Kitabı oku: «Chambers's Edinburgh Journal, No. 444», sayfa 3

HYGIENIC CHANGE OF AIR

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 3¼. 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 diarrhœa, 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