all that  remains of the cover of this booklet

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LINK to original presentation: Transactions of the Ninth International Medical Congress, September 1887

One very important difference to note with Charles Denison’s maps when compared with most medical maps is that Denison’s map  defines the healthier regions in the country.  This is counter to the reasoning for medical mapping, the focus of which is upon disease and spatial features related to disease such as poverty or exposure.  This difference is more important to note due to the time when Denison’s maps were produced.  Disease maps have been around since the turn of the century.   Maps about health and the way to prevent disease are rare, if these exist at all.  The general behavior over time with mapping has been to define those paces unhealthy or physically limiting to us, such as swamps, rugged terrain, densely packed forests, those parts of the ocean where the winds are impossible to sail through and where sea monsters and frigid temperatures make it unlikely for us to survive should we attempt such a route to the unknown.

For this reason, when we produce a map about the healthiness of a potential living place, we often map the places that are ill to reside in first, leaving it up to the interpreter to figure out where the healthiest places can be found.  We usually define health on a map indirectly by inferring where the best places are to live based on relative degrees of climate and topographic types, temperatures, humidity, wind flow patterns, seasonal climatic changes, topography, water bodies, potential soils and farmlands, and on occasion nearby demographic features.

Denison’s maps defining those places that are healthiest for certain disease patterns rely upon certain geographical features that he and others in his field have defined.  The healthier places in the United States that are illustrated by Denison’s map are defined based primarily upon two features which Denison produced one map each for–average diathermy and total number of cloudy days per year.  He then combines this large area data with specific point information developed depicting  the  healthiest places in the United States.  Together these are used to determine where it is best for somebody with certain diseases to move to.  Upon removing to one of these healthy regions, the person fearing or suffering from a particular illness can then abide by Denison’s recommended living patterns, thereby making their body healthier and hopefully, healthy enough to move back to where they previously resided or move to another much healthier location.

According to Denison’s additional regimens he recommends to people who decide to remove to his healthy living setting, healthy food, water and air, and specific exercise activities, including arts and dance are all important to improving upon or maintaining the healthy state of a person’s failing body.   This particular form of  health maintenance and how we behave in turn defines our vitality and long term longevity.  By making the right use of our natural resources, and by taking advantage of the cleaner air found in mountain settings, in places of low humidity, where was can bathe in mineral springs or engage in a Turkish sauna, we directly engage our self in such a way so as to better and more effectively deal with whatever medical conditions we have to face.  This is the natural philosophy concerning disease and nature that Denison tries to guide us through with his books, a philosophy that has remained ever since.

The specific requirements for healthy places were uniquely defined as follows by R. Charles Powell in 1886:

Defining Healthy Places, by R. Douglas Powell, 1886, from On Diseases of the Lungs and Pleura, including Consumption (New York), p. 287.

Diaphaneity, the degree of change that the air goes through between hot and cold, dry and moist, per day and over the course of a year, was very important to defining the healthiness of a place.  Diaphaneity essentially related to the average days of cloudiness for a region per year.   Low diaphaneity meant for low precipitation, and often lesser humidity, and therefore more comfortable living conditions.  But low diaphaneity also meant there were more cloudless days during which the sun had the ability to cover the area and your body with light and heat, and as a result reduce the unhealthy state of your body.  In modern terms, we might say that this links to the effects of sunlight upon our endocrine system to our mood state, healthy attitudes, good mood, and overall health and exercise.   During Denison’s time, the impact of sunlight, less clouds, solar rays, health and the rest, were all related to the healthiness of the air we breathed, and the healthiness of the other parts of the environment around us that contributed to the health or lack thereof of such inspired gases and such.

One parallel thought for this time that helped support this notion that low diaphaneity (lesser days of clouds) increased the healthiness of a setting related to Max von Pettenkoffer’s theory for soil-based disease onset.  Pettenkoffer claimed the soil held air between its particles, which over time became infested with a particular factor, that once expressed back into the air made people ill.  To a chemist, this substance between the soil particles could simple by gas, or methane, sulphur fumes, or carbon dioxide released by alkaline materials such as limestone.  To a person more adherent to biological and poison based theories of disease, these substances removed from the soil were toxic to the body, or equated to the unknown object known as a virus, or considered akin to “animalcules” that were so small that you couldn’t see them.  (For bacterial or physiological-anatomical theories for phthisis, see New Orleans Medical and Surgical Reporter, 1874 and the Medical Examiner for the same year.)

Whatever your logic, Pettenkoffer’s theory and Denison’s claims did seem to make sense when merged together into one philosophy.  With such thinking the saturation of soil with water due to floods and rain now seemed to have a way in which a region suddenly became unhealthy to people.  This logic was used to define how and why phthisis or consumption was distributed the way that it was, in temperate to cold temperate zones where uncomfortable humidity often prevailed, where mold and mildew persisted, and where sometimes the fungus (a rare but very rendering of the animalcule) of such a setting could inhabit your lungs.   With such an interpretation of disease cause and onset in your mind, it become easier to understand how climate and topography play a role in the development of this disease, and why removing to a high elevation, where temperature changes during the course of a day or year (diathermy) increase, and where  sunlight was inhibited the least (fewer cloudy days).  According to Denison, low humidity and dryness meant that the air was dry and the soil less likely to become pathogenic.  Low diaphaneity or average days of cloudiness over the year meant for less precipitation and more sun to drive the causes for disease away.

Aside from the place and its climate, Denison promoted some specific behaviors and activities recommended for improving one’s health within the healthy living environment at his Denver hospital.  He recommended healthy food ways and daily breathing exercises, for which he developed a specific exercise device for “invalids” with a consumption-infested lung.

In one sense, we can visualize this means for making your lungs healthy by viewing the lung as an expanding, contracting unit.  The more we move it, the more elastic it is and the more pliable, usable, and vivifying it is.  In some cases, the lungs lost their elasticity or ability to retract upon expiration.  Such a problem was treated by the emphysema jacket, which helped one maintain the rib cage so important to respiration in a much healthier state and stable size and shape (i.e. no more barrel chest from over inflation, over inspiration, thereby wearing your out.)  The inhaler-exhaler served as an exercise tool of sorts, assisting you in learning your most appropriate breathing activities.

Each of these above two contraptions focused on the “exercising” of your lungs.  In the high elevation setting, the thinner atmosphere at first made it feel as though our body was undergoing drastic chances due to drastic air pressure differences between high and low elevation settings.  This geographic feature of the high elevation montane setting also made for some interesting parallels that could be developed in an arguments that focused upon changing from one extreme to the next, for example from high pressure to low pressure, of from hot to cold, from moist to dry.  With this in mind, if we visualize the lung as a balloon, we can easily understand why many physicians like Denison felt that high elevations were the best place to improve the outcomes of these “exercises” we had the lungs go through, allowing for maximum expiration and inspiration to happen without the problems of apoplexy setting in, or feelings of heaviness and fatigue, and or being “heavy chested”.  When a person moves to a high altitude setting, the first experience is fatigue and light-headedness–the constant need for more air at first.  But with time, this feeling disappears and in theory you lungs are now adapted to the new setting and your ability to undergo all the processes of respiration improved greatly.  To exercise your lungs properly, Denison recommended the following pulmonary exercises:

Health and Stature; Denison’s Pulmonary Exercises

When review the other literature for the time, especially pertaining to evolution and such, we find that other interesting arguments can be made supporting Denison’s theory for improving you health within the high mountain setting.  On could argue that Denison’s review of Climate and Mountain Air was based upon an evolution and natural selection based philosophy.  It includes considerable coverage on how to take advantage of nature to assist in the healing of Phthisis.  His method of cure focuses on the ways in which the disease leads to a deterioration of the natural abilities of our body.  Phthisis is responsible for first weakening the power of our lungs by removing parts of this vital organ to undergo respiration, to make good use of health pulmonary tissue and how we can naturally stop the diminishing power disease presents us with and prevents us from staying alive. This natural philosophy based argument for dealing with chronic diseases that are long lasting, severe and life threatening became a regular part of health care by 1900.

Such an ideology was also applied to numerous other diseases as well.  The next important disease to treat in this manner according to Denison is asthma, followed by rheumatism, and then heart disease.  Denison’s work ultimately gave others important insights into the other ways we have for treating diseases and medical problems aside from just medicine and drugs.  In this way solar light therapy later became quite  popular for treating certain conditions, and the importance of living in a healthy non-allergenic fresh air setting for treating and preventing certain forms of asthma and bronchitis.  Clean water and a healthy diet were always important for strengthening our body’s ability and willingness to survive in general.  Denison’s theory also stated why different parts of the United States within different diathermal and diaphaneic settings could be better places to go if your disease was of a certain form.

With time, as more scientific backing of Denison’s claims were developed, meteorologists, climatologists and other science investigators came out with numerous proofs supporting Denison’s philosophy.  As a result, Powell discusses Denison’s diathermy-diaphaneity theory for the treatment of phthisis as follows:

Powell, 1886, p. 288

If we turn to other writings on this topic, we get a broader view of the impact Denison’s work had on climate based disease theory.   Edwin Moses Hale defined this more thoroughly in his textbook on this part of medicine written for the medical school setting.   The loss of good health Hale claimed is a result of people’s compliance or non-compliance with these natural abilities and requirements for a body to remain alive and be healthy.  He also provides still more insights into how different places can be healthier to others, based on disease type, form and pathogenic behaviors.

Throughout the 1890s and into the early 1900s, this ideology prevailed about the healthiness of a particular place.  As these rules of degrees of healthiness for a place became better understood, one could understand how the health of removing to a particular area made this practice good for us, even if that place was not necessarily the best place to be.   Such a manner of thinking could be used to explain your trip to the local mountains for a brief vacation, even though it wasn’t as healthy as spending a week or two at an expensive hotel further west or high up in the mountains.  This made the practice of removing to other places seem more practical to some, espeically those with busy lives residing in the disease-ridden, heavily-polluted and unsanitary downtown urban settings.

By the end of the 19th century, other medical climatologists and topographers produced a number of important essays about health and outdoor places.  The following section of an article on diseases and climates summarizes some the basic scientific theory behind these beliefs about healthy living and recreational places.

Denison’s two maps show nationwide distribution of these healthy places relative to his diathermy and diaphaneity lines.  But they lack much visibility on Denison’s original versions.  They have been highlighted on the above and below maps by changing the color of these points.

One can in turn draw conclusions about the healthiness of these places in relation to specific disease patterns.  This additional value is perhaps why Denison’s work became popular, but also very much believed in by physicians and patients alike.   This work also led to many future programs on treating diseases with the sun, the weather and climate.  We see the influences of these accomplishments in the form of new theories and therapeutic regimens surfacing for tuberculosis, asthma,  rheumatoid arthritis, and other chronic diseases surface for decades to come, including some epoch events related to Franklin D. Roosevelt.

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Healthy Cold Water, Mineral and Thermal Springs depicted on Denison’s Map, with points emphasized to display spatial distribution.  The blue to red zone depict overall climate patterns, from cold to hot.  (The legend for this map is adjacent to similar figure below.)  

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The same, over Denison’s Thermal regions map.  Number ranges indicate number of cloudy days per year.  (The legend for this map is adjacent to a similar figure below.)

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This fungal cause for phthisis was still unknown when Denison managed his facility.  Regardless of this lack of knowledge, these methods worked and ultimately cured patients or put them in a state of remission.  Higher elevation made for lower pressures overall, and less oxygen stored vital to the survival of the cause for tuberculosis residing in the lung–the mycobacterium.     

 This method of managing tuberculosis is still in use today for the toughest of cases.  People with asthma, bronchitis and COPD are urged to move to dry climates free from certain forms of pollen producers.  The Jewish Hospital in Denver specializes in treating medication resistant strains of mycobacterium in tuberculosis patients.

This article is a republication of some material first published in the transactions for 1887.  

The discovery of the organism responsible for phthisis, or tuberculosis as it later came to be called, occurred just a year or two later in 1891. 

This page complements another page I developed on Denison’s work on medical climatology and topography.

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Maps and Notes

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Diathermy

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Diaphaneity

 

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A contemporary map of annual mean number of cloudy days

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A contemporary annual mean number of cloudy days map (left), with polygon boundaries (edges) overlain on Denison’s cloudy days map, to demonstrate relative conformity.

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Regions up close — Climate (Diathermy) Zones

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Regions up Close — Cloudy Day (Diaphaneity) Zones

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Regions — diaphaneity and diatherms (side by sides)

NEW ENGLAND

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SOUTHEAST

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SOUTHWEST

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PACIFIC NORTHWEST

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GULF OF MEXICO

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LINE-AREA OVERLAYS

The following is an overlay of the major boundary lines for Climate onto Percent Cloudy Sky.

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This disassociation of warmth and cloudiness is important to the late 19th century philosophies of health, leading into the early twentieth century.  Solly would use these observations to define the varying levels of healthiness of certain regions.  He noted Colorado to perhaps be the healthiest of most options then popular and available, but allows for other defining features of a region to make it healthier than the norm as well.  It is for this reason we have some “healthy retreats” situated in high elevation settings, and others in desert climate settings.

More references, links:

Searches for discussions of Denison’s work, Search1, Search 2, Search 3, Search 4.  (These searches are reversed, time wise; 1888 on back to 1865, but starts with the earliest citation in 1874.)