones from the use of the Shoshone Spring at Manitou, Colorado, and this in cases where the patients had previously been treated at Carlsbad without much benefit. The spring at Manitou is much poorer in the requisite salts than the one at Carlsbad, and often requires an artificial addition ; therefore I cannot but believe that a mild mineral water in a suitable climate is sometimes more beneficial than a stronger spring in a place of which the climate is not so appropriate for the case. The question is, Does the nervous or the circulatory system call for a sedative or a stimulating quality to provoke or regulate the necessary metabolism in order that health may be restored ? Afltections of the Stomach. Dyspepsia is usually amenable to treatment at home. When chiefly due to the condition of the mucous membrane the regulation of the diet and habits of the patient is of the most importance, aided as may be required by drugs or other therapeutic measures, or by change of climate for the purpose of taking the waters at some special spa. Catarrh, dilatation, and ulceration of the stomach do not usually of themselves call for climatic change ; but when a change is made it is necessary to consider particularly the food and cooking to be found in the resort recommended. The change needed may be of a purely negative character, perhaps to induce the patient to drop a too engrossing occupation, habits of irregular and rapid eating or 12 178 MEDICAL CLIMATOLOGY. of over-indulgeoce, and to take him away from the temptations of hjxury to a plain table and simple living. Prolonged indoor occupations particularly foster dyspepsia, and therefore the place where much pleasant outdoor life and exercise is to be obtained is most desirable, especially one possessing a climate suited to the action of the patient's liver. If anaemia be present, the climate must be selected with a view to curing it. This disorder demands a bracing air, and the seashore, the moorland, or the mountain should be chosen, in accordance with the strength and idiosyncrasy of the patient. While most gastric cases require good and varied diet, plain food and rough, open-air life are best even for many delicate dyspep- tics. An iron spring which contains also a small quantity of alkaline salts and is well charged with carbonic acid is often of the greatest service to the anaemic dyspeptic. It must not be situated in a hot, low valley, but on the moor or mountain. San Catarina, at San Moritz, and the Iron Ute, at Manitou, are notable examples of the best quality of iron springs in a bracing climate. If, on the contrary, the dyspeptic tends more to plethora and obesity, low, inland climates possessing springs strong in alkaline and purgative salts without iron, which induce active metabolism, are the most suitable; the resort should also possess resources for the carrying out of intelligent hydrotherapy. Saratoga and Glenwood on this continent and Carlsbad in Europe are excellent examples of such spas. When the dyspepsia is largely nervous in character the climate must be selected with a view to its probable efEects upon the nervous system, and all the attendant circumstances must be carefully studied. Diseases of the Bowels. Chronic diarrhoea is sometimes cured by a radical change of climate without other therapeutic remedies. The proper change would be from a damp to a dry, from a warm to a cool, from a high to a low, climate or viae versa. Heat is generally more provocative of diarrhcea than cold, and dampness than dryness ; but these are not universal rules. In warm, humid climates or seasons and sometimes also in a dry atmosphere, sudden changes of temperature will cause diarrhoja or even dysentery. Such variations are less frequent in OTHER FORMS OP DISEASE INFLUENCED BY CLIMATE. 179 cold climates, especially if the air be dry; but if it be damp, they occur ofteuer, and are more to be dreaded. Chronic constipation is often benefited by change of climate, usually because the patient lives more out of doors, takes more ex- ercise, and is very apt to drop temporarily any unhygienic habits. In all affections of the bowels the influence of climatic change upon the hepatic functions must be especially considered. Tuberculous disease of the bowels or of any portion of the abdomen is benefited or increased by climatic change according to the same principles as those set out in the chapter upon Phthisis. Gout and Rheumatism. Both of these diseases are frequently benefited by climatic change. Gout is more especially influenced by diet. Next to this in im- portance come certain drugs and mineral waters, and then exercise and bathing. The geographical distribution of gout is chiefly due to the diet, drinking, and the social habits of the residents in countries where it is most prevalent, as in England, for example. Climate, however, has some influence in its causation and cure. The appropriate climate for aiding the treatment of a particular case of gout depends mainly upon its effect on the general health of the patient; but in deciding the question certain points dwelt upon by Dr. Haig should be considered.^ He says: " I have pointed out that the excretion of uric acid is greater in summer than in winter, and Sydenham speaks of gout as a winter disease. JSTow, there is no doubt that a laboring-man has, so to speak, summer all the year round. His exertions keep his skin constantly active. He gets rid of a large amount of acid in this way, hence the acidity of his urine rules low, and the alkalinity of his blood is well maintained; he therefore excretes uric acid freely and retains but little in his body; and so, as observed by Cullen, he but rarely suffers from gout, and this is so almost without regard to his diet, for he excretes all the uric acid he introduces as well as all that he forms. As to the acidity of the sweat, see also Jlenss, Monatseh. fiir prakt. Dermatol., Band xiv. Nos. 9, 10, and 12; and Lancet, 1892, vol. ii. page 118. A sedentary man has not only higher acidity and retention of uric acid, but his circu- 1 Uric Acid, third edition, London, p. 479. 180 MEDICAL CLIMATOLOGY. lation, especially in peripheral parts, like the hands and feet, is less well maintained, and as a result the alkalinity of the fibrous tissues in such parts is also less well maintained. " Though, as I have said, I used to have headaches when my life was not sedentary, I have no doubt that I could indulge in meat and beer with comparative impunity if I lived the life of a laborer. ''After Avhat I have said about the effects of summer, it is not surprising to find Sir A. Garrod saying (page 235), 'Gout is un- doubtedly much less prevalent in hot than in temperate climates,' though no doubt, as he remarks further on, food and habits have also something to do with its absence. " The reverse effects of cold need hardly be gone into; but Sir A. Garrod says (page 247), ' When cold acts as an exciting cause the effect is due, at least in part, to its arresting the secretion of the skin and checking the escape of acid from the surface,' and my experimental experience is in complete accord with this statement." Rheumatism. Articular rheumatism is more common in a cold climate than in a warm one, and in a damp than in a dry atmos- phere; but it occasionally occurs in a dry climate, especially if it be also hot, like that of LoAver Arizona. Muscular and nervous rheumatism are perhaps nearly as fre- quent in dry as in damp climates. Altitude does not prevent, and sometimes even aggravates these affections. I believe, as has so often been said in regard to other diseases, that the climatic effect upon the functions of the liver has especially to be considered. While the war still rages round the question of the identity or kinship of gout and rheumatism and the part played by uric acid in their causation, it is difficult to speak definitely as to the role taken by the liver in these diseases; but, as has been said in discussing liver disease, I believe that both humidity and dry- ness have a great and direct influence upon the secretion and nervous action of this organ, and consequently upon the excretion of urea or its accumulation in the tissues. Again, climate undoubtedly has an indirect influence upon the action of the liver through its effect upon the functional Activity of the skin Variability in a damp climate, or the exaggerations of meteorological variations resulting from ex- cessive dryness, often cause a chilling of the surface of the body; thus the pores are closed, the excretory functions of the skin tem- porarily interfered with, and the work performed by the liver increased. OTHER FORMS OF DISEASE INFLUENCED BY CLIMATE. ]81 It may be stated as suggestive that it is a common saying in Colorado that persons who have rheumatism when they go there lose it, and those coming without it acquire it. This, although an exaggeration, has a basis of truth. In rheumatism it is particularly important, before sending a patient to a resort, to inform one's self as to the humidity tables, the range of temperature, the nature of the soil, and the presence or absence of fogs. SECTION III, INTRODUCTION. The physician who has studied the principles outlined in the first section of this book can, on consulting the facts contained in this portion, form for himself a very fair opinion of the climate of the resorts mentioned, and be independent of the statements of igno- rant or prejudiced persons. The main facts necessary to the forming of au opinion are the elevation, latitude, distance from the ocean, proximity of large bodies of water or mountains, aspect, configura- tion (whether flat, irregular, or sloping), and the nature of the soil and vegetation. Knowing these, he can estimate approximately its general meteorology, even if he is unable to obtain reliable records; but if these are at hand, let him remember that humidity is more important by far than any other single factor, and their importance as climatic conditions depends upon the place held by it. He must not forget also that weather and climate, though allied and inter- dependent, are not the same thing, and that a climate may, in the long run, be beneficial to a patient to whom much of the weather is unpleasant and even adverse if precautions be not taken. The mode of heating and ventilating houses at resorts is of espe- cial importance, because, unless a proper relation is maintained be- tween the house-climate and that of the open air, catarrhs and other evils are more prevalent than they otherwise would be. The ideal is to keep the surface of the body warm and the air which is breathed cool. In Italy and Mexico the transition from the warm, sunny, open air to the gloomy, vault-like chilliness of the native houses is dangerous, unless one follows the manner of the Mexican, who reverses the usual custom and puts on his overcoat when he comes indoors. Again, in American winter-resorts the steam-baked, overheated air of most hotels unfits the guests for benefiting by the cool, bracing atmosphere outside or combating the trials of that exceptionally stormy, chilly weather which is to be found at times at all health-resorts, not even excepting those of the sunny South. 184 MEDIO AL CLIMATOLOGY. Physicians very properly inquire into the range of •temperature, but they should remember that its good or evil effects can only be estimated fairly when the humidity is studied with it. Climates may be divided therapeutically into negative and posi- tive. They are negative where it is simply a question with the trav- eller of avoiding perhaps the damp cold of home and seeking the warm South, hoping to find the poet's land, " where it is always afternoon" ; thence he returns, not changed or toned, but satisfied to have escaped, for another season at least, the climatic dangers and disagreeables of his customary abiding-place. Positive climates, on the other hand, are those which produce an alterative or tonic effect. The two extremes of climate, sea and mountain, both do this; but sea-air is, for the most part, sedative in character, while moun- tain-air is stimulating; and the wise physician chooses on this prin- ciple or takes a middle course, and, selecting a medium climate, remembers, " In medio tutissima ibis." In deciding Avhat order of sequence appeared to be best and most convenient for reference to the climates described in this section, the author selected the geographical, starting from the northwest and going east and then south and returning by the west and north. This plan has been followed so far as was practicable in every quar- ter of the globe, and it has only been deviated from where the pre- scribed order would have separated certain resorts from the climatic groups to which they properly belong. The coast- and island-resorts are generally described before the inland places. PLATE 1. From bdtlee's geogkaphies, by permission of e. h. bctler & co. Copyright, 1888. CHAPTEE X. NORTH AMERICA. It is difficult for those who have not travelled throughout this continent to realize its size and the variations of climate consequent upon its topography and its extent from arctic to tropical regions. As compared with Europe, the stranger would at first be struck with the dryness of the climate and with its great range. Cities in the same latitude as those of Europe are colder by many degrees, a striking example being that furnished by the contrast between Naples and New York. This observation is, however, applicable only to the eastern coast of the continent, the climate of the western coast being much milder and more equable. This is, of course, due to the fact that while the Kurosiwo, or warm Japan current, fol- lows almost the entire western coast, the Gulf-stream, whose warm waters are deflected from the equatorial current near the Caribbean Sea, turns from the eastern coast, after following it for a compara- tively short distance, and flows across tlie Atlantic to warm the coasts of western Europe. Charles Maclaren, in an interesting article on the American con- tinent, written for the Encydopcedia Britannica, gives a very clear explanation of the way in which prevailing winds and mountain- ranges influence a climate, and especially this climate. Between the parallels of 30° north and 30° south latitude are found the so- called " trade-winds," which blow from the east. Beyond these limits, unless local causes suffice to alter the direction, the prevail- ing winds would be westerly, which is the general direction of winds in the United States. The barriers to the free sweep of wind are: first, the high range near the western coast, beginning in Alaska, known throughout the continent as the Cascade and the Sierra Nevada Mountains, and terminating in the chain which extends through the peninsula of Lower California; secondly, the Rocky Mountain system, the backbone of the continent, which is con- tinued through Mexico under the name of the Sierra Madre; thirdly, the Appalachian system, arising south of the St. Lawrence and ter- minating in the northern part of Georgia and Alabama. 186 MEDICAL CLIMATOLOGY. The general conclusion from this would be that the west coast of Mexico and the eastern portions of the more northerly parts of the continent would be least humid, and, local differences aside, this is, in fact, very much the case. It is true that the western coast of Mexico, as far as 23° north latitude, is fertile and well-watered, because there is no intervening elevation high enough to form an effectual barrier to the moisture-bearing east winds, and, also, it is thought that a branch of the trade-winds is deflected from that which crosses the flat Nicaraguan territory and follows the west coast for some distance; but from 23° to 33° or 34° north latitude the western coast of Mexico and even the narrow peninsula of Lower California are dry, sandy, and practically without vegeta- tion. A marked change is exhibited on the west coast of the United States. Here the prevailing westerly winds have free sweep over the land until stopped by the Sierra Nevada and the Cascade ranges, and bring not only moisture from the Pacific Ocean, but the tem- pering warmth imparted by the Kurosiwo. Eastward of these ranges the land is very dry and sandy, and would, according to Maclaren's hypothesis, continue so throughout the Mississippi basin were it not that as the land is level from the Gulf of Mexico northward, part of the trade-wind from that gulf, unable to cross the Mexican Cordilleras, is thereby deflected to the right and carries its moisture to the region drained by the Mississippi and Ohio. The eastern coast is mainly dependent for its moisture on the east and northeast winds which blow off the Atlantic Ocean and bring to this region most of its storms. The climatic divisions of the country are, then, three : first, that including the region from the Atlantic Ocean to the neighborhood of the Rocky Mountain system, possessing, especially throughout the Appalachian Mountains, very marked local variations; secondly, the high plateaus and mountainous districts of the Rocky Moun- tain region, distinguished by a dry, cold climate, lacking, for the most part, in any element of harshness, and showing a very large number of clear days; thirdly, the district extending from the Sierra Nevada Mountains to the shores of the Pacific, and possessing a moderate, equable, humid climate with mild winters. These divi- sions will be found amply typified in the selected resorts. NORTH AMEBIC A. 187 Canada. The superficial extent of Canada is nearly equal to the whole of Europe. It runs from about 45° north latitude to the Arctic Ocean, and has the two great oceans of the world — the Atlantic and the Pacific — for its eastern and western boundaries. The climate of British Columbia partakes of the general character of that of the Pacific coast, and is consequently much milder than is the climate of the Atlantic provinces. The climate of the Atlantic provinces resembles that of S\'\'eden and Xorway. The winters are colder and the summers hotter than is the case in corresponding latitudes in Europe. January and Feb- ruary are the coldest months in the year. Snow finally disappears in Quebec about the middle of April, and in Ontario almost a month earlier. While the summers are hot the nights are usually cool. The dangerous times for invalids in Canada are during the melting of the snows and in the late autumn, when snow and sleet are apt to come with alternating thaws. When the winter snoAvs finally lie upon the ground the air, although cold, is dry and bracing. In northeastern Canada, especially, the change from winter to summer is very sudden. Extensive forests cover the greater part of Canada. The penin- sula formed by Lakes Erie, Huron, and Ontario has a fertile soil which yields large crops, especially of wheat. It is extremely difficult to speak with definiteness and justice of the claims of Canada as to its health-resorts, because, even in regard to general climatic characteristics, the area to be covered is so great and accurate information is so scanty and difficult to obtain. The local variations, too, are many, and would require close investiga- tion before their exact merits and demerits from this point of view could be decided upon. Dr. P. H. Bryce, Secretary of the Ontario Board of Health, to whom the author is indebted for much of his statistical information on this subject, divides the country into three districts: first, that which includes the provinces of Ontario and Quebec, and is char- acterized by the climatic conditions peculiar to low-level districts; secondly, that including the prairie-land extending from Calgary to the foot of the Rockies; and, thirdly, the Eock jMountain region itself, possessing the characteristics of ' ' high-level ' ' climates. As to the first region, a portion of it, " the central plateau of 188 MEDICAL CLIMATOLOGY. Ontario," has a greater exposure to winds, its forests having been cleared away. Its soil is a clayey or gravelly loam overlying lime- stone rock. The remaining portion, the Muskoka district, has wooded areas, and its surface is divided by rocky ridges with val- leys lying between. The forest-growths include balsam, hemlock, and spruce trees. The second or prairie region, having an elevation of from 400 to 6000 feet, is characterized, as are all such regions, by absence of humidity, great amount of sunshine, rapid radiation of heat during the night, and high winds. Variability from day to day, more than between seasons, is the main feature of such climates. The third or mountain region, marlved by valleys through which flow streams of greater or less volume, presents, necessarily, the ■ greatest variety of climatic conditions. One valley differs from another in aspect, in elevation, and in exposure to the sun and wind. The sides of the foot-hills are often almost barren, and yet, as we rise higher, we find that the climate is damp enough to sup- port a considerable forest-growth far up the slopes of those loftier peaks whose summits are always snow-covered. Dr. Bryce, as an instance of local variability, mentions two climates between Vancouver and Kamloops, one of which has an annual rainfall of 35 inches, while the other records but 11 inches. Kamloops, situated in British Columbia, in a broad, open valley and on the line of the Canadian Pacific Railroad, has an altitude of 1100 feet. The neighborhood offers many inducements to sports- men and many incentives to an active outdoor life, as the fishing and shooting are good and the natural surroundings attractive. The climate is dry, the annual rainfall being 11.05 inches, and the number of rainy days per year only 75. The mean annual temperature is 46.3° F., nearly 10° higher than that of Calgary, and the average annual range is less, being but 22.8°. The mean daily range is as follows : August. September. October. November. December. 29.2° 27.9° 17.9° 11.0° 11.9° The soil is light and gravelly and dries quickly, and the water- supply is pure and abundant. It is stated that the hotels are good and the charges reasonable. BanflF, lying on the line of the Canadian Pacific Railroad and surrounded by the most beautiful mountain-scenery, possesses many NORTB AMERICA. 189 natural advantages. There is also a handsome hotel with spacious accommodations and a good cuisine. Many pleasant excursions may be taken through the neighborhood. Banff, being situated in the Canadian National Park, has a government museum which is well worth visiting; although shooting is forbidden within the limita- tions of the reservation itself, the vicinity affords many attractions to the sportsman, and there is good fishing close at hand. From this point many of the wonderful parks and glaciers of the Selkirks can be visited. Banff also possesses hot sulphur springs, which are recommended in cases of rheumatism, etc. Calgary, situated in the province of Alberta, at an elevation of 3500 feet, has a dry, sunshiny climate. The annual rainfall is but 11.54 inches, and the number of rainy days during the year is 90. The mean annual temperature is 36.9° F., and the average annual range, from the records for four years, is 26.1°. In a pamphlet upon Calgary, Dr. George Macdonald gives the following monthly means : January. February. March. April. May. June. 6.3° 11.8° 14.9° 37.5° 48.8° 55° July. August. SeptemlDer. October. November. December. 59.6° 58.1° 50.9° 40.5° 24.7° 14.7° During the winter months snow frequently lies long upon the ground, affording good sleighing, and, as the thermometer may remain below zero for several weeks together, sometimes dropping to — 25° F., there is excellent skating. There are no available wind-records, but it is stated that the " chinook" sometimes blows here. A visitor to Calgary reports that there is a light daily breeze from the northwest. The mean daily range in temperature is : August. September. October. November. December. 28.9° 30.4° 27.1° 28.7° 21.6° There is no record of humidity, but all the evidence points to the conclusion that the climate is dry. There are very few cloudy days, particularly during the winter season. The climate being, therefore, sunshiny, dry, and bracing, is well suited to tuberculous patients who are sufficiently robust to exercise. The city is lighted by electricity and is furnished with water- works and a system of sewerage. There are comfortable, but simple, accommodations, and the expense of living is moderate. St. Lawrence River Resorts. The pleasures of a trip down the St. Lawrence to Quebec and from there up the Saginaw are well 190 MEDICAL OLIMATOLOOT. known. There are a number of charming resorts from Kingston to Brockville, on the shores of the St. Lawrence opposite the Thousand Islands, all along which are numerous fine hotels and villas. This district, as a summer residence, with a cool, equable, and medium-moist climate, is hard to surpass, and one may live as luxuriously or as simply as the individual inclination prompts. Gravenhurst, in the province of Ontario, is the distributing- centre for the resorts of the Muskoka Lake district. It is situated some miles from Montreal, and has an elevation of 600 feet. The snowfall here is heavy. The annual rainfall is 36.77 inches, and the number of rainy days throughout the year is 143. The mean annual temperature is 41.8° F., and the average annual range is 21.3°. This country is much resorted to for summer camping, boating, and fishing, and enjoys a reputation similar to that of the Adiron- dack region for healthfulness and pleasantness. Caledonia Springs, in the province of Ontario, have been re- sorted to for many years by sufferers from rheumatism, disorderd liver, kidney-troubles, etc. It is expected that the Montreal and Ottawa Railroad will be completed to Caledonia within a year; it has not heretofore been reached directly by rail. The accommo- dations are good, and many amusements are provided for visitors. There are four springs, a strong saline well and one not so power- ful, a carburetted hydrogen gas spring, and one known as the white sulphur spring. The waters are used for drinking and bathing. The summer climate is said to be pleasantly cool, and great heat is rare. St. Agathe, in the province of Quebec, is situated about seventy miles from Montreal, upon a branch of the Canadian Pacific Rail- road, among the Laurentian Mountains. Its altitude is about 1200 feet. The hotels are only moderately good, but cottages can be rented, and here many of the residents of Montreal have their summer-homes. The village is situated on a lake studded Avith islands; the adjacent country is covered with pine-forests and the scenery is beautiful. It is much used as a health-resort, and is con- sidered to rank, climatically, with the Adirondacks. The country offers many attractions to sportsmen and supplies good fishing and shooting. St. Leon Springs, located between Montreal and Quebec and lying about five miles from the St. Lawrence River, is situated in a charming district of country. The hotel-accommodations are NOE TH AMERICA . 191 good and all the usual amusements of a summer-resort are provided for guests. The waters are used internally and externally, and are said to possess aperient and tonic properties and to be efficacious in disorders of the digestive tract and in renal troubles. Dalhousie (New Brunswick), on the Bale des Chaleurs, at the mouth of the Restigouche River, has a mild summer climate aud affords excellent bathing; there is a first-class hotel, the " Incharron." Here is the starting-point for those who are going, in search of sport, up the widely celebrated salmon rivers. The Region of the Great Lakes. The district lying on the frontier between Canada and the United States, with a climate cool, moist, and equable, abounds in pleasant, quiet, inexpensive resorts which afford all the sports and diversions that make a seashore-life so attractive. The climate, too, possesses some characteristics in common with that of the coast, chief among which are the increased ozone, the purity of the air, and its com- parative freedom from dust-particles and bacteria. A trip on these inland seas, starting, for instance, from Duluth, crossing the lakes and following the St. Lawrence River down to Quebec, with an occasional stop-over at some of the pleasant resorts en route, is a most agreeable and healthful experience. The steamers are fine boats, and the cuisine is good. Apropos of the voyage between Buffalo and Duluth, the follow- ing remarks in a recent number of Outlook^ are worthy of notice : " Ocean-voyages usually grow monotonous. Not so a trip on a fast steamer on the lakes, for there is a constant succession of novel- ties to arouse the attention. It may be the historic Macinac, with its picturesque headlands and its decadent fort, last year finally abandoned by the government. It may be the St. Clair River, with its ' little Venice' of cottages and club-houses, the resort of Detroit's water-loving citizens, or a glimpse into Canada, with a hint of French and Indian in such an inn as the "Ashiganikauing," L6on Bellair, proprietor, or a view of the famous copper country on Lake Superior, with the smoke rising from the ' Calumet' and ' Hecla,' the richest copper-mines in the world; or, here and there, a whaleback, a lumberbarge, or a ' sand-sucker'. " It may be, at night, the vast dim luminosity on the far horizon 1 September 26, 1896, 192 MEDICAL CLIMATOLOGY. that indicates some large city like Cleveland or Duluth, soon to appear to the groups of watchers on deck. " The tourist who makes the trip of the lakes is sure to come back a wiser, healthier, happier man, with new ideas as to ocean- travel in his own land, so to speak, and with a memory full of pleas- ant reminiscences to hearten him for his daily work." The United States. This portion of the North American Continent, inclusive of Alaska, extends from about 48° north latitude at the northwestern corner of Washington State, near Vancouver, to latitude 25° north at Cape Sable, the extreme southern portion of Florida. British Columbia forms the western half of the northern border, and the Great Lakes and the St. Lawrence Eiver the eastern half. The eastern boundary is the Atlantic Ocean, the entire western coast is washed by the waters of the Pacific, and as Mexico forms only part of the southern boundary, the rest of the south coast bordering ou the Gulf of Mexico, the country may be said to possess four water-fronts, three of which touch upon salt water and one upon fresh. All of these are resorted to by health-seekers at different seasons of the year. The Pacific coast region has the most equable and temperate climate, both in summer and in winter, and this is particularly true below the thirty-fifth parallel, where the climate is pleasant during the entire year, and resembles that of the Riviera, although the temperature is higher in winter and lower in the summer. Above the thirty-fifth parallel the rainfall is much augmented and increases toward the north, and the climate is too damp and the winters too chilly for most invalids, though the summers are usually pleasant and temperate. The Atlantic seaboard is used in summer as far south as Old Point Comfort, and in winter the resorts from Atlantic City to Palm Beach are much patronized. On this coast the range is greater and the climate less temperate than is the case on the Pacific shore. The peninsula of Florida is used by invalids only during the cold season; but, exclusive of Florida, the Gulf coast is frequented both in winter and in summer, the former being the season for North- erners, while the latter brings an influx of visitors from the Southern States. The air of this district is, however, much more humid than that of Southern California or the Riviera, and the rainfall is greater. From butler's geographies, by permission of e. h. butler & co. Copyright, 188S. NORTH AMEBIGA. I93 These climatic features and the temperature are also somewhat in- creased on the Florida peninsula, although there is more equability than on the Gulf coast. SIERRA ROCKY NEVADA MOUNTAINS APPALACHIAN SYSTEM As regards the interior of the continent, if reference is made to the relief-map opposite, and to the profile shown here, it will^be seen that there is high ground near the eastern coast — the Appa- lachian system. Through these uplands are situated numbers of valuable summer-resorts, with cool, though somewhat moist climates, at elevations ranging from a few hundred to three thousand feet. A few of these resorts, such as Saranac, in the Adirondacks, and Asheville, in North Carolina, are used also in winter. In the South, running east and west, are the Ozark Mountains, of a more moderate elevation and possessing a somewhat drier climate, but not at present much resorted to by invalids. In the western half of the continent is the Cordilleran system, in which are situated the high-climate stations of Colorado, New Mexico, and Arizona. In these resorts, which are situated at alti- tudes ranging from 3000 to 8000 feet, the precipitation and humidity are less, the temperature usually higher, the hours of sunlight longer, and the wind-movement aud the dust greater than in the Alpine stations of Europe. Still further to the west are the Sierra Nevada and Coast Ranges of California, which are beginning to be much used in summer, but are too cold and snowy for pleasant winter- residence except at very moderate elevations. The lowlands of Arizona and Southeastern California resemble in climate Egypt, Syria, and other desert-countries of Northern Africa, though they are inferior to those countries in interest and accommo- dations. In comparing the resources of American and European resorts it may fairly be said that while the former rival and even excel those of Europe in places which are well established and most frequented, this is not the case with the smaller, less-used, and more recent resorts, though there are notable exceptions and a general improve- jxxeat is noticeable. 13 CHAPTER XI. EASTERN CLIMATES. Atlantic Coast Kesorts. The direct influence of the Gulf-stream on the eastern Atlantic coast is less marked than is commonly supposed. The hot waters flowing north are kept at a distance of from twenty to one hundred miles from the coast by the counter-current from Baffin's Bay, which skirts the shores of North America. The inner limit of the Gulf- stream is well defined by a bank or wall, where the waters of the opposing currents meet in passing. One of the mildest and driest of the sea-climates north of St. Augustine is found on the south- eastern shore of Nantucket. The Gulf-stream approaches nearer to the coast at this point, and it is warmer in winter and cooler in summer than any other point on the northern Atlantic coast. Table I.— Atlantic Coast Climates in the United States.' Mean moi ithly temperature. No. years of record ' Annual Locality. rainfall. January. July. ! Annual. 41° Temp. Rainfall Eastport • 1 20° 60° 48.4 in. 18 18 Portland (Me.) 23 69 46 42.7 " 18 21 Nantucket . 33 67 48 42.0 " 5 16 Wood's HoU 31 68 49 44.9 " 9 13 Newport . 1 30 50 50.9 ■' S 5 Block Island 1 31 68 49 44.4 " 11 12 Philadelphia ' 33 76 54 40.9 " 18 22 Baltimore . 34 78 55 44.8 " 19 21 Atlantic City 32 72 52 42.8 " 18 19 Cape May . 34 74 53 46.7 " 13 10 Norfolk . 41 79 59 52.7 " 19 22 Charleston . 51 82 66 56.3 " 18 21 St. Augustine 57 81 69 49.2 " 20 17 Pensacola 53 81 68 59.9 " 12 13 Cool summer marine climates are found along the New England seacoast, from the Islands of Campobello and Mt. Desert and the Isles of Shoals, to Cape Ann and the Manchester and Beverly shore. South of this the temperature is higher and the air more 1 For temperature, rainfall, etc., of other ocean coast-stations— Boston, New York, Jupiter Key West, San Francisco, Santa Barbara, San Diego— see Tatle V. EASTERN CLIMATES. 195 humid, and of the seashore-resorts on the south coast of Massachu- setts Dr. V. Y. Bowditch says ''that they are not often benefi- cial to people with pulmonary disease, the prevalence of wet fogs being a serious drawback to the climate in that region. The quality of the climate is distinctly relaxing, and is often beneficial to patients suffering from nervousness and insomnia." Bastport, lying very near the Canadian border at the southeastern extremity of Maine, is first described because it is the most northern resort mentioned and also because it has a weather-station ; its re- port is inserted in Table I. Its meteorological conditions are more or less typical of this part of the coast. It is a pretty place, with a population of about 4000, and is located on a small island on the western shore of Passamaquoddy Bay. It has many natural advan- tages, among them being, of course, facilities for yachting and fish- ing. Summer-life there is, however, subject to the disadvantages contingent upon residence in a town. Mount Desert, an island far-famed as a summer watering-place, of which Bar Harbor is the most important and fashionable resort, lies off the coast of Maine and rises from sea-level to a height of over 1500 feet. On the west the slope is gentle and gradual, but on the east the hills rise precipitously from the sea. The northern coast is very near the mainland, to which it is joined by a bridge. The island is reached over the Maine Central Railroad, which connects with the Bar Harbor ferry, or by steamer from New York, Boston, Eastport, and Bangor, or via Rockland. Mt. Desert is formed of granite-rock, and the soil is notably dry and has great power of absorption. The climate during the summer is cool, refreshing, and very equable, the meau temperature being 70° F. for the days and 64° for the nights.^ Fogs are rather frequent. No records of humidity are obtainable, but the observa- tions furnished by Dr. Longstreth would indicate that it is by no means excessive for a place so situated. He writes that the prevail- ing wind is from the west, but that the " high" winds blow from the southwest and bring with them the greatest degree of humidity, and that, under these conditions, the mountains are often capped with fog-clouds. During many dense fogs the humidity, as shown by instruments, is 25 or 30 points less than it is during a southwest wind with general sunshine. It is only fair to say that Dr. Long- 1 New York Medical Record, June 13, 1896. ]96 MEDICAL CLIMATOLOGY. streth's remarks refer exclusively to Bar Harbor and its immediate vicinity, and perhaps would not, he says, be wholly applicable to all parts of the island because of difference in relative position with regard to the mountain elevations, the ocean, and the wind. The water is usually too cold for bathing, but the boating and fishing are of the best. Accommodations are good all through the island, and at Bar Harbor they are as luxurious as could be desired. The roads and foot-paths in this vicinity are very tolerable. Bar Harbor affords a delightful social life and every kind of outdoor and indoor diversion ; but those who wish to pass a rather monoto- nous, purely restful summer will find more suitable quarters in other parts of the island. Portland, situated on the southwestern coast of Casco Bay, is the commercial centre of Maine, and is also the centre of a group of attractive seaside-resorts. The weather-report is to be found in Table I. It is reached from the south by the Boston and Maine Railroad and from the north by the Maine Central Railroad. Its summer climate is very pleasant because of the sea-breeze, which blows steadily. There are some fine baildings and churches in Portland, and the accommodations are good. The drives through the suburbs and environs are most enjoyable. Soarboroug-h Beach, Old Orchard Beaoh, Kennebunkport, Wells Beaoh, and York are coast- resorts to the south. The hard, gradually sloping beach at Old Orchard affords particularly good and safe bathing. Portsmouth, New Hampshire's only seaport, is situated on a peninsula near the mouth of the Piscataqua River, and is almost surrounded by water. It is, historically, one of the most interest- ing towns of the coast. The streets are broad and beautifully shaded, and the residences are large and comfortable. The hotel- accommodations are very good. The Isles of Shoals, nine rocky islands lying from six to nine miles from the mainland, are reached from Portsmouth by steamers which leave and arrive several times daily. They are much resorted to because of the pure sea-air, mild and even temperature, and their freedom from that pest of summer seaside-life — the mosquito. There are two large hotels on these islands. The Isles of Shoals have been rendered famous by the writings of Lowell and Celia Thaxter. New Castle, Rye Beaoh, and Hampton Beach, lying to the south of Portsmouth, are well-known resorts. All of them afford EASTERN CLIMATES. 197 good hotel-accommodations, boating, fishing, bathing, and driving, and Eye Beach is, perhaps, the most fashionable seaside-resort on the New England coast. Cape Ann, projecting from the east coast of Massachusetts, and Gloucester, on the same peninsula, are resorts of the quieter order. They have been much visited by artists and authors on account of their quaintness and picturesque interest. There are two hotels. East Gloucester, reached from the station by an electric tram- way, is much resorted to by invalids and by persons who desire a quiet summer-life. The accommodations, though of a simple order, are good. Plymouth is a charming old town which lies on the coast forty- six miles south of Boston. It was the landing-place of the Pilgrim Fathers. It is reached by the Old Colony Railroad. Besides its claims to historic interest it possesses all the attractions of a watering- place, and is, moreover, situated in a charming country which gives opportunity for many delightful drives and excursions. The accom- modations are good. Cape Cod, which extends eastward from the coast of Massachu- setts for miles into the Atlantic Ocean, is, for the most part, a flat, sandy expanse, devoid of rocks and trees. It is traversed through- out its entire length by the Old Colony Railroad, and is much re- sorted to during the summer. Its lovers asseverate that there is an especial charm about the resorts on ''the Cape" not to be found elsewhere. Sea-fishing, yachting, and surf and Stillwater bathing are enjoyed here in their perfection. Good accommodations of all sorts may be had at various points on Cape Cod. Wood's HolL a small maritime village situated at the southeastern extremity of Buzzard's Bay, is reached by the Old Colony Railroad from Boston, and from New York via Fall River. It is a station of the United States Fish Commission, has a marine biological laboratory, and is an attractive resort of the quieter order. It has one hotel and good accommodations may be obtained. For weather- report of Wood's HoU, the reader is referred to Table I. Martha's Vineyard. Off the southern coast of Massachusetts lies Martha's Vineyard, an island twenty-three miles long and, at its widest, ten miles across. Its inhabitants, like those of Nantucket, were formerly engaged in the whale-fisheries ; but it has long owed its importance to its advantages as a summer-resort. Most of the summer visitors go to Cottage City, on the northeastern shore of the 198 MEDICAL CLIMATOLOGY. island. A narrow-gauge rail way runs southward along the east coast to Edgartown and Katama. There is every facility for fishing, sail- ing, and Stillwater bathing, and the roads are excellent, so that both driving and wheeling are popular amusements. At Martha's Vine- yard are the great camp-meeting grounds, where from twenty to thirty thousand Methodists gather every August. Nantucket. The island of Nantucket, sandy and treeless like Cape Cod, lies about fifteen miles east of Martha's Vineyard, far out in the Atlantic. Steamers ply daily between Nantucket and Cottage City and New Bedford, and there is a weekly steamer to Portland and New York. Dr. Harold Williams says : " The soil is chiefly sand — very dry and porous. For the summer of 1894 the highest temperature was 85° F., and the lowest 51° F. The greatest diurnal range was 19°. The mean relative humidity was 84 per cent, for July, August, and Septem- ber, 1894." The yearly mean of relative humidity for five years is 81 per cent. The mean monthly temperature for summer is 64°; relative humidity 83 ; seasonal rainfall 8. 5 inches. There is about the same amount of rainfall as at Atlantic City. The air is unusu- ally dry for sea-air and more stimulating than that of the adjacent coast. Dr. Williams says, further, that there are frequent fogs, and that the wind is constant and often high — blowing, of course, off the ocean, no matter from what quarter it sets. In 1894, beginning with July 1st, there were 92 consecutive pleasant days. There are excellent hotels and boarding-houses. One may also rent or buy houses, and the rates of living are low. The settle- ments are quaint and picturesque, and the island bears a great variety of wild flowers. The amusements comprise bathing, row- ing, sailing, fishing, shooting, tennis, golf, riding, and driving; the blue-fishing is especially fine. A narrow-gauge railway runs from the village of Nantucket to Surf Side and Siascouset. Dr. Wil- liams says : " Nantucket claims to be especially desirable as a summer health-resort because of the purity of its air, its coolness, the smallness of its diurnal range of temperature, and the particles of sea-salt contained in its air." Newport, one of the capitals of Rhode Island and " Queen of American seaside-resorts," is situated on a low plateau in the south- western part of the State. The town is an old settlement of much historic interest, but it is chiefly known as the most fashionable summer-resort in America. The scenery and surroundings are EASTERy CLIMATES. 199 beautiful, and the climate is equable and balmy, but humid and relaxing, Xewport has fine buildings and churches, a casino, and a library of 40,000 volumes. The hotel-accommodations are good. Narragansett Pier, situated on the Avest shore of Narragansett Bay, is also a noted and fashionable resort. It has a very fine bathing-beach, many magnificent hotels, and a large casino. Watch Hill is a favorite resort on the extreme southwestern corner of Rhode Island. Here are to be found good bathing and fishing, beautiful scenery, and hotel-accommodations of much excel- lence. Block Island. To the south of the Rhode Island coast, at a distance of ten miles from the mainland, lies Block Island. It is reached by steamer from Stonington, from New York direct, or from Providence and Newport. The mean temperature for the summer months is 73° F. On the north shore are good beaches for surf-bathing. The Connecticut shore and both the north and south shores of Long- Island are dotted with attractive little summer-resorts affording all the usual seashore diversions and, in addition, charm- ing drives. The coast of Ne^w Jersey is lined with resorts which are fre- quented by seekers after health and by those who desire to escape from the disagreeables which form an accompaniment to summer residence in the ilat, inland country of New Jersey, Pennsylvania, and Delaware. There are to be found at most of these resorts good hotel-accommodations and all the diversions which such places usually afford — boating, surf-bathing, and fishing. The bathing- beaches of the New Jersey coast must be especially commended. The great disadvantage of summer-life upon this coast is found in the presence of swarms of mosquitoes ; but this is mitigated when- ever the breeze blows from the sea. Of the New Jersey resorts may be mentioned the following : Monmouth Beach is chiefly a collection of private cottages, with a club-house and a casino. Long Branch, with which we may include Elberon, Hollywood, and West End, is one of the most popular watering-places on the continent, and one of the most expensive. The number of summer- guests rises as high as 50,000. The original settlement is a small village situated on a bluff about thirty feet above the beach. At Elberon are located most of the fine villas. The hotel- accommoda- 200 MEDICAL CLIMATOLOGY. tious are, as might be expected, comfortable and luxurious iu accord- ance with the requirements of one of the most fashionable resorts in the country. The Hollywood Hotel, surrounded by trees, is especi- ally excellent, and is open all the year round. Asbury Park and Ocean Grove are neighboring resorts, equal in natural advantages, the former being frequented by those who, liking the locality, object, nevertheless, to the exclusively religious management of Ocean Grove. Each settlement has a plank-walk about a mile long bordering the beach, and the accommodations are good in both places. Other attractive resorts are Sea G-irt, Squam, Barnegat (not- able for the good shooting which it affords). Beach Haven, *and Brigantine Beach. Atlantic City is situated on a long and narrow island on the New Jersey coast, where the coast-line bears sufficiently to the west to afford a southeasterly exposure to the sea. This resort has a permanent population of 12,000, which is increased during the summer to about 60,000. It is ninety-five miles, or about four hours by rail, from New York City, and fifty-six miles, or one and one-quarter hours, from Philadelphia. The soil is sandy. Snow seldom remains on the ground for any length of time. The water-supply is considered good. Besides house-cisterus for storing the rain-water there are town water- works, which bring spring-water from the mainland, seven miles distant. There is a town-system of sewerage. The mean monthly temperature and total rainfall for Atlantic City, by seasons, are as follows : Winter Spring Summer Autumn There is a yearly average of 6 days above 90° temperature and 127 days below 32°. Number of cloudy days, 110. The mean annual relative humidity (three years, 1891-93) was 81 per cent.; for winter, 81 per cent.; for summer, 83 per cent. The sea-breeze usually begins to blow about 11 a.m. and con- tinues until nightfall. The mean annual hourly wind-movement for the three years 1891-93 was 11.9 miles. n temperature Total rainfall (18 years). (mean of 19 years) . 34° 11.1 inches. . 47 10.0 " 70 11.4 " . 55 10.4 " EASTERN CLIMATES. 201 In 1885 a report of the mean yearly wind-movement for five years for Atlantic City and Cape May, published by Mr. B. A. Blundon, observer at Atlantic City, was as follows : Atlantic City 82,630 miles.' Cape May . 130,055 " The total wind-movement for Atlantic City for the year 1891 was 108,624 miles; for 1892, 105,120 miles; for 1893, 92,492 miles. It was in each case higher than the above mean for five years. In the pamphlet just referred to, two reasons were advanced on which the claim of ''dryness'' could be made for the climate of Atlantic City. One was that the rainfall was less than at any other place on the coast, and the other that the records of the hygrometers were not significant, as the instruments at that time (1885) were but thirteen feet above the sea and ''affected by the spray, during the strong winds off the water, and by occasional morn- ing mists which do not extend back iuto town." For several years past (1895) the instruments used by the Weather Bureau have been located sixty-eight feet above sea-level. The percentage of relative humidity does not, however, appear to read any lower than in the former records. Atlantic City has a number of advantages as a resort. It is easily accessible from the large cities of the East. The town is well built, possessing markets and shops, miles of streets and suburbs, street- cars, and churches, and hundreds of hotels and boarding-houses of every grade. There is a good beach and in summer excellent sea- bathing. In a pamphlet entitled Atlantic City as a Winter Health-resort, Dr. Boardman Reed says: "There is no body of fresh water nearer than the Delaware River — distant about sixty miles — and the salt-water bays to the landward side are nearly always open, ice seldom forming, except for a short time, occasionally in the severest winters." Dr. Reed also notes that the land-winds pass for long distances over dry and porous, sandy soil before reaching Atlantic City. The rainfall is surprisingly regular during the four seasons. It averages 3.5 inches for each month iq the year. The climate of Atlantic City is mild for its latitude. The winds 1 Atlantic City as a Winter-resort. B. A. Bhmdon, Sergeant Signal Service, U. S. A., 1885. 202 MEDICAL CLIMATOLOGY. are bracinsf, and in winter the winds from the sea are warm winds. The soil is dry, and an absence of malaria is reported. During the cold season, when the temperature is low and the winds come from the west and northwest, the amount of humidity in the air is much smaller than that at some southern and warmer stations. During the summer, with the mean temperature about 70° F. and the relative humidity in the neighborhood of 80 per cent., the amount of actual humidity is high, as may be expected in all marine climates. Atlantic City has a plank-walk bordering the beach for four miles. Among the attractions are fishing and \yild-fowl shooting, and there is a very pretty casino with reading-, smoking-, and dancing-rooms and an enclosed piazza overlooking the boardwalk and the ocean. Cape May. This well-known summer-resort is situated at the southern end of the State of New Jersey, opposite the entrance to Delaware Bay. The soil is gravelly, with sand under the gravel, and below another layer of gravel. The water for domestic use is obtained from wells aod distributed after the Holly system. It is soft and pleasant to the taste. There is an absence of extreme temperatures at Cape May. In winter there are rarely any readings down to zero. Dr. Huntington Richards, in the article on this resort in Buck's Reference Hand- book, says that the equability of the temperature at Cape May is at all seasons more marked than at Atlantic City. From the same authority the following table is obtained, based on observations taken from 1871 to 1883 : JIetkorologecal Table foe Cape May — Record for 13 Years. observations of temperature taken at 7 a.m., 3 p.m., 11 p.m. Mean relative Mean monthly humidity. Total rainfall. Wind. temperature. Per cent. Inches. Miles per hour. Winter . 36° 77 11.9 15.4 Spring . 49 75 11.1 14,5 Summer 72 80 12.8 10.2 Autumn . 58 75 11.7 13.7 Year . . 53 77 47.6 13.4 Average number of cloudy days in a year, 117. It is very windy — in fact, Cape May is one of the windiest sta- tions in the country. EASTERN CLIMATES. 203 The distance from Philadelphia is about eighty miles, a ride of two hours by rail. There are good hotels and boarding-houses. During the summer the sea-bathing is one of the greatest attractions. Cape May may be said to be rather more fashionable than Atlantic City. It has a magnificent hard bathing-beach five miles in length. Norfolk, mentioned because its weather-report (Table I.) may be taken as representing this part of the coast, is the second city of Virginia, and is surpassed among the Atlantic ports south of the Chesapeaiie only by Savannah. There are three good hotels. Eighteen miles from Norfolij is Virginia Beach, a seaside-resort surrounded by pine-woods. Currituck Sound, thirty miles to the south, is much resorted to because of the wild-fowl shooting it affords. Old Point Comfort, situated on a peninsula north of Hampton Roads, is the site of the great fortification Ivuown as Fortress Mon- roe. There are two hotels, comfortable, but rather expensive, of one thousand beds each, and some cottages. The winter-tempera- ture is rarely below 40° F., uor does the summer-temperature often exceed 80°. Good bathing, boating, and "crabbing"' are among the amusements. The social life of the place is, partly because of the presence of the garrison, very gay. Old Point Comfort may be reached by railroad or by steamer. The hotels have sun-galleries protected by glass. During the winter and spring the place is resorted to by visitors from the North who wish to escape the inclement home- season, but during the summer it is frequented chiefly by health- and pleasure-seekers from the Southern States. The climate is consid- ered beneficial to patients recovering from bronchitis and for sufferers from nervous troubles. St. Augustine, latitude 29° 53' north, has a resident population of 5000, but during the winter the population of this popular resort is increased to 10,000. It is thirty-eight miles from Jacksonville, two hundred and forty-four miles north of Jupiter, and rather more than two hundred and fifty miles from Lake "Worth. St. Augus- tine is the oldest town in America, and is situated on the Atlantic coast of Florida, on a peninsula opposite Anastasia Island. The harbor is small and shallow, but, with its miles of connecting rivers, is well adapted for small boating. The surrounding country is flat and sandy and is overgrown with scrub-palmetto. The average elevation of the town above tidewater is twelve feet. The older portions of the town have narrow streets and quaint old houses 204 MEDICAL CLIMATOLOGY. built of "coquina" or shell-limestone. In the modern town are some of the finest hotels in America. There are also beautiful parks and semi-tropical gardens. North Beach is a favorite driving- resort. St. Augustine is a United States military-post, and has guard-mount daily and frequent parades with the military band. The climate is mild, equable, and humid. A record of the mean temperature of St. Augustine for twenty years (1824-'53) was quoted by Dr. J. P. Wall, of Tampa, in a paper read before the American Climatological Association in 1891. The following is a summary: monthly mean, winter, 58° F. ; spring, 68°; summer, 80°; autumn, 71°; annual, 69°; January, 59°; July, 81°. A record of rainfall in St. Augustine for seventeen years shows an annual mean of 49.2 inches. The greatest yearly precipitation was 67.4 inches, in 1880, and the smallest 33.9 inches, in 1851. The winter climate of St. Augustine is partly shown in the fol- lowing report, which is adapted from a paper prepared by Dr. Frank F. Smith in 1887. Mean of records for ten seasons from 1877-'78 to 1886-'87 : Temperature, November, 64°; December, 58°; January, 55°; February, 59°; March, 62°; April, 68°; mean, six months, 61°. During these six months the average temperature for ten seasons was at 7 a.m., 56°; at 2 p.m., 67°; at 9 p.m., 59°. Mean temperature for winter (December, January, and Febru- ary) 57°.i There was an average of 152 days in each season above 60°, of which 90 days were over 70°. The wind blew from the east about half the time. Mean rainfall for six months (November to April, inclusive) was 33.5 days, of which rain fell at night on 19.1 days, and during the daytime on 14.5 days out of 181 days in each season. Inland Resorts. Maine. The Rang-eley Lakes. Among the inland summer-resorts of New England should be mentioned these famous trout-lakes, which afford the attractions of camp-life, beautiful scenery, and clear air. There are half a dozen lakes connected by waterways. The eleva- 1 The formula jg 7 + 2 + 9 + 9 : 4 EASTERN CLIMATES. 205 tioii of the highest lake is 1511 feet above the sea. Black-flies and mosquitoes are troublesome until after July. The climate is cool during the summer. There are numerous hotels and camps around the lakes, which are reached by a narrow- gauge railroad from Farmington — forty-seven miles distant — in about four hours. The little village of Rangeley affords good hotel-accommodations. The Maine "Woods. The climate of the forest country of Upper Maine resembles that of the Adirondacks, and has been visited for many years, both in summer and in winter, by those who wished to live a rough, hearty, outdoor life. The principal gateway of this region is Greenville, at the southerly end of Moosehead Lake, which can be reached by railway. Moosehead Lake (elevation, 1023 feet) is about thirty-five miles long, with an average width of ten miles. It varies, however, from one to fifteen miles in width. Half-way up the lake is the Mt. Kineo Hotel, which has accommodatiou for 500 guests. The lake and its tributary streams afford good fishing. From the north end of the lake there is a two-mile carry to the west branch of the Penobscot River. By means of canoes long trips can be made arouad Mt. Katahdin (5385 feet) and further into the pine-forest, or down the stream to Bangor. Black-flies and mosquitoes are very troublesome throughout this region iu summer. There are no detailed weather-records for the forest country. It is a land of severe winter cold and heavy snows. The trees are pine, spruce, hemlock, and fir, with some hardwood growth in the highlands. There are good hotels to be found in the village of Greenfield. Good hunting can still be found at a distance from the settlements. In the Aroostook farming country, northeast of Moosehead Lake, a broken record of temperature for two years can be given for Houlton, a town of 4000 inhabitants, situated near the New Bruns- wick line about one hundred miles from Moosehead: Winter. Spring. Summer. Autumn. Year. Max. Min. 1 for two years, 1892-'93. 11° 35° 64° 4S'' 38° 97° —28° January, 1892, and June, 1893, missing. Annual rainfall about 30 inches. Poland Spring's, a favorite inland watering-place, lies five miles 206 MEDICAL CLIMATOLOGY. from Danville, and is reached from there by means of six-horse coaches. It has an elevation of 800 feet, and the views are very fine. There are two hotels. The chief attraction of the place lies in its mineral springs. Vermont. Breadloaf Inn, in the Green Mountains, is twelve miles from Middlebury. It is very well kept and the prices are extremely moderate. The hotel stands at an elevation of 1600 feet, and the air is dry and bracing. Ne"w Hampshire. Bethlehem (elevation, 1459 feet). Among the summer-resorts in the White Mountains Bethlehem ranks high as possessing a cool, pure, and clear atmosphere; a supply of pure, soft water, free from all danger of contamination ; adequate drainage; freedom from malarial and typhoid fevers; good accommodations ; and beautiful scenery. The place is remarkably free from insect-pests. Dr. W. H. Geddings, in 1891, prepared a paper for the American Climatological Association, descriptive of Bethlehem and of Maple- wood (one mile distant), from which much of the following informa- tion is taken : The plateau upon which Bethlehem and Maple wood are located, formerly known as Bethlehem Street, is protected by a range of high hills from warm south winds. There is a fine view over the beautiful valley of the Ammonoosuck, which is-over 200 feet lower, and insures good drainage. In the early morning the valley is often tilled with fog and mist, while the plateau above is bathed in sunshine. On the east the town is protected by Mount Washington (elevation, 6923 feet), twenty miles away, and by the peaks of the Presidential Eange. On the west the country is rolling, a succes- sion of hills and valleys, with a distant view of the Green Moun- tains. Water is supplied from a reservoir fed by springs behind the town. A drain-pipe runs through the streets and into the valley below. The soil is rich but rocky, and is usually covered with boulders. There are a number of hotels and boarding-houses in Bethlehem and a large hotel and cottages in Maplewood. The population of Betlilehem is 1000. The summer visitors are said to number 10,000 or 15,000. The season is from the 1st of July to about the 1st of September. EASTEBN CLIMATES. 207 Few people remain throughout the fine weather of September and October. The mean temperature from three daily observations (7 a.m., 2 and 9 p.m.) for nine years' records was : July, 66° F.; August, 65°; the first half of September, 63°. The average temperature for the season was 65°. The temperature once reached 90°, but it rarely rises above 87°. The mean daily range for July and August for two years was 10°. The mean relative humidity for five years was : July, 64 per cent.; August, 65 per cent.; first half of September, 68 per cent. This record is lower than that of any other summer- resort known to the author east of the Rocky Mountains. (See Table Y.) The normal rainfall is at the rate of 3i inches for each month of the season, the amount being usually greater in August. The prevailing wind comes from the southwest. There is no record of the wind-velocity. Mosquitoes are troublesome in June, but are rarely seen after the 1st of July. Bethlehem has for years been especially noted for affording exemption from hay-fever. Its climate is considered cool and tonic, with a tendency to sudden changes. Jefferson (elevation, 1440 feet), situated in the Franconia region, is to be classed with Bethlehem as to accommodations, and is equally popular. It is a station on the Concord and Montreal Railroad, and is two miles from the Maine Central Line. The view from Jefferson is considered by many to be the finest general view of the White Mountains obtainable. The drives and walks in this vicinity are very good. The villages near Lake \yinnipeseogee are much used as summer- resorts. The lake is traversed by small steamers. Gilmanton, situated on a high tableland, is a favorite resort. There are no good hotels, but there is one first-class boarding-house. Dublin is a beautiful village, finely situated on the northwestern base of Mount Monadnock, at an altitude of 1500 feet. It may be reached by stage from Peterboro', or via Harrlsville over the Boston and Maine Railroad. There is one first-class hotel and one thor- oughly good boarding-house, and Dublin possesses also Episcopal and Unitarian churches and a fine public library. The roads are good and the surrounding scenery particularly beautiful. A body of water, called Monadnock Lake or Dublin Pond, lying within easy reach, affords boating, swimming, fishing, and bathing. 208 MEDICAL CLIMATOLOGY. The social life of the place is easy and pleasant, and includes dances and concerts as well as the usual outdoor diversions of a summer- resort. There are frequent strong west winds, but fogs are rare. It is said that the climate is characterized by the purity of its air and its tonic 'qualities. Below is a table giving meteorological data (humidity not recorded) : 1893. Max. Min. January . 45° —14° Clear days 13 ; part cloudy 8 February . 45 —10 Ci fi 13 5 March . . 53 1 ii 11 9 April . . 61 17 l( 12 5 May . . 85 82 If 14 5 June . . 86 44 '^ 10 7 July . . 84 46 ([ 18 9 August . 86 47 i( 16, 9 September 72 37 i( 12, 6 October . 70 23 ** 10 3 November 58 11 (C 10 5 December . 51 — 8 it 12 7 Franoonia Village, while it does not in itself offer attractions to the visitor, is the point for reaching several pleasant summer-resorts. Of tliese, one— Forest Hills Hotel — looks down from an elevation of 1100 feet upon the village. The hotel faces south, and the rooms and table are excellent and reasonable in price. The views are varied and beautiful. The soil is dry and sandy. Dr. Francis Bacon, of New Haven, considers it one of the most desirable places in the White Mountains, being especially dry and bracing for that region. There are golf-links, tennis-courts, etc., and pleasant walks and drives. Acro.ss the valley on Sunset Hill are good hotels and many private cottages. Peterboro', Jaflfrey, and Rindg-e are resorts lying in the same district. Good farmhouse-accommodations may be obtained through- out this vicinity. Massachusetts . Princeton, Worcester County, is sixty miles from the sea, and has an elevation of about 1000 feet. The situation is open, with a good, free exposure, and stands well up above the surround- ing country, which, while hilly, in this immediate neighborhood slopes rapidly to the plain, except in the direction of Mt. Wachusett. The vicinity abounds in beautiful views and pleasant drives and walks. The air is bracing and markedly drier than that of the sea- EASTERN CLIMATES. 209 coast. There is a good country hotel, and excellent plain boarding can be obtained. Mt. Wachusett, in the immediate neighborhood, is somewhat higher than Princeton. It has one or two good hotels situated above the town, and therefore aifords to those who desire to benefit by it, the more rarefied air of a comparatively mountainous district. Petersham, at a little distance from Princeton, possesses the same general climatic conditions, and, like Princeton, is an excellent re- sort during the summer and early autumn for people suffering from pulmonary trouble. Sharon is a small town eighteen miles from Boston, on the Provi- dence Railroad, with an elevation of 300 to 400 feet. The soil is gravelly and the water-supply pure, and there is an additional ad- vantage in the presence of pine-woods. The east winds of the coast are much tempered, and the air has a medium bracing quality not noticed at lower points. It haS a local reputation for healthfulness. Dr. V. Y. Bowditch, of Boston, selected this region as the best accessible spot for a sanitarium, which is referred to more particu- larly in the therapeutical portion of this book. It is an admirably conducted and pleasant home for consumptives of limited means, and is situated on sloping ground at the edge of pine-woods, about a mile from the village. Ne'w York. Adirondacks. This elevated plateau lies in the northeastern portion of the State of New York. Roughly outlined, it extends from the Mohawk Valley, on the southern boundary, northward one hundred and fifty miles to the St. Lawrence valley and the Cana- dian line, and is bounded on the east by Lakes George and Cham- plain ; the high, rolling forest country continues westerly for eighty or one hundred miles, covering an area of 3,588,000 acres. The mountains run in a southwesterly direction from Lake Champlain in five parallel ranges seven or eight miles apart. The greatest width of the mountain-belt is about forty miles. The most westerly of these ranges forms the backbone or divide of the region, separating the watershed of the St. Lawrence River from that of the Hudson River and Lake Champlain. There are a number of peaks rising over 4000 feet, the highest being Mt. Marcy (5345 feet) and Mt. 14 210 MEDICAL CLIMATOLOGY. Mclntire (5200 feet). The mountaia-plateaii has a general elevation of from 1500 to 2000 feet. Except on the peaks, the entire wilderness is still well covered with forest, although a vast quantity of lumber has been removed. Tiie proposed reservation, Adirondack Park, will set apart over 2,800,000 acres in the centre of this country, of which over 1,500,000 acres are primeval forest and more than 1,000,000 acres lumber- forest. Much of this is still under private ownership. The principal tree-growth is pine, balsam, spruce, and hemlock, and the resinous odor is very strong. A network of lakes and pouds is one of the attractive features of the Adirondacks, adding diversity to the landscape and affording easy communication throughout the interior country by means of light boats. The facilities for camping, hunting, and fishing all through this region are well known. There are nearly two hundred comfortable hotels, boarding-houses, and camps scattered through it.' The prin- cipal resorts are from ten to fourteen hours' journey from New York City by rail. The most important gateways are Plattsburg, Port Kent, and Westport from the east; Saratoga on the south; and several stations on the Adirondack division of the New York Cen- tral Railroad from the west. A meteorological record for Saranac Lake for the year 1894 was kindly furnished to the author by Dr. E. R. Baldwin, voluntary observer, from which the following abstract is taken : Saranac Lake, Weatherstation.,,,,. . ,„ . Lat. 44° 19' N. I Winter. Spring. Elevation 1760 ft. ' 18° Mean monthly ) '. temp. (1894), | Total rainfall, 7 in. Cloudy days, 35 days 43° 7.2 in. 35 days Summer. 63° 10 in. 17 days Autumn. ! Annual. 44° 42° i 10.4 In. 34.7 in. 42 days 129 days Mean for Jan.20°, min.— 15° " July, 66°, max. 91° Including snowfall, 85i in.2 Stormy days, 125 The coldest month was February: mean temperature, 13°; mini- mum— 31°. One of the best known resorts is Paul Smith's, or the St. Regis Lake House (1620 feet), which is situated on the north shore of ' See hotel-list of the Adirondack Railroad for 1895. 2 The snowfall is usually measured by melting. An approximate value is one inch of water for each ten inches of snow. EASTERN CLIMATES. 211 Lower St. Regis Lake, a lovely chain of lakes about five miles in length, with sandy shores and very little rock, well suited for camping. This region is comparatively level, there being only one mountain in the vicinity — St. Regis — about 3000 feet high. Saranac Lake Village (elevation, 1600 feet) is the largest settle- ment in the Adirondacks, and the only winter-resort. On a hillside one mile from the village and ten miles from Paul Smith's is the Adirondack Cottage Sanitarium (1750 feet), a cluster of nearly twenty small cottages and other buildings, built up during the past ten years under the management of Dr. E. L. Trudeau. The sani- tarium is situated on a shelf-like plateau, seventy-five or one hun- dred feet above the Saranac River. A hill rises on the northwest to a height of about one hundred feet, and at a considerable distance north and northeast is a range of the Adirondack Mountains. Saranac Lake can be reached in ten hours from New York by the Adirondack division of the New York Central Railroad, which joins the main line at Utica. The climate of this region shows the temperature to be low and steady during the entire winter. Much snow falls, and there are many windless, cold, snowy days. The normal annual rainfall was stated by Dr. A. L. Loomis, several years ago, to be as high as 55 inches.^ Rain- and snow-storms are frequent, although they are said to be less severe than on the coast. Snow lasts from the middle of November to the middle of March or April, varying in different seasons. The soil is porous and dries quickly. There is a preponderance of cloudy weather at all seasons, espe- cially during the winter. There are no records of the relative humidity nor of the wind- velocity, but the movement of the wind is usually gentle, as might be expected in a forest-region, while the percentage of humidity is high. Ampersand (elevation, 1600 feet) is a large and excellently kept hotel on the slopes of Lower Saranac Lake, one mile from I he Saranac Lake "Village. It has attached to it a little village of tents. No meteorological data for this resort were obtainable. Saranac Inn is to be found at the head of the Upper Saranac Lake. It is reached by the New York Central Adirondack Rail- way. It is a comfortable hostelry, situated upon one of the most picturesque and largest of the Adirondack lakes. 1 The Adirondack Eegion. A. L. Loomis, M.D. Transactions of the American Climatolo- gical Association, 1879. 212 MEDICAL CLIMATOLOGY. Blue Mountain Lake (elevation, 1800 feet) is thirty miles by turnpike from North Creek (via Saratoga), or it can be reached from the Adirondack division of the New York Central and Hudson River Eailroad, via Fulton Chain, by lakes and carries. The lake is two miles in diameter, and lies in a basin formed by Blue Mountain on the north and a ridge of mountains on the south side, and on its shores are two large hotels. The pine-forests are said to be very extensive in this region. A table of seasonal temperature from records for three years^ is as follows : Winter. Spring. Summer. Autumn. Annual. Mean monthly temperature, 20° 37° 61° 41° 40° Meanfor January, 18°; for July, 61°; maximum, 86°; minimum, —26°. The prevailing winds are from the northwest. The winds are occasionally high. The fly-nuisance is usually over by July. While visiting this country in June the author was agreeably surprised to tind it not noticeable. Lake Placid (elevation, I860 feet), four miles long by two miles wide, with its close companion. Mirror Lake, and with numerous hotels and cottages and fine mountain-scenery, is a deservedly popular resort. The beautiful Keene Valley (1015 feet) contains a village and hotels. In this valley lie the Ausable Lakes, with St. Hubert's Inu, a mo.st comfortable hotel; Raquette Lake (1775 feet) and Adirondack Lodge (2160 feet), in a secluded corner of the forest, must also be mentioned. In the Fulton Chain regions are the domains of the Adirondack League Club and other clubs which attract the sportsman, but are not readily accessible to invalids. All these and dozens of other equally attractive resorts must be dismissed for lack of space. They will be found fully described in guide-books. The climate of tiie Adirondacks can only be described in the most general way, as there are no complete meteorological reports for a series of years covering any portion of this well-known region. Such records as exist are far from adequate, and are for limited periods. The stations sometimes used as a basis for estimating the values of the Adirondack climates — Plattsburg, on Lake Cham- 1 The Southern Adirondacks. E. T. Bruen, M.D., 1S86. EASTERN CLIMATES. 213 plain, and Malone and Potsdam, in the St. Lawrence valley — are beyond the limits of the true Adirondack region. A record for Saranac Lake for one year has been given above. This weather- station was established November, 1893. From the report of the Director of the State Meteorological Bureau of New York for 1893 the following data were obtained, taken from the valuable article on the " Climate of the State of New York," prepared by Mr. E. T. Turner, Meteorologist to the New York Weather Bureau : Northern Plateau. Winter. Spring. Summer. Three stations.^ Jlean elevation, 1578 feet. Mean monthly 1 temperature j Eight stations.2 Mean elevation, 973 feet. Total rainfall. 18° 62° Autumn. Annual. 43° 40° f January, 16° I July, 64° Records of temperature, average for 3 years. 79 in. 9.17 in. 10.87 in. I 10.14 in 38.97 in. Records of rainfall, aver- age for 15 years. The records of extreme temperatures are incomplete, but the maximum reported temperature is 89°F. for Constableville (in 1889- '90-'91), and 88° for Teuton's Hotel, or "Number 4" (in 1889 and 1892). For Saranac Lake the maximum is 91° (1894) and the minimum —34° (1889). The above mean annual rainfall of 39 inches includes melted snow. The amount of seasonal rainfall is indicated by the follow- ing record: Constableville, mean depth, average of three years, 137 inches ; Number 4, mean depth, three years, 108 inches ; Saranac Lake, mean depth, two years, 75 inches. Tiie snow lies less long in comparatively cleared districts, such as Saranac Lake, than in the more wooded regions. In summer thunderstorms from the eastern Adirondacks often pass down the St. Lawrence valley. The interior of the Adirondack region, with its high mountains and numerous streams and lakes, appears favorable for the development of thunderstorms. Summer-rains are frequent in the Adirondack highlands. Al- though there are local variations, a general increase of rainfall is 1 The three weather-stations were Lyon Mountain (1917 feet), about thirty-five miles north in an air-line from Saranac Lake ; No. 4, Fenton's Hotel (1571 feet), about seventy miles south- west in an air-line from Saranac Lake ; and Constableville (1246 feet), some thirty miles south- west from No. 4. - The eight stations were Constableville, Lowville, Fairfield, Johnstown, Pottersville, Eliza- bethtown, Keene Valley, and Dannemora. 214 MEDICAL CLIMATOLOGY. found in the mountain region over the Champlain and St. Law- rence valleys. The number of rainy days averages high during the year, but detailed reports for the forest or mountain-plateau are lacking. There are no published records of relative humidity for the Adir- ondacks. Mr. Turner says in his report that the region of least moisture appears to be the Champlain valley. The moisture is much greater in the St. Lawrence valley, and in summer an increase of humidity is noticed, with an increase of altitude in the region of the mountain-plateau. The humidity appears to be largely determined, however, by local conditions. In the valleys the air is very moist, and there are fogs nearly every morning over the lakes during August and September. Many of the hotels throughout the Adirondacks are located in the valleys and near lakes and rivers. The fact that the humidity is lower in the Champlain than in the St. Lawrence valley would in- dicate that it is probably lower in the eastern than in the western portion of the Adirondack highlands. The earliest frosts occur in the eastern highlands. In the vicinity of Keene Valley the first frost of autamn occurs about September 20th and the last frost of spring near the close of May. It is some- times a week or two earlier in September and late in May or early in June. As this region is almost entirely covered with virgin forest and very sparsely settled, it necessarily possesses great purity of atmosphere, being especially free from dust. The climate can be characterized as cold and moist. It is cold in winter, when the air is dry for most days and the snow lies for months, and cool and moist during the summer. There are a large number of cloudy days, and the humidity is high. The soil is generally light and sandy. The region surrounding Lake George and Lake Champlain is interesting picturesquely and historically. Lake George has been favorably known as a summer-resort for so many years that its attrac- tions need no special mention. Its excellent accommodations and the facilities which it offers for boating, fishing, and camp-life have made it a favorite spot with all classes of summer visitors. It lies at an elevation of 345 feet above sea-level, and is surrounded by well-timbered mountains. The attractions of the Lake Champlain district are of much the same order, but the elevation of this sheet of water above sea-level is only 100 feet. At Bluff Point, beyond EASTERN CLIMATES. 215 Port JacksoD, stands the luxurious Hotel Champlain, splendidly- situated so as to command views of the Adirondacks, Green Moun- tains, and Lake Champlain. Richfield Springs lies at an elevation of 1700 feet, and is dis- tant only a mile from the head of Candarago Lake. It is reached over a branch of the New York Central and Hudson River Rail- road, from Richfield Junction. The scenery of this district is most picturesque ; but the chief attraction lies in the sulphur springs, seventeen in number, which are used for both drinking and bathing. There is an excellent bath-house, completed in 1890, which includes a swimming-basin. The accommodations are very good, and boat- ing and fishing, riding and driving are among the amusements. Coaches run to the head of Otsego Lake, making connection with the Cooperstown steamer. Sharon Springs, lying about sixty miles west of Albany and fourteen miles distant from Richfield Springs, has an elevation of 1350 feet. It is situated in a narrow valley, and the surrounding hills rise to a considerable height, affording beautiful views. The sulphur and chalybeate springs are chiefly used for bathing ; the bath-houses ai-e of especial excellence, being spacious and elaborately fitted up for every variety of baths. The hotel-accommodations are very good. AXALYSIS or THE WHITE SULPHUJB SPRING AT ShARON SpRIXGS. One gallon contains : Sulphate of magnesium . 34.000 grains. Sulphate of calcium .... . 85.400 Bicarbonate of magnesium . . 24.000 Chloride of sodium ] Chloride of magnesium I 2.700 Sulphurets of calcium and magnesium 3 000 Total . 149.100 Gas : sulphuretted hydrogen 20.50 cub. inches. Saratoga Springs, in the eastern part of New York, has an elevation of 300 or 400 feet and is situated in a valley which has a dry, sandy soil. Monthly normal temperatures are : January, 21°; February, 22°; March, 30°; April, 44°; May, 58°; June, 68°; July, 72°; August, 70°; September, 62°; October, 50°; November, 37°; December, 25°. The mean daily range is 20°. No humidity-records have been kept, but the climate is said to be comparatively dry. There are few high winds or fogs. Saratoga 216 MEDICAL CLIMATOLOGY. is, and Ions: has been, one of the most fashionable resorts on the continent. It possesses an electric tramway, schools and churches, a good water-supply, and fine shade-trees. The hotels and board- ing-houses are, as might be expected, most excellent, and the place affords all the usual attractions of resorts of this order. The springs are numerous, some being chalybeate, while others contain iodine or sulphur, but in all of them carbonic acid gas is noticeably strong. Their temperature ranges from 45° to 50° F. They are both tonic and cathartic, and are, for the most part, pleasant to drink. Analysis of the Congress Spuing at Saratoga. One gallon contains : Bicarbonate of lithium Bicarbonate of sodium Bicarbonate of magnesium Bicarbonate of calcium Bicarbonate of strontium Bicarbonate of barium , Bicarbonate of iron Chloride of sodium Chloride of potassium Sulphate of potassium Phosphale of sodium Biborate of sodium Bromide of sodium Iodide of sodium . Fluoride of calcium Alumina Silica Total Gas : carbonic acid 4.761 grains. 10.775 ti 121.757 ti 143.399 it trace. 0.928 grain. 0.840 a 400.444 grains. 8.049 li 0.889 grain. 0.016 li trace. 8.559 grains. 0.138 grain. trace. trace. 0.840 grain. 700.895 grains. 392.289 cub. inches Ne'w Jersey. The Pine Belt. Running through the centre of the State of New Jersey is a sandy strip of land, which was described by Dr. I. H. Piatt, of Lakewood,"^ as sixty miles in length and from eight to twenty miles in breadth, reachiug from Freehold (Monmouth County) almost to Vineland (Cumberland County). The soil varies from light sandy loam to clear beach-sand. Extensive pine- forests are a prominent feature of this region. 1 The Pine Belt of New Jersey. Climatological Association, 1889. Isaac Hull Piatt, M.D. Transactions of the American EASTERN CLIMATES. 217 Lakewood lies ten miles from the sea and one mile from the border of the sandy strip under consideration, with which it is identical in soil and climate. It is the only place affording good accommodations, and has several large hotels and a number of cot- tages. Lakewood is sixty miles, or one and one-half hours by rail, from New York City, and has become well known as a winter- resort. The temperature is usually ten or twelve degrees warmer than in New York. The town is from sixty to one hundred feet above the sea, situated on the southern slope of a low ridge, which forms a shelter from northerly and northwesterly winds. Pleasant walks and drives have been laid out through the woods. The pines are thickest to the north and west. The town is supplied with water from the Metedeconk River. There is a fine spring of pure water about a mile from the village. The town has a system of drainage. Xo meteorological record for Lakewood could be obtained. Dr. Piatt gave a summary of the record for Vineland, which is sixty miles southwest of Lakewood and twenty-five miles inland from the sea. In its physical features, however, it is almost iden tical with the Pine Belt region, from which it is separated by the strip of damp soil that lies between the town and the Pine Belt. A^ineland's annual record for ten years : Temperature. Eainfall. , ■ . Relative , • , Mean. Max. Min. humidity. Mean. Max. 54° 104° —9° 72perct. 47.4 inches. 60 inches. Average number of cloudy days, 107. Fogs are very rare. Snow seldom remains on the ground more than a few hours. By seasons the mean monthly record of temperature in Vineland for three years (1891-'93) was as follows : winter, 34°; spring, 49°; summer, 73°; autumn, 55°; annual, 54°. The mean for January was 30° and for July 74°. In 1893 the maximum tem- perature was 102° and the minimum 9°. The region west of Lakewood and north of Vineland possesses the natural advantages of a dry, porous soil, an environment of pine-forest, and easy accessibility from the great centres of popula- tion. The accommodations are better in Lakewood than elsewhere. There the hotels are large, with glass-screened verandas, and are noted for their comfort and luxury. 218 MEDICAL CLIMATOLOGY. Pennsylvania. The system of mountains known as the AUeghenies, extending in several parallel ranges through Pennsylvania, Maryland, and Vir- ginia and into North and South Carolina and Tennessee, furnishes throughout its entire length innumerable summer- and health-resorts. The Delaware Water Gap lies between Pennsylvania and New Jersey. The scenery of this mountainous district is wild and beauti- ful, the " Gap " itself being a narrow gorge through which tlovvs the Delaware Kiver. The walls of the gorge attain a height of 1600 feet, and are capped by Mounts Minsi and Tammany. The Water Gap is a famous and favorite resort, and affords many amusements and occupations, among which are driving, shooting, and fishing. Mauch Chunk, lying in the centre of the Pennsylvania coal- region and surrounded by beautiful scenerj', is located on a I'ocky shelf overhanging the Lehigh River and at the foot of Eear Moun- tain, which rises to a height of 700 feet above the town. It is reached over the Reading Railroad, and is much resorted to in summer ; it abounds in comfortable hotels. The famous Switch- back Railroad, built to bring coal from the mines, but now u,?ed only for pleasure, is the chief curiosity of this vicinity. Glen Summit is thirty miles from Mauch Chunk, lying on the crest of the mountains at an elevation of 2000 feet. It affords the most beautiful views and many charming walks and drives. There are a number of pretty cottages and one good hotel, and the place is much patronized in summer. Cresson Springs, lying at the summit of the Alleghenies, 3020 feet above the sea, is a popular summer-resort. The scenery in this neighborhood is most beautiful. The summer climate at Cresson is delightful, for the elevation adds dryness to the pure air and insures a low temperature. Coaches run between Cresson and Loretto, which was founded by Prince Demetrius Gallitzin, who for forty years worked as a missionary in this vicinity. Kane is in the northern part of Pennsylvania, on the watershed which separates the waters flowing into the Ohio from those which empty into the Susquehanna. This region is drier than any other district of Pennsylvania. Kane has an elevation of 2000 feet. The surrounding country is rough and mountainous, and the heights are, for the most part, well timbered to the top. The soil is sandy and absorbent, the climate stimulating, and there are opportunities EASTERN CLIMATES. 219 for pleasant and healthful outdoor life. The population of the town is about 4000, and the chief industry is manufacturing. Kane has an excellent hotel, which is kept open throughout the year. Eagle's Mere is a summer-resort lying at an elevation of 2060 feet. It has a lake, which furnishes opportunity for boating and bathing, and four hotels ; there are also some cottages which may be rented. Mount Pocono. Three and a half hours by rail from New York and an hour longer from Philadelphia, in Monroe County, is Mount Pocono. This resort has a stony, absorbent soil and a dry, pure air, and the quality of the climate is decidedly tonic. The water- supply is said to be especially pure. The scenery is remarkably beautiful, and there are delightful drives and walks through the surrounding country. Dr. Judd^ says that the temperature of the plateau is ten or fifteen degrees lower than it is in New York and Philadelphia, and there are no mosquitoes. There are good, plain accommodations. 1 Transactions of the American Climatological Association, 1895. CHAPTEK XII. SOUTHERN CLIMATES. Maryland. Deer Park. In the extreme southwesteru part of Maryland, in the heart of the Alleghenies, lies Deer Park, which is reached by the Baltimore aud Ohio Railroad. Its elevation is 2400 feet, and it is situated in a region the beauty of which is unsurpassed. The summer-climate is delightfully cool and fresh, and among the diver- sions of the place are charming walks and drives and good boating and fishing. Virginia. The group of thermal springs known as the Hot, Warm, and Healing Springs lies in a mountainous region at an elevation of over 2000 feet. The waters of the Hot Springs have a temperature ranging from 78° to 180° F. The Warm Springs have a tempera- ture of 98° and the Healing Springs of 84°. The Hot Springs are provided with the most elaborate modern bathing-accommodations of every kind for invalids or visitors, which compare favorably with those at certain celebrated spas in Europe, such as Aix-les-Bains ; the surrounding grounds are beautifully and attractively laid out, and the hotels are acceptable to the most fastidious. The Warm Springs and Healing Springs are each within a pleasant drive, and the accommodations at these places are comfortable, with a pleasing, old-time air about them. The climate is moderately cool and fairly dry, giving an agreeable change in sum- mer to Northern visitors, for whom this has recently become a fash- ionable resort. West Virginia. "West Virginia has several resorts where the chief attraction is the presence of mineral springs. Among them may be mentioned the Jordan Alum Springs, in the Mill Mountains ; the Old Sweet Springs, in the midst of the Alleghenies, where ample swimming- baths form the chief feature; and the White Sulphur Springs, in SOUTHERN CLIMATES. 221 Greenbrier County, lying amid beautiful mountain-scenery and well known for many years as a fashionable resort. North Carolina. Asheville (elevation, 2250 feet ; population, 10,000). The town of Asheville is situated on an elevated plateau one hundred and seventy-five miles long and from ten to fifty miles wide. The average elevation of this irregular plateau is 2000 feet, rising still higher in the northern portion. On the south and east are the Blue Ridge Mountains, while the Great Smoky Mountains form the northern and western boundary. This plateau is one of the most beautiful tracts of land in the United States, and has long been a favorite summer-resort. It has a few hotels that are open all the year round. The win- ters are said to be fine, as snow seldom remains long in the valleys. The soil is mostly red clay — in some places sandy. After rain there is deep mud, but it dries rapidly. The mountains are covered with a dense growth of forest. On the mountains the rainfall is 15 to 20 inches, and the relative humidity 10 or 12 per cent, higher than at Asheville.^ There are numerous streams of clear water. Good water is obtained for town-supply from the mountains. The hotel-accommodations are excellent. Sulphur and chalybeate springs are found near Asheville. The average number of fair days is 259. The mean of annual rainfall is 45.4 inches. Taken from the record for thirteen years, ^ by seasons the rainfall is: winter, 9.3 inches; spring, 11.2 inches; summer, 13.7 inches; autumn, 8.2 inches. The mean monthly temperature for winter is 38°; spring, 53°; summer, 71°; autumn, 53°. The mean anuual relative humidity is 69 per cent.^ The principal seasons are in February and March and July and August. Seventy thousand persons are said to visit Asheville annually. The wind-movement for Asheville is not obtainable. As none of the peaks are within ten miles of the town there is room for free air-circulation. If the winds are too keen aud penetrating during 1 Asheville and its Climate. Karl Von Ruck, B.S., M.D., 1891. ' Rainfall and Snow of the United States, Prof. M. W. Harrington, 1894. 3 Records of J. W. Gleitsmann, M.D., for AsheTille temperature (thirteen years) and humidity (four years), as quoted by Buck's Reference Handhook of the Medical Sciences. 222 MEDICAL CLIMATOLOGY. the winter and spring, a more sheltered country can be found over the Blue Eidge Mountains, on the southern slopes of the range, in some of the picturesque northern counties of South Carolina. There are no complete meteorological records, but as a guide the following records of temperature for the year 1891 may be compared : Ashe- ville— January, 37°; February, 45°. Spartanburg— January, 42°; February, 48°. Spartanburg is 790 feet above the sea, and has a population of 5500. It is seventy miles, or three and one-quarter hours by rail, from Asheville. Warm Springs. Thirty-seven miles northwest from Asheville are the Warm Springs of North Carolina. There are two springs flowing at the temperature of 97° and 102°F. They are situated in a small and pretty open park, surrounded by mountains covered with hard and pine timber. For accommodation there are one good hotel, two boarding-houses, and several cottages. The eleva- tion of the Warm Springs is given in Toner's Dioiionary of Eleva- tions as 1326 feet. A recent record of the weather for six months — November to April, inclusive — shows 32 days cloudy or rainy, and a mean tem- perature of 47°F., with a relative humidity of 71 per cent. Southern Pines. There are a small village and a hotel at South- ern Pines Park,' sixty-eight miles southwest of Raleigh, and near the line of the Raleigh and Augusta Railroad. The situation is on the summit of an extensive sandy elevation covered with pine- forests. The record of temperature at Manly, on the railroad, seven miles to the northwest of Southern Pines, for one year (December, 1881, to November, 1882) is: for winter, 48°; for spring, 61°; for summer, 79°; for autumn, 62°; mean annual temperature, 62°. For eastern North Carolina the average temperature for a series of years is stated to be : for winter, 46°; for summer, 80°; annual, 69°. The average annual rainfall is 44 inches. Snowfall rare and light. The soil is sandy and porous. Spring-water can be obtained at a depth of forty feet. There is a large hotel at Southern Pines, and at Pine Bluff are a number of cottages which may be rented with or Avithout board. Pinehurst, situated six miles to the west of Southern Pines, is reached over the Seaboard Air Line, or via Aberdeen by the Aber- deen and West End Railroad, and is said to be a comfortable and 1 Southern Pines Park, a New Winter Healtli-resort. A. N. Bell, M.D. Transactions of tlie American Ciimatological Association, 1886. SOUTHERN CLIMATES. 223 inexpensive resort. The town is furnished with a sewerage-system and has a plentiful supply of pure water. Pinehurst is connected with Southern Pines by an electric tramway. The average summer temperature is 77°F., and that of the winter 44°, corresponding nearly to those of Southern France and of Genoa and Florence ; and snow is rare. The soil is sandy and absorbent, the situation sheltered, and the atmosphere dry. There is a good hotel — the Holly Inn — which has a glass-enclosed sun-room, and there are cottages and apartments to let. South Carolina. Camden (population, 3500), situated in the upper pine-belt of South Carolina, has been well spoken of as a winter-residence. It is a gently rolling country, covered with forests of long-leafed pine. The elevation is about 200 feet. There are two hotels. The soil is light and sandy, and the water and drainage are said to be good. The coldest noon-temperature in February, 1890, was 50°F. ; in March, 40°; in April, 50°. The warmest noon-temperatures were in February, 83°; in March, 81°; in April, 86°. Mean winter- temperature, 45°; mean spring-temperature, 62°. The mean an- nual rainfall is 41i^ inches'. The greatest precipitation is usually in July and August, the least in October and November. The aver- age monthly rainfall for December to May, inclusive, is 3J inches. Frosts occur at night only, and snow is exceptional. Aiken (elevation, 550 feet ; population, 2500) is situated in South Carolina near the Georgia State-line, on an elevated plateau between the Savannah and Edisto Rivers, and distant from the ocean a little over one hundred miles. The town lies on sandy soil and in the country of the yellow or long-leafed pine, the balsamic odor of the surrounding forests being very perceptible. Grass grows scantily, but there are beautiful gardens in the town. There is said to be no malaria. Pure water is procured from wells at a depth of from eighty to one hundred and fifty feet. The mean annual temperature is 61° F., and by seasons: winter, 47°; spring, 59°; summer, 77°; autumn, 61°. The mean monthly temperature of January is 41° from records for the three years ]891-'93. The mean annual rainfall (fo"- twenty-five years) is 48 ii.ches.* The greatest annual precipitation was 65.6 inches in 1888, and the least 33.9 inches in 1860. Snow rarely falls. There is 1 Rainfall and Snow of the United States. Prof. M. W. Harrington, 1894. Month ly means. Eai (uy 3.43 Temp. (11 years). 54° Eel. humidity (7 years). 62 per ct. nfall ears), inches. Cloudy days (11 years). 11 days. 47 59 " 3.28 (( 11 " 48 62 ■' 3.64 (( 11 " 50 56 ■' 3.26 " 9 " 56 52 " 4.86 " 10 " di] 56 " 4.71 " 7 " 224 MEDICAL CLIMATOLOGY. little dew. Frosts are light, and usually occur in January and February. Dr. W. H. Geddings, of Aiken, read a paper before the meeting of the American Climatological Association in 1886, in which he reported the following meteorological data for Aiken : November, December, .January, February, March, April, Winter : December, i January, [ 48 59 " 10.18 " 31 " February, J The greatest monthly precipitation is in March and April, but the sandy soil of Aiken i.s porous, and it will be seen that for those months there is no increase of cloudy days. The mean monthly relative humidity for the year 1877 was 64 per cent.; for the winter it was 65 per cent.^ The wind-movement in winter averages 3.5 miles per hour. The prevailing winds are from the southwest. There are occasional high winds. Aiken is about fifteen miles from Augusta, Georgia, which may be described here, as its meteorological record is more complete. Georgia. Augusta is an attractive city of 35,000 inhabitants, situated on the Savannah River, about four hundred feet lower than Aiken, although no nearer the sea. It has broad, well-shaded streets. Its weather- record for two years is as follows: Me TEOROLOGI ;CAL DATi ., 1892-'93. Mean monthly Relative Absolute Total wind Cloudy temperature. humidity. humidity. rainfall. per hour. days. Winter, 47° 75 per ct. 2.56 gr. 11.80 in. 6 miles. 32 Spring, 63 66 ■' 3.95 ■' 7.92 " 6 " 20 Summer, 79 78 " 7.74 ■' 15.41 ■' 4 " 22 Autumn, 63 76 " 4.38 ■' 8.95 " 4.9 " 16 Year, 63 74 " 4.38 " 44.09 " 5.3 " 91 1 Aiken as a Health-station. W. H. Geddings, M.D. Charleston, 1877. SOUTHERN CLIMATES. 225 The annual means for Augusta (for ten years) are as follows: temperature, 64° F. ; relative humidity, 74 per cent.; absolute humidity, 4.54 grains; rainfall, Ab\ inches; number of cloudy days, 99 ; average wind-movement, 3.8 miles per hour. Summerville. Many visitors and invalids resort in the winter season to the Bon Air Hotel at this point, which is well known for its pleasant features. Thomasville (elevation, 330 feet ; population, 5500) is situated in the pine-woods in the extreme southern part of Georgia, near the Florida-line. It is about one hundred and sixty miles from the Atlantic Ocean and sixty miles from the Gulf of Mexico. The soil is sandy. Water is obtained from artesian wells, one well having a depth of 1900 feet. There are several good hotels and boarding- houses. The annual precipitation is bl\ inches. The greatest amount of rainfall is in the spring. There are 97 cloudy days during the year. The mean annual temperature is 68° F. ; relative humidity, 65 per cent.; absolute humidity, 4.56 grains of vapor per cubic foot ; wind-movement, 5.7 miles per hour. For winter Thomasville has 50° of temperature; 67 per cent, of relative humidity;' 4.6 grains of absolute humidity; and 11.71 inches of rainfall. The wind- movement in winter is low. The prevailing winds are south and northwest. Florida. The peninsula of Florida, bounded on the north by the States of Georgia and Alabama, projects southward with a slight inclination to the east, and separates the Atlantic from the Gulf of Mexico. Its length is about three hundred miles, and its width averages over one hundred. As set forth in the valuable article by the late Dr. J. M. Keating,^ Florida may be divided by two methods and into two parts. The first, or geographical, division is into north and south Florida, and is determined by the twenty-ninth parallel of north latitude. The second, or topographical, division is into the low- lands which border the rivers and coasts and the higher tracts found inland. 1 Buck's Reference Handbook of the Medical Sciences quotes temperature- and hiumidity- recorda for six years. - Transactions of tlie American Glimatoiogical Association, 1885 . 15 226 MEDICAL CLIMATOLOGY. The climate of the peninsula below the twenty-ninth parallel is very different, in both summer and winter, from that of the country immediately north of it. During the summer there is more breeze and the nights are usually cool. In winter, besides the fact that the climate of the southern portion of the State is, of course, milder, there remains the consideration that the cold winds which blow from the northwest reach here only after crossing the warm waters of the Gulf and receiving their tempering influence, and, as a con- sequence of this, the temperature, which may drop rather suddenly in the northern part of Florida, changes much more gradually in the southern part. The land is mostly low and flat, though there is a ridge extending about halfway down and ranging from one hundred to three hun- dred feet in height, upon which pines grow. Florida is studded with lakes and traversed by numerous streams and salt-water channels. The soil is very porous, and is for the most part sand over a clay subsoil. Semitropical fruits grow freely. The climate, as follows from its geographical position, is marine in character, and, though situated in the same latitude as Northern Hindustan, Southern China, and the Desert of Sahara, it is far more equable and temperate. The mean annual temperature varies from 69° F. at Sanford to 79.8° at Jacksonville ; for the winter the variation is from 54.6° at Pensacola to 66.5° at Jupiter. The range, for winter, averages be- tween 14° and 20°. Frost, snow, and ice are very rare. The mean annual rainfall varies from 53.19 inches at Pensacola to 57.16 inches at Cedar Keys. Of this about one-half usually occurs in the summer. The mean relative humidity for the year varies from 76 per cent, at Pensacola to 80 per cent, at Cedar Keys. In. the winter months it is from 76 per cent, to 87 per cent. Of the absolute humidity Dr. J. P. Wall, of Tampa, speaks as follows: "The amount of absolute humidity for summer is about twice what it is in the winter, dependent, of course, upon the higher temperature of the summer. According to General Greely's esti- mate of absolute humidity based on ten years of observation, 1876- 1886, the absolute humidity for the month of January is, for the northern part of the State, 3 grains of water to the cubic foot of air; for the base or neck of the peninsula, 4 grains of water to the SOUTHERN CLIMATES. 227 cubic foot; along the twenty-eighth parallel of latitude from the Atlantic to Tampa Bay on the Gulf, 5 grains of water to the cubic foot; and for the extreme point of the peninsula aud Key West, 6 grains of water to the cubic foot. The amount of absolute humidity for the month of July is 9 grains of water to the cubic foot for the entire State. " Of course, as might naturally be expected of a climate with the temperature and humidity of that of Florida, heavy dews on clear, still nights are always present, and during the winter and spring fogs in the nights and early mornings are not uncommon. Fogs are, however, somewhat worse on the Atlantic coast and on the St. John's Eiver than on the Gulf side of the peninsula."' The avera^ hourly velocity of the wind (for 1887) varied from 7.4 miles at Pensacola to 9.4 miles at Cedar Keys. The total number of rainy days for the year 1887 ranged from 103.8 at Cedar Keys to 124.1 at Pensacola, and the number of cloudy days for the same year and the same places was 66.8 and 84.5. Dr. Wall, while admitting the prevalence of malaria, states that there are many places entirely free from it, and that it is generally diminishing. Dr. Keating expresses the opinion that southern Florida is better adapted for invalids than the northern section of the State. He was not favorably impressed with the resorts upon the St. John's River for health-purposes, and speaks of the interior lake-district around Winter Park and Orlando as best adapted for chest-cases. Dr. J. C. Wilson also writes of this country: " It is safe to predict for this region a useful future in the climate-treatment of diseases of the chest. "2 Florida was formerly much used as a winter-resort for consump- tives, but of late years physicians have recognized the fact that in the enervating air of this beautiful peninsula there is great danger of increasing the anaemia usually found in phthisical invalids ; dan- ger also to them through the fact that their depressed vitality ren- ders them peculiarly susceptible to the^ insidious malarial influences which are present at so many of the Florida resorts at certain seasons of the year. For elderly people, well-nourished persons with irritable catarrhs, 1 The Climate of Florida. Pr. J. P. Wall, in the Climatologist for Novemher, 1891. - Transactions of the American Climatological Association, 1885. 228 MEDICAL CLIMATOLOGY. and certain valetudinarians and convalescents, Florida is well suited, and for them it presents peculiar attractions. It is easily accessible from the Eastern and Southern States, and has accommodations suited to the millionaire or to the health- seeker of moderate means. The weary may rest out of doors in the temperate and sunny air, and the invalid who is able to live a more active life may seek diversion in hunting, fishing, and boating, for which the extensive coast-line and the numerous lakes, rivers, and forests offer exceptional opportunities. Jacksonville, on the left side of the St. John's River and twenty-two miles from its mouth, is a city of nearly 8000 inhab- itants. It is a busy town, well provided with hotels and tram- ways. The shell-roads are good, and many charmiqg drives may be taken through this vicinity. The town is a much-frequented resort. The winter climate is medium moist, mild, and equable. The mean winter-temperature is 55° F. Palatka, situated south of Jacksonville, on the St. John's River, is a very pleasant town of about 3000 inhabitants. It is a gather- ing-point for many Northern visitors. The smaller steamers which make the trip up the Ocklawaha River start from here. Palatka possesses good hotels*. Winter Park, one hundred and twenty miles south of Jackson- ville and sixty-five miles north of Tampa, is situated in the narrow part of the peninsula of Florida, about forty miles from the Atlantic coast. It is reached direct by rail from Philadelphia, New York, and Washington, and is thus easily accessible. It offers good edu- cational facilities and possesses a pleasant society. Dr. Eager,^ of Winter Park, says that there are good sanitary arrangements and a pure and abundant water-supply, and that there is no malaria. The site and surroundings of the town are the high pine-lands of the peninsula. From April 1st to June 1st very little rain falls, and during these months the temperature from 4 P.M. to 9 A.M. ranges from 65° to 72° F., and from 72° to 85° for the remaining hours. The average temperature of the winter-day is 60° to 65° for the twenty-four hours. Frost is very rare. A large hotel, the "Seminole," offers first-class accommodations to visitors. Orlando, a town of 2500 inhabitants, lies one hundred feet above i The Climatologist for July, 1892. SOUTHERN CLIMATES. 229 the St. John's Kiver, ia an undulating, often hilly country. It is surrounded by pine-forests, aud is said to be entirely free from malaria. The soil is very absorbent. Altamonte, a few miles from Orlando and situated in the pine- forests, has a good hotel with an excellent cuisine. The soil is sandy and readily absorbs moisture. In Orange County, near the Ocklawaha Lakes, are a number of towns — Bustis, Taverse, Leesburg-, Mount Dora — situated in a rolling country which is well suited for health-seekers. Tampa, on Hillsborough Bay, a branch of Tampa Bay, and at the month of the Hillsborough River, is a town of over 5000 in- habitants. This part of the country affords good sport, as the waters abound in fish, and inland are deer and other game. Tampa is a favorite resort, and has become more so since the establishment of the Tampa Bay Hotel, which is a magnificent building provided with every possible luxury and convenience. There are also other hotels and fine villas. The neighborhood is interesting, and various pleasant excursions may be taken. At Indian Hill, not far distant, are the singular shell-mounds in which were found human remains. Los Pinellas is a small peninsula running southwest between Tampa Bay and the Grulf of Mexico. Its climate has been com- pared with that of the peninsula of Coronado. It is recommended by Dr. J. C Wilson, of Philadelphia, for its climate and attractive- ness. The climate is colder than that of places in the same latitude on the Indian River. The mean temperature is 72° F. ; mean win- ter-temperature, 62°; mean summer-temperature, 80°. The relative humidity is 85 per cent. The soil is sandy and porous. The Lake Worth district is much resorted to by visitors who desire to escape the inclemency of Northern winters. The lake is twenty-two miles in length and varies in width from one-half a mile to one mile. Its waters abound in fish, among others the much- talked-of tarpon. The vegetation includes the cocoanut-palm. Many handsome villas have be3n built at different points along the shore. The hotels are first-class, and include the handsome Lake Worth Hotel and that at Palm Beach. Gulf Coast from Pensacola to Galveston. Along the Gulf coast westward from Pensacola to New Orleans and on to Galveston are many shore-resorts where the winters are mild and the summers cooler than the neighboring inland. These 230 2IEDICAL CLIMATOLOGY. are much used by the inhabitants of the Gulf States. Perhaps the most agreeable of such resorts are found where the bay curves from Mobile southwest to New Orleans. The Ijest known and the most frequented in winter by Northern visitors is Pass Christian. No meteorological tables are obtainable, and the information given below was obtained from a local physician and from statements of visiting patients. Pass Christian lies on the coast of the Gulf of Mexico, in the centre of the curve between Mobile and New Orleans. It is eighty- four miles from Mobile and fifty-eight miles from New Orleans via the Louisville and Nashville Eailroad. The population is about 3000. It has a large, well-kept hotel, several boarding-houses, and cottages for rent. In the winter-season, from November to May, it is much frequented by invalids and visitors from the North, and in summer by the residents of neighboring cities. Dr. C. L. Le Eoux, of Pass Christian, writes of its situation : "At a distance from shore varying from five to eight miles a belt of islands forms a protective bulwark against the occasional storms that may prevail in the Gulf, making the body of water between the islands and the main shore a sort of inland lake, ellip- tical in shape and rarely disturbed beyond a ripple. Immediately behind the town . . . lies a pine-forest which extends hundreds of miles in depth." The average mean temperature in summer is given at 85" F., and in winter at 70°. The range is said to be small, and the rains neither frequent nor protracted. An occasional "norther" is experienced. There is an average of six pleasant days a week. The soil is well drained, porous, and dry. There is no malaria, and there are pure artesian-well water aud a good sewerage-system. Roses bloom in profusion throughout the winter. There is a shell- drive for five miles along the coast, and good boating, fishing, and shooting are among the attractions. Tennessee. Chattanooga (elevation, 700 feet ; population, 30,000), in the southeastern part of Tennessee, on the Tennessee River, is reached over the East Tennessee, Yirginia, and Georgia Eailroad, connect- ing with the Norfolk and Western and the Baltimoi-e and Ohio lines. It is surrounded by beautiful and varied scenery, and the atmosphere is pure, stimulating, and bracing. The soil of this region is dry and loamy, and the drainage good. Maximum daily SOUTHERN CLIMATES. 231 temperature, 101 ° F.; minimum, 7° below zero. The relative average annual humidity is 71 per cent. The average number of clear days per year is 117, and of fair days 147. Owing to the sheltered situa- tion of the city fogs and winds are seldom experienced, and extreme sudden changes of temperature are rare. The roads in the neigh- borhood are good, and driving and wheeling are popular amuse- ments. Chattanooga has excellent accommodations as regards both hotels and boarding-houses. Lookout Inn, located on Lookout Mountain, is open all the year. The vicinity is historically very interesting, having been the scene of the famous battles of Lookout Mountain, Orchard Knob, and Missionary Ridge, so ably described by Benjamin Taylor in his TJiree November Days. Arkansas. Hot Springs (elevation, 425 feet; population, 10,000) is situated in a narrow valley or ravine in the heart of the Ozark Mountains. It has become one of the most frequented resorts in the United States, the great attraction being the springs, numbering about seventy, the waters of which have a temperature ranging from 76° to 158° F. The land on which they rise is the property of the Government, which has erected a hospital for officers, soldiers, and sailors. These springs discharge about 500,000 gallons of water daily. The amount of solids is very small. The town has good hotels and shops and handsome bath-houses. The Eureka Springs in Arkansas are also well known. Texas. El Paso (elevation, 3700 feet; population, 10,000). The old Mexican town of El Paso is situated on the banks of the Rio Grande, at the foot of the Rocky Mountains, in the extreme western portion of the State of Texas, where it narrows to a point between Mexico and the Territory of New Mexico. Climatically, this district belongs to the latter more than to its own State. It is blessed with cloudless skies and is beyond the "northern" belt of Texas, and consequently less liable to high winds, although, as the valley is not very wide, the full force of the wind is felt as it sweeps through. There is least wind during the winter months, when it averages 5.3 miles per hour. In the three mouths of spring it averages 6.6 miles, and for the year 5.5 miles per hour. There are, however, occasional severe wind- and dust-storms. The Gov- 232 MEDICAL CLIMATOLOGY. ernment record for the year 1892 shows the number of days with gales (wind 40 miles per hour or over) to have been 15 for El Paso, as against 3 at Santa F6 and 3 at Denver. The principal rainfall is in July and August, about 40 per cent, of the year's supply falling during those two months. Mean of annual precipitation, 9 inches. Temperature for January, 44° F.; July, 83°; for the year, 64° (means for twelve years). Average number of days above 90°, 94 ; below 32°, 47. Cloudy days, 39; stormy, 37 (means for six years). The mean minimum temperature for three years (1891-'92-'93) in July was 70°, indicating hot nights. Fair accommodations can be secured. There is one tolerable hotel, " The Vendome," and comfortable lodgings can be found in the town, while good meals can be obtained at a Chinese restaurant. The soil is sandy in places, but adobe near the river, and the water is bad unless from artesian wells. The river bottom-lands should, of course, be avoided. Across the river in Mexico is the town of Juarez, where Mexican customs prevail. There is some dirt and squalor, but a visit is usually con- sidered interesting. El Paso has limited resources for the entertainment of visitors. It has a fine winter-climate, but after April the midday temperature becomes too high for comfort. Fort Bliss, a military-post, is about five miles northeast of El Paso. The present Port Bliss is in a better location than the old post, which was one mile from the town. San Antonio (elevation, 650 feet ; population, 40,000). San Antonio is situated in latitude 29° 27' north, about one hundred and thirty miles inland from the Gulf of Mexico. There are no mountains to obstruct the prevailing winds from the southeast and east, and the town is not, probably, entirely beyond the climatic influence of the Gulf, as the cooling effect of the "sea-breeze" may indicate. As a health-resort it is available only during the mouths of winter and early spring. It is a picturesque and interesting town, containing many reminders of the early mission-days. Many of the old churches and Spanish-looking public buildings are in an excellent state of preservation, and Spanish names are commonly used. In the suburbs are several picturesque old missions. San Antonio is on the edge of what was formerly a great cattle- raising country. It can be reached by three lines of railroads. SOUTHERlSl CLIMATES. 233 Two small rivers — the San Antonio and San Pedro — flow through the town. The San Antonio River is a dirty stream about sixty feet wide and spanned by numerous bridges. Formerly a highly objectionable method of draining into these winding rivers was practised. In 1895 an improved system of town-sewerage was put into operation ; but a medical writer recently stated that of 8000 houses but 400 were connected with sewers. There are three plazas or public squares, street-cars run by electricity, a social club, six hotels, and a number of boarding-houses and restaurants. The accommodations for invalids are inferior. For housekeeping a location on the outskirts of the town should be selected. The town is supplied with pure but hard water from springs at the head of the San Antonio River. Artesian wells have been drilled in the town, which vary greatly in the character of the water they yield. Many of them furnish good, soft water. There are also wells flowing hot sulphur water of marked qualities. The soil is adobe. The mean temperature of San Antonio for January is 51° F.; for July, 84°; for the year, 69° (means for thirteen years). The record of rainfall for twenty-one years gives a yearly mean of 30.6 inches, of which 6.7 inches usually fall during the three winter months, and 7.8 inches in the spring. The air is moist, the absolute humidity even exceeding that of San Diego. The annual wind-movement is not high, being a little more than that of Denver — about 7 miles per hour. San Antonio is not exempt from ''northers," but they are infrequent and are much modified compared with those felt in the upper portion of the State. They rarely last over forty-eight hours. The average number of cloudy days during the year is 92; of stormy days, 82. Number of days above 90°, 90; days below 32°, 12 (means for six years). The winters are mild in San Antonio. Roses usually bloom until Christmas, and sometimes later, and in February they begin again to bloom outdoors. The summers in San Antonio are hot. In 1893 there were 124 days on which the temperature rose over 90° F. Of these, 85 days were in July, August, and September (out of a total of 92 days), the temperature being over 90° every day in July. The maximum 234 MEDICAL CLIMATOLOGY. temperature for the year was 103°. The mean raiuimiim, or night, temperature for three years (1891-'92-'93) for July was 73°. (See Table XL, ''Night-temperatures.") Boerne' (elevation, 1670 feet; population, 800). The towu of Boerne is situated on the River Cibolo, about thirty miles north- west of San Antonio, on the road to Kerrville (San Antonio and Aransas Pass Railroad ; time, one and one-half hours). The soil is mostly sandy loam, with a gravelly subsoil. The coun- try is hilly. Except for narrow borders of timber along the streams and a few tracts of post-oak and forests of cedar, the principal growth is brush and mesquite. Iq a description of the town prepared by a local physician^ it is stated that the water-supply is chiefly from wells of an average depth of thirty -five feet. This water is considered "fairly good." Water from cisterns is also much used. There are said to be 88 cloudy days during the year. The vv^ind is moderate, coming usually from the south or southeast. There are two or three medium-sized hotels aud a few boarding- houses in Boerne. Boarders are always received at a number of ranch-houses a few miles from town. The drives are good. There are several waterfalls and other objects of interest in the vicinity. Three and one-half miles from Boerne, on the Hughes ranch, are the Indian Mineral Springs. The following analysis was made by C. F. Chandler, Ph.D., of New York : In one U. S. gallon. Chlorine in chlorides . . . 0.512 grain. Equivalent to sodium chloride . . . 0.844 " Oxides of iron and aluminum . 0.093 " Lime .... . 45.832 grains. Magnesia . . . 6.435 " Sulphuric acid (SO3) in sulphates 67.246 Silica .... 0.355 grain. Solids by evaporation .... 138.388 grains. Dr. I. M. Cline, who has charge of the Texas weather service, has written of the country in which Boerne lies as follows : "Between latitude 29° 45' and 30° and to the iOOth meridian on the west the elevation changes rapidly from 1000 to 2000 feet, with considerable irregularity, and is broken with deep ravines and small creeks, and ' Pronounced Ber'-ney. The town was settled by Germans thirty or forty years ago. 2 Boerne and Adjacent Country. William Miller, M.D. SOUTHEBN CLIMATES. 235 along the western border, as the 2000-foot line of elevation is reached, it is much sculptured by erosion. The soil between these elevations is very irregular in its formation, but is to a great extent of the black, stiff soil over the eastern portion, and then blends toward the west with black and red sandy and red loam, with a pebbly soil in some parts; it is also crossed here and there by strips of white, sandy land, with a growth of scrub post-oak."^ The monthly mean temperature for eight years, arranged by sea- sons, is as follows : winter, 50°; spring, 69°; summer, 79°; autumn, 65°. Mean for January, 49°; for July, 81°; for the year, 65°. The total seasonal rainfall based on nine years' records is: winter, 5.9 inches; spring, 9.6 inches; summer, 6.4 inches; autumn, 4.9 inches ; annual mean, 27 inches. The mean relative humidity is said to be from 66 to 72 per cent.^ Galveston (latitude, 29° 18' north; population, 35,000) is situ- ated on the northwesterly end of the island of the same name, four miles from the mainland. The harbor is the finest on the coast of Texas, and the depth of water over the bar has been greatly increased in recent years by means of jetties. The island is thirty miles long by an average width of three miles. It is level, with sandy soil. Galveston is an attractive and healthy city, with wide, straight streets, ranging from six and a half to ten feet above ordinaiy tide- level. There are several parks and squares. Many of the streets are shaded with oleanders. The climate of Galveston is warm, mild, and humid. Occasion- ally there are winters when the temperature does not fall below 32°. During the past twenty years there have been thirteen years in which the temperature has not fallen below 24°, and but two years below 20°. The seasonal mean-temperature, from the Government records for eighteen years, is as follows: winter, 65°; spring, 69°; summer, 83°; autumn, 71°. The annual mean is 70°. Monthly mean for January, 53°; for July, 84°. The extreme maximum temperature-record is 98°, and the minimum 20°. The mean of the annual rainfall for twenty years is 51 inches, distributed as follows: winter, 11.5 inches; spring, 10.2 inches; summer, 13.3 inches; autumn, 16.6 inches. The greatest precipi- 1 The Climate of Texas. I. M. Cline, M.A., M.D., Galveston, 1891. 2 Eeport of the Committee on Health-resorts. Transactions of the American Climatological Association, 1895. 236 MEDICAL CLIMATOLOGY. tation is in September and the least in February and July. The annual meau of cloudy days is 92, of stormy days 108. The mean annual relative humidity is 77 per cent.; for winter it is 81 per cent. The wind-movement averages for the year 11.1 miles and for the winter 11.7 miles per hour. The prevailing wind is from the south and southeast. The highest winds occur during the winter, and blow from the north, but the average " northers" of Upper Texas are but little felt on the west coast of the Gulf of Mexico.^ Galveston is rendered accessible by railroads from the north and west, and by steamers from New York and one or two European ports. There are good hotels and boarding-houses. On the eastern shore of the island is a fine beach for driving and surf -bathing. Galveston is supplied with pure, soft water obtained from arte- sian wells and brought twenty-five miles through thirty-inch pipes. The natural drainage is aided by a slight incline from the centre of the island toward the bay and the gulf. Sewers empty into both bay and gulf. 1 Notes on the Climate and Health of Galveston. I. M. Cline, M.A., M.D., Galveston, 1894. CHAPTER XIII. EOOKY MOUNTAIN REGION. Monthly Rainfall of the Southwest. Before proceeding to the study of the climates of Colorado, Utah, 'New Mexico, Arizona, and Southern California it is thought best to present a general view of the monthly rainfall over these regions.^ January. This is a very wef month over all California except the southeastern portion, where it is wet. Over Colorado (except the eastern half, where it is very dry), New Mexico, and Arizona the amount of precipitation is either about the proportional amount with reference to annual rainfall, or deviates slightly therefrom. The normal rainfall-records for the principal cities are as follows for January: Denver, 0.6; Colorado Springs, 0.2; Santa F6, 0.6; EI Paso, 0.4; Prescott, 1.4 ; Tucson, 0.8; Salt Lake City, 1.6 ; Los Angeles, 3.9 ; San Diego, 1.6 inches. February. This month is wet over California (except the south- western part of the State, where it is ve7-y wet). It is dry over the Dakotas southward to Western Texas, including Eastern Colorado. Elsewhere the rainfall for February shows but slight deviations from its proportional amount with reference to the yearly range. The normal rainfall-records for the principal cities are as follows for February : Denver, 0. 5 ; Colorado Springs, 0. 3 ; Santa Fe, 0. 9 ; El Paso, 0.5 ; Prescott, 1.7 ; Tucson, 0.9; Salt Lake City, 1.8 ; Los Angeles, 0.4; San Diego, 2.1 inches. March. A wet month for the western part of California. A dry month over Western Texas and the eastern part of New Mexico. In 1 ' ' The terms wet and dru, witli reference to months, are something more than'relative as nsed in this report. Here it is defined fully with reference to average rainfall, the same rule being followed as has been employed elsewhere. A wet month is one in which 50 per cent, more rain falls than the average, and, in like manner, a very wet mouth is one in which double the usual amount of rain occurs — that is to say, 8.33 per cent, of the annual rainfall is the proportional amount for each month, so that under the definition here given a month with 12.5 of the average yearly rainfall is a wet month, and one with 16,7 is a very wet month. In Uke manner a dry month is one in which the average rainfall does not exceed 4.2 per cent, of the annual rainfall, and a very dry month is one in which 2.1 per cent., or less, of the annual amount occurs." - Adapted from a Report on the Climatology of the Arid Regions, etc. By General A, W. Greely, Washington, 1891. 238 MEDICAL CLIMATOLOGY. Eastern Colorado the rainfall is a little less than the proportional share for the month. The normal rainfall-records for the principal cities are as follows for March : Denver, 0.9; Colorado Springs, 0.6 ; Santa Fe, 0.7 ; El Paso, 0.3 ; Prescott, 1.6 ; Tucson, 0.9 ; Salt Lake City, 2.1 ; Los Angeles, 2.2 ; San Diego, 0.1 inch. April. A dry month in the southern half of Arizona and New Mexico, with tendencies in localities to be very dry. A wet month in the interior valleys of Southern California, over Western Colo- rado, and parts of Eastern Utah and Northern Texas. Usually a wet mouth for Eastern Colorado. The normal rainfall-records for the principal cities are as follows for April : Denver, 2. 1 ; Colorado Springs, 1.5; Santa Fe, 0.8; El Paso, 0.1 ; Prescott, 0.9 ; Tucson, 0.1 ; Salt Lake City, 0.2; Los Angeles, 1.3; San Diego, 1 inch. 3Iay. A dry month over all California, the western half of New Mexico, and the northern half of Arizona, and a vei-y dry month in Southern Arizona. A wet month over Texas (except in the neigh- borhood of El Paso) and Northeastern Colorado. In Southeastern Colorado very wet. The normal rainfall-records for the principal cities are as follows for May : Denver, 2.8; Colorado Springs, 2.5 ; Santa F6, 0.8; El Paso, 0.2 ; Prescott, 0.5; Tucson, 0.1; Salt Lake City, 2 ; Los Angeles, 0.3 ; San Diego, 0.3 inch. June. The month is very dry over California, Southern Nevada, Southern Utah, and Arizona, and is dry over Western Colorado. Over extreme Eastern Colorado it is wet. The normal rainfall- records for the principal cities are as follows for June : Denver, 1.4; Colorado Springs, 1.7; Santa F6, 1.2; El Paso, 0.5; Pres- cott, 0.1; Tucson, 0.2; Salt Lake City, 1.2; Los Angeles, 0.1; San Diego, 0.1 inch. July. A ve7-y dry month over California. A very wet month over Eastern Colorado, Western Texas, New Mexico, and the eastern part of Arizona. It is a dry mouth over Western Arizona (except in the extreme southwestern part) and Southern Utah. The normal rainfall- records for the principal cities are as follows for July : Denver, 1.6; Colorado Springs, 3.2; Santa Fe, 2.7; El Paso, 1.6; Prescott, 3 ; Tucson, 2.8 ; Salt Lake City, 0.9; Los Angeles, trace ; San Diego, 0.1 inch. • August. A very dry month over California (where it is practically rainless). It is very wet over Arizona, New Mexico, and the moun- tain region of Colorado and Southern Utah. The normal rainfall- records for the principal cities are as follows for August : Denver, BOOKY MOUNTAIN REGION. 239 1.5; Colorado Springs, 2.2; Santa F^, 2.7; El Paso, 0.2; Pres- cott, 2.8; Tucson, 2.3; Salt Lake City, 1.4; Los Angeles, 0.1; San Diego, 0.1 inch. September. Very dry and nearly rainless in California, dry over Nevada and Southern Utah and Eastern Colorado. Wet over all of Texas. The normal raiufall-records for the principal cities are as follows for September : Denver, 0.8; Colorado Springs, 1 ; Santa F6, 1.6; El Paso, 1.7 ; Preseott, 1.1 ; Tucson, 1.2; Salt Lake City, 1; Los Angeles, trace; San Diego, 0.1 inch. October. The month is dry over Western Arizona, Southern Cali- fornia, and Southern Nevada. Elsewhere about the proportional amount of the annual rainfall, or a little less, occurs. The normal rainfall-records for the principal cities are as follows for October : Denver, 0.9; Colorado Springs, 0.6; Santa F6, 1; El Paso, 0.8; Preseott, 0.6 ; Tucson, 0.6 ; Salt Lake City, 1.8 ; Los Angeles, 0.7; San Diego, 0.3 inch. November. A wet month in Northern California. From the one hundredth meridian to the crest of the Rocky Mountains it is a dry month. The normal rainfall-records for the principal cities are as follows for November : Denver, 0.6; Colorado Springs, 0.3 ; Santa Fe, 0.9; El Paso, 0.5; Preseott, 0.8; Tucson, 0.5; Salt Lake City, 1.5 ; Los Angeles, 1.6 ; San Diego, 1 inch. December. A dry month over Western Texas, Western New Mexico, and Eastern Colorado, with a tendency to be very dry in extreme East- ern New Mexico and extreme Southeastern Colorado. The month is very wet over Western A rizoua and California. The normal rain- fall-records for the principal cities are as follows for December : Denver, 0.7; Colorado Springs, 0.3 ; Santa F6, 0.8 ; El Paso, 0.4 ; Preseott, 1.8; Tucson, 1.2; Salt Lake City, 2.1; Los Angeles, 3.7; San Diego, 2.1 inches. "It must be clearly understood that these terms — wet, very wet, ■dry, and very dry — refer not to the absolute quantity of rainfall over the regions mentioned, but to the average monthly quantities with reference to the proportional part of the annual rainfall — that is, if equitably distributed, 8.33 per cent, of the year's rain would fall in each month.'" 1 The normal precipitation of cities is taken from the Report of the Chief of the Weather Bureau (1892), Report on the Climate of Arizona (1891), and the records of the United States Weather Bureau at Denver (1895), and are for the following years of record : Denver, 26 years ; Colorado Springs, 16 years; Santa FS, 33 years ; El Paso, 28 years; Preseott, 18 years ; Tucson 14 years; Salt Lalie City, 24 years ; Los Angeles, 21 years ; and San Diego, A'l years. 240 JIEDIOAL CLIMATOLOGY. Colorado. For the purposes of health-resort stations the climate of Colorado may be divided into three groups: first, the prairie-plains, ranging from 4000 to 6000 feet in elevation; second, the foot-hills and adjoining valleys, varying from 6000 to 7000 feet; third, the natural parks, varying from 7000 to 10,000 feet. It has been estimated that there are over 130 peaks of the Rocky Mountains in Colorado between 13,500 and 14,500 feet in height, of which Blanca Peak (14,483 feet) in the Sangre de Cristo range is the highest. Of this number but sixty or seventy have been named. Pike's Peak (14,134 feet)^ is twenty-fourth in height on the list. The rainfall of the State varies from 8 to 22 inches, with an aver- age of 15 inches per annum, and is more copious near the mountain- peaks. It does not, however, necessarily increase with the altitude, as Gunnison, 7680 feet, with 10 inches, and Leadville, 10,200 feet, with 12.80 inches, have each less rain than Denver, 5300 feet, 14J inches. The rainfall in Colorado does not reach great annual extremes. In Denver the maximum is 21J inches (1891) and the minimum 9.4 inches (1890). In Colorado Springs the extremes are 18 J inches (1872) and 8i inches (1893).^ The influence of a high mountain-chain or peak in forcing the moisture out of warm air-currents through condensation is shown by the summer rains around Pike's Peak. The mornings in July and August are invariably fair ; for several hours after sunrise there is not a cloud in the sky ; then the hot air of the southern plains rises, and clouds begin to gather, until by noon the peak is likely to be quite obscured. When this heated air meets the colder currents its moisture is condensed, and a sharp fall of rain is the result. There may be one or two showers during the afternoon, but the night is usually clear and the morning bright as before. These showers, which are apt to be of daily occurrence during a por- tion of July and August, form one of the pleasant characteristics of 1 Elevation from the records of the United States Weather Bureau. A meteorological station was maintained by the government for several years on the summit of Pilie's Peak. It was discontinued October 1, 1894. 2 Compare with Los Angeles rainfall : extremes of 40>^ inches (1884) and 5}4 inches (1881). BOCKY MOUNTAIN REGION. 241 the summer climate, as tbey materially cool the air, and the total precipitation is not very large during what is called the rainy season. The normal monthly rainfall at Boston or New York, for instance, is greater than at Colorado Springs during this " rainy" period. The total yearly precipitation on Pike's Peak is less than one might expect, being barely 30 inches, and its local character is in- dicated by the fact that on the plains at its base the rainfall is but half as much — 14 or 15 inches.' In Colorado, east of the Conti- nental Divide, the rainfall of April and May frequently equals that of July and August, when about 30 per cent, of the annual precipi- tation occurs. On the eastern plains snow falls occasionally during the winter and early spring, and more rarely in the late autumn ; but it seldom lies for any length ^of time on account of the bright, hot sunshine. The difference between the temperature in the sunlight and the temperature in the shade in these elevated regions is at all times very marked, being from 40° to 60° F. "The character of the sun- light of high altitudes is a nearer approach, if possible, to white light than at sea-level."^ After a cold night in winter, with the mercury perhaps down to zero, it will be warm enough during the day for an invalid to lie out in the sunshine. A table of sun-temperatures taken in 1886-87 shows a range of maxima from December to March of 112° to 123°, and of minima during those months from 95° to 108°. The extreme maximum sun-temperature for the year was 155° in July.' The average air-temperature for the month of January along the plains under the eastern foot-hills is 30°, which means the general average of twenty-four hours, and includes the extreme minima of the cold nights. The mean monthly temperature of Colorado Springs for January, 1887, taken at 2 p.m. (in the shade), was 38°, and for the winter months of 1893, taken at 12 M., 40°; while the mean monthly sun-temperature for January, 1894, was 60°. Air-tem- perature (January, 1894), monthly mean, 28°; per cent, of sunshine (January, 1894), 0.66. In Canon City during January, 1887, the monthly mean, taken at 2 p.m., was 42°. In Denver the tempera- 1 For details of rainfall, see Tables I. and V. to X. 5 Rooky Mountain Health-resorts. C. Denison, M.D. 3 An Invalid's Day in Colorado Springs. S. E. Solly, M.D., 1888. 16 242 MEDICAL CLIMATOLOGY. ture of the air at 1 p.m. (mean of two "years, 1884-'85 aad 1886) was 31° for January, aod the mean for winter 37°. The solar temperature for winter, taken at the same hour, was 99°, a differ- ence of 62° between sun and shade. The mean monthly solar tem- perature for the three summer months (1886) was 144°; for the year it was 120°.' The unexpected mildness of the Colorado climate^ is well described by Dr. Carl Euedi, of Denver, who formerly practised in Davos- Platz, Switzerland. In October, 1891, he paid a visit to a small place called Hygiea, situated forty miles north of Denver, at an elevation of 5000 feet. When he left the house to look over the grounds he first stepped into the orchard, where " the ripe apples and pears were tumbling off the trees." Then he went through a chestnut-grove, and saw at the further end of the garden watermelons and sugarmelons sunning their backs and only waiting to be plucked. Tomatoes and other vegetables, from cabbage to peppers, were grow- ing everywhere. Referring to Davos, he adds : " No cherry or fruit tree can bring forth its savory product, and even potatoes and barley attain a very doubtful success.'" One reason for this difference is that the limit of vegetable growth is much higher in Colorado, the "timber-line" being 11,000 feet above the sea, while in Swit- zerland it is 8500 feet. In making his comparison Dr. Ruedi comes to the conclusion that "Colorado, and probably also New Mexico aud Arizona, have in their mountains natural advantages and climatic conditions which equal or surpass the best European health-resorts of this character." The great dryness of the elevated plains of Colorado is well known. With a general mean of relative humidity during the year of 50 per cent, and an average annual temperature of 50° F., the air shows but 2.04 grains of moisture to the cubic foot, which is a small amount of absolute humidity for the average of the four seasons. It is this quality which enables one to bear the changes from an extremely high to a low temperature, or vice versa, with comfort. A temperature of 56° or 58°, for instance, is not unpleas- 1 See, also, articles on Denver and Colorado Springs. -'li may be interesting in this connection to call attention to the low average air-tempera- ture of the New England coast during the month of January, as indicated by Boston 26°, Portland 22° and Eastport 20°, taking the government records for aboutltwenty years. Davos- Platz has for normal mean of January, from observation of eight years, a temperature of 18° F. " Comparison pf the Winter Health-resorts in the Alps and Rocky Mountains. Carl Ruedi, M.D. See Estes Park. BOCKT MOUNTAIN BEQION. 243 ant if the air is dry, while the moist atmosphere of Florida, or even Southern California, is often chilly and disagreeable. The wind-movement of the open plains is a marked feature of their climate and at times appears to be unpleasantly prominent, although an examination of its action will show the following sur- prising result. Taking Denver as an illustration, the monthly and annual wind- velocity is found to be less than that of New York, Boston, Philadelphia, Chicago, San Antonio, Key West, St. Paul, San Francisco, and numerous other representative localities (see Table v.). A possible explanation of its apparent force in Colorado is that the wind blows with great irregularity, frequently in small squalls or gusts, as on the seacoast. Another reason why it is felt more strongly is that the towns are not closely built as in Eastern cities, and detached houses and wide streets offer a greater sweep for the wind. In the sheltered valleys of the foot-hills and in the smaller parks there is much less wind, the amount varying with the local conditions. Along the plains east of the mountains the prevailing pleasant weather winds are from the south, southwest, and west, while their opposites, the north, northeast, and east, bring most of the stormy weather. The advantages of continuous air-movement are well known. Perfect stillness of the air is only desirable in freezing weather. In other words, the warmer the atmosphere the more is a moderate air-movement desirable. After studying the matter of the natural climate, the most impor- tant essentials of an invalid's knowledge are the advantages of par- ticular localities as regards' drainage, soil, water, accessibility, the quality of the hotels and boarding-houses, and the possibility of securing good food and cooking. Especial attention should always be given to avoiding, if possible, muddy or " adobe "^ soil and hard or " alkali " water. Colorado is more favored than some of her neighbors in having several resorts of considerable size where good accommodations can be relied on ; but even here the list is not extensive. As most of these resorts are described later in detail, it will only 1 Adobe (ay-do'bay). Throughout the southwestern portion of the United States the term adode is applied indiscriminately to semi-dried bricks, to houses built of such bricks, or to the tena- cious, clayey loam or soil of which they are made. 244 MEDICAL CLIMATOLOGY. be necessary to refer in a general way to the advantages of the plains lying east of the protecting shelter of the mountains. These health stations may be said to extend from Estes Park, Longmont, and Boulder south to Canon City or Pueblo, with Den- ver and Colorado Springs as places of refuge or main points of supply. The elevation of this country ranges from 4700 to 7400 feet. It is not easy in Colorado to get below an altitude of 4000 feet, certainly not without enduring great privations, which are not advisable for a delicate invalid. If a decidedly lower altitude is desired, it should be sought in New Mexico, in Western Texas, or in Arizona, where any elevation from 100 to 7000 feet or more can be found, or in Southern California, if the influence of a marine cliiiKite is not objectionable. The belt of 45° to 50° F. mean annual temperature embraces Denver, Fort Collins, Greely, Boulder, Colorado Springs, and Trinidad. The Continental Divide runs irregularly north and south through Colorado, usually between the 106th and 107th de- grees of longitude. An attractive feature of the Rockies in Colorado is the natural parks — great tracts of land with meadows and pastures, brooks and trees, lying at high altitudes, sheltered on every side by huge ranges of mountains. Each enclosed valley has its own peculiar climate, and offers opportunities for hunting and fishing and the exploration of grand and beautiful scenery. During the summer and early autumn these regions are most attractive for visitors and those strong enough for camping out. North Park lies at an elevation of 8000 feet and contains 2500 square miles. Middle Park has an elevation of 7500 feet and an area of 3000 square miles. It is sixty-five by forty-five miles in extent. Its climate is milder than that of North Park. Within its boundaries are well-known sulphur springs. South Park has an elevation of 9000 feet. It is sixty miles long by thirty miles wide, and contains 2200 square miles. San Luis Park is the largest of all, containing 18,000 square miles. Its average elevation is a little under 7000 feet. It has a warm climate and is more thickly wooded than any of the others. All these parks contain game and trout, and fine feeding-ground for cattle. Dr. Denisou says : " We have every indication that these basins ROOKY MOUNTAIN REGION. 245 were ouce beds of immense bodies of water, wiiich, breaking through their rocisy barriers, cut deep, rugged gorges or canons down which the rivers have flowed for centuries, depositing their debris below the foot-hills. That the plains are overlaid by mountain-washings is very evident to the intelligent observer."^ Egeria, Estes, Antelope, and Manitou Parks, and other smaller sheltered valleys are more or less known as summer-resorts, and in some of them good board can be found. No fully equipped weather-stations have been established in the large parks, but there have been a few voluntary observers, from whose reports to the United States Weather Bureau the following details are taken : San Luis, 7946 feet elevation. Temperature (average for two years, 1891-92), autumn, 44°; winter, 20°; spring, 40°; summer, 62°. Annual mean, 41°; maximum, 91°; minimum, — 25°. Average for January, 15°; July, 66°. Rainfall, 1891, 18.85 inches; 1892, 11.04 inches; 1893, 11 inches. Average for the three years, 13.6 inches. Como, in Middle Park, shows a temperature even lower, as the annual average (for two years) is 83°, with the mean for July, 55°; maximum, 78°; minimum, — 14°. Eainfall, 1891, 15.72 inches; 1892, 10.48 inches; 1893, 12.97 inches. An average of 13 inches for those years.^ In making a summary of the climate of Colorado, Dr. C. T. Wib liams, of Loudon, says : "The chief elements appear to be — " 1. Diminished barometric pressure, owing to the altitude, which throughout the greater part of the State does not fall below 5000 feet." Dr. Williams also quotes from General A. W. Greely's American Weather the interesting statement that "it has been found that the actual barometric pressure in the Rocky Mountains, generally at altitudes above 4000 feet, attains its minimum in Janu- ary and its maximum in July and August, and that the barometric phases are of the same kind, in reference to the annual mean, as the temperature-phases at such stations. This phenomenon of atmos- pheric pressure is the reverse of that in parts of the United States at low elevation, and results, according to General Greely, from the lower average temperature of the winter months contracting the great body of air, so that much of it is brought below the summit of the mountains, while in summer the reverse conditions obtain. 1 Rooky Mountain Health-resorts. C. Denison, M.D. - Aerotherapeutics. The Lumleian Lectures for 1893. London. 246 MEDICAL CLIMATOLOGY. " 2. Great atmospheric dryness, especially in winter and autumn, as shown by the small rainfall and the low percentage of relative humidity. " 3. Clearness of atmosphere and absence of fog or cloud. "4. Abundant sunshine all the year round, but especially in winter and autumn. ''5. Marked diathermancy of the atmosphere, or, as Dr. Denison expressed it, the ' increased facility by which the solar rays are transmitted through an attenuated air,' producing an increase in the difference of sun- and shade-temperatures varying with the elevation in the proportion of 1° F. for every rise of 235 feet. " 6. Considerable air-movement, even in the middle of summer, which promotes evaporation aud tempers the solar heat. " 7. The presence of a large amount of atmospheric electricity. "Thus the climate of Colorado is dry and sunny, with bracing and energizing qualities, permitting outdoor exercise every day, all the year round, the favorable results of which may be seen in the large number of former consumptives whom it has rescued from the life of invalidism and converted into healthy, active workers." Estes Park (average elevation, 7200 feet). Estes Park is situ- ated sixty miles northwest of Denver, on a branch line of the Chi- cago and Burlington Railroad. From Lyons, which is the present end of the railroad, it is necessary to stage twenty miles, usually in a light, covered wagon. The road winds through the picturesque St. Vrain Canon, which was once known as Muggin's Gulch. Estes Park is a plateau about ten miles long and six miles wide, with a number of little side-valleys. " In general contour it is not unlike the other valleys which make up the park system of Colo- rado, abounding in gentle slopes, dark pines, and beautiful winding trails leading from the open glades of the valley up dark canons. Its clear brooks, fed by snowbanks high up on the mountain-side, and filled with speckled trout, uuite in one large stream, the Big Thompson, which breaks its way from the hills to the plains below. From any of the neighboring mountains the view from this charm- ing little valley is one of tranquil beauty, in marked contrast with the sublimity of its surroundings. '" Dr. Carl Ruedi, of Denver (formerly of Davos), had weather- observations taken during the winters of 1891-92 and 1892-93, 1 Rocky Mountain Health-resorts. C. Denison, M.D. ROCKY MOUNTAIN REGION. 247 and compared them with similar ones taken at Davos, with a result exceedingly favorable to the Colorado resort. The elevation of Davos is 5200 feet. A greater elevation was selected in Colorado because the timber-line is so much higher, and it was desired to choose a location similar in regard to the character of the fauna and flora. "A difference of 2000 feet between Colorado and Switzerland is required to put invalids under the same conditions.'" The barometric pressure in Colorado is remarkably uniform. The Estes Park record shows December, 1892, 22.06 inches ; Janu- ary, 1893, 22.11 inches; February, 22.01; March, 22.01. The percentage of relative humidity is much less at Estes Park than at Davos. Dr. Ruedi's short table is as follows : Relative humidity. Denver. Estes Park. Davos. Sentis.2 October, 0.53 per Ct. .... per ct. 0.77 per ct. 0.85 per ct November, 0.45 It 0.40 " 0.79 " 0.76 " December, 0.60 IC 0.47 " 0.81 " 0.77 " January, 0.39 (t 0.38 " 0.86 " 0.71 " February, 0.54 tt 0.49 '■ 0.82 " 0.79 " March, 0.52 0.41 0.62 The following table is compiled from a record of the rainfall in Denver for ten years : November 0.577 inch December 0.370 " January ... 0.706 " February 0.563 " March . . ■ 1.080 " The total precipitation for ten years showed an average of 0.759 inch for each of the months given. A comparison of the rainfall between two Swiss stations and two in Colorado is markedly in favor of Colorado : Days of Precipitation. Denver, 28 in 6 months (October to April) . . 6.79 inches. Estes Park, 19 in 6 months (October to April) . . 6.64 " Davos, 53 in 5 months (October to March) . 11.24 " Sentis, 103 in 6 months (October to April) . . 30.52 " , 1 A Comparison of the Winter Health-resorts of the Alps with Some Places in the Rocky Mountains. Carl Ruedi, M. D. Denver, 1894. 2 The Sentis is an isolated peak 9500 feet high, and the observatory is 2000 feet above tim- ber-line. It is the highest point in Switzerland where official observations have been taken. 248 MEDICAL CLIMATOLOGY. The record of hours of sunshine during the winter of 1891-92 shows a daily average from November to February, inclusive, of 2.85 hours for Davos and 6.80 hours for Denver. The hours of possible sunshine during the winter of 1892-'93 were October to February, inclusive, daily average: Davos, 3.26 hours; Denver, 7.85 hours. The hours of possible sunshine by months for Estes Park and Davos is recorded as follows : Davos. Estes Park. December 165 hours. 264 hours. January . . ... 182 " 268 February 186 " 267 " March Not received. 325 " (See Table VIII.) The record of temperature for Estes Park is not reported by Dr. Ruedi in detail, but he states that "for weeks (in winter) you read 20° to 40° F. at 7 a.m., 40° to 45° at 1 p.m., 25° to 30° at 9 p.m. The only variations take place when sharp continental winds set in, and then at once the temperature falls very low, stays low until the snowfall has set in, to rise again to the usual point after three days." The greater amount of electricity in Colorado as compared with Switzerland is noticed by Dr. Ruedi. In the important matter of wind-velocity he considers the air-movement in the sheltered moun- tain-parks very light. While the wind-movement for the year will average from 7 to 9 miles per hour in Denver or Colorado Springs, in Estes Park the air is usually still, owing to the protection of the surrounding mountains. The main basin of Estes Park rises from an elevation of 6800 feet, near the base of Mount Olympus, to about 7800 feet, near Moraine, which is seven miles further up, on Divide Creek. Owing to its irregularity of configuration, Estes Park cannot all be seen at one time, even when viewed from one of the surrounding peaks. Numer- ous brooks come down from ravines and canons and flow over the meadows. Pine-groves are scattered over the park and on the slopes of the hills. Several large canons leading from the park will repay exploration. They contain a number of picturesque waterfalls and cascades. Good trout-fishing is furnished by the numerous mountain-streams. Hunting is usually sought "over the range" to the west. Long's Peak (14,271 feet) is one of the highest elevations in Northern Colo- ROQKY MOUNTAIN BE OWN. 249 rarlo. It can be climbed to a point above the timber-line on horse- back, but the journey must be completed on foot. There is a small but comfortable hotel in the park. Accommo- dations can also be secured at various ranches. The following seasonal meteorological data for Moraine are based on observations for five years. Mean temperature: winter, 24°; spring, 37°; summer, 57°; autumn, 43°; annual, 40°. For Janu- ary, monthly mean, 24°; minimum, — 17°. For July, monthly mean, 60°; maximum, 88°. Rainfall: winter, 3.56 inches; spring, 6.19 inches; summer, 4.25 inches; autumn, 2.31 inches. Mean aunual, 16.31 inches. Boulder (elevation, 5300 feet; population, 4000). The town of Boulder is thirty miles northwest from Denver, on a branch of the Union Pacific Railroad. It has fair hotels and has a local popularity as a summer-resort. The town is situated close to the foot-hills, near the entrance to Boulder CafSon. The water-supply is drawn from a reservoir on Boulder Creek, five miles above the town. Water is also used from wells, from springs, and from the creek. There are no sewers in the town. Many of the streets are well shaded and bordered with handsome residences. The Seltzer Springs, of Springdale (6500 feet), are ten miles northwest. From Boulder the Union Pacific Railroad has built a narrow-gauge railroad through Boulder Canon to Sunset (7696 feet), about ten miles to westward. The mean monthly temperature for Boulder, from observations for one and one-half years, is as follows: winter, 30°; spring, 49°; summer, 66°; mean for January, 30°; July, 69°. As the month of September is missing, the mean for autumn and the year cannot be given. They would each be probably not far from 49°. No reports of the rainfall for a complete year nor records of the percentage of relative humidity and wind-velocity could be obtained. The average number of cloudy days during the winter is 13. Denver (elevation, 5300 feet; population, 150,000; latitude, 39° 45' north). It is very nearly in the same latitude as Balti- more. Its altitude is easily remembered, as the business portion of the city is said to be exactly one mile (5280 feet) above the sea. The streets in this section of the city are wide, level, and paved with asphalt. Julian Ralph, in an article on ''Colorado and its Capital," first 250 MEDICAL CLIMATOLOGY. published in Harper's Magazine, says : "I had supposed it to be a mountain-city, so much does the Eastern man hear of its elevation, its mountain-resorts, and its mountain-air. It surprised me to dis- cover that it was a city of the plains.'" It is fifteen miles due west to the foot-hills and thirty or forty miles to the highest snow-clad peaks of the range ; yet in the clear air they seem only distant a comfortable walk or a ride of an hour or so. There are a number of fine office and mercantile buildings in Denver. To quote Mr. Ralph once more, " They are massive and beautiful, and they possess an elegance without and a roominess and lightness within that distinguish them as superior to the show buildings of most of the cities of the country." There is a large and lively retail dis- trict. The animation on the streets usually impresses a visitor as being greater than in other Western towns of about the same size — Kansas City, Omaha, and St. Paul, for instance. This may be partly due to the constant coming and going of a large number of invalids, who are usually accompanied by friends. Many of these visitors remain, nearly one-fifth of the population being credited to the class who came for climate and health. The most desirable residence- section of the city is on Capitol Hill, east of the new capitol, on a mesa thirty or forty feet above the business streets. Here are modern, well-designed dwellings, some of great size and costliness, always standing alone, so that light and air have free access, and each house is surrounded by its own grounds. This generous method of building spreads the city over an unusual amount of territory, but insures pleasanter homes and a healthier way of living than the customary method adopted in large cities of build- ing in crowded blocks. Denver is unusually well provided with electric and cable street- roads. The supply of water is ample, derived both from submerged drains in the Platte River and from a reservoir in the mountains, thirty-five miles distant. The water from the first-named of these systems is alkaline. There are a number of artesian wells, a source of supply upon which many of the hotels rely. Denver possesses a number of good hotels, the principal one being surpassed by few Eastern hotels. There are six national banks, four theatres, two of them of the highest class, and well-built churches of all denominations. Denver has a number of social clubs, three of 1 The Great West. Julian Ralph, New York, 1894. ROGKY MOUNTAIN REGION. 251 which — the Denver Club, the University Club, and the Athletic Club — have each a fine, modern club-house. The visitor will find congenial society and better opportunities for business in a city of this size than in the smaller towns. The markets are well supplied with the best beef from Kansas, and fresh fruit and vegetables from the fruit-growing centres of Colorado and from the warmer climates of Texas, Arizona, and California. The stores are large and well equipped and sup- plied. Denver has about 315 sunny days during the year. It is a pleasant place in which to spend tlie winter. The weather is usu- ally mild enough for a light overcoat, except during a week or so of snow in December and perhaps the same length of time in Feb- ruary. The direct rays of the sun usually melt the snow in a few hours, and the ground lies dry and unfrozen nearly all winter. The advantages of the Colorado plains as a winter-resort should be better known. The contrast between the storms and cold of the Eastern or Northwestern States and the dry ground, moderate temperature, and constant sunshine of the country sheltered by the Rocky Moun- tains is always a matter of astonishment to those who have had no previous knowledge of the climate. Reference to the records of the Weather Bureau will show the surprising fact that the climate of Denver greatly resembles that of Prescott — a town in the middle of Arizona — so much further south that it would be natural to ex- pect a much milder climate. As Denver is now a city of sufficient size and resources to gratify any want, and is less than fifty hours by rail direct from New York, its desirability as a place of residence compared to the half-civilized adobe-towns of the southern alkali- country is obvious. During the spring the wind — especially in the afternoons — be- comes annoying, as there is frequently a great deal of dust flying about. The presence of the smelters north of the city is sometimes noticeable ou account of the amount of objectionable smoke which, like a fine brown haze, fills the lower business streets. This condition of the atmosphere is usually due to a north wind, and to avoid it as much as possible a residence east or southeast of the capitol should be secured. " There is a feeling that the air at times is being con- taminated by the smoke and gases from the massive smelting-works, containing, as they do, volatilized galena (lead), arsenic, antimony, etc., although an effort is being made to condense these from the 252 MEDICAL CLIMATOLOGY. smoke, as is done ia other smelters. The same obiection is increas- ing against Pueblo and El Paso."' As before stated, the business streets have asphalt pavements. In the surrounding residence-districts the soil is usually sandy, but in some places it is very tenacious after a rain. There are occa- sional outcroppings of clay on Capitol Hill— the neighborhood of which should be avoided. The monthly average temperature for January is 27° F.; for July, 73°; for the year, 50° (means for twenty years). Number of days in the year above 90°, 21; below 32°, 143 ; cloudy days, 57; stormy days, 73 (means for six years). The hourly velocity of the wind in Denver from the Government records for ten years shows a yearly average of a little less than 7 miles per hour. The total wind-movement for the year 1893 averaged, for the full day of twenty-four hours, 8 miles per hour or 193 miles per day. During the extreme length of what I have termed the ''invalid's day," from 8 a.m. to 6 p.m., it blew at the rate of 9.2 miles an hour. The smallest wind-movement was from 2 A.M. to 9 a.m., when it aver- aged 6,6 miles an hour. The greatest velocity was usually in the afternoon between the hours of 1 and 5 p.m., when it averaged 10.5 miles per hour.^ Occasionally wind-storms come up during the night, and the velocity at that time is greatly increased. A record, however, of the number of days with gales (wind forty miles per hour or over) during the year 1892 shows 3 days for Denver as against 3 days for Santa F6, 15 days for El Paso, 4 days for St. Paul, 6 days for I^ew York, 8 days for Boston, and 59 days for Chicago. In Den- ver a record of the high winds (18 miles per hour or over) during the year 1886 was 23 days. The record of sunshine for Denver for three years (1891, 1892, 1893), as reported by the United States Weather Bureau, is given herewith, adapted from the record for each mouth. For purposes of comparison the record for Davos-Platz for six years, adapted from the tables prepared by Arthur "William Waters, Esq., is included: 1 Health Journal. W. P. Roberts, M.D. - Fourth Report of State Board of Health, Colorado. Denver, 1894. Weather-tables. ROCKY MOUNTAIN REGION. 253 Monthly means. Sunshine-record. Winter. Spring. Summer. Autumn. Year. Percentage of possible sunshine- Denver . . ... Per cent. 62 Per cent. 60 Per cent. 66 Per cent. 71 Per cent 65 Davos-Platz ... . . 57 52 55 62 54 Hours of actual sunshine- Denver ... Hours. 188 Hours. 242 Hours. 290 Hours. 243 Hours. 240 Davos-Platz . 100 166 196 126 147 The general weather-characteristics are much the same as at Colo- rado Spring.s, except that the rainfall at Denver is about 2 inches less during the summer season and the snowfall is two or three times greater in winter. There are also more hot days during the summer. Eighteen miles northeast of Denver, on the Burlington Railroad, is the Colorado Carlsbad Spring, the water of which is bottled for commercial purposes. An analysis by Karl Langenbeck yielded : Grains per gallon. Sodium sulphate 87.16 Sodium chloride 10.00 Calcium carbonate 19.70 Sodium carbonate ... .... 2.44 Magnesium carbonate 3.58 Potassium sulphate, iodide, and bromide . . . trace Iron, aluminum, and silica trace Total solids .... 122.88 Colorado Springs (elevation, 6000 feet ; population, 22,000). This well-known health-resort is seventy-five miles south of Denver. It is well located on gravel-soil which extends to a depth of sixty feet and insures dryness and good natural drainage. The town has a system of sewerage, electric lights, and electric street-cars. The supply of good water from mountain-sources is ample. The streets are wide, level, and well shaded by trees, usually cottonwoods. There are good stores, three banks, an opera-house, several first- class hotels, one of which ranks with the best hotels in the State, a fine social club-house, and remarkably fine churches for a place of its size. The residences are detached and surrounded by handsome lawns. There are a surprising number of large, costly dwellings, built in excellent architectural taste, giving the town the appearance of a long-settled, prosperous Eastern city. Five miles 254 MEDICAL GLIMATOLOOY. to the west are the foot-hills of the Rockies, while twelve miles distant, in au air-line, the summit of Pike's Peak — bi'own in summer and covered with snow during the rest of the year — rises to a height of 14,134 feet above the sea. On the peak there is a stone build- ing, formerly occupied as a signal-service station, and now used as a hotel, and the cogwheel railroad carries up visitors daily during the summer season. From Colorado Springs to the southwest, west, and northwest the hills rise upward of 4000 feet above the town. To the north and northeast are high mesas, also affording protection from winds and storms, while to the east and south the country is an open plain, rolling, brown, and dry. Even so small a distance as separates the town from the foot-hills is of benefit during storms, for a heavy downpour is often seen on the mountains which does not reach Colorado Springs. The rainy months are from April to August, inclusive, the most protracted season being usually a period of four or six weeks of daily rains, beginning during the last half of July. In the moun- tains these rains are more severe, but on the plains they frequently amount only to afternoon thundershowers. The total yearly rainfall averages 14.46 inches; of this the nor- mal precipitation is 11.18 inches during the five months from April to August, inclusive, leaving 3.28 inches to fall during the re- maining seven months from September to March, inclusive. "It therefore follows that the fall of snow is infrequent and scanty through the winter.^ By reason of the dryness and porosity of the soil and the dryness of the air, with the warmth of almost constant sunshine, the evaporation of snow is very rapid. In looking at the temperature-record it will be noticed that once or more during the winter the temperature drops below zero, and sometimes a long way below. Such temperatures rarely last throughout the day, as the sun seldom fails to shine. "When such cold weather occurs during the day the wind, instead of taking its usual daily course from north to south through the eastern quarter, remains in the 1 Owing to the near protection of the mountains on tlie west, and the presence of the Arkansas Divide, twenty-flve miles north, which hrealLS the force of the northern storms, Colorado Springs has usually lighter winter snowfalls than her neighbors which have a more exposed position on the plains. The record for total rainfall and snowfall for three consecutive winters Is as fol- lows : Denver. Pueblo. Colorado Springs. 1892-'93. Nov. to May, 3.73 inches. Nov. to May, 2.74 inches. Jan. to May, 0,66 inch. 1893-'94. " " " 5.98 ■' " " ■" 3.21 " Nov, to May, 1,46 " 1894-'95. " " " 4,09 " ,, ,. ,. 357 „ "■ " " 2:25 inches. ROCKY MOUNTAIN REGION. 255 north, but has a small velocity, a high wind and low tempera- ture being rarely in conjunction. On these exceptional days the younger and more vigorous invalids go out to exercise with benefit, but those who are more delicate remain indoors, bearing their cap- tivity with grace, as something that occurs to them only three or four days out of the whole winter. Driving is most agreeable in the morning, as there is usually very little wind; but after luncheon a strong breeze from the southeast is not uncommon, making walking or riding more pleasant."^ June is likely to be one of the most suitable of the summer- months for camping-out, as there are usually several weeks of dry, sunny weather before the coming of the cooling summer-rains. The mornings are invariably fine during the entire year, and are therefore the most favorable time of the day for being outdoors. A few hot days occur during the summer, but the nights in these high altitudes grow rapidly cooler toward morning. " The absence of dew permits all but the most delicate invalids to sit on the porches in the evening with enjoyment.'" The autumn and winter are delightful, the sun usually shining strong and clear and warm, even after a night when the mercury has dropped pretty low. The air is so dry in winter that during the "invalid's day" lasting from 9 to 4 o'clock the temperature outdoors in the sun is rarely uncomfortable. ''After a night in which there have been a hard frost and a clear sky, with a light breeze from the north, and during which the in- valid has usually slept soundly under several blankets, with his window partly open, he awakes to find the sun shining into his eastern window. And this is a feature which, whatever the weather may be later in the day, is rarely absent. After breakfast our invalid steps into the street, being then in an atmosphere in which the heat in the sun is 92° and in the shade 30° F. A gentle air is stirring from the northeast at the rate of six miles an hour. The mean dew-point is 18°. "As the day proceeds the temperature rises to its highest point, being 100° in the sun and 40° in the shade between 2 and 3 p.m., while the wind, which has veered rapidly from the north to the south, blows with its highest daily velocity, thirteen miles an hour. After 2 p.m. the wind works back again toward the east, being at sundown northeast, and continuing as darkness falls to 1 An Invalid's Day in Colorado Springs. S. E. Solly, M.P. "- Ibid, 256 MEDICAL CLIMATOLOGY. shift back to the northern quarter, whence it blows from 8 p.m. to 9 A.M., its velocity dropping to between seven and eight miles an hour,^ and the temperature of the air at the same time falling from three to four degrees. The ground is usually bare of snow, no rain falls from mid-September to mid-April, and the sun shines unob- structed by clouds. During the three winter months the number of cloudy days does not average more than five a month. The effect of such an air is bracing and genial, and being so dry the cold in the shade is very little felt, a medium- weight wrap being all that is needed. The roads are good and seldom obstructed by snow or mud, and the neighboring hills and plains are full of interesting points to visit, and pleasant, sheltered nooks where the invalid can rest under the agreeable heat of the sun and eat his midday meal without fear of taking cold." The very cold days of winter (they are not numerous) and the windy days of spring are the greatest trials for an invalid at Colo- rado Springs. " The spring weather in Colorado, as in most climates, is the least desirable; during late March and early April the chief part of the snow falls and the wind that goes mainly to swell the total of the annual movement occurs."^ The night-air is cold and dry all the year round, with very few exceptions. Wiudows can be left open on the coldest nights, as the air in a room will never get as cold as the air outside, and the colder the air is the less moisture it contains. Immunity from fog is proved by the low dew-point, the yearly average dew-point for Colorado Springs for 1893 being 24°. The mean daily range of temperature in Colorado Springs is 25°, and it varies but little from that average for every month in the year. It is a question how adversely the constant and wasteful water- ing of the lawns in summer affects very delicate invalids who spend a great part of the day on porches exposed to such influence. A short series of experiments in the way of daily observations of the relative humidity, taken during one summer by means of Mason's hygrometer, on a front porch over a lawn that was not sprinkled excessively, showed a usual variation of 13 per cent, increase over the Grovernment observations, which were taken forty-nine feet above the ground, with no lawn around the building. 1 See, also, Wind-movement in Denver. ' A.n Invalid's Day in Colorado Springs. S. E. Solly, M.D. ROGKY MOUNTAIN REGION. 257 There is little doubt that the desire for fresh grass in a naturally arid country leads to a questionable freedom in the use of water. Except for the short-lived objections of spring winds and rains, August rains, and winter cold — none of which periods is long con- tinued — there are few objections to Colorado Springs as a health- resort for those who are not affected by long-continued residence at a considerable altitude. On the other hand, it possesses advantages such as few other resorts can offer : a dry, porous gravel-soil ; unusually wide streets; town-sewerage ; remarkably pure, soft mountain-water, containing less than three grains of total solids to the gallon;^ and good drives, beautiful natural scenery, and the absence of manufactories. The markets are surprisingly good in Colorado Springs. The grocery, provision, and fruit-stores are numerous and unusually well supplied for a town of this size. There are few opportunities for business, but Cripple Creek — twenty miles west in an air-line — has grown to be a bustling mining-town of over 20,000 inhabitants. It is quite dependent on Colorado Springs as the nearest town of any size, and the development of its mines has brought much wealth to the Springs. Colorado Springs has sixteen trunk-lines of railway and direct daily communication with the East via the main line of the Chicago, E,ock Island and Pacific Railroad to Chicago.^ The monthly mean temperature for January is 26° F. ; for July, 69°; fortheyear, 47° (means for sixteen years). Average annual days ' The town-water of Colorado Springs is drawn from Lake Moraine, a natural basin on the shoulders of Pike's Peak, situated above the timber-line. It is fed by the melted snows of the summit, seeped through granite and gravel. The water is unusually pure and soft, and is probably as near an approach to distilled water as any public vrater-system could furnish. The supply is ample for a town several times the present size of Colorado Springs. The last analysis of this town-water made by Prof. William Strieby, of Colorado College, showed two and one-half grains of total solids to the gallon. 2 As Colorado Springs is not a large place, it may be useful to travellers to explain its railroad connections : Passengers from the East have a through sleeper from Chicago to Colorado Springs on the Santa Fe and the Rock Island Railroads. There is one change from St. Louis on those roads. The Missouri Pacific runs a through sleeper from St. Louis, and has one change from Chicago. Passengers from New Orleans or Galveston find a through Pullman running from Houston to Denver (Houston is one and one-half hours from Galveston) on Union Pacific, Denver and Gulf Railroad. Passengers from California come over the Santa Fe, Colorado Midland, or Denver and Rio Grande Railroad with but one change. From Oregon, with but one change, over Colorado Midland or Denver and Rio Grande Rail- road. Chicago to Denver, direct through sleeper on the Burlington Railroad, one change to Colorado Springs. 17 258 MEDICAL OLIMA TOL OOY. above 90°, 7 (means for seven years) ; below 32°, 155. Stormy days, precipitation, 0.01 or over, 69 (means for four years). Normal winter-rainfall, 0.7 inch. J^umber of cloudy days in winter, 13; in spring, 20; summer, 13; autumn, 11; year, 57 days (means for six years). The, annual wind-movement averages 9.1 miles per hour. Table II.— Colorado Springs. Means ro^ Two Years, 1893 and 1894. Month, Temperature. Extremes. Monthly. Max, January, 31° February, 26 March, 36 April, 44 May, S4 June, 6S July, 67 August, 64 September, 59 October, 48 November, 39 December, 32 Annual, 47 Winter, 29 Spring, 44 Summer, 64 Autumn, 48 (1894) 42° 36 50 60 68 75 78 78 72 Min. (1894)! 16° I 10 25 32 43 48 65 62 44 Max. Min. 65° —2° 66 —3 72 6 73 11 81 27 91 38 90 47 85 42 82 31 76 14 71 2 69 —7 91 -7 Rela- tive humid- ity. Per ct. 44 53 46 41 48 43 52 59 43 51 44 49 47 45 51 46 Abso- lute humid- ity. Grains 0.83 0.80 0.99 1.16 1.88 2.27 2.36 2.45 2.03 L61 1.12 0.99 1.48 0.87 1.26 2.95 1.55 Dew- point. IS 17 29 34 45 46 31 26 16 13 23 10 19 41 24 Total. I Rain- fall. Inches. 0.01 0.36 0.18 0.38 4.34 2.17 2.73 2.22 0.49 0.46 0.17 0.22 13.72 0.59 4.92 7.12 1.11 Cloudy days. Wind, hourly ve- locity. (1893) 2 10 Miles. 11.1 10.7 12.4 12.5 11.1 10.0 8.2 7 7.2 2 I 8.9 1 '9.1 6 I 10. 6 9.6 68 10. 10.4 12.0 17 25 18 8,4 8 9.0 Note. — The maximum temperature for 1893 was 93° on one day in June and one day in July. For 1894 it was 90° on one day in June. The number of days (or, more accurately speak- ing, nights) below 32° during 1893 was 168. The minimum temperature for 1893 was —3° in February, and for 1894 —10° in January. The month of October is missing from the record for 1894, and the mean for sis years is used, except in cases when unattainable, when the mean for October, 1893, is employed. lu the seasonal averages no difference of importance will be perceptible. The year 1893 was a dry year, and the year 1894 unusually wet, especially in May, when the precipitation was 7.34 inches. The mean of both years (13.72 inches) is nearly one inch below the normal annual precipitation for sixteen years. The wind-movement for 1893 was unusually high, averaging 10.3 miles per hour for the year, which is about one mile per hour above the normal. The year 1893 also contained an unusual number of cloudy days, (See Table V.) ROCKY MO UNTAIN BEGIO^\ 259 The summers iu Colorado Springs are usually cool. In 1892 there were 11 days when the thermometer rose above 90°, the highest point being 94°; in 1893 there were two days above 90°, the highest temperature being 93°; in 1894 a temperature of 90° was reached on one day only ; in 1895 there were no days over 90°, the highest temperature being 89°. In the warm days that occur in Colorado Springs the air is in- variably dry. When the temperature goes above 85° the relative humidity usually drops below 25 per cent., and the ''sensible" temperature is about 60°. The mean of the summer minima is 51°, showing cool nights. There are severe wind- or dust-storms at infrequent intervals when the air is very dry and electrical. They are exceedingly disagreeable, but do not occur more than half a dozen times a year, and the greatest violence of the wind rarely lasts more than a few hours. The gravel-soil of the plain on which the town of Colorado Springs stands greatly mitigates this annoyance as compared with that experi- enced in towns built on adobe-soil. Manitou (elevation, 6300 feet; population, 3000). Five miles west of the town of Colorado Springs, in a sheltered valley at the foot of the mountains, are located the mineral springs which give the name to Colorado Springs and form one of the principal attrac- tions of the lively hotel-resort called Manitou. Two railroads, a line of electric cars, and good roads for driving connect the two towns. There are eight sparkling soda and iron springs, varying in tem- perature from 44° to 59° F. — -all strongly charged with carbonic acid gas. The water of one of these — -the Navajo — is bottled in immense quantities, and is known all over the country as a table- water of great purity and value. In composition and taste it closely resembles the imported Apollinaris Water. A half-mile or so above the village, situated iu a beautiful caflon, and on the banks of Ruxton Creek, is the summer-house over the iron Ute Spring, which is " highly effervescent, of the temperature of 44.3° F., and very agreeable in spite of its marked chalybeate taste.'" Professor O. Loew, Mineralogist and Chemist of the Wheeler Expedition, said that the springs of Manitou "resemble those of Ems and excel those of Spa." There are three picturesque caiions leading into the mountains 1 Manitou, Colorado ; Its Jlineral Waters and Climate. S. E. Solly, M.D., 1S82. 260 MEDICAL CLIMATOLOGY. from Manitou — Ruxton, or Engleman's Canou, William's Canon, and the Ute Pass, the latter of which contains the old Indian trail through the apparently impassable range. Besides the cog-railway to the summit of Pike's Peak there is also a wagon-road. Manitou has a number of good hotels, and duriog the " season," from June to September, they are usually lively with visitors. One or two keep open during the entire year. The climate of Manitou differs slightly from that of Colorado Springs. The valley is more sheltered from the winds, but is somewhat damper in summer, owing partly to the effect of more frequent mountain-rams and partly to the presence of the brooks that flow through the town. The days in winter are short, on account of the height of the mountains on the west. During the month of December the sun sets in the town of Manitou a few minutes before 3 o'clock, which is about one hour and a quarter earlier than it sets in Colorado Springs. Analysis of the Peincipal Mineral Springs in Manitou, Made by Dr. Waller. In a pint of water are contained grains as follows ; Potassium sulphate Sodium sulphate Sodium chloride Sodium bicarbonate . Calcium bicarbonate Magnesium bicarbonate . Lithium bicarbonate Iron oxide Silica . Aluminum . Ferrous carbonate Strontium carbonate . Potassium chloride Magnesium sulphate Calcium sulphate Total Ute Chief 1.949 0.932 3.346 6.657 10. 477 2.235 0.141 0.046 0.467 0.015 trace Navajo Mani- I Hiawa- Ute tou. tha. Iron. 1.919 1.367 2.974 5.326 8.667 2.005 0.089 0.003 0.308 0. 013 1.336 1.268 2.193 5.083 8.635 2.085 0.077 0.003 0.312 0.009 trace 4.271 6.023 0.092 0.092 0.031 0.134 trace 0.213 1.123 I 0.214 0.979 1.880 2.116 3.613 3.963 1.005 trace 0.035 0.452 0.019 0.049 Little Chief. Sho- shone. Minnie- haha. 0.501 0.333 trace 3.601 2.601 0.750 3.333 3.000 1.003 1.114 6.201 1.666 5.251 7.602 2.801 1.001 0.501 trace trace trace 0.125 0.102 0.143 trace trace 22.671 21.801 I 12.193 14.211 15. 6.823 ROOKY MOUNTAIN REGION. 261 The Garden of the Gods is situated a mile or two from Manitou and about four miles from Colorado Springs. This imaginative title is applied to a number of fantastic rock -formations. The red sandstone has been ground by a mighty agency in the past into strange forms resembling with an accuracy sometimes grotesque the shapes of animals and objects. The huge rocks at the gateway are over three hundred feet high. Glen Eyrie and Blair Athol, a few miles further north, contain similar freaks of nature. Broadmoor. Four miles southwest of Colorado Springs is Cheyenne Mountain, which guards the Broadmoor Casino, where, during the summer season, visitors can hear good music and cooling refreshments can be obtained. The Broadmoor Hotel, a well- equipped building fronting on the grounds of the Broadmoor Casino, has been recently finished. In the Cheyenne Valley are a number of charming homes. There are also several summer-camps and a few boarding-houses, where quarters can be secured all the year round. The valley is sheltered from the wind by the higher land rising on either side. Not far from Broadmoor are South Cheyenne Canon and the Seven Falls, North Cheyenne Canon, and still further north Bear Creek Canon, through which the first Government trail to Pike's Peak was constructed. A few miles west of Manitou are a number of attractive summer- resorts, rising higher in altitude as the railroad steadily climbs around the huge shoulders of Pike's Peak to reach the park-like country beyond. Cascade (7240 feet), Ute Park (7500 feet). Green Mountain Falls (7730 feet), and Woodland Park (8480 feet) are stations on the Colorado Midland Railroad, between eleven and twenty miles from Colorado Springs. They are picturesque resorts, situated in canons and small natural parks, and are supplied with good hotels. Some of them have also accommodations for tent- and cottage-life. Manitou Park (elevation, 7800 feet) is a green valley surrounded by beautiful mountains, the slopes of which are covered with pine- forests. The rides aad drives are very fine. It is seven miles from Woodland Park, and is reached by a stage which makes daily trips between the two places during the season. There is a comfortable hotel surrounded by pleasant cottages, and the grounds contain golf- 262 MEDICAL CLIMATOLOGY. liaks, tennis-courts, and a lake which affords excellent trout- fishiug. There is a greater summer rainfall on the mountains than on the plains, the showers usually occurring during the afternoon.' Pueblo (elevation, 4700 feet; population, 35,000). It is best known as a rising manufacturing-city, but the records of dryness and fairj mild winters entitle it to consideration among the healtii- resorts of the Colorado plains. The town is situated on both sides of the Arkansas River, which is a muddy, rapid-flowing stream. The soil iu the lower portion of the city is adobe, caking to the hardness of brick under the hot summer sun, dust}' under the in- fluence of a strong wind, muddy and tenacious after heavy rain or snow. From late September to March the weather is usually all that can be desired. The nearest mountains are twenty-five miles away, and the lower altitude of the Arkansas valley insures milder weather than that found farther north. This portion of the year is a season of almost perpetual sunshine and moderate temperature. The spring months are more doubtful on account of occasional dust-storms and parching winds. The summers are very hot. The highest tem- perature is usually about 10° F. above that at Colorado Springs. The Pueblo Board of Trade report for 1893 contains, on page 96, the statement that " wind-storms are unknown, winter or summer." On .June 14, 1893 — -one of the days this report was being sent through the mail — a dust-storm raged in Pueblo about sunset for an hour or more, at times too thick to see through it a church- steeple at a distance of two blocks. Such storms are infrequent, but this incident illustrates the constant allowance that must be made for local prejudice. Regarding the heat, the average number of days over 95° during five years is 16 for each year, showing a high general temperature for the impaired vitality of invalids to withstand. A visiting physician writes: " Pueblo is several degrees warmer than either of the other cities visited (Denver and Colorado Springs). In fact, it was hotter than any place in New Mexico when I was there. Except for the smelters already noticed, it is a good health-poiut for those with weak lungs."' If Pueblo is to be entirely a manufacturing-city, the smoke-nuisance should be care- fully considered by delicate visitors, who should select a place of 1 See Climate of Colorado. "- Dr. W. P. Roberts, in Health Journal. ROCKY MO UNTAIN REGION. 263 residence as far from the noxious outpourings of cliimneys as pos- sible. The water-supply of the town is drawn from the Arkansas River, the water of which is alkaline and contains considerable muddy sediment. There are artesian springs of good quality, but settling basins for the north side water-system should be provided to clear and purify the regular river-supply for domestic use. Pueblo has good stores, banks, and churches. There is one good hotel, and others are contemplated. There is a pleasant social club, and the Opera House-is one of the finest buildings of its kind in the State. The average mean temperature for January is 29° F.; for July, 76°; for the year, 52° (from records for fifteen years). Average number of days above 90°, 41; below 32°, 146; cloudy days, 53; stormy, 52 (from records for four and six years). The average annual velocity of the wind is 7.4 miles per hour. In 1892 the number of days on which there were gales (wind over 40 miles an hour) was (for Pueblo) 19 days. Two of the artesian wells in Pueblo yield water of remarkable qualities. In one the water contains a large amount of lithium salts. Tub-baths are given at the hotel adjoining the spring, which in every way offers good accommodations. The water flows from a depth of 1200 feet. An analysis made by Professor A. A. Cunningham, of the University of California, follows: Grains per U. S. gallon Lithium bicarbonate . ... 7.81 Lithium sulphate . . ... 1.92 Magnesium sulphate . 60.47 Magnesium carbonate 4,71 Iron carbonate 4.14 Potassium chloride . 8.83 Calcium sulphate 14.79 Calcium carbonate 15.12 Sodium sulphate 12.41 Sodium chloride 19.72 Phosphoric acid . ... trace Organic matter ... none Total solids 149.92 The other well furnishes a sulphurous chalybeate water, flowing from a depth of 1400 feet, which is extensively used for bathing. It is called a " Magnetic Mineral Spring." A circular issued by the 264 MEDICAL CLIMATOLOGY. proprietor states that ''a qualitative analysis of the water gives the following constituents : "Sulphuretted hydrogen, iron (form titanic acid), bicarbonate of lime, sulphate of soda, sulphate of magnesia, manganese, potassium (trace), sulphuric acid, arsenious acid(?). One remarkable peculi- arity of the water is that knives are readily magnetized by holding them in the water." N"o quantitative analysis of this water has been published. Beulah, twenty-eight miles from Pueblo, is a resort at an eleva- tion of 5600 feet, situated in a basin along the foot-hills on the eastern slope of the Greenhorn range. It is reached by regular stage in about five hours. The village has a population of 200. There is a good hotel. Board can also be secured at some of the ranches. Water is obtained from the mountain-streams. There are canons and other places of interest to visitors. The Beulah Springs are mild soda springs of excellent quality. Fifteen miles west from Pueblo is the Carlile Soda Spring, which is carbonated and put on the market. An analysis made by T. A. Stoddard, M.D., of Pueblo, is as follows : Grains in U. S. gallon. Sodic carbonate . 9.33 Calcic carbonate Magnesium carbonate Ferric carbonate Potassic sulphate Sodic sulphate . Sodic chloride . Calcic phosphate Sqdic phosphate Silica 18.56 11.60 0.58 1.16 23,20 8.70 1.50 0.87 trace Total solids 75.50 Canon City (elevation, 6300 feet ; population, 3800). Canon City is situated in a valley near the entrance to the Arkansas CaQon. The town lies mainly on the north side of the Arkansas Eiver. It is forty-five miles northwest of Pueblo, on the main line of the Denver and Rio Grande Railroad and on a branch line of the Santa Fe Railroad from Pueblo. It has a milder winter climate than the cities on the plains. This is due largely to the shelter from the wind afforded by the surrounding mountains, which rise 2000 or 3000 feet above the town and protect it on the north BOCKY MOUNTAIN REGION. 265 and south. A westerly wind blows occasionally through the canon, but its force is principally felt south of the river. To the east — or a little south of east — the valley opens to the plains. Snow seldom falls and quickly disappears. The soil of the valley is adobe. There is a small residence- district south of the river where the soil is more sandy. The town is supplied with electric lights, waterworks, and a system of sewer- age. The waterworks are artesian wells sunk near the Arkansas River, on the Holly system, into which the river- water filters. It is good water, but hard. Canon City has a number of comfortable-looking residences, each house being built usually of brick and standing alone on its own lot of land. The residence-streets are well shaded. There are two or three fair hotels and a few boarding-houses. About three-quarters of a mile west of the postofSce are the two cold soda springs, one of which has slight traces of iron. Half a mile further are the hot springs, where there are a hotel and a bath- house. The analysis of these mineral springs by Professor Loew is appended : Analysis op Mineral Springs, Canon City. Iron Duke. Little Ute. Ojocaliente. Cold. Cold. Hot, temp. 102°. Sodium chloride . 83.0 118.0 18.2 Sodium sulphate 12.2 12.1 79.3 Sodium carbonate 76.8 76.4 73.2 Calcium carbonate .33.0 22.5 33.5 Magnesium carbonate . 14.6 14.0 12,8 Iron . traces traces Lithia . traces traces traces Grains in one gallon 219.6 243.9 217.0 The valley in which the town of Canon is situated is famed for its strawberries, grapes, and apples. The latter fruit is exteusively cultivated with the aid of irrigation-ditches. The attractions in the neighborhood are the Royal Gorge (which begins within two miles of the town, but which requires a twelve- mile drive to be fully appreciated) ; the Saurian bone-fields ; the Marble Caves (twelve miles) ; the Bottle Rocks ; the Bottomless Pit; and Grape Creek Canon (distant about two miles). The State Penitentiary is located on the edge of the town, about half a mile west of the postoffice. 266 MEDICAL CLIMATOLOGY. Directly south of the town is a large zinc, lead, and copper smelter, the smoke from which is usually carried away from the business-centre and residence-district by the prevailing winds. An abstract of the temperature-record for Canon City for four years is as follows: mean temperature for January, 32° F.; for July, 74°; for the year, 53°. The minimum for January is — 6° and the maxima for July and August 100°. By seasons the temperature and rainfall are as follows: Winter. Spring. Summer. Autumn. raperature, four years, 34° 62° 72° 53° infall, six years, 1.80 in. 4.24 in. 4.21 in. 1.63 in. ■The mean of the annual rainfall for six years is 11.38 inches. The year 1894 had an excessive rainfall, its total being 16.96 inches. There are no records of the relative humidity, but it is about the same as Pueblo, perhaps a little higher in summer on account of the irrigation and the absence of strong winds. Glenwood Springs (elevation, 5200 feet ; population, 1500). A little west of the centre of the State of Colorado, not far beyond Leadville (10,200 feet), is the crest of the great Continental Divide. Glenwood Springs is on its western slope, and the waters of the Roaring Fork and the Grand River, which meet opposite the town, find their way eventually into the Pacific Ocean. The town is reached by the Den ver and Rio Grande and Colorado Midland Railroads. The principal attraction is the famous Yampa Hot Spring, which flows the enormous quantity of 2000 gallons per minute, at a tem- perature of 124° F. A large and complete bath-house has been built to utilize this hot saline water under medical direction. There are also sulphurous vapor caves and an open swimming-pool 700 feet in length by 100 feet in width, where outdoor baths may be enjoyed during the entire year. Glenwood Springs has one of the finest hotels in the West. It is a large building in the Italian style of architecture, constructed of Colorado peachblow colored stone and Roman brick. It surrounds an open court which is terraced, and has grass-plats, fountains, and beds of flowers. The hotel has 200 guest-rooms ; it is well heated, liberally supplied with open fireplaces, and is lighted by electricity. Glenwood Springs has an ample water-supply, and sewers in the populous section. ROCKY MOUNTAIN REGION. 267 The meteorological i-ecord for Glenwood Springs is incomplete. It is only possible to obtain a record of the temperature for two full years, and of the rainfall for three full years, which, given by seasons, are as follows: Spring 50° Summer, 69° Autumn. Winter. Monthly mean i temperature, [ 27° 50° 69° 47° Rainfall (total), 4.90 in. 3.04 in. 3,80 in. 4.22 in. Monthly mean temperature for January (two years) Monthly mean temperature for July (two years) . Mean yearly minimum (three years) . Mean yearly maximum (three years) . Year. 48° 15.96 in. , 22° . 72 , —5 , 100 Analysis of the Yampa Spkings (Glenwood Spkings, Colorado) (made by C. F. Chandler, Ph.D., June, 1888). Temperature 124° F. Grains in U. S. gallon of 281 cubic inches ot water Sodium chloride . 1089.83 Magnesium chloride . 13.09 Sodium bromide 0.56 Sodium iodide ... trace Calcium fluoride trace Potassium sulphate . 24.04 Calcium sulphate . 92.38 Lithium bicarbonate 0.22 Magnesium bicarbonate 13.55 Calcium bicarbonate 24.37 Iron bicarbonate trace Sodium biborate trace Sodium phosphate .... trace Alumina . trace Silica ... . . 1.97 Organic matter trace Total . 1250.04 Steamboat Springs (elevation, 6800 feet) is one hundred miles south of Rawlins, Wyoming, on the Union Pacific Railroad, and eighty-five miles northwest from Hot Sulphur Springs, Middle Park, Col. Leaving the Denver and Rio Grande Railroad at Wol- cott, the tourist first goes by stage to McCoy's, distant tweuty-two miles to the north. From there a stage can be taken the next morning at 6 A.M. for Steamboat Springs, sixty miles further north. This part of the ride occupies about twelve hours. The road goes through Egeria Park, which is noted for its lovely scenery. Elk, deer, antelope, bear, and mountain-sheep are 268 MEDICAL CLIMATOLOGY. said to be fairly plentiful on the mouutains in this vicinity, and the best trout and grayling fishing in the State is found between Zampa (formerly Egeria) and Steamboat Springs, on the Bear E-iver. The town of Steamboat Springs has about 400 inhabitants. It is situated in a narrow valley surrounded by mountains. Within a radius of two miles from the centre of the town there are over 300 springs, of which more than 60 are known to contain soda, magnesia, sulphur, and iron. Some of the cold, sparkling waters are very palatable, noticeably those of the Iron Spring. They vary in temperature from cold to 156° F. Many of the hot springs send off clouds of steam, which are particularly noticeable on a cold morning. There is no detailed weather-record for Steamboat Springs. It is on the western slope of the Continental Divide, and has a larger rainfall and snowfall than many localities further south in the State. It is a beautiful place for camping-out and hunting during the summer and early autumn. The value of the hot springs is very great, and it would be considered a marvellous resort if it were more accessible and better known. The mean record of rainfall for Steamboat Springs for three years is as follows : winter, 9.30 inches (including melted snow) ; spring, 6.03 inches; summer, 0.85 inch; autumn, 3.11 inches. Total annual, 19.29 inches. The mean monthly temperature at Steamboat Springs in 1893 by seasons was as follows: winter, 19°; spring, 37°; summer, 59°; autiimn, 44°; year, 40°. Monthly mean for January, 16°; for July, 61°. Maximum, 91°. The minimum temperature was below 32° every month in the year. Grand Junction (elevation, 4500 feet; population, 2500). The town of Grand Junction, which is on the Denver and Rio Grande and Colorado Midland Railroads, lies in a valley fifteen miles long, opposite the junction of the Gunnison and Grand Rivers. It is a busy town in the centre of what will probably be in time the greatest fruit-growing region of Colorado — the moderate altitude, adobe soil, shelter from heavy winds and storms, and ample supply of water for irrigation all contributing to that result. All decidu- ous fruits flourish in the valley, but it is especially noted for its fine peaches. Like Glenwood Springs, Grand Junction is on the Pacific slope. BOOKY MOUNTAIN REGION. 269 west of the Continental Divide, which is crossed at an elevation of over 10,000 feet on the Denver and E,io Grande Railroad, and on the Colorado Midland Railroad at an elevation of 11,500 feet. There is no complete weather-record. The mean temperature for two years (1893-'94) by seasons was as follows : winter, 31°; spring, 52°; summer, 75°; autumn, 52°; for the year 53°. The minimum temperature in 1894 was 8°; maximum, 100°. The rainfall of the valley is very low, the annual mean for five years being 8.45 inches, divided as follows: winter, 1.88; spring, 2.38; summer, 1.97; autumn, 2.22 inches. The annual snowfall is 34 inches (in Colorado equal to about 3 inches of rainfall), of which nearly 19 inches fall in February. Snow seldom remains on the ground for any length of time. The wind-movement is small, although an occasional lively wind-storm blows through the valley. The town-supply of water for domestic purposes in Grand Junc- tion is taken from Grand River, and is poor. An appropriation has recently been made, however, for the construction of a pipe- line from the mountains, which will furnish pure water. There are no sewers. The valley has mild winters, the thermometer seldom reaching zero. The summers are hot. When it was an arid plain the humidity was low. How far the universal soaking of the soil by means of irrigation will affect it as a resort for pulmonary invalids remains to be seen. During the winter months, however, this objection does not exist. Springs. Colorado is favored with a great number of mineral springs, the value of which is known; but it may be said now, as it was said several years ago, " it is impossible to do full justice to the curative properties of the whole number, as but a small portion has as yet been subjected to quantitative analysis and few have been tested as to the effect of their medicinal qualities upon diseases." The best known of these resorts are Manitou and Glenwood, where villages have sprung up around the springs, and there are first-class hotels. The Siloam Springs (6000 feet) are in the centre of a beautiful valley on the Grand River above Glenwood Springs, on the line of the Denver and Rio Grande Railroad. 270 2IEDICAL CLIMATOLOGY. The springs range in temperature from 94° to 104°, and are said to resemble the combination of saline waters found at Saratoga.' The total flow is about 10,000 gallons per hour. They are similar to those at Glenwood, and can be used in the vapor-caves and in an open pool one hundred feet in diameter. The Seltzer Springs at Springdale, ten miles from the town of Boulder, are situated near the edge of James Creek, surrounded by wooded mountains and in the midst of picturesque scenery. They are reached by stage from Boulder. A small hotel has been erected near the springs. Idaho Springs (elevation, 7700 feet ; population, 2000) is thirty- five miles west of Denver, on the Colorado Central Railroad, a branch of the Union Pacific Kailroad. The town is situated in the Clear Creek Canon, and is reached through picturesque scenery ; on account of its accessibility from the plains it promises to become eventually a desirable retreat for invalids. The mountains on the north protect the town from inclement winds, " while the less precipitous mountains to the south allow a desirable long continuance of sun-exposure." There are several hotels and boarding-houses. There are a number of warm springs, and hot springs with a temperature of 110° to 120° F. A little further up the valley are the Cave and Tunnel Springs and bathing-pool. The town of Idaho Springs is supplied with. pure water from mountain-springs. The soil is sandy and porous. The mean temperature for winter for five years is 28°, with over 2 inches of melted snow, falling on 20 stormy days. Relative humidity for winter, 50 per cent. The minimum temperature in 1892 was —14°. The mean temperature for spring is 40°. Total precipitation 3 or 4 inches, and cloudiness about the same as for winter, with per- haps more stormy days. The mean temperature for summer is 62°; relative humidity, 50 per cent. Rainfall about 7 inches. About 36 cloudy days. The summer-showers are usually hard and brief. The water is quickly drained away. The mean temperature for autumn is 44°. Rainfall from 2 to 3 inches on 15 days. 1 Mineral Springs of Colorado. C. Denlson, il.D., 1889. BOGKY MOUNTAIN REGION. 271 The remarkable Steamboat Springs are referred to on page 267. In Middle Park are the Hot Sulphur Springs, previously men- tioned, situated on the banks of the Grand River. It is a delight- ful region for camping-out. In a basin, bounded bj^ peaks of the snowy range, southwest, and high up amoug the mountains, are effervescing soda springs, not yet improved. In South Park are Hartzell's Hot Sulphur Springs and the South Park Springs, saline alkaline waters, on the bank of the South Platte River. There are also other undeveloped chalybeate and alkaline or sulphur springs in the vicinity. In the small valley occupied by Caiion (Jity are several hot and cold springs, chalybeate, sulphur, and soda, some of which have been improved. (See Canon City.) South of Canon City sixty miles, in Poncha Pass, are the Poncha Springs (7480 feet), a collection of hot and cold waters. There are thirteen hot springs at a temperature of 120° F., with sulphur and soda as the principal constituents. Twenty or thirty miles north of Poncha Pass, situated in the Arkansas Valley, at an elevation of 8000 feet, are the Chalk Creek Springs, twelve or more in number, at various temperatures, the hottest being 150° F. The Pagosa Springs (7100 feet) lie in a picturesque country on the northern bank of the San Juan River These are purgative alkaline waters, with a large excess of sulphate of sodium, and they rise to a temperature of 140°. In "Wagon Wheel- Gap (8500 feet) are purgative and alkaline hot springs of great local reputation, while near Canon Creek and Uncompahgre are great numbers of mineral springs, varying in temperature from 120° to 140° F. An analysis of the Colorado Carlsbad Spring will be found on page 253, and of two mineral artesian wells in Pueblo, the lithia water and the suphurous chalybeate "magnetic" water, page 263. Utah. Salt Lake City (elevation, 4300 feet; population, 70,000). It is about ten miles from the northwest corner of the city to the shores of the Great Salt Lake.^ Some of the popular bathing-beaches are 1 The Great Salt Lake (elevation, 4200 feet) is about 80 miles long by 30 or 40 miles wide, covering an area of 2360 square miles. It has an average depth of 12 feet, with about 60 feet as its greatest depth. It has no outlet. The last analysis of the water showed 16.88 grains of mineral ingredients In one U. S. gallon, which is about Jive times as salt as the Atlantic Ocean. 272 MEDICAL CLIMATOLOGY. a little more distant. Away to the east and north are the Wasatch, and to the west theOquirrh range of mountains, distant about twelve miles. The streets of Salt Lake City are wide, and, except in the active business-centre, well shaded with trees. In the business portions of the city most of the streets are paved. There are large, well- equipped stores and several good modern hotels. The city has an excellent service of electric street-cars. Water for domestic purposes is brought from tlie mountains. It is pure, but hard. Ditches along the sides of the streets carry the water for irrigation. In the residence portion of the town are well-kept lawns. The soil is adobe. There is a town-system of sewers. Salt Lake City is one of the three Western cities of good size possible for the residence of those to whom a sunny climate is necessary and who desire to settle in an active business-centre. The other two large cities are Denver, which shares with Salt Lake City the advantage of altitude, and Los Angeles, which is equally sunny but exposed to ocean-influence. Salt Lake City is accessible by rail. Its moderate elevation is a point worthy of consideration by a certain class of invalids. On some of the higher benches or mesas near the town desirable situations for residence can be found. It is important for invalids in all large cities to be at a safe distance from any possible ill-effects from the chimneys of manufactories or smelters. The proximity of the cailons and mountains, the hot springs, and the immense inland sea, with its bathing-resorts, give Salt Lake City unusual facilities either as a temporary resort daring the summer and autumn or as an attractive place for a permanent residence. Compared with some of the other high-altitude weather-stations, Salt Lake City has a somewhat capricious climate. This may be partly attributed to its being situated west of the Continental Divide, and therefore more directly subject to the far-reaching Pacific coast influence than localities like Denver and Colorado Springs, which are on the eastern slope and have the protection, on the west, of the great ranges of the Rocky Mountains. While the Government-records show it to be very dry in summer, it is also exceedingly hot. In the autumn it is moist compared with other cities on the plains, and in the winter it is colder and more stormy, judged by the same standard. The lowest record of ROOKY MOUNTAIN REGION. 273 temperature is 20° below zero, in January, 1883. The mean tem- perature for the month of January is 27° ; for July, 76°; for the year, 51°. Average number of days above 90°, 30; below 32°, 109. The annual mean of cloudy days is 88 ; stormy days, 81 (means for six years). Rainfall 18.9 inches a year (from records for eighteen years), of which 5J inches is the average rainfall for the winter. The wind-movement throughout the year is moderate, being about five miles per hour. Ne-w Mexico. In going from Colorado into New Mexico by rail the change of climate is noticeable. The traveller passes from the cool air of the northern side of the Eaton range, in Colorado, and after a glimpse of the Spanish peaks crosses the State-line, plunging at once into the blackuess of a half-mile of tunnel, which pierces the mountains at an elevation of 7600 feet. From this he emerges on to the sunny, southern slope of the range, where it seems perceptibly warmer and brighter than on the other more shaded side. It is a milder air, certainly, and bears promise of long, sunny winter-days aud freedom from snows. Topographically, New Mexico is a high plain, called by the Span- iards " mesa " or table-land. At Santa F6 this plateau rises to 7000 feet, while in the Lower Pecos Valley it is depressed to about 3500 feet above sea-level. The Mesilla Valley, forty miles above El Paso, has about the same elevation, from which the land rises to the northwest and north. The average elevation of the State is probably not far from 5000 feet. The great size of these far Western States has always to be borne in mind in dealing with their peculiarities. In this brief summary it is not proposed to treat of New Mexico's entire 390 miles of length, but only of those portions of the State suitable for the resideuce of invalids, so far as they are known. The rainfall for the year 1891 (which was evidently a rainy year) varied from 4.55 inches at Deming to 32.83 inches at Chama. The general average for the State is 13^ inches, with, of course, a quan- tity as large again falling on the mountain-summits, principally in the form of snow. In New Mexico there are several "islands of greater rainfall," where a much heavier precipitation may be ex- ' Rainfall and Snow of the United States. Prof. M. W. Harrington, Washington, 1894. 18 274 MEDICAL CLIMATOLOGY. peeked than in the country more than fifteen or twenty miles away on either side. Two of these are especially noticeable — one in the mountain-ranges north of Santa F6 and Las Vegas and west of Springer, where the rainfall surpasses by 5 or 10 inches a year that in the area immediately around it ; and the other around Fort Stan- ton, in the mountains to the east of the Rio Grande. The rainy season, as in Colorado, is in July and August. In the vicinity of El Paso 40 per cent, of the rainfall of the year descends in these two months. Captain W. A. Glassford, of the Signal Corps, U. S. A., describes the process of annual precipitation as follows ■} "In New Mexico the winter-precipitation does not begin until the earlier days of January. By April the winter-rains are defi- nitely ended, but in the eastern or Atlantic Divide section (the Pecos Valley region) an area of considerable precipitation remains. This follows the high summits of the Sangre de Cristo range until it sinks into the tableland of 4000 feet, thence it tends southeasterly across the Pecos head-waters region as far as Gallinas Springs, where it sharply curves to the north and extends over the Raton range. The winter-rains, according to the nomenclature of the meteorologist, are marked by curves of from 1 to 7 inches of precipitation, running nearly parallel. These curves are outside the mountain-lines and indicate the diffuse and diverting influence of topography on the aqueous currents borne to New Mexico from the South Pacific Ocean across Arizona. " The summer-rains are otherwise influenced, and the highest pre- cipitations appear upon the levels west of the Canadian River, and upon the canon-course of the Pecos, which includes Las Vegas and Fort Union ; at this point the fall reaches 17 inches. The lowest summer-precipitation is found in sections most favorably influenced by the winter-rains. The minimum is found in the southwest. " Step by step the humid winds are drawn across over graduated plateaus and extrusive summits, and at each higher step discharge so much of their moisture as is a surplusage over the saturation-amount of atmosphere of a given tenuity at a given temperature. There is nothing violent in these systematic draughts of the humid air from the sea toward the continental cyclones or vortexes ; the air is chilled by the seasonal causes which make the winter climate. 1 New Mexico. Ollicial Publieation of the Bureau of Immigration, Max Frost, Secretary. Santa F6, 1894. BOCKY MOUNTAIN REGION. 275 The earth-surfaces soon become largely covered with snow, and their radiating influence is thus mechanically obliterated ; the air lies in practically even strata of uniform temperature. The humid wind is drawn along these ruling conditions ; on every plateau it discharges down to the point of saturation ; th(i diminution in actual amount of moisture is constant and large; by the time it overlies the E,io Grande trough its last available moisture has been condensed by the heights of the Continental Divide, and shifts down to leeward. Such precipitation as is induced appears as snow, which forms a storage whose supply is constantly utilized uutil July. With the vanishing screen of snow the conditions proportionately alter. The surface of the elevation, with its soil and rock-masses, ceases to reflect the in- cident heat-rays of the sun, but absorbs much of it ; at the same time it radiates the heat which it receives, currents are formed in the surrounding air, and the mountain becomes a focus of activity, about which are currents rushing rapidly skyward and a lateral draft to supply the place of the air withdrawn by its action of con- vection; its excess of moisture and consequent precipitation therefore reach the maximum." The greatly decreased altitude and more southern latitude of the lower Rio Grande Valley together combine to provide a place of residence for winter for those who seek refuge from the higher and cooler regions above. In referring to this country El Paso will be considered as be- longing, climatically, to New Mexico. The climate of the elevated towns in the northern part of the State is similar to that of Colorado. There is a great resemblance, for instance, between the temperature of Santa F6 (70J0 feet) and Las Vegas (6500 feet) and that of Denver. Silver City (5800 feet), in the southwest, has a milder climate and is sheltered from severe winds. Albuquerque (5000 feet) is a larger town, with better accommodations, but more exposed to the wind. Las Cruces, Eddy, and El Paso (3700 feet) offer each about the same elevation, but varying grades of accommodations. The general mean of relative humidity during the year is about 40 per cent., which, with the average annual temperature of about 60°, shows for the year 2.30 grains of moisture to a cubic foot of air, or about the same dryness as Colorado — the higher temperature increasing slightly the amount of absolute humidity. The fine climate of New Mexico is its greatest asset. Unfortu- 276 MEDICAL CLIMATOLOGY. nately, there are no cities of importance, and the comforts of civili- zation are not easy to find, except ia two or three towns. " Sun, silence, and adobe !" is the graphic summary of the country made by Charles F. Lummis in his delightful book. The Land of Poco Tlempo. The adobe Indian pueblos where he lived would, of course, be avoided by invalids ; but even Santa Fe will be found some- what unsanitary, although t^uaint aod interesting. 320 cloudless days a year can be claimed for any portion of this great domain, but gravel-soil, soft water, and good supplies are more difficult to rely on. The cliiiiate is superb. It is in the details of living that the visitor is most liable to meet with disappointment. Among other testimony relating to the climate that of Ex- Surgeon-General W. A. Hamuiond is valuable. He says : "'New Mexico is by far the most favorable residence in the United States for those predisposed to or afflicted with phthisis ... In a service of three years in New Mexico, during which period I served at eight different sta- tions, ranging from the extreme northern to the extreme southern part of the territory, I saw but three cases of phthisis, and those were in persons recently arrived from the United States. Inflam- mation of the lungs is also very infrequent, as are likewise pleurisy and bronchitis." Dr. W. M. Yandell, of El Paso, asserts that if a mild climate during the cold seasou is desired, New Mexico and Arizona, south of the thirty-fifth parallel of latitude, furnish by far the best winter climate in the United States for consumptives. The summers, however, in the southern portion are exceedingly hot. The heat begins to gain in strength after the middle of March and increases up to September and October. In spite of the low humidity the impaired vital forces of an invalid are apt to be weak- ened by the prolouged high temperature. On the mountains a comfortable summer climate can be found, the nights in particular being usually cool. Santa Fe has very few hot days, and for those who enjoy camping-out the fine, wooded country of the Upper Pecos — where there is said to be plenty of game and where the streams " abound" in trout — or the top of the Black Range, will bring the visitor into a delightful summer climate and an interesting country. The annual wind-movement in the elevated northern portions of the State is about the same as that of Colorado, but the wind-move ROCKY MOUNTAIN REGION. 277 meut of the lower and more southerly portions is less, as is shown by the tables. A disagreeable feature of all open, treeless plains is the occasional dust-storm, which is the more objectionable when the soil is adobe in character, producing a very fine dust, which pene- trates every crack and cranny, no matter how obscure. Furious dust-storms are not frequent and are rarely of longer duration than a few hours. Springer (elevation, 5700 feet; population, 900) is situated on the main line of the Atchison, Topeka and Santa Fe Railroad, about fifty miles south of the Raton Range, Springer is the centre of a rich and fertile country. Forty miles to the west are the Rocky Mountains, as represented by the Taos and Saugre de Cristo ranges, whose average elevation is 10,000 feet and whose peaks reach an altitude of 13,000 feet. The soil is adobe, the clay having a depth of several feet. The country is under an immense irriga- tion-system, and large lakes are projected in the foot-hills, thirty or forty miles northwest of the town. Large ranches have been the rule previously throughout this region, which has been devoted mainly to stock-growing and the cultivation of alfalfa. As the irrigation-ditches are extended smaller fruit-ranches will become more numerous. The climate is fine, with apparently an uneven rainfall. The Pacific passage- winds which reach these ranges are relieved of their last moisture, and the precipitation even on the eastern slope is considerable. The snowfall is said to be from 15 to 20 feet on the level on the moun- tain-summits, or in water-measurement about 50 inches, an estimate that is probably too liberal. In the valleys the mercury rarely falls as low as zero, and the summer-heat is not excessive. Good well-water is said to be obtain- able, and there are some artesian wells. There are no complete weather-records, but from the voluntary observers' report the following facts are obtained : winter. Spring. Summer. Autumn. Year. Temperature, 1892, 35° 53° 68° 51° 50° Maximum, 99° Minimum, —5° Winter- estimate is made up of two Decembers and January, as the month of February is missing. Spring-estimate is for April and May only. March record missing. Inches. Inches. Inches. Inches. 3.07 10.53 5.28 21.92 5.23 5.31 2.78 18.93 278 MEDICAL CLIMATOLOGY. Inches. Eainfall, 1891, 3.04 1892, 0.63 The precipitation in the summer of 1891 was unusually heavy. The record for 1893 is incomplete. The mean monthly tempera- ture for spring was 50° and for summer 71°. The total rainfall for spring was 11.93 inches and for summer 7.02 inches. Las Vegas (elevation, 6500 feet; population, 6000). Las Vegas, like most of the Mexican towns in New Mexico, has a mixed popu- lation, consisting perhaps half of Americans and half of Mexicans and Indians. The last two live in low adobe-dwellings. The town is hot and dusty in summer, while in winter the tem- perature occasionally goes to zero or below. During the day and in the sunshine, however, it will be found warm and comfortable. The town lies somewhat exposed to north winds. Of the rainfall of 20 inches a year about half falls during July and August, with some rain during September and April. During the first four months of the year high winds blow, as is the case in most towns of the plains. Las Vegas is a healthy place, with the ' generally fine climate and bountiful sunshine of New Mexico. Las Vegas Hot Springs (6700 feet) are seven miles from the town, lying in a position that is well sheltered from the winds. Here one can get mud-baths of great efficacy in rheumatism aud kindred troubles. There are both hot and cold springs. A general analysis of the hot springs made by Dr. Walter S. Haines shows the temperature to be 140° F. Calcium carbonate Grains per gallon . 0.89 Magnesium carbonate Sodium carbonate Potassium carbonate . . 0.15 . 8.38 0.28 Sodium sulphate .... Sodium chloride . 3.45 . 14.68 Silica . 3.50 Alumina . . ... Volatile and organic matter Lithium carbonate . . 0.10 . 0.32 trace Sodium bromide trace Total solids . . 31.65 "The Montezuma," built by the Santa F6 Railroad, is one of the largest and best hotels in the mountains, but is at present ROCKY MO UNTAIN REGl ON. 279 closed. It is about 7000 feet above the sea. There are picturesque canons to explore and fine mountain-scenery. Santa Pe (elevation, 7000 feet ; population, 7000). This still retains the appearance of a Mexican town, the outgrowth of an old Indian pueblo. The plaza, the winding streets, and the adobe- houses are interesting features to visitors. The town lies on a treeless plain, at the base of one of the spurs of the Rocky Mountains. The general trend of the valley or plain is west southwest, the mountains affording protection to the north and east. Within thirty miles are peaks of 12,000 and 13,000 feet elevation. The low hills are covered with a growth of pinon-trees. The town has of late years improved its water-supply, but much is yet to be desired in the matter of drainage, and there are few shade- trees. The soil is light and sandy. The climate is not very different from that of Denver. It is somewhat cooler during the summer, not quite so cold in winter, and a little less windy throughout the year. The windiness of Santa Fe has been so frequently alluded to that it may be well to call attention to the fact that the hourly velocity of the wind during the year is much less than in New York, Bos- ton, or Chicago. The Government record for ten years shows for Santa Fe an annual mean of 6.4 miles ; for New York City, 9.4 miles; for Boston, 10.9 miles ; and for Chicago, 9.6 miles per hour. The weather-record for Santa F6 is said to show for the past twenty years but eight days when the thermometer registered over 90°, and but fifteen times during the same period when it went below zero. Average number of days in a year below 32°, 134; cloudy days, 48; stormy days, 72 (means for six years). Average temperature for January, 28°; for July, 70°; for the year, 49° (means for seventeen years). The maximum temperature in Santa Fe was, during the summer of 1891, 87°; 1892, 90° (one day); 1893, 89° (one day); 1894, 84°; 1895, 87°. There is a good hotel in Santa F6, and an excellent sanatorium, managed by Sisters of Charity. Upper Pecos Valley and Timber Reservation, covering 702 square miles. The region is rugged and mountainous, with numerous small streams, which, flowing south, form the Pecos River. In the beautiful upland valley, for twenty miles north of the GIo- rieta Mountains, are scattered stock-ranges and small farms. It is 280 MEDICAL CLIMATOLOGY. an attractive, park-like district, well-timbered and surrounded by raountaius. Tiie altitude ranges from 6000 to 8000 feet. Not only is tiie location picturesque, but there are also good soil, water, and climate. Much of the country is wild, and game is found, including bear and deer, while the streams are well filled with trout. It has not been in any way developed as a health-resort, but its natural advantages are too great to allow it to remain long unknown. Through the lower end of the valley tlie main line of the Santa F6 Eailroad passes, between San Miguel and Glorieta. The only way of learning to know the attractions of the country at present is by camping-out. Albuquerque (elevation, 5000 feet ; population, 8000). This town is situated in a wide valley, watered by the Eio Grande, and is on the Atlantic and Pacific division of the Santa Fe Railroad system. It is quite well known as a health-resort station. The spirit of the town is progressive, and it has street-cars, waterworks, and electric lights, gas, and sewers. There are churches of all denominations, and a hotel. Albuquerque has a large social club- building, but there are few diversions for visitors. In selecting a place of residence it is important for an invalid to live on the mesa or table-land, as far from the influence of the river as possible, for intermittent and malarial fevers are not unknown on the river bot- tom-land in the "old town". There is no detailed weather-record. The temperature for 1892 by seasons was as follows : winter, 41°; spring (March missing), 60°; summer (June missing), 77°; autumn, 58°; maximum, 97°; minimum, 15°. Mean for January, 41°; for July, 78°. For the year 1893 : winter, 38°; spring, 54°; summer, 72°; autumn, 53°; annual mean, 55°; maximum, 98°; minimum, 11°. Mean for Jan- uary, 37°; for July, 77°. The mean annual rainfall is about 8 inches, of which over 4 inches may be expected during the summer-months.^ No report of the wind-movement is obtainable, but the situation of the town is open and exposed. Deming' (elevation, 4300 feet f population, 2OO0). This town ^ Rainfall and Snow of the United Sbates. Prof. M. H. Harrington, 1S91. Mean annual rain- fall of Albuquerque for ten years, 7.7 iaehes. Buclc's Reference Handbook of the Medical Sciences gives the mean rainfall for 17 years as 8.12 inches. Precipitation for June, July, and August, 4.35 inches. 2 The engineers of the Santa F6 Eailroad hare estimated the elevation of Deming at 3600 feet. Barometric determinations of the Signal Service give the approximate elevation at 4300 feet. ROCKY MOUNTAIN REGION. 281 is situated on a plain about fifty miles square, surrounded by moun- tains. It is on the line of the Atchison, Topeka and Santa F6 and the Southern Pacific Railways. The climate is mild, the temperature never going below 32° during the day in winter. The mean of the rainfall-record for nine years is 8.8 inches, the precipitation being principally in July, Au- gust, and September. The winds begin in February. The town-water is brought from the Black Range — a spur of the Rockies. There are also a number of windmills for the purpose of raising water. The following is the mean seasonal temperature for two years : winter, 44°; spring, 63°; summer, 87°; autumn, 64°. Mean for the month of January, 40°. Silver City (elevation, 5800 feet; population, 3000; latitude, 32° 46' north) is situated on an elevated plateau in the Chihuahua Valley, south of the Finos Altos hills. It lies at the end of a branch-line of the Santa Fe Railroad, running up forty-eight miles from Deming. Silver City is about ten and one-half hours by rail from El Paso. The climate is considered very salubrious, being mild during the winter and spring and not subject to sudden changes, while during the heat of summer it is possible to go a little higher into the cooler regions of the pines. In winter the frosts are said to be less severe than in the valleys of lower altitude along the Rio Grande. The record of temperature for ten years^ shows the mean for January to be 37°; for July, 72°; for the year, 54°. By seasons it is as follows : winter, 37°; spring, 53°; summer, 72°; autumn, 55°. The highest record (in June, 1871) is 100° and the lowest 1°. In ten years there were only 22 days above 90° and 6 days below 10°. The average annual precipitation — based on a record for twenty years — is 14.58 inches, of which 8.11 inches usually fall in July, August, and September. The average number of cloudy days during the year is 37. Buck's Reference Handbook of the Medical Sciences states that the relative humidity showed an average of 50 per cent, for one year. The average during the winter was 49 per cent. The same authority » Quoted by A. F. McKay, in American Climates and Resorts, November, 1894. 282 MEDICAL CLIMATOLOGY. refers to Silver City as "enjoying tiie exceptional advantage of shelter from the wind." Actual wind -records were not obtainable, but the movement is small. Silver City has been called an American town with a Mexican quarter, to distinguish it from many of the towns in New Mexico where the old Mexican influence still predominates. The build- ings consist largely of brick, which is manufactured there. An ample supply of town-water is obtained from wells flowing into the reservoir above the town. An analysis made by Professor W. E. Waring shows an excellent quality of hard water. His report gave the number of grains of "total harduess" per gallon as 11.72, which would be equal to about 20 parts of "total hardness" per 100,000 parts. Softer water can be obtained, it is said, from some of the artesian v/ells. The soil is of a sandy nature. The general rock-formation of the vicinity is principally slate and limestone. Besides the usual public buildings there are four hotels, one of them a large three-story brick building, and a Sisters' Hospital. There is very little irrigation around Silver City ; fresh vegetables and grapes are supplied from neighboring ranches. This portion of New Mexico offers every .advantage for outdoor life. The pine-forests on the mountains are available for camping, and small game is said to be abundant. The roads are good. The heat is more moderate during spring and summer than in the lower river-valleys, and there is more freedom from dust and insects. Fort Bayard is a postofJice and United States Army post, lying at a lower altitude than Silver City and distant nine miles northeast. The extent of its accommodations is not known to the writer. Its population was over 500 by the census of 1890. The height of Fort Bayard is given in Toner's Blationary of Elevations as 4450 feet above the sea. In 1893 the air-temperature by seasons was as follows : winter, 41°; spring, 52°; summer, 72°; autumn, 55°. Annual mean, 56°; maximum, 99°; minimum, 13°. Mean monthly temperature for January, ^1°; for July, 74°. The rainfall during the year 1893 was slight in all the months except July, August, and September, when 12J inches fell. The Valley of Mesilla (see Las Cruces) is about seventy miles long and from one to six miles wide. Its elevation varies from 4000 feet at the Rio Grande, to 7000 feet among the foot-hills. The BOOKY MOUNTAIN REGION. 283 climate is mild, ranking high for dry air and continuance of sun- shine. Snow is rarely seen. The valley produces a fine variety of grape containing a large amount of sugar. Because of the fertile soil io the lower portion this district is one of the garden-spots of New Mexico. Mesilla was formerly noted for being one of the least windy of the Government weather-stations, but no official observations have been taken for several years. The wind-movement for Mesilla, given' in Dr. Denison's charts,^ shows for the year 2.3 miles per hour and for winter 2.1 miles per hour. The average temperature by seasons is : winter, 42°; spring, 61°; summer, 78°; autumn, 60°; year, 63°. Buck's Reference Handbook of the Medical Sciences gives the mean relative humidity for one year as 41 per cent., and for three months of winter as 43 per cent. Las Cruces (elevation, 3800 feet ; population, 3000). This is one of the Mexican towns above El Paso, distant forty-three miles — a little over an hour's ride by rail on the Atchison, Topeka and Santa F6 Railroad. The Mesilla Valley in which it lies is wide, and when irrigated the soil is fertile. Fine grapes are grown, and large fields of alfalfa. The principal supply of water for irrigation is drawn from the Rio Grande ; there are also a number of arte- sian wells, which furnish water for domestic use. The water, while alkaline, is said to be wholesome, and is best when obtained near the centre of the valley. The houses in Las Cruces are usually one story in height, and are built of adobe. There are two small hotels. Good board in the town can be had at Mrs. Barker's, and in Dona Ana, one mile from the Las Cruces railroad station, at ''The Alameda." The mean temperature for January is 39°. Extreme yearly range from — 2° to 106°. The average rainfall for twenty years has been at the rate of 7 inches a year. The number of cloudy days from August, 1892, to July, 1893, iuclusive, was 20. The average wiud-movement is said by one writer to be about 5J miles per hour, which is probably an overestimate. Winter visitors can remain until April without suffering from the heat. 1 Climates of the United States In Colors. Charles Denison. 284 MEDICAL CLIMATOLOGY. The Van Patten Mountain Camp is situated fifteen miles east of Las Graces, at an elevation of 6000 feet, in a sheltered notch of the Organ Mountains. It is protected by rocky walls from all winds, and has an abundance of pure mountain- water. ^ Small game can be found in the vicinity. The greatest height of the Organ Mountains is about 8000 feet. Twenty-five miles east of Las Cruces, on the eastern slope of the Organ Mountains, Dr. Petin has selected a site for a sanatorium as affording the greatest advantages. Its claims to favorable consideration are " moderate altitude of 4800 feet, good mineral-water, no malaria or dust, porous soil, tem- perature quite even, with an annual average of 62° F. Scarcely any snowfall. Rainfall about 4(?) inches a year. But little wind. There is an abundance of game of ail kinds and good fishing. Beautiful shade-trees grow at the foot of the mountains. There any patient can sleep out of doors eight months of the year without fear of catchintr cold." As yet there are no accommodations for invalids. It is necessary to camp out and rough it. Pecos Valley. Principal town Eddy (elevation, 3200 feet ; population, 2000). An extensive scheme of irrigation is transform- ing this valley in Southern New Mexico from an alkali-desert into a fruitful region. There are two or three large canals now in operation, the water being taken from the Pecos River, which not only carries a large amount of rainfall and snowfall from the Rockies, but is fed along its course by numerous living springs, flowing from fissures in the limestone which underlies the country. This river- water has been analyzed by Professor Precht, as follows: Grains per gallon. Calcium and sodium chloride . ... 69.23 Sodium sulphate (Glauber's salt) and magnesium sulphate (Epsom salt) . .... 34.62 Calcium carbonate 39.00 Calcium sulphate 80.00 Total solids .... 172.85 The amount of alkali present is indicated in another way by the deposit of over two tons of salts yearly, per acre, on the irrigated land, which is claimed to be of benefit to the soil for fertilizing- 1 A. F. McKay, in American Climates and Resorts. ROCKY MO UNTAIN REGION. 285 purposes. Water can also be obtained by means of artesian wells. Eddy secures its town-supply in this way. There is no timber in the valley except mesquite/ but plenty of timber is found fifty to one hundred miles west. The air is pure and dry. There are from 320 to 340 days of sunshine during the year. The winters are mild and the summers hot, the nights being usually cool. The extreme range of temperature is reported to be from 102° above zero to 7 ° below, but the mercury in winter seldom drops so low. The annual average is 63°. The rainfall is about 8 inches yearly. The wind-movement is not obtainable. The most objectionable feature is said to be the spring-winds, which are not dangerously heavy, but tiresomely persistent and charged with light sand. Eddy is a small town recently built. Fairly good accommoda- tions can be secured at "Hotel Hagerman," or furnished ranch- houses of moderate size can be hired. The Eddy Argus for April, 1894, contained a review of the weather for the preceding five months, which showed the following : Mean temperature. 6.30 A.M. 10 P.M. November, 1893 36° 48° December, 1893 January, 1894 February, 1891 March, 1894 35 43 31 82 32 41 2 p.m. 40 71° 53 Average temperature for the month of March . . 59 Cloudy days, November 1, 1893, to April 1, 1894. . 43 Windy days, November 1, 1893, to April 1, 1894 . . 52 During the winter of 1894-95 the monthly means at Eddy were as follows (based on the reports of Gr. W. Lane, observer) : Temperature Rainfall, inch. Mean. Mean max. Mean min. Cloudy days November, 1894, 54° 70° 37° 0.00 December, " 45 58 32 0.02 1 January, 1895, 42 February, " 37 March, " 55 57 50 72 27 23 38 0.65 0.19 0.00 2 9 1 April, " 64 80 47 0.10 1 1 The mesquite is a sort of shrub sometimes growing to a height of thirty feet or more, hut usually scrubby, forming dense clumps of bushy thicket or chaparral. 286 MEDICAL CLIMATOLOGY. Snowfall in February, 1895 2.10 inches. Extreme minimum temperature in January, 1895 . . 5° " " " February, " . . — 2 March, " . .22 " maximum " March, " . .88 April, " . .93 Cloudy days from November 1st to May 1st . . 14 days. Wind-velocity not given. The temperature of Eddy by seasons is as follows (based on the records for the year 1894, except for March and April, which are the means of 1894 and 1895): winter, 40°;' spring, 66°; summer, 79°; autumn, 65°; mean for the year, 62°. Extreme maxima for summer — June, 104°; July, 103°; August, 96°; all for the year 1894. Extreme minima for winter 1894 and 1895— December, 18°; January, 7°; February, 11°. During the cold wave of February, 1895, the extreme minimum temperature was 2° below zero. The mean daily range of temperature during the winter months is 34°, and the greatest daily range will average 41°. During the summer of 1894 the temperature at Eddy rose above 90° 73 times, and above 100° 8 times. Roswell. The railroad has been completed for seventy-five miles north of Eddy to E,oswell, which is situated at an altitude of 4000 feet, and has a population of about 1000. The older ranches are at this end of the valley. Mineral Springs. Like all mountainous countries, New Mexico has a great num- ber of mineral springs — both hot and cold — but only a few of them have been analyzed or developed. The best known are the Las Yegas Hot Springs (6700 feet), where the Atchison, Topeka and Santa F6 Railroad has built a fine hotel. An analysis of these waters will be found in the description of this resort. The Folsom Hot Springs (6500 feet), near Alps, in Colfax County, are said to have medicinal properties, but of what nature is not stated. The Ojo Caliente Springs (6290 feet) are on the creek of the same name and twelve miles from Caliente station, in the southwestern portion of Taos County. They have a tempera- ture of 108° to 114° F. The Jemez Hot Springs (6700 feet), in San Diego Cailon, Benalillo County, are in two groups, two miles BOCKY MOUNTAIN REGION. 287 apart, and they vary from 70° to 168° in temperature. Some of them flow from eaves of carbonate of lime. Their ingredients are principally sulphate and carbonates of sodium, calcium, and magne- sium. At Cherryville, near the Black Range, southwest of Socorro, are some hot springs, close by the falls of the Alamosa. The elevation is 6500 feet and the temperature 130°. They can be reached from Engle. In the southwestern part of Socorro County, on the west of the Gila or Diamond Creek, is a gi'oup of springs (elevation, 5500 feet; temperature^ 130°) similar to the Jemez Springs. They can be reached by wagon from Silverton. Twenty-four miles north of Deming and three miles from Hudson are several springs, situated at an elevation of 5780 feet. They contain soda, lime, and mag- nesia, and the water has a temperature of 130°. Arizona. An inquiry into the climate of Arizona discloses the fact that it is climatically distinct from each of its neighbors — New Mexico and California — and has natural laws of its own, although these laws are modified, in turn, by the climatic influences of both these Pacific coast and the Rocky Mountains. Captain W. A. Glassford, of the Signal Corps, U. S. A., pre- pared in 1890 an exhaustive '' Report on the Climate of Arizona, with particular reference to the Rainfall and Temperature," which is of the greatest value to all students of the subject and from which the author has drawn freely. Although the report was the result of an investigation undertaken in order to learn the possibilities of irrigation in the territory, the information gained is also of value for the benefit of invalids for whom the curative power of climate is necessary. To understand the geographical position of Arizona attention must first be directed to the presence of the great Continental Divide, which passes through the western portion of New Mexico in a fairly direct course north and south along the one hundred and eighth degree of longitude. West of this line the waters all flow toward the Pacific ; and this vast country, which decreases steadily in height in a series of plateaus to the southwest corner, is influenced by the winter rainy season of the California coast. The northern half of the territory is also affected by another great 288 MEDICAL CLIMATOLOGY. divide, running southeast and northwest (from the point where lati- tude 34° crosses the New Mexican boundary to the Sau Francisco Mountains, north of Flagstaff). This ridge separates the watersheds of tlie Gila and Colorado Eivers, and may be roughly described as lying along latitude 35°. "The axis of the mountain-system of Arizona," says Captain Glassford, "is remarkably well defined and appears with the utmost distinctness, not only in the general trend of the main mass of eleva- tion, but also in minor ranges and notably in detached spurs, often widely separated from the plateau-system, to which, on the score of altitude, they may claim to belong. With sufficient accuracy to satisfy all legitimate demands of the present inquiry, the direction of the mountain-axis may be placed at northwest and southeast." In the valley of the Eio Santa Cruz, in Pima County, there are fifteen peaks rising to an altitude of more than 3000 feet from a mesa 2000 feet high. In the Gila valley are twelve members of a butte-system rising from 1000 to 2000 feet above benches 1000 to 3000 feet high. The tableland of 3000 feet is crowded with sierras of 5000 feet and upward, and on the high plateau of 5000 feet are six examples of mountain-masses rising from 7000 to 9000 feet, and culminating (in the group called the San Francisco Mountains) in three peaks — Humphrey, Agassiz, and Humboldt — of which the first two have an elevation of nearly 13,000 feet above the sea. In no case does the mountain-system diverge from the characteristic axial direction. " It must be remembered that the Pacific Ocean is the reservoir of Arizona, and an important result of this uniformity of the moun- tain-axis, carried consistently over five hundred miles, is that the prevailing moisture-bearing wind, being from the southwest, comes at right-angles to the broadside of the mountains, and thus encoun- ters the maximum bluff-surface. " In other words, the passage of the rainy winds across Arizona is by no means an easy gliding over an inclined plane, but the labo- rious ascent of a flight of steps. "^ For meteorological purposes Arizona is divided into three series of elevations : 1. The Plain. This embraces about one-third of the territory which lies to the south and west below the level of 3000 feet, and 1 Captain W. A. Glassford. ROCKY MOUNTAIN REGION. 28& includes luost of the desert-country that has given Arizona its unen- viable reputation for heat and discomfort. On this low plain the rainfall is only from 2 to 6 inches during the year, and, including the desert on the California side of the Colorado Eiver, the records approximate the absolute minimum of rainfall of the world. It was, however, a careless estimate of the early emigrants to consider it all a desert, as this area — as great as that of Italy or the six New England States — has a rich alluvial soil along the river- bottoms, brought down from the hillsides by centuries of washing, which is found to be capable under irrigation of growing almost any- thing. Oranges, lemons, almonds, figs, apples, grapes, etc., all thrive and even mature earlier than in Southern California. The mountains above can furnish the needed supply of water if it is properly stored, and this rich land promises to be eventually one of the most productive agricultural sections of the United States. Its intense heat, unfortunately, forbids its consideration as a health-resort except during the winter months, when its cloud- less skies and moderate temperature aiford perfect immunity from the cold and snow which characterize that season in northern regions. 2. The Peo-plateau is a bench of from 3000 to 5000 feet elevation, which, from its geographical and physical relations to the high plateau covering fully half the territory, has been distin- guished by this term. "It closely follows the axial inflection of the mountain-system, although its continuity is somewhat inter- rupted by more or less detached spurs of its higher neighbor. Across the central portion of the territory it preserves, with con- siderable uniformity, a mean width of less than one hundred miles. Widening at the canon of the Gila, it covers the whole southeastern corner of the territory. . . . The pro-plateau is so narrow a strip for the greater part of its length, and so vestibular in its rela- tion to the plateau, that in the absence of climatic data it should be provisionally included in the great plateau-mass which overshadows it. This may be well done with all that portion lying northwest of the Gila. The southeastern expansion of the pro-plateau, embracing portions of the counties of Graham, Pinal, and Pima and the whole of Cochise, is so marked by two systems of extrusive highlands, each composed of a considerable number of extensive masses of elevation reaching in every case the altitude of the plateau and in some cases 1000 or 2000 feet higher, that this region may be rationally included 19 290 MEDICAL CLIMATOLOGY. in the discussion of the rain-making influence exerted by the extru- sive summits of the plateau." This country is that surrounding Tombstone, Huachuca, Critten- den, and Calabesas, as far as ^ogales on the Mexican line. There are settlements of from 3000 to 6000 feet elevation, in or near canons and valleys, affording picturesque S3enery and claiming a delightful winter-climate. The accommodations are, however, crude and primitive. The principal industries are mining and fruit- raising. 3. The Plateau. This is an approximately level mesa above the 5000-foot line, which embraces more than half the territory. It enjoys the greater portion of the rainfall, chiefly because of its two mountain-systems. These summits exert an important influence on the yearly rainfall. The annual amount of rainfall on the pro-plateau approximates 10 inches and that on the plateau from 10 to 20 inches, the greatest precipitation falling to the south of the Great Divide — the San Fran- cisco Mountains. The curve of precipitation of 20 inches appears, first, southeast of Tucson, over the Santa Rita Mountains ; secondly, over the Natanes mountain-group, between the valleys of the Upper Gila and Salt Rivers ; thirdly, over the flanks of the Mogollan range and the San Francisco Mountains ; fourthly, in a narrow region over the head- waters of the Hassayampa, the Agna Fria, and the Rio Verde, near Prescott ; another region showing 20 inches is the high country east of Fort Apache, over the White Mountains and the head-waters of the Little Colorado, extending to the edge of New Mexico. A small curve of 25 inches appears south of the San Francisco Mountains. These are " islands of greater rainfall," where the rainfall decreases from the centre in every direction, until not more than half the amount of rain may be expected but a few miles away. One point to be borne in mind is that the actual maximum rainfall is not known, as the stations are for the most part in the valleys, where the gauges cannot record the heavy rains which are seen on the tops of the mountains. The record of the station on the summit of Pike's Peak in Colorado may be mentioned to illustrate the increased pre- cipitation compared with the plains, although it shows an unexpect- edly low average, being barely 30 inches per annum. A noticeable feature of Arizona meteorology is that it has two plainly marked rainy seasons. The winter-rains begin usually ROOKY MOUNTAIN REGION 291 some time iu December, and terminate in February. "As in the case of the seasonal rains of California, so in Arizona the variability of the winter-rains in amount and frequency is in the ratio of the intensity and recurrence of barometric disturbances These rains are caused by the proximity of approach of great storms in low-pressure areas which form a part of the storm- system of the country at large. . . . They are moderate in force and are interrupted by the anti-cyclonic types of high barometer and cloudless skies which are distinctive of the Pacific coast weather.'" Much of the winter-precipitation occurs in the form of snow, which quickly melts on the plains, while on the mountain-tops it may be found from three to seven feet deep. This acts as a storage-reservoir to supply the streams through the dry season almost to the beginning of the summer-rains. In fact, it is a practice of the Indians and old settlers to calculate that when the last snow disappears on the mountain-summits the summer-rains commence. These come on during July, August, and September, " being somewhat sharply defined from the preceding dry season, but shading off so indeterminately toward the beginning of the winter- rains that it becomes quite proper to say that while Arizona has two rainy seasons it has but one dry season."^ The rains of summer are local in character and due to mountain- influences. They are of almost daily occurrence on the high sum- mits, falling invariably in the afternoon. Their intensity is re- markable. "From 30 to 40 per cent, of the entire precipitation occurs in heavy showers, where the rainfall is upward of 0.75 inch during a day of precipitation, and frequently more than an inch falls in a heavy shower."^ The brief and violent summer-storms are felt almost entirely on the elevated mesa called the plateau. Captain Glassford is authority for the curious statement that in Arizona in summer, owing to local causes, "the greatest jiluvial effort is registered on the leeward side of ranges." Regarding the proportional rainfall during the two rainy seasons, a record of ten weather-stations* (excluding Yuma) gave a total pre- cipitation for the winter months (December, January, and February) of 3.55 inches ; for the summer season (July, August, and Septem- 1 Captain W. A. Glassford. - Captain W. A. Glassford. s General A. W. Greely. 4 The ten stations were Port Apache, Calabesas, Crittenden, Fort Defiance, Fort Grant, Sua* chuca, Phcenix, Tucson, Prescott, and Verde. Their average elevation is 3900 feet. 292 MEDICAL CLIMATOLOGY. ber), 7.71 inches. Total for the entire year, 14.67 inches. The mean annual rainfall for the whole territory is 11 inches.^ The belt of mean annual temperature of 60° follows nearly the line of 3000 feet elevation. It luns north of Fort Thomas, Globe, Gillette, and Signal — except for a narrow strip which runs up the valley of the Rio Verde, penetrating into the higher mesa. The belt of 50° to 55° mean annual temperature includes Prescott, Flag- staff, and nearly all of the mesa or plateau above 5000 feet. The belt of 50° or less mean annual temperature includes the northeast corner of the territory above Fort Defiance. In the southern half of the territory the mean temperature of 60° or more shades into the heat of the desert, with a mean annual temperature of about 70° and a monthly mean for July of 90°. The relative humidity will average about the same percentage as in New Mexico, giving a little over 2 grains of absolute humidity to the cubic foot. The marked dry season of Arizona is in the spring and early summer before the coming of the cooling summer-rains ; but the number of cloudy days during the autumn and during the year is fully as low— if not more so — on the high plateau as in New Mexico and Colorado, while on the almost rainless desert the number of cloudy days is exceedingly small. The wind-movement at Prescott, Fort Grant, and Fort Apache shows an annual average velocity (for four and six years) of a little under 7 miles per hour. Phoenix has the smallest recorded annual wind-movement, averaging about 2^ miles per hour. In Buck's Reference Handbook of the Medical Sciences the article "Arizona," based on reports of surgeons of the United States Army, states that " the exceptional dryness and purity of its atmosphere, the wonderful clearness of its skies, and the very small number of rainy days there occurring, would all seem to point to the desira- bility of the territory of Arizona as a health-resort for patients suffering from pulmonary phthisis or from other diseases of the respiratory system. . . . The climatic advantages of Arizona are almost identical with those to be found in New Mexico." Arizona is sadly destitute of large modern towns where satisfac- tory accommodations for invalids can be relied on. In all the vast country there are but two or three towns where it is possible to get 1 Rainfall and Snow of the United States. Professor M. W. Harrington, Washington, 1894. BOCKY MOUNTAIN REGION. 293 needful supplies. The largest, Phoenix (1100 feet) and Tucson (2400 feet), in spite of their fine winter climate, leave much to be desired in the matter of modern conveniences and accommodations for visitors. Prescott (5300 feet) is even more poorly equipped, as it has been losing ground for several years. The opening of the railroad connecting Phcenix through Prescott with the main line of the Santa F6 road at Ash Fork may be the means of restoring its commercial prosperity. Prescott is in the centre of a fine country, and if it were larger and more prosperous would make a suitable place of residence for the entire year. Near Flagstaff (7000 feet), on both sides of the railroad, are great forests of tall pines. It is a park-like country, with grazing-land, sandy soil, and good water in the mountains. Photographs of the plateau show picturesque groups of pines and a general resemblance to Estes Park, Colorado. From the hills south of Prescott to the forest-plateau north of Flagstaff the altitude varies from 4000 to 7000 feet. In many of the canons are found old villages of the cliff-dwellers. The pines rarely grow below 4000 feet. It is a country with fine possibilities, which, so far, are utterly undeveloped. Besides its climatic advantages this locality is but a few miles north of the lower and warmer Phoenix fruit-country, a change to which may be advisable in the course of winter, while the high plateau stretching away north to the Grand Ganon of the Col- orado makes a pleasant summer camping-ground ; or it is but a couple of days' journey to the rainless, pine-clad slopes of the Sierra Nevada range in California. It should be noted among Arizona's peculiarities that, in spite of her two rainy seasons, the annual total precipitation is no more than in Colorado or New Mexico, while the spring is usually dry and there are but few cloudy days in the autumn. Prescott (elevation, 5300 feet ; population, 3000 ; latitude, 34° 30' north; longitude, 112° 30' west from Greenwich). The town of Prescott is situated a little to the west of the centre of Arizona (on the Santa Fe, Prescott and Phcenix Eailroad), sixty miles beyond Ash Fork. Its geographical position is in some re- spects unique. Seventy miles to the northeast is the San Francisco range of mountains, while the snow-clad peaks of Humphrey, Agassiz, and Humboldt rise to an altitude of nearly 13,000 feet. Away north are the Coconimo hills and the great canons of the Colorado Kiver, where the surface of the rushing water is over 294 MEDICAL CLIMATOLOGY. 6000 feet below the level of the plateau. Through this country above Prescott, at a varying elevation of 6000 or 7000 feet, are great forests of pine and an open grazing-country. It is a land of summer-rainfall and winter-snows. Eighty miles to the south are the plains of the Gila and Salt Rivers, which, although naturally arid, have been so cultivated by means of irrigation that Phoenix, situated in their midst, at an elevation of 1100 feet, is surrounded by fertile fields and groves of oranges, olives, figs, and semitropical fruit. It may be said that Prescott is distant but an hour or t^o by rail from both the torrid and the temperate zones. Although very much further south, Prescott has a climate re- sembling that of Denver, which has the same elevation, but exceeds Prescott slightly in the number both of very hot and very cold days. The high plateau and mountains of Arizona, lying mostly north of latitude 34°, have "two plainly marked rainy seasons'" — i.e., the season of winter-rains between December and February and the summer-rains of July, August, and part of September. The mean annual rainfall at Prescott for eighteen years is 16 inches, and the record for that time shows but two years exceeding 20 inches. The town is situated on Granite Creek. The town-supply of water is hard. There are wells of softer water for domestic use. The horizon is bounded on all sides by distant hills and mountains, ■which afibrd protection from cold northern storms in winter and the desert-heat in summer. Near by are the pines, which offer especial attraction to invalids. These trees are seldom found in Arizona below an elevation of 4000 feet. The pine-forests are most extensive to the east and south of Prescott. Prescott is situated in a gray-granite country, and much of the soil surrounding the town is of a sandy nature, drying quickly after a rain. The town itself is on adobe-soil, although Whipple Barracks, one mile from the plaza, has a sandy soil. There are windy and dusty days in the spring. The summers are hot, but are rendered more endurable by the cooling influences of afternoon rains. Snow falls occasionally during the Avinter, but the direct rays of the sun rarely allow it to remain long, although sleighing has been known even in the streets of Prescott. The climate during the autumn and winter is delightful. It is an American town, with few adobe-dwellings. 1 Climate of Arizona. Captain W. A. Glassford. ROCKY MOUNTAIN REGION. 295 Accommodations are poor. The hotel is principally for the ac- commodation of miners, and the best way of living is to go to house- keeping. The average temperature for January is 34°; for July, 74°; year, 53° (means for thirteen years). Average number of days above 90°, 21; below 32°, 115. •" Cloudy days, 51; stormy, 69 (means for three years). Average annual velocity of wind 7 miles per hour. Phcenix (elevation, 1100 feet ; population, 10,000). This town has become favorably known as a winter-resort of low altitude. It is situated near the centre of the great Salt River Valley, about two miles north of that stream and twenty-eight miles (in a direct line) north of Maricopa Station, on the Southern Pacific Railroad, with which it is connected by rail.' Direct railroad communication with the Santa Fe Railroad at Ash Fork is now open.^ Phoenix is the present capital of Arizona. Its growth during the past few years has been phenomenal. It has waterworks, street-railways, gas and electric lights, seven churches, six banks, and three daily newspapers. Its accommodations for visitors are not yet of a high standard, and its best hotel is greatly overcrowded in winter, especially when the Legislature is in session. However, two new hotels are being built. The streets of Phoenix are broad and level, shaded on each side by rows of cottonwoods and willows. Streams of water flow in the ditches, and the houses — which until lately were usually built of adobe — are well shaded and surrounded by grass lawns. The Salt River Valley is a favored region for the cultivation of fruit, as snow seldom or never falls, and the rich alluvial bottom- lands yield largely under irrigation. Fruits mature one or two mouths earlier here than in Southern California, and a great number of small ranches are being developed since the completion of the Arizona Canal. In order to show the character of the climate it may be stated that an exhibit of the valley's products sent to Chicago, December 15, 1894, consisted of oranges, lemons, olives, grape- fruit, peaches, pears, strawberries, figs, watermelons, muskmelons, ripe tomatoes, green pease, green corn, pomegranates, almonds, etc.; also alfalfa, broom-corn, sorghum, sweet potatoes, squashes, pumpkins, etc. These were gathered outdoors in the month of December. 1 The Resources of Arizona. P. Hamilton. - The Santa F§, Frescott and Phoenix Railroad. 296 MEDICAL CLIMATOLOGY. In the matter of summer-heat this country rivals the famous Yuma Valley. The average temperature (from records for twelve years) is for January, 49°; for July, 90°; for the year, 69°. By seasons it is as follows : winter, 51°; spring, 67°; summer, 87°; autumn, 69°. The mercury frequently rises to 95° in March and sometimes to 100° in April, while during the summer months the heat is intense. Records of the humidity wei'e not obtainable, but the atmosphere is considered dry. The average annual rainfall is 7 inches. The amount falling in each month is light, the heaviest rainfall occurring in August and December. The average annual wind-movement (taken from obser- vations for three years) is 2|- miles per hour.^ General A. W. Greely says that "Phoenix is the locality where the wind is per- haps the feeblest of any point in the arid regions.'" Tucson (elevation, 2400 feet ; population, 6000). An old Spanish grant is said to show a Spanish town here in 1553, built on the site of an Indian pueblo which is lost in the mists of tra- dition. Another account dates the Spanish Mission of San Xavier from 1694. At any rate, in the words of a thoughtful writer, "■ it is certainly of sufficient age to promise permanence."^ The name is said to be from an Indian word pronounced ''Chook- son," meaning "Black Water" or "Black Creek". With the exception of one or two public buildings and mercan- tile structures and a few residences of better style, the houses are built of adobe, one story in height, and arranged after the usual Mexican fashion. The town is situated on the Santa Clara plateau, and is surrounded by mountains. On the north are the Santa Cata- linas, east the Rincons, south the Santa Ritas, and on the west the Tucson range, with its most prominent peak — Tucson Mountain. The plateau is about twenty miles wide. Water is brought from a point on the Santa Cruz River, seven miles distant. The winter climate has been highly praised for its warmth and sunniness. Tiie average temperature for January is 50°; for July, 88°; for the year, 69° (means for fourteen years). "The mercury is never below 90° at 2 p.m. in July, and the mean minimum for that month is 78°, indicating nights too hot for comfort. ... On twenty- 1 Report on the Climate of Arizona. Captain W A. Glassford. 2 Report on the Climatology of the Arid Regions. General A. W. Greely. -5 Arizona. Honorable John A. Black. ROCKY MOUNTAIN REGION. 297 five of the thirty-one days in January, 1878, the mercury fell to the freezing-point, the lowest point being 24°.'" In 1892 the lowest points touched were : January, 17°; February, 30°; December, 16°. These low night-temperatures preclude the successful cultivation of semitropical fruit, which is so large an industry in Phoenix and Yuma, but the winters are considered mild and desirable for in- valids. The best part of the season is from December to April, as after that it grows too hot for comfort. For the year 1892 the highest temperatures were: in May, 100°; June, 107°; July, 106°; August, 107°; September, 102°. The average number of days above 90° is 128 ; below 32°, 33; cloudy days, 57; stormy days, 42 (means for two years). The record by season is shown in the following table, the figures for temperature and rainfall being based on the reports of the army- posts for fourteen years ■? Temperature. Rainfall. Relative humidity 1892. Winter . 52° 3.01 inches. 52 3er cent. Spring . 67 1.22 " 34 11 Summer . . 87 5.47 " 27 u Autumn . . 70 2.41 " 32 " Year . 69 12.11 " 36 il The accommodations for invalids are not very desirable. Tucson is on the main line of the Southern Pacific Railroad, and there are through trains east and west daily. See meteorological data for Fort Grant (4860 feet), sixty-odd miles northeast of Tucson, page 299. Oracle. Elevation, 4500 feet. This settlement is forty miles north of Tucson, by a good road. It is less than one day's journey by stage. The population numbers twenty-five or thirty persons. Oracle contains three or four ranches, two of which take boarders. The accommodations are good for the Southwest. The soil is a granitic detritus. There is no adobe. Grood, soft drinking-water is obtained from wells. There are live- oak trees, and pines grow further up the mountains, eight or ten miles away. The great mountain-ranges afford shelter from northern storms. 1 Handbook of the Pacifle Coast. Dr. J. S. Hittell. 2 Report on the Climate of Arizona. Captain W. A. Glassford. 298 MEDICAL CLIMATOLOGY. There are no springs or streams of water immediately around Oracle, but within convenient reach for exploring are said to be interesting canons and attractive scenery. The winter-climate is dry, warm, and mild. There is little or no dust. Yuma (elevation, 140 feet ; population, 1200). During the winter months there is probably no place near the sea-level where as mild and dry a climate can be found as iu Yuma, which is situ- ated in the Great Arizona Desert, on the banks of the Colorado River, fifty or sixty miles above the salt water of the Gulf of California. Early semitropical fruit can be grown on the soil watered by the Colorado River, and this industry is one that will probably be extensively developed, as the fruit ripens earlier here than in Cali- fornia. Yuma is famed for sunshine and heat, the latter being a delicate subject to refer to local opinion. The mean monthly temperature for January is 53°; for July, 92°; for the year, 72° (from observa- tions for fourteen years). The mean of the minima for three years (1891-'93) for July is 75° and for August 77°, indicating hot nights. The average number of days during the year above 90° is 163 ; be- low 32°, 4 ; cloudy days, 21 (mean for six years). The mean monthly winter-temperature for Yuma is 56°. The maximum temperature is likely to exceed 100° during the months of May to October, inclusive. Frequently it exceeds 100° in April, and it may rise to 90° during the month of March. In 1893, from April to October, inclusive, out of 214 days 162 days were over 90°. The maximum temperature for the year was 111°. Physical suffering is not so great under this intense heat as it would be if it were not for the great dryness of the desert-air and the consequent rapid evaporation. The sensible temperature (wet-bulb thermometer) is, however, frequently over 80°, which would any- where be considered hot. The yearly mean of the relative humidity is 46 per cent. The present hotel-accommodations are ordinary. The Southern Pacific Railroad has for several years been reported to have in con- templation the erection of a good-sized hotel. There is little amusement in Yuma, as there are few objects of interest in the vicinity. An army-post — Fort Yuma — is situated on the opposite side of the Colorado River, in the State of California. ROCKY MOUNTAIN BEGION. 299 Army-posts and Other Stations/ Fort Defiance (elevation, 6500 feet) is situated in the northeastern portion of Arizona, near the line of New Mexico. It is in the belt of mean annual tempera- ture of 45° to 50°, and is an elevated country with forests and springs and a climate resembling the Colorado plains. Due north of Fort Defiance are the Moqui and JSravajo Indian Reservations. Autumn. Winter. Spring. Summer. Year. Temperature' (8 years) 46° 27° 46° 68° 47° Rainfall (7 years) 3.72 in. 2.55 in. 2.03in. 5.89in. 14.19in. Fort Apache (elevation, 5000 feet). This post, like Fort Grant, is near the old Apache Indian Reservation. The country generally, though sparsely settled, is devoted to sheep- and cattle- raising and agriculture. About thirty miles northeast of Fort Apache are the White Mountains, which are said to possess fine natural scenery. They lie within one of the rainfall-belts of 20 inches for the year, of which there are four or five in Arizona. There are pine-forests and beautiful parks and valleys. Game and fish are plentiful. Autumn. Winter. Spring. Summer. Year. Temperature (18 yrs.) 54° 37° 52= 73° 54° Rainfall (15 yrs.) 3.05in. 5.07in. 2.96in. 8.96in. 20.04in. Wind-movement, annual average, 6J miles an hour. Relative humidity, annual average, 46 per cent. Fort Grant. Elevation, 4860 feet. Sixty or seventy miles north- east of Tucson, in the foot-hills of the Graham Mountains. It is a military post, with commodious quarters for officers and men, hos- pital, waterworks, store, postoffice, ice-machine, etc. There is tele- graphic communication with Fort Thomas. Autumn. Winter. Spring. Summer. Year. Temperature (17 yrs.) 62° 45° 59° 77° 61° Rainfall (16 yrs.) 3.64 in. 3.68 in. 1.80 in. 7.73 in. 16.85 in. Wind-movement, annual average, 7 miles per hour. Average number of days above 90°, 40 ; below 32°, 29 (for two years). Mean monthly temperature — January, 44''; July, 79°. 1 These army-posts are mentioned on account of their fine climate, and the illustration they afford of the natural resources of the hill-country of Arizona. It would be important for a casual visitor to be provided with proper letters of introduction to some of the higher army officers, before venturing so far away from ordinary hotel-accommodations, as there is usually no settlement of any size near the post. It may be added that on the frontier it is often difli- oult to supply two of an invalid's greatest needs— fresh meat and milk. I 2 From Report on Climate of Arizona, etc., by Captain W. A. Glassford, Signal Corps, U.S.A. 300 MEDICAL CLIMATOLOGY. Mean annual relative humidity, 45 per cent. Absolute humidity, 2.38 grains. Average number of cloudy days per annum, 45. (These last three records for ten years.) Port Verde. Elevation, 3200 feet ; population about 50(?). Forty-five miles east of Prescott. Situated near the E.io Verde. Camp Yerde has a pretty location. It now consists largely of abandoned adobes. Cottonwood-trees grow near the river. Hittell's Handbook of Pacifia Coast Travel divides the year into two periods of six months each, and reports the relative humidity of Camp Verde as follows: cold semester, 41 per cent.; warm semester, 38 per cent. Average for the year, 40 per cent. Autumn. Winter. Spring. Summer. Year. Temperature (21 yrs.) 61° 43° 61° 80° 61° Rainfall (21 yrs.) 2.82 in. 3.45 in. 1.98 in. 4.88 in. 13.13 in. Tombstone (elevation, 2300(?) feet ; population about 2500(?)). The town is built on an elevated mesa on the San Pedro River, twenty-eight miles south of Benson, on the Southern Pacific Rail- road, and eight miles from Fairbanks, on the New Mexico and Arizona Railroad. The buildings are largely adobe, one story in height, with arcades shading the sidewalks. The natural facilities for town-drainage are said to be good. An ample supply of pure water is brought twenty-two miles from the Huachuca Mountains. Autumn. Winter. Spring. Summer. Year. Temperature, 62° 46° 65° 77° 62° Kainfall, for the year, about 16 inohea (see Port Pluachuca). Port Huachuca (elevatioUj 4780 feet) is one of the most im- portant military posts in Arizona. It is situated in the Huachuca Mountains, at an altitude where, as a rule, the summers are cool and pleasant. There are picturesque mountain-views and forests of pine- timber in the vicinity. Fort Huachuca — and also the settlement of Huachuca, ten miles north- — are near the influence of the belt of 20 inches annual rainfall, which lies over the Santa Rita Mountains, Temperature (4 yrs.) Rainfall (5 yrs.) In this corner of the territory are several other well-situated settle- ments of high altitude on the line of the New Mexico and Arizona Railroad, which runs into Mexico. In the mountains are a num- ber of picturesque canons. The country, unlike the low, desert por- Autumn. Winter. Spring. Summer. Year. 61° 44° 59° 76° 60° 4.57 in. 3.02 in. 1.20 in. 7.60 in. 16.39 in, ROCKY MOUNTAIN REGION. 301 tion of Arizona, is green and fertile. There are fine mountain-scenery and pine-timber on the ridges. It is not thickly settled ; the prin- cipal occupations, aside from mining, are grazing and fruit-raising. The rivers rise in the higher mountains in Mexico and flow north to the Gila. Crittenden (41 00 feet) has fine natural scenery and productive fruit- farms. Old Camp Crittenden (2000 feet) has an annual average temperature of 60° and an annual rainfall of 16 inches. It is near the Senorita Canon, in which are hot springs. At Calabasas (about 4000(?) feet) the views of the mountains are extensive. There is said to be hunting in the vicinity. There is a brick hotel at Cala- basas, with some modern conveniences. Nogales (4000 feet) is on the Mexican line. Transfer is here made to the Sonora Railroad, running to Homosillo and Guaymas. Nogales is an American town with some Mexican characteristics. It claims a population of 2000. The buildings are mainly adobe. It lacks many facilities for com- fortable living, and is not exempt from dust-storms. The soil is sandy loam, which dries rapidly after rains. The climate is fine, sunny, and mild, though somewhat warm. The rainfall is about 10 inches a year. Speings. The foot-hills and valleys of Arizona, in or near the " rain-islands " before alluded to, are supplied with mineral springs — both hot and cold — but they have not been developed, and so little is known of them that any reference to the springs of Arizona, at this day, is necessarily meagre and incomplete. In the hilly country between Pi'escott and Phoenix are numerous springs. The Rio Verde is formed from a series of springs in what is known as Chino valley, in the Great Colorado plateau, between the Jupiter range and Bill Williams's Mountain. In the Verde valley is the Montezuma well, near which is a warm soda spring. The Castle Creek Hot Springs, in the southern part of Yavapai County, have been much visited by invalids. Twenty miles or so below Phoenix, on the Gila River, are hot medicinal springs, well known to the Indians. The streams rising in the mountains in the eastern portion of Arizona are fed by numerous cold springs. Near Wilcox (Cochise County) are Hooker's Hot Spring's, consisting of a cold sulphur spring and six hot springs, in which magnesia and iron are said to predominate. CHAPTEE XIV. PACIFIC SLOPE EEGION. The Climate of Southern California. " Two influences dominate the climate of California, radically dis- similar in every particular, combining in ever-varying forces to pro- duce the resultant which is recorded by observers of the weather. One is the sea, tending always to charge the air with moisture ; the other is the mountain-mass, tending always to discharge the moisture from the air. The combination of these two activities in varying proportions is responsible for the variation in the amount of precipi- tation, including months of drought."' The important mountain factors are the great chain of the Sierra l^evada and the Coast Range. In the southern portion of the State is a third series of elevations which may belong to either of the other northern systems, and which has been distinguished as the Southern Coast Range. It extends from the Tehachapi region southeasterly to San Bernardino Peak and Grayback, the altitudes of which approximate to 12,000 feet. South of these peaks the range runs parallel to the coast into Lower California. It is with Southern California that we have principally to do. That portion of the State south of latitude 35° lies more open to the sea. The hills no longer form a barrier to the wind directly over the shore. They are here further inland, and leave large and beautiful fertile valleys accessible to the daily ocean-wind. Among these are the Santa Inez and Santa Monica and the rich, broad valleys of Los Angeles ; the fertile district extends through the valley of San Gabriel and as far as that of the Santa Ana. It includes Riverside, Coltou, Pomona, and the long plains of the San Jacinto, stretching south- ward to the valleys of San Diego, while facing directly upon the sea are the valleys of the Santa Clara and Santa Buena Ventura and the Santa Barbara plains. These inland tracts of country are » Climate of California and Nevada/with Particular Reference to their Rainfall and Temper ature, etc., by Captain W. A. Glassford, Signal Corps, U. S. A. PACIFIC SLOPE BE O ION. 303 irregular in outline, branching out in many directions and often merging into rolling upland mesas. Dr. J. P. Widney says, in his able and entertaining Climatology of the Pacifio Coast :^ " The area of the plains of Southern California is really largely increased over their apparent size by the rolling, hilly uplands into which, in many directions, they merge. This is espe- cially the case in the country which lies between the San Fernando valley and the lower Santa Clara valley, and also in the great upland which rises from San Jacinto toward the south in San Diego County. These uplands have a rich, deep soil, and are well watered by numer- ous small streams." Directly north and east of the highest part of the Southeru Coast Range are the great deserts. The Mohav§ Desert has an average elevation of about 2000 feet. In the southeasterly corner of the State, bordering ou the Colorado River, is the low desert-land called the Colorado Desert, which in some places is depressed nearly 300 feet below the level of the sea. The influence of these vast desert-areas on the country to the windward of the mountains — that is, on the fertile plains south and west of the ranges — is plainly perceptible. Besides the influences of the mountain-masses in aiding to dis- charge the moisture from the atmosphere, another influence has been referred to as constantly exerted to charge the atmosphere with moisture, namely, the Pacific Ocean influence. In his elaborate and comprehensive memoir of the California climate, which is full of scientific detail, Captain Glassford has placed bounds around that part of the North Pacific Ocean which may be considered as modifying the climate of California, as follows: "To the west it is bounded by the extreme Orient, the islands of Japan, with their northern projection over the Kuriles to the coast of Kamtcbatka and their southerly connections with the Philippines. The northern limit is drawn by the Aleutian Islands, and the eastern border is the shore of North America. To the south no consistent mass of land appears to hem this ocean in, yet the barrier is none the less strong because it may be measured only with the instruments of the meteorologist. It exists at the thirtieth parallel of north lati- tude. Below this bounding-line is the region of the northeast trade- wind and the westward drift of the equatorial current, and these 1 California of the Soutli, by Walter Lindley and J. P. Widney, 1888. 304 MEDICAL CLIMATOLOGY. two serve sufficiently to bound in wind and water the great basin above." It is a basin within these limits — a rough ellipse having a major axis of 100° of longitude and a minor axis of 25° of latitude. It has its characteristic systems of circulation, both of atmosphere and sea. The strongly individualized ocean-current of the region is the Kurosiwo. Developed from the culmiuative process of the equa- torial drift and directed by the rapid alteration in the plane of the sea-bottom and the trend of the Asiatic coast, this warm stream moves across the whole Northern Pacific. Flowing through a broader sea than does the Gulf-stream, it shows several important differences — it has a slower motion, its warmth is not in such strong contrast to the water through which it flows, and the wind blowing counter to its course frequently avails to deflect it or even to check it entirely. Its eastern development and dispersion have been for years a battle-ground for theorists, and even now it is impossible to say definitely that it reaches any part of the Californian coast. The winds upon this basin are of the system of the passage-winds which are developed upon the surface of the earth by the descent from high altitudes of upper currents. In general these winds vary with the latitude from southwest, westerly, to northwest. It should be noted that these winds begin to appear about the parallel of 30° north, and that at first they are practically dry winds, but present- ing all the best conditious for absorption. The sea is warm and in the best condition for giving off moisture, and the wind is most receptive. ' 1 la order to gain a broader view of the distinctive climate of California— which differs from that of any district in this country— it may he well to quote here Captain Glassford's technical review of the climatic characteristics which dominate the whole region : "The distinguishing characteristic of the climate of the region Is that varieties of weather endure practically unaltered for days at a time, and even when supplanted by others return again and again, and on each such recurrence are symmetrical with their former appearance, even when they are not practically identical . In this regard there is a wide variation from the conditions which obtain elsewhere in the United States. Nor is this the only difference. Another notable one is that the storms of the Pacific are, with comparative infrequency, traced across Into the Central Valley and the Atlantic Slope, Another is that the storm-area fre- quently increases rapidly toward the north. "When the area of low barometer of considerable depth overlies Oregon and Washington, and probably Is central far to seaward, and the cyclonic type appears, its translation eastward is checlied If not prohibited by the barrier of the Cascade Range and the Rocky Mountains, which here begin to fuse. Held back by the mountain-wall and the equally potent barrier of high pressure eastward, the low Is kept beating against these obstacles'and the high remains steadfast over the Great Basin* and the Northern Plateau. While this condition endures gales * The Great Basin, a high plateau lying between the Sierra Nevada and the Wasatch Moun- tains. It contains 208,500 square miles, embracing all of Nevada and Western Utah, and por- tions of the adjoining States. PACIFIC SLOPE REGION. 305 are felt upon the Californian coast as far down as Cape Mendocino, and rain occurs in the Great Valley* and down the coast to San Luis Obispo. These storms leave the southern part of the State untouched, except when a subsidiary low is developed over the Colorado Desert, "When the brief ' Sonora storms ' occur." * The Great Valley. This term includes both the Sacramento and San Joaquin Valleys. It has a length of about 450 miles by about 40 miles arperage width, taking in the lower foot-hills. " When this lower area is shallower, and can be plainly seen to have its centre not far out upon the sea,',but over Washington, and the high is plainly marked upon the Great Basin, then occur light showers from San Francisco northward, with strong gales at Cape Mendocino ; the temperature over the dry area is usually high and occasionally of steep gradients, and in the Los Angeles region the warm Santa Ana winds occur. The rain rarely passes south of San Francisco, except in cases where the definition of the high is so strong toward the south of the Great Basin as to condition a low advancing over the Southern Coast Ranges and back of the Sierras to meet it ; then light showers may occur between San Luis Obispo and San Diego. " These two cases have presented the conditions oi low pressure over Washington and Oregon, accompanied by rains, which, for the most part, occur in California only in the region north of the southern inosculation of the Coast Range and the Sierra Nevada. When, on the other hand, a high area rests upon the two Northern States and the low type is permanent over Southern California, it conditions for California a climatic manifestation of extremely unstable equilibrium, and while this arrangement of the meteoric elements is of frequent occurrence it is often of short duration. When the low is in the north rain falls upon California ; when the high is in the north fair weather is a marked concomitant. '' During the perfection and greatest intensity in the prevalence of this arrangement, and while the isobars are perpendicular to the general trend of the coast-line and the axial inflec- tion of the Coast Ranges and the Sierra Nevada, the Great Valley is exposed to ' northers,' marked with disastrous desiccating influences. The day-temperature is usually high, increas- ing proportionally to the duration of this climatic type, but at night frosts are of character- istically frequent occurrence. The winds increase toward the south, being light and variable on the Oregon coast, but high gales on the Californian coast. When this type occurs in spring, and is accompanied in Southern California hy high winds and sandstorms, rain is almost cer- tain to follow. In general, the breaking up of this type is heralded by frosts of more or less severity. "The most severe and general rains of the region occur in co-ordination with a general climatic disturbance over the whole country. To the eastward there is a series of waves of abnormally high pressure over the eastern guiding-planes of the Cordilleran system, reaching thence across the Central Valley and the Appalachian system to the Atlantic seaboard, and everywhere accompanied by severe storms and Intense cold. Upon the Pacific coast, in corre- lation with this eastern disorder, the barometer drops very;low, and exhibits rapid fiuctuations, with remarkable gradients between the coast and the interior, the rain-area overspreads all sections, gales are marked with the greatest violence, the rivers attain their high levels and tend to floods ; in general, the condition is that of an extensive cyclonic disturbance, which, proving unable to scale the Sierra Nevada, is forced to spread out over the entire length of the coast region, until it gradually wears out with the restoration of climatic equilibrium beyond the range, or if it does move eastward, does so at some extreme point beyond the sphere of observation. In this condition of the weather the rain is precipitated with practical impar- tiality from Siskiyou to San Diego. " Another rainy condition is found when a diffuse and moderate high exists upon the south- western coast, accompanied by unusually low temperature, and apparently unaffected either by the presence or the absence of a faint and shallow lo,w on the Northern coast. With this arrangement of climatic factors the isobars are somewhat perpendicular to the coast, a condi- tion almost certain to bring rain, while if these curves of pressure assume a parallelism with the coast-line fair weather soon follows. During the prevalence of this condition there are rains upon the Los Angeles conn try and the Great Valley, and the winds above San Francisco are feeble, except in the rare instances when the barometer sinks excessively. Should the absolute general pressure fall considerably below the normal, yet retaining the relative high upon the southwestern coast, gales rage in Southern California, with occasional storms of thunder and hail. This condition determines very suddenly by the movement of the high up the coast, and its obliteration as a distinct feature in its progress. " A condition "which leads to rains of local character, yet impartially distributed as to occur- rence within geographical limits, is marked by a moderate low continued through a succes- sion of days and below the normal over a large area. The isobars are then diffusely disrupted ; 20 306 MEDICAL CLIMATOLOGY. The amount of annual rainfall along the southern coast and on the valleys of the southern slope is from 10 to 20 inches, diminish- ing to 3 or 4 inches over the Colorado Desert and increasing to about 40 inches on the highest summits.^ The period of the winter-rains is seldom established before No- vember, and is over usually by April. The months of the heaviest rainfall are December, January, and February, when two or three inches during each month may be expected, with intervening rain- less periods, perhaps several weeks in length, of fine, sunny weather. In Los Angeles over 60 per cent, of the rainfall for the season occurs during these three winter months.^ The normal rainfall is well illustrated by the following table from the Government records for each of the months of the rainy season separately and the remaining six months of the year together. The average rainfall for these three towns for the months from November to April, inclusive, is 14 inches ; for May to October, inclusive, 1.1 inch. Rainy season, Southern California. Los Angeles Santa Barbara San Diego Nov. Dec. Jan. 1.6 3.7 3.9 1.6 3.9 3.7 1.0 2.1 1.6 Feb. March. I April. 4.0 2.2 3.8 2.1 2.1 ' 1.0 1.3 1.4 1.0 i^cluSve. 'Length of record. 1.2 1.3 1.0 To 1892, 21 years. " 1891, 24 " " 1892, 42 " It is interesting to note that no rainy season ever runs along on normal lines in California. The rain may hold off for weeks at a time, and then it may pour for days and days, until from 3 to 10 inches of water have fallen before fair weather is again definitely restored. It is of great value to know the annual average precipi- Irrigation and Rainfall Maps. William Ham Hall, C.E. Rainfall and Snow of the United States. Professor M. W. Harrington, Washington, 1894. they are wavy, or enclose several subsidiary lows, occurring over mountain-basins with a marked absence of any decided gradients. The winds are variable, the temperature declines, the sky is cloudy, rain comes at intervals, rising under favorable conditions to a gale, which, while quite local in character, sometimes does considerable damage within its narrow limits. " The dry season shows little variation from beginning to end. Rain is almost entirely absent, and the light showers which sometimes occur on the Washington coast only rarely drop down upon a limited district of the Californian shore. Another feature of the season is the development and persistence of marked intensity of the high in Oregon, accompanied with a corresponding fixity of a slight low area over Southern California, creating the characteristic northerly winds which blow down the Great Valley." PACIFIC SLOPE REGION. 307 tation for twenty years, but it does not in the least indicate what the rainfall will be for the coming year. Santa Barbara, with a normal precipitation of 17.6 inches, had a minimum record of 8.01 inches for the year 1881 and a maximum of 38.8 inches for 1884. Los Angeles, normal 18 inches, has varied in diiferent years from 5.6 inches (1881) to 40.5 inches (1884). Riverside, normal 10 inches, has had minimum 2.46, maximum 25.32 inches. San Bernardino, normal 16 inches, has had minimum 8.98, maximum 37.51 inches. San Diego, normal 10 inches, has had a minimum of 3.71 and a maximum of 25.97 inches; while Julian, with a normal of 38 inches and no record below 25 inches, has known 61.62 inches during a season. One of the heaviest seasonal rainfalls in Southern California was during the winter of 1883-'84 when previous records were everywhere exceeded. Southern California has been divided into three belts of mean annual temperature: (1) A belt of 60° to 68° F. along the seacoast and extending inland from thi!rty to fifty miles. (2) A belt of 52° to 60°, running up the sides of the Southern Coast Range and ex- tending from Tehachapi to San Bernardino Peak and from San Jacinto Mountain south to Lower California. (3) A wide belt of 68° to 78°, beginning at the base of the mountains, stretching east and northeast to the Colorado River, and including the Colorado and Mohave deserts. These arbitrary divisions cannot be followed closely, however, as every valley and hillside has variations both of temperature and rainfall, owing to its position with relation to the prevailing wind. On the Coast Range this variation is often experienced. Dr. \yidney says: "While upon the ocean side of the range are great forests where the giant redwood is bathed nightly in the dense, cool fog which seems to be essential to its growth, just across the summit are warm mountain-slopes facing off toward the morning sun, their rolling hills green to the very crest with the olive and the vine; and yet from their sheltered warmth one may pass on for a few miles to some pass or gap in the range that is swept during all the summer months by the great, cool ocean-wind as it rushes through to the heated interior. '"^ The relative humidity of the coast is usually in the neighborhood of 70 per cent., which, taking a mean annual temperature of 60°, 1 California of the South. J. P. Widney, M.D. 308 MEDICAL CLIMATOLOGY. would show the amount of absolute humidity to equal 4.03 grains of vapor to each cubic foot of air. This humidity decreases steadily on goiug inland until the desert is reached, where, east of the moun- tains, the atmosphere is perceptibly drier. It is here, directly within the desert-influence, that any dryness in California is to be found, for within the sweep of the sea-breeze great moisture will always be present. During the so-called "dry" or rainless summer season the relative humidity in the air is equal in amount to that of the winter season, as shown by the Government weather-reports. The Pacific coast has, during the spring and summer, a frequent night-fog, which becomes visible about sunset or a few hours later and disappears during the early forenoon. Many observers who have lived directly on the coast believe the fogs to be more frequent during the winter, especially north of Point Concepcion ; but the record of night and morning fogs at Los Angeles (fourteen miles from the sea) for thirteen years shows that the number of days on which fogs occur increases steadily from the beginning of spring through, July, continues large in August and September, and decreases to a marked degree between October and March. By seasons the average number of foggy nights at Los Angeles is as follows (means of thirteen years) •} AVinter , . 7.3 days. Summer . . . 23.5 days. Spring. . . 12.1 " Autumn . . 13.9 " Annual average, 57 days. Owing undoubtedly to local conditions Los Angeles is more sub- ject to fog than San Diego. In 1891 there were 22 fogs at San Diego, the greatest number in one month being 7, which occurred in November. In the same year there were 62 fogs at Los Angeles, the maximum number per month being reached in June and July, in each of which there were 12 fogs. In 1893 there were 12 fogs at San Diego, the greatest number in one month being 3, occurring in October; while there were 46 fogs at Los Angeles, 11 of which, the maximum monthly number, come to July. In 1894 there were 26 fogs at San Diego, the greatest monthly 1 From records of Los Angeles office of U. S. Weather Bureau. PACIFIC SLOPE BEOION. 309 number being 9 in November. At Los Angeles there were 46 fogs, of which 9 were in the month of July, 8 in August, 7 in September, and 6 in November. Santa Barbara had 73 fogs during this year, July and November, during which months they were most frequent, having 16 and 12 respectively. Records for other years were not obtainable. In Southern California a fog lasting through the entire day is in- frequent, the usual course being for it to appear in the night and vanish in the course of the morning. This fog is a virtual prolonga- tion of the rainy season for the immediate coast-district, and its humidity and freshness help to make the day cooler and more brac- ing. It is said rarely to rise above an altitude of 2000 feet. Dr. Widney writes: " The heat of the summer is not felt along the coast within reach of the sea-breeze — a midday temperature of 65° to 80° being the rule, varying with localities. Back from the coast, in the interior valleys, where the fog does not penetrate, the midday temperature may, in exceptional cases, during a hot spell, reach 90° or 100° or even 105°; but it is a dry heat, without the discomfort or danger attending a like temperature in the Atlantic or Mississippi States. These hot spells, as they are called, may occur several times during the course of the summer, generally lasting for three days, when the mercury drops and the normal coolness returns. Even during these hot spells, however, the night is generally marked by a rapid fall in temperature, so that sleep is restful and refresh- ing. The heating of the interior valleys gives rise during the after- part of each summer-day to a strong surface-current sea-breeze, which dies away toward sunset." As the cooler air from the sea flows in upon the warmer air over the land the moisture in the warmer air is condensed into visible vapor, and the formation of fog goes rapidly on. Along the imme- diate coast there is seldom or never fog on the land unless there is also fog on the ocean, and while there is little wind at night the sea- influence is very marked. '^ In some of the interior valleys, however, the light, cool evening-wind which blows off the sides of the moun- 1 From Report of Chief of U. S. Weather Bureau, 1893. San Diego. Frequency of winds, 1893. Hours winds were blowing from the W. 2904 ; E. 190 " N.W. 1677; S.E. 256 ' " S.W. 1522 ; N.E, 704 Total sea-winds, 6103 hours ; total land-winds, 1150 hours. As is usual on a seacoast, the time when the wind is blowing from the land toward the sea is during the night. 310 MEDICAL CLIMATOLOGY. tains performs' the office of condensing the vapor in the warmer strata of air lying over the plains. Thus a fog is formed which remains until dissipated by the rays of the sun during the early forenoon. But, after all, the source of the fog is of less importance than its frequent presence and the fact that the amount of moisture in the air increases with the approach and advance of night, as shown by the instruments registering that factor.^ Dr. Widney continues : " It is the coolness and nightly moisture of these summer-fogs which draw the frost-line well down the coast in N"orthern California. To persons of delicate constitution, those who do not make blood and bodily heat rapidly, these keen sea- breezes and the chiil fog are very trying."^ During the months of June, July, and August, which are the driest months of the year in California away from the coast, any precipitation is rare except on the highest mountains. This is the time of year for camping-out in the pines on the sides of the Sierras, 4000 or 5000 feet or more above the sea. In well-protected spots there is little if any dew, and the relative humidity during the middle of the day is sometimes as low as 20 per cent. ; between the 1st of June and the 1st of September there is little danger of frost. In the fertile valleys during the rainless season the irrigation of groves, orchards, and vineyards is constant and increases with the more extended cultivation of the soil. How great an effect this practice has had in augmenting the rainfall and the atmos- pheric humidity is yet an unsettled question. The following evi- dence is submitted as suggestive, the first illustration especially: In the official record of the rainfall at Riverside for fourteen years, from 1880 to 1893, inclusive, the average precipitation of the first seven years is 8.02 inches and of the last seven years 11.75 inches, an increase of 46 per cent. Looking at it in another way, the annual rainfall at Riverside for the four years 1880-83, inclu- sive, averaged 4.42 inches; while for the four years 1890-'93 it was 10.69 inches, an increase of 140 per cent, in ten years. The record of Santa Barbara for twenty-four years, from 1867 to 1891, gives the average pi-ecipitation of the first twelve years as 15.78 inches and of the last twelve years as 20.50 inches, an in- crease of 32 per cent. The question of irrigation does not, how- ever, euter into the discussion, so far as Santa Barbara is concerned. 1 See p. 313. - California of the South. J. P. Widney. PACIFIC SLOPE REGION. 311 The cloudy days in Southern California number about the same as on the high plains of Arizona, ISevf Mexico, and Colorado. There are usually from forty to sixty cloudy days during the year, except perhaps in particular locations on or near the coast, where the effect from fog is greatly felt. In the inland desert-country in Southeastern California and Southwestern Arizona the total of cloudy days numbers barely twenty during the year. The average annual wind-movement of San Diego is equal to a velocity of 5.6 miles per hour; at Los Angeles, 5.1 miles; and at Santa Barbara about 4 miles per hour. The general movement in California is usually small. " The feature which most impresses the observer upon the Pacific coast in his study of the winds is their regularity. . . . He knows that at certain seasons there will be a prevalence of wiud from a certain quarter, and that at a certain time of each day the wind will rise. He knows that a persistence of the wind from a certain quarter will bring a very moist atmos- phere and rain, while the current from another quarter as surely means clear, cool weather, with a moderately humid atmosphere ; and from yet another quarter means an exceedingly dry atmosphere, cold in winter, hot in summer. . . . While the whole Pacific coast has much less really calm weather than the Atlantic coast, yet the records of the Signal Service show that the total wind-movement is less; in other words, in a given length of time there are more hours of wind but of less velocity. It is a region of more continuous wiud-currents, but of milder character. The brisk sea-breeze is diurnal ; the gale rare ; the hurricane and the cyclone are un- known."^ In an entertaining discussion of the climatic characteristics of Southern California by Dr. C. P. Hemondino, of San Diego, in a magazine article,^ he refers to the great range of the rainfall over that country from the lowest yearly record to the highest twelve- hour record for the United States, as indicating a " land of seeming and incomprehensible climatic contradictions." The arctic current that passes the coast with its waters never below 60° F. in winter, nor over 66° in summer, he regards as the "great equalizer of Southern California temperature." Before summing up the advantages of California as a health- resort a frequent source of error in estimating the character of the 1 Dr. J. P. Widney. 2 California as:a Health-resort. P. C. Eemondino, in the California Magazine, Octoher, 1893. 312 MEDICAL CLIMATOLOGY. climate should be particularly pointed out. The great number of days of sunshine and the small amount of annual rainfall should never be confused with the actual degree of atmospheric humidity. In connection with any discussion of the climate of California this important fact should always be kept in mind. When writers speak of its " dryness " they mean — if they mean anything — to refer to the interior desert-country, beyond the mountains, where the wind has lost its coolness and moisture, and where it is dry, but for most of the year excessively hot during the day, although somewhat cooler at night. When they speak of its "coolness" they refer to the coast-districts, where high tempera- tures are rare and the cool sea-breeze is full of moisture. There are found the features of an ocean climate, and this is the secret of its equability. In order to have a general knowledge of the climate of Southern California this relative distinction is important : the coast is cool and moist; the interior is hot and dry. Or, to put it a little differently, it should be thoroughly understood by the Eastern visitor in search of health that if he seeks more days of sunshine and opportunities for outdoor life, with a more equable temperature and an average humidity a little greater than that of New York or Boston,^ he can find what he desires at Santa Barbara or San Diego. If he needs the elemeut of absolute dryness with low altitude and sunshine, he will hardly find them together, except along the low plains of Arizona and New Mexico ; that is, while the barren inland desert-country of California is dry, it lacks the conveniences of civilization, which cannot be obtained short of the towns of Phoenix, Tucson, or El Paso. 1 The accompanying table, taken from records of U. S. Weather Bureau, shows that the number of grains of moisture to each cubic foot of air averages during the year more by one- third along the coast of Southern CaUfornia than in Boston or New York, This is partly owing to a higher average of temperature. From Table V. : Mean annual Tempera- Relative Absolute ture. humidity. humidity. New York 62° 73 per cent. 3.19 grains. Boston . . 49 72 2.84 Santa Barbara 60 73 4.20 Los Angeles . 62 72 4.42 San Diego 61 73 4.34 PACIFIC SLOPE REGION. 313 There is, however, a good country along the foot-hills from Sierra Madre to Beaumont, where on the " benches " of from 1500 to 3000 feet elevation the air is moderately dry. The winters throughout this region are mild, but except at a considerable elevation the summers away from the sea are cloudless and quite hot. It may be well to call attention to the fact that the climate only is under consideration here, the matter of accommodations being referred to elsewhere. For a cool, dry air there are the elevated plains of Arizona, New Mexico, and Colorado. The marked changes of temperature during the day in California are frequently trying, and the humidity is sometimes greatly in- creased by fogs and in winter by protracted rains. It is a point worth noting that even when the atmosphere has been fairly dry from 11 A.M. to 5 p.m., it is always damp at night. The author has noticed this at Redlands — one of the most favorably situated of the inland towns. On one occasion when at 4.30 p.m. the relative humidity, as indicated by the hygrometer, was 55 per cent. , at 6 P.M. it had increased to 80 per cent., and a light haze was visible in the valley. While the minimum relative humidity at Kedlands is sometimes as low as 30 per cent, for a limited period taken during the middle of the day, it always reads high during the night, and will probably be somewhere from 70 to 80 per cent, or over, with a night-temper- ature ranging usually during the year from 44° to 60° and in the winter from 44° to 52° ; freezing weather is very rare. This means to an invalid a climate possessing perhaps six hours in the day of moderate dryness and eighteen hours of positive dampness. This peculiarity of the climate of Southern California explains many of its apparent contradictions. The great difference between the character of the atmosphere during the day and during the night usually escapes observation. It is of importance because it shows the danger of making an estimate of the climate without considering the prepondering night-influence. The weather-records are not so complete for the night as for the day, but they are sufficiently so to establish this fact — that, in spite of the great amount of sunshine during the day in California, the foggy and damp nights and mornings take up a great part of the twenty-four hours. At Los Angeles observations taken at 8.15 and 8.07 p.m. (local 314 MEDICAL CLIMATOLOGY. time) for six years (January, 1882, to December, 1887) show the following results by seasons (for office of United States Weather Bureau) : AVinter Spring Summer . Autumn . Yearly mean Observations showing the hum: night and 4 a.m., have never been One more example of night-hum Ight- Relative erature. • humidity. 52° 76 per cent 57 81 65 82 60 82 58 80 dity at its greatest, between mid- published, dity in California may be quoted, taken in the Ojai Valley during ten clear nights in January and Feb- ruary, 1895 : Nordhoff, average hour for observations, 10 p.m.: mean temperature, 47°; mean relative humidity, 79 per cent. The observers in the United States Weather Bureau stations take synchronous observations at 8 p.m., Washington or 75th meridian time. A comparison of the tables of relative humidity for that hour for several health-resort stations, on the elevated inland plains and in Southern California, may be of value in this connection. Mbast Monthly Relative Humidity. (1892 • 1 1893 Winter. Spring. Per cent, 41 40 Summer. Autumn. Year. Denver (6 p.m. local time) Per cent. 55 42 Per cent. 32 33 Per cent. 31 31 Per cent. 40 37 Colorado Springs (6 p.m. local time) 1893 No complete record for 1892. 41 34 39 36 38 Santa Fe (6 p.m. local time) J 1892 ■ (1893 52 36 31 17 33 28 31 83 34 29 El Paso (6 P.M. local time) (1892 ■ 1 1893 35 23 12 10 19 26 26 25 23 21 San Diego (5 p.m. local time) 51892 • J 1893 69 67 69 68 71 70 70 72 71 70 Los Angeles {5 p.m. local time) fl892 ■ 1 1893 68 68 65 66 61 61 63 69 65 66 In reading the preceding summary it should be remembered that the observations for the first four stations were taken at 6 p.m., mountain or 105th meridian time, while the last two stations have the advantage of having had the observations taken still earlier, at 5 p.m., Pacific or 120th meridian time, only a few hours after the driest portion of the day. PACIFIC SLOPE REGION. 315 If this record of relative humidity for Los Angeles, taken at 5 P.M., is compared with the record of the same station taken at 8 P.M., which was given on page 313, the steady increase of moisture with the approach of night at all seasons becomes most evident. On the elevated plains of Colorado or Northern New Mexico the night-air can be admitted into sleeping-rooms on the coldest nights in winter because it is so dry. The temperature of a room with the window partly open seldom falls below 40° F., even if the air out- side is 20°. At that temperature, even with 70 per cent, of rela- tive humidity, the amount of absolute humidity the air can hold is less than one grain (0.91) to the cubic foot. In California, on the contrary, as in the Riviera, the night-air is usually damp and frequently saturated with fog. To those to whom the presence of dry air is not important Cali- fornia offers many attractions. From Monterey to San Diego are wooded ranges, fertile valleys, vineyards, orange and lemon groves, tropical and semitropical fruit in abundance, plenty of sunshine, well-built and prosperous towns, pleasant society, and for the transient visitor, what is most important, good hotel and boarding accommodations. The winter or rainy season is the favorite time for visiting Cali- fornia. The monthly rainfall at that time is not usually more than the normal monthly rainfall for Eastern cities, and there are longer periods of fine weather. The welcome rains bring a vivid green to the brown valleys and hills, and the beautiful "procession of the flowers," which continues from December to May, enraptures Eastern visitors. In the protection from cold northern or eastern winds afforded by the mountains (with the additional climatic advantage of the miles of desert beyond), its soft, balmy air, bright days, and equa- bility of temperature from one season to another, this southern coast resembles the Riviera and may even claim superiority over that resort. Some of these points of comparison are alluded to in the more detailed descriptions of the towns themselves (see Santa Barbara), The attention of invalids or delicate persons should be directed to a marked feature of the Californian climate — that is, its peculiar chil- liness in the shade and when the wind blows, even on a summer- day. It is always chilly at nightfall, at which time a light over- 316 MEDICAL CLIMATOLOGY. coat or wrap is needed all the year round. Rooms with a sunuy exposure are much to be desired. It is greatly to be regretted that no suitable health-resort station has been developed in the highlands of Southern California, where the natural advantages of sandy soil, soft water, moderate elevation, and an atmosphere containing less moisture than is to be found directly on the coast could be supplemented with good accommoda- tions. Such a resort is possible. Beaumont (2500 feet) and the higher ^'benches" above may be suggested as possessing some of these advantages. The Sospe Valley, above Ventura, which is moderately elevated and similar iu character, has been strongly recommended, and other locations can be found equally good if not superior. In San Diego County, thirty or forty miles from the sea, are sev- eral places which might be developed into health-resort stations, such as Alpine (2200 feet) ; Ballena (2500 feet) ; the Santa Isabel Valley (3200 feet); Julian (4300 feet); Cuyamaca (4700 feet) ; and the Palomar and Coleman valleys (each 4000 feet). Above an alti- tude of 2500 feet the trees grow more thickly, and fir, pine, and oak trees are found up to the crest of the mountains. On the west side of the mountains the rainfall also increases. In the desert east of Jacinto are stations on the Southern Pacific Eailroad where the experiment of living a little below the sea-level may be tried, viz., at Salton (260 feet depression) and Volcaao Springs (220 feet depression) ; good accommodations are lacking. Indio (50 feet depression) has better facilities for visitors, but is not so low. San Diego. Population, 18,000. The bay of San Diego is a beautiful land-locked body of water twelve miles long by a mile wide. It is the best natural harbor south of San Francisco ; but, although the settlement dates from 1542, when it was first discov- ered by Cabrillo, its commercial supremacy is still in the future. The completion of the Nicaragua Canal will be of the greatest benefit to this port, which, from the strength of its geographical position, will receive a large share of the enormous trade that will then be developed. The town of San Diego lies on the main land, facing the Pacific. Dr. Walter Lindley thus describes it : " Situated on one of the most perfect harbors in the world, with vessels unloading at its wharves from all the chief ports of civilization, the culmination of the Santa PACIFIC SLOPE BEGION. 317 r^ Railway system, that brings it into intimate relations with Chi- cago, 'New York, and Boston ; planted on a series of hills that gently slope to the ocean, with a soil that produces almost everything de- sirable from a pumpkin to an olive ; with business blocks which, for elegance, solidity, and size, are rarely surpassed ; with a climate that is enjoyable and healthful both summer and winter ; with every facility for boating, fishing, and hunting; with a population noted for culture and refinement ; with schools, churches, and hotels that would be creditable to much larger cities ; with commercial prospects of dazzling brilliancy — with all these attributes the visitor does not wonder when he finds that every one of San Diego's fifteen thousand inhabitants, from the infant just beginning to prattle to the great- grandmother who dozes away the sunny Christmas-day in her arm- chair on the veranda — has learned to sing her praises loud and long."i The soil in the highest portions of the town is sandy. The shores of the bay are high at Point Loma — the entrance — but low and marshy around the southern end. The mesa or tablelands rise higher going from the bay until they reach the mountains, distant about forty miles. In the fertile valleys and on the hillsides a great variety of soil can be found. San Diego is now supplied with pure, soft water, brought from the mountains. There are also wells. The natural facilities for drainage are good. Forty miles of sewers emptying into the bay have already (1894) been built. San Diego has several lines of street-cars, mostly electric. There are a number of good hotels. One of the best portions of the town for residence is Florence Heights, which lies at an elevation of 180 feet above the sea. The climate of San Diego is noted for its equability, the range of the mercury between winter and summer being usually under 15°. The monthly mean temperature for January is 53°; for July, 68°; annual mean, 61°.^ The average number of days during the year above 90°, 1 ; below 32°, none. During twenty-three years the records show that the mercury three times rose to 100° (going once to 101°). It went to 95° but three times, and to 90° but seven- teen times. It does not usually reach 86° more than twice a year. The highest temperatures are likely to be recorded in September. 1 California of the South. Walter Lindley, M.D., 1888. 2 Government record for twenty-three years— to 1894. 318 MEDICAL CLIMATOLOGY. Summer-nights are invariably cool. Frost is said to be unknown on the coast, although 32° has been recorded five times in twenty- ihree years. In the foot-hills a thin skim is sometimes formed on the lowest lands when the slopes of the uplands are exempt. The temperature of the winter-days on the high mesa near the mountains is said to be usually about 45° at daylight, running to 65° or 70° at noon. It is seldom as low as 55° at noou, and some- times it is as high as 75°. San Diego has an annual rainfall of 10 inches. During a " dry " winter it has been known to be as low as 4 inches. The heaviest rainfall was during the season of 1883-'84, when 25.97 inches fell. There are few stormy days during the year (37), but a large number of cloudy days for Southern California (69), and the degree of humidity is high. Fogs are less prevalent at San Diego than at Los Angeles.^ Four or five miles inland from San Diego the amount of fog is still less than directly on the bay. The wind-movement is moderate, the yearly average being 5.6 miles per hour. The prevailing sea-wind is frequently alluded to by local writers as "dry". This is an error, as will appear if the movement of the winds is considered. The wind is dry when it first starts from the heated deserts of Southeastern California and Southwestern Arizona, and rising to a great elevation passes out to sea over the incoming cur- rents ; but when it has to descend to the ocean about latitude 30° and, reversing its course, becomes in turn the southwest or west wind blowing landward, it presents such conditions for the absorption of moisture that long before it reaches the coast of California its original dryness has been completely lost. This is the daily wind from the sea. "What its characteristics are, then, is shown by the meteorological analysis, which can be better illustrated by instituting a comparison with a locality of admitted dryness. El Paso will afford an excellent parallel,^ although it has a little higher temperature during the year — a fact slightly to the advan- tage of San Diego, as the warmer the air is the greater the amount of moisture it can contain. ' See reference to night and morning fogs, in article on the Climate of California. - Latitude of San Diego, 32° 43' N. Latitude of El Paso, 30° 47' N. PACIFIC SLOPE REGION. 31 9 Tempera- Relative Absolute Dew- ture. humidity. humidity. point. Saa Diego . . 61° 73 per ct. 4.34 grains. 52° El Paso . 64 48 " 3.16 " 40 We thus find that Sau Diego, at nearly the same temperature, exhibits over El Paso 58 per ceut. increase in relative humidity, 37 per cent, increase in absolute humidity, and 30 per cent, increase in the dew-point. The only conclusion possible to reach is that air which at 61° of temperature shows an annual mean of 73 per cent, of relative humidity, 4.34 grains of absolute humidity to the cubic foot, and 52° for the dew-point (or point of saturation), cannot be properly described except as a warm, moist climate. Particular emphasis is given to this point, because so many pul- monary invalids — to whom the amount of moisture in the air is sometimes of the greatest importance — have suffered sadly from lack of early knowledge regarding this detail. It is surprising to notice how constantly one meets references to the "dryness" of this coast, not only in guide-books and in edito- rial utterances, but even in articles on the climate by medical writers. On the part of strangers such a misconception would prob- ably be due to mistaken inferences based on the large number of sunny days during the year and on the small amount of the annual rainfall. It is unfortunate that it should be kept up by local writers to whom the actual dampness of the country within the ocean-influ- ence ought to be well known.^ Admitting, then, as we must, the presence of the important factor of humidity in this as in all coast climates, it can be said that the climate is delightful, equable, and healthful. The ocean-current that brings so much fog and chill to the coast north of Monterey passes by so far out to sea that its influence is greatly modified. Curiously enough, it is said that one hundred and fifty miles fur- ther south in Lower California, where it again approaches the shore, it brings to San Quintin a climate cooler than that of San Diego. Opposite San Diego, on the ocean-side of the promontory that 1 An article by Mr. John D Parker on "California Electrical Storms," in the American Meteoro- logical Journal for June, 1895, suggests that " one cause for the infrequency of electrical storms is probably found in the humidity of the atmosphere. . The humidity of the atmos- phere in California, so contiguous to the Pacific Ocean, is naturally much greater than that found at points more remote from large bodies of water. At San Diego the mean humidity of the air in 1891 was 74 per cent, of complete saturation ; in 1892, 76 per cent. ; in 1893, 74 per cent. ; and the mean humidity for eleven years, from 1884 to 1894 inclusive, is 77 per cent." This percentage of humidity for San Diego, which is for different years than those used for the computations for this book, is even more excessive. 320 MEDICAL CLIMATOLOGY. forms the harbor, is Coronado Beach, the whole development of which — from the great hotel of 750 rooms to the tropical garden — has taken place since 1887. It is an attractive resort with an equable marine climate, and in many respects is unequalled in the country.^ Coronado Beach is easily reached by ferry from San Diego. There are a great many cottages near the hotel, and quite a settle- ment is growing up, with shade- and fruit-trees, which are developing rapidly under the stimulus of irrigation. The Coronado Springs are worthy of notice. They are thirty feet above tide-water and flow 50,000 gallons per hour. The water is pure, soft, and sparkling, resembling the well-known Wauk- esha Springs in Wisconsin. There are about 26 grains of total solids to the gallon.^ It is carbonated and bottled for commercial uses, making a fine table-water. Miss Kate Field, in a letter which appeared in the San Francisco Chronicle, in June, 1893, made a strong and cliaracteristic plea for better water for domestic purposes in California. Her summary of the general quality of the water in the State is somewhat severe, as many towns are supplied with excellent water from either the mountains or from artesian wells ; but what she says is well worth reading, especially for its bearing on the climate. " California has herself to thank for her national reputation as the purveyor of bad water. Nature produces no bane without an antidote. Though mountain and desert send water freighted with lime or alkali, heaven sends rain pure, soft, and health-giving. If every house in Southern and Lower California should have its cistern, nobody need drink hard or poisonous water. Were it known to tourists that soft water abounded in hotels and boarding- houses many an invalid would hasten to breathe the balmiest air in this country. " Rain, however, is not the only means by which soft water can 1 For meteorological data, see records for San Diego, Tables V.-IX. 2 Coronado Springs. Light alkalo-carbonated water. Analysis by C. Gilbert Wheeler, of Chicago. Grains in U. S. gallon. Grains in U. S. gallon. Sodium chloride 10.16 Ferrous sesquioxide . . 0.04 Potassium chloride 0.91 Silica . , 108 Potassium sulphate 0.55 Organic matter 0.99 Magnesium . . 4.72 Calcium carbonate 6.48 Total solids . 26.25 + Calcium sulphate . 1.32 PACIFIC SLOPE MEOION. 321 be obtained. It is a remarkable, but little recogaized fact that the dew or fog of the Pacific coast would, if caught in cisterns, supply every family with soft water. Seeing is believing, and I have seen. An acquaintance of mine, living near San Diego, has never dug a well, though his house is half a mile from the sea. His cistern sup- plies all the water necessary for domestic purposes and for a horse and cow. Twenty-four hundred square feet of roofs produce 140 gallons of water in twenty-four hours. Multiply 140 by 365 and you are amazed to learn that this householder obtains an annual supply of 51,100 gallons of soft water without counting the rain- fall. Another acquaintance, while building on Coronado Beach a cottage with a roof measuring 1000 square feet, saw a stream of water as large as a small pen-handle running from this roof as late as 9 o'clock in the morning. Here is a beneficent nature coming to the rescue of that beautiful coast, yet purblind residents rarely accept the blessing falling upon them nightly. " 'Irrigation? No, indeed,' said a ranchero, as we sat in the shadow of his cottage on the border of Mexico. ' We don't need irrigation for farming, as the rainfall suffices to raise crops in our region. If it did not, dew would supply the deficiency. Here we are twelve miles from the sea, yet the nightly moisture almost equals rain. We don't irrigate, but, as we have no well, we send sixty miles for drinking-water.' '' ' Why don't you utilize your wonderful fog ?' I asked. ' Why don't you put gutters and spouts on your roofs and improvise a cistern ?' '' ' By Jove ! I never thought of that. That's an idea.' "Acting on this suggestion all the water needed for domestic pur- poses was readily obtained. " Many a morning I've risen at Ensenada, Lower California, fully persuaded from the dripping on the roof that rain had come, and I've found a fog almost thick enough to cut with a knife. Yet not one drop of soft water could be had at the hotel for love or money. Santa Barbara abounds in fogs so heavy as frequently to lay the dust in summer, despite which the fastidious traveller must pay ten cents a quart for distilled water if he objects to coating his mucous membrane with lime. "South America has learned the wealth of its dews. In his memoirs General Sherman refers to a very interesting conversation in which Henry A. Wise, then our Minister to Brazil, ' enlarged 21 322 MEDICAL CLIMATOLOGY. on the fact that Rio was supplied from the " dews of heaven," for it rarely rains there, and the water comes from the mists and fogs which hang around the Corcovado, drips from the leaves of the trees, and is conducted to the madre fountain by miles of tiled gutters.' " What can be done in Rio Janeiro can be done from one end of California's coast to the other; the peninsula itself can be redeemed from desolation. Yet though nature failed to furnish this welcome moisture, there are simple methods of distilling water that come within the ken of all. " ' For heaven's sake don't refer to our fogs,' exclaimed a boomer. " 'Why not? They are a boon to the coast. Moreover, was there ever seaboard without fog ?' " 'True; but if people knew we had fogs they'd be frightened away.' " ' What kind of people ?' " ' Invalids.' " So I'm not to make known a valuable fact because it may keep a few sick people away from the coast. That's the reason it should be advertised far and wide. California gains nothing by concealing the truth. It is big enough and wonderful enough and varied enough in climate to be honest about every locality." Julian (elevation, 4300 feet). East of San Diego is a chain of mountains rising higher in successive ranges until, about forty miles from the coast, they culminate in pine-clad summits with an alti- tude of from 4000 to 6000 feet. The rainfall ou the western slope of these mountains is said to amount to about 20 inches per annum at 3000 feet altitude and 30 to 34 inches on the top of the range. It is probably somewhat more, as General A. W. Greely, in his Report on the Climatology of the Arid Regions of the United States, 1891, credits Julian with about the same annual precipitation as Pittsburg, and by means of an inter- esting comparison shows the difference in the methods of distribution. The following is by seasons : winter. Spring. Summer. Autumn, Year. Length of record. Julian, 18.34in. 16.56in. O.OOin. 2.78in. 37.68in. 6 years. Pittsburg, 8.58 " 8.53 " 12.00 " 7.60 " 36.71 19 " The California rainy season is made still more prominent when the year is divided into two periods, the rainfall at Julian being for PACIFIC SLOPE REGION. 323 November to April 36.40 inches; for May to October, 1.28 inch. General Greely remarks: " At Julian only 9 per cent, falls from the 1st of May to the last of November, while nearly one-half (48 per cent.) of the entire precipitation of the year falls during the months of February and March." The greatest seasonal rainfall was in 1883 and 1884, when it amounted to 61.62 inches. The smallest record is 25.89 inches. " The soil on the hillsides is more or less gravelly, resulting from the decomposition of granitic rock. Tn the valleys it is finer and often of a brownish or reddish color, and strong and fertile. In the lowest part of the valleys it is a dark alluvium." Below 4000 feet the timber is largely live-oak; above that eleva- tion there are pine, fir, cedar, and deciduous oak groves. Fruits and cereals can be successfully grown on the western slope of the mountains, where springs and small streams are abundant. There are fruit-ranches near Julian, which is also the centre of mining- interests. The eastern slope pitches more steeply down to the desert, which lies nearly at the level of the sea. On this slope little rain falls, and the increased dryness and temperature produce a very different climate. There is no meteorological record for the eastern side of these mountains at 4000 or 5000 feet elevation, but the influence of the ocean must have almost vanished, while the influence of the desert is marked. The description of the climate of Hesperia and Daggett, on the Mojave Desert (pages 333 and 334), may be of value in this con- nection. If water could be impounded and brought from the summits, or around from the western slope, this arid land would undoubtedly produce luxuriantly and trees and verdure would reward the culti- vator. The winter climate is probably fine. The degree of heat of blasts from the desert in summer at that altitude is not yet a matter of record. The hill country back of San Diego has been proved by indi- vidual experience to possess most valuable climatic characteristics, and it is to be hoped that the necessary detailed information will soon be obtainable.' 1 See Climate of California. 324 MEDICAL CLIMATOLOGY. Los Angeles (elevation, 330 feet ; populatiou, 80,000). The full name bestowed by its pious founders was La Puebla de Nuestra Senora la Beina de Los Angeles — The Town of Our Lady the Queen of the Angels — eight-tenths of which we leave off nowadays, and usually mispronounce the remainder. The town is on a rolling plain, fourteen miles from the sea and about the same distance from the mountains. It is a beautiful and interesting place, full of archi- tectural and social contiasts. Several elements go to make up the city, the Southern or Spanish, and the American ; and brown faces, betraying Castilian and Indian ancestry, mingle on the busy streets with those of the fairer-skinned Yankee type. Low adobe- quarters and American country houses are found near each other, within a few minutes' walk, although the old-fashioned "adobe" is growing more rare. Modern office-buildings appear within sound of the bells of the early Missions. The near presence of the mountains insures a good supply of water both for domestic and irrigating uses. Much of the sewage has been used for the purpose of fertilizing the plains below the city. Large sewers have also been constructed to the sea. Los Angeles is well supplied with hotels and churches. The hotels are, however, not worthy of this attractive city. Cable and electric cars reach all points. South of latitude 35°, that portion of the State called Southern Cahfornia, is more free from cold summer-fogs and strong winds than the country near San Francisco. Los Angeles is far enough from the sea to have a temperature perceptibly higher in summer and lower in winter than directly on the coast. While its average annual rainfall is but 18 inches, it is subject to great extremes. For instance, during the summers of 1882 and 1883 there were 12.67 inches of rain. During the seasons of 1883 and 1884 there were 32.16 inches. In 1892 and 1893 about 30 inches fell. The mean annual relative humidity is 72 per cent. There are frequent fogs both night and morning during the spring and summer. They usually clear up during the forenoon.^ The average number of foggy nights and mornings for the year at Los Angeles is 57 days.^ The percentage of cloudiness and sunshine and the number of clear days for Los Angeles and San Diego by seasons and by the year are as follows : 1 See Climate of California. 2 From records of thirteen years at Los Angeles offlee of U. S. Weather Bureau. PACIFIC SLOPE REGION. 325 Winter. S iring. Summer. Autumn. Year. Cloudiness and CO d i J^. 1 ^, 6 1 .1 d Length of sunshine. fl.2|fl.2 03 rn cS n 1! Mean Dshin verage ear da Meau oudm Mean nsbin verage ear da Mean oudln Mean nshin si gSgg record. giSi ^-S fi:? <6 o i^ <'o Q S^ ,"t;^'" 4- '.;,.;f t \ xpC'^ r,- ' :%,it;^"^ J -', "J X H < 1 Q. GO o a- < '^^i rrom BUTLER s oEobKAPH IIS 1\ reiiDiwion of I H iiTLEr I CO Coijri lit ]aS8 AFRICA— ASIA— AUSTHALASIA. 427 Asia. Practically the only portions of Asia which can be regarded as health-resorts for Europeans are the mounfainous districts of India. The Himalayas. Through the northern part of this country run the numerous ranges of the immensely high Himalayan system, which in many -ways characterizes and modifies the climate. The southern slopes of the Himalayas are dotted, from Darjiling to Simlah, with hill-stations ranging in elevation from 4000 to 8000 feet. While this country is much cooler than the plains, it is sub- ject during the summer to very heavy rains, owing chiefly to the influence of the so-called southwest monsoons, which are very damp winds and bring a great amount of moisture. It is stated that fifty miles north of Dalhousie, a British station in the North Punjab, the influence of the monsoon dies away, so that, while no climatic records are obtainable, there is little doubt that the humidity of this section is greatly lessened. Good, dry health-resorts could undoubtedly be established on the north slopes of the Himalayas ; for this, being the lee side of the range, receives only a small amount of the moisture brought by the mon- soon, which, reaching first the south slopes of the mountains, deposits upon them, as has been said, the chief pait of its burden. The country on the northern side is, however, too remote from European settlements to be at present available. Kassauli and Murree, and Dagshai and Nynee Tal are stations lying between Simlah and Umballa. Kassauli and Dagshai are used as military sanatoria. These resorts stand at elevations ranging between 6000 and 8000 feet. Darjiling, in Bengal (latitude, 27° north; elevation, 8200 feet), is one of the best-known resorts in India. The town has a popu- lation of about 4000. It is 308 miles north of Calcutta, and is much resorted to in summer by residents of the hot plains. There are grand views of the mountains on the north and west. The mean annual temperature is 54° F. ; winter, 41°; summer, 73°. The rainy season is from June to September, and the total rainfall is stated to be 132 inches. The mean annual atmospheric pressure is 24.058 inches. During the tremendous summer-rains the atmos- phere is very moist. Simlah, the hill-metropolis, is a cool mountain-resort which, dur- ing the summer, is the seat of the British Government. It is also 428 MEDICAL CLIMATOLOGY. used as an invaliding station, is said to be dry, and is one of a series of stations of similar quality. It is very gay during the season. The climate is characterized by an absence of wind and a usually cloudless sky. Nilgiri Hills. Portions of the Madras Presidency, lying in the Nilgiri Hills, inside the Western Ghats, possess very good resorts, having an elevation of from 5000 to 7000 feet. The monsoon, striljing the Western Ghats which form the coast-range, sheds naost of its moisture before reaching these hills, so that the annual rainfall is only 55 inches — less than half that of most Himalayan stations. It is stated that the climate is also more equable. The mean winter- temperature is 60° F.; that of summer, 65°. Occasional fogs are reported. Utakamand, the summer capital of the Presidency, with an elevation of 7000 feet, is situated in these hills. Australasia. Australasia has been used by the English for health-purposes especially on account of the long sea-voyage required to reach it. A description of such a voyage and of the meteorological conditions has been well given by Dr. Williams in his Lumleian Lectures for 1893, when he presented an instructive record and chart showing the meteorology of a sailing-voyage from England to Australia, around the Cape of Good Hope, by a gentleman connected with the British INIeteorological Office. Starting in October, " the tempera- ture ranges from 53° to 58° F. for the first five days. Off the Azores it rises to 60°, and passing Madeira to 69°. In crossing the line the maximum, 82°, is attained, but breezes are present and temper the heat; afterward it gradually falls; in 30° south latitude 70° F. is the average, and this sinks to 58° on reaching the Cape. After rounding the Cape the temperature, owing to the mixture of the warm Agulhas current with the antarctic current, is uncertain, varying from 47° to 56°, the currents overlapping each other and causing great varieties of atmospheric temperature. The vessel reaches 43° south latitude and steers eastward, and, on account of the influence of the antarctic circle, the temperature ranges from 47° to 55°, and rises to 67° on approaching the continent of Australia." The actual range of temperature on the voyage is from 47° to 82°, the number of rainy days being about 20. The relative humidity varies from 74 per cent, to 91 per cent., the average per- AFBIOA—ASIA—AUSTBALASIA. 429 centage being 82. The average length of such a voyage is usually from eighty to ninety days. If the voyage is commenced in May or June, the heat is greater near the equator, and Australia is reached in midwinter. The return-voyage to England via Cape Horn is not so favorable. "Near Cape Horn the temperature falls to 41°, and for several days is often little over 43° — a rather wretched state of things. In 40° south latitude a rise of 50° F. occurs, and off Rio de Janeiro 78°. England is reached in the early part of June." The great objection to the route via Suez is the intense heat of the Red Sea, which is overpowering for many invalids. Speaking of the voyage to New South "Wales, Dr. G. L. Mullins, of Sydney, writes: " The following, as a rule, bear the long voyage and are benefited by a sojourn in New South Wales : those who are predisposed to phthisis; the scrofulous; those in the early stage of phthisis, with consolidation of the lung around the tubercle ; those in whom the disease is quiescent ; the subjects of frequent small hemorrhages; those with slight lung-mischief, with irritable cough but no fever; the anaemic, or those with defective appetite ; those fairly free from dyspncea and cough and able to take exercise. "The following may be considered unsuitable and should not be allowed to travel so long a distance: weak, nervous, or excitable subjects ; those who suffer severely from mal-de-mer; the subjects of severe hemorrhages ; those in the acute or fever stage; the sub- jects of other organic diseases in addition to slight phtiiisis ; those in whom the phthisis is advanced and the mischief still extending. "As to the suitability of any particular district in the colony, a local practitioner should be the judge in each individual case." The Intercolonial Medical Congress, which met at Dunedin, New Zealand, in February, 1896, adopted resolutions to the effect that professional attention in England should be directed to the impor- tance of the nature of cases of tuberculosis sent to Australia, and that such as are sent should be directed to avail themselves of the climates of the interior. Australia. The climate of the Australian seacoast is very variable at all times of the year, and the air is peculiarly irritating.' 1 Winters Abroad. R. H. Otter, M.A,, London, 1882. 430 MEDICAL CLIMATOLOGY. The highland regions of Australia present a choice of elevations from 2000 to 7000 feet, but there are as yet few accommodations for invalids. Eegarding the value of the climate of Australia for consumptives, an Australian correspondent of the Lancet^ recently referred to the need of sanatoria in suitable locations. He stated that the deaths from phthisis in each of the colonies of Victoria and New South Wales exceeded k thousand a year, and thought that there was " quite sufficient tuberculous disease among the native-born popu- lation to keep such institutions well filled". "As a general rule, it will be found that a suitable climate will possess the two characteristics of being inland and having a rela- tively high altitude ; and this is the case all over the colonies. " In regard to accessibility, the different places vary most mate- rially. The greater number in Victoria and New South Wales are accessible by rail, but often it is a very long journey, as to Hay. To reach some places involves a rough coach-journey. These, of course, are all points which demand attention. Places deserving a trial are as follows: in Victoria, Ballarat, Geelong, Echuca, Mount Macedon. In New South Wales : Blue Mountains, Bathurst, Orange, Hay, Dubbo, Blayney. In Queensland the Darling Downs. I by no mpans wish it to be thought that this list is exhaustive.'" Melbourne, 37° 5' south latitude, lies at the mouth of the Yar- row River, and is the capital of the province of Victoria. It has a mean annual tempei'ature of 58° F. , with extreme ranges during the year from 111° to 27°. The average annual rainfall is 26 inches. The seasonal mean temperatures are for winter, 49.2°; for spring, 57°; for summer, 65. -3°; for autumn, 58.6°. The mean daily range is 22.3° for summer, 18.5° for autumn, 15° in winter, and 20° in spring. The rainfall on the coast of New South Wales varies from 20 to 50 inches, with from 100 to 150 rainy days. Mr. Otter, in a charming account of his sojourn in Australia, says that out of several invalids in various stages of disease whom he met travelling for their health the one who had made real progress had spent most of his time at an elevated station in New South Wales. He speaks very highly of the station-life for invalids. Sydney has a mean annual temperature of 62° F.; winter, 55°; summer, 74°; the annual rainfall is 48 inches. The amount of 1 Lancet, 1894, ii. p. 57. - G, A. Van Someren, M.B.C.M., in British Medical Journal, October 10, 1896. AFRICA—ASIA— AUSTRALASIA. 431 rainfall decreases steadily on going inland, while the temperature increases, rising to 100° in the shade, and in some places to 140°. The hot north winds during the summer are very trying, and the dust is so annoying that nearly all the residents wear dust-coats to preserve their clothing. To the north of Sydney are the resorts of Port Maquaire and Ne-w Castle, and to the south "WoUongong, Cape St. George, and Eden. There are other stations lying at some distance from the sea, but on the ocean-side of the mountain-range. Orange, a place of 5000 inhabitants, lying about one hundred and ninety miles west of Sydney, tias an elevation of 2400 feet above the level of the sea. The mean annual rainfall for twenty years is 38.95 inches, distributed over 101 rainy days; but, although the rainfall is large, the atmospheric humidity is not proportionally high, and the winter atmosphere, although stimulating and tonic, allows of much outdoor life. The variation in temperature is less during the winter months than at other times of the year, but the summers are spoken of as " never oppressive". These statements are on the authority of Dr. Van Someren, of Orange. Tasmania. This island, known to an older generation as Van Diemen's Land, and more especially defined in their minds as a station for trans- ported convicts, lies south of Victoria, a province of Australia. It is reached from Melbourne in twenty-four hours by the steamships of the Australian Steam Navigation Company, whose Tasmanian port is Launceston. There is no lack of water in Tasmania, and the vegetation is con- sequently luxuriant. Fruits fine as to size and quality are produced, and the hop-growing industry has become very important. A very good beer is produced from these hops, lighter than the English beer and much esteemed in the colonies. Mines of gold, iron, and tin have been developed and found to be profitable. Fishing, rab- bit-shooting, and kangaroo-hunting are among the attractions which this island offers to sportsmen, the kangaroos being hunted by means of dogs especially bred to the work. Quail, duck, and snipe abound. The climate is not extreme, the mean annual temperature being 54° F. and that of the summer 63°, while in the winter season it is 46°. Inland for a short period during the winter the climate is quite rigorous. In summer the same hot wind which blows in Australia sometimes visits Tasmania also, but, on the whole, the 432 MEDICAL CLIMATOLOGY. island is a valuable and cool summer-retreat, especially for Austra- lians. The annual rainfall is 24 inches. Martin says that at Hobart Town the number of rainy days for dry years is 100 and for wet years 120. It is said that snow does not lie on the plains and valleys of the lowlands, and on the highest peaks only during two or three of the winter months. The eastern part of the island is reputed dry and the western rather wet. Hobart To-wn, the chief town of Tasmania, is a city of about 20,000 inhabitants, and is charmingly situated at the mouth of the Derwent River, near Mounts Welliugton and Nelson. It has sev- eral comfortable hotels and a small club, and the social atmosphere is pleasant. There are walks, rides, and drives through the beauti- ful surrounding country, and many dehghtful and interesting excur- sions may be taken, among them one to Port Arthur, where live such of the convicts as have not yet served out their sentences. The drainage of Hobart Town, however, is spoken of as defective. New Zealand, New Zealand consists of two large islands and one smaller one, with the adjacent Auckland and Chatham groups. It lies south- east of Australia, between latitude 34° and 47° south. Both of the principal islands are mountainous. North Island having its highest peaks in its southern half, while in South Island Mouut Cook, the highest point of the range which borders the entire west coast, reaches an elevatioa of 12,300 feet; these have lately been explored by Fitzgerald. There aie few rivers, although each island has one about 200 miles long ; but running streams are numerous, so that the islands are well watered. There are many lakes, and in North Island is the well-known and beautiful lake- district where are found, besides geysers and sulphur springs, placid pools, like baths, containing warm, clear water, azure in hue. All of these waters have a reputation for the relief of rheumatism, scor- butic affections, tuberculous and nervous disorders, and skin-diseases. In the Southern Alps, which, as before stated, run along the west coast of South Island, are a number of lakes, two among them — Lakes"\Vakatipu and Te Anau — being especially notable for size and beauty. The scenery of these islands is grand and beautiful in an unusual degree. The yearly rainfall is large, occurring chiefly during the winter season iu North Island, but being more evenly distributed through AFBICA— ASIA— AUSTRALASIA. 433 all seasons ia South Island. Observations at Wellington in 1882 showed the amount of rain for that district to be 55J inches, falling on 166 days, and the smallest record, that for Dunedin from 1864 to 1881, was 34.6 inches. Droughts very rarely occur, and it is humid throughout the year. Dr. Hector, in his Handbook of New Zealand, says: " The climate resembles that of Great Britain, but is more equable, the extremes of daily temperature only varying throughout the year by an average of 20° F. ; while London is 7° colder than the North and 4° colder than the South Island of New Zealand. The mean annual temperature of the North Island is 67° and of the South Island 52°, that of Loudon and New York being 51°. The mean annual temperature of the ditferent seasons for the whole colony is in spring, 55°; in summer, 63°; in autumn, 57°; and in winter, 48°. The climate on the west coast of both islands is more equable than on the east, the difference between the average summer- and winter-temperature being nearly 4° greater on the southeast portion of the North Island and 7° on that of the South Island than on the northwest, on which the equatorial winds impinge. This constant wind is the most important feature in the meteorology of New Zeal- and, and is rendered more striking by comparing the annual fluc- tuation of temperature on the opposite seaboards of South Island, which have a greater range of temperature by 18° at Christchurch on the east than at Hokitika on the west." The prevailing wind for all districts and for the entire year is westerly. The soil is lighter than that of England and more easily worked, and it is also, for the most part, very fertile. New Zealand has about 750 endemic species of flowering plants. The principal towns are "Wellington, the seat of the Government, Auckland, and Christchurch. 28 CHAPTEK XIX. ISLAND CLIMATES. The Bermudas. This group of islands lies 600 miles east of the North Atlantic coast of the United States, in latitude 32° 14' to 32° 25' north. It is less than three days from New York by steamer. Hamilton aud St. Georges are the principal towns. They are provided with good hotels. There are supposed to be 365 islands in all, many of them but coral-reefs. The largest island, called Great Bermuda, is sixteen miles long by one and a half miles wide. The porous limestone rock that lies underneath the surface-soil readily absorbs water. Rainwater is used for all domestic purposes. The climate is moist and equable. The nights are usually but 3° or 4° cooler than the day. The mean temperature for the year is 69° F., with extremes from 42° to 90°. The January mean is 61°; for July it is 79°. The coolest mouth is March, 61°; and the warmest August, 80°. The record for two winters, 1888-'89 and 1889-'90, shows a mean monthly maximum of 70° and a mean minimum of 51°. For the two months of March and April for two years, 1889 and 1890, the mean maximum was 72° and the mean minimum 55°. The annual precipitation is 50 inches. October has the most rain, and the months from April to June the least. The annual mean relative humidity for Bermuda is 80 per cent. The islands are resorted to almost solely in winter. The summer, which holds on late, is said to be extremely debilitating, with warm fogs. The prevailing wind at that season is a damp southwest wind. The roads on the island are good and hard. Bermuda is an important naval and military station of Great Britain. It is the headquarters of the North Atlantic squadron, and at Ireland Island is the largest floating dock in the world. The Bahamas. The Bahama Islands (latitude, 25° 5' north) are under the Eng- lish flag and have a governor appointed by the Crown. ISLAND CLIMATES. 435 The islands are of coral-formation, covered with drift. Mr. Stark, in his guide-book,^ says that they are evidently formed on a plateau of submarine mountains of great height. Soundings on the north- east or ocean-side of Eleuthera Island show on the charts a depth of water of 12,000 feet near the shore and 16,000 feet fifteen or twenty miles out. The island of New Providence is 960 miles south (and somewhat west) of New York — a little over three days by steamer —and about 200 miles east of the end of the Blorida peninsula. From Key West the distance is nearly 300 miles. The island is about sixteen miles long, with an average width of five miles. Nassau. The capital city faces a harbor on the northern shore, where the benefit of the constant northeast trade-wind can be felt. Its population is placed at 12,000, the negroes greatly predomi- nating in numbers. The roads around the town are very good, being hard and smooth. There are two good hotels. From the harbor of Nassau the land rises steadily to a height of 100 feet, affording natural facilities for drainage, but there is no town-system of sewerage. The soil absorbs water rapidly, and this porous quality adds to the danger from cesspools and vaults, The usual arrangements for water for domestic use are frequently open to criticism. Kainwater is the best source of supply, and great care is necessary to keep the cisterns thoroughly clean. The residences are usually built of limestone, with thick walls. Each house stands alone, surrounded by more or less land, with its own flower-garden and fruit-trees. The general health of Nassau is very good. There are large marshes near the centre of the island, which, although they feel the cleansing influences of the daily tides, would undoubtedly affect injuriously the healthfulness of the town if winds from the south and west were not, fortunately, of extremely rare occurrence. The prevailing northerly and easterly winds, which are quite steady during the winter and spring, are of great value to the residents on the northern shore of the island. Mr. Drysdale, in his entertaining collection of letters,^ which were first published in a New York paper, says : " From November to June there is no healthier place (than Nassau). ... I do not see how it could be otherwise. The island is a solid rock, per- i History and Guide-book to tlie Bahama Islands, etc. James H. Stark, Boston, 1891. 2 In Sunny Lands. William Drysdale, New York, 1885. 436 MEDICAL CLIMATOLOGY. petually swept by sea-breezes, and being on it is like being on the deck of a great steamer in mid-ocean witiiout any sea-sickness. I have mentioned before the fact that tropical islands with rich soil are generally unhealthy, while the rocky islands built up by the industrious coral insect are always the reverse. No stretch of the imagination could make the soil of Nassau appear rich, and there is nothing for sickness to build itself upon." Mr. Drysdale quotes from the Nassau Almanac a record of the mean monthly temperature for the year 1878, taken at 3 p.m. (the hottest portion of the day), which by seasons was as follows: winter, 73°; spi-ing, 79°; summer, 84°; autumn, 80°. January had an average of 73°; March, 76°; July, 86°. The mercury rose above 90° for three days during the year. The maximum solar tempera- ture was in January, 140°; March, 149°; July, 159°. A record of the mean monthly temperature of Nassau for ten years, compiled from observations taken on week-days at 9 a.m. at the Nassau Military Observatory,^ arranged by seasons, is as fol- lows: winter, 71°; spring, 75°; summer, 81°; autumn, 77°. The monthly mean for January was 70°; for March, 72°; for July, 82°; annual mean, 76°. Mr. Stark reports the average temperature for the winter months as 70° F. ; for spring, 77° ; and says the coldest day registered for twenty-one years was 64° (which seems a few degrees too high), and the warmest day from November to May was 82°. Mr. Drysdale, in one of bis letters to the New York Times, referred once to a temper- ature of 55°, and the writer has a recollection of having seen the thermometer at 58° under the stone porch of the hotel during a cold rainstorm one February. It would therefore be wise for a delicate invalid to take the precaution of securing quarters where a fire could be had if needed, for, although frost is unknown, the damp chill of a long, hard storm is most penetrating. As is usual with warm and humid marine climates, the annual range of temperature at Nassau is limited. The mean annual baro- metric pressure is 30 inches. The average relative humidity for the year is 79 per cent.; for winter, 83 per cent.; for spring, 76 per cent, (means for five years^). Taking the above temperature-record for ten years as a basis, this would show for the year an average of ' This temperature-reoQrd appeared originally in Governor Rawson's report for 1864. It is quoted in Ives's Isles of Summer and Buck's Handbook of the Medical Sciences. 2 Furnished by United States Weather Bureau. ISLAND CLIMATES. 437 7.63 grains ; for winter of 6.84 grains, and for spring of 7.12 grains of absolute humidity or vapor present in each cubic foot of air. The average rainfall for ten years was for winter, 7.2 inches ; spring, 13.8 inches. Annual mean, 56 inches. The rainfall at Nassau during the six months from November to May is usually about one-third of the total amount for the year. The only danger from hurricanes is from August to November, and the heaviest and most damaging hurricanes are separated by intervals of several years. The most attractive occupation for a visitor is boating in row- boats and sailing in small craft to the beautiful Sea Garden and to the white beaches and cocoanut-groves of neighboring semitropical islands. Sea-bathing is a luxury that can be enjoyed at any time of the year, the temperature of the sea-water being usually in the vicinity of 70° F. Nassau has warmer winters than Bermuda, the Azores, Madeira, or Teneriffe.'^ The air at Nassau appears to be less moist aud muggy than that of Bermuda. The E-oyal Victoria Hotel is built of limestone, four stories in height, with wide verandas. It is the finest hotel in the West Indies, and has the advantage of being less than four days from the markets of New York. Beginning in January, 1896, a steamer will run regularly three times a week during the winter season from Palm Beach, Florida, to Nassau, making the trip in fifteen hours. Bleuthera. Forty or fifty miles east northeast of Nassau, Eleu- thera Island stretches its irregular, narrow length of seventy miles on the Atlantic, affording in a measure a breakwater for the protection of Nassau from the ocean-surges. It is a safe and delightful cruise in the lee of islets and cays to the tropical quiet of the settlements on Eleuthera for those who can live for a time without the comforts of modern civilization. The best way of seeing the islands leisurely is to charter a small schooner with suitable accommodations, with skipper and boy, ample pro- visions, and a cook. The principal harbor is on the northeast of Eleuthera, inside of Harbor Island. It is well sheltered, and can be entered by vessels drawing less than nine feet of water. Harbor Island is about two miles long by one mile wide. 1 See Table XIV. 438 MEDICAL CLIMATOLOGY. Dunmore Town, the largest settlemeut in the Bahamas next to Nassau, is on the lee side of the island, facing the bay. Mr. Stark gives its population as 2000. "A very pleasing little place it is, encircled by beautiful cocoanut-groves, and sauntering and dreaming by its beantiful green waters in an air of solitude and peace is very enticing to one who is weary of the rush and giddy whirl of modern life, while the cool trade-winds always moderate the heat." Besides Harbor Island there are in the district of Elenthera eleven other settlements, the population of which varies from a dozen persons or thereabout to 500 or more. Governor's Harbor, half-way down the island, is one of the largest and most attractive settlements, with its churches and public buildings on a ''cay" (as such a small island or reef is usually called), which is connected with the " mainland " by a causeway leading to the foot of the hill. "The houses on this hillside are white and very neat appearing, each one standing alone in its own garden, and the whole place having the appearance of a beautiful tropical watering-place." On the ocean-side of Elenthera, a few miles south of Harbor Island, is a limestone arch, eighty-five feet above the sea, known as the "Glass Window." In 1872 an extraordinary tidal- wave, unaccompanied by wind, washed under this arch and over the island. In this vicinity is also the curious rock-formation called the " Cow and Bull" and a limestone cave extending underground several hundred feet. Cocoanuts, pineapples, oranges, lemons, bananas, sugar-cane, figs, almonds, corn, potatoes, yams, tomatoes, and melons are all more or less cultivated on the island and shipped to Nassau and New York. Jamaica. The island of Jamaica is about ninety miles south of Cuba. Its total length is one hundred and forty miles, with a width varying from twenty-nine to forty-nine miles. It is the largest and most important of the British West Indian possessions. A ridge called the Blue Mountains runs through the eastern end of the island from southeast to northwest, rising at the highest point to a height of 7500 feet. The temperature in the lowlands of the coast will average 75° F. ISLAND CLIMATES. 439 at night and 85° in the day. New Castle (3800 feet) is credited with 68° for the hottest month and 61° for the coldest. On the highestlevels it is from 40° to 50°. The healthiest portion of the island is said to be above an eleva- tion of 1400 feet, and the north side of the island is preferred. The highest regions of the mountains have many clouds. In this cool, moist region is found vegetation belonging to colder climates. Buck's Reference Handbook of the Medical Sciences states that at an elevation of 4000 feet the temperature ranges from 44° F. in the winter to 65° in the summer. The difference in temperature be- tween the north aud south sides of the island is about 5° for the year and from 8° to 10° daring the first three months. The mean annual rainfall of the island for five years, according to the Handbook, was 50 inches on 116 days. One of the healthiest portions is the parish of St. Ann, which is in the centre of the porthern side of the island. The mean annual temperature is 76° F. The inland village of Moneague (950 feet) has a small hotel. The roads in this vicinity are good. Mandeville (2500 feet) is a pleasant town in the coffee and grazing country. It has a good hotel. The Santa Cruz district has also a healthy climate. The rainiest portion of Jamaica is naturally at the northeast end, facing the trade-wind. Hurricanes may occur between July and October. The population of the island in 1891 was 640,000, of which about 15,000 were white. Kingston, the capital of the island of Jamaica, is situated in lati- tude 17° 58' north. Population, 50,000. The city is regularly laid out on a gently sloping plain on the south coast near the east end of the island, at the foot of the Blue Mountains, the loftiest ridge being to the northeast of the plain. The harbor of Kingston is one of the best in the West Indies. The town is commonplace, with unpaved streets, frame buildings, and few trees. It is always hot. The soil on which Kingston is built is gravel, sloping to the harbor and offering natural opportunities for drainage that are sadly neg- lected. The water-supply is drawn from two rivers several miles above the city, and is considered good. The town is lighted by elec- tricity and has a tramway. The new Hotel Rio Cobre is fifteen 440 MEDICAL CLIMATOLOGY. miles north of Kingston. The island of Jamaica has an equable, hot, and moist climate. The mean' annual temperature of Kingston (ten years' records) is 78° F. Mean relative humidity, 78 per cent. Mean absolute humidity, 8.02 grains of vapor to the cubic foot. Wind-movement for the year a little over 3 miles per hour from the southeast. Dur- ing the winter it is about 4 miles and during the summer 2f miles per hour. The mean of annual precipitation is 32J inches, the greatest rainfall being in May and June and August, September, and Octo- ber. The least rain falls from November to April. The mean of the rainfall for the island of Jamaica for the year 1893 was S6^ inches. The following seasonal meteorological table for Kingston is adapted from a valuable table compiled by Maxwell Hall, M.A., F.R.A.S., r.E..M.S„, published in the Handbooh on Jamaica, pre- pared by the Honorary Commissioner for Jamaica to the World's Fair at Chicago in 1893, Lieutenant-Colonel the Honorable Charles J. Ward, C.M.G. Table IV.— Kingston, Jamaica. For the ten years from June, 1880, to May, 1890. Temperature. Cloudi- Wind ; Total rainfall. Montlily mean. Mean Max. Min. Relative Absolute humidity humidity ness; per cent, of whole sky. miles per day. Kings- ton. The Island. Winter 74° 86° 67° Per cent. 78 Grains. 7.07 31 65 Inches. 2.78 Inches. 12.09 Spring 76 86 70 Y6 7.34 41 73 9.H 15.46 Summer . 80 89 73 77 8.42 53 99 11.75 18.98 Autumn . 78 89 72 79 8.12 64 59 8.90 19.77 Annual 78 88 71 78 8.02 44 74 32.54 66.30 Temperature, maxima and minima, based on monthly means, not on the extreme readings. The above figures represent the monthly means, except for the rainfall, which is total. Barbados. Barbados is the most eastern of the Car i bee Islands under the English flag. It is situated in 13° 4' north latitude and 59° 37' west longitude. Authorities do not agree as to its size, but it is nearly eighteen miles long by twelve miles wide. It is seven days from New York by direct passage on the Brazil line, and about two ISLAND CLIMATES. 441 weeks by steamers stopping on the way at other islands. Landing is made on the leeward or southwest side of the island, on the shores of an open roadstead called Carlisle Bay, where the town of Bridge- town is located. The Marine Hotel — an excellent structure built by the Government — is at Hastings, two and one-half miles east from Bridgetown, connected by tramway. The soil is coral and limestone rock. It is quite bare of trees. The greatest elevation is 1200 feet on the eastern side of the island. The healthiest residence- portion of the island is in what is called Scotland. Residence in Bridgetown is to be avoided. Barbados has a moist but salubrious climate, without rains or heavy dews during what is called the "dry " or rainless season, from December to May. It will average several degrees warmer during the winter than Nassau. Its blandness and equability of tempera- ture are suited to a certain class of invalids, as there are no sudden or dangerous changes. The northeast trade-wind blows steadily during the day; occasionally it is unpleasantly strong. The air is pure and healthy. Temperature ranges from 76° F. at night to 83° for the day during the winter months. The mean for January is 76° and for August 80° The rainy season is from June to Novem- ber, when the island is also liable to be visited with hurricanes. August and October are usually the rainiest months. The annual rainfall is about 57 inches, of which about 2 inches fall in March, the driest month, and 11 inches in October, the dampest. The mean annual relative humidity is 72 per cent. The mean for winter is the same, 72 per cent.' The sea-water temperature is about 78° F., and dehghtful for bathing. The population of the island is estimated at 182,000, of which 15,000 are white, the rest African. Barbados is one of the most thickly populated places in the world, there being an average of 1100 persons to each square mile. There is a railway which renders most of the island accessible. The principal industry is the cultivation of sugar-cane. The Azores. The nine islands called the Azores are two thousand miles from Boston and over eight hundred miles from the coast of Portugal, to 1 Humidity deduced &om observations by tbe Royal Engineers. Means for eight years. Obtained through the courtesy of U. S. Weather Bureau. 442 MEDICAL CLIMATOLOGY. which country they belong. They are of volcanic origin, and have suffered from iofrequent earthquakes of great violence. They are rugged and picturesque, with precipitous coast-lines, rising toward the interior to an average height of 3500 feet. On the island of Pico is a peak 7600 feet above sea-level, and extending below to a depth of 1600 feet. There are no natural harbors; large vessels anchor in the open roadstead off the principal ports. A breakwater is being constructed off Ponta Delgada that is supposed to be capable of protecting one hundred vessels of all sizes. The islands are reached by steamer from I^ew York, and by a regular sailing packet — the barque "Sarah" — from Boston. Tiiere are mail steamers to Lisbon twice a month and fruit steamers to Loudon, as well as ships putting in constantly for sup- plies or repairs. Sao Miguel or St. Michael's, the largest island of the group, is over forty miles long and from five to twelve miles wide. A pamphlet by Dr. Emerson Warner, of Worcester (Mass.), descriptive of the islands,' says the population of the principal town, Ponta Delgada (latitude, 37° 45' north), is 25,000. The city is situated on the southwest side of the island, and extends along the shore for two miles. The streets are straight and broad. The houses are built of basaltic lava. Stoves are seldom seen, fires being used by the natives for cooking-purposes only. Hotel-accommodations are limited, and are mostly under Portu- guese management. There is a small hotel in Ponta Delgada kept by an English family. At Fayal is a Portuguese hotel of some pretensions. The expenses of living are moderate. The roads are good. In the larger cities are fairly comfortable carriages, usually drawn by mules, but in the country the donkey is the chief beast of burden. The highest point on St. Michael's is on the west and has an elevation of 3060 feet. The plains are fertile. Hot springs abound in St. Michael's. A palatable table-water is bottled on the island and offered for sale. In the lovely valley or crater of the Furnas, twentv-seven miles from Ponta Delgada, are many hot mineral waters. A large bath-house and small hospital adjoining have been bnilt for the use of patients. Springs of fresh water are plentiful on the islands. 1 The Azores as a Resort. Emerson Warner, M.D. ISLAND CLIMATES. 443 On the island of Fayal the principal town is Villa de Horta (latitude, 38° 30' north) ; population about 8000. This port trades largely with America, while Poata Delgada is in more direct com- munication with England. The Azores have an equable climate. The mean annual tempera- ture is 62° F. The extremes are stated to be 86° and 45°. The range between winter and summer is from 10° to 15°. The night- temperature is ordinarily not more than 4° cooler than the day. The summer is enervating at 70°; one is drenched with perspiration on the slightest exertion.^ The mean temperature for winter is 58°, for spring 61°, for sum- mer 68°. The three coldest months are usually January, February, and March. In winter it sometimes feels chilly and damp, and one seldom leaves home without an umbrella. The climate is very humid. Wall-paper will not adhere, and the veneering of furniture strips off. The mean annual relative humidity is 76 per cent., and for winter it is 77 per cent. The mean annual rainfall is 38J inches.^ The winds blow with great force at times and there are frequent storms. The prevailing direction of the wind in winter is from the south, southwest, and northwest, and in summer from the northeast, east, and north. (See Table XIV.) The Madeiras. Madeira Island, the largest of the group of that name, is about thirty miles long by thirteen miles wide. It is traversed by a moun- tain-chain running its entire length from east to west. Near the middle is the highest peak, 6100 feet. The northern and southern sides of the mountains are broken by deep ravines watered by limpid streams. On the slopes are gardens and vineyards. The soil is fertile. The islands are of volcanic origin, but earthquakes are rare. Deep-sea soundings show them to be the peaks of lofty submarine mountains. The inhabitants are of Portuguese descent, with some admixture of Moorish and negro. The population of the island is 132,000. The wine of Madeira has always been famous. 1 A Summer in the Azores. C. Alice Baker, Boston, 1882. 2 Records of humidity and rainfall furnished by kindness of U. S. Weather Bureau. Records for Azores for four years, for Madeira for Ave years. 444 3IEDICAL CLIMATOLOGY. Punchal (latitude, 32° 38' north; population, 20,000), the capital of Madeira, is picturesquely situated on the south coast of the island, on an open bay or roadstead, from which the mountains rise behind the town to a height of 4000 feet. Funchal is 360 miles from the coast of Africa, 535 miles from Lisbon — with which it is con- nected by the Brazilian cable — and 1215 miles from Plymouth. It has communication by steamer with Liverpool (four days), London, and Plymouth, Antwerp, Lisbon (two days), Brazil, Cape of Good Hope (five days), the Cape Verde Islands, Azores, and Canaries (one and a half days). The streets of Funchal are narrow, but fairly clean. They are paved with cobblestones, are without sidewalks, and are lighted at night by oil-lamps. The shops are poor. Food-supplies are said to be good except the mutton, which is execrable. Wheeled vehicles are hardly ever used by the natives — not even wheelbarrows. The town has two public walks bordered with trees and flowers. There is plenty of excellent water. There are good English hotels, and quintas^ can be rented fur- nished. There is a good English club and library. There are no amusements except riding and being carried in hammocks through the beautiful scenery. Both English and French are generally understood. There is good fishing, but no shooting. Madeira has long been noted for its soft, damp air and equable temperature. It was formerly held in high repute as a resort for consumptives. The mean annual temperature is 65° F. , for winter 60°. The coldest mouths are January, February, and March, and the hottest August and September. The extreme range of tem- perature is from 90° to 46°, which is the lowest record. The tem- perature of the sea-water in winter ranges from 61° to 72°. The mean annual rainfall is 27 inches, with extremes for different years, as high as 49 inches and as low as 16 inches. The greatest amount of rain falls from November to March. There is little rain during the summer, but the vegetation is freshened by dews. In winter snow occasionally falls on the mountain-peaks. The mean annual relative humidity is 66 per cent.; for winter it is also 66 per cent. There are no cold winds, but occasionally a hot and dry east wind — the teste — is felt from the distant desert. 1 Quintas, the name for pleasant villas in their own gardens, the rent teing three hundred dollars a year and upward. ISLAND CLIMATES. 445 The opposite, or west wind, usually brings rain. The prevailing winds are from the uorth, northeast, or northwest. (See Table XIV., for seasonal details.) The Canaries. The Canary Islands, which are under the Spanish flag, lie sixty miles east of the coast of Africa, in the main current of the Gulf- stream and in the line of the trade-winds. There are seven inhab- ited islands and a few uninhabited islets. Island of Teneriflfe. It is said that nearly one thousand steamers call at Teneriffe during the year, rendering it particularly accessible from European ports. The time from England by steamer is from four and one-half to six days. Communication can also be had with Portugal and Spain. There is a good hotel on the island. The island of Teneriffe is described by Dr. G. V. Perez,^ of Oro- tava, as sixty-seven miles long, sixty miles being its greatest width and sixteen miles its smallest. The peak is very near latitude 28° north, and rises 12,000 feet above the sea. It is usually partly obscured by a cap or "parasol" of clouds, about 1000 feet thick, which begins at an elevation of 3500 feet. This cloud forms during the forenoon and remains until blown away by the south wind that arises in the afternoon. Orotava is the capital of Teneriffe. It has one good hotel in the port and a larger one higher up in the valley. The valley or amphi- theatre of Orotava rises from the harbor of Port Orotava on the sea to an elevation of 2000 feet. The hills shelter it on all sides except to the north, which gives the benefit of the pure ocean-breeze. The "trades" begin to blow between 9 and 10 a.m., dying away be- tween 1 and 2 p.m. At sunset the south land-breeze begins and continues throughout the night. The cloud "parasol" that covers the higher portion of the island tempers the strength of the sun's rays and furnishes shade for the upper part of the valley. Toward the seashore there is more sun at midday than there is higher up. During the summer the trade-winds blow more strongly than in winter, and the "parasol" then appears more regularly. Above the cloud-layer the climate presents great extremes, ranging in July from 83° to 28° F. The air is much drier, the difference between the dry and wet bulbs even amounting to 30°. The wind 1 Orotava as a Health-resort. George V. Perez, M.D. 446 MEDICAL CLIMATOLOGY. which blows from the northeast on the shore of the island, at an altitude of over 10,000 feet blows from the west and southwest. Orotava has an average temperature for January of 60° F.; for July, of 73°. Mean annual temperature 67°, with an average annual range of 14°. The temperature is said rarely to rise above 82°. By seasons it is as follows : winter, 60°; spring, 65°; summer, 72°; autumn, 70°. From May to August there is no rainfall. The annual precipi- tation is 13 inches. Average number of rainy days, 51 ; the rain most frequently falls in the night. The average percentage of relative humidity is at 9 a.m., 65; 2 p.m., 60; 9 p.m., 72. Mean annual relative humidity, 66 per cent. The record for temperature and humidity is for two years. The temperature of the sea-water is lowest in March, 64° ; highest in July, 68°. The climate of Orotava is equable, moderately damp, and rather relaxing, while the island has this great advantage, that higher elevations and drier air are obtainable, if desired. The extraordi- nary luxuriance and profusion of vegetable growth are evidence not only of the equability of the climate, but also of its humidity- Oranges, figs, pineapples, bananas, dates, etc., are found on the island, but not cocoanuts or breadfruit. The air is said to be rich in ozone. The water-supply is from tunnels bored into the sides of the mountains, and is reputed to be very good. The soil is porous and dries rapidly after rain. The editor of the British Medical Journal, Dr. Ernest Hart,' says that Orotava is not troubled by heavy dews, frosts, siroccos, mias- mas, extreme heats, or even mosquitoes. Dr. Perez recommends the regions of the Canadas, at an elevation of 7000 feet, as a site for a sanitarium. The Hawaiian (or Sandwich) Islands. These islands are twenty-one hundred miles southwest from San Francisco, and are usually reached by steamer in six and a half or seven days. By sailing-vessel the time may be eighteen days. The group is made up of eight inhabited islands. Honolulu (latitude, 21° 18' north; population, 25,000) is situated on the southern shore of the island of Oahi, on a deep and spacious bay. The city is sheltered by mountains from some of the trade- 1 A Winter Trip to the Fortunate Islands. Ernest Hart, in British Medical Journal, 1887. ISLAND CLIMATES. 447 winds and from much of the rainfall of the windward coast. Hono- lulu is laid out on a level plain about 25 feet above the sea, and claims a good system of municipal government; broad, clean streets lined with beautiful homes ; many churches, a theatre, street rail- ways, electric lights, telephones, and a town water-system, besides artesian wells. While the soil is of a volcanic nature and fertile when well watered, it is porous and dries quickly after rains. The town possesses a large hotel with adjoining cottages and other hotels and boarding-houses. At "Waikiki, a seaside-resort a few miles east of Honolulu, there is fine surf-bathing. There is a hotel at Waikiki, and the shore is lined with villas and cottages. The island of Oahi is thirty-five miles long by twenty-one miles wide. A peak in the western range of mountains reaches a height of over 4000 feet. On the eastern shore there is a lower range of mountains running northwest and southeast, which offers its sides directly at right-angles to the northeast trade-wind. On the slopes of all these mountains are beautiful valleys, with deep ravines, cas- cades, and luxuriant tropical vegetation. The mean annual tem- perature at Honolulu is 74° F. The lowest record in the Government Survey series for ten years was 54° and the highest 89°. The average midday maximum is about 80°. The greatest daily range of temperature was 23°. The normal record by seasons for Punahou, a station near Hono- lulu, is as follows:^ Temperature. Winter . . 70° Spring . 73 Summer . 77 Autumn . 76 Year . . .74 The average absolute humidity is for the year 6.53 grains, and for winter 5.91 grains of vapor to each cubic foot of air. The wind-movement at Honolulu is from 3 to 4 on the Beaufort scale — which indicates a breeze from 18 to 23 miles per hour. The mean barometric pressure for fourteen years was 30. 038 inches. The annual mean of cloudiness for four years expressed in tenths is 4.22. 1 TTom reports of Prof. C. T. Lyons, in charge of Weather Bureau, Honolulu. Relative humidity. Rainfall. 74 per ct. 12.4 inches. 74 " 9.9 " 69 " 5.7 " 71 " 9.8 " 72 " 37.8 " 448 MEDICAL CLIMATOLOGY. A very good illustration of the varying quantity of rain regis- tered in different rain-gauges not far from each other, but exposed under different conditions, is shown in the report of Prof. C. T. Lyons for 1890. In the showing of comparative rainfall the table for the year 1889 presents the records from four reporters residing on different streets iu Honolulu, showing totals for the year ranging from 18 to 25 inches, a difference of 7 inches in the same town. In the same report is given a record of rainfall in Honolulu kept by Dr. R. McKibbin for thirteen years, showing an annual mean of 30.1 inches, and a record kept by Mr. W. W. Hall for sixteen years (including the same thirteen years), showing an annual mean of 39.5 inches. Points of small annual precipitation are Mahukona, Kawaihae, and South Kona, all on the west coast of the island of Hawaii. Ha-waii, the largest island of the group — one hundred miles long by ninety miles wide — is nearly two hundred miles southeast from Honolulu. It has the great volcanic peaks Manna Kea (13,953 feet) and Mauna Loa (13,760 feet). On the southern side of the latter, at au elevation of 4000 feet, is the famous active crater of Kilauca, fourteen miles from the sea and thirty miles south of the port of Hilo. There is a hotel at the volcano. The annual rainfall at Hilo is said to average 144 inches a year. The tropical verdure is unusually rich on this side of the island. West of the great peaks the town of Kona, on the west coast, and Waimea, which is further inland, are reported to have climates with comparatively low temperatures and less moisture than the wind- ward coast. Between the two peaks is a desert-plain lying at an elevation of 5000 or 6000 feet. It is entirely destitute of water and has not even a trail. The Hawaiian Islands are in about the same parallels of latitude as the south coast of Cuba. The climate is equable, warm, and moist. Compared with Teneriffe the island of Hawaii is larger, and its two peaks rise nearly 2000 feet higher from the level of the sea into the region of cold and snowstorms ; it is further south, and on the coast has a warmer average of temperature. The great elevation affords the possibility of an unusual range of climate, but there is no elevated interior valley on the protected western slope which is known to possess the natural advantages of the valley of ISLAND CLIMATES. 449 Orotava, aud, although such a spot may exist, it is not as yet within easy reach of necessary supplies. A Voyage upon Southern Seas. The value of the climate of the Pacific Ocean has been brought into prominence of recent years by the example of that distinguished writer, the late Robert Louis Stevenson, in seeking an asylum within its influence. In his romance. The WrecJcer-, occurs a reference to this sea-life, in which a personal note can perhaps be detected. It is when the adventurers are fairly started in the schooner ''Norah Creina," in search of the wreck of the " Flying Scud." The pas- sage is as follows: " I love to recall the glad monotony of a Pacific voyage, when the trades are not stinted and the ship day after day goes free the deliberate world of the schooner, with its unfamiliar scenes, the spearing of dolphin from the bowsprit end, the holy war on sharks, the cook making bread on the main hatch : reefing down before a violent squall, with the men hanging out on the foot- ropes, the squall itself, the catch at the heart, the opened sluices of the sky, and the relief, the renewed loveliness of life, when all is over, the sun forth again, and our out-fought enemy only a blot upon the leeward sea. . . . Day after day in the sun-gilded cabin the whiskey dealer's thermometer stood at 84°. Day after day the air had the same indescribable liveliness and sweetness, soft and nimble, and cool as the cheek of health. Day after day the sun flamed; night after night the moon beaconed or the stars paraded their lustrous regiment. I was aware of a spiritual change, or per- haps rather a molecular reconstitution. My bones were sweeter to me. I had come home to my own climate, and looked back with pity on those damp and wintry zones miscalled the temperate. " ' Two years of this, and comfortable quarters to live in, kind of shake the grit out of a man,' the captain remarked ; ' can't make out to be happy anywhere else. A townie of mine was lost down this way, in a coal-ship that took fire at sea. He struck the beach some- where in the Navigators, and he wrote to me that when he left the place it would be feet first. He's well-off, too, and his father owns some coasting-craft down East; but Billy prefers the beach and hot rolls off the breadfruit trees.' 29 450 MEDICAL CLIMATOLOGY. "A. voice told me I was on the same track as Billy . . . perhaps it is the impression of a few pet days which I have uncon- scionsly spread longer, or perhaps the feeling grew upon me later in the run to Honolulu. One thing I am sure ; it was before I had ever seen an island worthy of the name that I must date my loyalty to the South Seas. The blank sea itself grew desirable under such skies ; and wherever the trade-wind blows, I know no better coun- try than a schooner's deck."^ » The Wrecker. R. L. Stevenson and Lloyd Osborne, New York, 1893. CHAPTEE XX. METEOEOLOGICAL TABLES. Table V. — Axxual Averages in the U. S. A. Temperature Month. mean o ■II si 1 d K January. July. p ■ aS 9£ go, Number of years of record. Ft. Adirondacks, 1500 16° 64° Asheville, 2250 38 73 Aiken, ,S.=iO 48 ThomasvUle, 330 62 82 Jupiter (Fla.), 00 65 SO Key West, 00 71 84 Chattanooga, 700 42 79 Denyer, 5300 27 73 Colorado Springs 6000 26 69 Pueblo, 4700 2U 76 Santa Fe, 7000 28 70 Salt Lake City, I430U 28 76 El Paso. ■3700 44 83 San Antonio, 650 51 84 Prescott, 5300 R4 74 Tucson, 2400 50 88 Yuma, 140 !i3 92 Los Angeles, 300 53 72 Santa Barbara, 00 52 6h San Diego, 00 53 68 St. Paul, 800 10 72 Boston, 00 i 27 72 New York, 00 31 74 Chicago, 600 24 72 St. Louis, 600 31 80 San Francisco, 00 50 59 Dayos-Piatz, 5200' 20 65 40° .54 44" 61 68 56 73 67 77 69 61 51 50 31 47 29 .52 31 49 30 ,52 36 64 40 69 .58 53 35 69 44 72 49 62 52 60 51 61 52 44 36 49 40 ,52 43 1 49 41 56 46 67 49 38 81 1 p.c. grs. m. ... 39.0129= 24 45. 106 .. 48.0 ... 86 51.5 97 2168.0' 73 48 40.0, 71 04 57. 102 04 14.41 57 84 14.4' 57 14 12.0, 53 79 14.6, 48 36 18.91 88 16, 9.0; 89 ■ 26 30.61 92 3116.0 51 25 12. 57 91 3.0 21 4218.0 45 20 18. 73 34 10. 69 2. 44 27. 6 107 2.84 46.0,107 3.19 46.o!ll0 2.88 36.0!ll7 3. 52 88. 110 3. 90 24. 88 77 12.03 33.6 63 miles. inch. 1 3 15 13 4 13 8 '* 4225 6 6 6564 30.06 5 7 5 4 6952 30.04 m 18 21 in 4116 29.28 13 10 13 10 4980 24.73 20 6 22 11 6663 24.03 16 6 16 4 5438 25.27 15 5 11 4 4681 28.26 17 10 .33 8 3681 26.64 18 10 24 10 8941 26.21 12 10 28 10 5301 29.38 13 10 21 7 4898 24.74 13 5 20 10 3785 27.45 14 6 14 4 4570 29,76 14 11 16 10 3758 29.64 14 10 21 7 2872 8 8 24 7 4105 29.92 17 10 42 10 5156 29.10 19 10 22 10 7997 29.88 20 10 22 10 6883 29.85 20 10 22 10 7007 29.14 19 10 22 10 7011 29.45 19 5 21 5 6868 29.87 18 17 42 5 24.86 21 21 21 5 20 14 20 2 4 20 20 14 15 13 2 17 15 20 20 20 20 20 20 15 1 The elevations are given in round numbers for convenience in memorizing. They are believed to be within fifty feet of the actual measurement. 2 Adirondacks cloudy days from record for Saranae Lake Weather Station for one year (1894). 452 MEDICAL CLIMATOLOGY. Table VI.— Seasonal Averages, U. S. A. Winter (December, January, February). Wind. Seasonal Relative Absolute Total Mean tempera- humidity. humidity. rainfall. monthly ture. movement. per cent. grains. inches. miles. Adirondacks 18° 8.8 Asheville 88 63 1.67 9.3 Aiken . 46 63 2.83 10.7 2489 ThomasTille 50 63 2.57 10.6 Jupiter (Fla.) 64 82 5.38 9.1 ICeyWest . 71 82 6.66 6.5 8029 Chattanooga 44 72 2.38 17.4 4802 Denver 30 54 1.06 1.8 6245 Colorado Springs . 29 50 0.94 0.7 Pueblo . 31 57 1.16 1.4 5027 Santa Fe 80 52 1.02 2.3 4909 Salt Lake City 31 56 1.14 5.5 3092 El Paso . 46 52 1.84 L3 3867 San Antonio . 54 69 3.24 6.7 5438 Prescott . 36 57 1.40 5.0 4602 Tucson 49 48 1.89 3.0 3667 Yuma . 56 47 2.36 1.6 4416 Los Angeles . 54 68 3.19 11.6 4031 Santa Barbara 52 69 3.02 1L5 2688 San Diego 54 62 2.91 6.8 3842 St. Paul . 15 77 0.80 3.2 4822 Davos-Platz . 23 82 1.21 6.1 Albuquerque 41 Silver City 37 49 1.25 1.0 Las Cruces 43 43 1.37 Eddy . 40 1.0 Phcenlx . 61 2.6 Eedlands 51 6.5 Charleston 52 81 3.' 54 11.0 Jacksonville . 55 77 3.52 10.0 Nassau (W. I.) 70 83 6.63 7.2 Table VII.— Seasonal Averages, U. S. A. Spring (March, April, May). Wind. Seasonal Relative Absolute Total Mean tempera- humidity. humidity. rainfall. monthly movement. per cent. grains. inches. miles. Adirondacks 37° 9.1 Asheville 63 61 2.76 11.2 Aiken . 59 52 2.89 13.4 Thomasville . 67 62 4.49 12,9 Key West 76 71 6.86 5.8 7160 Chattanooga . 60 65 3.74 15.2 4790 Denver . 48 49 1.88 5.8 5295 Colorado Springs . 49 46 1.81 4.5 Pueblo 51 45 1.90 3.6 6314 Santa F6 48 36 1.37 2.3 5378 Salt Lake City 50 47 1.92 6.1 4208 El Paso . 64 36 2.36 0.6 4853 San Antonio . 68 66 4.94 7.8 6677 Prescott . 61 44 L86 3.1 6079 Tucson 62 37 2.27 L2 3797 Yuma . 70 43 3.43 0.3 4830 Los Angeles . 60 73 4.2U 3.8 3961 Santa Barbara 68 72 3.87 3.9 3347 San Diego 59 72 4.01 2.3 4496 St. Paul . 43 63 2.0 7.0 5873 Davos-Platz 35 74 1.74 6.4 METEOROLOGICAL TABLES. 453 Table VIII.— Seasonal Averages, U. S. A. Summer (June, July, August). Seasonal tempera- Relative Absolute Total Wind. Mean humidity. humidity. rainfall. monthly movement. per cent. grains. inches. miles. Adirondacks 62° 10.8 Bethlehem (N. H.) 65 65 4.41 14.0 AshevlUe 70 71 5.67 13.7 Aiken 77 71 7.08 13.8 Thomasville . 80 66 7.22 16.2 Key West S3 72 8.64 13.4 5405 Chattanooga 77 74 7.38 12.7 3278 Denver 70 46 3.67 4.5 4806 Colorado Springs . 67 50 3.62 7.2 Pueblo . 73 44 3.87 5.0 5402 Santa F6 .... 64 43 2.82 6.6 4628 Salt Lake City 72 33 2.81 3.5 4139 El Paso . 83 45 5.40 4.1 3742 San Antonio . S2 66 7.68 8.8 4698 Prescott . 70 48 8.83 e.i 5167 Tucson . ... 82 40 4.65 5.4 S656 Yuma .... 89 43 6.18 0.5 4720 Los Angeles . 70 72 5.75 0.2 3616 Santa Barbara 64 74 4.86 0.1 8130 San Diego . . . . 67 76 5.52 0.3 4320 St. Paul. 69 71 5.49 11.3 4697 Davos-Platz 52 74 3.29 11.9 Table IX. — Seasonal Averages, U. S. A. Autumn (September, October, November). Seasonal tempera- ture. Relative Absolute Total Wind. Mean humidity. humidity. rainfall. monthly movement. per cent. grains. inches. miles. Adirondacks 43° 10.1 Asbeville 53 66 3.0 8.2 Aiken . . . 61 77 4.58 8.4 Thomasville . . . . 66 67 4.70 11.7 Key West 78 78 8.02 15.3 7213 Chattanooga . 61 73 4.34 11.6 3892 50 60 2.04 2.3 4617 Colorado Springs . 48 54 2.05 2.0 Pueblo .... 52 50 2.19 1.7 4346 Santa PS . . . 56 56 2.81 3.6 4101 Salt Lake City 52 49 2.14 4.3 3289 El Paso . 62 56 3.44 8.0 3292 San Antonio . 68 69 6.16 8.5 4930 53 49 2.21 2.7 4218 Tucson . 68 43 3.22 2.4 3646 Yuma . . - ■ 73 46 4.04 0.7 3646 Los Angeles . 64 68 4.46 2.3 3530 Santa Barbara 62 70 4.30 2.5 2422 San Diego 63 69 4.38 1.4 3760 St. Paul . 45 68 2.33 6.2 5232 Davos-Platz 34 79 1.81 9.2 454 MEDIO A L GLIMA TOLOGY. pq H D 02 OQ n 15 .3 ^ g § COr-IO OOoi O is^ Pi OJ O CQ CJ CO CC r-^ CS CO 'J*' CC l-^ rJH-qi-^lC^i— "C0U2OO10 •H J XI •ifj 8 < ■M'Yi WJ u Si — — ■WJ 8 •WV4 •K'a n •WTZ, ■K* J It •H'-Ig m-rpio-*-^iOcococoiOira ■K'J 8 "K ooooooooo 2^ looooo-^ooo OJ ^o)t-r~-ooi-icQoco &;< -^ CO iM -^ iCr-o •5 "IS OS —•X. tiD> jj )-. 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IS ■5 fs ^ CO CO CO CO S g ^ CO CO A &i ^ rn in d=«-i d^ •lajniAl ■* -^ Ttl s I> l> ing O-gio nB8K 1 CO g CO s g § co CO I> ^ i> g ^3 ^ S d 1 i |3h ft £ ■a g 1 1 03 d 6 a S3 PQ 1 '3 5 03 1 a 8 ii ^ w c ^ C} ■2 S c ^ 1 >> c r^ in a d F?H Si a §a ^ p" ■2 a ^1 o-S 458 MEDICAL CLIMATOLOGY. Table XV. — Comparative Table op Health-eesortsJ Average temperature Rainy days. in winter Year. . 154 Winter. 79 Madeira 13.5° R. 62.4° F. Torquay Cairo 13.0 61.25 Ventnor 152 80 Algiers 11.2 57.2 Hastings . . 152 Ajaccio . . 9.3 52.9 Pau . . 140 ■Palermo . 9.1 52.47 Pisa . 122 62 Mentone 9.0 52,25 Madeira 94 44 Nice 7.0 47.75 Venice 84 22 Cannes . 7.0 47.75 Algiers 83 72 Pan 6.4 46.4 Mentone . 80 Pisa . 6.3 46.18 Nice . 72 38 HySres 6.8 46.18 Hy6res 62 17 Ventnor 6.1 45.72 Montreux 60 21 Torquay . 5.6 44.6 San Eemo 56 15 Venice .5.0 44.37 Cannes 52 Meran 4.3 41.67 Meran . 52 13 Montreux 3.8 40.55 Cairo . 12 (■') 9(?) Absolute minima of Average differences of temperature. Cairo . temperature in vpinter. Davos — 24.0°R. — 0.22°F. 7°to8°E. 15.75° to 18° F. Torquay —11.0 +7.25 Nice . 4 " 5 9.0 ' 11.25 Ventnor —10 9.5 Venice 2 " 3 4.5 ' 6.75 Pau -10 9.5 Palermo 1 " 3 2.25 ' 6.75 Pisa -6.5 17.38 Arco —5.0 20.75 1 Taken from Dr. Julius Brauu's Climatic Health-resorts. INDEX OF AUTHORITIES QUOTED. * IKEN, Dr. J., 50 A Airlong, Prof., 82 AUbutt, Dr. CliflFord T., 33, 50, 54 Anderson, Dr. Winslow, 336, 340, 341, 342, 343, 346, 349 BACON, Dr. Francis, 208 Baker, C. Alice, 443 Baldwin, Dr. E. B. , 210 Barwick, Sergeant J. A., 337 Bates, Dr. C. B., 339 Beevor, Sir Hugh, 75 Bell, Dr. A. N.^ 222 Bennett, Dr. J. Henry, 391, 396, 398, 399, 400, 422 Bert, Dr. Paul, 40 Bezencent, Dr., 417 BiUingS, Dr. John S., 50, 82 Black, Hon. John A , 296 Black, Mr. William, 378 Blake, Dr. J. , 345 Blundon, Mr. B. A , 201 Blunt, Mr. Thomas P., 81, 83 Bosworth, Dr. Francke, H., 149 Bottini, Dr. E. . 132 Bouveret, Dr. L., 149 Bowditch, Dr. V. Y., 84, 88, 133, 137, 138, 140, 195, 209 Bowers, Dr Stephen, 93 Brann, Dr. Julius, 380, 406, 409, 412 Brehmer, Dr. G.,410 Brown-Sequard, Dr., 80 Bruen, Dr. E T., 137 Bryce, Dr. P. H., 187 Buchanan, Dr. G. S , 84, 88 Buchner, Dr. E. C, 82 nASSE,Dr. J., 150 \j Chandler, C. F., Ph.D., 234, 267 Charteris, Dr. M., 381, 388, 403 Chrystie, Dr. Walter, 150 Cline, Dr. I. N., 234 Conway, Sir Martin, 45 Copland, Dr. J., 48, 50, 80 Cormack, Dr. Charles, 397 Cunningham, Mr A. A., 263 Curtin, Dr. K. G., 137 Curtis, Mr. W. E , 369 DALE, Lieut, 92 Darwin, Mr. Charles, 49 Davidson, Dr , 18 Davis, Prof. W. M., 19, 27, 28, 33, 374 Denison, Dr. Charles, 133, 156, 188, 241, 244, 270, 283 D'Espine, Dr. C, 150 Dettweiler, Dr., 410 De Wit, Dr. P. C, 426 Donaldson, Dr. F., 137 Downes, Dr. A., 81, 83 Drysdale, Mr. William, 435, 438 Duclaux, Dr , 82 EAGER, Dr. J. H., 228 Egger, Dr. J. N., 414 Eskridge, Dr. J. T., 61 FABER, Dr. C, 132 Fayrer, Sir Joseph, 330 Field, Kate, 320 Fisk, Dr. Samuel, 131 Flint, Dr. Austin, 126 Fox, Dr. Wilson, 126 Frankland, Dr. E., 886 Frost, Mr. Max, 274 riARDINEE, Dr. C. F., 116 U Garrod, Sir A., 180 Geddings, Dr. W- H., 132, 206, 224 Geiseler, Prof., 82 Glassford, Capt. W. A., 287, 288, 291, 294, 296, 299 Gleitsmann, Dr. J. W., 221 Goldschmidt, Prof., 132 Gooch, Mrs. F. C, 336 Greely, Gen. W. H., 66, 67, 237, 291, 296, 322, 335, 338 HAIG, Dr. Alex., 179 Haines, Dr. W. S , 278 Hall, Maxwell, M.A., 440 Hall, W. H., C.E., 306 Hall, Mr. W. W., 408 Hamilton, Mr. P , 295 Hammond, Dr. W. A., 276 460 INDEX OF AUTHORITIES QUOTED. Hanks, Prof., 93 Hare, Dr. H A., 86 Harrington, Prof. M. W., 62, 63, 64, 221, 223, 273, 280, 292, 306 Hart, Dr. Ernest, 442 Hassall, Dr. A. H., 399 Hassaurek, Mr. P., 370 Hector, Dr., 433 Hell wig, Prof. C, 120 Henss, Mr. P., 179 Hilgard, Prof. E. W., 330 Hirsch, Dr. A., 18,80,86, 87 Hittell, Dr. J. S., 297, 300, 344 Holden, Mr. C. P., 352 Humboldt, Prof, 355 Hunter, Dr., 87 [NGALLS, Dr. E. P., 137 TACOBI, Dr. A., 150 O James, Dr. Bushrod W., 369 Johnson, Dr. H. A., 132, 133 Jourdanet, Prof D., 18 Judd, Dr. L. D., 219 KEATING, Dr. J. M., 225, 227 Kelley, Mr. W. D., 369 Knight, Dr. P. I., 137, 143, 160 Koch, Dr. K., 78, 82 Koeppe, Dr., 412 Krummel, Dr. Otto, 374 T AMONT, Prof, 38 ij Lane, Mr- G. W., 285 Langenbeck, Dr. Carl, 253 LaKoux, Dr. C. L., 230 Levy, Dr. Eobert, 146 Lindley, Dr. W., 92, 94, 303, 316, 317, 332, 333 Loetsoher, Dr. J., 417 Loew, Prof. O., 259, 265 Lombard, Dr. H. C, 18, 80 Longstreth, Dr. Morris, 195 Loomis, Dr. A. L., 211 Lownes, Mr., 141 Lummis, Mr. C. P., 276, 372 Lund, Dr., 132 Lyons, Prof. C. T., 447 MoKAY, Dr. A. P., 281 McKibbin, Dr. B. M., 448 MaoCarthy, Prof. P. J., 351 Maclaren, Mr. Charles, 185 Madden, Dr. T. M., 398 Martin, Sir Eanald, 432 MiUer, Dr. William, 234 Milroy, Dr. G , 84 Minok, Dr. G. N., 82 Mittemaier, Dr., 132 Muller, Prof., 120 MuUins, Dr. G. L., 425 Musser, Dr. J. H., 137 ABEE, Mr. P. A., 356 U Oertel, Dr. M. J., 113 Ord, Dr. William M., 58 Osborne, Mr. Lloyd, 450 Osier, Dr. W., 79 Oswald, Dr. Pelix L., 359 Otter, Mr. E. H., 420, 429 DAEKEE, Mr. John D., 319 I Peckham, Dr., 82 Peirce, Mr. E. M., 328 Peltier, Prof., 38 Pepper, Dr William, 84, 88 Perez, Dr. G. V.,445 Peterson, Dr. P., 421 Petin, Dr., 284 Pickering, Prof. G., 372 Piatt, Dr. I. H., 216 Piatt, Dr. Walter B., 418 Precht, Prof., 284 RALPH, Mr. Julian, 249 Eeed, Dr. Boardman, 137, 201 Eemondino, Dr. P. C, 311 Eenton, Dr. J. , 132 Eichards, Dr. Huntington, 202 Eoberts, Dr. W. P., 251, 262 Eohden, Dr. L., 18, 399 Rotch, Dr. A. Lawrence, 372 Eoux, Prof., 83 Euedi, Dr. Carl, 133, 242, 246, 415 QANDEESON, Dr. Burden, 42 O Sandwith, Dr. P. M., 133, 420 Saussure, Prof, 37 Sawyer, Dr. W. B., 19, 20, 327 Schiibler, Prof., 37 Scrivener, Mr. J. H., 373 Shattuck, Dr. P. H., 137 Smith, Dr. Andrew H., 40, 95 Smith, Dr. Archibald, 114, 159, 373 Smith, Dr. P. Fremont, 204 Sparks, Dr., 132 Spengler, Dr., 133 Squier, Dr. E. G., 372 Stark, Mr. J. H., 435, 438 Sternberg, Dr. G. M., 83 Stevenson, Mr. Eoljert Louis, 449 Stoddard, Dr. T. A., 264 Stokes, Dr. W. , 80 Symonds, Lieut., 92 INDEX OF AUTHORITIES QUOTED. 461 TABAEIE, Dr. L. K, 94 Taylor, Mr. Benjamin, 231 Thompson, Dr. St. Clair, 407 Thompson, Dr. Symes, 424 Thompson, Dr. W. Oilman , 40 Toner, Dr. J. M., 222 Treves, Dr. Frederick, 150 Trudeau, Dr. E. L., 78, 80, 82, 133, 138, 139, 140, 211 Turner, Mr. E. T., 213 'IT" AIL, Mr. Hugh D., 339 » Van Someren, Dr. G. A., 430, 431 Vincent, Mr. Frank, 369, 372 Virchow, Dr K., 149 Von Buck, Dr. Karl, 133, 139, 221 Von Vivenot, Prof., 18, 41 Von Ziemssen, Prof., 38 WAGNEE, Dr. Clinton, 146 Wall, Dr. J. P., 204, 226 Waller, Dr , 260 Walshe, Dr. W. H., 126 Ward, Hon. C. H., 440 Waring, Prof. W. E., 282 Warner, Mr. C. Dudley, 337 Warner, Dr. Emerson, 442 Waters, Mr. A. W., 252, 415, 418 Weber, Dr. Hermann, 18, 41, 55, 80, 89, 132, 138, 140, 160, 380, 401 Wendt, Dr. G. C, 34 Wesselovski, Prof., 375 Whymper, Mr. E., 44, 45, 46, 47, 371 Widney, Dr. J. P., 303, 307, 309, 310, 311, 350, 351 Williams, Dr. C. T. B., 18, 126 Williams, Dr. C. T., 18, 41, 126, 129, 132, 245, 372, 395, 396, 415, 423 Williams, Dr, Harold, 198 Wilson, Dr. J. C , 227, 229 Wise, Dr. Tucker, 418 Woiekof, Prof. A., 80, 369 Wolf, Dr., 412 Woodhead, Dr. G. Symes, 75 VANDELL, Dr. W. M., 276 1 Yeo, Dr. I. B , 18, 385, 387, 391 , 392, 393, 402, 405, 407, 413, 416 Youatt, Dr. W., 49 INDEX TO TABLES. Table I. Table II. Table III. Table IV. Table V. Table VI. Table VII. Table VIII, Table IX. Table X. Table XI. Table XII. Table XIII. Table XIV. Table XV. Atlantic Coast Climates in the United States, 194 Colorado Springs. Mean for Two Years (1S9.3 and 1894), 258 Davos-Platz, 415 Kingston, Jamaica, 440 Annual Averages in the U. S. A., 451 Seasonal Averages (Winter), 452 Seasonal Averages (Spring), 452 Seasonal Averages (Summer), 453 Seasonal Averages (Autumn), 453 Winter Weather, U. S. A., Supplementary Table, 454 Night-temperature, U. S. A., 455 Sunrise and Sunset for the First Day of January, 455 Mexican Cities, Annual Averages (from Eecords of the Mexican Government), 456 Comparative Table of Health-resorts, 457 Comparative Table of Health-resorts, 458 INDEX. A ACHEN, 409 A_ Aci Eeale, 402 Adirondack Lodge, 212 Adirondacks, 209 Africa, resorts of, 425 Aguas Calientes, 350, 362 Aiken, 223 Air, composition of, 24 compressed, uses of, 41, 42, 95 evaporative power of, 31 humidity of, and phthisis, 84 mountain, use of. [See Elevated Climates. ) purity of, 80 sea, use of, in kidney-diseases, 174 in liver-diseases, 175 in nervous disorders, 162 in neurasthenia, 167 in phthisis, 136 in scrofulosis, 150 Aix-les-Bains, 393 -la-Chapelle, 409 Ajaccio, 400 Albuquerque, 280 Alcohol, 163 Algeria, resorts of, 422 Algiers, 422 Alivral North, 425 Altamonte, 229 Ampersand, 211 Anaemia, effects of altitude upon, 111,113 use of compressed air in, 97 Andermatt, 417 Anderson Mineral Springs, 347 Aneurism, effects of altitude upon, 159, 160 Antelope Valley, 334 Apoplexy, 165 Arcachon, 390 Ardrossan, 378 Arequipa, 372 Argentine Republic, 373 Arizona, resorts of, 287-301 Arkansas, resorts of, 231 Aroostook Country, 205 Arosa, 414 Arrowhead Hot Springs, 330 Asbury Park, 200 Asheville, 221 Asia, 427 Asia, therapeutically useful districts of, 427 Asthma, bronchial, 154 effect of compressed air upon, 97 nasal (hay-fever), 156 nature and causes of, 153 use of depressed climates in, 93, 94 Athletic feats, 46, 47, 106, 112 Atlantic City, 200 coast resorts, 194^203 climatic characteristics of, 194 Atlas Peak, 344 Auckland, 433 Audierne, 390 Augusta, 224 Ausable Lakes, 212 Australia, resorts of, 430 Australasia, 428 Austria, coast resorts of, 404 inland resorts of, 404-406 Avelon, 351 Azores, the, 441 Azule Springs, 348 BAASSEN, 408 Baden, 405 -Baden, 412 Bagneresde-Luchon, 394 Bahama Islands, 434 Balloon ascents, 43 Bandarem, 377 Banff', 188 Banning, 332 Barbados, climate of, 441 Bareges, 394 Barnegat, 200 Barometric pressure. (See also Depressed Climates and Oxygen-ten- sion ) decreased, 42 balloon ascents, 43 blood-changes due to, 43, 99, 109 effects of, on heart, 43, 45, 46 mountain-climbing, 44 -sickness, 43 oxygen-tension, 42 increased, 40 464 INDEX. Barometric pressure, increased, effects of sudden change in, 40 experiments in, 40 physiologic effects of, 40 Bartfeld, 408 Bath, 386 Baths, compressed air, 41, 42, 95 sea-, 58, 150 Beach Haven, 200 Beaufort West, 425 Beaumont, 331 Bechuanaland, 426 Belgium, climate of, 888 resorts of, 388 Bermuda Islands, resorts of, 484 Bethlehem, 206 Beulah, 264 Biarritz, 390 Biskra, 423 Blankenberghe, 888 Block Island, 199 Bloemfontein, 426 Blood, changes in, due to altitude, 48, 99, 109 germicidal power of, 113, 114 Blue Mountain Lake, 212 Boerne, 234 Bogota, 369 Bordighera, 899 Boulder, 249 Boulogne-sur-Mer, 389 Bournemouth, 382 Bowel-diseases, 178 tuberculous, 179 Bray, 377 Bregenz, 406 Bridge of Allan, 879 Bridgetown, 441 Bridlington, 385 Brigantine Beach, 200 Brighton, 382 British Isles, the, 376, 877 Broadmoor, 261 Broadstairs, 384 Bronchitis, change of climate for, 153 chronic, effects of compressed air upon, 98 Burghersdorp, 425 Burtscheid, 409 Buxton, 385 Byron Spring, 847 pAIKO, 420 \J Caisson disease, 99 Calabasas, 301 Caledonia Springs, 190 Calgary, 189 California, resorts of, 316-853 Seltzer Springs, 347 Calistoga Springs, 847 Camden, 228 Canada, climate of, 187 resorts of, 188-191 Canary Islands, 445 Cannes, 398 Canon City, 264 Cape Ann, 197 Cod, 197 May, 202 St. George, 431 Town, 425 Carlsbad, 404 Carnelian Mineral Springs, 350 Cascade, 261 CasteDamare di Stabia, 403 Castle Creek Hot Springs, 301 Catania, 402 Catarrh, as a cause of phthisis, 117 nasal and pharyngeal, 157 Cauterets, 394 Chalk Creek Springs, 271 Channel Islands, climate of, 388 resorts of, 350 Chattanooga, 230 Chest expansion, effects of altitude upon, 112 Cheyenne Valley, 261 Chihuahua, 360 Chorea, 164 Christchurch, 433 Clear Lake, 345 Climate, classification of, 57 coast, 59, 130, 132 definition of, -21 depressed, 42, 60, 91, 93, 94 desert, 130, 133, 165, 175. (See also Depressed Climates.) dry and moist, 33 elevated, 60, 99, 130, 138 ethnologic effects of, 48 influence of, upon germ life, 53 inland, 59, 130, 132 island, 59, 180, 132 moderately dry, cold, 60, 91 warm, 60, 91 moist, cool, 60, 91 warm, 59, 60, 91 ocean, 57 physics of, 23 physiologic effects of, 89 summer and winter, 62 temperate, 51 Climatology, medical, 21 Clouds, 31 Cobb Valley, 346 Cold, general causes of, 36 local causes of, 37 physiologic effects of, 36, 37, 39 Colesberg, 425 Colorado, resorts of, 261, 271 Springs, 253 Concarneau, 890 Conduction, 86 Connecticut Shore, 1 99 Constipation, 179 Convection, 27 INDEX. 465 Cornwall, 379 Coronado Beach, 320 Springs, 320 Corral de Luz Hot Springs, 349 Corsica, 400 Cottage City, 197 Cradock, 426 Cresson Springs, 218 Crieff, 379 Crittenden, 301 Croupous pneumonia, 151 Currents, atmospheric. [See Winds.) ocean, 58, 185, 186, 194, 304, 319, 336, 350, 374, 380 Currituck Sound, 203 DAGGETT, 334 Dagshai, 427 Dalhousie, 191 Daxjiling, 427 Davos, 414 Death-rates from phthisis, 102 tables of, 103-105 in various germ-diseases, 54 Deer Park, 220 Delaware Water Gap, 218 Deming, 280 Denver, 249 Depressed climates, 42, 60 influence of, upon asthma, 93, 94 upon phthisis, 91, 93, 94 Desert climates. [See Climate. ) Dew-point. 34 Diabetes, 174 Diarrhoea, 178 Dieppe, 389 Dinard, 390 Donaghadee, 177 Doolan Vichy Springs, 346 Douarnenez, 390 Dover, 383 Droitwich, 386 Dublin, 207 Dundrum, 177 Dunmore Town, 438 Durango, 361 Dust, 26 Dyspepsia, 177 EAGLE'S MEBE, 219 Earth in relation to climate, 25 Eastbourne, 382 Bast Gloucester, 197 Eastport, 195 Echo Mountain, 326 Eden, 431 Edgart6wn, 198 Egypt, resorts of, 420 Elberon, 199 Electricity, 37 Eleuthera, 437 Elevated climates, active hypersemia of the brain in, 163 blood-changes in, 43, 99, 109 effects of, in aneurisms, 114 on healthy kidneys, 173 on kidney-diseases, 170 on liver-diseases, 175 in nervous disorders, 162 in scrofulosis, 150 influence of, upon prevalence of phthisis, 99 inherent nervous irritability in, • 164 insanity in, 164 insomnia in, 163 neurasthenia in, 167 physiologic effects of, upon phthisis, 108 sanitary effects of, 106, 115 therapeutic effects of, upon phthisis, 113 El Paso, 231 Elsinore Springs, 349 Emphysema, use of compressed air in, 98 Empyema, 153 England, climate of, 379 coast resorts of, 379, 885 inland resorts of, 385 Epilepsy, 164 Estes Park, 245 Ethnological considerations, 48 Etretat, 389 Eureka Springs, 231 Europe, extent of, 374, 375 Eustis, 229 Evaporation, its general effects, 31, 35, 115 TALKENSTEIN, 410 r Falmouth, 381 Fayal, 442 Felixstowe, 384 Filey, 385 Florida, resorts of, 228, 229 Fogs, influence of, upon phthisis, 195 Folkestone. 383 Folsom Hot Springs, 286 Food, effects of increased barometric pressure on consumption of, 40 relation of climate to, 50 Fort Apache, 299 Bayard, 282 Bliss, 232 Defiance, 299 Grant, 299 Huachuca. 300 Verde, 300 France, coast resorts of, 389-391 inland resorts of, 391-394 Franconia Village, 208 Fulton Artesian Wells, 349 Fulton Chain region, 212 Funchal, 444 30 466 INDEX. GALL-STONES, 177 Galveston, 235 Genoa, 399 Geographical distribution of disease, 53. (See also Germs.) modification of, by season and weather, 55 Georgia, resorts of, 224 Germany, resorts of, 409, 413 Germs, 26, 53 altitude as aflecting, 114, 115, 116 contagion from, 53 influence of climate upon, 53 ' innocence and virulence of, 54, 55 prevalence of, 53 sunlight and heat as affecting, 81 tubercle-bacillus. (See Tubercle- bacillus. ) Geysers, 347 Gijon, 395 Gil man ton, 207 Gizeh, 421 Glengarriff, 377 Glen Summit, 218 Glenwood Springs, 266 Gloucester, 197 Gorbersdorf, 410 Gout, 179, 180 Governor's Harbor, 438 Grand Junction, 268 Granville, 390 Gravenhurst, 190 Great Lakes, climate of, 191 Green Mountain Falls, 261 Grindelwald, 417 Guadalajara, 357 Guadalupe, 362 Guanajuato, 363 Gulf coast, resorts of, 229 HAMILTON, 434 Hampton Beach, 196 Harbin Hot Springs, 347 Harkanyi, 408 Harrogate, 386 Hartzell's Hot Sulphur Springs, 271 Hastings, 383 Hawaii, 448 Hawaiian Islands, 446 Hay fever, 156. (See Asthma ) Healing Spring, 220 Heart, diseases of the great vessels and, 158 effects of compressed air upon, 41, 96 physiologic effects of decreased baro- metric pressure upon, 43, 112 Heat, 36, 37 physiologic effects of, 39 Helensburgh, 378 Heligoland, 387 Helouan, 421 Hemorrhage, effects of altitude upon, 114 Herculesbad, 408 Heredity, 80, 145 Hesperia, 333 High altitude, effects of, upon sanitation, 115 general therapeutic effects of, 113 Himalayas, resorts of, 427 Hobart Town, 432 Holland, climate of, 387 coast resorts of, 387 Hollywood, 199 Honolulu, 446 Hooker's Hot Springs, 301 Hot Springs, 220, 231 Sulphur Springs, 271 Howell Mountain, 345 Howth, 177 Humidity, absolute, 33 physiologic effects of, 39 and altitude, 114 and sensible temperature, 32 relative, 33 temperature and, 34 of air, 84 of soil, 84 Hungary, resorts of, 407, 408 Hyeres, 397 Hysteria, 164 IDAHO SPEINGS, 270 1 Ilfracombe, 381 Ilkley, 385 Indio, 332 Individual, the, in climato therapy, 118 conduct of, 123 temperament of, 120 Insanity, 164 Insomnia, 163 Irapuato, 363 Ireland, climate of, 376 resorts of, 376 Isohia, 403 Ischl, 406 Island of Teneriffe, 445 Isles of Shoals, 196 Italy, coast resorts of, 402 inland resorts of, 403 JACKSONVILLE, 228 t> Jaffrey, 208 Jalapa, 366 Jamaica, climate of, 438 Jauja, 373 Jefferson, 207 Jemez Hot Springs, 286 Johannesburg, 426 Johannisberg, 410 Jordan Alum Springs, 220 Julian, 322 KAMLOOPS, 188 Kane, 218 Kassauli, 427 INDEX. 467 Katama, 198 Keene Valley, 212 Kennebunkport, 196 Kidney-diseases, 96, 168 climatic treatment of, 170 effects of compressed air upon, 96 hepatic complications in, 174 influence of climatic factors in, 169 lardaceous, 172 prevalence of, 168 Kilkee, 377 Kilrush, 377 Kimberly, 426 Kingston, 439 Kingstown, 377 Kissingen, 413 Kreuznach, 412 T A BOUEBOULE, 893 Jj Ladybrand, 426 Lake Champlain, 214 George, 214 Placid, 212 Taboe, 346 Worth, 229 Lakes, influence of, upon climate, 30 Lakewood, 217 Laryngitis, chronic, 158 tubercular, 146 Las Cruces, 283 Vegas, 278 Hot Springs, 278 Laubbach, 410 Le Croisic, 390 Leesburg, 229 Lemoenfontein, 425 Leon, 363 Leysin, 417 Lisbon, 395 Lisdunvarna, 877 Liver, diseases of, 175 climatic treatment of, 175 functional, 175 mineral waters in, 177 organic, 175 Llandudno, 380 Long Branch, 199 Los Angeles, 324 Bancs Chicos, 362 Pinellas, 229 Lucca, 403 Luhatschowitz, 405 Luxor, 421 MADEIEA ISLANDS, 443 Maine, resorts of, 204, 205 Malaga, 395 Maloja, 418 Malta, 401 Malvern, 386 Mandeville, 439 Mauitou, 259 Park, 261 Maplewood, 206 Margate, 384 Marienbad, 405 Martha's Vineyard, 197 Maryland, resorts of, 220 Massachusetts, resorts of, 208, 209 Matlock, 386 Mauch Chunk, 218 Mediterranean Islands, 400 Mehadia, 408 Melbourne, 430 Meningitis, 163 Mentone, 398 Meran, 406 Mesilla Valley, 282 Meteorology, 21 comparative tables of, 451 Mexico, City of, 355 resorts of, 355-366 Migraine, 164 Mirror Lake, 212 Mists, 31 Mobility of atmosphere, 89. (See also Winds. ) Moffatt, 379 Moneague, 439 Monmouth Beach, 199 Mont Dore-les-Bains, 392 Monterey, 344, 359 Montreux, 414 Moosehead Lake, 205 Morelia, 365 Morocco, resorts of, 423 Mount Desert, 195, 196 Dora, 229 Harvard, 326 Lowe, 326 Pocono, 219 Wachusett, 209 Mountain-climbing, 44 -sickness, 43 Mountains, influence of, upon climate, 25 Murree, 427 Miirren, 417 TVTAIKN, 378 i^ Nantucket, 198 Napa Soda Springs, 345, 347 Valley, 344 Naples, 403 Narragansett Pier, 199 Nassau, 435 Nauheim, 411 Nephritis, acute, 171, 172, 173 chronic, 172, 173 scarlatinal, 173 Nervi, 400 Nervous disorders, climatic change in, 162 effects of altitude on, 115 use of compressed air in, 115 Neuenahr, 410 Neuralgia, 164 468 INDEX. Neurasthenia, 165 Newcastle, 177 New Castle, 196, 439, 431 Hampshire, resorts of, 206-208 Jersey coast, 199 resorts of, 216, 217 Mexico, resorts of, 273 Providence, 435 York, resorts of, 209-215 Zealand, resorts of, 433 Newport, 198 Nice, 398 Nilgiri Hills, 428 Nogales, 301 Norderney, 387 Nordhoff, 334 Norfolk, 203 North America, general climatology, 185 Berwick, 378 Carolina, resorts of, 221, 222 Sea Islands, 387 Norway, 387 Nynee Tal, 427 AAKI, 447 \J Oban, 878 Occupation, as aflfecting phthisis, 88, 103 Ocean Grove, 200 Ojai Valley, 334 Ojo Caliente Springs, 286 Old Camp Crittenden, 301 Orchard Beach, 196 Point Comfort, 203 Sweet Springs, 220 Oporto, 395 Oracle, 297 Oran, 423 Orange, 431 Oregon, resorts of, 354 Orizaba, 366 Orlando, 228 Orotava, 445 Ostend, 388 Oxygen, 109. [See also Balloon Ascents and Mountain-sickness. ) -tension, effects of decreased barome- tric pressure upon, 42, 108 of increased barometric pressure upon, 40 Ozone, 26 PACHUCA, 364 Pagosa Springs, 271 Paimpol, 390 Palatka, 228 Palermo, 402 Palm Beach, 229 Springs, 332 Panticosa, 395 Paraiso Hot Springs, 348 Pasadena, 325 Paso Eobles, 340 Pass Christian, 230 PStzcuaro, 365 Pau, 394 Paul Smith's, 210 Pecos Valley, 279, 284 Pegli, 400 Pennsylvania, resorts of 218, 219 Perspiration, 39, 176 Peterboro, 208 Petersham, 209 Phoenix, 295 Phthisis, catarrhal, 117 causes of, 79 chart showing comparative results of climatic change in, 136 death-rates from, 102 definition and nature of, 73 early diagnosis in, 142 forms of, as influenced by climate, 117 indications and contraindications in climatic treatment of, 143 influence of sea-air upon, 136 personal equation in, 118 physiologic eflects of altitude upon, 108 pneumonic, 117 prevalence of, 80 rarity of, in elevated climates, 100 sanitarium-treatment in, 133, 138 stage of, and results, 141 statistics concerning climatic change in, 128 syphilitic, 137 therapeutic eflfects of altitude upon, 113 treatment of, by change of climate 126 tuberculin-treatment in, 139 tuberculous, 117 use of compressed air in, 96, 98 Physiological considerations, 39 Pine belt, the, 216 Mountain, 336 Pinehurst, 222 Plains, 25 Pleurisy, 153 Plymouth, 197 Pneumonia, catarrhal, 152 croupous, 151 eflfects of cool, dry air in, 118 Poland Springs, 205 Polar regions, the, 51, 90 Poncha Springs, 271 Pontresina, 418 Population, density of, 80, 88 Pornic, 390 Portland, 196, 354 Port Maquaire, 431 Stewart, 177 Portrush, 177 Portsmouth, 196 INDEX. 469 Portugal, resorts of, 395 Prescott, 293 Pretoria, 426 Princeton, 208 Puebla, 365 Pueblo, 262 Puget Sound district, 354 Pulse, effects of decreased barometric pressure upon, 43, 45, 46 of increased barometric pressure upon, 40 Pyrmont, 409 QUEENSTOWN, 377 Queretaro, 364 Quito, 370 RADIATION, 36. {See Sun. ) Rainfall, 30 of the Southwest, 237 Eamsgate, 384 Eangeley Lakes, 204 Eaquette Lake, 212 Eedlands, 327 Eeiboldsgriin, 412 Eespiration, absolute humidity and, 39 effects of decreased barometric pres- sure upon, 43, 113 of increased barometric pressure upon, 40 Eheumatism, 179-181 articular, 180, 181 muscular, 180, 181 nervous, 180, 181 Eialto, 329 Eichfleld Springs, 215 Eindge, 208 Eippoldsau, 412 Eiverside, 326 Eiviera, the, climate of, 396 French, resorts of, 397, 398 Italian, resorts of, 399, 400 Eome, 403 Eoscoff, 390 Eosstrevor, 177 Eothesay, 378 Eoyat-les-Bains, 392 Eoyan, 390 Eussia, climate of, 408 Eye Beach, 196 QT. AGATHE, 190 U Andrews, 378 Augustine, 203 Georges, 434 Jean de Luz, 391 Lawrence Eiver resorts, 189 Leon Springs, 190 Leonards, 383 Malo, 390 Michael's, 441 Moritz, 418 Saltillo, 360 Salt Lake City, 271 Samaden, 417 San Antonio, 232 Diego, 316 Luis Potosi, 362 Eemo, 399 Sebastian, 395 Sanitation, effects of altitude upon, 106, 115 Sanitariums, 133, 138 Santa Barbara, 336 Hot Springs, 339 Catalina, 351 Cruz, 353 Fe, 279 Eosa, 353 Sao Miguel, 442 Saranac Lake Village, 211 Saratoga Springs, 215 Scarborough, 385 Beach, 196 Scheviningen, 388 Schwalbach, 411 Scotland, 441 climate of, 377 resorts of, 378, 379 Scrofulosis, 149 sea-bathing in, 150 and mountain air in, 150 Sea Girt, 200 Seas, influence of, upon climate, 50 Seattle, 354 Seelisberg, 413 Seltzer Springs, 270 Sespe Valley, 336 Seven Oaks, 330 Seville, 395 Sharon, 209 Springs, 215 Siasconset, 198 Sicily, resorts of, 402 Sierra Madre, 325 Silao, 363 Siloam Springs, 269 Silver City, 281 Simlah, 427 Skin, color of, as affected by climate, 49, 50 Soil, composition of, 24 humidity of, 25, 84, 88 Sorrento, 402 South America, climate of, 367, 369 Carolina, resorts of, 223 Park Springs, 271 Southern Pines, 222 Spa, 388 Spain, climate of, 394 resorts of, 395 Spezia, 400 Squam, 200 Steamboat Springs, 267 Stomach, diseases of, 177 climatic changes for, 178 470 INDEX. Stomach diseases, mineral waters in, 178 Stonehaven, 378 Strathpeffer, 378 Strawberry Valley, 332 Summerville, 225 Summit Soda Springs, 350 Sunheat, 36 as affecting germ life, 81 general causes of, 36 local causes of, 37 Sunlight, 35 effects of, 35 hours of, in mountain regions, 455 Sunstroke, 114 rarity of, in desert-climates, 165 in high climates, 165 Surfside, 198 Sweden, climatic advantages of, 387 Switzerland, resorts of, 413 Sydney, 430 Szobrancz, 408 TACOMA, 354 Tampa, 229 Tangier, 423 Tarasp, 416 Tarkastad, 425 Tarma, 373 Taxtary, steppes of, 408 Tasmania, resorts of, 432 Taveres, 229 Temperament, in disease, 120 Temperature, as affecting the prevalence of phthisis, 84 mean annual, 37 night-, 455 sensible, 32, 62 variability, 87, 88 Tenby, 380 Tennessee, resorts of, 230 Teplitz, 404 Texas, resorts of, 231-235 Thomasville, 225 Toluca, 865 Tombstone, 300 Topo Chico Hot Springs, 360 Torquay, 382 Trequier, 390 Trieste, 404 Tropical regions, the, 50, 51, 169 functions of the skin in, 49 Trouville, 389 Tubercle-bacillus, the, 73, 75 pure air as affecting, 80 Tuberculin, 139 Tuberculosis, 75 Tuberculosis, definition and nature of, 75. (See also Phthisis.) Tucson, 296 TTNITED STATES, climate of, 193 U Utah, resorts of, 271 Ute Park, 261 YAN PATTEN CAMP, 284 V Vegetation, 25, 35 Ventnor, 382 Vermont, resorts of, 206 Vichy, 391 Virginia Beach, 203 resorts of, 220 Voslau, 406 Voyages, sea-, in neurasthenia, 167 in phthisis, 129, 132, 135 on the Great Lakes, 191 on Southern Seas, 449 to Australia, 428 WAGON WHEEL GAP, 271 Waikiki, 447 Warm Springs, 220, 222 Washington, resorts of, 354 Watch HiU, 199 Water, composition and forms of, 24 modification of climate by bodies of, 30 Weather, 21, 183 Wellington, 483 Wells Beach, 196 West End, 199 Virginia, resorts of, 220 Whitby, 385 White Sulphur Springs, 220 Wiesbaden, 411 Wiesen, 416 Wildbad-Gastein, 406 Wilson's Peak, 326 Winds, effects of, upon phthisis, 89 general remarks on, 27 influence of, in kidney diseases, 171 Winter Park, 228 Wollongong, 431 Woodhall Spa, 386 Woodland Park, 261 Wood's Holl, 197 yORK, 196 1 Yucaipe Valley, 330 Yuma, 298 7ACATECAS, 361 Catalogue of Booka PUBLISHED BY Lea Brothers & Company, 706, 708 & 710 Sansom St., Philadelphia. 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