described method of treatment, which may possibly be also found useful in other cases of epilepsy.

To conclude, I shall sum up what has gone before in two propositions:I. It is made evident by the case described, that in a perfectly healthy person, free from any hereditary disposition, epilepsy can be brought on by traumatic influences upon the head, causing cerebral commotion without any structural lesion of the brain.

II. Further investigations will be needed to prove that such traumatic influences during childhood may constitute a most frequent etiological factor in the production of epilepsy.

THE INFLUENCE OF HIGH ALTITUDES ON THE PROGRESS OF PHTHISIS.

BY

CHARLES DENISON, A.M., M.D.,

OF DENVER, COLORADO.

Ir is assumed that this occasion calls for something suggestive, leading an inquiring mind to look at an important subject in a new light, and seeing the errors of former beliefs through a change in the channels of thought. How desirable then, if we are not now perfect (and I believe the hopeful mind of to-day has more to expect from what we are to learn, than from what we now know), that a controversy of opposing views should here be stimulated in friendly discussion. Believing that our profession as a body is proving itself an insufficient barrier to "the progress of Phthisis," and having convictions which persuade me to differ from many of the authors who have written on the subject of climate and consumption (and I have endeavored to consult them all), I may be excused for seeking to introduce this discussion by occasionally emphasizing these differences of opinion.

The subject assigned me is one of the most interesting and important that can claim our consideration, and all the more so because it has not hitherto received any special attention from our profession at large. As to the disease itself this great and persistent destroyer of mankind— valuable results have of late accrued from the constant inquiry and pathological research of eminent medical men. Thus this disease has come, through the critical analysis of a transitionary stage in professional opinion, to include, under the one name of Phthisis, various and widely differing abnormal conditions.

CLIMATE AND CONSUMPTION.

We can define Pulmonary Phthisis as slow death commencing in the lungs, or, going back of the local affection to the dyscrasia or abnormal blood state which precedes or accompanies its progress, we can enlighten ourselves as to the various pulmonary and other defects which have till of late been considered as one disease. However, the scope of this report, and lack of time, make the minute consideration of this subject an unwarrantable digression, so that we will content ourselves with the generally accepted significance of the term Phthisis in its broadest sense, including those morbid conditions (chiefly inflammatory) which favor

' Dr. Hermann Weber and Dr. Archibald Smith, late of Lima and elevated resorts in the Peruvian Andes, are notable exceptions.

2 Dr. Hermann Weber, in the Medico-Chirurgical Transactions, vol. lii. (Treatment of Phthisis by Prolonged Residence in Elevated Regions), gives the credit of first promulgating these views to the late Dr. Thomas Addison, "whose teaching, that inflammation constitutes the great instrument of destruction in every form of phthisis, was for a long time either ignored, or regarded as erroneous, by most of his contemporaries." (On the Pa

weakening or a breaking down of pulmonary tissue; and refer to special phases of the disease as the illustration of our thought may seem to demand.

In considering the climatic treatment of Phthisis, it is not essential to dwell upon the first experiences of our medical fathers in this matter. The conclusion of Dr. Walshe, that "climate takes its occasional share in bringing about the nearest approximations to real cure therapeutically obtainable," has at length come to be very generally held by medical men. Even before the disease was well understood, while the failure of medicine to cure or check it was slowly being realized, the considerable benefit derived from even mild changes of climate must have strongly suggested a climatic cure. So if the remedy of high altitudes had not long been utilized, as we now learn it has been in the Peruvian Andes, the first two cases mentioned by Dr. Hermann Weber, in his excellent paper "On the Treatment of Phthisis by Prolonged Residence in Elevated Regions," would have suggested this most potent means of cure to every reflective mind. These cases occurred in natives of elevated localities, who had become residents of London. Prostrated by acute phthisis, they returned to spend the remainder of their probably short lives in their early homes, the one to the Black Forest, in Germany, at an elevation of 2800 feet, and the other to Switzerland, 5000 feet above the sealevel, and in both the disease was quickly arrested. The evidences of the therapeutic value of high altitudes are, however, comparatively recent.

Thus it is not strange that, having no better experience to trust to, the medical profession has hitherto placed confidence in the scattered successes furnished by Mediterranean, low continental, maritime and English health resorts. In England, and on the continent, the description and classification of favored health resorts have been carried to an exactness which has hardly been reached elsewhere. But it is a question, in my mind, if these analyses are not sometimes made to the exclusion of important data, notably the moisture of the air, and with undue importance given to less vital points, such as the precise degree of temperature and the daily variation. Then again the author so often feels it incumbent on himself to tell you how to get away from a place, if you are not suited, that often no relief would seem to be expected; while the poor invalid, usually in some doubt, ekes out a six months' health trip at as many separate resorts. This guessing at the answer to the invalid's conundrum, "where can I best find relief," is far from the certainty and confidence in the course to be pursued, which should characterize the climatic treatment of phthisis. There may be some physicians who are so specially gifted in the adaptation of these low climates to the consumptive's needs as to gain very fair apparent success. After studying the descriptions of numerous low, inland, and seaside Mediterranean health resorts, with all the phases and symptoms of phthisis so nicely met by the appropriate

thology of Phthisis, by T. Addison, M.D., Guy's Hospital Reports, 2d Series, No. V., 1845.) The same has recently been emphasized in the works of Dr. Felix Von Niemeyer, and among others by Dr. Ludwig Buhl (Inflammation of the Lungs, Tuberculosis, and Consumption, New York, 1874).

Diseases of the Lungs. W. H. Walshe, M.D. London, 4th edition, page 585. 2 Loc. cit.

3 Climate, in Williams's Pulmonary Consumption; Lettsomian Lectures, on the influence of climate in the treatment of pulmonary consumption, by C. T. Williams, M.D.; Consumption, its early and remedial stages, by Edward Smith, M.D.; Diseases of the Lungs, by Dr. Walshe, 4th edition; The effects of climate on Tuberculous disease, by Edwin Lee, M.R.C.S., one of the Fiske Fund Prize Essays.

climatic remedies, I must confess to a slight feeling of hesitation. It is well for us to ask ourselves how certain we are of any permanent relief being obtained by consumptives in low humid climates. Though there is no lack in the number of "watering places," the field is so small (with elevation left out) that one might almost as well think of supplying all the climatic needs of consumptives within the boundaries of the little State of Massachusetts. If in these low and narrow limits favorable qualities are found, then efficiency in the climatic treatment of phthisis demands more decided proportions of these same qualities, which we hope to show are to be found, together with additional advantages, at suitable elevations.1

Low Climates.-As I am going to speak positively in favor of the utility of high altitudes, where not specially contra-indicated, and shall ask you to concur with me in this favorable opinion, it is well to make mention of the grounds I have for feeling less confidence in low climates. As will be apparent when we come to discuss the humidity of the air, we are deprived of important data with regard to the undesirableness of low climates, in that we have few positive records of the relative or absolute humidity of these places in Europe. They all, however, represent more or less moist climates. Of climates in England, Dr. C. T. Williams, in his very carefully prepared Lettsomian Lectures, gives valuable statistics. of several localities, mainly along the southern shore of the Island, and remarks upon the favorable results of 386 winters spent at those places by 243 consumptives. "Bear in mind," he says, "that these general results assign the largest amount of benefit to the most easterly stations, and follow a course exactly the reverse to that of the warmth of the localities; Hastings, the coldest, being at the top of the list, and Torquay, the warmest, being at the bottom," Ventnor and Bournemouth being between these. This result will be claimed as an argument for high altitudes, when we come to consider that a cooler temperature, as well as decreasing humidity, are found to be the natural attributes of great elevations.

On the continent, there are also warm, moist climates, called sedative, and more exhilarating resorts, termed stimulating, which, like Hastings in England, begin to partake of the best qualities of high altitudes, and to show, according to Dr. C. T. Williams's excellent tables, a proportionate improvement for the winters there spent by consumptives. Of the former group there is Pau, remarkable for the stillness of its climate, where, as we are informed, a plentiful amount of rain "falls perpendicularly.”

In Europe, a reason has seemed to exist for sending south to the warm shores of Italy and to the south of France those consumptives who, from feeble stomachs, are unable to digest the quantity of food necessary to supply the waste caused by the greater amount of oxygen inspired in the colder regions of the north. In the warm, moist climate, less carbonic acid is given off, and less heat required, so that the feeble digestion is not so heavily taxed as in the severe climate of England. The plan works well, chiefly as a palliative measure; but as warm weather comes on it is reasonable to believe that the scales must be turned, and that the indigestion and enervation felt at the South may be much relieved by a return to the cool climate of the North. So the consumptives who have shunned a harsh New England spring, by a sojourn in Florida, hasten back, as warm weather approaches, to cool seaside and country resorts, and are kept constantly on the move, with considerable indifferent benefit. This idea of allowing the digestive capacity to decide to what climate a consumptive should go, may often seem to result in good, but it is founded on uncerta n premises, and lacks much desired definiteness in results. Like much of the theorizing as to the treatment of phthisis indulged in by authors for many years, it is not radical enough to answer our needs in the war we have to wage against one of the greatest of human destroyers. 3 C. T. Williams, op. cit.

2 Walshe, op. cit.

There is Valencia, in Spain, which Dr. Walshe characterizes as " probably one of the warmest, most humid and depressing spots in continental Europe;" Pisa, a once populous city in Italy, of which the same author says that it has "completely lost its quondam prestige as a sanitarium,” though, as we fail to notice positive climatic qualities to greatly recommend it, we are surprised with the further assertion that this "changed opinion is the result of sheer medical caprice;" and Venice and Rome, the latter of which Dr. Williams' represents to have "had formerly a great repute, though for many years its unfitness as a shelter for invalids has been recognized, and it is now mainly resorted to for pleasure, and not for health." Among the latter group ("stimulating"), we find Hyères, Cannes, San Remo, and Nice (representing the Riviera), Barcelona, Gibraltar, Malaga, Lisbon, and the Mediterranean islands (as Sicily, Sardinia, Malta, and Majorca), which, as before remarked, partake of more favorable qualities, and are notably less moist, thau the "sedative” group, or which have some peculiar attributes; thus Dr. Edwin Lee says of Naples, "The frequent variations from dryness to moisture, and from warmth to coldness, promote the disengagement of electricity."2

There are marine climates which, being wholly surrounded by salt water, I fancy confer some of the advantages of sea voyages, in that the air is constantly in motion, and the insensible activity of the skin thereby promoted, while the air is always pure and bracing, considering the temperature. So that these may be considered better than the moist climates on the continent of Europe; and yet Dr. Walshe says of Madeira, "much of this promising character turns out to be practically delusive. The damp is so extreme that changes of temperature thermometrically small -of three or four degrees-prove sensationally great; a temperature of 58° indoors, without being actually cold, is disagreeably chilly," etc.3 The Canary Isles, St. Helena, some of the Mediterranean islands, the Bermudas, Bahamas, West Indies, etc., may also be considered in this group. There are relatively very dry climates, as Egypt and Syria, whose enervating quality is the high temperature which would hardly be bearable, were the dryness absolute.*

Of American climates, we have the characteristic low resorts of moist and sedative Florida; the balsamic regions among the pines in southern Georgia; the dry and alkaline regions of southwestern Texas, in the vicinity of San Antonio; and the exceedingly equable and mild Pacific coast, San Diego, Los Angeles, Santa Barbara, San Luis Obispo, San Josè, and San Rafael, in California. Because of the great humidity of the atmosphere, these last are much like the warm moist climates in the Mediterranean basin. The favored low resorts in the United States might be much better chosen climatically speaking, but then the attrac tions have thus far been where the comforts of life are to be found.

2 Op. cit.

Op. cit. 3 A sea captain of long experience, who now lives in Denver, for the relief of asthma, tells me he has carried many consumptives to the Sandwich Islands, "but brought none of them away."

In America, in Southwest Arizona, and in the inland portion of Southern California, notably in the vicinities of the Death Valley and Fort Yuma, the winter months only are comfortable, and sometimes hardly that, because of the intense radiation from the sandy plains. At Fort Yuma, Dr. Geo. S. Rose, of the U. S. Army, has informed me that the mean annual rainfall has been for nineteen years only 2.95 inches, while the average annual temperature has been remarkably high-about 750.

5 The Pine Forests of Georgia as a Resort for Invalids; by Ezra R. Pulling, M.D. Reprint from N. Y. Med. Journ., Sept. 1871.