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that other gloomy self in the analogous atmosphere of the north, and assumes a new form under a more brilliant sky.
There is yet another way in which we believe change of climate often proves beneficial, and in a very considerable degree; and here, in place of a Physician, we shall quote a Poet, (Crabbe) -taking leave, however, to make a small alteration upon his lines:
For change of air there's much to say,
When ten physicians have prescribed and fail'd.'
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 physician 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 woe 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 mere act of travelling, (says Sir James Clark,) over a considerable extent of country is itself a remedy of great value, and, when judiciously conducted, will materially assist the beneficial 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.'
In former times, indeed, if expatriation had been proposed as a common remedy for a whole host of diseases, the prescriber would assuredly have been considered as standing most in need of his own prescriptions; and naviget Anticyram would have occupied a prominent place in his carte du voyage. But in those days, steam-engines and patent axles were not; neither had that organ of the Pbrenologists, which gives us the inclination to change our residence, been stimulated into full activity, by universal peace abroad, and universal travelling at home. At present, we are hardly more startled at Sir James Clark's prescription of Nice, Naples, or Rome, for the cure of a cough, an attack of indigestion, or of 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 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 favourably 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; asthma; gout; rheumatism; diseases of the skin ; scrotula; 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 import ance, ought to claim from us, as they have obtained from the author, more particular notice. These are disorders of the Digestive organs, and Consumption. In the first part of the present work we are presented with two admirable outline sketches of these affections, to which we must refer the reader; as our business in this article is not to describe diseases, or to detail their general mode of treatment, but to point out the influence of climate upon them.
them. We must, however, take leave to say, that it has but seldom been our fortune to meet with any piece of medical writing so characteristic of the best school of physic --the school of Hippocrates and Sydenham-as these sketches present.
In the chronic state, and secondary stages of dyspepsia or indigestion, and its multiform progeny, 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. The mode of its operation is explicitly detailed in his work; and the adaptation of particular 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 a matter of indifference. The place that is useful in one case is detrimental in another.
• The different forms of the disease require different climates. The patient with gastritic dyspepsia should not, for example, go to Nice, nor the south-east of France. In cases of this kind, the south-west of France or Devonshire are preferable, and Rome and Pisa are the best places in Italy. On the other hand, in atonic dyspepsia, in which languor and sluggishness of the system, as well as of the digestive organs, prevail, with lowness of spirits and hypochondriasis, Nice is to be preferred to all the other places mentioned ; and Naples will generally agree better than Rome or Pisa ; while the 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 the 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 effects 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 RegistrarGeneral'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.
Is a removal to a mild climate really beneficial in the curé, 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 any where else; but we fear we must say that the information is satisfactory chiefly because it is extensive and accurate. veys to us much less hope, and opens less prospect of benefit from the change, than we could desire. But it will, no doubt, be highly valuable to the medical profession, and to the public generally ;-by setting the case in a true light, and by showing what climate can do, and what it cannot do. If the effect of Sir James Clark's delineation of the true features of Consumption, and his exposition of the way in which climate influences its development and progress, were limited to the abolition or even discouragement of that insane system, so generally followed at present, and too generally countenanced by the medical profession, of sending patients abroad in a state of confirmed consumption—that is, in a hopeless state—his 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 cone sists, 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 deranye many of the functions essential to life. When once developed in the langs, it is extremely doubt
VOL. LXXVI. NO, CLIV.
ful 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 irregular order, whose confident promises (sometimes, perhaps, sincere) and loud boastings, impose upon many the belief that this hitherto intractable malady has at length been brought under the dominion of art. But the total ignorance of this class of persons respecting the real nature of the disease, and the great difficulties often experienced by the most learned in discriminating it, in its early stages, from some other diseases, sufficiently explain these occurrences. And the great teacher, Time, soon justifies the scepticism of the man of science, by covering with oblivion what, if true, could never be forgotten, nor permitted to yield its place to any novelty, however great, or any claimant, however loud. It is, therefore, with much satisfaction that we find the present author devoting all his powers to the elucidation of the remoter causes of consumption ; and of the nature and character of that morbid condition of the system to which it is found commonly to supervene. If we cannot cure consumption 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 knowledge, bas formally described the precursory disorder; or attempted (to use his own words) to fill up the blank which has been left in the
natural history of consumption, 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 Ca
* 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 on Consumption.