[Reprinted from THE CLIMATOLOGIST, September, 1891.] 
THE PERSONAL EQUATION IN THE TREATMENT 
OF PHTHISIS.1 
By S. E. SOLLY, M.D., 
COLORADO SPRINGS, COLORADO. 
The influence that the conduct and temperament of the con- 
sumptive exert over the progress of his disease is the question 
that I desire to bring to the attention of this association. We all 
of us doubtless agree that the amount of prudence and intelligence 
shown by the invalid in the care of his case greatly modifies the 
results. Further, that his general physique and his temperament 
are important elements in determining improvement or deteriora- 
tion. Nothing, however, has been done, so far as I can ascertain, 
to demonstrate by statistics what are the proportionate influences 
of wisdom and unwisdom, of the quality of the physique, and of 
the special kind of temperament. The difficulty in correctly 
classifying each case and the difference in definition, and in read- 
ing the signs of each quality, among the various observers, has 
doubtless stood in the way of such attempts being made, and at 
the best it is to be admitted, in dealing with many cases, that a 
large margin must be allowed the exact figures given for the pre- 
cise influence of such factors as conduct and temperament. It is 
only when the main points are agreed upon, the material plenti- 
ful, the observers many, and their opportunities of judging of 
these personal matters frequent and scattered over a good portion 
of the period of illness, that such facts can be arrived at. It is 
not the consultant who sees the patient once or twice, and is 
ignorant of his daily history, who can determine how far over- 
exercise or sloth, apathy, or worry, lack of physical resistance, or 
excess of reaction, has been displayed during the months or 
years of the sickness, so as to bring the patient correctly under 
the special denominations used in the classifications which follow, 
1 Read before the Colorado State Medical Society, June 17, 1891. 2 
but it is for the physician in charge to furnish the facts upon 
which such matters can be determined. 
Admitting that it is possible to produce a rough scheme of 
classification out of elements so indefinite and complex, and then 
to demonstrate the influence of each class, it may be urged cui 
bono f The answer is that, although we are probably correct in 
our general common-sense views of these subjects, and we usually 
influence our cases so as to mitigate the various evils arising from 
the different elements, yet, although it is well to believe rightly, it 
is still better to know correctly, even though in each case the con- 
sequent treatment be the same. Further, our patients will hearken 
to us the more, when we can speak to them to the effect that the 
percentage of improvement is much greater among the wise in- 
valids than among the foolish who perish by their own folly, in the 
proportion shown by the statistics of so many thousand cases. 
The physician, also, if he knows the relative percentage of danger 
that lurks in the special physique or temperament of his patient, 
is forewarned and so forearmed, and thus can shape his treatment 
and his prognosis with greater accuracy. 
With these objects in view I have further analyzed the 141 
cases of phthisis treated by me in Colorado, which I reported 
to the Climatological Association last September, and now pre- 
sent the resulting tables for your consideration. The number of 
cases are too few to be able to found upon them absolute proof 
of any of the points inquired into ; and these statistics can be taken 
only as in a greater or less degree foreshadowing what is the 
nature of the truths to be discovered by longer and ampler in- 
vestigations. As the whole question of the value of these figures 
rests upon the quality of the material on which they are based, 
and the opportunities enjoyed by the observer for forming his 
conclusions, I shall begin with a resume of the previous analysis 
of the 141 cases before taking up the special one that I now desire 
to bring before you. 
These cases - are from the records of my practice in Colorado 
Springs during the past sixteen years, and were taken as they 
were able to be followed up accurately to date. In order to 
allow a reasonable time to elapse to judge of the results, none 
were taken whose first visits were paid less than two years before 3 
the report was made, and in most of them many years ago. The 
number was limited to 141 for comparison with a like number 
treated in the Alps and reported on by Dr. C. Theodore Williams. 
The cases were not in any way selected, but as the history of any 
one was completed it was put in the tables, until the required 
number was reached. Although not giving a continuous record, 
yet taken as they were at random as regards results, and being 
widely scattered over the period of my practice, as the dates will 
show, they may be considered to give a fair average sample of it. 
The results of each case can be relied upon as known to me and 
not merely inferred. In the analysis I followed closely the plan 
of Dr. Williams, and gave each case under the same headings, 
viz.: Number of case; name; sex; date of first visit; nature 
and extent of disease-, length of illness; family predisposition; 
haemoptysis ; length of residence. Next follows the result under the 
various headings of: General results; weight; local results ; chest 
circumference; notes. The opinion that the results shown by 
these cases are, in spite of their fewness, average ones is shown by 
their close resemblance, where the quality of the cases was alike 
to those of all other observers which I could obtain, and which I 
present further on. I have confined myself, so far as possible, to 
practical conclusions and the main points, omitting details for the 
sake of clearness and brevity. The diagnosis of the cases in 
almost all instances was confirmed by several physicians, and in 
the later cases the presence of bacilli in the sputum was demon- 
strated. 
Those which are put down as cured were those in whom all 
symptoms, both local and general, had disappeared, and who were 
known by me personally, or through their physicians elsewhere, 
to be in good health within a month or so of the time of making 
the report. That occasionally, at least, all detectable signs dis- 
appear, even in cases where marked cavities have existed, is the 
fact; and within the past week I examined with a colleague, and 
passed for life assurance as perfectly sound, a gentleman in whose 
paper we detailed the well-authenticated history of rapid phthisis 
and a considerable cavity, which had brought him to Colorado 
eighteen years before. The other divisions of results were greatly 
improved, improved, worse, and died. The greatly improved had 4 
apparently perfectly recovered, except for some remaining evi- 
dence in the lungs of past disease, or slight partial disability in 
general health. The improved were those in whom the disease 
was in a state of arrest, or slowly improving; in whom the ten- 
dency to death was apparently averted ; in whom there might have 
been some advance of disease since coming; and in whom there 
were still some local or general evidence of disease; but of whom 
it was fair to say they were improved- by their residence in 
Colorado. The number grouped under the heading worse were 
few, as in most cases the time of observation being prolonged 
they had terminated in death. Under the head of died are all those 
who died of the disease in Colorado or elsewhere. For the pur- 
pose of more ready reference and comparison I have also grouped 
the results under two headings only, viz : cured and benefited, 
benefited including the first heading cured, as well as the greatly 
improved and improved. 
Sex.-There were 35 females and 106 males. 
Condition of Life.-Of all sorts, but none in actual want 
or poverty. 
Age.-Females, average age 23 years. Males, 30.7 years. 
Date of First Visit.-Usually within the first few weeks of 
residence. 
Length of Illness.-This was the period between the ap- 
pearance of the first symptoms and the first visit. Average length 
of illness: Females, 19 months. Males, 24 months. 
Heredity.-Present in 57.14 per cent, of the females, and in 
56.6 per cent, of the males, or 58.1 per cent, of the total of 141 
patients. There was more or less benefit in 70; i. e., 73 per cent, 
of the hereditary cases, (Dr. Fisk's 100 cases, referred to later, 
showed nearly the same, viz., 73 per cent). These are a little above 
the average improvement among the total number, which was 68 
per cent., suggesting that perhaps the knowledge of heredity made 
these invalids take earlier and better care of themselves than those 
wTho, not having this warning, were slow to believe in the serious 
character of their indisposition. 
Haemoptysis.-Occurred in 55.31 per cent. Recurrence took 
place in 12.76 per cent, of the whole 141 after coming to Colo- 
rado, that is, in 21.79 per cent, of those who previously spat 5 
blood. 64.1 per cent, of all who had haemoptysis were benefited, 
which is somewhat less than the total average of improvement. 
Pyrexia was more or less present in 56.73 per cent., of whom 
only 60 per cent, improved, which was decidedly below the ave- 
rage improvement. 
History and Nature of Cases.-5 had pigeon breast; 2 
syphilis; 3 heart displaced; 3 marked cardiac dilatation ; 1 old 
mitral regurgitation; 1 asthma; 20 tuberculosis (besides pulmo- 
nary), viz., 3 anal fistulae, 2 of hip, 3 aural, 2 of testicle, 2 renal 
(lardaceous), 2 glandular (cervical), 7 laryngeal (unmistakably 
tuberculous); and besides these, 13 had marked symptoms of 
laryngeal congestion, with more or less aphonia, which in several 
suspiciously suggested early tubercular deposit. Of the 7 un- 
doubted cases of tubercular laryngitis 2 improved and 5 died, 
giving of improved 28.57 per cent. Of these 7 in all but one there 
was, at least at first, some improvement and healing of ulceration, 
and in some the ulcers remained healed till within a few weeks of 
death. Of the 13 dubious and the simple chronic laryngitis cases 
61.53 per cent, improved. 
State of the Lungs.-43.97 per cent, were in the first stage or 
that of tuberculization, 34.47 per cent, in the second or that of soft- 
ening, and 21.27 per cent, in the third-that is, with cavities-and 
16.3 per cent, had both lungs affected. In 83.68 per cent, one 
lung only was diseased. Of these the right was affected in 42.55 
per cent., the left in 41.13 per cent. Of the 62 cases in the first 
stage, 16 had signs limited to one apex, all of whom improved. 
17 were limited to both apices; of these all but 3 improved; one 
of the 3 would probably have improved had he not gone home 
too soon ; 4 had more or less tuberculization scattered through 
both lungs. 
Length of Residence.-This does not convey an accurate 
idea of what was the length of time needed to effect permanent 
improvement or a cure, because so many invalids make their per- 
manent residence in Colorado, as they often find opportunities to 
engage in work or business, and always pleasant society, and a 
climate in which they can live agreeably all the year round. 
Returned Home.-41.84 per cent, left Colorado, of whom 
61.44 per cent, are still to-day in the improved class-less than 6 
the average improvement-while of those who remained in Colo- 
rado 82.76 per cent, are improved. This would show that several 
more of those who left would have improved if they had remained 
longer. While of those who stayed some undoubtedly could have 
left in safety-19 cases, for instance, being evidently cured. I 
believe it may be assumed that 50 per cent, of those who come 
with phthisis to Colorado may in a longer or shorter time return 
without danger to their homes unless the surroundings and attend- 
ant circumstances to which they return are unhygienic. My obser- 
vations in this regard corroborate the opinion of Weber, Williams, 
and others, that patients cured at an altitude have at least as good 
and probably a better chance of keeping well at home than those 
cured at or near sea-level. 
Gross Results.-Of the total number, the percentage benefited 
was 67| per cent., and cured 33J per cent.; while in the first stage 
alone 58 per cent, were cured and 87 per cent, benefited. In the 
second and third stages combined 14 per cent, were cured, and 52 
per cent, benefited. 
For the purpose of showing that, although the number of cases 
is small, one is justified in believing that they bear a close resem- 
blance to the results that would be obtained from a much larger 
number, and are a fair sample of the results of most of the cases 
treated in high climates which have been reported upon, I offer 
for your inspection a table that is published in my article on 
Climate, in Hare's System of Therapeutics, giving the results of 
treatment in high climates, gathered from all the reports I was 
able to obtain. It will be noticed that the results are grouped 
for the better comparison under two headings only, namely, cured 
and benefited. Of the six observers, the first three, viz: Drs. 
Weber, Williams, and Johnson are consulting physicians who 
selected the cases and sent them to an altitude for treatment; and 
the last three, Drs. Denison, Fisk, and myself are resident phy- 
sicians who had no control over the selection of the cases, and 
had to make the best of the material we received, many of our 
patients having come on their own judgment, or on the advice of 
physicians unacquainted with the principles of climatology. This, 
probably, accounts for what the original records would show, that 7 
the quality of the cases treated by the last three observers was 
inferior; and, therefore, the gross results not as good as those of 
the first three. 
Table I. 
Stage. 
Number. 
Per cent. 
State of lungs before residence 
in Colorado. 
Cured. 
Greatly 
improved. 
Improved. 
Worse. 
Died. 
Total. 
1st 
62 
43.97 
25 had right lung alone affected. 
13 
7 
3 
- 
2 
25 
21 had left lung alone affected. 
15 
3 
- 
- 
3 
21 
16 had both lungs affected. 
8 
4 
1 
1 
2 
16 
Totals 
36 
14 
4 
1 
7 
62 
2d and 3d 
79 
56.02 
30 had right lung alone in 2d 
and 3d stages. 
5 had right lung in 2d and 3d 
8' 
6 
6 
1 
9 
30 
stages, and the left in the 1st. 
28 had left lung alone in 2d and 
- 
1 
- 
- 
4 
5 
3d stages. 
9 had left lung in 2d and 3d, 
2 
5 
8 
- 
13 
28 
and right in 1st stage. 
7 had both lungs in 2d and 3d 
- 
2 
1 
- 
6 
9 
stages. 
1 
- 
1 
1 
4 
7 
Totals 
47 
28 
20 
3 
43 
21 
■ * 
<D 
'fl 
rO 
fl 
g 
State of lungs in 2d and 3d 
"S 
► 
o 
d 
m 
-• 
bo 
a 
OQ 
a 
a 
- 
s 
Pm 
stages separately. 
fl 
o 
£ 2 
& 
J 
O 
£ 
2 
o 
H 
3d 
30 
21.27 
13 had right lung alone affected. 
1 
3 
3 
- 
6 
13 
14 had left lung alone affected. 
- 
5 
1 
- 
8 
14 
3 had both lungs affected. 
- 
- 
1 
- 
2 
3 
Totals . 
1 
8 
5 
- 
16 
30 
2d 
49 
34.75 
22 had right lung alone affected. 
7 
4 
3 
1 
7 
22 
22 had left lung alone affected. 
2 
2 
8 
- 
10 
22 
5 had both lungs affected. 
1 
- 
- 
1 
3 
5 
Totals 
10 
6 
11 
2 
20 
49 8 
Table II.-Elevated climates (4500 feet and upwards). 
ALL STAGES. 
Reported by 
No. of cases. 
Cured. 
Benefited. 
Where treated. 
1. Dr. Herman Weber, 
106 
36 per cent. 
75 per cent. 
Swiss Alps. 
2. Dr. Theo. Williams, 
141 
41 " 
75 " 
u 
3. Dr. H. A. Johnson, 
19 
37 " 
79 " 
Colorado. 
4. Dr. Charles Denison, 
, 202 
37 " 
80 " 
u 
5. Dr. S. A. Fisk, 
100 
35 
67 " 
u 
6. Dr. S. E. Solly, 
141 
33| " 
67| " 
u 
Beported by P. c. 
of eases. 
Cured. 
Benefited. 
Where treated. 
1. 
Dr. Herman Weber, 
66 
51| per cent. 
64 per cent. 
Swiss Alps. 
2. 
Dr. Theo. Williams, 
65 
63 " 
30 " 
<< 
3. 
Dr. H. A. Johnson, 
47 
44£ " 
78 " 
Colorado. 
4. 
Dr. Charles Denison, 
37 
75 
92 " 
<< 
5. 
Dr. S. A. Fisk, 
42 
66 " 
90j " 
u 
6. 
Dr. S. E. Solly, 
44 
58 " 
87 " 
<c 
FIRST STAGE. 
1. Dr. Herman Weber, of London, reported, in the London "Lancet," May 
12th, 1888, 106 cases that were sent by him to the Swiss Alps. They were of 
a selected class only in the sense that they belonged to the well-to-do classes, 
and were, therefore, persons who were able, and generally intelligent enough, 
to take care of themselves, and had previously been in good condition, and 
were chosen as suitable cases for altitude treatment. 
2. Dr. C. Theodore Williams, of London, reported on May 8th, 1888, to the 
Royal Medico-Chirurgical Society of London (Vol. 71 of the "Transactions"), 
the results, etc., of the treatment at an altitude of 141 cases, all but four 
having been resident in the high Swiss Alps. The four had been in Colorado, 
New Mexico, and the South African Highlands. They were all of a similar 
class to Dr. Weber's patients, and carefully selected for the climate they were 
sent to. 
3. The late Dr. Hosmer A. Johnson, of Chicago, reported to the American 
Climatological Association, September, 1890, 25 cases of phthisis that went to 
the Western Country. Of these I found that 18 came to Colorado, and 1 to 
Western Kansas, where the climate and elevation are very similar, the re- 
maining 6 going to California. The exact stage of the disease was not given, 
but the descriptions are such as to justify their separation in the way given 
here. The social condition of the patients, I believe, was favorable. 
4. Dr. Charles Denison, of Denver, in his work entitled " Rocky Mountain 
Health Resorts" (published in 1881 by Houghton, Mifflin & Co., Boston), 
reports on 202 cases treated by him in Colorado. He did not put any under the 
head of cured, but of much improved he reports 47 per cent. He estimates, 
however, that a deduction of 10 per cent, should be made from this to arrive 
at the approximate number of cured ; and as this brings it in close resem- 
blance to the other figures, it is probably near the truth ; the unusually high 
percentage of benefited in the cases of Drs. Denison and Johnson are proba- 9 
bly due to the subsequent histories of the cases not having been traced for as 
long a period as by the other observers. 
5. Dr. S. A. Fisk, of Denver, in his address as president of the Colorado 
State Medical Society, reported in June, 1889 (see "Transactions"), 100 
cases treated by him in Colorado. Like Dr. Denison, he does not give any as 
cured, but as much improved. From recent correspondence with him, I learn 
he estimates that a deduction of 15 per cent, from his 50 per cent, of those 
much improved would give about the proportion of cures. 
Temperament.-Looking carefully through the original notes 
of my 141 cases, and recalling mental pictures of each individual, 
their mental and physical peculiarities, and the tendencies exhi- 
bited in their reactions to their surroundings, I find it compara- 
tively easy to range them under the several temperaments which 
I have described in a paper read by me before the Denver Medi- 
cal Association (" Journal of the American Medical Association," 
June 8,1889). In order to explain my views upon temperament, 
I quote the following extracts from this article:- 
"The ancient writers upon our art endeavored to explain these different 
underlying forces as due to certain humors; the history and description of 
their views is too well known for me to recapitulate them here. We moderns 
have accepted and must still accept much of their nomenclature, but we 
have rejected their explanations of the causes of the several temperaments, 
without seriously concerning ourselves with finding new ones. A recent 
writer in 'The Medical Record' (Aug. 4, 1888), in reviewing two essays 
of Hellwig upon temperament, says : ' Physicians learn, consciously or un- 
consciously, to recognize temperamental differences, and to suit both manner 
and medicine to the fact.' He further goes on to remark that the best defi- 
nition has been given by Muller, who essentially describes temperament as 
'the reaction of the individual to his environment.' In the same article 
Hellwig's tabular definition of temperament is presented, which is founded 
on the view that it is the varying strength of the reception of an impression 
and of the reaction of the individual to it that distinguishes the temperament. 
Hellwig's Table. 
Temperament. 
Reception. 
Reaction. 
Choleric. 
Strong. 
Strong. 
Sanguineous. 
Strong. 
Feeble. 
Melancholic. 
Feeble. 
Strong. 
Lymphatic. 
Feeble. 
Feeble. 
"Darwin Hudson (Johnson's Encyclopaedia) defines temperament ' As a 
mixture or tempering of the essential elements of the body, whose excess or 
variable quantity determines the chief characteristics of mind or physique.' 
" What are the essential elements of the body ? In the various definitions 
of temperament that are to be found there is always a reference to some such 
undefined factors as being at the foundation of the problem of temperament. 
Before we can build up any reasonable scheme of temperament we must clear 
off the wrappings and expose the root of the matter; in short, we must ex- 
plain what is meant by the essential elements of the body. 10 
"What is the essential quality of living matter; its power of renewal, 
that is, nutrition ? When a portion of elementary living matter, which we 
term protoplasm, becomes separate and individual, as in an amoeba, what is 
the essential quality of its individuality ? It is its capacity to receive an im- 
pression from, and its power to react to, its environment. This quality is ex- 
ercised through nerve force. It is true that we cannot detect nerve structure, 
as we know it, in the dawning life of the individual, but though the localized 
and visible machinery, which we term nerve-tissue, is not apparent, the real 
essential element of nerve force is undoubtedly diffused through the general 
mass of the individualized protoplasm, conferring on it the capacity to re- 
ceive impressions, at least in an elementary manner. 
"The first reaction of the separate piece of protoplasm to the reception of 
an impression received from its environment would appear to be the forma- 
tion of a cell wall, whereby it reacts to external pressure by hardening itself 
superficially. Thus it defines its individuality and protects itself in the exer- 
cise of its essential function of nutrition, which function consists of the im- 
porting of raw material for food, and the manufacture of it into the structure 
of the individual. The first evidences of a nervous system show that it is 
used to receive and react to impressions made from without; the passing food 
is drawn in when reflex action is developed by the impression received from 
without. 
" Thus we see that a living individual has two essential qualities, nutrition, 
whereby it lives, and innervation, whereby it individualizes itself, both 
essential to each other. 
" The evolution of nutrition is briefly thus : Simple absorption and assimi- 
lation of food by the whole mass of protoplasm and the general excretion of 
its waste ; then the localization of digestion in a stomach ; next the carrying 
of the digested nutriment to remote parts by lymphatic vessels; then this 
circulatory process elaborated into a vascular system, with its heart or pump. 
Then a portion of the clear, white lymph gradually changed into red blood, 
then the chemical changes producing bodily heat. Thus the circulatory sys- 
tem of nutrition passes from a lymphatic, cold-blooded stage to the warm, 
red-blooded form of the mammal. 
" The nervous system beginning in the sympathetic form, next the motor, 
then the sensory up to its highest elaboration in the brain of man, with its 
power of receiving impressions without bodily contact, by means of thought. 
"Through innervation comes the power of reception of impressions made 
upon the individual. 
"Through nutrition the power of reacting to such impressions, the latter 
being exhibited immediately through its circulatory system, which in man 
in its most important form, with respect to the power of reaction, is sangui- 
neous. 
"The essential difference in reception is in speed, and, therefore, the two 
chief divisions are into quick and slow. Quick reception may be best called 
'nervous;' slow, 'phlegmatic.' 
" The essential difference in reaction is in strength, therefore the chief divi- 
sion is into strong and weak. Strong reaction may be called ' sanguineous ;' 
weak, 'lymphatic.' 
" Thus temperaments should be primarily divided into those of quick recep- 
tion, nervous ; and those of slow, phlegmatic ; those of strong reaction, san- 
guineous, and those of weak, lymphatic. But as each individual has both 
qualities of reception and reaction, so each quality should be expressed in the 
name of each temperament; therefore, taking these four in their main varie- 
ties of combination, we have eight different temperaments, the first of the 
names signifying the most pronounced of the two qualities as exhibited in the 
temperament. 11 
Temperament. 
Reception. 
Reaction. 
1. Nervo-sanguineous. 
Quick. 
Strong. 
2. Nervo-lymphatic. 
Quick. 
Weak. 
3. Phlegmo-sanguineous. 
Slow. 
Strong. 
4. Phlegmo-lymphatic. 
Slow. 
Weak. 
5. Sanguineo-nervous. 
Quick. 
Strong. 
6. Sanguineo-phlegmatic. 
Slow. 
Strong. 
7. Lympho-nervous. 
Quick. 
Weak. 
8. Lymplio-phlegmatic. 
Weak. 
Weak. 
"No mention has been made of a normal or balanced temperament, as it 
was styled by Galen, it being an ideal not met with in real life. The nervo- 
sanguineous, or perhaps rather the sanguineo-nervous, would be nearer to it, 
that is with respect to quality, though it may not be in regard to quantity. 
That is, it is normal when the reception of an impression is in proper 
degree to the cause. For instance, a normally nervous person, when angered 
with sufficient cause, would not let his passion run riot, but would fit it to the 
occasion, while the abnormally nervous person is thrown into a passion by a 
trifle or is over-excited by trifles. The normally sanguineous individual, 
when affected by disease or injury, responds by vascular excitement and per- 
haps even inflammation, sufficient to defend his tissue or repair the damage, 
and no more. The phlegmatic temperament is always behindhand in its work 
of reception, and is evidently a type of arrested evolution at the stage when 
the sympathetic and motor systems are well developed and the sensory yet 
incomplete. 
"The lymphatic temperament always lags behind in reacting to the stimulus 
conveyed to it through the nervous system, and may be looked upon as a type 
of arrested evolution at a stage when the change from white, clear, cold lymph 
to red, thick, hot blood is going on, but is not fully accomplished. 
" An individual born with a certain temperament can undoubtedly modify 
it considerably by force of will and education. Circumstance or disease will 
also modify, and permanently or temporarily change the relative force of its 
phenomena. Change of climate often exaggerates or diminishes certain of 
its manifestations. As physicians the impression made upon temperament 
by disease is what chiefly concerns us. The reception of the impression made 
by the invasion of the body by disease is quick or slow, excited or calm, ac- 
cording to whether the individual is of the nervous or phlegmatic, and reac- 
tion is strong or weak as he is of the sanguineous or lymphatic temperament. 
Knowing the temperamental type of a patient, we can explain and allow for 
many of the incongruities of pulse, temperature, and nervous phenomena that 
we meet with. 
" How are we to diagnose the temperament ? Is the individual plethoric 
or anaemic in appearance ? Finely chiseled in feature and small-boned, or 
coarse in outline and large-boned ? Is he mentally quick or slow in conversa- 
tion, and nervous or phlegmatic under our examination? Is his view of his 
case exaggerated in its despondency or cheerfulness ? Does his history show 
a tendency to inflammation or to passive congestion ? Is he inclined to fever? 
Does he react quickly to cold ? Are his feet usually warm ? These, sugges- 
tively, are some of the observations and questions which will give us the 
material for classifying a patient's temperament. 
" The old classification of temperaments into hot and cold suggests the san- 
guineous or hot and full-blooded, the lymphatic the cold and thin-blooded. 
The old forms of dry and moist are suggestive of the nervous and phlegmatic, 
high nerve tension and dryness being necessarily allied, while moisture and 
low tension are equally inseparable. 
" If Hellwig's table and the one herewith presented are compared, the first 
four temperaments are identical except in name. The nomenclature suggested 12 
is somewhat cumbersome, and if it could be lightened without losing the ad- 
vantage of the name conveying the meaning and the dual nature of the tem- 
perament, it would doubtless be better. The chief advantage, if the previous 
premises are accepted, is that the meaning and the name are linked together, 
instead of, as in other titles, the meaning being open to various interpretations 
and merely suggestive of ancient physiological errors and not of the under- 
lying and causative physical facts. 
" These definitions admit of subdivisions if needed to describe particular 
temperamental peculiarities, as in the nervous system when the mental, motor 
or sympathetic systems appear most prominent in excess or deficiency of 
action; or with respect to special phenomena of nutrition as exhibited in the 
working of a special organ, as the liver, stomach, etc. All these, however, 
will be found to ultimately range themselves under the divisions here given. 
Diatheses which are pathological temperaments, and excesses or deficiencies 
of function dependent upon pathological changes, are not here considered." 
Following the classification thus laid down, I find that the 141 
cases range themselves with respect to their temperamental pecu- 
liarities, as follows: nervo-sanguineous, 31; sanguineo-nervous, 
29; nerve lymphatic, 25; lympho-nervous, 19; phlegmo-san- 
guineous, 13; sanguineo-lymphatic, 3; lympho-phlegmatic, 12. 
Grouping together all those with a nervous tendency, we find that 
there are 104 such cases, that is about 74 per cent., while of the 
phlegmatic there are but 37, or 26 per cent. Taking now all the 
sanguineous, which term may be misleading owing to its old 
meaning, and therefore may, perhaps, better be spoken of here 
as those with a strong physique, we find that there were 84 
(about 60 per cent.); while of the lymphatic, which again, owing 
to the old application of the term, we may perhaps better distin- 
guish as having a weak physique, there were 59, which is about 
41 per cent, of the whole number. Dividing them still further, 
we find that, taking those of a nervous temperament and a strong 
physique, there were 60, that is 42J per cent.; while of the 
nervous, with a weak physique, there were 44, about 31 per 
cent.; while of the phlegmatic temperament 22 (15| per cent.) 
possessed a strong physique, and 15 (that is 10J per cent.) had a 
weak one. It would, therefore, appear that of the 141 persons 
who had phthisis, the greatest number were of a nervous tempera- 
ment ; and that there were more of a strong than a weak physique. 
It is impossible to show whether the nervous and strong are more 
subject to consumption than the phlegmatic and weak, without 
knowing what is the normal percentage of the various tempera- 
ments among the whole population from whom these people came. 13 
This, however, we may remember, that, among the American 
people to whom most of the persons belonged, the nervous tem- 
perament is believed to predominate; but this throws no light 
upon whether those of strong or weak physique are most open to 
attack by phthisis. It may be there are more people of a strong 
physique than a weak, in the population generally. We, how- 
ever, must leave this interesting question for more extended in- 
vestigation, and turn to the influence of temperament and phy- 
sique upon the course of the disease. 
This is exhibited in the following table:- 
Table III.-Proportion of cured and benefited in the different 
temperaments. 
Temperament. Physique. 
Cured. 
Benefited. 
Cured. Benefited. 
Phlegmatic, Strong, 
" Weak, 
59 per cent. 
13 " 
86 per cent.' 
47 " 
Ui 
per cent. 70 per cent. 
Nervous, Strong, 
" Weak, 
45 per cent. 
18 " 
68 per cent. "1 
62 " J 
>37 
" 60 " 
Strong physique, both nervous and phlegmatic 
49 
" 84 " 
Weak physique, both nervous and phlegmatic 
19 
" 57 " 
IN ALL STAGES OF THE DISEASE. 
We find from this table that the greatest number cured and 
benefited are among those possessing a strong physique irrespec- 
tive of their temperament, while contrasting temperaments the 
phlegmatic are more benefited than the nervous, providing they 
each possess a strong physique; but on the other hand when the 
physique is poor those with a nervous temperament show a greater 
power of resistance to the disease than the phlegmatic. 
Wisdom and Unwisdom.-To find out in a measure what 
amount of influence tlie prudence and common sense of the indi- 
vidual exerted over the course of the disease, I went carefully 
over the records, and marked down each person as wise and 
unwise in the matter of taking care of himself, and then found 
the percentage of the 141 cases. 86, i. e., 61 per cent., were wise, 
and 55, that is 39 per cent., were unwise. I then proceeded to 
find out the percentage of wisdom in the various temperaments, 
and these are shown in the appended table. 14 
Table IV.- The proportion of wisdom among the various 
temperaments. 
Wise. 
Wise. 
Phlegmatic . . . 
1 Strong 82 per cent. 
I; Weak 53 " 
J- 76 per cent. 
Nervous 
r Strong 62 per cent. 
L Weak 57 " 
[-60 " 
Strong, both nervous 
and phlegmatic . . 
67 " 
Weak, both nervous and phlegmatic . . 
56 " 
From this it appears that the greatest amount of wisdom was 
among those of a phlegmatic temperament, and there was more 
among the strong than the weak, and that therefore those of a 
phlegmatic temperament and a strong physique were by far the 
most apt to show wisdom. 
Finally, I found the percentages of cured and benefited among 
the wise and unwise in the first stage cases only, then in the 
second and third stages combined, and, lastly, in all stages 
together, heading each table with the average percentage for the 
total 141 cases, so as to show the relative effect of wisdom upon 
the results. 
Table V.-Proportion of cured and benefited among wise and 
unwise in the different stages. 
Cured. 
Benefited. 
Total 141 cases . 
. 58 per cent. 
87 per cent. 
1st stage . . . - 
Wise cases . . 
. 68 " 
91 
• Unwise cases . . 
. 31 " 
75 " 
2d and 3d stages 
- Total 141 cases . 
. 14 per cent. 
52 per cent. 
combined . . 
Wise cases . . 
. 21 " 
59 " 
-Unwise cases . . 
. 2 " 
41 " 
All stages com- 
Total 141 cases . 
. 33 per cent. 
68 per cent. 
bined . . . 
Wise cases . . 
. 42 " 
77 " 
• Unwise cases . . 
. 11 " 
51 " 
From these tables it would appear that among the wise the per- 
centage of cures in all stages was a third more than the average, 
and nearly four times as many as among the unwise. The per- 
centage of benefited was similarly higher, though in a less degree. 
Among the first stage cases a like difference prevailed, but in both 
the cured and benefited in a degree about 50 per cent, less; while, 
taking second and third stages, and omitting the first stage cases, 15 
the difference was similar, but among the cures very much more 
marked in this than in the other tables. This would indicate that, 
although imprudence was a bad thing in an early stage, it was far 
more serious in an advanced one, in which an act of folly was 
often irremediable. The superiority of results among the prudent 
serves to explain in a measure the better reports obtained from 
sanatariums than those from open resorts, which is demonstrated 
by my tables in the article upon " Climate" already referred to, for 
doubtless the discipline and example enforced in the sanatariums 
turn many of the would-be unwise into the class of wise invalids. 
Conclusions.-If, as would appear from the comparison made 
with the other reports of cases treated in high climates, that these 
141 cases represent the average qualities of such cases, then the 
truths indicated by these inquiries are that the qualities which 
most aid the consumptive in recovery are, first, strength ; second, 
wisdom ; and third, equanimity. 
Therefore, the essentials of the general treatment of phthisis are to 
preserve and strengthen the physique, enforce prudence, and induce 
placidity. Published the 15th of each Month. 
' THE 
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