Atlantic City as a winter health resort

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ATLANTIC CITY

DDP.

AS A

Winter Health Resort,

Embracing Official Reports, Meteorological Tables, &c..
Concerning the Climate of Atlantic City, N. J., the
Testimony of Eminent Physicians as to its Ef-
fects ON Various Formis of Disease, Hygienic
Hints for Invalids at the Seashore, and
Information about the Sanitary
Condition of Atlantic City.

BY BOARDMAN REED, M. D.

Sfxond 1

vDITION.
\

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philade

ALLEN, LANE & SCOTT
Nos. 229-231 Sou

\,

'.G HOUSE,

ATUNTIC CITY

AS A

Winter Health Resort,

Embracing Official Reports, Meteorological Tables, &c.,
Concerning the Climate of Atlantic City, N. J., the
Testimony of Eminent Physicians as to its Ef-
fects on Various Forms of Disease, Hygienic
Hints for Invalids at the Seashore, and
Information about the Sanitary
Condition of Atlantic City.

BY BOARDMAN REED, M. D.

Second Edition.

PHILADELPHIA:

ALLEN, 'LANE & SCOTT'S PRINTING HOUSE,

No. 22q-23i South Fifth Street.

Exchange

N. y. Pub. Lib.

JUL 1& '90t>

1 V

A<^~K3

PREFACE.

THE reprint from the Philadelphia Medical Times of a paper
on "The Climate of Atlantic City, and its Effects on Pul-
monary Diseases " was sent last winter to numerous physicians in
various parts of the United States. There have since been many
requests for additional copies, which could not be furnished, the
edition having been exhausted. It has been deemed advisable in
preparing a second edition to include with this the principal part
of a paper contributed by me to the New York Medical Jotirnal
for March, 1881, entitled "-What Atlantic City can do for Con-
sumptives; " also portions of an article contributed to the Phila-
delphia Medical Bulletin for November, 1880, relating particularly
to the hygienic precautions needed to be taken by invalids sojourn-
ing at the seaside, and of a communication to the Philadelphia
Medical and Surgical Reporter of July 9th, 1881, on "The Sani-
tary Condition of our Seashore Health Resorts."

A letter from Dr. William Pepper, Provost of the University of
Pennsylvania, written in reply to a request from me for a statement
of his experience in sending pulmonary cases to Atlantic City, was
not received in time for insertion in the original paper, but is now
printed for the first time.

Another year's experience has been strongly corroborative of the
views hitherto expressed by me as to the curative value of this
climate at all seasons, but especially in the winter and spring.
Last winter was much colder than the average, here as well as in
Florida and all over the continent ; yet quite as much benefit as
usual was derived by consumptives in the earlier stages. The same
may be said of persons suffering with bronchial or throat affections.
But perhaps the most marked improvement has been noted in cases

3

of nervous exhaustion in all its protean forms, and of chronic
malaria. These have almost uniformly gained rapidly and steadily
here under proper hygienic conditions.

Testimony has been gathered with regard to the effect of this
climate upon lung diseases especially, because, while it is generally
admitted that sea air is highly curative in nearly the entire list of
chronic ailments, there has been a widely-prevalent impression,
both among the laity and medical profession, that consumptives
are always better away from it. This impression is now known to
be erroneous, it having been demonstrated by abundant clinical
experience that phthisis in its earlier stages is no exception to the
rule that all the morbid results of weakness and impaired nutrition,
when not too far advanced, may hope for improvement from the
tonic and alterative effects of a dry and stimulating sea air. This
fact has been well attested in Europe, and is confirmed in the fol-
lowing pages by the testimony of a few of the many physicians
who have long been sending consumptives to Atlantic City.

B. R.
Atlantic City, N. J., November 15th, 18S1.

ATLANTIC CITY

AS A

WINTER HEALTH RESORT.

SOME years ago it occurred to me that there was need of exact
and reliable facts concerning the climate of Atlantic City.
With a view to obtaining such facts I began making regular obser-
vations of the weather at my office, noting the temperature, relative
humidity, direction of the wind, and condition of the sky, four times
daily. This was kept up for about one year. Afterwards, finding
that my instruments were inferior in accuracy to those at the United
States Signal Station in another part of the town, I arranged with
the observer there to furnish me with any information desired.

Furthermore, in order to determine as definitely as possible the
benefit to be derived from the climate by various classes of invalids,
and especially by persons afflicted with pulmonary complaints, I
addressed inquiries to many eminent physicians who had been in
the habit of sending patients to Atlantic City in the winter and
spring as well as in the summer, asking them to report the number
of cases sent here, the proportion cured or benefited, the propor-
tion aggravated if any, and the proportion which had remained
stationary.

The replies were not in point of fullness all I had hoped to obtain,
but, together with the meteorological data previously accumulated,
they were given to the profession in an article first published in the
Philadelphia Medical Times, for December iSth, 1880, and entitled
"Winter Health Resorts ; The climate of Atlantic City and its effects
on Pulmonary Diseases."

That article is here reproduced as follows : —

" Where shall we send our invalids for a change of air in winter?
This is a practical question which is becoming, year by year, more
important to busy physicians, particularly in the great cities of the
North. There are certain chronic diseases for which a pure and
invigorating air, and especially a climate which will tempt the pa-
tients out of doors, are highly desirable. For many cases a

5

change to such an air offers the best hope of cure, or even of ameli-
oration.

''Florida has been much in vogue lately as a winter-resort, and
undoubtedly suits numerous patients well ; but it is too far away, in-
volving a long and tiresome journey. The distance from home and
friends, and the impossibility of conferring in an emergency with
the usual medical attendant, are serious inconveniences. The
prevalence of malaria there is a source of danger, and the very
warm and enervating character of the Southern climate unfits it for
a large class of diseases altogether.

" Colorado and Minnesota are even farther away, and their
climates, however tonic and useful, are so cold that invalids there
can live very little out of doors during the winter ; and if they are
to be kept prisoners in close heated rooms it might almost as well be
in their own homes.

" Northern Africa and Southern Europe, especially Pau, Nice,
Mentone, and other places along the northern shore of the Medi-
terranean, are just now in great repute. IiTvalids are flocking
thither every winter, and, the impartial chroniclers tell us, are
leaving their bones in the cemeteries there in sadly large numbers.

"Dr. Madden, in his 'Health-Resorts of Europe and Africa,'
says: — 'With one exception the most frequented winter health-
resort in Europe is Pau;' then proceeds to denounce the climate
as 'essentially cold, variable, damp, and dreary during the winter.'
During one December while he was there he states that ' the
thermometer/^// eleven tiines to zero.''

" Dr. John Parkiii, in his work on ' Climate and Phthisis,' is
equally emphatic in condemning that climate, saying, among other
things, that ' of a number of patients I have known who passed a
winter in Pau, not one received any benefit— the majority died
soon after their return.'

"As to Nice and Mentone, Dr. Madden quotes several medical
travelers and former resident physicians to the effect that these
places are exposed to very sudden changes of temperature, and
that the native residents are very subject to pulmonary complaints,
which with them are apt to run a rapid course. Dr. Parkin, in
the work already quoted, is particularly severe upon the climate
of those places, stating that though it is usually very warm there
in the sun, insomuch that umbrellas are indispensable, it is apt to
be cold in the shade, necessitating the heaviest wraps. Crossing the
street is like passing from summer to winter. The same author
shows that, from the location of these towns in the neighborhood
of mountains, some of whose tops are always covered with snow
in winter, theymust be continually subject to cold, raw winds, which
are all the more intolerable and dangerous because of the heated
air which they displace.

" Says Dr. Parkin : — ' During January and February, then, there

would be two cold winds prevailing at Mentone, as is frequently
the case at Nice. It is not surprising, therefore, that I should have
left the latter town in the month of March in a snow-storm, or that
snow should have fallen heavily all the way to Genoa.'

"Dr. J. H. Bennett, of Mentone, the chief eulogist of that cli-
mate, insists very strenuously upon certain precautions against
taking cold. ' Without them,' he says, ' it is unsafe and treacher-
ous. This is evidenced by the great mortality of the natives of the
Nice and Mentone districts by pneumonia and pleurisy, two of the
commonest maladies.'

" Dr. Parkin's conclusion is that the Riviera is ' one of the most
unfavorable and dangerous climates for chronic diseases of the respi-
ratory organs, and especially for phthisis.' As to Africa, he cites
army reports showing that ' of the British troops passing through
Egypt during 1872 en route for India, 29.9 per 1000 were at-
tacked with phthisis, and 2.3 per 1000 died.' He ' adds,
* When it is remembered that these patients manifested no
symptoms of the disease when they left England, otherwise they
would have been detained, this result speaks trumpet-tongued as re-
gards the influence of such a climate in the development of
phthisis. '

" If these are the most desirable winter-resorts in the Old World,
American invalids, especially those suffering from chronic pulmo-
nary affections, would do well to remain on this side of the ocean.

"Atlantic City, New Jersey, a place most^favorably located as re-
gards convenience of access, being ninety minutes' ride from Phila-
delphia by the West Jersey Railroad, and only four hours from
New York by the Pennsylvania Railroad and its West Jersey branch
line, possesses certain physical advantages which are well worth
considering. It has been twenty years or more since physicians be-
gan sending patients here in winter. First only now and then a
courageous invalid ventured here at this season, but their numbers
steadily increased. The experiment proved so successful in hasten-
ing the convalescence from acute disease, in improving a large class
of chronic affections, and especially in arresting numerous cases of
incipient as well as confirmed consumption, that within the last
three years the travel to the place in winter has reached very con-
siderable proportions, and the numerous thoroughly-heated winter
hotels — some of which are as sumptuously furnished and as luxuri-
ously conducted as the leading houses at the summer-resorts — are
crowded with invalids, convalescents, and wearied society people
through all the months from January on.

"Actual experience has demonstrated that sea air is as valuable in
winter as in summer. It also bears out the statistics which prove
that the climate of Atlantic City is superior to that of most sea-coast
towns, being drier, more equable, and, considering the latitude, un-
usually mild.

8

"The city — for it is in fact as well as in name a city, having a
permanent population of six thousand, and being supplied with gas,
street-cars, &c. — is situated in latitude 39° 22', on an island ten
miles long and averaging about half a mile wide. This is separated
from the mainland at either end by broad bays or inlets, which are
connected by a narrow arm of the sea called 'The Thoroughfare,'
There is no body of fresh water nearer than the Delaware river,
distant about sixty miles, and the salt-water bays to the landward
side are nearly always open, ice seldom forming, except for a short
time occasionally in the severest winters.

" Another peculiarity of the location is that all the winds from the
landward must pass for long distances — hundreds of miles in some
directions — over a very dry and porous sandy soil upon which snow
rarely lies for any time. These winds, including those from the
north, north-west, west, and south-west, are therefore to some extent
both dried and warmed in their passage.

"INFLUENCE OF THE GULF STREAM.

"Though the coast of Southern New Jersey has a general direc-
tion from north-east to south-west, the beach at Atlantic City trends
more to the westward, so that it faces almost directly southward.
Therefore south as well as east winds are sea breezes here, and both
blow across the Gulf Stream, which, by the way, exercises consider-
able influence upon the climate of this part of the coast.

" Mr. C. P. Patterson, Superintendent of the United States Coast
and Geodetic Survey Office at Washington has kindly furnished me
with a large map indicating accurately the course of the Gulf
Stream, and with some interesting facts concerning it.

" This map shows at a glance that the heated waters of the tropics,
pouring through the space between Cuba and Florida, flow in a
north-easterly direction along the coast of Georgia and theCarolinas,
diffusing themselves as they go, until from a compact stream less
than fifty miles wide, they have become opposite Chesapeake Bay a
broad expanse upwards of four hundred miles in width. This really
includes numerous parallel or slightly diverging currents of very
warm water with overflow currents of a somewhat lower tempera-
ture. One of these overflow currents approaches within sixty-iive
miles of Atlantic City, while it is one hundred and ten miles from
Sandy Hook. The principal current is farther away, being one
hundred and thirty-five miles from Atlantic City, one hundred and
eighty-five miles from Sandy Hook, and about the same distance
from Long Branch and Montauk Point.

" But the exceptional mildness of this climate may be attributed
to the peculiar course of the Gulf Stream in this vicinity as much as
to its proximity. The innermost current, according to the map re-
ceived from the Coast Survey office, has a direction opposite At-
lantic City of east-north-east, but turns more and more to the east-
ward till in latitude 40° — that of Philadelphia — it bears nearly due

east. The main current turns more abruptly, and a little north of
latitude 38°, some distance to the southward of Atlantic City, has
a course directly eastward. Our south, south-east, and east winds,
then, must all pass for three hundred to five hundred miles at least
over more or less heated water which has come directly from the
Gulf of Mexico. Our only ocean breezes not affected m this way
are those from the north-east, and experience shows that these are
the only winds which are generally unpleasant here. But for places
farther up the coast, particularly those north of latitude 40 , the
case is different. Neither their north-east nor east winds can be ap-
preciably modified by the Gulf Stream. Their south and south-east
winds may be favorably influenced to some extent, but less than are
the same winds at Atlantic City, since they pass over a much larger
surface of cold water after crossing the Gulf Stream. It may be
added that some small maps issued by the Signal Service office repre-
sent the Gulf Stream as occupying different positions m winter and
summer, but on this point Mr. Patterson writes, ' I greatly doubt it
there can be any material change of the stream from season to
season ; at least there has been no reliable evidence obtained on
that subject.'

METEOROLOGICAL STATISTICS.
" To Sergeant E. W. McGann, who has charge of the United
States Signal Station at Atlantic City, I am indebted for meteor-
ological statistics and official records, from which the following in-
formation, bearing directly upon the subject of the climate of the
place, has been condensed and tabulated : —

Temperature, Humidity, Barometrical Pressure, and Rainfall at
Atlantic City, New Jersey.

Months, 1880.

Mean temper- Range of tern-
ature. perature.

Mean humid-
ity.

Mean ha- 1 Rainfall, in
rometer. i inches.

January,
February,
March, .

41. 1
38.2
40.1

Min.

13

II
18

79-3
74-4
71.9

30.1B9
30.129
30.061

1.70
2.85
5 97

39-8

30.126

Mean for three months.

"The mean temperature f^TTanuaryrFebruary, March, and De-
cember, the four coldest months of the year, was, m 1879, 34-7 5

in 1878, 36.8°; and in 1877, 35-9°- , r .1, f o^ri

- The prevailing winds in winter are those from the west and
north-west, which are usually dry and bracing. The east and south
winds, which often blow for days at a time, are warmer and rnore
humid North-east winds, which are unpleasant, usually prevail for

two or three days at the time of the equinoctial storms, but are in-
frequent during the remainder of the year.

" Observations taken at my office, in the centre of the town, at
7 A. M., 12 M., and 6 and lo p. m., show that in December, 1879,
there were twenty-six days during which the tliermometer did not
fall below 32° — the freezing point; also that there were only two
days in the same month when the thermometer did not indicate at
noon a temperature above 40°; and that there were ten days upon
which it was not below 50° at the same hour. During the January
following (1880) there were twenty-four days during which the
mercury never fell below the freezing point at any hour, and only
two days during which it went below 30°. It was only once in the
same month lower than 40° at noon, and only three times lower
than 45° at the same hour. On nineteen of the thirty-one days the
thermometer stood at 50° or above at mid-day.

" These mid-day temperatures are obviously more important than
averages, for it is in the daytime that invalids take their airing out
of doors.

" The dryness of this climate, as compared with other seaside
resorts, is best shown by the statistics of the rainfall, which is less
here than at any other place on the coast, as appears from the table
given below. The readings of the hygrometers at the different sta-
tions are not so significant, since at some of them, including At-
lantic City, the instruments are located so near to the beach, and
at so low an elevation above the sea-level ( less than thirteen feet
here), as to be affected by the spray, during strong winds off the
water, and by occasional morning mists, which do not extend back
into the town.*

Annual Amount of Rainfall at the Principal Cities and Stations
en the Atlantic Coast.

Stations.

Year ended
June 30th, 1879.

Year ended
June 30th, 187I

Atlantic City, N. J., 40.60 inches.

Barnegat, N. J., 49-38 "

Boston, Mass., 62.96 "

Cape May, N. J., 42-44

Charleston, S. C, 64.33 "

Galveston, Texas, 51-03 "

Jacksonville, Fla., 51-62 "

Newport, R. I. 52.20 "

New Orleans, La., . . 58.29 "

New York, N. Y., 43.68 "

Norfolk, Va., 44-44 "

Portland, Me., . 41.10 "

Sandy Hook, N. J., : 60.37

Savannah, Ga S5-I4 "

Wilmington, N. C , 1 50.90 "

.90 inches.
•35 "

* Since the foregoing was published, it has been ascertained from the records of the signal
station here that there is greatly less wind at Atlantic City than at most points on the coast.
For instance, the whole movement of the wind during the year 1879 was 84,117 miles at Atlantic
City, 109,059 miles at Barnegat, and 135,883 miles at Cape May.

Thus at the neighboring stations on either side of this place there are, on the average, much
higher winds.

II

" The mean barometer for the year ended June 30th, 1879, was
higher at the Atlantic City station than at any other on the coast
north of Chesapeake Bay, and, with one or two exceptions, the
same may be said as to the preceding year. This is a matter of im-
portance, since depressions of the barometer affect the majority of
invalids far more decidedly and injuriously than low temperatures.
An extra wrap out of doors, or a fire in-doors, will perfectly anti-
dote any ordinary degree of cold, but it is far more difficult to ren-
der comfortable the invalid whose breathing is distressed or whose
joints and nerves have been set to aching by a sudden fall in the
atmospheric pressure. Barometrical changes are also connected in-
timately with variations in the electrical conditions of the atmos-
phere, and these again strongly impress the delicate nervous sys-
tems of the sick.

*'In the following table the figures represent the average atmos-
pheric pressure for the years named at the sea-level, allowances hav-
ing been made for differences in the elevation of the stations : —

Table Showing Mean Barometer at Various Stations.

Year ended Year ended

June 30th, 1879. June 30th, 187

Atlantic City, 30.031 30.002

Bamegat, 30.029 29.998

Boston, 29.975 29.969

Cape May, 30.029 ' 30.007

Galveston, 30.049 29-995

Jacksonville, 30.079 30.030

Newport, 29.993 29.980

New York, 30.026 30.006

Portland, Me. 29-944 ! 29.952

Sandy Hook, 30.014 I 30.C00

"After all, however, it is with climates as with medicines, —

trustworthy evidence as to what they have accomplished is the most
valuable. With regard to nervous, rheumatic, gouty, dyspeptic,
and various other chronic ailments (including most of those pecu-
liar to women), which are usually found to be benefited here in the
summer, equal benefit may be expected in the winter. Convales-
cents from acute disease, or from surgical operations, nearly always
improve remarkably upon being removed to this place from the
large cities.
' "As to diseases of the respiratory organs, I have had personal
knowledge of many patients suffering from various forms of such
affections who have made trials of this climate in winter. The
bronchial and laryngeal cases have, as a rule, improved, some of
them very decidedly, though there have been exceptions. The con-
sumptives who were in the third stage, or in any stage with evi-
dences of actively progressing disease of the lung and decided

hectic, have only exceptionally been benefited. Those, however,
in the pretubercular or incipient stage, and those even in the ad-
vanced stages where the destructive process has been advancing
slowly, have often experienced very marked improvement. In a
considerable proportion — about one-fourth — of the cases of these
latter classes, the disease has been apparently arrested, and some of
them seem to be cured.

'' Detailed reports of the cases I have treated at Atlantic City'
would fully bear out the foregoing general conclusions, but would
unduly extend this paper and necessitate the exclusion of several
reports I have received from prominent Philadelphia physicians
concerning the effect of this climate upon their patients, in winter
especially. Some of these physicians have been sending patients
hither for more than twenty years. Their testimony is more valua-
ble than mine, and can not be impugned on the ground of partiality.

" It is a significant fact that pneumonia and bronchitis are of
infreqnent origin here, and when they do occur the patients almost
invariably recover-. Upon this point my experience as a resident
physician enables me to speak very positively. I have not known
an uncomplicated attack of either disease to prove fatal.

REPORTS FROM PHYSICIANS.

" The reports from physicians above referred to were received in
response to inquiries recently sent to them. Many others wrote
brief apologies, not having the notes or the leisure to tabulate the
results of their experience as I had requested. Only one physician
objected to the climate either for bronchitis or early phthisis.

"Dr. Laurence Turnbull writes; 'The number of cases of
phthisis that I have sent to Atlantic City have been few iri the last
stages, as I found they were not improved by a residence at the sea-
shore, dry even as it is,' adding that a few cases in those stages
were aggravated, but goes on to say, ' I have been much pleased
with its influence on the first stages of phthisis, asthma, laryngitis,
bronchitis, and nasal catarrh, when all ordinary means have failed
in the city, by causing improvement in the appetite, assisting the
digestion, and giving a healthier tone to the skin. In convales-
cence from catarrhal pneumonia and typhoid fever the results have
been most gratifying. In certain forms of otitis media purulenta J
do not find the air of Atlantic very beneficial, and in many cases
diseases of the ear are caused by exposure of that organ to the waves.
In strumous diseases of eyes, joints, limbs, &c., I have found the
change to Atlantic City, if persisted in for several seasons, of per-
manent benefit.'

" Dr. Thomas J. Yarrow writes : ' It has not been my practice,
as a rule, to advise patients suffering with tuberculous and other

13

diseases of the respiratory passages to sojourn at the seaside. Ex-
ceptionally, I have had them go to Atlantic City, and have known
cases of incipient phthisis, chronic bronchitis, asthma, and laryngitis
to improve in that location. My experience of late is inducing me
to recommend a larger number of such cases to reside at Atlantic
City.'

' ' Dr. Thomas G. Morton thus bears testimony : ' I have been in
the habit of sending to the shore at Atlantic City many patients,
more especially surgical cases, but a large number also of those with
lung affections, and especially those having a (hereditary) tubercular
disposition, and I think especially such cases have been vastly ben-
efited by the sojourn.'

"Dr. James Darrach, of Germantown, writes: 'Have sent sev-
eral cases of autumnal catarrh to Atlantic City, and think without
exception they were benefited, two of them being certainly exempt
from these attacks while at the shore. The only case of slow con-
valescence from pneumonia died at Atlantic City. This was about
twenty-three years ago. A case of obstinate general bronchitis was
cured in about ten days. A case of what I supposed to be tuber-
cular laryngitis was very much benefited, and subsequently recov-
ered. I have also had other cases of obstinate catarrh which re-
turned well after a sojourn at Atlantic City.'

" Dr. Eugene P. Bernardy reports as follows : ' With but one ex-
ception, all my cases of phthisis, both in the early and late stages,
amounting to twelve in all, have been decidedly benefited by a
sojourn at Atlantic City, and one case positively cured, — that is, as
far as human ear can ascertain. Of the three cases of convalescence
from pneumonia all were decidedly benefited. In a child suffering
from chronic pneumonia the lung in a few weeks was almost entirely
cleared up. In bronchial affections (chronic) I have seen no per-
manent benefit in any of the six cases I have sent there ; all bene-
fited while at the seashore, but a few months after their return
relapsed. The case of phthisis cured had been examined by myself
and Dr. Hall in Philadelphia, and while at the seashore examined
by Dr. L. Turnbull. We all diagnosed incipient phthisis. This
was nearly six years ago. On her return she had gained forty
pounds, and has remained well ever since.'

"Dr. John H. Packard says, referring to Atlantic City, 'I can
only say that I frequently advise convalescents to go there, and that
it is a very common thing with me to be asked by patients whether
it would not do them good to spend a week or two there. I do not
now recollect any case that has been wholly without benefit from
that climate, and could adduce many that have gained great advan-
tage from it.'

"Dr. D. Murray Cheston writes : ' I can not say how many cases
of pulmonary or bronchial troubles I have sent there, but the gen-
eral result has been most satisfactory. The cases were all sent in the

14

late winter or early spring months, and have invariably returned
improved.'

"Prof. J. M. Da Costa writes briefly, as follows: 'I have sent
too few patients with pulmonary disease to Atlantic City to have the
data to answer your questions. Some who were in a run-down con-
dition and affected with chronic bronchial catarrh did very well.'

" Dr. Ellwood Wilson writes that in the summer months he does
not think patients with fully-developed phthisis improve by a pro-
tracted residence at Atlantic City, but adds, ' During the winter
months — say from October to July — I regard it as a very favorable
locality for consumptive patients.'

"Dr. R. J, Levis writes that his practice (being almost exclu-
sively surgical) ' is not of a kind to furnish experience with regard
to the beneficial influence of Atlantic City in pulmonary affections,'
but that he has ' a good opinion of its dry and mild climate.'

" Dr. James J. Levick has not sent any cases of phthisis, but has
sent ' several cases of laryngeal and bronchial irritation and one or
two cases of hay asthma, which improved greatly while at Atlantic
City.' He adds, * The cases which have derived most benefit,
however, and of which I have sent not a few in the late winter
months, have been patients after typhoid fever, — patients whose
nervous systems have been much disturbed, persons who have needed
brain rest, &c.'

"Dr. William H. Bennett, resident physician at the Children's
Seashore House and Seaside House for Invalid Women at Atlantic
City, contributes the following full report : ' My experience of the
effects of a sojourn at Atlantic City upon those suffering from pul-
monary diseases has been confined to what I have seen among
transient visitors during the summer months of the past seven years.
I have had little or no experience of the effects either of a pro-
longed stay or of a stay in winter. I can not give you exact figures,
but the following is a fair statement of what I have observed. My
patients were, with the exception of a majority of those suffering
from phthisis, nearly all children. I have had not less than a hun-
dred cases of acute bronchitis, nearly all of which ran a milder and
shorter course than similar cases do in Philadelphia. The majority
of these cases had during treatment the best possible hygienic sur-
roundings, but a few which were much exposed during cool, rainy
weather in leaky, damp apartments, seemed to do equally well. A
few, perhaps ten, cases of subacute bronchitis, which had remained
stationary in the city for some time, rapidly recovered at the sea-
shore. Three or four cases of chronic bronchitis, with emphysema
and occasional severe attacks of asthma, greatly improved ; but
about an equal number showed no change. Two or three cases of
tardy convalescence from pneumonia made much more rapid pro-
gress towards recovery after their removal to the seashore. Two
cases of empyema with external fistulse greatly improved. About

IS

twenty cases of phthisis have been under my care at Atlantic City.
These have been in all stages of the disease. A very few, I recall
but three, derived no benefit ; all the others improved in general
health. In some, even of the advanced cases, the improvement was
marked. In many of the cases the cough became less troublesome
and the breathing less labored. Nearly all slept better. Hectic
frequently disappeared entirely, or was greatly lessened. These
cases, with two exceptions, remained too short a time to allow of
any inference in regarci to the effect of their stay upon the progress
of the disease itself. One of these two exceptional cases remamed
three months. It was one of the few that did not improve at all,
and the disease ran its usual course. The other spent most of the
time during the last eighteen months of his life at Atlantic City,
and his downward progress was undoubtedly much retarded by so
doing. I am aware that the experience which I have thus detailed
has been too meagre, except perhaps in the cases of acute bronchitis,
to allow of any general conclusions. But, after comparing my own
experience with that of others, I am convinced that the atmosphere
of Atlantic City in summer (perhaps also in winter, but I do not
know) will prove especially beneficial in the large majority of cases
of diseases of the respiratory organs, and that the very common
opinion that the sea-coast is everywhere unsuitable for cases of
phthisis has little foundation. So thoroughly am I convinced of
this fact that I am striving to have special provision made m the
Seaside House for Invalid Women for consumptives, and m doing
so I 'am but following in a small way the example set by the
establishment of the magnificent Royal National Hospital for
Consumption on the sea-coast of the Isle of Wight.'

"The good accomplished by this climate I attribute not to any
specific influence of the air upon the lungs, but to its tonic and al-
terative properties, acting by the improvement of digestion and
nutrition, the promotion of sleep, &c. Atlantic City is the most
accessible to the New England and Middle States of any place hav-
ing claims as a winter resort and admitting of out-door exercise for
most invalids the whole winter through."

A DRY AND BRACING CLIMATE.

Dr William Pepper's report of his experience in sending patients
to Atlantic City was not received until after the publication of the
above article. It is emphatic testimony from a recognized authority
in pulmonary diseases, and is therefore given a place here :—

"Philadelphia, i8ii Spruce Street.

"My Dear Doctor Reed:— In reply to your question as to my
experience with the climate of Atlantic City in cases of diseases of
the chest, I would make the following remarks : —

" I am more strongly convinced each year of the advantage m
the treatment of such cases possessed by dry, bracing climates as

i6

compared with moist, sedative climates. Undoubtedly there are
certain special types of disease that do better in the latter, but it
has seemed to me that the benefit derived amounts to palliation or
relief, and not to radical cure. One difficulty attaching to the re-
sidence of invalids in dry, bracing climates is the fact that a far
greater degree of attention to personal hygiene and systematic re-
gimen is required. There are fewer risks of renewed congestions
or increased catarrhs in a moist sedative climate, it is true ; but on
the other hand, if the patient is carefully instructed by his medical
adviser as to the proper mode of living in a dry, bracing climate,
and is willing to faithfully attend to all the details of such instruc-
tions, there is in my judgment a far higher degree of actual, perma-
nent benefit to be secured in the great majority of cases.

"This applies especially to patients who are still in the curable
stage of consumption, for in a large proportion of cases of phthisis
there is an early stage when no true tuberculous disease exists, and
when a cure is possible under the combined influence of suitable
climate, rigidly careful hygiene, and judicious medical treatment.

"I would further say that I have seen enough of the results of
the climate at Atlantic City to satisfy me that it acts powerfully in
most cases as a dry and bracing climate. Many cases of incipient
phthisis, and even of phthisis in the second stage, have been greatly
and permanently benefited by a residence there under a strict rule
of living and treatment. In several cases of chronic pleurisy with
marked atony of the skin and system, and retarded absorption of
the morbid products, I have seen the removal to Atlantic City soon
followed by rapid improvement. I am referring to this climate as
I have observed it at all seasons of the year. And in respect par-
ticularly to that which I have just mentioned, the element of relaxa-
tion of the skin, which is common to so many diseases and is so
powerfully conducive to renewed attacks of congestion or inflam-
mation, I have observed excellent results from the stimulating dry
air of Atlantic City.

"In retarded convalescence from acute diseases, and in conditions
of impaired nervous tone, I have also found its climate very valuable.
On the other hand, in the majority of cases of organic heart disease
and of bronchial asthma, the results of residence at Atlantic City
have not been favorable.

" It is unquestionably an admirable climate, and I am convinced
that if those who resort to it would but observe with sufficient pa-
tience and minuteness the necessary precautions, they would for
the most part avoid the bad effects that some have experienced, and
would find it highly beneficial in the conditions I have above men-
tioned, as well as in others to which I have not time to allude.
" Yours verv truly,

"WILLIAM PEPPER.
"Dr. Boardman Reed,

Atlantic City, N. /.''

17

My experience as a resident physician coincides in the main per-
fectly with that of Dr. Pepper as above recorded ; but with regard
to asthma, it has happened to me to see a majority of cases do well
at Atlantic City, though with some few the climate has manifestly
disagreed. One prominent railroad man who suffers much from
asthma when inland, spent the whole of last winter here with entire
relief.

FURTHER ADVANTAGES OF ATLANTIC CITY AS A
SANITARIUM.

Certain partisans of Florida and Minnesota last winter engaged
in a spirited controversy concerning the merits of those regions
respectively, as resorts for consumptives in winter. Since these
climatic extremes were each setting forth its claims so earnestly
in the New York Medical yournal, it occurred to the writer that
the many marked advantages of Atlantic City ought to be placed
before the readers of the same publication. Hence an article enti-
tled "What Atlantic City can do for Consumptives," was pre-
pared and appeared in the number for March, 1881. The fol-
lowing portions are deemed worthy of being reproduced in this
pamphlet : —

•' It does not seem necessary to decide in favor of either Florida
or Minnesota — the extreme south or extreme north — as the only
proper residence for such patients in the winter season. Professor
Bennett in his work on 'Pulmonary Consumption,' expresses a
sentiment on this point, which, though Dr. Kenworthy has quoted
it, appears scarcely to help his case. It is this : ' Now that medical
doctrines have changed, that vitalistic and sthenic views of treat-
ment prevail, and are found to give infinitely more satisfactory re-
sults than those that followed antiphlogistic treatment, the medical
mind in America and Europe looks about for a colder climate. As
usual, the pendulum has a tendency to pass to the other extreme ;
to go from Madeira, Jamaica, and Barbadoes, from Havana, Florida,
and Nassau, to the ice-covered summits of the Swiss mountains, to
the frozen plains of Northern America. Many minds can never con-
stitutionally accept and follow the golden adage, ''Medio tutissimus
ibis ;'' they can not remain in the middle of the road; they must
pass from one extreme to the other. '

" Evidently Professor Bennett considers Florida and Minnesota
as extremes, and would give the preference to some middle region.
Atlantic City, N. J., situated in latitude 39° 22', is just about mid-
way between the peninsula of Florida and the ' frozen plains of
Northern America,' and may therefore claim to be the ' golden
mean.' It is rapidly growing in favor as a winter resort for many
classes of invalids. It has one of the driest and most equable

i8

climates on the coast, has better hotel accommodations than can be
found in either Florida or Minnesota, and is so accessible to the
New England and Middle States that a trip hither is neither a seri-
ous undertaking nor a finality involving a complete cutting adrift
from home, friends, and physicians, with the prospect of dying
among strangers if the climate should not suit.

" There are many patients who are drifting into phthisis as the
result of a general break-down following excessive devotion to busi-
ness or pleasure. These may not care and do not need, to expa-
triate themselves for half the year. They may often do perfectly
well at home, provided they avoid all excesses and have the best
possible medical treatment ; but, their vital forces being at a low
ebb, they need occasionally the stimulus to be derived from a few
weeks' sojourn in some invigorating seaside climate, where it is not
so cold as to keep them in-doors, and yet not so warm as to relax
their tissues and still further debilitate them. It is this class of
phthisical cases, and numerous other affections resulting from ner-
vous exhaustion, that we see most of here, and find to receive most
of the benefit from the climate.

"Through the courtesy of Sergeant E. B. Garriott, the observer
in charge of the signal station in New York, some statistics of the
weather in that city during the three spring months of the year
1880 have been obtained, and in the following table are compared
with the corresponding figures for Atlantic City, furnished by the
observer here : —

Mean Rainfall Mean

March, 1880. Temperature. in Inches. Barometer.

New York City 34.0 4.66 30-065

Atlantic City, 40.1 5.97 30.061

ApiHl, 1880.

New York City, 49.0 3.38 30-015

Atlantic City, 49.3 1. 83 30.045

May, 1S80.

New York City, 65.0 0.82 30.059

Atlantic City, 63. 1 0.54 30.088

" From this table it will be seen that the temperature during March
averaged six degrees higher here than in New York City ; in April
it was only slightly higher ; and in May, when New York began to
experience its foretaste of the summer heats, it averaged cooler in
Atlantic City. The rainfall was less here in April and May, though
a little greater during March, than in New York.

" During the entire year ended June 30th, 1879, the amount of
rainfall in New York was 43.68 inches, as against only 40.6 inches
at Atlantic City. Taking a series of years, the rainfall in New
York City is found to average only a little more than at Atlantic

19

City, though greatly less than at most seaside stations. For in-
stance, during the two years ended June 30th, 1879, thci'e were
135.02 inches of rainfall at Wilmington, N. C, 108.04 inches at
Newport, R. I., 103.73 inches at Jacksonville, Fla., 86.36 inches
at New York, and only 83.5 inches at Atlantic City.

"If it were desirable to prolong this article, I could cite numer-
ous cases of consumption which have been markedly benefited by
a winter's residence here. I can recall several persons who came
here a few years ago with chronic cough and evidences of consoli-
dation in part of one lung, and, having experienced decided im-
provement, have remained ever since, winter and summer. The
disease in these cases seems to be arrested. The majority of such
patients here are from Philadelphia and Pennsylvania, but within
the last two or three years I have seen many consumptives from
New York, as well as from Boston and other cities of New England.
Some who came in the last stage found no benefit, but nearly all
who have come while the disease was yet in an early stage, or, if
further progressed, was pursuing a slow and chronic course, gained,
at least, for a time.

" One notable case is that of a New York merchant who spent
last winter here. After having had several hemorrhages and be-
come considerably emaciated, he came here early in November,
with instructions from his physicians to proceed farther south as
soon as the weather grew too cold for him. He remained all winter,
walking out almost daily, and returned to New York in the spring
to resume his business, greatly improved in health.

"Atlantic City offers, then, as its chief advantages for winter
residence, a pleasant and highly remedial climate and great accessi-
bility. But a place where invalids accustomed to the usual com-
forts, luxuries, and social enjoyments ot civilization are expected
to reside for months at a time, must possess other attractions be-
sides a good climate and accessibility, else ejinui and home-sick-
ness would soon more than counteract the exhilarating effects of
the air, and then the more numerous the railroads, the quicker an
escape would be made.

"Atlantic City is now one of the largest of the distinctively sea-
side towns in the United States, having a permanent population of
six thousand. It has church services conducted all the year, accord-
ing to the Episcopal, Catholic, Presbyterian, Methodist, and Bap-
tist forms of worship, with the usual social organizations of these
different denominations. The place also boasts of street railways,
omnibus lines, and no lack of carriages and phaetons for hire at all
seasons j good fishing and shooting ; circulating libraries ; hot and
cold sea-water baths; and finally, excellent hotels, at some of
which, during the latter part of the winter, there is to be found as
choice and brilliant a society as at the height of the summer
season."

HYGIENIC HINTS AND SANITARY PRECAUTIONS,

In an article contributed to the Philadelphia Medical Bulletin,
for November, 1880, the writer thus alluded to some important hy-
gienic considerations : —

" The matter of diet here is not so important in winter as in sum-
mer. Errors in this respect are not then apt to be followed by such
serious consequences. But it is safe to counsel all invalids to re-
strain the prodigious appetite they are almost sure to acquire soon
after coming. Otherwise, constipation, headaches, and loss of appe-
tite eventually result, showing that an overloaded stomach and em-
barrassed liver have struck work.

"It is a mistake to suppose that one can not take cold at the sea-
shore.

" It is necessary, then, that invalids here should take the usual
precautions against being chilled. In the winter season, and on
summer evenings, wraps of some kind are always in order, out of
doors, though usually they need not be heavy.

"As to exercise, while some is needed by the weakest invalids,
even though only of a passive kind, such as massage by a manipula-
tor, or rubbing by an ordinary attendant after the bath, there is com-
monly little danger that those able to walk shall not get enough.
Many are inclined to take too much, owing to the extraordinary
stimulant effects of the air, and need to be restrained, lest they ex-
haust their small stock of vitality as fast as it can be replenished.
But this tendency is far less in winter than in summer, when the
nightly hops and other multitudinous pleasures and dissipations keep
the more impressionable visitors in a constant whirl of feverish ex-
citement.

"There is, at this season, a restful air about not only the select
cottage boarding-houses, but also the largest hotels, even when
crowded as they are in February and March with the elite of the
great cities. The tired brain-workers and exhausted devotees of
fashion, equally with the convalescents and more chronic invalids,
having come to rest and recuperate, go about it, generally, in a quiet,
sensible way.

" One word, finally, as to medicinal treatment. For some cases
the air alone is sufficient. Others get on famously with the air and
the help of judicious bathing. Still others need medicines, and lose
by having them stopped during their stay at the seashore. For these
last, the tonic and alterative virtues of the air often furnish just the
adjuvants necessary to accomplish the cure. The medicines which
at home were nugatory or only half successful may succeed perfectly
with the aid of the sea-air, when neither, alone, would be sufficient."

The following, with regard to the sanitary condition of Atlantic
City, is from an article contributed by the writer to the Philadelphia
Medical and Surgical Reporter of July 9th, 1881 : —

"The sandy beaches on the New Jersey coast are generally free
from malaria, except at points where freshwater streams empty into
the ocean. Professor Alfred L. Loomis, of New York, in a recent
lecture, discussed the subject of malaria with his accustomed abil-
ity. He said : 'Salt-water marshes are, as a rule, especially free from
malaria ; but mix salt and fresh water, as on some of the New Jer-
sey marshes, and you have the conditions for generating the poison.
Marshes that rest on a substratum of sand are not so malarial as
those that rest on limestone, clay, or mud.'

"Atlantic City, which, by reason of its rapid growth and promi-
nence among health resorts, is now attracting to an unusual degree
the critical attention of sanitarians, is fortunate in being surrounded
by a plenitude of unmixed salt water, and in being founded upon
the driest of sand. So far, therefore, as concerns malaria, that
subtle, intangible poison, which defies alike the microscope and the
reagents of the chemist, but produces in some unknown way the
periodical fevers, Atlantic City seems to be highly favored. Inter-
mittent and remittent are strangers to the regular residents, and it
is the constant experience of malarial patients coming here that they
obtain rapid relief with far less medication than at home, often
especially in the case of children, with no medication at all.

"Among the important improvements lately effected may be
mentioned the following : There has been a general filling up of
lots which were below the city grade. A most stringent contract
has been made for the removal of garbage, at least once a day, in
sealed or closely-covered wagons, from every hotel and dwelling-
house in town, and its transportation by rail back into the country,
where it is used for fertilizing purposes. All privy wells are re-
quired to be cleaned at stated intervals, and the contents removed
in odorless excavators, and these latter appliances are already here
in use.

"A few words may be said as to the drainage of Atlantic City.
There are now eight sewers, which run from the ocean side of Pa-
cific Avenue across the town and empty into a canal or ditch out
on the meadows, which in turn empties into Absecon Inlet. This
would be objectionable if the attempt were made to carry off by
these sewers any animal refuse, or other offensive matters, such as
that from water-closets, or even kitchen-slops. Though they have
a fall of from three to six inches in every one hundred feet, it
would be impossible for them to remove such substances with suffi-
cient rapidity and thoroughness ; and even if they could, to pour such
a quantity of offal into the ocean at our very doors would be most
undesirable. Therefore, the sewers are used only to drain away the

ordinary surface water, the refuse matters being removed as above
described.

"The system in use here, as now carried out, is beheved to be
the best attainable on the flat seaside beaches. If any sanitarian
can suggest a better, the health authorities of Atlantic City would
be pleased to hear from him.

"Another important consideration at these seaside resorts is the
drinking water. At many places the surface water obtained by
digging a few feet in the sand is habitually used for drinking and
culinary purposes. This is decidedly unsafe. Intestinal fluxes,
and even typhoid fever, may be produced in susceptible persons by
using such water. The hotels, boarding-houses and cottages in At-
lantic City are supplied with cemented cisterns or wooden tanks
for collecting rain water, and either the latter or melted ice is al-
ways obtainable."

Under the head of hygiene very much more might profitably
be said, since many invalids fail to improve here as they ought,
solely because of neglecting little precautions which, though ap-
parently trivial, often make just the difference between success and
failure ; and a whole chapter might well be devoted to the subject
of salt-water bathing, facilities for obtaining which in-doors are
now obtainable at all seasons of the year. But this little pamphlet,
hastily and imperfectly prepared in the hope that it may supply
a want, has already far outgrown the dimensions originally con-
templated.

LIBRftRY OF CONGRESS

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