INFLUENCE OF ALTITUDES 
*—ON—s 
CONSUMPTIVES. 
BY 
.T. IIILGARD TYNDALE, M. D., 
NEW YORK. 
[.Reprint from the St. Louis Courier of Medicine, March, 1879.] 
ST. LOUIS: 
C. R. Barns. Printer, 215 Pink Street, 
1879. INFLUENCE OF ALTITUDES 
■—ON—* 
CONSUMPTIVES. 
BY 
J. HILGARD TYNDALE, M. D., 
NEW YORK. 
[Beprint from the St. Louis Courier of Medicine, March, 1879.] 
ST. LOUIS: 
C. R. Barns, Printer, 125 Pine Street, 
1879. INFLUENCE OF ALTITUDES 
—ON— 
CONSUMPTIVES. 
Bt J. Hilgard Tyndale, New York. 
THE curative influence of high altitudes in checking 
the progress of pulmonary consumption is beginning 
to be universally recognized by the medical profession. 
In Germany, Dr. Brehmer, of Goerbersdorf, in Silesia, 
first started a sanitarium for the treatment of phthisical 
patients. On account of the active opposition of the Ber- 
lin professors, it was some four years before he succeeded 
in obtaining a concession from his government. But truth 
will prevail, even in medicine, in which deeply-rooted pre- 
judices oft seem to gather strength as time advances. 
Brehmer held that reduced atmospheric pressure, the 
constant sojourn of a phthisical patient in an atmosphere 
rarified and pure, was the proper food for the diseased lung, 
and, as such, was to be considered the long-sought-for 
agent for the cure of consumption. The idea that a reduc- 
tion of about one-sixth to one-fifth of the pressure of the air 
column should be the means of bringing about such results 
as were actually accomplished by Brehmer’s treatment, was 
ridiculed by these same authorities, and some vials of wrath, 
in the shape of publications, were poured out over his head. 
The undoubted success of his method is attributed to a 
change of habits and of surroundings of the invalid, aided 
by Dr. B’s local treatment by shower-bath, etc. Later on 4 
Tyndale.—Influence of Altitudes on Consumptives. 
I will present my theory of what agents constitute the true 
remedy for the collective conditions known as phthisis 
pulmonalis, and based as it is upon the truths of natural 
philosophy, hope to have it acknowledged in the future 
that it is the true solution of the great problem of success- 
ful treatment of consumption. But I will not anticipate. 
In Europe there are now three or four health resorts at 
high altitudes. In this country attention has been drawn 
to the subject by Drs. Loomis, Dennison and others, chiefly 
at the sessions of the American Medical Association. One 
sanitarium is in successful operation at Asheville, North 
Carolina, situated on a spur of the Blue Ridge Mountains. 
The elevation at that point is 2,250 feet above the level of 
the sea, and it is in connection with this elevation that I 
wish to offer a point for consideration. 
It has been found that, in order to find almost perfect 
immunity from phthisis, an increased elevation is required 
as we approach the equator from the north or south, 
and this additional altitude is reckoned to be 300 feet for 
every degree of latitude towards the equator. Thus in 
Northern Germany, immunity from phthisis is placed at 
about 1,600 feet (Goerbersdorf is 1,715 feet); in Switzer- 
land, from 4,500 to 5,000 feet; under the equator, at from 
10,000 to 11,000 feet. If we examine the elevated regions 
of this country (I confine myself to the United States), 
we find that the mountain ranges of the East present no 
high upland plateaux of any great dimensions. Single 
mountain spurs and strictly localized plateaux are there, but 
even these latter have not the requisite altitude which 
their latitude calls for. It is so in North Carolina, where 
the Southern region calls for fully double the altitudes 
which exist, as at and near Asheville. It is the same in 
Western Tennessee, where, in addition to lack of elevation, 
the favored spots are so small, cramped, confined to a lim- 
ited space, as to be accessible to and affected by all the 
noxious influences of the surrounding lower regions. As 
this subject will be again referred to, I will only add here Tyndale.—Influence of Altitudes on Consumptives. 
5 
that in Colorado the immunity from phthisis is placed at 
6,000 feet. And Colorado is in a more northern latitude 
than North Carolina and Tennessee. 
The western part of North Carolina and the mountains 
of Eastern Tennessee serve to illustrate all that can be 
said for and against medium altitudes, though there are 
other sections of this country and South America, which 
come under the same heading. In their favor it is held 
that they are advantageous resorts for cases in which high 
altitude is not well borne, or not at all permissible. Such 
cases are rare. Further on I will show that patients who 
are not so far advanced in phthisis as to leave them no 
chance save to die at home and among friends, can safely 
be taken to an altitude where consumption is unknown. 
Now, it will be said, the altitudes at which approximate 
immunity from phthisis is found are very high altitudes, 
the sudden change to which might endanger the patient’s 
life. Be it remembered that strictly localized high alti- 
tudes (single mountain tops, for instance) are not to be 
counted as health resorts, under any circumstances. High 
altitudes, however, of vast extent are approached by grad- 
ually rising ground, thus affording the invalid a chance to 
make a slow ascent without seeking a different part of the 
hemisphere each time a change becomes necessary. 
The second objection to medium altitudes, as existing 
in this country as well as in Europe, is, as I have said, 
their limited extent, confining the invalid to a prescribed 
locality. I do not mean to say that such localities are 
cramped up within a narrow space, because I know better. 
What I do mean to say is, they are in no case extensive 
enough to be free from the influences of the surrounding 
lowlands. 
Last, but not least, comes the objection that even such 
resorts as are high enough for their particular latitude (as 
the northern ones of Europe) are burdened with an excess 
of moisture, gathered by the mountains, exposed as they 
are to the moist Atlantic currents. 6 
Tyndale.—Influence of Altitudes on Consumptives. 
It will be seen, therefore, that the ideal resort for con- 
sumptives must have other attributes than elevation alone. 
One of these is absolute inland position. This would point 
to the Rocky Mountains as the most desirable range, run- 
ning, if not through the geographical center of the coun- 
try, at least sufficiently distant from the great oceans. Of 
the whole range again we should prefer the eastern slope of 
the Rocky Mountains, and, to keep within proper latitude, 
that portion which we find in Colorado, and including the 
northern half of New Mexico, and the northeast corner of 
Arizona. In addition, we count in as approaches the 
whole western half of Kansas. This gives us, as an ap- 
proach to the higher altitudes, a vast plain, from the Missouri 
River to the foot of the Rocky Mountains, with a rise so 
gradual that it appears to be a perfect level, until at the 
foot-hills of the Rocky Mountains an altitude of 4,000 feet 
has been reached. 
Then comes the mountain range itself, interspersed with high 
plateaux of various altitudes, from 5,000 feet to 12,000 feet, the 
whole extending over the entire State of Colorado and a 
goodly portion of the neighboring States. The highest of 
these mountain peaks range from 11,000 feet (Mt. Came- 
ron) to 14,000 feet and some hundreds (Long’s and Pike’s 
Peak). 
Again, we find among the foot-hills, parks of lesser di- 
mensions, in many cases covered by pine forests. “ Foot- 
hills ” must not be confounded with hills in any other part 
of the country, since their average elevation is about 8,000 
feet. 
The same favorable general and local conditions exist in 
some parts of New Mexico and Arizona, but these sections 
are at present more or less inaccessible. Speaking of the 
continuation of the elevated plateaux in Mexico, Dr. Den- 
nison says : “ These exceedingly dry, elevated plains, in- 
cluding extensions to the north, into New Mexico and 
Arizona, would claim much more of our interest and study 
were the habits and lives of their greasy original inhabi- Tyndale.—Influence of Altitudes on Consumptives. 
7 
tants more inviting and congenial to the cultivated Amer- 
ican. The loose sand and line lime-dust, together with the 
rapidly increasing growth of the prickly and inhospitable 
cactus, as you go south and southwest from Colorado, may 
reasonably indicate the undesirableness of much of that 
southern region.” 
Our duty in this generation, with regard to the treatment 
of phthisis, is, lirst, to arrive at definite conclusions as to 
what should constitute an ideal health resort for consump- 
tives ; and, secondly, to adapt this ideal to the standard of 
what we find of real localities among the varied climates 
of the earth, which answer all requirements, so far as sci- 
entific research may have determined them. 
In selecting such a region we must assure ourselves of 
its possessing four qualifications, sine qua non: 
1. It must be accessible to mankind ; railroad facilities 
should be near. 
2. The comforts of life should be as nearly the same as 
invalids are accustomed to at home. 
3. The locality should have much and varied scenery as 
surroundings, and not be a limited oasis in a desert. 
4. If a town or village, it should be one the future of 
which is more or less secured, and not open to the possibil- 
ity of early decay. 
As yet we have no established rules for the treatment of 
pulmonary phthisis, as regards the exact elevation, aver- 
age temperature, humidity, amount of sunshine, electric 
tension, the suddenness, direction and velocity of winds. 
Not even the experiences of the European sanitaria 
(Goerbersdorf, Davos, Falkenstein) are as yet out of their 
infancy. Most of them would not be applicable to this 
country, except as to generalities, least of all to Colorado, 
no such enormous inland plateaux of great elevation 
throughout, existing in Europe. 
The various attributes of climate above mentioned are 
intimately interwoven, and dependent upon each other. 
These points will be enlarged upon when I come to speak 8 
Tyndale.—Influence of Altitudes on Consumptives. 
of and explain my new theory in regard to the climatic 
therapeutics of pulmonary phthisis. 
Of elevation, the general rule holds good, that the nearer 
the equator the greater should he the elevation. It has 
been calculated that for every degree of latitude toward 
the equator, an additional elevation of 300 feet is requisite. 
The temperature of high altitudes is, of course, lower 
than on the level ground at sea-level; that is, it is at all 
times cooler. Near the equator, this is very desirable. As 
with elevation, so it has been calculated with temperature, 
that its decrease is about 1° Fahrenheit for each 300 feet of 
elevation. This is not true in all cases, but holds good as 
a general rule. The mean annual temperature on the east- 
ern slope of the Rocky Mountains, for instance, is higher 
than the average elevation would seem to indicate. Thus, 
the remarkable fact is developed, that the mean thermo- 
metrical showing (whether daily, monthly, or annual) of 
elevated stations at the base of the Rocky Mountains is 
higliei' than in the same latitude on the Atlantic coast, or 
the Pacific, and in the Mississippi Valley. The explana- 
tion of this is found in what I have dwelt upon before, 
to-wit: the far inland position. The rays of the sun pass 
through the rarefied air almost unobstructed. They fall 
upon land and water. The specific heat of water is four 
times as great as that of land, and when heat rays strike 
this land surface without having lost any of their power, 
they will be absorbed far more rapidly than by water. 
Now, the greater the surface presented, the more heat can 
be absorbed, and this condition is present in the shape 
of the upturned sides of the mountains presenting a greatly 
increased surface for the action of the sun’s rays. But the 
earth which so readily absorbs heat, as readily gives it out 
at night-fall into a dry atmosphere, and, of course, causes 
as sudden and great a falling of the thermometer as it had 
at sunrise caused a rising. Thus, the ample daily and 
yearly fluctuations are caused. 
Besides, the mountains protect the plateaux from strong 
winds and moisture which they gather, allowing the sun Tyndale.—Influence of Altitudes on Consumptives. 
9 
shine to prevail on the level ground. The mountains pro- 
tect the plateaux mostly to west and northwest. In high 
altitudes, the capacity of the rarefied air for holding moist- 
ure is very much reduced. 
Then there is the dry, sandy soil, which rapidly absorbs 
moisture, being only slightly covered with buffalo grass. 
Rivers and creeks, as sources of moisture, are scarce. 
So are trees, comparatively speaking, and what of moist- 
ure is gathered by them during a rain storm is afterwards 
rapidly absorbed by the dry atmosphere. 
UvmTtUfy, 4&olness, and dryness of the atmosphere are 
increased by increased elevation. The expansion of air 
under the infiuence of solar heat increases its capacity for 
holding and retaining vapor. Now, the elastic force of 
vapor, or the absolute humidity of the air, diminishes with 
height, though as yet we do not know at what established 
rate, if any. Of the air becoming more and more rarefied 
by increased elevation, we know that it is twice rarefied at 
a height of three and one-half miles, four times at seven 
miles, sixteen times at fourteen miles, and so on in regular 
multiples of four. It is natural, and we are not surprised 
to learn from Prof. Tyndall that this expansion of the air, 
at such a rapidly increasing rate, with increasing eleva- 
ion, is accompanied with a loss of a part of its humid 
contents. 
I have shown that the earth has four times the capacity 
for absorbing heat as water, and how in high regions, sur- 
rounded by mountains, turned up as it were, and present- 
ing their surface to the sun, the absorption of heat goes 
on very rapidly, and quickly warms the enclosed plateau. 
The degrees of heat are, of course, correspondingly great, and 
would so be felt at low altitudes, especiall} when laden 
with moisture; but on high plateaux of 6,000 feet, where, 
in the natural course of things, it ought to be cold, the 
higher degrees serve to cancel the one degree of Fahrenheit of 
reduced temperature for each 300 feet of elevation, and thus 
what is thermometrically great will convey only the sensation of 
•omfort. Thus, at 6,000 feet, we would have : At 92° Fahr. 10 
Tyndale.—Influence of Altitudes on Consumptives. 
in the shade, the sensation conveyed the same as if it 
was 72°, minus any appreciable moisture, and plus all the 
beneficial effects of the intense sunlight. In winter, should 
the thermometer indicate zero, this would be felt as if it 
were 20° to 25° above zero, with the same addition of light 
and rapid warming of the earth’s surface as soon as the 
sun rises, and its rays pass unobstructed through the rare- 
fied atmosphere. 
Or, to make my meaning still plainer: For each 300 feet 
of increased elevation the temperature is reduced about 
one degree of Fahrenheit. The heat of summer, therefore, 
(as indicated by the thermometer) would be the same at 
6,000 feet as at sea-level, but for this reduction of one 
degree for 300 feet, which at 6,000 feet is equal to twenty 
degrees. In winter, the thing is reversed: On the one 
hand, a low temperature, as indicated by the thermometer,, 
but not by our sensations. These are largely governed by 
the relative amount of moisture. So, we have, on the other 
hand, as an off-set to the thermometricalshowing: Absence 
of moisture, almost continued unobstructed rays of heat 
and light, which have to penetrate no mist before reaching 
us, a more than double expanse of surface absorbing the 
heat (by the up-turned sides of mountains), and the pro- 
tection against winds which these latter afford. 
The absolute humidity in high altitudes is likewise less 
than in the lowlands; that is, this rarefied air, with three 
pounds of pressure to the square inch less than in the 
lower altitudes, has a diminished capacity for holding 
moisture. Thus, in Denver, (I quote from a statement by 
Dr. Dennison) the average cubic foot of air contained 1.13 
grains of vapor at a mean temperature of 33°, while at 
Jacksonville, Florida, during the same time (five cold 
months), there were 3.92 grains of vapor to the cubic foot 
of air at a mean temperature of sixty degrees. 
High altitudes, therefore, enjoy remarkable dryness 
throughout the year. And nowhere is this the case more 
than in Colorado, with its high and varying altitudes 
throughout the whole of the State. So great indeed is this Tyndale.—Influence of Altitudes on Consumptives. 
11 
dryness, that the limited amount of rain-fall, including 
snow, which rain is, moreover, rapidly absorbed by the 
sandy soil, barely suffices to supply the necessary moist- 
ure for the scanty indigenous vegetation. 
Again, I cannot too often recur to that greatest of features 
in the high altitudes of Colorado: The wonderful and 
uniform clearness of the air, as shown by the intensity of 
the sunlight. So clear is the air, and so intensely blue the 
sky, that, for the first few days of a stay in Colorado, you 
find it to your advantage to wear smoked glasses. 
In regard to dryness of the atmosphere as one of the 
factors in the treatment of phthisis, the opinion expressed 
by Dr. C. T. Williams, of England, represents the accepted 
idea: “ It has been shown that, taking collectively all forms 
and degrees of phthisis, the dry climates are the most likely to 
arrest the disease.” 
Take, on the one hand, the effects destructive of life, such 
as we find them in mines, cellars, and ill-lighted abodes, 
and on the other, the benefits of sunlight at low levels, where 
a stratum of moisture intercepts the sun’s rays like a thin 
cloud. Take away the moisture and the interception of the 
sunlight, and we have the unobstructed full effect of a sun- 
bath in the highlands, as found in Colorado. The sun’s 
rays being less obstructed, two effects are produced: 
First. Much more rapid taking up of warmth by the 
earth, presenting as it does, with the mountain sides, a 
largely increased expanse of surface, 
Second. The sun shining unobstructedly in a usually 
cloudless sky (cloudless far in excess of other sections of the 
country), there is a proportionately longer influence of sun- 
shine in each twenty-four hours ; the sunlight, likewise, is 
more intense because steady, by being, as it were, undis- 
turbed. Thus, we have, even on days during which the 
sun would be clearly visible for eight hours only, a sun- 
bath which in its intensity, purity, and fullness of effect 
makes up for the little deficiency in time, and may be said 
to have fully double the effect on the human system than on the 
plains below. It is for this reason that Dr. Dennison feels 12 
Tyndale.—Influence of Altitudes on Consumptives. 
justified in setting forth as a maxim that: “ The bene- 
ficial effects of sunshine increase with increasing altitude.” 
Atmospheric Electricity.—We know more of electricity as 
a therapeutical agent than we do of the element itself. 
Among the established facts is, that electric tension in the 
atmosphere is increased with each decided elevation. Ex- 
cepting during storms, when the atmospheric electricity is 
negative, we have it from extensive observations, that when 
the sky is clear the electricity of the air is always posi- 
tive. Dr. Dennison says : “ It would seem that with the 
increase of tension due to elevation, the positive electricity 
of the air, so abundant in dry elevated regions, would be 
constantly nearing the negative electricity of the earth.” 
The high electric tension of high altitudes is no doubt due 
to this, though we have no other proof of this than our 
own nervous sensations. Houses, trees, and all other 
shelters for the human race only serve to intercept this 
vital fluid. 
In outdoor life, there is no hindrance to its full action, 
and the human body is the receiving medium between the 
positive electricity of the air and the negative electricity 
of the earth. This fact, too, is a plea in favor of sleeping 
on the ground in open air, because “you get up in the 
morning from your negative electric bed to stretch yourself in 
the positive electric airy 
Of ozone as a curative power, nothing is known, and its 
utility is a matter of speculation. What is known is, that 
in Colorado as well as at other great-altitudes, the increase 
of ozone in the mountains is shown, as compared with the 
plains below. 
Winds.—As a general thing, a moderate amount of wind 
has a decidedly healthful influence in keeping the air in 
motion. A rapidly moving, chilling wind, alone can be of 
harm to the human organism, by the too rapid reduc- 
tion of the temperature of the external surface of our 
bodies. In such high regions as the Rocky Mountains, the 
general movement of the air is, of course, greater than in 
the lowlands, but the difference is not so great as one Tyndale.—Influence of Altitudes on Consumptives. 
13 
would suppose, excepting on high, exposed plateaux, 
chiefly the so-called divides, where the force of the wind 
has it all its own way. The topography of the country, 
on the other hand, the variety of shapes and relative posi- 
tion of mountain ranges to each other, naturally brings 
about a great variety of strictly local conditions. The 
predominating features are the more or less limited high 
plateaux, for the greater part (two-thirds to three-fourths) 
surrounded by mountains, which break the force of the 
winds. Luckily too, this protection is chiefly in the north 
and northeast, from which directions the most disagreeable 
winds are to be expected. For, as a rule, it may be set 
down for the eastern slope of the Rocky Mountains in 
Colorado, that the south, southwest and west winds bring 
pleasant weather, while their opposites, the north, north- 
east and east winds bring most of the rain. 
Again, it should be borne in mind that the winds in 
these high altitudes, though moving with the same rapid- 
ity as on the plains, exercise much less force on account of the 
reduced weight of the atmosphere, due to elevation. So, while 
purifying the air and changing it, the force of the wind 
does not suffice to create discomfort by rapid cooling off of 
the outer man, nor exercises any chilling effects upon the 
respiratory mucous membranes of the inner man. 
The general effects of altitude on man are well under- 
stood, when we consider the lessened pressure of the air- 
column, which exists at great elevations. The surface of a 
man’s body may be said to be sixteen square feet, and the 
pressure of the air-column upon a square centimeter of 
surface at mean barometric pressure 1033 grammes. 
At the height of 6,000 feet (the average height of the 
foot-hill plateaux of Colorado), the surface of the human 
body is relieved of a pressure of three pounds to the square 
inch, which is equal to 7,000 pounds for the whole man. 
So much for the outer surface. The respiratory mucous 
membrane of the lung has been calculated by Lieberkuehn 
to be 1,400 square feet. The lungs are the organs chiefly 
influenced by the reduced pressure of the air-column, 14 
Tyndale.—Influence of Altitudes on Consumptives. 
whereby primarily increased activity in breathing is brought 
about, which in turn secondarily influences the centres of 
circulation, assimilation, and innervation. In a compara- 
tively short space of time, these functions will have accom- 
modated themselves to the change. The proportions of 
oxygen, nitrogen, and carbonic acid are the same at high 
altitudes as at sea-level. At the height of 6,000 feet, where 
the pressure of the air-column is diminished one-fifth, a 
given space of air will, of course, contain one-fifth less of 
oxygen, and, therefore, at first the lungs must inspire a 
fifth more of air to get the same amount of oxygen. 
The oft-disputed question, whether increased frequency of 
respiratory movements, or greater profoundness in breathing 
makes up this one-fifth deficiency, is best decided by first 
examining the known effects of inspiring rarefied air, and 
expiring into it, at low altitudes. These effects can be 
summed up as follows : First. The muscles of inspiration 
are strengthened, inasmuch as the atmospheric pressure in 
the lungs is lessened, while that on the surface of the chest 
remains the same ; second, there is a greater determination 
of blood to the lungs from relaxation of the tension on the 
ubes and air-vesicles. This relaxation allows the lung to 
contract in the exhaling process, and by expulsion dimin- 
ish the amount of residual air. Let it now, for a moment, 
be kept in mind, that this increases the capacity for taking 
in of air; third, the blood being determined to the lungs, 
the left heart is relieved somewhat from pressure, and this 
causes, as we know, at first, rapid action and softness; 
fourth, elimination of carbonic acid is favored, because of 
the diminished density of the inspired air. So we have of 
immediate effects : Increase of venous blood in the lungs, 
rapid action of heart, increased riddance of carbonic acid, 
and increased room in the air-vesicles for fresh air. Now 
let us first, and entirely overlooking the permanent effects 
for the present, transfer these facts to our high elevation, 
where we also inspire and expire into rarefied air, but 
with the difference from the foregoing, that now the pressure 
on the outside of the chest is diminished (for convenience Tyndale.—Influence of Altitudes on Consumptives. 
15 
sake we will say one-fifth). Then we will get of immedi- 
ate effects mentioned above, only those which are caused 
by a rather sudden change from a denser to a rarer medium. 
And these effects are always temporary unbalancings of 
the functions, are disturbances of innervation, pure and sim- 
ple, manifested by rapid breathing and accelerated heart’s 
action. Increased rapidity of propulsion causes not merely 
fullness of bloodvessels in the lung, but drives the blood into 
and through the capillaries; it begets a determination to the 
periphery, as any one can notice upon himself before 
he has been in Colorado many hours. Let us say then, 
that lungs and periphery (lesser and greater circulation 
both) are in a temporary state of venous fullness, caused 
by a disturbance of innervation of lungs and heart from 
an unaccustomed change from dense to rare medium. 
The lungs will rid themselves first of this stasis by taking 
in oxygen. But the peripheral stasis can only be perma- 
nently relieved after the left heart has acquired more force 
of contractility by oxygenated blood, and the right heart 
is no longer crowded by backward pressure from the lung. 
Of course, I am fully aware that such conditions cannot 
exist for any great length of time, and I have taken care to 
speak of them as “ temporary.” Yet, both the capacity of 
the system for standing changes of any kind for a length of 
time, as well as that the compensating hypertrophies (heart), 
and dilatations (air receptacles, and subsequently chest- 
walls), take place in a comparatively short space of time, 
are facts too often overlooked. The stasis is soon compen- 
sated for, and answered by dilatation of the capillaries, and 
their consequent increased capacity for holding blood. In 
inspiration of rarefied air at sea-level, carried on through 
a number of months, daily, the effects outline the respira- 
tory act, and in a measure beget hypertrophy of the 
heart’s muscle, and a moderate expansion of air-vesicles, 
through increase of their contractility. Eventually, how- 
ever, the outside pressure of the air-column will regain its 
supremacy sufficiently to cancel most of the benefit 
derived. Not so in the rarefied air of high altitudes, where 16 
Tyndale.—Influence of Altitudes on Consumptives. 
the pressure of the air-column is at all times reduced, 
barely disturbed by any rise of the barometer, because 
moisture is wanting. Here the permanent conditions will 
bring about permanent changes, to-wit: Hypertrophy of 
the muscular tissue of the heart, and distension of the 
pulmonary respiratory membrane as represented by the 
air-vesicles. 
Now, let us not forget that the endosmotic action of ox- 
ygen through the lung-membrane is of a more rapid and 
thorough kind in the clear, rarefied air, the very rarefaction 
of which is a guaranty for its ready passage through mem- 
branes. The increased elimination of carbonic acid, at 
first due to determination of a larger quantity of blood, 
and answered by increased absorption of oxygen through 
more rapid inspirations, is now answered by deeper and 
fuller inspirations, and the taking up of the same quan- 
tity of oxygen as before. As soon, then, as increased 
frequency of respiration and heart’s action approach the 
normal once more, to be supplanted by deep, full respi- 
rations and regular but more powerful heart’s action, 
we are justified in believing that the respiratory function 
has adapted itself to the change of elevation. Dilatation of 
the capillaries and expansion and tension of the air-vesi- 
cles with their sub-structure of elastic tissue have now 
become permanent, as evidenced by enlargement of the 
circumference of the chest. 
To recapitulate: The lessened pressure of the at- 
mospheric COLUMN FROM WITHOUT IS ANSWERED BY IN- 
CREASED ACTIVITY OF THE ORGANS WITHIN, WHICH RESULTS 
IN HYPERTROPHY OF THE MUSCLES OF THE HEART, FULL- 
NESS AND SUBSEQUENT DILATATION OF THE PULMONARY 
AND PERIPHERAL CAPILLARIES AND EXPANSION OF THE AIR- 
CELLS. These changes beget perfect adaptation to 
THE CHANGE OF ELEVATION, AND RE-ESTABLISH THE EQUI- 
LIBRIUM PREVIOUSLY EXISTING BETWEEN EXTERNAL AND 
INTERNAL FORCES. 
This explanation readily accounts for the varied effects 
upon the circulation of different persons, and chiefly as Tyndale.—Influence of Altitudes on Consumptives. 
17 
regards cases of haemorrhage from the lungs. Every indi- 
vidual, whether safe and sound or afflicted with disease, 
has to pass through—tirst, the functional changes, and sec- 
ond, the resulting organic changes. The character of the 
tissues of the heart and blood-vessels will determine the 
issue in each case. For the great majority, even of sick 
persons, great reliance may safely be placed upon the won- 
derful adaptability of the human organism to all manner 
of changes. But a heart loaded down with fat, blood- 
vessels whose elasticity has been impaired by atheroma- 
tous changes, calcareous deposits, or when resistance to the 
pressure of blood is diminished by syphilitic or scorbutic 
changes, or the luemorrhagic diathesis (more frequent than 
is generally allowed); stumps of occluded vessels, from 
whose mouths haemorrhage has occurred before—all such 
may give way under the increased pressure, and a haemor- 
rhage be the result. This speaks for the safety of the plan 
of slowly and gradually crawling up toward high eleva- 
tions. At the same time a slight haemorrhage need not 
necessarily be fatal, and will in all human probability not 
occur again. The time spent and lost in reaching the 
proper altitude by very slow stages, may prove fatal. 
Where no haemorrhage has taken place in some months, 
the danger of a sudden change cannot be so great. 
As before stated, the altitude of approximate immunity 
from phthisis is required to be higher the nearer we move 
towards the equator, and it has been asserted by Brehmer 
to be equal to 300 feet of rise to every degree of latitude. 
Such a calculation would not amount to much in itself, 
were it not in consonance with the total absence of phthi- 
sis among the inhabitants of these increased altitudes. The 
altitude of immunity in Colorado, has been found, by the 
necessarily limited observations thus far at hand, to be 
6,000 feet. A great portion of Southern Colorado and its 
high plateaux on the eastern slope of the Rocky Moun- 
tains have an average altitude of 6,000 feet and somewhat 
above. According to surveys by Professors Parry, Hay- 
den and others, the following altitudes are correct: 18 
Tyndale.—Influence of Altitudes on Consumptives. 
Average elevation of foot-hills, about 8,000 feet. Sum- 
mit of the range, 11,500 feet. Timber line, from 11,800 to 
12,000 feet. 
For convenience sake, I divide the plateaux and local- 
ities under three heads: 
First. Among the foot-hills, and ranging from 4,000 to 
7,000 feet. Of such are Boulder (5,536 ft.), Canon City 
(4,700 ft.), Colorado Springs (5,975 ft.), Denver (5,317 ft.), 
Manitou (6,124 ft.), Pueblo (4,400 ft.), San Luis Valley 
(6,400 ft.). 
Second. Higher plateaux among the mountains of av- 
erage height and below timber line, from 7,000 to 11,000 
feet. Here we have Manitou Park (7,752 ft.), Middle Park, 
head, (8,690 ft.); Estes’ Park (7,528 ft.), Morrison (9,842 ft.), 
Hot Springs (7,725 ft.), Georgetown (8,466 ft.), Montezuma 
(10,113 ft.). 
Third. The elevated prairies of Western Kansas and 
Eastern Colorado, which might be designated as approaches 
to the Rocky Mountains, and with a continual rise from 
2,000 to 5,000 feet. Among these I will mention Lachine, 
Kansas ; Kit Carson, Colorado, (4,191 ft.). 
The elevations above timber-line consist of the solitary 
peaks of great altitude, such as Pike’s Peak (14,436 ft.), 
Mt. Lincoln (14,183 ft.), Mt. Wright (11,800 ft.), Long’s Peak 
(14,300 ft.). These altitudes are not for consumptives. 
Let me now summarize the general facts in regard to 
high altitudes and their utility. Part of the conclusions 
are derived from Dr. Denison’s instructive monogram. 
1. Cool and dry are better than warm and moist climates. 
2. The only favorable attributes of low altitudes, dry- 
ness of the air and diathermancy, are found multiplied in 
high altitudes. 
3. The uniformly warm climate of southern regions, 
(Florida, Bermuda Islands etc.), with their high thermom- 
etrical reading without noticeable falls, is at last begin- 
ning to be recognized as relaxing, depressing and enerva- 
ting factors, for which its equableness is no compensa- 
tion. Tyndale.—Influence of Altitudes on Consumptives. 
19 
4. The moist, salt air of sea-coasts is beneficial to the 
consumptive only in its purity and absence of malaria, but 
decidedly harmful in the too frequent absence of continued 
sunshine, and that greatest of factors necessary for con- 
sumptives, uniform withdrawal of the watery constituents of the 
body at large and the lungs in particular. 
5. Almost any change of locality and climate, differing 
from the home climate, is of temporary benefit to consump- 
tives, as well as to other folk. But consumptives have no 
time to fool away. It is this temporary benefit upon which 
is founded that monstrous assertion that miasmatic sec- 
tions had been found to be a paradise for consumptives, 
and vice versa. 
6. The benefits of high altitudes are not contained in the 
one factor of low barometric pressure, as still adhered to 
by Brehmer. The three chief factors are doubtless the 
three imponderable agents, heat, light and electricity, with 
their separate and combined influences on the human or- 
ganism, consisting, broadly stated, of rapid change of tissue 
and strengthening of functions, with consequent strength- 
ening of organs by gradual accommodation and adapta- 
tion. 
7. The detailed requisites of high altitudes, in order to 
derive benefit therefrom, consist of 
(a) Rarified air. Pressure of the air-column must be 
reduced from one-sixth to one-fifth. 
(b) Heat-rays of the sun coming unobstructed through 
rarefied atmosphere, quickly warming the earth’s crust. 
(c) Rays of light should be equally unobstructed, giving 
a steady and intense light, a uniform sun-bath. 
(d) High mountains, enclosing upland plateaux from 
two-tliirds to three-fourths of the circumference, sheltering 
them from strong winds, and adding vastly to the expanse 
of earth warmed by the sun. 
(e) Increased electric tension. The undoubted benefit 
derived from the positive electricity of the air, and the 
negative electricity of the earth, with the patient as a me- 
dium. 20 
Tyndale.—Influence of Altitudes on Consumptives. 
(f) The presence, within reasonable reach, of pine for- 
ests, for the benefits derived from inhaling their odors. 
Also, other plateaux, to the north and south of the chosen 
one, for changes in summer and winter. The most prefer- 
able would be one of somewhat increased altitude to the 
north and of lesser to the south. 
(g) Moisture, just sufficient to keep the land from be- 
coming a desert; in other words, a limited rain-fall through- 
out the year. 
All of these requirements and their attendant benefits 
are to be found along the eastern slope of the Rocky 
Mountains, extending through Colorado and parts of New 
Mexico and Arizona. The same conditions on the same 
gigantic scale are nowhere else to be found. 
Coming to look at the seeming disadvantages, as they 
would appear to laymen, and as sometimes complained of 
by patients during the first weeks of their soj urn in Col- 
orado, we find the following : 
Frequent rains. This frequency is deceptive. It may 
rain on three successive days for one hour each day, which 
occasionally occurs as a sequel to three weeks or more of 
uninterrupted sunshine. The quantity of actual rain-fall 
by inches is barely sufficient to sustain vegetable and ani- 
mal life, and is so rapidly absorbed by the sandy soil and 
taken up by the dry air, that often after a severe shower, 
no trace of moisture is left on the ground or upon the leaves 
of undergrowth in a couple of hours. 
Occasional short-lived winds. The motion of the air is 
at all times barely sufficient to aid in purifying the air and 
changing it. 
Let it be remembered here, that sudden changes, which 
do not occur often, nor create persistent change, are of 
decided benefit for all classes of chronic diseases. Con- 
stant dryness is anything but a desirable factor. 
The cold weather is not felt as such, a fact previously 
dwelt upon. On account of the absence of moisture, 
the lowness of the temperature exerts only its tonic in- 
fluence. It is in the winter, therefore, that most cases oj Tyndale.—Influence of Altitudes on Consumptives. 
21 
consumption reap the greatest benefit, the air being then ex- 
tremely dry and highly electric, with no rain and very 
little snow. The thermometer shows great variations be- 
tween day and night, sometimes going below zero ; but, as 
before stated, the absence of any appreciable amount of 
moisture and the shelter of the hills, prevent any depress- 
ing influence from the low temperature being felt. With a 
moderate quantity of woolen clothing, pnly the bracing, 
tonic effects upon the human body are experienced. Dur- 
ing the day, from 10 till 4, the sun shines almost uninterrupt- 
edlyf, and with such power as to enable the invalid to enjoy 
out-door exercise without additional wrap or overcoat. 
The hill-sides do not, as has been too frequently asserted 
by medical men, also, act as a screen to the sun’s rays, but 
as a trap, concentrating their effect. 
I have no doubt that future experience will show the 
necessity of dividing the therapeutical directions under 
three general heads, as regards the primary disposal of 
patients: 
1. Those in whom infiltrations not yet exulcerated, catar- 
rhal processes consequent upon the foregoing and atelecta- 
tic lungs supervene, where the trouble is chronic and with 
out very active tendencies. Includes chronic interstitial 
pneumonia. Such patients may likely have to reside in 
Colorado the greater part of the year, and yet be able to 
be at home the rest of the time. They can probably go 
to the elevation of 6,000 feet at once. 
2. Those in whom destructive processes have begun, 
limited, rather well-defined cavities have formed, including 
bronchiectatic conditions and cheesy infiltrations; such 
in whom the sub-acute processes are still manifested by 
fever, but have not yet reached the colliquative stage, yet 
in whom there exists a constant tendency to conditions 
which disturb the balance of health, might begin with 
4,000 feet, and in accordance with their more or less rapid 
improvement change to 5,000 or 6,000 feet. 
3. Those in whom destructive processes are decid- 
edly active; who have reached the colliquative stage; 22 
Tyndale.—Influence of Altitudes on Consumptives. 
where the destructive tendency has recently been mani- 
fested by haemoptysis; finally, those afflicted with acute 
miliary tuberculosis (though now considered hopeless cases) 
might travel by slow stages through the gradual rise in 
Kansas, and remain a month or two at choice localities, 
such as Lachine, Kansas; next, go to Denver or Greeley, 
and from thence to Manitou. 
The first two or three months of rational treatment 
would readily determine which of the second and third 
class would have to make Colorado their permanent home. 
On a previous page, I have intimated my belief, that the 
three imponderable agents, heat, light, and electricity, 
IN THEIR COMBINED ACTION, SERVE TO STAY THE DISINTE- 
GRATING CHANGES OF TISSUE IN THE HUMAN ORGANISM, AND 
THUS PAVE THE WAY TO THE CURE OF CONSUMPTION. 
I now re-assert this as a theory upon which the thera- 
peutics of phthisis will, in my opinion, be based in the 
future. The high elevations, and the rarefied atmosphere 
previously referred to, are free from all baneful influences 
in the three forms in which matter presents itself, namely: 
solids, fluids, and gases. 
They are free from : Dust (as a solid), excessive moisture 
(as a fluid), and from intoxicating vapors (representing the 
gaseous form). 
In the relatively total absence of these baneful influences 
at high elevations, the life-giving and life-sustaining agen- 
cies of heat, light, and electricity can and do have full and 
uninterrupted sway. We see, therefore, that it is on high, 
upland plateaux, far removed from large bodies of water 
alone, that these agents can exercise their powerful cura- 
tive influence upon the human system to its fullest extent. 
In what way, I have pointed out. In how far these forces 
operate, by being converted into each other, is a matter 
for future investigation and speculation. 
Now, if I insist once more upon the correctness of my 
theory concerning the cure of phthisis, it is because I am 
thoroughly convinced that it will prove to be the solution 
of the great problem of the proper therapeutics for all Tyndale.—Influence of Altitudes on Consumptives. 
23 
forms of consumption. When once the use of the impond- 
erable agents has been reduced to something like a sys- 
tem, by careful observation of their effects upon different 
forms and stages of phthisis pulmonalis, I am confident 
that this theory will be found to cover the whole ground. 
By careful individualization, and strict attention to detail 
in the therapeutical application of heat, light, and elec- 
tricity, every form of consumption will finally be treated 
successfully on a scientific basis. 
So important does it appear to me to have my theory 
well understood, that, at the risk of its being voted 
as tedious, the whole matter is here condensed once more, 
and the points presented in proper succession : 
1. The products of phthisis are either hereditarily scrof- 
ulous or directly inflammatory, and are respectively known 
as: hyperplasia of connective tissue, cheesy degeneration, and 
tubercle. 
2. When found in the lungs, we look upon them (gener- 
ally speaking), as products of lessened and retarded nutri- 
tive changes in the lungs, caused by an insufficient supply 
of blood and its consequent stagnation from lack of central 
propulsion. These conditions may aptly be termed, “ in- 
creased venosity” Now, the vitality of a part being lowered 
by the amount of venous blood in it being out of natural 
proportion to the arterial, the nerves do not act sufficiently 
upon stimulation. For this reason, we find mucous mem- 
branes, which, in a state of proper vitality, secrete 
their special fluid in due proportion to the stimulus 
applied, and shed and renew their surface in exact propor- 
tion to the nervous influence they receive, acting irregu- 
larly in this respect. They now show little and imperfect 
re-action after the nerve-influence, which is natural to 
them, remaining sluggish and secreting an excess of fluid, 
and when more than ordinarily irritated are found to shed 
their coat unduly. 
3. The accepted great therapeutical measure for the 
removal of these products by expectoration and absorp- 
tion is the removal of patients to high elevations, where 42 
Tyndale.—Influence of Altitudes on Consumptives. 
the pressure of the air-column is reduced from one-sixth to 
one-fifth. 
4. The curative influences of high elevations have been 
attributed by Brehmer to this lessened barometric pressure 
alone; in other words, to the effects of rarefied air. This 
has been ridiculed by other writers, but not successfully 
contradicted in the absence of other explanations. 
With these facts in view, my deductions from them are 
as follows : 
1. The healthy lungs, to properly perform their function, 
must have pure, unadulterated air. The infiltrated lung re- 
quires rarefied air, because by reduction of outside pres- 
sure alone, can the propulsive power of the heart be in- 
creased, and thereby overcome stagnation. 
2. We next ask ourselves, why is this atmosphere una- 
dulterated? Because of the proper action of heat, light 
and electricity, which agents manifest uninterrupted 
power through an almost purely unobstructed medium. It 
is unadulterated by dust, excessive moisture, noxious 
gases ; representing in turn the three forms of matter: sol- 
ids, liquids and gases. 
3. The three imponderable agents have full play. Heat 
manifests all its beneficial effects upon the human system 
by that most important of regulating factors, withdrawal 
of water from the tissues of the body. Heat at high ele- 
vations is not restrained from diffusing itself by its va- 
rious ways of transmission, radiation and convection. The 
rays of light pass unobstructedly through an ether of in- 
tensest blue, and consequently beget the nearest approach 
to white light at the proper elevation. Its distribution by 
radiation, refraction, etc., is untramelled. The effects of 
electricity at high altitudes manifest themselves in increase 
of ozone for breathing purposes, and in the positive elec- 
tricity of the air, with its effects upon the human body as 
a medium between it and the negative electricity of the 
earth. 
4. In addition, I hold that an upland plateau for thera- 
peutical purposes must have three qualifications in order Tyndale.—Influence of Altitudes on Consumptives. 
25 
to escape dust, moisture and gases : Elevation sufficient to 
exclude all dust not of its own local origin; mountainous 
surroundings, sufficient to break the force of winds and the 
noxial carried by them ; inland position, removed as far as 
possible from the seas or any great body of water. Upon 
this latter point I lay particular stress, and insist, that any 
elevations still reached by moist sea-currents are not ideal 
health-resorts for consumptives. Thus any of the high 
altitudes west of the divides in the Rocky Mountains, as 
well as those of the Alleghany Mountains, are, though far 
removed from, still too near to either ocean or the Gfulf of 
Mexico. 
Both sea and mountain air are known to encourage and 
promote rapid change of substance, although they differ 
in the modus operandi. Both are subject to irregular varia- 
tions of the barometer, as they are known to occur rap- 
idly, and of short duration, both at the sea-side and in the 
mountains. 
In contradistinction to wide plains, where slow changes 
of the barometer indicate equally slow and long-lasting 
rains, the sea-shore and the mountains have rapid changes, 
with rain of very short duration. These changes, once 
considered as productive of evil, are now known to be es- 
sential to the highest condition of health. 
There is no doubt that rapid changes of short duration are 
more favorable for the more important functions of the human 
body than relative stability. We cannot endure either 
constant dryness or dampness, and since, therefore, baro- 
metric changes are necessary, such changes as take place 
rapidly, and having supplied the absolutely necessary 
amount of moisture only, equally as rapidly return to the 
normal and usual standard, must be of benefit to invalids. 
These conditions are shared by sea-shore and mountains, 
as above stated. 
The difference in action between sea and mountain air is 
now to be considered, of which Dr. Brown says, in sub- 
stance : 
Sea air acts rapidly, mountain air slowly ; sea air very 26 
Tyndale.—Influence of Altitudes on Consumptives. 
soon compels a more increased ingestion of food, stimu- 
lates digestion powerfully, so that the bodily weight is- 
considerably increased in a short time. Mountain air, on 
the other hand, acts as a more subtle, slow stimulant, ex- 
erts its influence beneficially on enfeebled bodily functions,, 
and their naturally increased irritability. Sea air pre-sup- 
poses robust assimilative functions and equally robust in- 
tegrity of the functions of the heart and lungs, however 
anaemic or otherwise enfeebled a person may be, if only 
their circulation and nervous system are sufficiently above par 
to bear the strong stimulant. Mountain air exercises a calm- 
ing and indirect, quite gentle influence on the atonic and 
catarrhal conditions of mucous membranes, and, however 
persons may suffer from weakness with increased irritabil- 
ity, it will act slowly but surely beneficially, if only the cir- 
culation and nervous system are still capable of responding 
to the gentle and scarcely perceptible influence of mountain air. 
I have stated my conviction (in which I am confident fu- 
ture statistics will bear me out) that dryness of the atmos- 
phere, to be of lasting benefit to consumptives, must be as 
nearly absolute as possible, relieved by moisture only to 
the extent of keeping up limited vegetation. And such 
moisture must not be lingering, as, for instance, in the 
shape of dew. The average distance of localities in Colo- 
rado from the Culf of Mexico is 800 miles, while the At- 
lantic and Pacific oceans, respectively, are more than 1,000 
miles away. 
Now there is, therefore, extraordinary dryness of atmos- 
phere, which is only temporarily relieved during the sum- 
mer months by occasional short-lived thunder storms. Na- 
ture supplies most excellent drainage, and water falling 
upon level ground is rapidly absorbed by the gravelly soil. 
In his pamphlet on the advantages of Manitou, in South- 
ern Colorado, Dr. Solly says: “ The buffalo grass forming 
a thick, dense sod, rapidly sheds the rain-fall, the surface 
water being carried away by the gulches and water courses, 
thus leaving an inappreciable amount of moisture to be 
taken up by the atmosphere. It is unquestionably owing Tyndale.—Influence of Altitudes on Consumptives. 
27 
to tlie proximity of this enormous volume of dry air that 
none of the evidences of damp are encountered at Manitou, 
even in those occasional seasons, when the rain-fall is con- 
siderable. 
Glancing once more at what at the present day we would 
consider our ideal of an elevated health-resort for phthisi- 
cal patients, there is not one requirement that is not satis- 
factorily found in Colorado, and at some of its choice spots, 
such as Manitou, in particular. Let me rehearse these re- 
quirements and their fulfillment once more. In establish- 
ing certain facts it is utterly impossible to avoid repetition, 
and I condense as much as practicable. 
1. High upland plateau, covering a considerable expanse 
of territory, the approach to which shall be a gradual rise, 
and with altitudes likewise extensive, which answer to the 
elevation required for immunity from phthisis in that lat- 
itude. 
2. This plateau must be sufficiently far removed from the 
high seas or lakes of any size, in order to be entirely free 
from moist currents. 
3. Occasional passing thunder storms of short duration 
are sufficient sources of moisture. 
4. The plateau must not be above timber-line, or close to 
the snow-line. The presence of pine forests is a desirable 
object. 
5. It must be sheltered from two-thirds to three-fourths of 
its circumference by mountains sufficiently high to protect 
the plateau from strong winds, but not high enough to ren- 
der it shady. No straight pass or canyon should be situ- 
ated at the entrance to the plateau, nor should it be tra- 
versed by a very frequented highway, where dust 
abounds. 
6. The natural drainage of the plateau should be per- 
fect, the soil sandy, firm, mixed with gravel. 
7. A natural water-course of melted snow from the 
mountains in rapid motion and with rocky bottom. 
8. Total absence of noxious vapors. Proximity to a 
large town should be avoided, and the plateau itself should 28 
Tyndale.—Influence of Altitudes on Consumptives. 
be so constituted as to preclude the possibility of a town 
of any size growing upon it. 
9. A commercial centre of sufficient dignity, to serve as 
a base of supplies, to be within reasonable distance. 
10. Other plateaux, or upland parks, within reachable 
distance, both north and south, to serve as a change for 
invalids in summer and winter. Also, variegated scenery 
in the more immediate neighborhood. 
11. The plateau should be sufficiently open to admit of 
the greatest benefit being derived by the heat and light 
rays of the sun, so as to enable the invalid to have a sun- 
bath for not less than nine hours in the summer, and seven 
in the winter. 
12. According to observations of several years past, one 
of the requisites is that the number of clear days shall 
approximate tliree-fourths of the 365 days in the year. 
13. The variations of temperature should not exceed 
twenty degrees during any one of the four seasons of the 
year. 
14. An average barometric pressure of twenty-four. 
15. Presence of an increased quantiy of ozone in the 
atmosphere, engendered and replenished by the thunder- 
storms of short duration. 
All of the general requirements enumerated, are found in 
Colorado, and the local ones in a number of localities in 
the northern, middle, and southern natural divisions of the 
State (north, middle, south, San Luis Parks). 
A short rehearsal of the disadvantages, as they appear to 
the uninitiated, and form the basis of more or less fre- 
quent complaints, will not be out of place here: 
First. The sudden changes, short as they usually are, 
are a prime necessity, constant dryness not being desirable. 
Second. Cold weather, at any season (I refer to the sen- 
sations of invalids), is only bracing, and moisture, which 
some persons claim to be sensible of in various parts of 
Colorado, is absent. 
Third. High degrees are not felt as such (90° Fahr. and 
upwards), moisture being rapidly withdrawn from the Tyndale.—Influence of Altitudes on Consumptives. 
29 
body. This deficiency needs replenishing, and insures 
constant and rapid nutritive changes. 
Fourth. Openness of a plateau to the northeast, to- 
wards the plains, brings no harmful winds, but plenty of 
pure, unadulterated, rarefied air from the high plains. 
The only objections which hold good are the spring and 
autumn equinoctical changes, which, however, are of short 
duration. These occur all over the globe, of course. At 
such periods patients could make the changes previously 
mentioned to northern and southern localities, or else 
remain where as their condition at such time 
would seem to indicate.