FRANCIS ON CHANGE OF CLIMATE. * TILE influence of change of

air on health as a preservative or re- storative is within the experience of every one ; so extraor- dinary are its effects, that a day or two, sometimes even a single day, will temporarily as it were " set up " a person, if the mind has been amused and the sensations have been gently stimulated. The curative power of climate in actual disease May be a doubt- ful question, notwithstanding the sanguine notions entertained by many persons and tacitly encouraged by practitioners. In agate diseases' there is not time, even if climate would be of use. In organic diseases or structural change, originating in what is termed constitutional tendency—as cancer—climate would seem of little avail, though it may occasionally benefit cases where functional irregularity is combined with structural change. Such may be the ease with heart-disease, when a climate which soothes the nerves and regulates instead of stimulating or oppressing the cir- culation is found. Such is the case with consumption, where the lungs are injured by tubercles, and the climate is favourable

to the general health of the patient; for it is a very grave ques- tion in eases of constitutional, not accidental consumption, whether the original tendency is ever more than suspended.

The broadest maxim that can be laid down upon the subject is, that climate can cure what climate causes. Ague and local fevers are cured by removal ; though, as in the ease of the Niger fever, they may sometimes shake the constitution irretrievably. Risen- matiam, originating in cold or damp, will often be alleviated, some- times cured, by change of climate. The feeling, from mere uneasi- ness to actual influenza or other disorder, which many people suffer in this country when an Easterly wind is accompanied by a damp at- mosphere, and which passes away with the weather, is another ex- ample. Climate also may act mechanically or chemically—as some disorders of the kidneys are benefited in the Tropics by. the funational relief afforded through the skin. The second maxim is, that climate will cure what medicine or treatment cannot. In the debility which follows acute disease ; in the general derangement which originates in various causes—over-work, over-excitement, over-feeding, and

the other undue stimuli of a high civilization ; in torpidityof func- tion—as the digestion, or in a general sluggishness, when some subehronic disorder "hangs about" you—as, to take the most familiar case, an obstinate cold—medicines have little effect, Lit a change of air (and habits as well) will frequently work wonders, lio in that strumous constitution, whose most common termination is consumption, and where medical treatment (unless the regulation of life may be called such) is utterly useless, climate, as we have already said, may have some effect in suspending, if it cannot ac- tually cure the disorder.

When the popular opinion of the influence of climate on disease, and the extent to which the opinion was acted on by practitioners, are considered, it is remarkable that the present generation was the first to witness a large philosophical and practical examination of the subject with a view to discover the climates best adapted to particular diseases. Exceptions might occur from individual thought and experience, but before the appearance of Sir James Clarke's book, the popular notion was "a warmer climate 5; and this region of the blessed in foreign parts was supposed to lie any- where towards the South. Patients were sent as a matter of course to Montpellier and other places in the South of France, often really to be killed by the climate, so unfit was it for their. complaints. Lisbon and Madeira were the other two sanatoria ; and, though less dangerous, they were equally unadapted to many

diseases.

Dr. Francis's book is a useful successor to Clarke's, as the author, is a creditable disciple of the master. He enters, and perhaps snore fully than Dr. Clarke himself, into the various disorders which may be benefited by change of climate, as well as into the various climates best adapted for each disorder. Without losing sight of Italy and the South of France as spots for the invalid, he suggests certain places as a residence for patients, which were either little known when Clarke first wrote, or were practically unavailable from want of access and accommodations. Spain and Portugal are the countries chiefly recommended ; and Malaga, Cadiz, Seville, Cintra, and Lisbon, with a few places of lesser note, are the spots chiefly urged upon the invalid's attention. In describing the-cha- racter of the climate and the diseases for which it is adapted, Dr. Francis does not confine himself to a dry account of the " elegies' " but varies them by sketches of landscapes, accommodations, and manners, as well as by incidental notices of local complaints. The great terror of the middle ages, leprosy, still exists at Lisbon, con- fined to the poor ; and apparently the result of poverty and its con- comitants, dirt, foul air, and bad living, in depraving the blood.

• Change of Climate considered as a Remedy in Dyspeptic, Pulmonary, and. other Chronic Affections; with an Account of the most eligible Places of Reside,pee for Invalids, in Spain, Portugal, Algeria, &c., at different seasons of Die, y • 1111 Appendix on the Mineral Springs of the Pyrenees, Vichy, and Aix fel; J. T. Francis, M.D. Lond. &c., Roc. Published !vault-chill. "Of all the leper hospitals in the Peninsula, at Lisbon only did I find one tenanted by the unhappy beings for whom they were built. Here there were forty beds for men and fifteen for women, all being occupied by con- firmed cases of the disease. The first indication of the presence of leprosy- is a discolouration in pateheseff the skin of the face; or dingy red tubercles of various sizes show themselves. One of the most characteristic signs is an elongation and thickening- of the lobe of the ear, or a distortion and spreading out of the she Of lbe nose; and one or other of these changes often exists as almost the sole foreshadowing of what is to come. s.,tifter a time, the face, beset with tubercles, becomes puffed out, although net.eyminetrically, by subcutaneous deposit, and is traversed by deep lines, which corrugate the cheeks and brows. The lips are thickened and fissured ; and the whiskers, eyebrows, and lashes fall off. "In this way; the human aspect of the countenance is sometimes almost lost, and a most remarkable resemblance to that of the lion occurs. Among the lepers in the hospital at Lisbon, during my visits, were two or three with this peculiar physiognomy strongly marked. But many others may always be seen in whom some approach to this humiliating disfigurement is apparent.

"6/actually the tubercles extend over the limbs, and sometimes upon the trunk; whilst the skin, becoming more and more thickened and wrinkled, assumes a light coppery colour.

"Life is reduced to a state of vegetation ; the intellectual and vital func- tione are all blunted ; smell is lost, and common sensation impaired, so much so,-indeed, that the most severe pinching of the flesh may fail to arouse the benumbed feeling. In some cases this loss of sensation is the most promi- nent feature of the complaint.

"Sometimes the disease in its early career seems to be arrested ; but gene- rally, after the lapse of some years, the tubercles ulcerate, and dark scabs are formed. A similar state of things occurring in the nose, and extending to the bones, gives rise to mem. The mucous membrane of the throat is affected like the skin, and the voice, at first husky, becomes lost.

"The fingers and toes ulcerate at the articulations, and drop off joint by joint. So that a whole hand is sometimes seen with the terminal phalanges, which are the last to suffer, reposing upon the metacarpal bones. Sponta- neous amputations of the larger joints in like manner occur.

"In this way the wretched being, his body experiencing successive mu- tilations, and exhaling a loathsome fmtor, passes his days, and at length turns in his bed and dies without a struggle ; or the labouring breathing bespeak an extension of the malady to the bronchial tubes, and he dies suf- focated ; or an attack of diarrheea or erysipelas, almost always a fatal symp- tom, closes the scene."

Dr. Francis has resided for some time in Madrid ; and he gives a better account of the capital and the royal palaces in the adjacent country than many professed travellers. The climate of Madrid is described as a warning for invalids to avoid if practicable ; and no wonder.

"The pneumonia of Madrid, or pulmonia, is most common during the colder part of the year, but no season is exempt from its invasion. The ex- traordinary rapidity of its progress and its fatal character, are the chief pe- culiarities of the disease ; so that it not unfrequently happens for people, leaving balls orwarm rooms at night and encountering the treacherous wind, to be seized with pulmonia and die in a few hours. The disease often ter- minates futally without advancing to hepalization of the lung ; an intense congeetion of blood seeming to induce asphyxia.

"IL should be impressed upon the stranger in Madrid, that the air which produces these terrible consequences, the assassin breath of death, as it has been graphically termed by Ford, is often so gentle in its movements, that na. suspicion of its hurtfulnessmight be created. Indeed, the proverb in the mouth of every Madrilenian, that the subtile wind will kill a man although it -cannot extinguish a candle- ' Es el sire de Madrid tan sotil

- Clue mate a an hombre, y no apaga a un candil

is founded on sad experience, and sufficiently illustrates what has been said. "Flannel, voluminous enough to cover the abdomen as well as the chest, should be worn in all seasons : this, along with the habitual use of the cloak, so that the mouth may be covered, in the winter and at night, and the avoid- ing as much as possible exposure to the winds, constitute all that can be said in the way of prevention."

This book is to a great extent the result of personal observa- tion. As regards the Peninsula, indeed, the means of scientific deduction are wanting. Spain is not a country of statistics, and even thermometrical observations are not always to be had- "The repeated inquiries of several friends in Seville, official

and •non-official, as well as my own, could obtain no knowledge of the existence of any recorded meteorological data whatever." Dr. Francis is therefore driven to the test of vegetation : and not a bad one, for plants, like ourselves, are subject to all the skyey in- fluences, which mercury is not. "Turning now to the test of climate afforded by the state of vegetation, I will state some facts that came under my own observation in 1848-9, which, I am told, may be viewed as un average season. The process of growth pro- ceeded, although in a diminished degree, throughout the winter. Many kinds Of flowers were, at the same time, blossoming in gardens in the open air; and among them, smelling roses were so common, that the gratification of the general taste for weaving them among the hair was indulged in freely by,the young women of the poorest class. There were deciduous trees, es- pecialla the white poplar, (alamo blanco,) a great favourite in Spain, the old lekvele of which remained green upon the boughs at the same time that the new ones were coming forth. The first great burst of vegetation, corre- sponding with our March or April, took place in the second week in January. Then the ranunculus ficaria, one of the harbingers of spring, was in flower, and a ;profusion of thick herbage already covered the banks and way-sides. On ehe 16th of February poplars and willows along the river-walk were gay with 'theirnew full-blown foliage.

may be useful now to compare the above account in regard to Seville with what was observed at Malaga at a corresponding period of the year. Journeying from the former to the latter place in the middle of May, the vegetation was found to be much more advanced on approaching Malaga, making every allowance for the four days spent on the road. The cactus was more fully in bloom, the aloe shoots much taller, and instead of showing nierely the unexpended spike-like stem, had already put out some of the lower flowers. The oleander, the flower-buds of which at Seville were still in the -state of unopened calyx, all along the banks and bed of the Malaga river ftom Caratracca were blazing with mature flowers. Then, again, as the valley opened out towards Malaga, the golden tint of harvest was spread over thewhole country, whilst several fields of wheat had already fallen beneath the sickle. There was nothing corresponding with this at Seville."

• tjal advantages which the Iberian Peninsula possesses ovet Italy Ind he South of France consist in the greater warmth,

the greater dryness, (except Provenoe, which is too dry,) the greater equability, and the absence generally speaking of biting winds. In addition, the vegetation is more striking and Trop the attractions of the country for walking are much greater, the manners and the people more racy and originaL Particular places may exhibit drawbacks' or an exceptional winter may occur, bat these are less frequent than in Italy or the South of France • and Dr. Francis judiciously remarks, that a perfect climate is not be found. In all changes of country, however, the patient has to be considered as well as the complaint. Some people can shift and not care, others are dissatisfied if they have not every accustomed comfort : some people are easily amused, or can amuse themselves ; others would die of ennui if they were without sights or society. Tha dissatisfied, the restless, the ennuyant class of people, would be better away from Spain, especially if they did not possess a good knowledge of Spanish ; for the endless worry would do them more harm than the climate would do them good. In most cases, per- haps the Peninsula is better fitted for cases of deranged or delicate health, where the person is capable of inquiry and of exertion within reasonable limits, than for patients suffering from disease, or so weak as to be dependent on home or street amusements.