Beprint from the St. Louis Courier of Medicine, April, 1883. 
THE CONSTITUENTS OF A SUITABLE CLIMATE 
FOR THE VARIOUS FORMS OF PULMONARY. 
CONSUMPTION. 
By J. Hilgard Tyndale, M. D., New York. 
THAT there is no rule without exception goes without 
saying; that exceptions do not invalidate a rule is 
quite equally true. With this latter maxim in view, we 
will endeavor to find what constituents of climate com- 
bined are suitable to the majority of patients suffering from 
pulmonary consumption. Nothing could be a greater fallacy 
than to try to find a specific cure-all, either in the home or 
climatic treatment of consumption. Nor can we, in the 
present light of our knowledge of phthisical pathology, look 
upon that disease as a unit, but rather as a combination of 
the two main elements of disease, namely inflammation 
and infection. This combination and destructive co-oper- 
ation of a localized inflammation and general infection 294 
Original Articles. 
[April, 1883. 
presents itself either as a chronic inflammation or an acute 
one, and as a chronic or acute infection. The various de- 
grees of intensity and of quantitative destruction result 
from the variety of combinations possible where four con- 
stituents are given. 
A chronic inflammation may exist alone (fibroid phthi- 
sis, cirrhosis); so may a chronic infection (chronic local- 
ized tubercle, cheesy centers); both may exist together,, 
this being the most common form of cavities and infiltra- 
tions; an acute infection may occur alone (acute tu- 
berculosis) ; an acute inflammation likewise, which, aside 
from the acute inflammation of lung tissue, occurs as sub- 
acute processes in the vulnerable (strumous) as “catarrh of 
the apex; ” while, during the progress of a phthisis, an 
acute attack appears in the shape of an exacerbation. 
Lastly, in the progress of a chronic phthisis, made up of the 
processes of inflammation and infection, one of these pro- 
cesses will assume an intensity out of proportion to the or- 
dinary course, when the result is death from suppurative 
peri-bronchitis or edema of the lungs in one case, or from 
acute tubercular invasion in the other. 
For the purposes of climate—therapy—it is convenient: 
1. To divide the chronic pathological processes in the 
lungs into a few general divisions, representing three stages 
of development for two classes of persons: the robust, and 
the irritable or vulnerable, either of whom may have been 
drawn below their physiological line by being exposed. 
2. To find for these various forms of phthisis the 
best conditions of climate for curing or mitigating the 
disease — to secure more or less permanent arrest. 
This much is prefaced, in order that what follows may 
be readily understood. 
The pathological conditions in consumption are readily 
fitted into these several frames : 
1. Superficial cases—so-called because the inflamma- 
tory condition of the respiratory tubes is still superficial, 
though chronic, with little or no involvement of the sub- Tyndale.] 
Climate for Pulmonary Consumption. 
295 
mucous connective tissue, where there is no septicemia, 
hut a lowered general condition, this latter constituting 
the cause of the superficial process, which without it 
would not exist. 
2. Cavities and infiltrations of the regulation sort, 
slowly hut persistently progressive chronic inflammation 
(ulceration), with more or less septicemia (infection). 
3. The same, in the condition of superadded acute or 
subacute exacerbations, occurring intermittently or remit- 
tently. Long intermissions often give rise to that mis- 
taken idea of “ self-limitation.” 
4. Assuming these forms to occur in the average indi- 
vidual, whether previously particularly robust or not, we 
find it necessary to assume the same conditions for the 
u irritable ” persons of high nervous tension, chiefly 
manifested by readily vulnerable mucous membranes and 
skins; the result of an equally irritable circulatory ap- 
paratus. 
5. The colliquative—the breaking down stage of any 
case of phthisis ; the exacerbations no longer intermittent 
or remittent, but continuous, indicating great intensity of 
infection (acute tuberculosis) or of inflammation (suppura- 
tive peri-bronchitis). We may at once say that these man- 
ifestations of an early dissolution are not amenable to 
climatic treatment. 
All of the other forms will be benefited or cured by a 
change to a climate suitable to their respective manifesta- 
tions. 
Because of the evidences of general depression of vital 
forces manifest in phthisis, it has been taught until recently, 
and is to-day believed by a majority, that the two chief 
therapeutical elements required are warmth and moisture, 
the fosterers of equability of temperature; elements 
which constitute what is called a mild, soothing or seda- 
tive climate. This fact will be shown in connection with 
the publication of the collected opinions of the pneuma- 
tologists of this country. 296 
Original Articles. 
[April, 1883. 
Dr. Jas. Henry Bennett,1 of London, has for a number of 
years -advocated the advantages of a cool, bracing and 
tonifying climate. This is well for a certain class of cases, 
but is going to the other extreme. 
First of all, let it be distinctly understood that no specific 
element which cures consumption, resides in any climate 
of any part of our globe, whether at land or sea, in the 
lowlands or at mountain altitudes. But it is no less an 
error to suppose that any benefit derived from change of 
climate is to be looked for only in the fact that the air 
is “pure and plentiful” and constitutes “nourishment to 
the lungs.” Nourishing of the lungs is carried on by the 
bronchial arteries, and not by that great net-work of pul- 
monary vessels which carry on the exchange of oxygen 
for carbonic acid, and thereby regulate our air supply. 
Air may be called pure when there is an absence of 
mechanical and organic admixtures, represented by dust 
and noxious gases on the one hand, and animal and vege- 
table germs on the other. (For the literature on this sub- 
ject see Tyndall on “ Floating Matter of the Air.” 
To the “ superficial,” above referred to, as well as to 
many phthisical patients in the more advanced stages, any 
change from city to country, from a marine to a continental 
climate, or rice versa, will be productive of temporary 
benefit. 
This benefit consists only in an increase of weight and a 
temporary amelioration of symptoms. In other words, the 
general condition will be improved, but the local lesion in 
the lung will remain in statu quo. The same benefit is 
reached by ocean voyages, which explains the cures 
reached by that method. 
Drs. C. T. Williams and Brelimer have observed that 
gain in weight bears no relation whatever to the local pro- 
cess in the limg. I have long been convinced that a mere 
gain in adipose tissue is a hindrance to absorption of in- 
1 On the Treatment of Pulmonary Consumption—Jas. Henry Bennett, M. D. Tyndale.] 
Climate for Pulmonary Consumption. 
297 
filtration in the lung. And more than that; as soon as an 
increased ingestion of food has re-established the average 
weight and something of the sensation of strength to the 
patient—as soon as this trifling change has accomplished 
all it can do—the phthisical process will resume its onward 
march. Hence the fallacy of teaching that a patient 
should “remain in that locality as long as he continues to 
improve ” (Loomis), for by the time the patient recognizes 
his mistake he is far on the road to dissolution. Dr. Wil- 
liams1 says that this “demonstrates, only too faithfully, 
how all the appearances of an improved state of health 
may be present, and yet the disease may continue its in- 
sidious and steady march unchecked.” 
Consumptives require more than mere quantity and nor- 
mal quality of atmospheric air; it should be aseptic (not 
permitting of the development of infectious germs) or di- 
rectly antiseptic (antidotal to germ life), as it is claimed 
for the exhalations of pine forests, and, in a lesser degree, 
for the salt-air of the sea. 
What are the chief constituents of climate in general ? 
1. Pressure of the air column (barometric pressure), in- 
dicative, among other things, of the degree of elevation. 
2. Humidity of the atmosphere—relative dryness. 
3. Temperature of the various months and seasons— 
the mean degree of warmth, and the question of range of 
temperature—indicative of its equability. 
These three: Dryness, equability and elevation, are the 
main constituents, the others being the result of the combi- 
nation of two of them, or resulting from the effects of one 
upon the other. 
a. Intensity of sunlight. 
b. Force, direction and frequency of winds. 
c. Electricity—its quality and tension. 
d. Precipitation of rain and snow. 
e. The production of ozone. 
f. Mechanical and organic floating matter. 
1<J Influence of Climate on Pulmonary Consumption.” 298 
Original Articles. 
[April, 1883. 
The number of clear days in the year is also of interest. 
In selecting our aseptic climate, we do nothing else than 
to look for such conditions of climate as will insure purity 
of soil and atmosphere. Of soil we demand that it should 
drain water rapidly from the surface and not retain it, and 
that no ground-water shall be found at little depth, i. e.r 
that there be an absence of subsoil moisture. 
Of atmosphere we demand that there shall be an ab- 
sence of mechanical and organic floating matter. These 
two are the elements to which both the robust and vulner- 
able are “ exposed ” at their homes quite frequently, and 
form the well-known immediate causes of consumption. 
What constituents of climate favor the development of 
organic germ-life ? Persistent heat and excessive moisture 
—the right temperature and the right fluid medium. Heat 
can be avoided by remaining within certain latitudes in the 
temperate zone. Excessive moisture is to be avoided, and 
dryness sought. 
If. then, dryness and coolness (or cold even) are to be pri- 
marily sought after, what else is this combination but an 
aseptic atmosphere—a term for which I have frequently 
been ridiculed — and where are they constantly found? 
Why, at more or less high elevations. So our formula 
reads: Dryness and elevation. But how about equability 
of temperature ? Have we no use for it ? Equability of 
temperature is desirable for those to whom sudden fluctua- 
tions are hurtful. And who are they? The “irritable” 
and “ vulnerable ” of all forms of phthisis. To them the 
allaying of irritation and low-lived inflammation is the 
prime necessity, after accomplishing which they need the 
services of dryness and elevation. And why? Because 
equability of temperature in the temperate zone is secured 
only by the protecting influence of moisture; and we have 
seen excessive moisture to be our worst enemy, while the 
greatest equability is found in the company of great 
moisture. Hence the rule: In the selection of climate 
for equability, choose rather a reasonable equability with Tyndale.] 
Climate for Pulmonary Consumption. 
299 
less moisture, than great equability with excessive moist- 
ure unavoidably thrown in. 
We have, then, as the desired factors for an antiseptic 
climate: Dryness, equability and elevation. 
In their various relations to each other they form so 
many different kinds of aseptic climate for so many differ- 
ent forms of phthisis—the usual combinations of inflam- 
mation and infection. 
Dryness is the antidote to infection. 
Equability is the antidote to inflammation (of a low type). 
It was my intention to add some of the facts regarding 
the effect of elevation upon respiration and circulation, 
but the scope of this article forbids it. The same applies 
to the effect of the other constituents of climate. This 
much I will say: Where we would have to choose between 
dryness and equability, we should take into account the 
importance of elevation, and it will make the choice easier 
to remember that dryness and elevation are found to- 
gether, whereas equability is not usually found there, but, 
on the contrary, in the company of moisture. 
Generally speaking, then, an aseptic atmosphere is the 
requirement for the majority of consumptives. Let us 
now see what constituents furnish us a reasonable guaran- 
tee against acute or subacute inflammatory exacerbations 
in the more robust. The conditions of climate best adapted 
to prevent these serious mishaps are the contrary of those 
which, in other climates, call forth fresh catarrhs and acute 
processes generally of the respiratory organs. By what 
are they called forth ? 
Besides the proofs elicited by Bowditcli, Williams and 
others, Dr. Seibert,1 of this city, has shown that the follow- 
ing meteorological conditions favor the production of 
pneumonia : 
1. A strong fall in the barometer. 
1 “ Influence of Meteorological Conditions upou the Causation of Croup- 
ous Pneumonia'’—By August Seibert, M. D., New York.— Amer. Journ. 
Med. Sciences, Jan., 1882, p. 108. 300 
Original Articles. 
[April, 1883. 
2. A low figure of the thermometer. 
3. Northerly, and more especially northwesterly, winds. 
4. Great velocity of the wind. 
“ It is principally the sudden appearance and long preva- 
lence of cold, moist atmosphere which exercises this influ- 
ence.” (Op. cit.) 
These conclusions coincide with well known facts, 
namely: 
1. That northerly winds of great velocity, in cold weather 
favor a too rapid and continuous abstraction of heat from 
the body. 
2. That a persistently high percentage of humidity hin- 
ders the loss of moisture from our body through the lungs 
and skin; thus disturbing that equalizer of our well- 
being—equable water-abstraction from the body. 
The natural effect of these disturbances is seen in in- 
ternal congestions. The inability of a consumptive to ad 
just himself to these meteorological fluctuations is mani- 
fested by repeated irritation and subacute inflammation of 
the pulmonary and gastric mucous membranes. 
If these, then, are the elements which cause the mis- 
chief, we must look to the contrary conditions for the ele- 
ments of repair and cure. These contraries are relative 
dryness, equability of temperature, and absence of 
strong and frequent winds. This baneful influence of 
winds reminds us that besides absence of moisture of the 
soil and admixtures of the atmosphere, we must look to the 
movements of the atmosphere. What is required is high 
local shelter to insure calmness. 
On this continent, and, in fact, in the whole temperate 
zone, the combination of our aseptic constituents does not 
exist. For this reason we must seek to content ourselves 
with what is within our reach, namely, an aseptic at- 
mosphere, both at elevations in the mountains and at low- 
altitude—a sea-level — including the ocean itself. Each 
one of these surfaces has a certain number of climatic Tyndale.] 
Climate for Pulmonary Consumption. 
301 
constituents which are suitable for consumptives, and 
neither has all of them. 
Beginning at sea-level, let us see what constituents are 
found^: 
1. WITHOUT ELEVATION, AFFECTING BAROMETRIC PRESSURE. 
a. Upon the Ocean: 
No dryness, but considerable moisture; no elevation. 
But we do have : equability of temperature, coolness, and 
abundance of sunshine. Added to these is the continuous 
inhalation of air impregnated with salt, a feeble antiseptic, 
but present in great quantity. All these advantages com- 
bined serve to explain the benefits derived from long ocean 
voyages. 
2. At the sea-shore: 
Advantages all relative, to-wit: moderate moisture: rea- 
sonable equability of temperature; coolness or cold; sea- 
coast climates are dependent upon local shelter against 
cold or moisture-bearing winds ; their equability upon prox- 
imity of the G-ulf Stream and the equalizing influence of 
the moisture blanket. 
3. Far inland: 
Dryness on account of distance from large bodies of 
water; no elevation ; no equability of temperature; warm, 
cool or cold. Much depends upon absence of subsoil 
moisture, of atmospheric organisms engendered by cities 
of any size, and shelter from too active movements of the 
atmosphere,—the type of continental climates, where rela- 
tive dryness forbids equability of temperature. 
d. Islands. 
Equability of temperature; sometimes elevation (Sand- 
wich Islands); no dryness. Upon elevation depend rela- 
tive dryness and calmness—type of marine climates. 
2. WITH ELEVATION. 
Sufficient altitude insures dryness and coolness with the 
elevation ; no equability; abundance of sunshine. 
Though, as we have seen, not an absolute sine qua non, 302 
Original Articles. 
[Apkil, 1883. 
equability of temperature is desirable in connection with 
medium or high altitude, and that degree of dryness which 
together constitute a perfect aseptic atmosphere. Now, 
equability of temperature is coupled to moisture at sea- 
level, and is wanting at altitudes in the temperate zone. 
We also know that warmth and moisture decrease, or what 
amounts to the same thing, that coolness and dryness in- 
crease, with increasing altitude. It is clear, then, that if 
we wish to find, combined, elevation and dryness (with 
coolness), and equability, we must look fur an equatorial 
latitude and for high altitude. And why ? The warmth of 
southern latitudes means a high thermometrical reading 
throughout the year, even on an average; the degree of 
moisture is throughout a relatively high one, frequently 
approaching saturation. As it requires about three hun- 
dred feet of elevation to find a reduction in temperature of 
1° Fahr., and as it requires correspondingly high elevation 
to expand so much moisture, it follows as a maxim: The 
extreme ideal aseptic climate, in which altitude, with 
dryness and sunshine and coolness, is coupled to equability 
of temperature, is found in equatorial latitudes at very high 
altitude. 
Such a combination is found in the Andes, of South 
America, in places where local shelter against high winds 
exists, and wherever the number of inhabitants is not large 
enough to constitute a fresh breeding-ground for infectious 
germs. 
Such, then, is a general outline of the character and con- 
stituents of climates suited to the various forms of pul- 
monary consumption. 
As to what class of cases is suitable for one climate and 
what to another, there are rules applicable within certain 
limits, and of these I have given a general outline. 
As to the enumeration of the proper localities and sec- 
tions of country, in accordance with the facts presented, 
this does not come within the scope of this article. Neither 
is this the place to point out the points in diagnosis upon 
which to base your choice of climate. Tyndale.] 
Climate for Pulmonary Consumption. 
303 
We need to keep in mind that all cases need an aseptie 
climate (“ aseptic ” being a convenient term for expressing 
an ideal combination of dryness and equability and their 
consequences); that asepsis exists at altitudes and at 
sea-level; that dryness in its most absolute form (below 50 
per cent.) is found at more or less high altitude and is the 
most important constituent; that the constituents of dry- 
ness, equability and elevation exist in various proportions 
in different regions, forming so many degrees of aseptic and 
antiphlogistic influences, to which the various forms of 
phthisis can be relegated with benefit; that acute exacer- 
bations (fresh inflammations—the hemorrhagic, “ pneumo- 
nic ”) require primarily equability of temperature with 
calmness, because the co-operation of the opposite condi- 
tions produce acute inflammations of the air-passages, and 
secondarily increased dryness and elevation. 
As a general picture of the pathological conditions on 
the one hand and their requirements on the other, let me 
present the actual lesions and their remedies, upon which 
my antiseptic and antiphlogistic home treatment is based. 
The pathological picture consists of: 
1. A local process of destructive ulceration or conden- 
sation by infiltration, or both, in the lung tissue. 
2. General septicemia—chronic blood-poisoning. 
3. An anemic and enfeebled heart, of great frequency 
of action and weak of impulse. 
4. An anemic and half paralyzed stomach and intes- 
tines, anemic glands, furnishing secretions poor in fer- 
ments ; all tending to establish a vitiated digestion and 
assimilation. 
These four combined are the cause of a lowered vitality. 
Iu an aseptic and antiphlogistic atmosphere (dryness and 
equability), the local process in the lung and the septi- 
cemic condition meet with their proper remedy for arresting 
these destructive agencies and pave the way to repair. 
In the rarefied air of medium or high altitude, the en- 
feebled heart, weakened diaphragm and the stagnant di- 304 
Original Articles. 
[April, 1883. 
gestive functions are stimulated to renewed effort by the 
increased arterial pressure, consequent upon the lessened 
pressure of the air-column, and thus make possible repair 
of defective nutrition, and ultimately of the lung lesion 
itself. 
31 East Twenty-Second Street.