empirical principles. But while admitting requisite to insure the proper action of the other that there is much in the influence of change remedies." of climate, considered as a remedy, which Leaving, then, on one side, the considerawe cannot at present explain, the author of tion of climate generally as a specific agent, the work before us wishes rather to consid- let us see in what way a removal to a er this complex agent on rational principles. warmer region either obviously acts, or He rejects, wherever it is practicable, the may rationally be presumed to act, in reidea of specific influence, and wishes cli- lieving or curing diseases. mate to be considered, in its known qualities, as one of the agents that variously affect the body in health and disease. He submits it to the same examination, and the same tests, by which we judge of other remedies-trying it partly by studying its known qualities in reference to the known capacities of the living body; and partly by observing the results of experience simply. In prescribing it, he, for the most part, considers it only as one of the many means that must co-operate towards the restoration of a constitution deranged and enfeebled by the long prevalence of a chronic disease; in many cases he looks upon it merely as permitting the efficient curative means to be more completely or more conveniently applied.

"The air, or climate, (he says,) is often regarded by patients as possessing some specific quality, by virtue of which it directly cures the disease. This erroneous view of the matter, not

In the first place, a warm climate is like a perpetual summer to a person accustomed to a cold one. The higher temperature of the air, and the finer weather generally, besides acting directly on the sensations, and through them on the mind-on the circulation of the blood, both general and capillary-and on the secretions-enable the invalid to do many things beneficial to his health, which he could not do in his own country. It will enable him, for instance, to be much more in the open air, and, consequently, to take much more exercise than he could do in England. Those persons, and there are many such, who languish in their chambers through the whole of the winter in this country, and only feel the pleasure of existence during the summer, will need no argument to convince them how beneficially a warm climate often acts on the enfeebled and disordered frame. An invalid of this class seems to change his very being with his climate

"The common sun, the air, the skies,
To him are opening paradise."

unfrequently proves the bane of the invalid, by leading him, in the fulness of his confidence in climate, to neglect other circumstances, an attention to which may be more essential to his recovery than that in which all his hopes are centred.... If he would reap the full measure Secondly, a removal to a mild, that is, of good which his new position places within his to the natives of the north a distant, clireach, he must trust more to himself and to his mate, effects a complete change of the air, own conduct than to the simple influence of any soil, water, and other physical circumstanclimate, however genial; he must adhere strictly

to such a mode of living as his case requires; heces of a strictly local kind; one or more must avail himself of all the advantages which the of which may, unknown to us, be exerting climate possesses, and eschew those disadvan- a baneful influence upon the individual, in tages from which no climate or situation is ex- his own place of residence. A most strikempt; moreover, he must exercise both resolutioning example of the effect of local circumand patience in prosecuting all this to a success-stances upon the general health, in a place ful issue.... Here, as in every other department not naturally unhealthy in the common acof the healing art, we must be guided by expe- ceptation of that term, and of the influence rience, and must rest satisfied with the amount of power which the remedy concedes to us. The of change of situation in removing the discharlatan may boast of a specific for any or for orders thereby produced, is afforded us evall diseases; the man of science knows that there ery day by the mass of human life squeezed exists scarcely a single remedy for any disease into our large cities. This striking cirwhich can warrant such a boast; and that it is cumstance has not escaped the notice of only by acting on and through the numerous and Sir James Clark. complicated functions of the living body, in various ways and by various means, and by carefully "On the Continent," he says, " the beneficial adapting our agents to the circumstances of each effects of change of air are duly estimated; and individual case, that we can check or remove the the inhabitants of this country, and more expedisorders of the animal system, more especially cially of this metropolis, are now becoming fully those which have long existed. Let it not then sensible of its value. The vast increase in the be imagined that change of climate, however size of our watering-places of late years, and the powerful as a remedy, can be considered as at deserted state of a great part of London during all peculiar in its mode of action; or as justify-several months, are sufficient proofs, not to mening, on the part either of the physician or pa- tion others, of the increasing conviction that, for tient, the neglect of those precautions which are the preservation of health, it is necessary to

change from time to time the relaxing, I may say, I change of climate. It is, indeed, surprising deteriorating air of a large city, for the more how local many of our miseries are; but pure and invigorating air of the country. This, that such is the case, any one may convince indeed, is the best, if not the only cure, for that himself by looking round among his friends, destructive malady, which my be justly termed Cachexia Londonensis; which preys upon the or by retracing his social experience. One vitals, and stamps its hues upon the countenance man is happy in town, but miserable in the of almost every permanent residenter in this country; another suffers equally, but regreat city. When the extent of benefit which versely; a third is only wretched in his own may be derived from occasional change of air, house, and a fourth is never happy in his both to the physical and moral constitution, is neighbor's. Now, it is obvious that to this duly estimated, no persons whose circumstances permit will neglect to avail themselves of it." very numerous class, a journey to a distant country must be of great service; inasmuch as it must necessarily alter, at least for a time, a great number of the relations in which such persons stand to the objects, whether animate or inanimate, with which they are usually surrounded; and, therefore, we venture to assert, in despite of the satirists of all ages, that in many cases the traveller truly does leave his miseries behind him: se quoque fugit. He leaves that other gloomy self in the analogous atmosphere of the north, and assumes a new form under a more brilliant sky.

Thirdly, a change to a new climate, in almost every case involves a great change in all the habits of life-in diet, sleep, clothing, exercise, occupations. And if all or any of these habits happen to be injurious to health, every medical man knows how difficult-often, how impossible-it is to break through them at home. But the chain of evil habits is frequently at once snapt asunder by a journey; and its links in many cases are prevented, by the usages of strange places, from being re-knit for so long a time that they never afterwards coa- There is yet another way in which we lesce. The disease, which if not produced believe change of climate often proves benwas at least aggravated by more or fewer eficial, and in a very considerable degree; of these habits, either entirely and sponta- and here, in place of a Physician, we shall neously disappears, or now yields to reme-quote a Poet, (Crabbe)—taking leave, howdies which were previously found altogether ever, to make a small alteration upon his ineffectual. Like the giant of old, it loses its power as soon as it loses hold of its native soil.

lines:

-For change of air there's much to say,
As nature then has room to work her way;
And doing nothing often has prevail'd
When ten physicians have prescribed and fail'd."

And this observation applies still better, perhaps, to moral than to physical habits; or, we should rather say to habits, whether We are not surprised that the fact should physical or moral, which affect the mind be as here stated. Few are the Doctors, we more particularly. Not only is the mer- verily believe, who can venture to put in chant torn from his desk, and the student practice all that they consider to be best in from his books, by a journey or a residence regard to the administration of medicines. abroad, but in very many cases the wretch- Some patients will have draughts, whether ed are torn from their cares. Most of our the Doctor will or no; and some Doctors, writers on intellectual philosophy, have perhaps, will prescribe them whether the shown too little regard to the influence ex-patient will or no. Besides, it is not more erted over the mind by the physical condi- strange that the professors of medicine tion of the body; and it is only the physi- should be fond of their instruments, than cian who knows fully the immense share that the professors of other arts should be among the causes of unhappiness-we may fond of theirs. And, may there not be say of wickedness-that bodily disorder something in the English character that may justly claim. In curing our corporeal prompts to what has been truly called the disorders, the physician, in many cases, lit-energetic empiricism" at present so much erally does "minister to a mind diseased;" in fashion in this country? and as the disorders which most affect the mind (disorders of the digestive organs) are, of all others perhaps, most benefited by a change of climate, this remedy of course becomes entitled to a distinguished place in the medicina mentis.

But cares and miseries of a different kind, which have no discoverable connection with bodily disease, are no less benefited by a

A very important agent in the cure of chronic diseases, by change of climate, still remains to be mentioned; although it is rather incidental to this measure than necessarily connected with it-we mean the mere act of travelling. This is a remedy, to be sure, which may be as effectually enjoyed in our own country as abroad. It is nevertheless often highly proper for the physi

cian to order his patient to a distant climate, even when all the benefit to be expected lies in the journey thither. People when sick must sometimes be cheated into health; and wo be to the Doctor who always speaks the whole truth to his patient! Every one has heard of the cure of a chronic disease in a gentleman whom Sydenham directed to ride on horseback from London to Inverness, with the object of consulting some imaginary Doctor in that region-no longer remote in our days of steam and mail coaches. And the same pious fraud may be often pardoned in the modern physician, who sends his patient to Genoa, to Rome, or to Naples: the influence of climate may be the ostensible cause of the journey, but the journey itself may be the true source of benefit.

the means of macadamizing it, it is well. For our own parts, we had been led by experience, before we saw Sir James Clark's book, to think so favorably of the Peripatetic School of medicine, that we should be willing to submit to its severest prescriptions in the proper case, even if we were, with the heroic patients of old, to incur the risk of all the imputations and penalties attached to such a measure

"I. demens, et sævas curre per Alpes,

Ut pueris placeas et declamatio fias." The diseases in which a change from a cold to a milder climate proves beneficial, are numerous. Those more particularly noticed in the work before us, are the following:-Disorders of the digestive organs, in all their various forms; consumption; chronic affections of the air-passages; asth

"The mere act of travelling, (says Sir James Clark,) over a considerable extent of country, is itself a remedy of great value, and, when judi-ma; gout; rheumatism; diseases of the ciously conducted, will materially assist the ben eficial action of climate. A journey may indeed be regarded as a continuous change of climate as well as of scene; and constitutes a remedy of unequalled power in some of those morbid states of the system, in which the mind suffers as well as the body. In chronic irritation, and passive congestion of the mucous surfaces of the pulmonary and digestive organs, especially when complicated with a morbidly sensitive state of the nervous system, travelling will often effect more than any other remedy with which we are acquainted."

|

skin ; scrofula; infantile disorders; diseases of hot climates; the climacteric disease; and broken constitutions generally. What we have already said of the nature of chronic diseases in general, and of the principles of cure in such cases, must content our readers in respect to the majority of these affections. But there are two diseases, or rather two classes of diseases, which, from their surpassing importance, ought to claim from us, as they have obtained from the author, more particular In former times, indeed, if expatriation notice. These are disorders of the Digeshad been proposed as a common remedy tive organs, and Consumption. In the first for a whole host of diseases, the presc er part of the present work we are presented would assuredly have been considered as with two admirable outline sketches of standing most in need of his own prescrip- these affections, to which we must refer the tions; and naviget Anticyram would have reader; as our business in this article is occupied a prominent place in his carte du not to describe diseases, or to detail their voyage. But in those days, steam-engines general mode of treatment, but to point out and patent axles were not; neither had that the influence of climate upon them. We organ of the Phrenologists, which gives us must, however, take leave to say, that it has the inclination to change our residence, but seldom been our fortune to meet with been stimulated into full activity, by uni- any piece of medical writing so characterversal peace abroad, and universal travel-istic of the best school of physic-the ling at home. At present, we are hardly school of Hippocrates and Sydenham-as more startled at Sir James Clark's prescrip- | these sketches present. In the chronic tion of Nice, Naples, or Rome, for the cure state, and secondary stages of dyspepsia or of a cough, an attack of indigestion, or of indigestion, and its multiform progeny, gout, than our fathers would have been by the household words of horehound, coltsfoot, elecampane, or dandelion. At all events, such a prescription is a very agreeable one; and, if their ailment is not very terrible, one might almost envy those patients who are obliged to use the remedy. It has been said that there is no royal road to health, any more than to learning; but we suspect that our author has actually discovered this royal road; and, if his patients have only

The

change to a mild climate is recommended
by Sir James Clark as a powerful means of
relief and cure. Indeed, it is in this tribe
of diseases that the beneficial influence of
the measure is most conspicuous.
mode of its operation is explicitly detailed
in his work; and the adaptation of particu-
lar climates to the different varieties and
stages of the affection, is there stated with
great precision and minuteness. This
seems very necessary, as the choice of a

residence for this class of invalids is far from | sire. But it will, no doubt, be highly valua matter of indifference. The place that is able to the medical profession, and to the useful in one case is detrimental in another. public generally ;-by setting the case in a "The different forms of the disease require true light, and by showing what climate can do, and what it cannot do. If the effect different climates. The patient with gastritic dyspepsia should not, for example, go to Nice, of Sir James Clark's delineation of the true nor the south-east of France. In cases of this features of Consumption, and his exposition kind, the south-west of France or Devonshire of the way in which climate influences its are preferable, and Rome and Pisa are the best development and progress, were limited places in Italy. On the other hand, in atonic to the abolition or even discouragement of dyspepsia, in which languor and sluggishness of that insane system, so generally followed the system, as well as of the digestive organs, at present,and too generally countenanced prevail, with lowness of spirits and hypochondriasis, Nice is to be preferred to all the other by the medical profession, of sending paplaces mentioned; and Naples will generally tients abroad in a state of confirmed conagree better than Rome or Pisa; while the sumption—that is, in a hopeless state-his south-west of France and Devonshire, and all similar climates, would be injurious. In the nervous form of dyspepsia, a climate of a medium character is best, and the choice should be regulated according as there is a disposition to the gastritic or the atonic form. In the more complicated and protracted cases, still more discrimination is required in selecting the best climate and residence; as we must take into consideration not merely the character of the primary disorder, and the state of mind with

which it is associated, but the nature of the secondary affection which may already exist, or to which the patient may be predisposed."

But the most important of all the subjects treated of in this volume is the influence of climate in Consumption. And although, as we have already said, the beneficial effect of a mild climate is much more conspicuous in the class of disorders last noticed than in Consumption, yet the association of the latter disorder with this measure is so strongly fixed in the public mind, and such erroneous opinions prevail on the subject, that we feel it incumbent on us to notice it particularly. To establish the vast importance of the question, it suffices to state that, according to the latest and best authority, (the Registrar-General's Report,) a fifth part at least of all the deaths that occur in this country is owing to Consumption! And there is too just reason for apprehending that even this tremendous mortality is on the increase.

book would be of inestimable value. It would at least afford some comfort to the hearts of the hundreds of parents who are now every year compelled by this fatal custom, to see their children die under all the aggravations of evil necessarily attendant on a residence in a foreign land. But the book, we confidently predict, will do much more than this; it will be the means of saving many lives, by pointing out the way in which a mild climate can truly be made efficient in lessening the appalling fatality of this disease.

Sir James Clark coincides in opinion with all the great pathologists of the day, that consumption, when fully formed, is almost universally fatal. The essential character of this disease consists, as is well known, in the formation of numerous small masses (called tubercles) in the substance of the lungs, which, in their growth and progressive changes, destroy the natural structure of the organs, and fatally derange many of the functions essential to life. When once developed in the lungs, it is extremely doubtful if these bodies can ever be removed by nature or art; when they have gone beyond their very first stage, and exist in considerable quantity, it seems nearly certain that they are utterly beyond the resources of either.* We, no doubt, every now and then, hear of this or that person cured of consumption, by a regular member of the faculty; and in the course of every half score years or so, there springs into temporary notoriety some bold pretender of the regular order, whose confident

Is a removal to a mild climate really beneficial in the cure, or even in the prevention of Consumption? If beneficial, in what way, and in what degree is it so And what climate is the most beneficial? The work before us contains much more information relating to these important points than is to be found anywhere else; but we fear we must say that the information is satisfactory chiefly because it is extensive and accurate. It conveys to us much less hope, and opens less prospect of benefit from the change, than we could de-on consumption.

We are well aware of the very peculiar and extremely rare yet well authenticated case, of a cure being effected after the discharge of a tubercle or tuberculous abscess by expectoration; but this case can only be considered as a rare exception to the general rule, and ought not to be at all calculated upon in practice. See, for information on this point, the classical works of Laennec, Andral, and Louis, and especially the present author's treatise

promises (sometimes, perhaps sincere) and "Unfortunately it too often happens, that the loud boastings, impose upon many the be- period of constitutional disorder, which we have

currences.

istence.

lief that this hitherto intractable malady has just been considering, is permitted to pass; and at length been brought under the dominion it is not until symptoms of irritation or impeded of art. But the total ignorance of this class breathing, or spitting of blood, appear, that the pafunction in the lungs, such as cough, difficult of persons respecting the real nature of the tient or relations are alarmed, and that fears are disease, and the great difficulties often ex- expressed that the chest is "threatened." Such perienced by the most learned in discrimi- symptoms are but too sure indications that tunating it, in its early stages, from some berculous disease has already commenced in the other diseases, sufficiently explain these oc- lungs. It may, indeed, be difficult, in some caAnd the great teacher, Time, although by a careful examination of the chest, ses, to ascertain the positive existence of this, soon justifies the skepticism of the man of and an attentive consideration of all the circumscience, by covering with oblivion what, if stances of the case, we shall seldom err in our true, could never be forgotten, nor permit- diagnosis; and it need not, at any rate, affect ted to yield its place to any novelty, how- our practice, as a strong suspicion of the presever great, or any claimant, however loud.ence of tubercles should lead us to adopt the It is, therefore, with much satisfaction that same precautions as the certainty of their exwe find the present author devoting all his "When tuberculous matter is deposited in the powers to the elucidation of the remoter lungs, the circumstances of the patient are macauses of consumption; and of the nature and terially changed. We have the same functioncharacter of that morbid condition of the al disorders which existed in the former state: system to which it is found commonly to and we have also pulmonary disease, predispossupervene. If we cannot cure consump-ing to a new series of morbid actions-to brontion itself, we may possibly be enabled to obviate the circumstances that lay the first foundation of it; or we may even be enabled to remove the first changes impressed by these circumstances upon the organization. The remote and predisposing causes of the disease are well known, and have been generally noticed by preceding writers; but Sir James Clark is the first, who, to our "When consumption is fully established-that knowledge, has formally described the pre-is, when there is extensive tuberculous disease cursory disorder; or attempted (to use his in the lungs, little benefit is to be expected from own words) "to fill up the blank which has change of climate; and a long journey will albeen left in the natural history of consump-most certainly increase the sufferings of the pation, between a state of health and of established and sensible disease of the lungs.' The precursory affection of the system is termed by him Tubercular Cachexy; and he looks upon it as the nidus or matrix of the subsequent disease of the lungs.*

It is a powerful adjuvant of the medical means best calculated to remove this disorder for, unlike its progeny, it is often curable-that removal to a mild climate is strongly recommended. The same measure is likewise advised, though with much less confidence, when there are strong reasons for believing that tubercles are actually formed in the lungs. But it is denounced, as we have already stated, in the strongest terms, not only as useless but cruel in the extreme, except in a few particular cases, when the disease is confirmed. We will here allow Sir James Clark to speak for himself; only observing that we entirely accord with every sentiment expressed by him in the following extract :

chial affections, hæmoptysis, inflammation of the pleura and lungs, &c.-which calls for important modifications in the plan of treatment. Removal to a mild climate, especially if effected by means of a sea voyage, under favorable circumstances, may still be useful as in the former case

namely, as a means of improving the general health, of preventing inflammatory action of the lungs, and even, perhaps, arresting the progress

of the disease.

tient, and hurry on the fatal termination. Under such circumstances, therefore, the patient will the most favorable residence which his own act more judiciously by contenting himself with country affords; or even by remaining amid the comforts of home, and the watchful care of friends. And this will be the more advisable

when a disposition to sympathetic fever, to inflammation of the Inugs, or to hæmoptysis, has been strongly manifested.

which seems to afford even a ray of hope; but "It is natural for relations to cling to that did they know the discomforts, the fatigue, the exposure, and irritation, necessarily attendant on a long journey in the advanced period of consumption, they would shrink from such a measure. The medical adviser, also, when Ire reflects liable, should surely hesitate ere he condemns the accidents to which such a patient is him to the additional evil of expatriation; and his motives for hesitation will be increased when he considers how often the unfortunate patient sinks under the disease before the place of destination is reached, or, at best, arrives there in a

upon

worse condition than when he left his own country, and doomed shortly to add another name to the long and melancholy list of his countrymen

See also his treatise on Consumption and Scro- who have sought, with pain and suffering, a distant country, only to find in it a grave. When

Fulous Diseases. London: 1835.