The age of hygiene is rapidly approaching, when the exhibition of
drugs will be the exception instead of the rule in medical treatment.
For this reason, the effect of climate on disease is rising into a
subject of first-rate importance, and, no longer a prejudice or a
tradition, submits to the investigations of science. The chief recent
writers on what we already presume to call climatology, are Sir James
Clark in England, Schouw in Sweden, and Carrière in France; and now
there comes Dr Burgess, armed with the united authority of these
physicians, and with his own experience, to indoctrinate the public as
well as the profession. His book is of moderate size and price, and we
recommend it to all invalids, whether they are able to travel abroad,
or are confined by circumstances to their own country; but in the
meantime, as the subject is both new and interesting to general
readers, we propose giving them an inkling of what it contains.[2]
We do not mean that the subject of climate is new in itself:
it is only new in its treatment. We have all, from our earliest
youth, heard of the effects of climate; we have all been brought
up to believe in certain foreign places; and we have all observed that
when--consumption, for instance--approaches its last stage (rarely
before), it is shipped off, as a matter of course, for Italy or the
south of France. And, alas! we have all heard from the wan lips of the
stricken one excluded by poverty from the privilege of foreign travel:
'If I could but get to a warm climate, I should live!' Such notions,
right or wrong, depended exclusively upon habit or prejudice. Experience
had no effect upon them, any more than it had upon the orthodox course
of medicines which entitled the death of a patient to be considered
professionally legitimate. Sometimes, indeed, the venue was changed, and
one place became more fashionable than another to die in. Here the group
of English tombs grew gray and ancient, and there a new city of the
silent sprang up with the suddenness of an American emporium. But still
the cry was: 'A warm climate! Give us Italy, or we perish!'
But we need not say the cry _was_: it continues to this moment. Such
impressions are long of being dispelled; it takes a great many years
for the voice of doubt even to reach completely the public ear; and we
think it a privilege to be able to take such advantage of our wide
circulation as will give repining invalids to understand, that the
advantages of a foreign climate are closely limited by one portion of
the profession, and considered by another portion as highly
problematical, if not entirely visionary. This applies, however,
mainly to consumption; for the advantages of the climatic change are
seldom denied in dyspepsy, rheumatism, scrofula, and the tribe of
nervous diseases. Even in these, however, the locality chosen is
rarely a proper one. There are countries which, if they could only
obtain the stamp of fashion, would be invaluable to the invalid. 'The
climate of Norway, for example,' says Dr Burgess, 'is admirably
suited, during several months of the year, between the middle of May
and the middle of September, for certain forms of dyspepsy, lesions of
the nervous system affecting the mind, or that form of general
innervation which results from an overwrought brain, and diseases of
repletion. But Norway is little frequented, because it is not
fashionable, although it would be difficult to point out a more
appropriate occasional residence for the numerous class of invalids
just mentioned, than Christiania, with its picturesque environs,
sublime scenery, and clear and rarefied atmosphere.'
The non-professional predilection in favour of a warm climate for
consumption, may be referred, we suspect, to the analogy that exists
between the earlier stages of that disease and those of a common cold.
In fact, in most cases in this country, consumption is for a long time
styled a cold; then it becomes a bad cold; then a worse; till it is
impossible to withhold from it the more formidable name. A cold,
however, it should be considered, occurs as frequently in summer as in
winter; and in neither is it owing to the temperature, whether high or
low, but to the _atmospheric changes_. The warmer the weather is, the
greater will be the morbific effect of a cold draught of air. That a
warm climate _in itself_ is neither prevention nor cure in
consumption, may be inferred from the prevalence of the complaint in
all latitudes. In India and in Africa it is as rife as in any part of
Europe. By the Army Reports from Malta, we find that upwards of 30 per
cent. of the whole number of deaths throughout the year is caused by
phthisis. In Madeira, according to Dr Heineken, Dr Gourlay, and Dr
Mason, no disease is more common among the natives than pulmonary
consumption. At Nice, it is stated by Dr Meryon, more natives die
annually of consumption than in any town in England of the same amount
of population. In Genoa, one of the most prevalent and fatal of the
indigenous diseases is pulmonary consumption. In Florence, pneumonia
is marked by a suffocating character, and rapid progress towards its
last stage. In Naples, 1 death from consumption occurs in a mortality
of 2-1/3; while in the hospitals of Paris, where phthisis is
notoriously prevalent, the proportion is only 1 in 3-1/4. In short, in
all the celebrated sanatoria to which we fly for relief, we find the
disease as firmly established as at home.
If we examine the analogies presented by the history of the inferior
animals, we find no argument in favour of a foreign climate. The
fishes, birds, and wild beasts of one region, die in another. 'Man,
although endowed in a remarkable degree, and more so than any other
animal, with the faculty of enduring such unnatural transitions,
nevertheless becomes sensible of their injurious results. For familiar
illustrations of this influence, we have only to look to the
broken-down constitutions of our Indian officers, or to the emaciated
frame of the shivering Hindoo who sweeps the crossings of the streets
of London. The child of the European, although born in India, must be
sent home in early life to the climate of his ancestors, or to one
closely resembling it, in order to escape incurable disease, if not
premature death. Again, the offspring of Asiatics born in this country
pine and dwindle into one or other of the twin cachexiæ--scrofula and
consumption; and, if the individual survives, lives in a state of
passive existence, stunted in growth, and incapable of enduring
fatigue. If such extreme changes of climate prove obnoxious to the
health of individuals having naturally a sound constitution, how are
we to expect persons in a state of organic disease to be thereby
benefited? In fact, view the subject in whatever light we may, we must
eventually arrive at the natural and rational conclusion--that nature
has adapted the constitution of man to the climate of his ancestors.
The accident of birth does not constitute the title to any given
climate. The natural climate of man is that in which not only he
himself was born, but likewise his blood-relations for several
generations. This is his natural climate, as well in health as when
his constitution is broken down by positive disease, or unhinged by
long-continued neglect of the common rules of hygiene.' It is Dr
Burgess's theory, therefore, that when change is necessary, a
modification of the patient's own climate--that is to say, change of
air in the same climate--is more in accordance with the laws of
nature, and more likely to effect good, than a violent transition to
warmer countries.
With regard to the curability of this disease, there is now, we
believe, no doubt of the fact, although, unfortunately the process has
not yet come completely into the hands of the physician. That a cure
has frequently taken place, somehow or other, even in advanced stages
of pulmonary consumption, has been demonstrated by _post-mortem_
examinations; but nature herself seems, in these cases, to have been
her own doctor, for no mode of treatment of general applicability has
been discovered. Some think that the progress of tubercles may be
arrested in the first stage--others, that nothing can be effected till
the second. Some resort to the water-cure--others, to the still more
marvellous Spanish baths of Panticosa; and others, again, swear by
cod-liver oil. As to the last remedy, our author quotes the statements
of Dr Williams, 'that the pure fresh oil from the liver of the cod is
more beneficial in the treatment of pulmonary consumption than any
agent, medicinal, dietetic, or regimenal, that has yet been employed.
Out of 234 cases carefully recorded, the oil disagreed, and was
discontinued, in only 9 instances. In 19, although taken, it appeared
to do no good; whilst in the larger proportion of 206 out of 234, its
use was followed by marked and unequivocal improvement--this
improvement varying in degree in different cases, from a temporary
retardation of the progress of the disease, and a mitigation of
distressing symptoms, up to a more or less complete restoration to
apparent health. The most numerous examples of decided and lasting
improvement, amounting to nearly 100, have occurred in patients in the
second stage of the disease, in which the tuberculous deposits begin
to undergo the process of softening. The most striking instance of the
beneficial operation of cod-liver oil in phthisis, is to be found in
cases in the _third_ stage--even those far advanced, where consumption
has not only excavated the lungs, but is rapidly wasting the whole
body with copious purulent expectoration, hectic, night-sweats,
colliquative diarrhoea, and other elements of that destructive process
by which, in a few weeks, the finest and fairest of the human family
may be sunk to the grave. The power of staying the demon of
destruction sometimes displayed by the cod-liver oil is marvellous.'
Dr Burgess, however, although witnessing the same results even in
far-gone cases, limits their duration to a year or eighteen months,
after which the medicine lost its effect. Although the oil, therefore,
is serviceable through the process of nutrition, he considers it no
specific, and concludes on the subject thus: 'All that our present
knowledge enables us to state positively on the subject is this:
cod-liver oil is the most effectual stay to the progress of
consumption, in a great majority of cases, that we possess; this
salutary action is not always lasting, and there are cases in which
its administration cannot be borne, and others in which it produces no
good effects whatever. In those cases in which the stomach rejects the
pure oil, if it be given in combination with phosphoric acid, it will
generally be borne easily, and the acid will assist the tonic action
of the oil.'
The non-professional notion respecting the curative powers of climate
is, that by breathing a mild and soothing atmosphere, the phthisical
patient withdraws irritation, and leaves nature at liberty to effect
her own cure. But this, it seems, is entirely erroneous, inasmuch as
it is through the skin, not the lungs, that a warm climate acts
beneficially. When an atmospheric change takes place so as to produce
a chill, 'whereby the cutaneous transpiration is instantly checked,
the skin then becomes dry and hard, so that the respiratory organs
suffer from the excessive action they now undergo, for the matter of
transpiration must be eliminated through the lungs if the action of
the skin be interrupted.' This is illustrated by the instantaneous
relief usually afforded by free perspiration in cases where difficult
breathing and oppression of the chest have been occasioned by
artificial heat. What really soothes, therefore, is _equability_ of
climate, not high temperature. Some authors even think that a cold
climate is more suitable for consumption than a warm one, and point to
Upper Canada, with its pure, dry, tonic atmosphere, affording hardly
any trace of the complaint at all.
Here we might stop, as the nature of our work precludes our following
Dr Burgess in his exposition of the action of climate on the lungs and
skin; but it may be useful, and at any rate amusing, to trace his
iconoclastic progress through the popular shrines of Hygiea on the
continent.
Malta is a famous resort for phthisical patients, although during the
winter and spring the weather is cold and variable, and in autumn the
sirocco is frequent. When a sirocco has blown for some days, it lulls
suddenly, and is succeeded by an equally strong breeze from the
north-west, contrasting violently with the former in temperature and
everything else. The extremes of heat and cold are as great here and
in other places in the Mediterranean as in London. In Malta, our
author saw five or six cases of bronchitis, which in a single month
terminated in incurable phthisis; and in two cases, six weeks only
elapsed between the first signs of the tuberculous deposit and the
death of the patients.
Madeira, a still more popular sanatorium for this disease, is a
complete delusion. Instead of the climate being essentially dry, it is
saturated with humidity during a great part of the year; and the
peculiar sirocco of the place is of a hot, dry, irritating nature. An
intelligent medical author, who had resorted to Madeira for change of
air, remarks, that 'very frequent and remarkable variations in a given
series of years, incontestably prove that Madeira is no more to be
relied on than any other place for certainty of fine weather, and that
it has equally its annual variations of temperature.... From what has
been stated by writers, a person might be led to believe that disease
was scarcely known there; but I am afraid, that were the subject
thoroughly investigated, as it ought to be, few places would be found
where the system is more liable to general disorder; while, at the
same time, I suspect that the average duration of life would turn out
to be inferior to that of our own country.'
Our author knows no place more unfavourable to patients suffering from
organic diseases of the lungs, than the far-famed sanatoria--Aix and
Montpellier. The atmosphere is pure, but ever and anon keen and
piercing, and the _bise_ and _marin_--one cold and cutting, and the
other damp--irritate the lungs, and excite coughing. Add to this, that
Provence is proverbially the land of dust, and, what is worse, the
land of the _mistral_--a wind from the north-west, which carries
stones, men, and carriages before it. 'For several days in spring the
climate may no doubt be delicious, although, however, always too warm
about mid-day, when suddenly the mistral, of evil celebrity, begins to
blow. It is difficult to give an adequate idea of the change, or of
the injurious effects of the climate under the influence of this
scourge. The same sun shines in the same bright blue sky, but the
temperature is glacial. The sun is there only to glare and dazzle, and
seems to have no more power in producing warmth, than a rushlight
against the boisterous winds, which chill the very marrow in one's
bones. During the prevalence of this wind, it is impossible to stir
out of doors without getting the mouth and nostrils filled with dust.
All nature seems shrivelled and dried up under its baneful influence.'
Nice, likewise, is scourged by the mistral, which there, however,
divides its empire with winds from the north and north-east. 'But one
of the greatest vices characterising the climate of Nice, if not the
greatest, is the remarkable variation of temperature noticed between
day and night--in the sun and in the shade. The land or continental
winds prevail during the night; the southerly or maritime during the
day. The former are cold and dry; the latter, soft and humid. As soon,
therefore, as the former subside, and the sun rises in the horizon,
the humidity commences to shew itself in the atmosphere; whilst, on
the contrary, when the diurnal winds cease, and the sun sets, the
above hygrometric condition of the air disappears.' M. Carrière cannot
conceive why our countrymen prefer Nice to a milder climate, and
considers that the annual mortality in the English colony ought to
discourage other hectic invalids from going thither.
Central Lombardy is, in general, characterised by marshy swamps
poisoning the whole atmosphere with their miasmatic exhalations. The
meteoric influences are decidedly cold and variable; and the 'extremes
of temperature increase in proportion as we approach the valleys at
the foot of the Central Alps, especially those most distant from the
Adriatic coast.' This climate, our author tells us, cannot afford more
benefit to the consumptive than that of the fens of Lincolnshire, or
of the marshes of Holland. Brescia, Pavia, Mantua, and other Lombard
towns, also share in this character; and at Verona, Mr B. Honan
writes, that of all humbugs, the humbug of an Italian climate is the
most intolerable.
At Genoa, although the air is pure and transparent in fine weather, it
is liable to sudden gusts of wind and violent transitions dangerous to
the invalid.
'In no part of England could a climate be found more unfavourable for
consumptive invalids than that of Florence, a town built in a deep
ravine, almost surrounded by the Apennines, and intersected by a
squalid river.... Extreme cold in winter, great heat in summer, the
prevalence of the northerly winds, the chilling effects of which are
not always neutralised by the antagonistic winds, rapid and violent
transitions, profoundly affecting the system, even in healthy persons;
and combined with these violent atmospheric and thermal variations are
also, in similar proportions, hygrometric and electric ever-changing
influences.' Leghorn, the seaport of Tuscany, is built in a sunk
locality, in the midst of a marshy country. Beggars, galley-slaves,
assassins, smugglers, these are the picturesque portions of the
inhabitants; and the promenade is an arid beach, anything but soothing
to the respiratory organs. The English cemetery is a touching
spectacle, with its numerous monuments of brilliant marble; among
which stands conspicuous the tomb of Smollett.
Of Pisa, the grand central depôt of Italy for foreign consumptive
patients, Dr Burgess says: 'The excess of humidity and warm
temperature of the Pisan climate depress the vital force, induce an
overwhelming lassitude, and are, in my opinion, most unfavourable
elements in a climate so generally recommended for pulmonary
consumption. Whatever effect the humid mildness of the air may have in
diminishing excitability, and in allaying pulmonary irritation in
patients of a nervous temperament, it is decidedly injurious in those
of a feeble and lymphatic habit.... The delusion of an Italian
climate, as regards the cure or prophylaxis of tubercular consumption,
is in no part of that country, so delightful to persons in sound
health, more clearly portrayed than at far-famed Pisa. The stagnant
life, the death-like silence, the dreary solitude of this dull town,
whatever utility these elements may have in allaying the restless
irritability of nervous and excitable patients, always produce serious
evils upon those consumptive invalids of a melancholy turn of mind, or
whose spirit is broken by hope deferred. Brooding over their
melancholy condition, in a foreign land, away from the comforts of
home, without the solace and cheering influence of friends and
relations, they soon break down and perish.' M. Carrière and Sir James
Clark consider the climate of Rome adapted only for consumptive
patients in the first stage of the complaint; but Dr Burgess, after a
train of reasoning founded on scientific facts, comes to a conclusion
consonant with his own theory, that it is not adapted for consumption
in any stage or form whatever.
It is needless to follow our author to Naples, for this place is
admitted by all writers to be injurious in cases of pulmonary
consumption; but we may conclude this fragmentary survey by stating
that, according to Dr Burgess, the least injurious portions of Italy
are the Lake of Como and the city of Venice, _the air in neither of
them being warm, but in both equable_. Here we end as we began: 'It is
a mistake to suppose that a warm, humid, relaxing atmosphere can
benefit pulmonary disease. Cold, dry, and still air, appears a more
rational indication, especially for invalids born in temperate
regions.' It will be seen that our author differs occasionally from
both his great predecessors, Sir James Clark and M. Carrière; but even
in so doing, he has at least the merit of fairly opening out a most
important subject.
Let it be understood, that we have merely mentioned the nature of the
contents of this volume, without attempting to follow Dr Burgess
either in his reasonings or in the facts on which these are founded.
We have now only to recommend the work as one that will be found
highly interesting and suggestive, both by the medical and non-medical
reader.[3]