This word embraces the consideration of many topics which our limits forbid our touching upon; but as the present work will doubtless be read in all parts of the world (at least such is our hope), it would be incomplete without a few remarks in relation to the causation and treatment of disease.

The Effects Of Change Of Climate

An inhabitant of a temperate climate going to a tropical country will suffer from excitement of the nervous and vascular systems, by the heat and moisture of the air. The respiratory functions become less active; while there is a decrease of the ordinary action of the kidneys in carrying off the refuse matters of the circulation. The consequence of which is that the skin and the liver have an excess of work thrown upon them (to speak metaphorically, and also exactly), in order to rid the system of certain effete elements which the lungs cannot throw off.

Hence the "seasoning fevers," as they are called, and the disorders of the liver, to which Europeans are specially liable on arrival in a hot climate, and to which full often they render themselves the more obnoxious by injudicious diet.

Europeans visiting hot climates should live abstemiously, taking every means to promote the functions of the skin by moderate exercise and by daily free ablutions. Exposure of the head to the heat of the sun should be carefully avoided, as well as the risk of contracting fever by exposure to dews, the cold, and the malaria of the night air. Warm clothing should be worn at night by new-comers, as the extremes of day and night temperature in tropical regions often pass through a very wide range.

The effects of a warm and moist climate upon the inhabitants of colder regions, in decreasing the functional activity of the lungs and increasing that of the liver and skin, has formed the basis of the recommendation of a change from a cold to a warm climate in pulmonary affections. It is, however, very doubtful whether the relaxing and enervating influence of the heat on the nervous system does not more than counterbalance this functional compensation. Certainly, when disease in the lungs has advanced much, more harm than good generally comes of the migration. On the other hand, the tonic and bracing effect of a cold climate more frequently checks the advance of consumption if care is taken to protect the surface from sudden chills, and so to protect it as to ensure a free circulation of the blood in the skin by active out-door exercise. Our British Hippocrates, Sydenham, was wont to call horse exercise the " palmarium remedy" for consumption, so strongly was he convinced of the importance of out-door exercise. A confirmation of this opinion is to be found in the fact that coachmen (if temperate men) are among the healthiest classes.

In the days when locomotion was performed more on horseback than is now the case, it was said that "bagmen," or commercial travellers, enjoyed a singular freedom from consumption. Unfortunately, however, these men, then as now, too often threw away their better heath by their irregularities in other directions.

While the stress of the effects of removal to warm climates upon the inhabitants of temperate regions is thus seen to fall upon the liver end skin, the reverse is seen to occur when the natives of hot climates migrate to colder countries. The negro, brought direct from Africa to England, will almost surely be the victim of consumption.

Between these extremes there are shades of tolerance of the change, which may be acquired by making the change gradually, by an intermediate residence in regions more temperate but less cold. Dr. Copland writes: "The native of Africa who removes immediately to Europe seldom lives more than two winters in it; whereas the negro who has been brought to the West Indies, and subsequently to the Southern States of North America, previously to his arrival in more northern countries, and enjoys necessary food and clothing, will often not suffer materially from the change." In these few words lies the secret of protection, to a very great extent, from the effects of change of climate - "necessary food and clothing."Only the necessary food; not the excessive and superabundant supply of the heating and stimulating food that is too frequently indulged in by Europeans in hot climates.

An important point to be borne in mind on the question of change of climate, is so to time it as to assimilate as much as may be the characters of the climate; to diminish the effects of the extreme diversity of the regions left or visited; to go from the cold season of the one to the warm season of the other, or the reverse. For an European returning after a long residence in a hot climate, it is wise to break the change by a short preparatory residence in the warmer parts of Europe - such as the south of France or the south-western coast of England.

The mildness and uniformity of the climate of the southern and south-western counties of England render them available for the change of air so commonly sought by invalids during the winter months. The access of a portion of the gulf stream to our southern and western coasts renders them mild, warm, and moist. The amount of rainfall at Penzance is double that of London. The daily range of the thermometer is less; it rarely falls so low in the night, nor rises so high in the daytime as in the midland, northern, and eastern counties. Thus, in the hottest summer, when the heat in London is almost intolerable, the temperature is moderated by the sea breezes, and is often quite bearable on the coasts of our southern counties.

Without attempting details which would carry us beyond our limits, we may briefly state that the more sheltered the situation, and the more equable the climate of any place, the better it is adapted for the out-of-door exercise so important for pulmonary affections, and beneficial for chronic inflammatory complaints, with deficient secretion from the mucous surface. The drier atmosphere and more bracing air of exposed positions - such as of our eastern and north-eastern coasts - are adapted to nervous affections and states of debility, accompanied with profuse discharges.

The change of climate must therefore be guided by these several conditions both of place and person, and may further require to be altered according to the changes of the seasons, and according to the special character of the season itself. Thus, it not unfrequently happens that the south coast of England is not suitable for invalids, even so late as June, if easterly winds prevail. The air is then almost as keen as that of the directly eastern coast, and a return inland becomes inevitable.

British And Foreign Climates In Relation To Disease

To enable the reader to select the climate most suitable to the requirements of the particular case he may have in view, we shall enumerate the diseases for which change is most frequently sought, and, by the help of the invaluable treatise of Sir James Clarke, endeavour to direct his choice.

Consumption

In this disease, change of climate, to be productive of real benefit, must be tried at a much earlier period than is generally done, as it is often delayed a year or two after the period that any good can be expected, and the result is that more harm than good is done thereby. Hence the trial is often not made through the discredit that arises out of its misapplication. It should be borne in mind that consumption is not merely a disease of the lungs, but a general morbid constitutional condition of which the disease in the lungs is but a manifestation. The early treatment must therefore be directed to invigorating the system and improving the quality of the blood. With these objects the climates most suitable for winter residence are those of our southern coast, Madeira, Nice, Pisa, and Rome, with removal during summer months to the drier situations of our own islands.

Chronic bronchitis is an affection that is often mistaken for consumption, and one which, through its persistence and its debilitating and emaciating effects, constitutes a veritable decline. The change from a cold and moist to a mild and dry air relieves the morbid conditions of the mucous surfaces.

The same climates that are of service in consumption are beneficial in chronic bronchitis. When asthma is combined with chronic bronchitis it is also relieved by the same climate as is found useful in chronic consumption. Torquay and Undercliff, for example, are most adapted to irritable states of the mucous membrane without much secretion; Clifton or Brighton for those in which expectoration is profuse and the system debilitated; Rome, Pisa, Madeira, are suited for the latter class of cases, Nice to the former.

Chronic Rheumatism is benefited by residence in a warm climate, such as the south-western coasts of England, the south of France, Rome, and Pisa.

Gout also derives benefit by a warm climate. The West India islands are especially marked in this respect.

Dyspepsia and nervous affections connected therewith are aggravated by a cold and damp atmosphere, and are greatly relieved by change to a drier and warmer climate; but great care in dieting is needful in order to ensure the full benefit of the change. The use of stimulants must be very cautiously watched. The nervous symptoms associated with dyspepsia are prone to take on the form of hypochondriasis; the change of climate should therefore be accompanied with change of occupation and of amusement. This class of cases rapidly improve under change of scene, and the relinquishment of the cares of business, to say nothing of "throwing physic to the dogs".