Finding
Anid even when another, perhaps apatlhetic, observer is co-operating wvith an enithlusiast, the final result will not much differ from his uniaided conclusions.
Paper
RAIN-BEARING WINDS AND EARLY PHTHISIS
Abstract
RAIN-BEARING WINDS AND EARLY PHTHISIS. SIR,-My namie appears in Dr. Gordoni's paper in tle BRITIS;H MEDICAL JOURNAL of Novenmber 29th1 (p. 983), so perhiaps oni will allow a few comiimelnts. If Dr. Gordloni's lypotlhesis is confiirme(ed by independent observers, and rain-bearing winds are found to be the maini factor in the incidence, anid the most imiportanit factor in the prognosis, of phthisis, the tulberculosis problem will be at once simllplified, and treatment will lhave to be profoundly mo(lified. The subject mnerits dispassionate consideration. My own experienee in South Devon leads me to believe that Dr. Gordon is mistaken. My district conitains several localities-Dartmiiouth, Brixham, and Salcombe, for instance -whlich are almost entirely sheltered from soutlh-west and westerly winlds, where yet the incidence and mortality from tuberculosis is higher than in Torquay, which is exposed for the most part to warm, rain-bearinlg winds but sheltered from cold winds. For generations m1]edical miieni hlave seInt tUberculous patieInts from all over Great Britaini to South Devoni, and especially to Torquiav; 40 per cent. of miiy notifications are importations, and onie well knows that only the miinority of importations are notified. It is difficult to believe that if all thlese patients lhad done badly their doctors would continue to send others. Dr. Gordon presents us witlh a lhypotlhesis based on statistics, but, it must be said, based on very malleable statistics, which lend tlhemselves obviously to considerable subconsciouis miiouldin-g by an enthusiast. Anid even when another, perhaps apatlhetic, observer is co-operating wvith an enithlusiast, the final result will not much differ from his uniaided conclusions. It must be admiiitted that enthusiasm is infectious. If t}lis hypothesis is to be accepted, it will enitail such important alterations in our methods that 1 would suggest certain steps before acceptance. 1. Dr. Gordon's chief axiom that an elevation of 100 ft. shelters half a mile should be carefully checked by accuirate observations. On the face of it this seems most unilikely. Does St. Paul's Cat,hedral, for instance, shelter the Banik? Does a wall 10 ft. high shelter an area of 88 yards behind it? I very muclh doubt if 100 ft. will shelter eveni as much as another 100 ft. 2. Tile Meteorological Office might tell uis the ten localities in Great Britain most exposed to rain-bearing winds anid the ten most protected. The incidence and miiortality frlom tuberculosis would then be in-vestigated in those areas by tlhree inidependent, unprejudiced observers. 3. The decision whether any spot is sheltered or not depends largely oni the opinion of the observer. When lhouses and streets in a town are consider-ed, the subject becomes still more niebulous. One lhunidred houses should be chosen and tllree observers asked to decide independently whether they are slheltered or exposed and the,r decisions compared. I doubt if tlher e is any material difference in the air of adjoining localities whlenl a. strong wind is blow-ing. 4. The wlhole of Dr. Gordon's istatistics shouild be carefully overhlauled by ilndepenidenit observers. These suggestionis could easily be carried out, anid we should then stand on solid ground. It is my imiipression that, in, the great majority of cases of plthliisis, an east wind is the most dangeerous. Some robust l)atients may stand this, anid improve because they have better appetites, but these form only a small miiinority. The influenceof winds depends oni other associated factors. In a cold climate abserce of winld (any wind) is important, and this is attained at Davos. In a w-arm climiiate, on the otlher lhand, exposure to winid may be desirable. And wliereas exposure in the summlilier (wlheii sanatorinlms are mostly visited) may be beneficial, the rieverse is trule, in the wvvinter. In thlis couintry, where extremes of temperature are unuilsiual, I would regard the ideal sanatoriumlli site as onie at considerable elevation, well sheltered froml the nortlh and east, but more open to the south and west. The nunmber of days in a year when uncomfortable and harmfufl hleat is to be expected at a hiigh altitude in this country is negligible. -I am, etc., E. WARD
Authors
E. Ward
Journal
British Medical Journal