SUGGESTIONS REGARDING 
TEE MANAGEMENT OF PHTHISICAL MINTS 
AT HEALTH RESORTS. 
Read before the American Climatological Association, composed*of American 
physicians and surgeons, Washington, September 20, 1888. 
BY 
ISAAC HULL PLATT, M.D., 
Lakewood, New Jersey. 
REPRINTED FROM THE THERAPEUTIC GAZETTE, NOVEMBER, 1888. 
DETROIT, MICH.: 
GEORGE S. DAVIS, PUBLISHER. 
1888. SUGGESTION'S 
REGARDING THE 
MANAGEMENT OF PHTHISICAL PATIENTS 
AT 
HEALTH RESORTS. 
THIS paper is intended merely as a note 
calling attention to some mistakes which 
I have observed in the conduct of patients in 
search of health, presumably due to lack of 
proper instruction from their home physi- 
cians, and also to some measures of treatment 
which I have found useful in the cases of such 
patients. This statement will, I hope, serve 
as an apology for the lack of scientific method 
and completeness in what is to follow. 
The factors in the etiology of pulmonary 
phthisis are so many and so complicated that 
it is usually impossible to determine the pre- 
cise chain of causes which result in the 
disease. To remove a patient from the en- 
vironment in which he has lived, and in which 
he has contracted the disease, or developed a 
predisposition to it, and place him under 
conditions as far removed as possible from 
those under which he has been living, might 
very likely result in benefit, by removing the 
unknown cause of disease among the other 
conditions of the patient’s former life. But 
I 2 
from the fact that good may be done by this 
arbitrary method it must not be concluded 
that much more advantage might not arise 
from a judicious and rational use of the ele- 
ments of climate. 
The proper application of climatic treat- 
ment depends upon two things : first, the 
selection of the proper climate, and, second, 
the direction of the invalid’s life while away 
from home, so as to secure the greatest 
amount of good from the changed conditions. 
Dr. Knight has recently given us some good 
advice upon the former of the subjects, and 
it is of the latter which I wish to speak. 
For the past two years I have been so 
situated as to observe the doings of many 
invalids, sojourning away from home for 
their health ; I find that, as a rule, they come 
without any special directions from their phy- 
sicians, believing that the change of air will 
be a cure for their troubles, no matter how 
they conduct themselves. Or they come with 
certain directions from their physicians, which 
they follow implicitly, very likely under con- 
ditions which have altogether changed since 
the directions were given, and where they 
may do more harm than good. As an example 
of the latter class, I may cite the case of a 
lady who was told by her physician to go to 
Lakewood and take cod-liver oil, which she 
did. After about a month she consulted me. 
I found her in the third stage of phthisis, 
much emaciated, cough very severe, temper- 
ature 103° to 104° in the afternoon, and her 
stomach in such bad condition that she vom- 
ited every day. In spite of all which she 
continued conscientiously to take her cod- 3 
liver oil, and vomit it ; and, believing that 
exercise and pines were good for her, walked 
about two miles every day, to and from the 
pine woods. A week of rest from the cod- 
liver oil and the walking, with a little tonic 
and antipyretic treatment, restored her 
stomach to comparatively good condition, 
brought her temperature down to ioo° as the 
daily maximum, and rendered her tolerably 
comfortable. She was then sent home, as her 
disease was so far advanced that that seemed 
to me to be the best place for her. 
The most frequent errors which I have 
observed on the part of invalids have been 
the frequenting of hotel parlors, very likely 
close and overheated, during the evening, 
remaining ' within-doors, probably in their 
sleeping-rooms, during the daytime, overex- 
ertion, and the use of drugs which are unsuited 
to their condition, although, perhaps, proper 
enough when prescribed. 
If I understand the objects in a change of 
climate correctly, they may be classified some- 
what as follows : First.—The influence of 
the rarefied air of high altitudes, which has 
an undoubted beneficial effect upon properly- 
selected cases, probably by increasing respira- 
tory activity. Second.—The substitution of 
a purer and consequently more nearly aseptic 
atmosphere for that in which the patient 
has lived. Third.—In case the patient is a 
resident of a city, the opportunity of spending 
a greater portion of the day in the open air. 
Fourth.—The escape from the conditions 
under which the disease has probably devel- 
oped. Fifth.—The mental and moral stimu- 
lant of change per se. 4 
It will be seen that, with the exception of 
the first and last, they are negative ; that is, 
they are attempts to escape from unfavorable 
conditions to those less so. High altitudes 
seem suited to those cases retaining a certain 
amount of vigor, in which the heart is sound, 
and in which the disease has not progressed 
too far, and where the bronchitis or nervous 
irritability are not too great to endure the 
highly-stimulating atmosphere. Cases suited 
to this form of climatic treatment require 
little or no medicine, should remain as much 
as possible in the open air, should practise 
mountain-climbing, one of the most potent 
adjuncts to the expansive action of the rarefied 
air, stopping, of course, short of overfatigue. 
Under the second head, the obtaining of 
pure air, it would seem as though it ought to be 
unnecessary to protest against the supposition 
that pure air can be found in an overcrowded 
ball-room or in a close sleeping apartment, 
and yet experience proves otherwise. Closely 
connected with the subject of fresh air is that 
of exercise. In the city it is almost impossible 
to obtain such comparatively fresh air as 
exists there without what, for an invalid, is 
overexertion. He may take a drive of an 
hour or two, and, if strong enough, a walk. 
But as people do not care to sit on the front 
steps or in the back yards of their residences, 
the greater part of the time will be spent in- 
doors. The mere fact that in the country 
one can live an out-of-door life is, in my 
opinion, one of the greatest sources of benefit 
in climatic change. In the case of a person 
whose strength is not at all or but little im- 
paired by disease, it is well to combine exer- 5 
cise with the out-door life. Mountain-climb- 
ing, horseback-riding, tramping, tennis-play- 
ing, here have their place, but as a rule the 
matter of exercise is overdone, and I have fre- 
quently observed debilitated invalids squander- 
ing their little store of strength by overexer- 
tion. The problem in these cases is to continue 
the maximum of out-door life with the mini- 
mum of exertion. In the summer or a semi- 
tropical climate, where invalids can sit or lie in 
hammocks or on cots out of doors all day, the 
problem solves itself, but in colder climates 
in winter it requires some management. If 
I were designing a sanitarium or hotel at a 
winter resort, I should have it constructed upon 
the following plan : The house should stand 
upon a southern slope and, of course, face the 
south. Across the front should be a veranda, 
which, instead of being enclosed to form a 
sun-gallery, as is the usual custom, should be 
open to the south, but protected at the east and 
west ends by glass screens. If the veranda 
were of considerable length, I should in addi- 
tion place similar screens across it at inter- 
vals of twenty or thirty feet, to prevent any 
sweep of the wind along its length. Except 
in special cases, where the larynx or bron- 
chial tubes are extremely sensitive, an invalid 
could sit upon a veranda constructed in this 
fashion in the coldest weather; and even with- 
out any special construction, I have seldom 
been unable to find sheltered nooks where 
invalids could sit, even in midwinter, wrapped 
up as if for a sleigh-ride, if necessary, with 
perfect comfort and great benefit ; nor have 
I known any cases where harm has resulted. 
Those cases where the laryngitis or bronchitis 6 
is too severe for this treatment should go to 
a warm climate, if anywhere away from home. 
Patients should accustom themselves to sleep 
with open windows, which may necessitate 
having their apartments warmed at night. In 
short, they should remain in the open air as 
much as possible, thus carrying out the prin- 
ciple of Dr. Dettweiler’s sanitarium, where 
such excellent results are obtained. 
Under the head of the mental and moral 
effect of change arises the question of sani- 
taria. The discussion of the comparative 
advantages of sending patients to sanitaria 
or allowing them to select their own places 
of residence, I have left to my friend Dr. 
Kretzschmar, who has made a study of the 
subject, and is much more competent to speak 
of it than I. I will, however, suggest that while 
it is most certainly desirable in many cases 
that patients should be under close watch and 
their daily lives regulated in all their details, 
yet the close association with other invalids 
is very depressing in its mental and moral as- 
pect. However situated our patient may be, 
all that is practicable should be done to make 
him forget his illness and enjoy himself, thus 
giving him the benefit of a rational mind cure. 
In dealing with phthisis pulmonalis we are 
fighting against odds, and it is important to 
seize and hold every vantage-ground possible, 
and to bring into action every weapon which 
our therapeutic.arsenal supplies, and the fact 
of our having adopted the plan of climatic 
treatment is no reason for dispensing with any 
other means of combating the disease. 
With regard to the question of climatic 
treatment applied to phthisis, our patients 7 
may be grouped in three general classes: 
First.—Those who are merely threatened with 
the disease or, having developed some slight 
signs, do not suffer from much constitutional 
disturbance, pyaemia, or loss of strength 
and appetite. Second.—Those in whom the 
disease is more advanced, who have become 
to some degree emaciated and debilitated, 
who may be suffering from pyrexia or ano- 
rexia, in short, who are actually ill, and yet 
not beyond the hope that climatic change 
with judicious treatment will result in allevi- 
ation or arrest of the disease. Third.—Those 
cases where advanced destructive changes in 
the lungs, combined with evidences of rapid 
progress of the disease, show them to be 
hopeless, and render it improbable that change 
of climate will do sufficient in the way of 
alleviation to recompense them for the loss of 
home comforts. 
The first class consists of those cases of 
which I have spoken as most suitable for high 
altitudes and an out-door life. They should 
receive instructions to spend their time as 
much as possible in the open air and to take 
exercise suited to their strength, the best 
form of which, for those who are strong 
enough to endure it, is, undoubtedly, moun- 
tain-climbing, from its action in expanding 
the lungs. In these cases, as in all others, the 
place selected should be one where there 
is no stint of good, wholesome food. Beyond 
attention to these points this class of cases 
should not need much treatment, but they 
should be instructed to seek medical advice 
upon the first appearance of any new develop- 
ment. 8 
Of the third class of cases, those with 
advanced disease, it is unnecessary to say 
anything, as they are not proper subjects for 
climatic treatment. The intermediate class 
is the one requiring the most careful and 
judicious management. If it is decided to 
send a patient of this class away from home, 
it is essential in the choice of a place to con- 
sider not only the suitability of the climate to 
the patient’s condition, but the character of 
his proposed surroundings with regard to 
comfort. He should, of course, have as good, 
wholesome, and appetizing food as possible ; 
his sleeping apartment should be large and 
airy, should receive plenty of sunlight, and 
should be furnished with an open fireplace. 
The appointments and surroundings of the 
house which is to be his temporary home 
should be as cheerful and pleasant as possible, 
and should be furnished with spacious, sunny 
verandas. These seem like truisms, but they 
are none the less important, and none the less 
neglected. Good drives and a good livery 
are essential for patients who are not strong 
enough for much tramping, and are desirable 
for those who are. 
No place, however desirable in other re- 
spects, is suitable for these patients unless 
supplied with a reliable physician ; one to 
whom the home physician feels that he can 
confide the care of his patient ; for it seems 
sufficiently evident that a person suffering 
from a serious chronic disease should not be 
at a distance from good medical attendance. 
He should be instructed to report to the local 
physician upon his arrival, even if in no im- 
mediate need of treatment, in order that the 9 
latter may become acquainted with his history 
and general condition. 
The general management of patients at 
health resorts does not differ materially from 
the home treatment, except so far as it involves 
the use to their best advantage of the increased 
facilities. The main points to be observed 
are to obtain the greatest amount of fresh air, 
the fullest lung expansion, and the best possi- 
ble nutrition. Means to the attainment of 
these ends, together with the treatment of 
symptoms as they arise, is the writer’s idea 
of the proper management of phthisis. With 
regard to fresh air, the problem is the one 
already mentioned, to induce patients to re- 
main in the open air without tiring themselves 
by overexertion. It takes some little time 
to make people believe that they can sit in the 
open air in cold weather without taking cold, 
but when they once try it, properly protected 
from wind and cold, they are usually so much 
pleased with the result as to require no further 
urging. I am in the habit of keeping my 
phthisical patients out of doors as many 
hours of the day as possible, of having them 
sleep with open windows, and instructing them 
to allow the windows of their chambers or 
living rooms to remain open whenever they 
are not occupied, to allow of thorough venti- 
lation. This is the nearest approach to 
an out-door life that I have been able to 
bring about, and I have been well pleased 
with the results ; but a plan by which a con- 
tinual out-door life can be led, without too 
much exposure, is undoubtedly a desideratu?n. 
Lung expansion can be best accomplished 
in those cases where the patients are strong 10 
enough for mountain-climbing and other 
forms of active exercise ; but, unfortunately, 
few of our patients are capable of the exertion, 
and then our last expedient is to fall back 
upon passive expansion by means of the 
pneumatic cabinet, or what I regard as equally 
efficacious and prefer upon the score of sim- 
plicity and cheapness, Dr. S. Solis-Cohen’s 
modified Waldenberg compressed-air appa- 
ratus. This apparatus I have combined with 
a slight modification of Semple’s atomizing 
inhaler, by means of which an exceedingly 
fine nebulized fluid is suspended in the com- 
pressed air and inhaled with it. In this 
manner I believe that a fluid can be carried 
farther into the air-passages than by any other 
of which I know. 
To accomplish the best possible nutrition 
of our patients is undoubtedly the most im- 
portant indication of treatment, but one of 
the most difficult to fulfil. Of course, the first 
thing to be attended to is to see that the 
table fare is good, wholesome, nutritious, 
and appetizing. If insufficient nutrition is 
accomplished by this means, it must be sup- 
plemented by milk or milk and beef powder, 
or one of the reliable preparations of beef 
peptinoids, taken between meals. If this can- 
not be persisted in, owing to gastric catarrh 
or indigestion, resort should be had to gavage, 
practised twice or thrice daily, and when 
there is much gastric catarrh lavage once a 
day. Lavage and gavage undoubtedly form 
our most powerful means of increasing nutri- 
tion, and a case seldom occurs where they 
are not well borne and the results well marked. 
In any case of forced nutrition, however, it 11 
is necessary to give the digestive organs a 
few days’rest occasionally when they show 
signs of fatigue. In regard to gavage, I find 
it much more easily borne and equally effi- 
cacious when performed with the small short 
tube with a forcing-bottle as described in 
Dujardin-Beaumetz’s “ New Remedies,” than 
when the stomach-tube is used.