two WILLIAM A AN.D BEATRICE HAE&ADEN V\SI\r-M R! ^ o TWO HEALTH -SEEKERS IN SOUTHERN CALIFORNIA By WILLIAM A. EDWARDS, M.D. FELLOW OF THE COLLEGE OF PHYSICIANS OF PHILADELPHIA, ETC., ETC. AND BEATRICE HARRADEN AUTHOR OF " SHIPS THAT PASS IN THE NIGHT," ETC. PHILADELPHIA J. B. LIPPINCOTT COMPANY 1897 COPYRIGHT, 1896, BY J. B. LIPPINCOTT COMPANY. PRINTED BY J. B. LIPPINCOTT COMPANY, PHILADELPHIA, U.S.A. , IT PLEASES ME TO DEDICATE THIS LITTLE BOOK TO MY LIFE-LONG FRIEND, GEORGE E. DE SCHWEINITZ, M.D., IN MEMORY OF MANY DAYS THAT WERE HAPPY AND SOME, PERHAPS AS PLEASANT TO REMEMBER, THAT WERE SAD. W. A. E. SAN DIEGO, 1896. 404136 PREFACE I HAVE long felt that an impartial ac- count of Southern California, devoid of the fulsome praise of guide-books and land-office advertisements, would be of interest and help to a large class of health-seekers. If invalids would bear in mind that no climate is perfect, much disappointment would be saved. Again, if physicians would explain to their patients the absolute necessity of coming earlier in their disease, much suffering could be avoided. Finally, if the general traveller were made to understand that he was coming to the arid belt of America, with its scant and uncertain rainfall, many complaints of barrenness would cease. Miss Harraden has kindly contributed -5 . ON ^f-oo o o m ONVO co o o o mvo mvo vo mmmmmmmmm mvo m m m m m * m 1 3 XK oooo ooo o o oco ooo oo oo oo o ooo oo oo o o o 1 d UK moo NrOHinHNMro mvo O N <* -* - ooo 'oo? Sfe c UK ^^^^^^^^^^^^^^^^^^^.^^o^ S XK "NroMinOoo ONONN onoo MOO C4 N O ^-vo ro m N OVO OVO O\vo OVO 00 VO 00 000 00 000 *s^ ^ . UK ?5-?a*%^a^%5.$%5.^%sg.5.S s fa XK co t^^-O omo\-<*-roN o ro ONVO ONO omr^ooo mov VO OVO OVO OVO 00 000 000 OVO 00 OVO OVO R J UK ; ^ *). *}. $ ^.> ^^ ^; ^ o^oQj <% WQ jj> jj>co oo^ c^ rt o s* ""* XK ro m M co moo co vo ro o ^*-vo oo co ^- rt- -^-co vo vo in o o\ OVC VO OVO Ovo OVO O OvO OvO O OCO VO 3 1 nA HHH^I s I si Suggs' * J 2 1 45 TWO HEALTH-SEEKERS wa VOVO OVO VO VO & vO t^vo vo vo VO Wd B oo N o ro vovo o\ u->\O vo VO VO \O NO ^asvgvS^ VO vo wa i IOVO ^vo > vo'vO vS^ O O OO N CO t>. txvo vo vo ^ uoo N ftvgSjv^^Sv^ O O t^ N fi t^ t>vO VO VO Tj- vo 'WV II tx o xnvo VO vo vo VO t>-vO vo vo VO wvoi o tx t^ o co m t^ IO ir> mvO VO vo vo V^^S^vS vS wv6 vo vnoo N Tj-vo m 10 10 vnvo vo vo 00 f- -^VOOO VOVO vo 10 10 vS wvs t^ m ir> invo vo vo t>. to o -*m vo vovo 10 10 . wv Z ^- in vr> lovo vo vo >0 m ON N vo vo >o o to ^VO H-Y9 < S.2>S>S>v8vS i V?VO lOtO VO ft wv S ^-aaX^^vS vo'vg^Lo^ S wv fr ^Into^^SvS vSVo^vVLo ft wv ^- 10 lO 10 10 IOVO ^vg^ioS?) ft wv e O M H CO O\ O\ fO TJ- 10 VO 10 OVO VO vo VO 10 ft wv i OO W M CO OS O\ f) ^J- 10 10 OVO VO vo 10 vovo ft iqSrapIK O \O IO O OVO VO ^- CO O\ -^- i*- VO VO VO >O VO S K . * 0^ $ .' : : ! * ?, w S 2 1 I/ ;| 'SS |i| tills i 46 IN SOUTHERN CALIFORNIA Ajiptra -nq Xpptioui treaj^ < &s8R5: < .g: W-RS* A.T2P 3UO AUB Ul UOpBUBA JSBai &ep auo XUB m N H O O VO O\ N N CO fO M M M ss-s^-s .^dm,rmnnu!W VO ONOO >* H M t*s CO CO CO TMO to 10 10 N to VO M I . 9 B -aaduia, umuiix*H t.oot.cooor.t. ^^^^ ^SSSSLn to to to tOVO VO*VO VO vo VO 10 10 j K-dE II ZMZ$g * cn o * * VOVO vO to to Wd 01 IO to to vovo VO VO * o to <* VO VOVO 10 10 00 to W - d 6 CO * rovo O M Th to IO to tOVO VO vO 10 10 M 10 to VO VO VO to IO oo iirg S? to 10 lOvO VO v? IO IO M IO VO VO VO VO to IO SJ irJ ^vo tooo H co to IO to to tOVO VO VO 1010 W VO VO vo vovo to to 8 KM 9 1000 VO O -<*-VO to 10 lOVQ VO VO vo vo vo CO t^ t^ \O VOVO vo 10 vo waS tov8 tovo vo vo vo ssvzrjovg- vS tovo vovo vo vo vo ^vo^vo 1 v? IO r ON OS ^ H M *-J E 1* t-< J^ Ql > rQ rQ S E 4) l~ita s ^J s t"J , lljjl 1 47 TWO HEALTH-SEEKERS The preceding table presents the aver- age temperature for each hour of the day of each month of the year, and the greatest and least variation of tempera- ture in any twenty-four hours. In ad- dition, it presents the mean monthly humidity. It was compiled from the statistics of the United States Weather Bureau by John Ginty, Esq. Temperature records are very mislead- ing, from the fact that two localities may have the same mean temperature, either annual or monthly, and yet be vastly different in their thermal conditions. This is well illustrated by W. F. R. Phil- lips, M.D.,* who presents the following example: Des Moines, Iowa, and Ta- toosh Island, Washington, have the same annual mean temperature, 49 R, but the mean temperature of the hottest month in the former place is 75 F., and * Report of the Chief of the Weather Bureau, 1891-92, pp. 29-30. 48 IN SOUTHERN CALIFORNIA that in the latter 56 F. The mean tem- perature of the coldest month of Des Moines is 18 F., and of Tatoosh Island 41 F. Again, the highest temperature recorded at Des Moines is 104 F., and at Tatoosh Island 78 F., and the lowest temperature at the first 30 F. below zero, and at the latter 7 F. above. This makes a total range of 134 F. for the one and 85 F. for the other. It will thus be seen that, in order to obtain a correct appreciation of the ther- mal conditions of a given place, though it may be on the same isotherm as one with which we are very familiar, it is necessary to consider their various phases of atmospheric temperature.* To ac- * Phillips (ibid.) considers the more important of these phases to be, I. The mean daily temperature or the average de- gree of heat received in twenty-four hours which, meteorologically defined, is the arithmetical mean of twenty-four-hourly observation. In practice this is 4 49 TWO HEALTH-SEEKERS complish this we present a record of the self-registering thermograph at the obtained by using the mean of the highest and lowest temperatures recorded by self-registering thermome- ters. 2. The daily mean maximum temperature, or the average of a series of the daily highest tempera- tures recorded at any moment and during a given period. 3. The daily mean minimum temperature, or the average of a series of the daily lowest temperatures recorded. 4. The average daily range of temperature, or the difference between the mean maximum and mean minimum temperatures. 5. The daily mean variability of the temperature, or the average difference between the mean tempera- tures of any two consecutive days. 6. The absolute maximum temperature, or greatest degree of heat received at any moment during a given period. 7. The absolute minimum temperature, or the lowest degree of heat at any moment during a given period. The first five phases show the temperature proba- bilities and the last two the temperature possibilities 50 IN SOUTHERN CALIFORNIA United States Weather Bureau, San Diego, California, showing the number of hours that each degree of temperature registered last year, compiled by John Ginty, Esq. The so-called rainy season in this sec- tion usually begins in November, though slight showers may have occurred in October, and it lasts until about the mid- dle of April. One must remember, how- ever, that this rain period is not one of continuous downpour, but is pleasantly interspersed with bright, warm days and dazzling sunshine, and also that the heaviest rain is very apt to fall at night. Here again we find it difficult to make a hard and fast statement. The seasons, even in this land of equable climatic con- of a climate. All these points are well shown in the tables which appear in the text. A careful study of these tables will furnish one with all the variations of temperature for the southern coast-strip of Cali- fornia. 51 CO TWO I sanojj IEALTH SI SS^WSV :EKERS | in sanoH ^Jtss'a ; ;ffsr*& CO NO sano H ^w^sra 1 : :*^w 1 3 sano H ^^JoJTJ?; H txrx 8 * SOTIOH RS^^ 10 * ; . M ON^OO_ 1 m in sanojj s^^*-; ;VM CO H ft SJTIOH 5Ja^ ; . CO M O > in SJ no H sss-sr; ; ; ; ; M %^ r ft sanojj inS^^w* [ ; HN S^ 2" 5 sanoH ^co^s^; ; ; ro IT) <3- sjnoji JTA'S'S ' ' ' ? * sonoH m M w . . M o xn | * sonojj ^s^ : * : ... H oo m sano H 's 2 2 H : : : m in $ sanojj s^: : : : % 3 s.no H H 9- SJHOJJ M M SOUGH m o H H Ot sanoH m M M 00 & sjnojj H H & SJtlOJJ *:::::: H > 2 ** ** 11 3 2 in i> ^ ^ JnrQ^ ^ H "ijlllli Illll <&OZQ 13 21 IN SOUTHERN CALIFORNIA R | -no H ' * M * in M N ' \n 2" fe sonoH ' ' M M * " m M ^- sanoH ;;;;; NO M -^- ' 2 ^ sanojj * * M ' * ^. sanoH <*CO ' W -*"*^ vo o t>. com CO CO 2 a sanojj N CO H W * t> M CO 0t> .00 'ft & sjno H MOO M in ro ox ^^^ ;a *. 8 sonojj ** i 10 * a a co moo M o \O * M M S 0. NO sjno H M txM \o m r^ o M M -4-NO OO VO O W VO tx 8 s ia NO 'sanojj ^^BST^i? | &"" NO ^ sano H ^^HS-ES invo 1 * N s NO- sanojjl ^srt&ag &S8RS IK <* NO SJHOH m 10 t^ \o M N M Cl 00 N vo w r> t^.m 00 CO M M K m vg sanoH ^M^S g.?. <8S,S*;T $ *. sjnojj ^S^^- R5- K^SS^S 1 vS sano H H M O\O\ VOVO N ro oo ei S^S^-S^ a S sjnoH 2 S 3^ 5; " t^rf * in O M CO CO CO 8. I Total hours . . . .--, ^^g itill m iovo vo *o \o vo vo 10 o sono H 'sanojj "sanojj P-M * rS Hill Greatest variation in any one day, 31 F., on February 27 ; least on January 14, variation being only 2 F. in the twenty- four hours. Greatest variation during the entire year, 53 F. Lowest temperature, 37 F., for one hour only, on January 27, at i P.M. ; highest, 90 F., for one hour only, September 15, at 4 P.M. Mean annual temperature, 60 F. Mean annual humidity, 78 per cent. From 1872 to 1896, out of 7401 days there were only a few hours in 247 days that the temperature exceeded 80 F., and only 2 days in which it fell as low as 32 F. above zero. [Copyright 1895, by John Ginty.] 54 IN SOUTHERN CALIFORNIA ditions, are liable to vary greatly in the total rainfall and its distribution. In some years it exceeds the quantity which has been established as the maximum, and in others is far below the average minimum. The following table shows the rainfall for twenty-four years, recorded by self- recording instruments in the United States Weather Bureau. During the winter months there are few days on which one cannot be out of doors at least a portion of the twenty- four hours. The rains occur when the winds are from the south, and discon- tinue as soon as the prevailing western winds arise, when the atmosphere at once clears. Thus there is an entire absence of the enervating steamy heat of the Atlantic coast, and one can imme- diately resume his out-door life. It is a well-known fact that a thermometrical heat which would be enervating in other 55 TWO HEALTH-SEEKERS I I * s? i M a\*o in tx e ro % O\in H H -+CO O O O H O N q ON <* ro H q q oo CO co m m N moo t*. Q o H H c\ r*) xninO-*H O^rOM R H "* M 0\ H OO o moo inline H -j-^c< o in *> fOOO OONMCO 8 00 H H H in M O ro Tt-vo vo o\ N O fnoo in vom-^-moOOcn V>NH rv H M H H 4 1 OO ^S'Svg ^ 00 8^ ro H w vd M tx i- 00 t W^S^ 000 ^ ^ tx OO * M -^- M H CO M fx ^^J? 0000 ^^^ a M H H H m OO \O Bi tx rhoo vo m m rovo rooo * m -* TJ- f. O OOOOOOOH jr 00 HAM tx 10 tx ootxinNONOHONOm^ o9 OO N VO s Mmo^-^ONOM tooo m H ON 00 en ro M s OO H *inMOmOOnoo t^^o O ro H Ssff^a 00 ^ - M I , . 2 . . . ft . t< u 2 S^b -2 U J^ > &^' -55S|fiS S 3 2 "^ >, ^S,- r o > % J SJJS-a tf frsl J WSjf July c 78 68 67 g 74 83 71 68 85 8q 86 76 68 84 Tuly 8 . . 51 83 77 67 78 uly Q . 7 8 67 75 yc RR 4 7^ 68 60 75 66 uly 12 78 7 65 ^6 72 82 72 66 Ro 71 76 73 7 1 82 60 74 77 75 8^1 uly ID . . 65 82 73 7* 66 9 74 69 81 uly 18 82 92 77 72 82 uly 19....... 82 85 B| 75 7O 80 93 75 65 75 uly 21 82 95 7 R 66 74 uly 22 , . 83 88 81 67 77 uly 23 8? 86 88 66 7 R uly 24 . ... 82 78 84 69 8^ 81 83 75 7 8^ 80 R? 75 71 70 July 27 79 7 77 71 7 R July 28 77 78 76 70 80 82 79 71 78 July 30 ........ 79 81 75 70 80 July 7i 72 74 74 *7 81 77 81 76 68 78 August i . . . 71 75 72 73 8^ 73 75 7 3 79 78 71 79 Augus 4 8? 7 R 68 85 Augfus "? 86 87 7^ 70 84 89 86 7 6 72 83 Augus 7 Ro 80 76 T Augus 8 84 91 ^6 70 7O Augus 9 84 QA RT 70 Rn Augus 10 86 96 70 6q 78 79 Qtf Rl 69 76 August 12 73 QI 1 70 78 August 13 73 ?n 80 60 g August 14 79 ft 8q 74 Ro R? R 7 H5 7 i 88 80 87 81 66 IN SOUTHERN CALIFORNIA Diego, said to be a little cooler in summer and perhaps a degree or so warmer in winter. Lindley has presented the pre- ceding table in the Journal of the Ameri- can Medical Association, March 21, 1896, which shows the comparative maximum temperature during July and the first fifteen days of August, 1895, in Boston, Baltimore, and Atlantic City upon the Atlantic coast, and in Coronado and Los Angeles upon the Pacific coast. 67 TWO HEALTH-SEEKERS CHAPTER III. THE CLIMATOLOGY OF SOUTHERN CALI- FORNIA. (CONTINUED.) HAVING considered the climatic pe- culiarities of littoral California at some length, taking San Diego as a type, we shall now turn our attention to the interior. The Sierra range of mountains marks the dividing line. But the coast range of this vast mountain-chain begins grad- ually to disappear in Southern Califor- nia, so that, in certain localities, the interior is more open to the sea. Wid- ney so well describes this topography that I shall quote from him at length. " This interior plain in Southern California is made up of the long reach which includes the San Fernando valley, the Pasadena country, the valley of the San Gabriel River, the Whittier foot-hills, 68 IN SOUTHERN CALIFORNIA the Pomona and Ontario uplands, the valley of the Santa Ana River, in which lie Colton, the San Bernardino country, and Riverside, and the long plains of the San Jacinto River southward. Unlike the inland plain of Northern California, it is very irregular in outline, branching out in many direc- tions, and often merging almost insensibly into rolling upland mesas. This plain, with its irregular windings, is about two hundred miles in length, with a width varying from fifteen to thirty miles. It is smaller than the corresponding interior valley of Northern California, but the reverse is the case with regard to the coast plain. Instead of the narrow rim which makes the ocean frontage outside of the coast range in the northern portion of the State, in Southern California, an extensive plain faces the sea, having a length of about one hundred and fifty miles, and a depth varying from fifteen to twenty-five miles. This does not include the long valley of the Santa Clara and San Buenaventura Rivers, which fronts on the ocean for some thirty miles, with a depth of about seventy-five, nor the Santa Barbara plain. Between this coast plain and the long interior valley, the coast range of moun- tains, instead of the continuous chain which it pre- sents in Northern California, is broken and opposite the Los Angeles plains for a space entirely disap- pears. The whole country, interior valley system as TWO HEALTH-SEEKERS well as coast plains, becomes thus a great open coast land facing the south, and with the high Sierra for a background. " The area of the plains of Southern California is really largely increased over their apparent size by the rolling, hilly uplands into which, in many direc- tions, they merge. This is especially the case in a country which lies between the San Fernando val- ley and the lower Santa Clara valley, and also in the great upland which rises from San Jacinto towards the south in San Diego County. The Sierra, which, north of the so-called Mojave Desert, makes a great curve westward round the south end of the San Joaquin plain of the central belt, turns southward again opposite Santa Barbara and Ventura Coun- ties, and, doubling back upon its course, walls in the west end of the desert, then, turning directly east- ward, separates the desert from the Los Angeles and San Bernardo plains. Turning southward again, it stands as a wall between the Colorado Desert and that portion of Southern California lying west of its base. The range varies in height from five thousand to seven thousand feet, with peaks reach- ing from eight thousand to eleven thousand feet. While maintaining this great elevation it yet de- velops one feature which it does not possess opposite the central belt. It breaks down at several points into low passes between the coast and the interior of 70 IN SOUTHERN CALIFORNIA the continent. The pass by which the Central Pacific Railroad, on its way eastward from San Francisco, crosses the Sierra, is seven thousand and seventeen feet in elevation. Yet the Soledad Pass, by which the Southern Pacific Railroad crosses the Sierra in South- ern California, is only two thousand eight hundred and twenty-two feet ; the Cajon Pass, by which the Atchison and Topeka Railroad enters, is about the same height ; and the San Gorgonio Pass, by which the Southern Pacific crosses on the road to Galveston and New Orleans, is only two thousand five hundred and sixty feet above the sea. There are numerous other comparatively low passes through the Sierra at the west end of the Mojave Desert, leading towards the sea in Ventura and Santa Barbara Counties, and also through the range south of San Gorgonio. These passes through the Southern Sierra have a marked influence not only upon the climate of the coast portions of Southern California but also upon that of the deserts lying at the east base of the Sierra. " The Mojave Desert lying beyond those passes which open northward has an area of several thousand square miles with an elevation above the sea of some two thousand feet. The Colorado Desert, which lies opposite the passes leading east- ward, is somewhat less in area, and has a portion of its surface three hundred and fifty feet below the level of the sea." 71 TWO HEALTH-SEEKERS Los Angeles may be taken as a typi- cal inland city of Southern California. It is the metropolis of all this southern country, and is situated about midway between the sea and the mountains, twenty miles from the former, and four- teen from the latter, and about equidis- tant from San Diego and Santa Barbara. It has grown into a beautiful town, and, in so far as it has reached the size and condition of a large city, has grown away from its suitability as a health-resort for a large class of invalids. Nevertheless, as far as I know, it has the best climate of any city of its size. Its winter tem- perature shows an average of 52 F. and its summer temperature is in the seventies and eighties. The mean yearly maximum temperature, compiled for a number of years, is 87.3 F., the mean yearly minimum is 43.4 F. The average number of clear days is one hundred and seventy-six, fair days one 72 IN SOUTHERN CALIFORNIA hundred and forty, cloudy days forty- nine, making three hundred and sixteen days during the year in which a person could be out of doors. The average number of rainy days is forty-two. During the night and morning the winds are generally land breezes, turning in the early afternoon to fresh westerly sea breezes ; there are high winds during the winter, and blustering storms during the rainy season. During the dry season there is an occasional " norther/' or hot wind, due to a very high atmos- pheric pressure in Northern California with a relatively low one in the Southern Californian regions. Fogs are more frequent during the change of seasons, when cooler, moist air comes in from the Pacific Ocean. The soil is generally dry and porous, though some few local- ities are adobe, or damp and sticky, but the dry soil predominates. The advantages of this region as a 73 TWO HEALTH-SEEKERS health-resort are, its dry soil, mild tem- perature, comparatively low humidity, the number of days when one can be out of doors, and the fact that the alti- tude and climate can be varied by a few hours* journey.* Los Angeles is surrounded by a most attractive country, well cultivated, and far in advance of the rest of Southern California. Here are many very good invalid stations, as Pasadena, Sierra Madre, Whittier, San Gabriel, and others; their climate is similar to that of Los Angeles itself. The temperature is less equable than in the sea-coast towns, but it is perfectly acceptable to the average invalid. All the surround- ing country has about the same climatic conditions, and varies in elevation from three hundred and fifty to five hundred * Report of Committee on Health-Resorts, Amer- ican Climatological Association, vol. xi., 1895. 74 IN SOUTHERN CALIFORNIA feet, with an average rainfall of about sixteen inches, having about fifty rainy days, a humidity of sixty-seven per cent, and a mean temperature varying, as we have seen, from 50 to 80 F. ; but it must be remembered that all these interior stations show a very high thermometric registration during the summer. The same degree of sunshine is found in the interior as we have recorded upon the coast. Far in the interior the fogs are somewhat less, but for twenty miles and more from the coast they are quite as prevalent and dense as on the coast itself. One escapes them only by re- treating far into the interior to the higher altitudes. There we arrive at a condition that is very similar to the mountainous region of the far Eastern States, and also nearly resembles the well-known stations in the Swiss Alps, such as Andermatt, four thousand three hundred and seventy-eight feet, Weisen, 75 TWO HEALTH-SEEKERS four thousand seven hundred and sev- enty-one feet, Davos, five thousand one hundred and five feet, and Malloja, six thousand feet. At this altitude we do not find so many of California's peculiar and distinctive charms. January . February March April . May . June . July . August September October . . November December . Means . 49-7 50.9 53-4 4 62.8 65.9 65-9 62.6 57-4 54-5 ;rat ? in 57.8 56.8 62 65 61.8 76-5 69.2 59-5 1 * 42.8 45 44 69.7 60.5 56.7 56.5 5: 4 1 58.3 66.7 52.5 0.84 0.99 0.76 0.29 0.24 0.9: 0.00 O.I2 o.oo 1.36 0.68 0.07 4.67 74 s 74 4-6 e-s 52.8 54-3 55-7 58. 59.6 62.6 65-9 & 62.8 58.5 55-3 59-9 The preceding table is a synopsis of the weather at Santa Barbara, California, for 76 IN SOUTHERN CALIFORNIA the year 1894, and is compiled by Hugh D. Vail from daily observation of tem- perature as shown by self-registering thermometers, and the movement of the wind as measured by a Robinson anemometer. Santa Barbara is in lati- tude 34 24' 30.7", and longitude 1 19 41' 22". The mean temperature of the year was 58.3 F., being 1.6 below the average; that of the three winter months 51.5, of the spring 56.2, of the summer 63.4, and of the fall 62. The highest temperature during the year was 94, on September 15, and the lowest 33, on January 7. There were but ten days when the temperature rose above 80 : of these one was in April, one in June, four were in August, and four in September. Of the three hundred and sixty-five days in the year, two hundred and fifteen were clear, seventy fair, and eighty cloudy. Rain to the amount of one-tenth of an 77 TWO HEALTH-SEEKERS inch or over fell on seventeen days. The rainfall for the year was 10.09 inches; that for the season 1893-94, 7.02 inches; while the average annual rainfall is about 1 8 inches. The mean relative humidity was seventy-four per cent. The prevail- ing wind during the year was west ; and the total movement forty thousand one hundred and eighty-one miles, making the average velocity about four and one- half miles an hour. The greatest move- ment for any one day was three hundred and eighty-six miles, on January 10, being an average of sixteen miles an hour. The most prominent peculiarities of the past year were light rainfalls, greater cloudiness than usual, and a general uniformity of temperature which was nearly two degrees below the nor- mal. The Ojai valley, in Ventura County, forty miles east of Santa Barbara, is a typical inland valley, six to eight miles 78 IN SOUTHERN CALIFORNIA long, and three to four wide ; its altitude is from nine hundred to fifteen hundred feet. The soil consists of gravel, and more or less loam on the levels, a clay subsoil, and considerable adobe, with some alkali. In some places water runs off quickly, or is rapidly absorbed, leav- ing little dampness. The winter shows temperature extremes of eighty degrees to twenty-six degrees ; ordinarily, the record is seventy to forty degrees; summer extremes, one hundred and ten to fifty degrees, ordinarily ninety to sixty-five degrees. The atmosphere is said to be extremely dry, and there is no dew. There are occasional high winds with sand storms ; the wind that blows from the north, from the Mojave Desert, creates considerable electrical disturb- ance. Fogs are infrequent, and, when they do occur, disappear by 9 A.M., with a few exceptions. During the year 1894 there were over three hundred 79 TWO HEALTH-SEEKERS bright, sunny days.* The average yearly rainfall is sixteen inches. Pasadena, about twenty-eight miles from the coast, is situated at an elevation of eight hundred to one thousand feet ; within eight miles are numerous points varying in elevation from twelve hundred to thirty-five hundred feet. The soil is a sandy loam. The mean average tem- perature for January is 53.9; July, 70.2; December, 58; August, 70 F. The mean maximum and minimum tem- perature for December, 88 F. maxi- mum, 37 minimum ; for July, 90 F. maximum, 51 minimum. The relative humidity for July is sixty per cent; December, sixty-four per cent; Sep- tember, seventy per cent. From April to September fogs are quite frequent in the early morning, usually disappearing * Report of Committee on Health-Resorts, Amer- ican Climatological Association, vol. xi., 1895. 80 IN SOUTHERN CALIFORNIA by nine o'clock. The proportion of bright, sunny days is about as in Los Angeles. Redlands is thirteen hundred and fifty feet above the sea-level, and is in a valley surrounded by mountains of from five thousand to ten thousand feet alti- tude. The soil is dry, red, deep, and porous, in some places stony. The average rainfall is twelve inches. The summers are hot, but owing to excessive dryness are said not to be oppressive. During the day the thermometer is apt to register 110 F. The winter ex- tremes are from 35 to 80 F., the former on December 12 and 29, 1893, and the latter on December 5 and 6, 1893. Occasional high winds occur, and some fogs which generally disap- pear during the forenoon. If one pursues his course farther into the interior, he reaches either one or the other of the two great deserts of South- 6 81 TWO HEALTH-SEEKERS ern California, the Mojave and the Colo- rado. In the latter, in the southeastern portion of San Diego County, is to be found a most remarkable depression in the earth's surface, the bed of an ancient sea, known as the San Felipe Sink, or the Conchilla Valley. The deepest part of this depression is three hundred and sixty feet below sea-level, the lowest spot in the United States.* * Other places below sea-level are : Sink of the Amargosa (Arroyo del Muerto), in Eastern Califor- nia, two hundred and twenty-five feet below sea- level; the Caspian Sea, eighty-five feet below sea- level ; Lake Assal, east of Abyssinia in the Afar country, eight miles long and four miles wide, seven hundred and sixty feet below sea-level. There are several depressions about six hundred feet below sea-level in this vicinity. The noted oasis Siwah, in the Libyan Desert, three hundred miles west of Cairo, is one hundred feet below sea-level. There are also numerous other depressions in the desert portion of Algeria and at various points in the Sa- hara Desert. (Lindley.) 82 IN SOUTHERN CALIFORNIA This sea-bed is one hundred and thirty miles in length and about thirty miles wide. At Salton, some little distance into the depression, the sun temperature reaches 135 to 160 F., but the hu- midity is low and the heat is fairly well tolerated. One may here obtain the effects of moderately compressed air. The famous volcanoes are a few miles from this point. Indio is near the edge of the de- pression, and is but twenty feet below sea-level. Invalids may select it for a location, as it is on the railroad, and water is supplied by artesian wells. In two hours' time by railway, Beaumont may be reached, twenty-five hundred feet above the sea, and in another two hours the San Jacinto Mountains, from six to ten thousand feet above the sea. Several years ago water returned to the bed of this ancient sea and gave rise to much speculation among clima- 83 TWO' HEALTH -SEEKERS tologists as to the possible effect that this large body of water would have upon the climate of Southern California. I contributed my quota to this discus- sion in The Climatologist for February, 1892, from which I extract the follow- ing : " To us as climatologists the most interesting part of this ancient sea is a valley about sixty miles in length, fifteen miles wide, and almost surrounded by mountains, some of which are of nearly ten thousand feet altitude. It is through this valley that the Southern Pacific Railroad finds its exit after leaving the pass of San Gorgonio. A recent writer has termed it 'The Death Valley/ al- though from four hundred to five hun- dred Cohuilla Indians consider it their home. The traditions of these Indians and the remains of ancient fish-traps seem to show that this sink has before been a large body of water, although not within the existence of any living 84 IN SOUTHERN CALIFORNIA man. The usual overflow of the Colo- rado River,* which skirts the sink, has been prevented from rinding its way into this sunken area by its outlet into the New River, which, until the extraordi- nary rainfall of last February, was suf- ficient ; but the unusual precipitation of that month broke down the sand ridges, and the Colorado River began to pour its waters into the desert at the rate of sixteen thousand cubic feet per second, increasing until the flow at Yuma was thirty -five thousand cubic feet per second. The water reached Salton on * Powell, of the United States Geological Survey, says that as the delta at the mouth of the Colorado bridges the great trough from side to side, and as the river, in the building of the delta, has shifted its course from place to place, it cannot be that it has always as now flowed southward to the Gulf. Part of the time it must have turned westward to the Cohuilla basin. Whenever it has turned to the southward the lake, having no other tributary, has died away, leaving the basin as we know it now. 85 TWO HEALTH-SEEKERS June 22 of the present year (1891), and now, as I write, the sink is covered with a vast expanse of water, one hundred and forty-five square miles in area, and from two to six feet in depth, while in a few places it reaches the depth of fifteen feet. The traces of the old sea show a depth of eighty feet." At the present time much, indeed most, of the water has evaporated or receded into the river, and the valley is almost dry. A very good article just published by Gaillard, Corps of Engineers, U. S. A.,* who was stationed here in San Diego, and was a member of the International Boundary Commission, United States and Mexico, states that it will be a sur- prise to many to learn that our own California desert holds the world's record for extreme heat, 128 F. in * The Cosmopolitan, October, 1896. 86 IN SOUTHERN CALIFORNIA the shade, at Mammoth Tank, a point in the desert twenty-five miles north of the international boundary-line, a record far in excess of any other ever observed at any regular weather bureau station in the United States. Death Valley, California, is not very far be- hind: it has a record, taken in 1891, of 122 F. The following table is a comparison of our desert with other well-known high-temperature locations. It is from Harrington's Report on the Climate and Meteorology of Death Valley, California : Mammoth Tank, Colorado Desert, Cal. . . 28.0 Pachpadra, Rajpootana, India ...... 23.1 Jacobabad, Sinde, India ......... 22.2 Death Valley, California ......... 22.0 Dera Ismaeel Kahn, Punjab, India .... 21.5 Hyderabad, Sinde, India ......... 21,0 Gardaia, Algerian Sahara, Africa ..... 18.4 Mooltan, Punjab, India ......... 18.4 It must be borne in mind that, as Gaillard says, the figures given for the 87 TWO HEALTH-SEEKERS California and Arizona deserts may be disappointing to some who have heard of extremely high temperatures as com- mon occurrences. These statements, he thinks, are partly due to exaggeration and partly to the effect of intense radi- ated and reflected heat, and the great difficulty in procuring suitable shade for the instrument. The desert traveller encounters but little shade, and is ex- posed to the fierce heat of the sun, unless he locates himself at a suitable invalid station, an oasis. The nights are always cool: just before daylight the thermometer may fall as low as 65 F. I quote from Gaillard : " But it is in winter that the desert is at its best ; the air then is clear and crisp, invigorating and stimulating to a remarkable degree, and although at times it is somewhat hot in the middle of the day, yet the nights are perfect and the stars shine with a dazzling brilliancy peculiar to the 88 IN SOUTHERN CALIFORNIA desert. It is by no means unknown at this season, and the writer recalls three occasions in March, 1893, when, on the Colorado desert, within thirty miles of Mammoth Tank, water froze in his can- teen at night, disproving completely the popular belief that in this region it never becomes cold enough for ice to form. Frost, like dew, is practically unknown, but it is on account of the small amount of moisture in the atmosphere, and not on account of the absence of cold suffi- cient to produce it." 89 TWO HEALTH-SEEKERS CHAPTER IV. OUT-DOOR LIFE FOR WOMEN. SOUTHERN CALIFORNIA is the very land for out-door life, and apart from riding and driving and bicycling and camping there are many occupations and interests which come well within the scope of even delicate women. In fact, a year of healthy country-life in Southern Califor- nia would do far more to restore many ailing people to health than several seasons spent in sanitariums and cure- resorts. To begin with, one learns to do without hampering luxuries, and one learns to make the best of everything, and, above all, one is generally at a con- siderable distance from a doctor. These are immense advantages for some inva- lids, especially for rich ones who have 90 IN SOUTHERN CALIFORNIA never known what it was "to have a single wish denied." A woman can do a great deal of sat- isfactory and useful work on a ranch. She can pick the lemons, oranges, olives, apricots, or peaches ; she can sucker the trees ; she can undertake the anxious task of pruning. She can superintend the curing of olives and lemons, and see after the packing and despatching of the fruit. One girl who came from the East, from a busy life, and had more leisure than she needed here, conceived the excellent idea of starting a strawberry ranch, and has made such a capital suc- cess out of it and brought such beauti- ful fruit to the market that others have been only too glad to follow her ex- ample. Another lady has turned her attention to the culture of pampas-grass, and is reported to have won good re- turns for her labour and outlay. One 91 TWO HEALTH-SEEKERS hears also of tired-out teachers giving up their school-work and taking to nursery gardening with all its various developments. Amateur gardening is a great resource in itself, and the satis- faction of seeing such quick and rich results from one's efforts is quite inde- scribable. Given a fair supply of water, one may soon have a beautiful garden around one, with every variety of rose and carnation ; wisteria, honeysuckle, plumbago, and stephanotis will grow almost like weeds ; in fact, anything and everything will grow as though in fairy- land. So that gardening in Southern California does not mean hope deferred making the heart sick ; it means some- thing quite unusual in the way of com- fort and encouragement, together with the knowledge that one is creating beautiful surroundings for one's home. With regard to camping, a few words of caution may not be out of place. 92 IN SOUTHERN CALIFORNIA Delicate women are likely to come back worse than they were when they started out, unless their men folk are willing to take upon themselves the whole burden of the work, or unless they can afford to have a Chinaman with them, or some other kind of servant, thus giving them the chance to rest and get the good from the open-air life. Otherwise they are always over-fatigued and can enjoy nothing, and would be far wiser if they remained at home. Walking is not one of the pleasures of out-door life in Southern California. Neither the climate nor the country is suitable for it, although botanists who are strong enough for the exertion scramble about everywhere, searching for treasures and fighting determinedly through the thickly-grown brush; but most of them when possible take a horse or pony, for no one would choose to walk here, if other means of getting 93 TWO HEALTH-SEERERS about should be within one's reach. Lovers of flowers can, however, make a very fair and characteristic collection by merely gathering what grows by the roadside, or by just taking a few steps up the slopes and laying hands on any- thing which strikes the fancy there. But there is no strolling about among shady trees and by the side of running brooks ; and many people will find this a great deprivation, which it undoubt- edly is. Driving is a necessity as well as a pleasure of every-day life ; and one soon becomes accustomed to going for miles and miles over roads which after a dry season are full of "chuck-holes." Nothing could be more enjoyable than starting out on a typical Californian day, with a nice little team and all the dogs scampering along joyously, and plenty of provisions and a fierce determination not to return until you feel inclined. The sense of freedom is delightful, and 94 IN SOUTHERN CALIFORNIA moreover the most delicate invalid need not be afraid of these expeditions, and will find that the more she drives the more she can drive, for there is some curious life-giving power in the air which prevents over-exhaustion and aids quick recovery from ordinary fatigue. On account of the many interests and occupations inseparable from country- life in Southern California, all of them enticing one into the open air, one feels more than justified in urging visitors to give themselves the best chances of recovering their health in the country rather than in towns. 95 TWO HEALTH-SEEKERS CHAPTER V. EXPENSES OF LIVING CLASS OF HEALTH- SEEKERS THAT SHOULD COME TO SOUTHERN CALIFORNIA CLOTHING METHOD AND TIME OF ARRIVAL LIFE TO LEAD AMUSEMENTS, OCCUPATIONS, AND BUSINESS OPPORTUNITIES. CALIFORNIA of the South is not the country for a poor invalid. One must not come here seeking health without sufficient means for him- self and his family, or care-takers. I have seen so much distress and suffering on this account that I wish to speak plainly. It is useless to strive after health with- out placing one's self under the most favourable conditions to attain that ob- ject. Everything that an invalid re- quires is expensive here, much more so than in the far East. One can live 96 IN SOUTHERN CALIFORNIA very cheaply, but only by denying him- self the comforts and luxuries which are essential to the well-being of an invalid. California has never recovered from the conditions incident to the dis- covery of gold within her borders; money is comparatively easily made and is quickly spent. There is little trade competition, and, in consequence, prices are maintained at an arbitrary standard. Coal, wood, gas, water, ice, groceries, and all manufac- tured articles, command a price that is far in excess of New York, Boston, Philadelphia, or Baltimore. On the other hand, vegetables, meat, milk, but- ter, and some fruits are very cheap. Horse-hire is within the reach of modest purses. The wages for domestic service are absurdly high, and the service very inefficient; if we exclude the Chinese and Japanese, who are not acceptable to the majority, there is practically no ser- 7 97 TWO HEALTH-SEEKERS vant class. House-rent is altogether too high. If one lives in Philadelphia, let us say, in a certain style for a cer- tain sum, and wishes to come to South- ern California for residence, it is safe to calculate that it will cost him about forty per cent, more than in his Eastern home if he wishes to maintain the same mode of living. It is a curious fact that notwithstanding these conditions the rates in the first-class hotels are not as high as in similar houses in the East Almost all classes of invalids will find a suitable climate somewhere in South- ern California, but the individual himself must hunt for it. A rather extended experience in these matters, both per- sonally and professionally, has con- vinced me of the inability of the medi- cal adviser to select absolutely and with certainty the proper climate for each patient. The personal factor is too strong, and one's likes and dislikes must 98 IN SOUTHERN CALIFORNIA be consulted. Let him take to heart Braun's trite remark, "We must con- sider not only the individual sickness but the sick individual." Speaking broadly, persons suffering from any of the following conditions will find certain locations in Southern California to be useful aids in restoring them to health, incipient or early phthisis or tuberculosis in any form, chronic pneumonia or a tardy conva- lescence from either pneumonia or pleu- risy, diseases of the liver following malarial poison, cirrhosis of the liver, simple congestion or hepatic catarrh, jaundice, functional disturbances, and organic ills in those of advanced years and weak or poorly-nourished children, children subject to one of the various diatheses, as the strumous, rachitic, or tubercular. The overworked and over- worried class will find here a most soothing climate to regain their lost 99 TWO HEALTH-SEEKERS energy or restore the nervous system to its normal equilibrium. My advice to the health-seeker who is independent both in time and money is to come to California in April or May after the rains are over. Let him remain during the summer on the coast, the climate of which is pleasanter, by the way, than that of any of the Atlantic coast resorts ; let him study the country, become accustomed to the very different conditions here, and be ready to obtain the full benefit of the winter after hav- ing recovered from the fatigues of the journey. Those who cannot devote so much time to the trip will do well to start for California before the snows occur in the East, thus avoiding the danger of blockades which are disas- trous to many weak persons who never recover from the exposure. Pulmonary invalids especially and sufferers from circulatory disturbances, or those weak- IN SOUTHERN ened by disease, should on this account select the southern route.* It is monot- onous and unpicturesque, but free from high altitudes, and it crosses a country whose climate is rarely objectionable in winter. To those who are able to stand an altitude of nearly eight thousand feet, the Santa Fe route affords perhaps the most comfortable and quickest mode of reaching Southern California. This necessitates, however, starting from Chicago or Kansas City, two towns not particularly well adapted climatically to the needs of a delicate invalid. The writer has been a somewhat extensive traveller and feels it but just to testify to the uniform excellence of the Hardy restaurant and dining-car system of this railroad. The invalid who is not a sufferer from * Southern Pacific Railroad from New Orleans to Los Angeles. diseased heart or lungs is practically at liberty to select any route he fancies, and as this little treatise is not a guide- book, he is referred to the various agen- cies of the different cross-continent sys- tems. The most picturesque routes are the Canadian Pacific and the Denver and Rio Grande. Many and varied combinations of routes may be selected, and much that is remarkable and inter- esting visited en route, if one has the strength, for example, the Yellowstone Park, the Yosemite Valley, and the Grand Canon of the Colorado. The advisability of an uninterrupted journey from the far East to California, or of the trip made in easy stages as the fatigues and monotony seem to demand, is to a certain extent a personal matter, and no one can decide it but the indi- vidual himself. Some, indeed the ma- jority of invalids, do much better by pushing on to their journey's end, while 102 IN SOUTHERN CALIFORNIA others seem to require one or more nights' freedom from the discomforts and lack of ventilation of the sleeping cars to preserve them from actual harm instead of benefit. All invalids, no mat- ter how they may take the trip, arrive in California fatigued and exhausted. This requires several days, and in some in- stances several weeks, to overcome. For this reason one must be prepared to suf- fer a little loss of ground when first coming to his health station. This loss is usually only transitory, and is gen- erally followed by a rapid gain. If the location be a suitable one this gain will be continuous and in many instances permanent. It is perfectly foolhardy to leave one's home for only a few months in the winter season and expect to find a magic cure in the climate either in this or any other resort. No happy results will be obtained unless the residence is 103 TWO HEALTH-SEEKERS continuous for at least a year. Under- stand me, I am referring, of course, to cases where so-called organic disease exists. The sea trip by way of the Isthmus of Panama is advised only in a small number of cases, and the home physi- cian must determine the proper subject for this tedious journey. It is very long, and in the tropical regions ex- tremely hot, and the steamers are not under very good discipline. It is cer- tainly not a trip that a woman should take alone. I am often asked what kind of clothes one should bring to California. I in- variably answer, just such clothes as are worn at home, and all the various thick- nesses and weights that the invalid is accustomed to there. We have already remarked upon the great contrast in all semi-tropic places between sunshine and shade, and mid- 104 IN SOUTHERN CALIFORNIA day and midnight. It is this contrast that will oblige the new-comer to use great caution in making any change in the weight of clothing until he has become thoroughly accustomed to all the conditions he will find in our land of many climates. New-comers from the furnace-heated houses of colder climates constantly complain of the chilliness of our winter air, a sensation no longer experienced by the older residents. While these strangers are thus complaining bitterly of the cold, the tenderest flowers are blooming luxuriously. This is of course no more peculiar to Southern California than it is to all semi-tropic countries. As soon as possible, the health-seeker must settle down in a proper and suit- able locality, and remain there until improvement begins or is fully estab- lished. It is a great mistake for him to move rapidly from place to place seek- 105 TWO HEALTH-SEEKERS ing an imaginary climate and blaming all climates because he is ill or does not recover as quickly as anticipated. It is much more reasonable to lay some of the blame to the disease itself which has brought him to California. He must investigate patiently and impar- tially the selection of a climate which at first may not be the proper one, or, perhaps, the time too short since his arrival to draw any conclusions. At all events, he must not decide at once that he has chosen the wrong environment because his disease, whose life-history has probably been of many years* duration, does not immediately improve. Disease is self-limited, and the only effect that we look for from a good climate is the increase of tissue-resist- ance, and the development of that peculiar something in the tissues which is inimical to disease. In other words, it places one in such a condition that 106 IN SOUTHERN CALIFORNIA nature asserts her functions in a healthy way, and the diseased processes are gradually replaced by healthy action. After having selected the climate, and made sure that his selection is a happy one, the new-comer should secure a properly constructed house and sur- round himself with all the conveniences and luxuries his means will allow. The most sensible house for this country is one modelled after the style of an East Indian bungalow, a one-story structure with overhanging eaves and wide all- day sun-porches. It must face south and east. Here, too, the porches must be placed, protected on their western extremity from the prevailing winds. Upon this porch the invalid is literally to live as many hours as his strength or the weather will permit. I have a medical friend at one of the inland stations who lives day and night on such a porch, the sleeping portion of 107 TWO HEALTH-SEEKERS which is enclosed in fine netting. One need have no hesitation about sleeping or living on the ground floor; there is practically no soil dampness in the place where he should build his house. The invalid must realise a few car- dinal points. First, in-doors is little different in Southern California from other parts of the world, and if he houses himself he would far better have remained at home. If a hotel is his choice of residence, he must not lounge about the ill-ventilated, over-heated of- fices, full of tobacco smoke and germ- laden air. The man who comes to this country and continues his club-life, the daily round of cocktails, cigars, and cards, without out-door exercise, had better return at once; his stay here would be useless. I have in mind such a man, who, last winter, could find nothing in Southern California that was praiseworthy, but everything as it should 1 08 IN SOUTHERN CALIFORNIA not be according to his standard. He was viewing Southern California through the smoke-impregnated air of a hotel- lobby. Again, one must not expect to find the comforts in housekeeping or hotel- life that could be obtained in an older civilization. This is a pioneer country, and we are the pioneers. The man who is not willing to relinquish some of his luxuries must not seek health in Cali- fornia of the South. The key-note to a healthy existence here is out-of-door life. One must prac- tically live in the open air. This can be easily brought about, as most of the locations that are considered health- resorts have from two hundred and sixty-five to three hundred and sixteen days on which an invalid can be out of doors from morning till sundown. Even during the long storms of winter the clouds often break, the rain ceases, 109 TWO HEALTH-SEEKERS and one may spend a few hours of the day in the open air. Tent-life in Southern California is peculiarly agreeable, if one does not mind the dust, because no provision need be made for rain-storms during eight months of the year. From April to November one may camp with the certainty of finding good weather every day. Camps may be located at any point from sea-level to extreme altitude, and the various climatic conditions se- lected as detailed in other chapters. House-wagons are serviceable, and pro- vide a very enjoyable way of seeing the country and regaining health. If one loves nature, there is much to entertain and absorb in this country ; indeed there is little else. Man has not accomplished much here ; the country is too vast, and too thinly settled. The larger cities and more pretentious towns have good theatres and music- IN SOUTHERN CALIFORNIA halls, but first-class attractions are rather scarce. There is but little club-life, as we understand it in the older cities. A few localities have endeavoured to establish country clubs, but as yet they are not very successful. Riding-horses are low-priced, and livery is compara- tively very cheap. On the coast, ex- cellent fishing, sailing, and yachting may be enjoyed the year round. San Diego has the only good harbour on the southern coast, but the roadsteads at Santa Barbara and Catalina are practi- cally good enough for pleasure sailing. The shooting is excellent ; quail, duck, snipe, curlew, mountain quail, and plover are among the small game which are plentiful. In the mountains deer may be found, and occasionally bear is seen. The occupations and business oppor- tunities in Southern California are neither plentiful nor varied. The coun- TWO HEALTH-SEEKERS try is distinctly agricultural, but even agriculture is not well developed. It is in an experimental state. The manu- facturing industries are hardly repre- sented at all, on account of the scarcity of water and the absence of coal and iron. In the cities and small towns one is confined to the trades and occupations which supply the inhabitants with the usual necessities and comforts of life. One who is obliged to gain his livelihood in Southern California must depend upon one of these occupations or turn his attention to agriculture. The professions are greatly over- crowded, more so, I think, than is true of other parts of the world, due to the fact that professional men who break down from overwork are continually coming to this country as health-seek- ers, and after regaining their health never go home. IN SOUTHERN CALIFORNIA CHAPTER VI. TUBERCULOSIS AND DISEASES OF THE RESPIRATORY SYSTEM. BEFORE beginning the study of cli- mate for the consumptive, it is perhaps as well to obtain a clear idea of just what is meant by the term consumption. This has popularly come to mean pul- monary phthisis, but this term no longer represents a specific pathological condi- tion. It is rather loosely applied to a number of more or less chronic inflam- matory processes in the lung.* * " Of the sixty-three million people living to-day in the United States, nine millions or more will, un- less something be done to prevent it, die of tubercu- losis. In the census year of 1890, one hundred and two thousand one hundred and ninety-nine deaths are reported as due to pulmonary tuberculosis or consumption. To the reported deaths not less than 8 H3 TWO HEALTH-SEEKERS Most observers of to-day are agreed that the following classification is as nearly accurate as our present knowl- edge allows : I. Pneumonic phthisis, a destruction of the pulmonary tissue through casea- thirty per cent, should be added in order to arrive at the actual number. When this computation is made it will be found that the annual number of deaths in this country from pulmonary tuberculosis amounts to nearly one hundred and thirty-three thousand; add to this the deaths from tuberculosis of other portions of the body, and without exaggeration we may state that the tubercle bacillus is responsible directly or indirectly for not less than one hundred and fifty thousand deaths in this country each year." Victor C. Vaughn, M.D., of Ann Arbor, Michigan, in the Medical News. Otis states that if we take the minimum estimate put upon the economic value of a human life, three million nine hundred and thirty-five thousand dollars are lost to the State of New Hampshire alone by the ravages of this disease. It is a simple problem to apply this to the entire United States, when the total becomes appalling. 114 IN SOUTHERN CALIFORNIA tion or cheesy degeneration of the in- flammatory products in the lung, and the subsequent softening or the breaking down of the caseous deposits. 2. Tubercular phthisis, a progressive inflammatory change in the lung-tissue, accompanied by the presence of the bacillus tuberculosis, a tubercular de- posit in the lung parenchyma with a subsequent or concomitant degeneration of the tubercle and adjacent pulmonary tissue. 3. Acute phthisis, sometimes called acute miliary tuberculosis, in which there is a rapid bacillary invasion and a deposit of the gray tubercle granule throughout the entire body, but espe- cially in the lungs. 4. Fibroid phthisis, an inflammatory hyperplasia of the lung parenchyma, subsequent cirrhosis, atrophy and de- generation of the vesicular structure. It seems hardly necessary at this late "5 TWO HEALTH-SEEKERS day to call attention to the contagious- ness of tuberculosis, and were it not for the fact that I constantly meet people who come to California for health and do not or will not believe that such is the case, I should pass the matter in silence, but for this reason I quote the following: "I should for obvious rea- sons dissuade the occupation of the same bed or even of the same sleeping apartment by two persons one of whom is known to labour under pulmonary consumption/* (Sir Thomas Watson.) Fuller has this to say on the subject : " It behooves the physician to warn the patient's friends of the dangers incident to long-continued attendance on him, es- pecially if the disease be in an advanced stage. It would be the height of im- prudence for a healthy person, espe- cially if young and of a scrofulous diath- esis, to sleep in the same bed or even in the same apartment with a consump- 116 IN SOUTHERN CALIFORNIA tive patient; for although the malady might not be communicated directly from one to the other, unless possibly under the conditions of some tubercular matter being accidentally introduced into his air-passages or into some other part of his system, the surroundings and the air would be calculated to predispose him to the disease!' It will thus be seen that a very im- portant duty of the physician is to sug- gest an intelligent prophylaxis which will maintain the normal mechanism in a state to repel a bacillary invasion and to make possible a spontaneous re- covery. The great desideratum in the climatic treatment of consumption is to have the invalid leave home soon enough and reach the selected locality before the disease has made any ad- vances. It is now usually possible, by the microscopic examination of the sputum, to determine very early in the 117 TWO HEALTH-SEEKERS case whether or not we are dealing with consumption in its gravest form the bacillary or simply some of the other pulmonary diseases whose import is far less serious. Just here, however, we may encounter a serious difficulty; the disease may develop without giving rise, for a time at least, to appreciable mani- festations. Indeed, the disease may have progressed to a very considerable extent without having become outwardly ap- parent. All of us engaged in the study of this subject have long observed that tuberculous changes are sometimes found after death, where, during life, the individual was seemingly entirely free from such lesions. The German ob- servers are so impressed with this fact that they have stated that every one ultimately becomes infected with tuber- culosis. In order to give rise to constitutional manifestations it is necessary that the 118 IN SOUTHERN CALIFORNIA multiplication of the bacilli and the generation of toxines reach such a de- gree that the accumulation finds en- trance into the circulation. Maragliano (Berliner klinische Wochenschrift, Nos. 19 and 20, 1896) says that when tuber- culosis is present without subjective or objective symptoms, the latency may pursue one of three courses : (a) it may persist indefinitely ; (b) it may be limited in duration; (c) it may be intermittent in occurrence. When the first condition exists, persistent latency, infection is be- yond the range of certain detection, the normal processes of nature (auto-therapy or auto-serumtherapy) controlling the advance of the disease. If the latency is limited in duration the infection sud- denly makes its appearance. These are the cases where hemorrhage from the lungs suddenly occurs without apparent previous symptoms, and causes much amazement to the patient and his 119 TWO HEALTH-SEEKERS friends. Another group of cases also occur under these conditions, those in which tuberculosis suddenly shows itself in connection with some acute infectious disease, such as typhoid fever. When one passes the border-line from latent to manifest tuberculosis one of two things has occurred, either in- creased infection or a diminished resist- ance, possibly both. There is another form of latent tuber- culosis which has recently been classified as larval tuberculosis, and subdivided into two types, dystrophic and typhoid. In the first the patient gives pronounced evidences of disturbed nutrition ; he has the symptoms which are popularly known as dyspepsia, namely, progres- sive failure in strength, an enfeebled heart and pulse, lost or impaired appe- tite, debility, mental depression, and anaemia. Fever is rarely present, and physical signs, if they appear at all, 120 IN SOUTHERN CALIFORNIA occur very late in the disease. The second type, the typhoid form of larval tuberculosis, is characterized by the early occurrence of fever, which is at first intermittent and then remittent. Derangements of innervation appear very early, although the general strength may be maintained. Attacks closely resem- bling typhoid fever occur from time to time. The greatest care is required to make the diagnosis of larval tuberculo- sis, and, as it is not our object to con- sider the methods of clinical medicine, we shall refrain from discussing abstruse problems. Suffice it to say that the diagnosis can be made by intelligent and painstaking observation. When the existence of consumption is recognized early, and the patient is immediately sent to a proper climate, I see often some most remarkable res- torations to health. I have two such instances in mind, of young medical men TWO HEALTH-SEEKERS in whom the infection was detected at once; one received his in a large city hospital and the other in a bacteriologi- cal laboratory. They came to Califor- nia, were placed in a suitable climate, lived a proper life, and within a year the bacilli had entirely disappeared, and the men presented every rational and phys- ical sign of complete restoration to health. Another great class of people who will derive marked benefit here are those in whom it is impossible to de- monstrate the existence of actual dis- ease in the lung (latent and larval tu- berculosis), but who are weak, ill nour- ished, take cold easily, are subject to attacks of winter cough and bronchitis, and whose family history points strongly to the ultimate consumptive break- down. These individuals present an inherited, or, if strumous or rachitic, an acquired, predisposition to the disease. IN SOUTHERN CALIFORNIA These and the very early or incipient consumptive will be considered in the same class climatically. They should come prepared to remain at least two years, five would be better, and they must be able to procure everything that aids in the promotion and maintenance of the general health. As I have said before, it is madness to come to Califor- nia in search of health without ample means to supply all comforts and lux- uries. Whatever impairs the vitality or im- properly affects the normal functions of a consumptive must be constantly guarded against. All acute pulmonary disorders should be promptly relieved; affections of the throat and nose, how- ever slight, should be made the object of careful treatment. Most important, indeed vital, is healthy digestion, both stomachic and intestinal. Here is the key-note of success. The pulmonary 123 TWO HEALTH-SEEKERS invalid who eats well, digests, and assim- ilates is on the high-road to success. Any change from city to country is of advantage to the phthisical invalid. There is usually a gain in weight and an amelioration of all symptoms. But the place of residence must be thoughtfully selected, its sanitary conditions and gen- eral appointments must be above re- proach, the local and meteorological conditions the best that can be found. However, if this gain does not at once occur, one must not conclude that he is immediately to change the location and seek a new climate. Nor is one to sit down in a porch-rocker on reaching the selected locality and wait for a miracu- lous climatic cure. Here, as in all other relations of life, little is to be gained without labour. The climate unaided will produce little if any benefit at all. The quantity and selection of food must be carefully looked to. Physical exercise 124 IN SOUTHERN CALIFORNIA cannot be neglected, and should be ad- justed to the needs of each individual. The only two aids which, in my hands, have produced happy results in restoring health are good food and out-of-door life. I do not mean by this a few hours in an easy-chair on the porch, but an out-of-door existence, in many cases for the entire twenty-four hours. Those who come early enough, remain long enough, and lead this life, are almost certain to find what they seek. I have records of too many cases of complete and partial recovery under these circum- stances, not to speak very positively on the matter and to feel absolutely sure of my statements. Many of these health-seekers have become my intimate personal friends, whom I see day by day, and whose maladies are cured, arrested, or quiescent. It is a fact that for eighty years, as Theodore Williams says, whatever 125 TWO HEALTH-SEEKERS success has been attained in the treat- ment of phthisis has been achieved by strengthening and fortifying treat- ment, whether by diet, climate, or medi- cines, and not by so-called specific treat- ment. We must lend aid and support to the organism's inherent power to resist disease. Metchnikoff has acquainted us with some of the powerful weapons with which nature fights the battle of resist- ance to such bacillary marauders. Our object is to increase the number and activity of the phagocytes (lymph or white blood-corpuscles, regarded as organisms capable of devouring what they meet, especially pathogenic mi- crobes). Williams considers pure air the most important factor in the treatment; suc- cess is largely dependent upon its thorough application to the system of the patient. He recommends an out- 126 IN SOUTHERN CALIFORNIA of-door life, and adds that phthisical patients should accustom themselves to open windows throughout the year. The question of occupation or amuse- ment for pulmonary invalids is always an important one. Early in their stay they are better without anything to do, other than taking extremely good care of their health, but as they improve, the life becomes very monotonous, and home-sickness asserts itself most vigor- ously. The commercial occupations, as I have already said, are few, but, as a rule, the man who resides in Southern California for the purpose of combating the invasion of tuberculosis is much bet- ter off without commercial duties; he would do better to seek occupation in agriculture, or, at least, in such a one as will enable him to perform his duties in the open air. If his means be ample, ranching in a small way will afford both occupation 127 TWO HEALTH-SEEKERS and amusement, and aid very materially in accomplishing his purpose. If this be not to his taste, he can still occupy himself with out-door pursuits, with his horses, his guns, and his dogs. Yacht- ing, sailing, and fishing, too, will keep him in the open air. The bicycle is to be used only upon the advice of his physi- cian. Under no conditions is he to lead a so-called society life. If he is not willing to relinquish these pleasures, he had better not come here as a health- seeker. In most cases a permanent residence is necessary to the maintenance of a cure. A majority of cases that receive any benefit retain it only by remaining in California. When the disease has been arrested in this or any good climate, and the individual has returned to his old life, where he again breaks down, he does not the second time make as good a recovery, or possibly he does not re- 128 IN SOUTHERN CALIFORNIA cover at all on revisiting California or his selected health-station. These remarks, of course, do not apply to those who come in an advanced stage of the disease ; with these little will be accomplished, except the prolongation of life. I have often been dumfounded at the length to which life is prolonged under these circumstances. We frequently see up and about individuals whose disease is in such an advanced state that they would most certainly be confined perma- nently to bed in their Eastern homes. It is this peculiar effect of a residence in this climate that seems most striking to the physician himself when first he comes an invalid to this country. 129 TWO HEALTH-SEEKERS CHAPTER VII. THOSE BENEFITED BY THE CLIMATE. THOSE who desire a change from the cold, damp winters of their homes, though they may not be ailing, or, in- deed, may enjoy good health, will find that Southern California offers them many pleasant and suitable locations. A large class of such people come yearly to this country ; it is even quite noticeable how they repeat this year after year. Convalescents from any acute disease will hasten their complete recovery by coming here, and will be restored to perfect health much sooner than is usual at home. All catarrhal affections do well in Southern California ; it makes little dif- ference whether it be catarrh of the re- 130 IN SOUTHERN CALIFORNIA spiratory system, of the gastro-intestinal tract, of the bladder, or, in fact, of any mucous surface, except the so-called catarrhal form of consumption. These invalids, however, must be particularly careful to avoid the unfavourable condi- tions which exist in our climate. They must constantly bear in mind that they are possessed of peculiarly unstable membranes and that very slight causes will give rise to congestion or inflamma- tion. The sufferer from catarrh of the stomach or intestines can no more abuse with impunity the ordinary laws of dietetics in California than he can anywhere else. Scrofulous affections, enlarged glands, the soft, flabby muscles of the strumous individual, and the lymphatic or adenoid child, receive a remarkable benefit from long residence on the coast combined with sea-bathing. Tuberculous disease of the bones is TWO HEALTH-SEEKERS rare in the native population, and is favourably affected in foreigners by the warm, equable climate and out-door life. These individuals can live in the open air, even if confined to bed, or to the use of the various surgical appli- ances for rest of the parts or correction or modification of deformities. The little sufferers from Pott's disease or coxalgia may be carried out of doors on their cots in the early morning and not be brought into the house until after- noon, an inestimable blessing. The sufferers from gout and rheuma- tism receive great comfort and benefit. The open-air life which they are able to lead is a condition very favourable to recovery. An active skin and pure air are wonderful helps in eliminating the disease. Those who have abnormal forms of gout and rheumatism, suppressed gout, gouty bronchitis, and the dyspepsia and 132 IN SOUTHERN CALIFORNIA anaemia attendant upon these con- ditions, will also find relief from their pains and an amelioration of their dis- ease. Invalids in this class must also be extremely careful to avoid indiscre- tions in diet, errors in clothing, damp, fatigue, or chill. Gout or rheumatism rarely develop in this country. I often hear complaints that such is not the case, but that a severe attack of rheu- matism has just appeared, much to the patient's surprise and annoyance. Care- ful inquiry, however, usually elicits the fact that he has had other slight attacks or, at all events, premonitory symptoms before coming to California. Or it may come to light that he has a decidedly gouty or rheumatic ancestry. It cannot be considered that rheumatic maladies which arise in Southern Cali- fornia among the native population, or those long resident here, are the result of any climatic conditions. The specific TWO HEALTH-SEEKERS originating cause of rheumatism is still under discussion. It is but fair to sup- pose that our climate presents nothing in itself which will retard the operation of this cause within the individual, just as the bacillus tuberculosis is not extermi- nated by climate. Those who, in addition to the ordinary manifestations of rheumatism, show a peculiar susceptibility to changes in the weather, and, like the West Point pro- fessor, are slaves to the clouds, also those who are neuralgic with or without rheumatic taint, will find almost entire immunity from their tortures somewhere in Southern California. The exact loca- tion they must decide for themselves by personal experience. Persons having diseases of the kid- neys, particularly the granular kidney, will find our climatic conditions very favourable to their comfort and well-being. In this connection I will quote from my IN SOUTHERN CALIFORNIA paper contributed to the Climatologist some years ago. " It appears, then, that a residence in a suitable locality, while it will not of course arrest well-marked kidney lesions, will at least prolong life to a degree far beyond the natural ex- pectancy. The constant skin activity, much of which is manifested as insen- sible perspiration, lowers arterial ten- sion, and depletes in a most beneficial manner, relieving the overtaxed renal circulation and the diseased parenchyma. Furthermore, the patient will be pro- tected from the dangers of intercurrent or concomitant maladies, which are so apt to prove fatal to one with renal in- adequacy." The future will show that in Southern California, from sea-level to two thou- sand feet, the invalid has at his com- mand the climatic conditions which will prolong his life if suffering from chronic renal disorders; and if the change be '35 TWO HEALTH-SEEKERS made soon enough, when the connective tissue is yet embryonic, it is but reason- ble to suppose that, with decreased ten- sion and active skin, freedom from inter- current renal congestions, and a constant out-door life, the disease may be arrested or removed. J. C. Wilson and Loomis (Transactions of the American Climato- logical Association, 1889) consider that there is reason to believe that low tem- perature, rapid change of temperature, and high altitudes are unfavourable, whereas equability and warmth are favourable influences. Anaemia, except the pernicious form, rapidly improves with us ; these invalids speedily grow better and stronger and are more able to lead the necessary out- door life. People who are afflicted with atonic dyspepsia, the various urinary diatheses, oxaluric, phosphuric, and other troubles of this kind, chronic rheumatic arthritis 136 IN SOUTHERN CALIFORNIA or rheumatoid arthritis, will find help from prolonged residence here. Pneumonia in Southern California is a very rare disease in my experience; it is apt to run a short course and pre- sent a speedy convalescence. In Los Angeles County pneumonia appears as a cause in only 2.41 per cent, out of a total of six hundred and sixty-four deaths. The report of the health de- partment of the city of San Diego shows but twelve deaths from pneu- monia during six months of the year. Baker has shown by diagrams and tables in a convincing manner that the rise and fall of sickness from pneumonia, bronchitis, influenza, tonsillitis, croup, diphtheria, and scarlet fever are more or less controlled by fluctuations of atmos- pheric temperature, the diseases being increased by lower and diminished by higher temperature. Erysipelas is a very rare disease here. i37 TWO HEALTH-SEEKERS Bullard's statistics show but one death in eleven years, and demonstrate the fact that in all Southern California ery- sipelas is only about half as frequent as in the rest of the United States. Advancing years and old age may be robbed of many concomitant infirmities by residence in a suitable locality. The aged are rarely safe in a high altitude ; nor can they with impunity change their station from low to high altitudes, more particularly if they suffer from chronic pulmonary disease, bronchitis, bronchi- ectasis, fibroid phthisis, or the like. A dilated, fatty heart absolutely forbids removal from sea-level. On the whole, a marine climate is preferable for old people, and if it be warm and equable, so much the better, as gout and rheu- matism may be warded off, or, if these be already present, the severity of their manifestations may be lessened. Cystitis, so often an attendant on ad- 138 IN SOUTHERN CALIFORNIA vanced years, and so apt to be aggra- vated by damp, changeable weather, will be markedly benefited by our warm, equable climate. Insomnia, the plague of the old, and sometimes the torture of the young, will find most speedy relief on the coast Indeed, the writer has observed most gratifying results in this respect after a sojourn of even a few months. This country is a veritable paradise for the growing child. There is no period during the entire year when it is necessary to house the little ones. There are no badly ventilated, over- crowded, or overheated rooms. The zymotic diseases are usually not at all prevalent. They are mild, run a very favourable course, and are generally followed by complete recovery. The scrofulous child lives under the most favourable conditions to combat the inherited taint. TWO HEALTH-SEEKERS CHAPTER VIII. THOSE NOT BENEFITED BY THE CLIMATE. CERTAIN diseases of the nervous sys- tem are not particularly benefited by a residence in Southern California. The chronic paralytic will be able to lead his remnant of life in the open air instead of in furnace-heated rooms, but he must not expect any curative effects from the climate. The dry electrical conditions of the interior seem to aggravate the pains of early spinal sclerosis or loco- motor ataxia. They do fairly well on the coast, but with these, again, climate is of little avail. Cases of neurasthenia that have reached the stage which it is now fash- ionable to call terminal neurasthenia are better away from Southern California; 140 IN SOUTHERN CALIFORNIA the head pains maybe aggravated by the dryness and constant sunshine. Such patients do better in a more humid and colder locality. They always complain bitterly of the " desert winds." I have never been able to see that epileptics are aided in any way. Hemorrhagic cases of tuberculosis should, if they come to Southern Cali- fornia, select a moderate elevation some- what removed from the coast. The so-called catarrhal forms of pul- monary disease, the catarrhal phthisis of the older writers, the phthisis florida of the more recent observers, are apt to do badly in any climate ; the best loca- tion for a large number of these patients in Southern California is at an altitude between fifteen hundred and eighteen hundred feet. Some patients with laryngeal phthisis find the humidity and winds of the coast very trying; they also complain 141 TWO HEALTH-SEEKERS of the dry heat of the interior, so that for them at least Southern California offers no suitable home. Other consumptive patients find Southern California entirely unsuited to their particular malady. They lose flesh, have fever and night-sweats and haemoptysis. The temperature changes, the difference between sunshine and shade and mid-day and midnight, and the fogs, all affect them unfavourably. They are unsuited to a semi-tropic sta- tion. I find that certain skin diseases, nota- bly eczema, are affected unfavourably by a residence too close to the sea. I have never observed that " fibroids," cases of cirrhosis of the liver, or gastric ulcera- tion show any particular tendency to hemorrhages in this country. They are no more apt to bleed here than else- where. Some cases of rheumatism find the 142 IN SOUTHERN CALIFORNIA coast and the interior unsuited to their form of the malady, and are obliged to seek other health-resorts. Asthmatics, whose disease is most peculiar in its cli- matic relations, must try this climate personally for a sufficient time before it is possible to decide upon the desirability of remaining here or selecting another and totally different climate. Persons suffering from this disease often find entire immunity by a change of only a few miles, or, indeed, in some instances, by a change from house to house in the same town ; others will travel the world over and fail to find relief. It is almost impossible to lay down a hard and fast rule and say with absolute certainty who will or will not receive benefit by coming to California. We must consider the individual case. We frequently meet with patients who seem unsuited, but nevertheless gain much after residence here. These exceptions TWO HEALTH-SEEKERS do not, of course, affect the general deductions, but simply serve to show that in many instances a personal visit of the invalid will alone decide the matter. THE END. 144 RETURN TO the circulation desk of any University of California Library or to the NORTHERN REGIONAL LIBRARY FACILITY Bldg. 400, Richmond Field Station University of California Richmond, CA 94804-4698 ALL BOOKS MAY BE RECALLED AFTER 7 DAYS 2-month loans may be renewed by calling (415) 642-6753 1-year loans may be recharged by bringing books to NRLF Renewals and recharges may be made 4 days prior to due date DUE AS STAMPED BELOW JA 1 4 1992 YA 02739 404136 UNIVERSITY OF CALIFORNIA LIBRARY