“My Flying Machine Was Out Of Order”

Abstract

Why did the founders of this organization—which was established in 1884 as the American Climatological Association—want to study climatology and respiratory diseases? In particular, where did the idea of treating tuberculosis with pure air and sunlight come from? How effective was this treatment for a disease that in 1880 afflicted a third of the population of Colorado? Why did this Association not acknowledge technological advances such as weather forecasting or large 20^th century population movements? This paper seeks to answer those questions in order to inform the Association's possible study of the effects of global climate change on human health, an issue that is arguably comparable to what the founders faced. Recent governmental reports suggest that the medical and health care communities have not yet become engaged. If the ACCA does not, then who will?

OUR STARTING POINT: CURIOSITY ABOUT THE MOTIVATIONS OF THE ACCA'S FOUNDERS

Recently, we analyzed unbound documents of the Association in the National Library of Medicine's History of Medicine Division. This, along with rereading A. McGehee Harvey's magisterial history of the Association's first century (1), prompt us to express admiration for the Association's founders and pioneers. We also note several areas of modern technology that escaped report in the Transactions during those 125 years. We were pondering the questions: What did the Association's founding clinicians mean by climate? Just a place? Just temperature? Just for tuberculosis? What were the elements of their thinking and their practices? In short, what was medicine like then?

The ACCA's Samuel E. Solly: A Pioneering Researcher in Medical Climatology

So pondering, we found a letter dated December 30, 1898, by S.E. Solly, M.D. (Figure 1), of Colorado Springs, and as we later learned, a former President of the Association. Dr. Solly, in his letter to Dr. Guy Hinsdale, the Secretary-Treasurer, begins, “My flying machine was out of order so I could not conveniently attend the meeting at Dr. Robinson's.” (Robinson was the incoming President and lived in New York City.) What a surprise! He sounds so like a modern man! A busy man! But what is he doing flying five years before Wilbur and Orville Wright? Some further reading made us wonder if that flying machine were actually a weather balloon, one of only two in the United States, this one stationed at a nearby Army fort. Dr. Solly was himself a serious student of the emerging science of medical climatology. Witness his 470-page Handbook of Medical Climatology. And witness his very optimistic assessment of climatology: “It is hardly too much to say that it is possible to prescribe a climate with as much precision as a drug, and with far greater effect in appropriate cases.” (2:vii)

Fig. 1.

Photograph of Solly from his obituary in the (3(1907):xxiv) Transactions. Born in 1845 in London, Solly's health problems led to travel in Europe and America, including visits to almost every major health resort. In 1874 he moved to Colorado Springs where he continued his climatological investigations and was instrumental in the establishment of Cragmor Sanatorium, now the campus of the University of Colorado at Colorado Springs. He was a member of the ACCA from 1887 until his death. Between 1887 and 1904 he contributed 11 papers to the Transactions on topics including treating tuberculosis in Colorado Springs, comparing health resorts, the effects of altitude on blood, and the study of climatology in medical schools.

EARLY ACCA INTEREST IN CLIMATIC TREATMENT OF TUBERCULOSIS

The early years of the Association were marked by an intense focus on rest and rustification in a “favorable” climate as one of the few hopeful approaches to the treatment of what we now call pulmonary tuberculosis, which was then called phthisis. After all, there were no good alternative methods for curing tuberculosis!

The Association's founders consciously turned against “laboratory” papers in favor of direct clinical observations on individual patients for presentation at the annual meetings. Even so, many papers of both sorts were presented at Association meetings. These included considerable talk of the growth by Koch and others of bacteria within the lung lesions of phthisis.

Another major new development was described at the 1898 meeting: the effects of “Röntgen light” in identifying lung lesions. Remember that this was barely three years after Röntgen's 1895 publication describing x-rays. Harvey tells us a good story about this time. An enthusiastic clinician at the Climatological presented a patient with a huge tubercular abscess, perhaps saying to himself, “You want Clinical, I'll give you Clinical!” The abscess was easily shown by the new Röntgen light but could not be found by physical exam—at least by the clinicians at the Association meeting—even after the Röntgen studies showed where to look (1:52–54). Imagine his glee! Whither hence, one wonders was the whispered pectoriloqy that we all remember so well?

THE ACCA'S TRUDEAU AND HIS TUBERCULOSIS SANITARIUM IN SARANAC LAKE, NEW YORK

What about the growth of the sanitarium movement? The best known of the “TB sanitaria” was of course founded by Trudeau (Figure 2) at Saranac Lake, New York (Figure 3). Actually, the entire town ultimately became the site of innumerable cottages or small groups of cottages. These were devoted to the cure of tuberculosis in those patients with the means to afford lodging, rest, occasional medical examination, good food, and prolonged exposure to the “favorable” climate of the site. The cottages' porches afforded patients exposure to pure air, ample sunlight and rest in the special “Saranac couches” (Figure 4). Some cottages were known for their excellent dining rooms. Others catered to specific ethnic, cultural, or occupational groups in order to contribute psychological comfort. World War I veterans comprised the largest special interest group.

Fig. 2.

As a physician suffering from tuberculosis, Trudeau (1848–1915), shown here in his laboratory (1:32), followed the thinking of the times by moving to a different climate in the Adirondack Mountains where he spent maximum time outdoors and regained his health. Trudeau was a member of the Association from 1885 until his death. The 1887 Transactions include Trudeau's report on his experimental study of the relationship between environment and the progress of bacterial invasion of tuberculosis in rabbits.

Fig. 3.

Trudeau opened the Adirondack Cottage Sanitarium (1:30) in Saranac Lake, New York, in 1885, after reading that a “‘rest cure’ in cold, clear mountain air” (4) had successfully treated tuberculosis in Europe. What became the Trudeau Sanitarium closed in 1954 after antibiotics were found to effectively treat the disease.

Fig. 4.

Dr. Lawrason Brown (1871–1937), who became a member of the ACCA in 1903 and was its President in 1920, designed the Adirondack Recliner, according to Philip L. Gallos, author of Cure Cottages of Saranac Lake (5:14). A graduate of the Johns Hopkins School of Medicine who had developed tuberculosis and been sent to Saranac Lake, Brown succeeded Trudeau as director of the Adirondack Cottage Sanitarium. Image (5:13) used with permission from Historic Saranac Lake.

SUNLIGHT FOR TREATING TUBERCULOSIS

The physician of 2008 may well ask, where did the ideas of pure air and exposure to sunlight come from? I'll skip discussion of pure air; this idea is as old as the hills. The sunlight hypothesis stemmed fairly directly from Koch. These doctors, of course, knew of Koch's epic discovery of the tubercle bacillus and his Postulates for extending the germ theory of disease. In spite of the Postulates, however, opinions at that time differed whether the presence of the bacilli in tuberculous lesions were evidence of causeN or merely of concomitant or secondary complication of the disease itself. Most doctors accepted the causal theory, but some did not, just as in our times, some questioned the relation of HIV to AIDS or of the discovery by Barry Marshall and Robin Warren that Helicobacter pylori infection causes gastric ulcer. In any event, the association of sunlight on control of the growth of tubercle bacilli was attested to by no less an authority than Koch himself: “tubercle-bacilli were killed by an exposure to direct sunlight varying in length from a few minutes to several hours …. tubercle-bacilli were destroyed in from six to seven days by exposure to ordinary diffuse daylight, such as is found near windows in fairly lighted houses.” (2:82)

Sunlight and good air quality are still often associated with mountain sites. Solly and his colleagues tried to document this association through scientific observations of the clinical courses of TB patients. He gathered almost 8000 reported cases, plotting improvement—or not—depending on the altitude of the treatment facility. From the plot (Figure 5), basically a meta-analysis, he concluded that “sea air and mountain air” are the most salubrious for TB treatment. This view was supported even by Virchow, who observed that in “Upper Silesia … there has not come under my notice a single case of phthisis”. (2:102)

Fig. 5.

Solly presents here all the statistical information he could find about the results of treating tuberculosis by change of climate. “P.C.” is the percent of patients who “benefited” from this treatment. England is called the home climate because it is the only source of information about people who did not relocate. Patients were sent, for example, on ocean voyages from England to Australia; to the island of Madeira; to the Riviera's coast climate; to low altitude land climates in South Carolina and southern California; to lowland sanitariums in Saranac Lake, Sharon (Massachusetts), and Asheville (North Carolina); to Egypt's desert lowlands; and to the high altitudes of the Alps and Colorado. (2:136)

But back to Saranac Lake. A rather interesting little hamlet! A curious consequence of the climate treatment of respiratory disease was the social networks; here's a short list of the famous who came to reside in Saranac Lake, New York:

• Robert Louis Stevenson (Figure 6)

• Albert Einstein (Figure 7)

• Bela Bartok

• Manuel QuezonN President of the Philipines

• Fiorello LaGuardia

• John Dos Passos

• Ralph Waldo Emerson

Fig. 6.

Robert Louis Stevenson (1850–1894) was in Saranac Lake from October 1887 to April 1888, after having spent the previous three years suffering from tuberculosis in England. He had been heading for Colorado, but heard about Trudeau and Saranac Lake and went there instead. Under Trudeau's care, with long afternoon walks, and in spite of smoking cigarettes, his health improved. In March he noted that the thermometer on Baker's veranda “was condemned to register minus 40” degrees Fahrenheit, and in April that “The greyness of the heavens here is a circumstance eminently revolting to the soul; I have near forgot the aspect of the sun. … Among other wild schemes, we have been projecting yacht voyages…. ” His wife Fanny, no fan of Saranac Lake, left for California in the spring. Six weeks later she wrote “Can secure splendid sea-going schooner yacht Casco for seven hundred and fifty a month with most comfortable accommodation for six aft and six forward. Can be ready for sea in ten days. Reply immediately.N Fanny.” He wrote back “Blessed girl, take the yacht and expect us in ten days.N Louis.” Image used with permission from The Stevenson Society of America, Inc. (5:36-37)

Fig. 7.

Albert Einstein (1879–1955) rented a house in the exclusive Glenwood Estates Colony neighborhood of Saranac Lake during the summers of 1936 and 1937. According to Gallos, the son of the owner showed Einstein how to change a fuse after he overloaded a circuit and telephoned the owner for help. Image used with permission from Saranac Lake Free Library. (5:124-125)

Those who passed through included Mark Twain, Ernest Hemingway, Edna Ferber, Stephen Crane, and Sylvia Plath.

Members of the Association in the late 1800s took a deliberate interest in the increasingly scientific development of weather as a part of climatology. Solly, who was Association President in 1895, in all his papers clearly shows his awareness of atmospheric measurements.

NO ACKNOWLEDGEMENT OF TECHNOLOGICAL ADVANCES OR POPULATION DYNAMICS IN EARLY ACCA TRANSACTIONS

But here's a strange thing. We found no papers from Association meetings that described the technological background of weather prediction. In retrospect, this technology is pretty straightforward: to predict weather one needs a system that moves information faster than the weather front itself moves. The system in those days was the telegraph and subsequently the transmission of radio waves. By 1884, many scientists, inventors and engineers were at work on weather prediction; the first synoptic weather charts had been produced by Elias Loomis in 1843. In the following year, the first telegraph line was established, between Baltimore and Washington, D.C. Within five years the Smithsonian Institution in Washington began to establish a network for observing the weather across the United States. And by 1854, the French astronomer Leverrier had already shown that a storm in the Black Sea could be followed across Europe and would have been predicted if the telegraphic network had been available at the time.

Amazingly, not one of these developments was noted by the Association. Lest we assume that the hours were completely consumed by the electric pace of medical progress, we must consider Mac Harvey. He summarized many meetings as containing “nothing new”. Others however do sound—to me at least—as truly exciting because of the participation of distinguished teachers. The deliberate narrowing of focus of annual meetings on purely clinical matters seems to have contributed to isolating these discussions from parallel changes in society that seem in retrospect to have been immensely important for health.

We have noted that the telegraph and transmission of radio waves were not mentioned in the Transactions. Also unacknowledged were the extension of the intercontinental railroad across the country and the discovery of gold in California and Colorado (these two developments themselves made sanitaria in Colorado Springs a possibility). In addition, the Transactions did not take note of the Weather Service, nor the massive population increase in the American West, a massive population shift in the East and Midwest caused by European immigration into the United States, the dustbowl drought and subsequent internal migration, arrival of antibiotics, psychotherapy, or the development of mathematical models of climate and weather. These developments were present—perhaps in some universe parallel to that reported in the Transactions—but were simply not acknowledged at Association meetings.

We must be careful in our day not to ignore major scientific and social changes. The founders missed some of these changes, but they were themselves part of the exciting post-Enlightenment era of scientific discovery and progress. Solly himself wrote in the Preface to his 1897 Handbook: “… there is a growing appreciation both on the part of the profession and the public at large as to the value of climate in the prevention and treatment of disease, and fortunately to answer this awakening we have now accumulated accurate and extended meteorological observations upon which to found natural laws affording trustworthy conclusions.” (2:vii) In their endless fascination with wind, temperature, humidity and altitude at many “favorable” locations and times of year, they were trying to see how the Natural Laws might permit understanding of climate and eventually how it affected human illness. In their assumption that understanding global scientific laws could permit man to better his understanding of life and to improve his lot, our ACCA predecessors seem to me to be medical inheritors of New England transcendentalism. I say, Cheers for Dr. Solly and his flying machine!

In following years, the name of the Association was changed on two occasions, generally stepping away from its climatological origins. Since 1884, the medical profession, and even the members of the Association, have come to view many such ideas as old fashioned. I suggest that it is time to reconsider this harsh conclusion!

ACCA MAY WISH TO ADDRESS THE IMPACT OF CLIMATE ON HEALTH

Many advancements have been made in the 125 years since the Association was founded. These include knowledge of the forces surrounding Earth and increasing understanding of the interactions between mankind and these forces. In light of this new appreciation of our world, are we not entitled to look again at the fundamental ideas that shaped the Association? Its founders questioned how climate influenced health and illness. Are the environment and global warming not the 2008 equivalent to climate and climatology?

There is already a vast literature describing and attempting to quantify the connections between global environmental changes and human health. Some are quite straightforward, hence already incorporated into medical dogma. These include, for example, marked increases in skin cancers, including melanoma, basal and squamous cell carcinoma, and cataract formation that appear to parallel increases in ultraviolet B-band sun radiation reaching Earth.

Another easily accepted association between global environmental change and health was pointed out several years ago. This is the predictability of cholera incidence, distribution and lethality based on tropical storm tracking.

I think that it might be time for medical and health professionals in the Association to take climate change seriously. Leaving aside political stance taking, and leaving aside tree hugging, there are important medical thinking and planning to be done. If not by us, by whom?

As we look to the future, let us reconsider the conclusion of the address made by our President, Charles Minor, in 1913: “Times change and men change with them.” The times have changed immensely since 1884, and it may be wise for ACCA to consider changing too. Here are some questions that may help us consider our future direction:

• What have we learned in the past 125 years about the connections between climate and health?

• What will happen over the next 125 years?

• What should the medical community be doing to prepare for these changes? How should we educate and train future medical researchers and health care providers?

REPRESENTATIVES OF MEDICAL AND HEALTH COMMUNITIES LARGELY ABSENT FROM RECENT GOVERNMENTAL CLIMATE AND HEALTH REPORTS

I draw your attention to two major studies on climate and health, one international—the 2007 report by the Intergovernmental Panel on Climate Change (6:391-431), and one purely American—by the U.S. Climate Change Science Program (7:2-1 to 2-78). In both, health professions input is either absent or marginal.

For example, of the 394 authors of the Intergovernmental report, at most a handful will be reasonably familiar to medical readers. One is Jonathan Patz, an M.D. at the University of Wisconsin-Madison. He was closely associated with Al Gore on this Nobel Prize winning team. In its conclusions, the IPCC states that the most vulnerable regions are the Arctic, Africa (especially sub-Saharan), small islands and Asian megadeltas. The report urges us to worry about low lying deltas like the Ganges-Brahmaputra due to its population size and possible rising sea level, storm surge and river flooding. One wonders: should we Americans not also worry about New Orleans and Galveston? The Baylor College of Medicine in Houston became the refuge for Tulane Medical School within a week of Hurricane Katrina striking New Orleans in 2005. Was it a surprise to anyone that it took three weeks to restore electricity to Houston after Hurricane Ike struck earlier this year?

Looking at the American climate change program, we find the signatories of the Health Report are the Secretaries of Commerce and of Energy!

IN CONCLUSION: A CALL TO PARTICIPATE AND CONTRIBUTE

What might our Association do? I think that the ACCA should participate and contribute to the studies on the influence of climate on health.