SIR JAMES CLARK ON CLIMATE.
THE present edition of this popular book is almost a new work. The arrangement of the matter has been entirely recast, and "whatever appeared not directly to the purpose has been omitted, in order to make room for the consideration of several new subjects, and the introduction of notices of some places not previously described." Mineral waters, and the climate of our Colonies in the Southern hemisphere, are considered with a view to their influence on the disorders which originate with the stomach and the lungs ; and new or additional statistics are introduced into the body of the work and the appendix. The most important novelty is that which relates to the climate of our own Colonies. In despite of economical science, John Bull has an ingrained notion of dealing with his friends, even if the
article be of inferior quality or higher price; there are pro- bably old-fashioned persons yet living wo would sooner die among Englishmen than be cured in some " outlandish place." Other things being equal, however, the habits to which we have been accustomed are important elements in the establishment of health. The little wants or annoyances which ruffle the temper of the healthy, are a source of injurious irritation to an invalid, especially if there be no superfluous wealth to transplant home comforts, but the sufferer must submit to the customs of the -country, and to the awkwardness and difficulty of a foreign language. If the climate of any English settlement, for example, were equal to Madeira, that settlement would offer a much better chance of recovery to the English invalid. Let us take a cursory survey of our West Indian and Southern Colonies so far as regards the "sanative influence of climate."
The West Indian islands have a high repute with American practitioners, in diseases of the lungs and throat whose tendency or termination is consumption. The research of Sir JAMES CLARK (for he seems to have had no practical experience in this quarter) is less favourable, and is limited to a peculiar class of disorders and constitutions. All public statistical experience is against sending patients to the West Indies when consumption has begun. For many years it was the practice in the Navy to draft men labouring under chronic pulmonary diseases into, ships going to the West Indies ; and it was found that the progress of consumption to a fatal termination was much . more rapid than in temperate climates. Among the military, Dr. FERGUSON remarks that the disease resembled " in its pro- gress an acute rather than a chronic affection." The cases of con- sumption originating among the troops stationed in the West Indies are double the number of those at home ; 12 per thousand being the average proportion of those annually attacked there, and only 6 in the Dragoon Guards serving in Great Britain. The disease also appears to prevail among the native Africans ; but the Creole Negroes of many generations (and, we presume, the mixed bloods) are altogether free from it. Upon these facts, however, this remark may be hazarded—that the labours, exposure, and dissipated habits of soldiers, sailors, or native Africans are mostly such as to aggravate the evils of a hot climate without eliciting any of its benefits. In cases where only a predisposition to consump- tion exists, the West Indies will sometimes be found beneficial, if
the constitution of the patient will enable him to bear the heat.
" When the morbid condition of the system which gives reason to fear the approach of phthisis depends chiefly upon hereditary predisposition, and occurs in early life, especially in feeble irritable constitutions, the climate of the West Indies will rarely agree. At a more advanced period of life, and in constitu- tions free from much disorder of the nervous system and of the digestive organs, the climate may prove useful. The revolution effected in the distribu- tion of the circulating fluids and in the secretions, may have the effect of enabling a constitution in which there exists considerable powers to overcome the tuberculous diathesis.
" Independently of the nature of the patient's constitution, other circum- stances will deserve consideration: for instance, whether the invalid can com mand the accommodations and comforts necessary upon a voyage, and during his residence in the West Indies ; whether he may have the power of selecting a proper situation, and of quitting the country on the approach of the summer heat, See. &c.
" It is a remarkable fact, confirmed to me by Drs. Arnold and Musgrave, that persons obviously predisposed to consumption are rarely attacked by the indigenous fever. " Tha cases of pulmonary consumption, therefore, in which the climate of the West Indies promises advantage, are very few, and their character scarcely ascertained ; while those in which it produces mischief are numerous, and ge- nerally well marked. Of persons predisposed to the disease, a certain propor- tion are likely to be benefited by the climate; but the nature of the constitu- tion should be well considered before it is recommended even as a prophylactic."
This is but a limited recommendation. At the same time, it
seems to us that the knowledge of the climate of the Blue Moun- tains in Jamaica is remarkably scanty. We know perfectly well that occult causes of disease exist quite independent of situation, scenery, or thermoinetrical results : but with such an extent of range and such variety of aspect and climate as these mountains possess, we have long thought that many places must be found in them offering a favourable retreat during a large portion of the year to the invalid in search of a warmer climate. The novelty of the scenery—the ease with which he may pass, if proper care be- taken, from the vegetation of an almost temperate zone to the magnificence and variety of the tropics—together with the con- venience with which the powers of steam will ere long enable the voyage to be performed—are such favourable circumstances as strongly to recommend Jamaica to the invalid, if the climate will agree with him. This is a point which the medical men of the island should do their best to ascertain ; for the sick, of course, cannot be sent on experiment.
Of all our Colonies in the Southern hemisphere the report of Sir JAMES CLARK is highly favourable. The climate of the Cape of Good Hope is at least as beneficial to health as that of Great Britain, and that of the Eastern province (Albany) more so. The troops of Cape Town are less subject to diseases of the lungs than on any foreign station except the East Indies ; and this class of disorders is still more rare in the newly-colonized province. Throughout Aus- tralasia the climate is greatly favourable to health : on an average of twenty years, the mortality amongst the troops was lower than in any other colony, the Cape excepted ; and of the actual mortality, more than a fifth part arose from accident or violence attributable to the nature of the duties on which the soldiers were employed. Comparing Hobart Town with our healthiest colonies, the re- spective proportions in consumption are—Hobart Town, 1 in 290: Cape, 1 in 180; Gibraltar, 1 in 148; Malta, 1 in 198; the Ionian Islands, 1 in 249; giving, it will be seen, a great advantage to Van Diemen's Laud,—although the greater number of the cases of dis- ease from which the summary was drawn up " were brought on by intemperance, imperfect clothing, and exposure to wet and cold; and though the greater part of the patients were European con- victs of the most dissolute habits and broken constitutions." With regard to other diseases than those connected with the lungs,
" It appears," says Sir James, " that fevers are exceedingly rare, even com- pared with the healthy colonies above referred to. Dysentery and dispcpsia very common, and constipation extremely so ; while diarrhea is but little experienced. Affections of the liver, too, are more rare than in any other climate with which we are acquainted ; but rheumatism is a disease of great frequency, and also of more than usual severity ; and it is very remarkable, that of the 30,102 eases, no fewer than 1,134 were from toothache. " Scrofula and glandular diseases are rare. Idiopathetic intermittent fever, malignant sore throat, smallpox, measles, scarlet fever, hydrophobia, &e. have not been met with in the colony. Hooping-cough was once introduced, and for a short time extended as rapidly and as widely as in England; but gradually became milder, and in a few months disappeared. There have been no epi- demics in the colony except on two occasions. The first of these was an epi- demic influenza, which carried off many persons infirm from age; the second was an epidemic continued fever. The diseases, both acute and chronic, are generally mild, and of comparatively short duration, and yield easily to the usual remedies. " The frequent and sudden changes of weather in Van Diemen's Land do not appear to be attended with the same hurtful consequences to the health as
ie other ; piid it is remarked by Mr. Scott, that *Watkins apparently
unhealthy are inhabited with the utmost freedom, without injury to the con- stitution, though in any other country they would probably be attended with inevitable destruction, or at least much hazard to human life.'" Of course, the distance of these colonies will prevent their be- coming a place of resort for invalids from England, unless under peculiar circumstances, where life is valued at a higher rate than it usually is by relations, however closely connected, or even by patients themselves. To families predisposed to hereditary disease, or where this predisposition is already developed, it may be a question how far permanent emigration might not be worth consideration, especially when natural disposition and worldly cir- cumstances may also incline to recommend the step. It seems of little use to " heap up riches" or cultivate connexions, when those for whom such things are generally valued prematurely perish before the eyes of their parents, or linger on spiritless and broken down, their life " a long disease."
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