University of California • Berkeley 
 
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DISSERTATION 
 
 ON THE 
 
 INFLUENCE OF A CHANGE OF CLIMATE 
 
 IN 
 
 CURING DISEASES. 
 
DISSERTATION 
 
 ON THE 
 
 Influence of a Change of Climate in Curing 
 Diseases^ 
 
 BY PROFESSOR GREGORY, 
 
 OF EDINBURGH. 
 
 Translated from the original Latin, and enlarged with occasional Notes: 
 BY WILLIAM P. C. BARTON, M. D. 
 
 " Pessimum segro est coelura quod segrum fecit; adeo ut in id quoque genua^ 
 quod natura pejus est, in hoc statu, salubris mutatio sit." 
 
 C£Lsus ns Rs Mkdica. 
 
 PHILADELPHIA: 
 
 PUBLISHED BY THOMAS DOBSON, 
 
 AT THE STONE HOUSE, NO. 41, SOUTH SECOND-STREST. 
 
 WilUam Fry, Printer, 
 
 1815. 
 
District of Pennsylvania, to wit: 
 
 ********* BE IT REMEMBERED, That on the second day of May, 
 
 I Seal. * in the thirty-ninth year of the independence of the United 
 
 *«««««««» Stites of America, A. D. 1815, Thomas Dobson, of the 
 
 said district, hath deposited in this office tl»e title of a book, the right 
 
 whereof he claims as proprietor, in the words following, to wit: 
 
 ** A Dissertation on the Influence of a Change of Climate in Cur- 
 ing Diseases; by Professor Gregory, of Edinburgh. Translated 
 from the original Latin, and enlarged with occasional Notes: 
 By William P. C. Barton, M. D. 
 
 * Pessimum 3cgro est ccclum quod segrum fecit; adeo ut in id quo- 
 que genus, quod natura pejus est, in hoc statu, salubris mutatio 
 sit.' — Celsus de Re JMedica** 
 
 In conformity to the act of the congress of the United States, inti- 
 tuled, •• An act for the encouragement of learning, by securing the 
 copies of maps, charts, and books, to the authors and proprietors of 
 such copies, during the times therein mentioned.*' — And also to the 
 act, entitled, *• An act supplementary to an act, entitled, ' An act for 
 the encouragement of learning, by securing the copies of maps, charts, 
 and books, to the authors iiud proprietors of such copies during the 
 times therein mentioned,' and extending the benefits thereof to the 
 arts of designing, engraving, and etching historical and other prints.'* 
 
 D.CALDWELL, 
 Clerk of the District of Pennsylvania. 
 
TO 
 
 NATHANIEL CHAPMAN, M.D. 
 
 PROFESSOR OF MATERIA MEDICA IN THE UNIVERSITY OF 
 
 PENNSYLVANIA: WHOSE TALENTS AND URBANITY 
 
 HAVE ELEVATED HIM TO THE HIGHEST 
 
 EMINENCE IN HIS PROFESSION; 
 
 IN GRATEFUL ACKNOWLEDGMENT OF MANY ACTS OF 
 
 FRIENDLINESS, AND IN EVIDENCE OF ESTEEM, 
 
 JS RESPECTFULLY DEDICATED 
 
 BY HIS FRIEND, 
 
 THE TRANSLATOR. 
 
CONTENTS. 
 
 Page 
 Section I.— -General observations relative to the effects 
 
 of climate on the human constitution, and ^specially re- 
 specting the effect of that of Great Britain on the inha- 
 bitants. — Remarks on the constitution of the air, and 
 its modus operandi on the solids and fluids of the body; 
 also, of the disorders induced by its inclemency, and 
 the sudden vicissitudes to which it is liable.— Of the 
 effects of sailing on the system, and the peculiar kind 
 of nausea, vomiting, and exercise, arising from it.— 
 Observations tending to prove that a change of climate 
 may reasonably be expected to cure many obstinate 
 chronick diseases, and more especially those endemi- 
 cal to the inhabitants of Great Britain IT 
 
 Section II. — Of the nature and symptoms of pulmonary 
 consumption, and its similarity or identity with scrofula. 
 
 Of the different notions of physicians respecting the 
 
 curableness and incurableness of genuine phthisis.— 
 Of the effects of wounds and other injuries of the 
 lungs, on that viscus.- — Of the remote and proximate 
 causes of consumption, and the reasons that may be 
 
8 
 
 Page 
 deduced from them, in favour of a change of climate 
 upon the diseases.— Of the curative effects of travel- 
 ling, riding on horseback and sea-voyages 76 
 
 Section III.— .Of the causes of hypochondria, especially 
 its origin from the effects of climate, diet, and mode of 
 life. — Its various symptoms.— Its connection with the 
 haemorrhoidal flux and its affinity to this disease, deduced 
 from the similarity of its causes.-— The general absence 
 of any praeternatural appearances in the dissection of 
 the dead bodies of hypochondriacks.— Sometimes tur- 
 gescence in the mesenterick veins observable.— The 
 different remedies for this disease. — The beneficial 
 effects of riding on horseback, especially when conjoin- 
 ed with a change of climate 155 
 
 Section IV. — Of gout.— Of the effects of a cold and 
 humid climate on arthritick constitutions, and the ge- 
 neral incfficacy of the remedies used in this disease. — 
 The advantage of a change of climate over all other 
 remedies in this complaint, particularly from a cold to 
 a warm one, deduced from the effects of travelling and 
 warm air, in promoting a free and healthy determina- 
 tion of the fluids to the skin, especially in old persons. 
 — Also the beneficial effects of a mild climate on the 
 disorders of the stomach, so intimately connected and 
 almost always combined with gout. — Arguments in 
 favour of a change ef climate in gout, inferred from a 
 consideration of the remote causes of the disease Of ' 
 
9 
 
 Page 
 its effects in averting the ill consequences of repressed 
 
 gout, which generally succeed the use of other reme- 
 dies 176 
 
 Section V. — Of invigorating old age— The signs and 
 effects of declining life in old persons, and the particu- 
 lar consequences of the depreciated functions of the 
 system .-^Reasons why a change of climate may be ex- 
 pected to relieve them, and produce a general invigora- 
 tion of the fading body.— Of the injurious effect of a 
 cold and humid climate upon old people, and the ad- 
 vantages to be derived from travelling to warm coun- 
 tries . . 190 
 
 B 
 
PREFACE. 
 
 The original of the following Dissertation, is from 
 the classick pen of Dr. Gregory, professor of medi- 
 cine at Edinburgh, and author of the Conspectus. 
 It was written for his inaugural Thesis in the year 
 1774, under the title " De Morbis Coeli Mutatione 
 Medendis," enlarged and amended by the author 
 in 1776, and republished in 1785 in the " Thesau- 
 rus Medicus Edinburgensis Novus." It is from this 
 last edition that the translation is made. This dis- 
 sertation, besides its classical Latinity, contains many 
 useful observations and important facts on the sub- 
 ject of which it treats. The reasoning of the author 
 is sound, his arguments pertinent, and his conclu- 
 sions correct. He has treated an interesting subject 
 judiciously and with ability, and satisfactorily de- 
 monstrates the powerful operation of climate on the 
 physical and moral constitutions. The pathology of 
 this work is not the least important part of it. The 
 
12 
 
 arguments in favour of a change of climate, in the 
 treatment of many of the diseases which afflict the 
 human race, are all logically deduced from an at- 
 tentive consideration of the causes and symptoms 
 of the diseases in which the author deems it expe- 
 dient to recommend it: and it is believed that the 
 translation may be useful as a mean of giving in- 
 formation, on a subject not particularly treated in 
 any other medical work in the English language. 
 All the notes added are by the translator, and they 
 are intended to convey such observations illustra- 
 tive of the text, as his practical experience, while a 
 surgeon in the navy, enables him to offer. With 
 regard to the mere diction of the English version, 
 but one end has been aimed at, which is, to render 
 into intelligible English, what was believed to be 
 the true meaning of the author, and never deviating 
 even from the actual phraseology of the original, 
 excepting in those instances where an adherence to 
 it would have been incompatible with the idiom of 
 our own tongue. As no liberties have been taken 
 with the original, but have been on the contrary 
 sedulously avoided, the reader must not look for, 
 and he certainly will not find, the embellishments 
 of style. If the translator has succeeded in present- 
 
13 
 
 ing the publick with a literal and faithful version of 
 the original into clear and unvarnished English, he 
 will have accomplished his design, and be satisfied. 
 He has not relinquished his intention, announced 
 some time since, of presenting the medical publick 
 with an English translation of the Conspectus Mc- 
 dicinae Theoreticae. An engagement with a book- 
 seller, is all that is necessary to enable him to com- 
 ply with his promise. 
 
 THE TRANSLATOR. 
 
 No. 222, Walnut-street, 
 Philadelphia. 
 
TABLE OF ERRATA. 
 
 Page 38, line 2 from the bottom of note, for vascillancy, read vaciUancy. 
 
 Page 41, line 4 of note from the top, for necisse, read necesse. 
 
 Page 63, line 7 from the top, for vascUlation, read vacUlatton, 
 
 Page 113, line 10 of the note, for patient, vesA patients. 
 
 Page 131, line 6 from the bottom, for vascUlating, read vacillating. 
 
 Page 83, line 1 of the note, leave out the word General, between parenthesis. 
 
 Page 171, line 4 from the bottom, for concommitants, read concomitants. 
 
 Page 174, lines 5 and 7 from the top, for vicera, read viscera* 
 
 3*age 174, line 9 from the top, for Carribeans read Caribbean. 
 
A DISSERTATION, &c. 
 
DISSERTATION 
 
 OK 
 
 THE INFLUENCE OF A CHANGE OF CLIMATE. 
 IN CURING DISEASES. 
 
 SECTION I. 
 
 General Observations relative to the effects of Climate on 
 the Human Constitution, and especially respecting the ef- 
 fect of that of Great Britain on the Inhabitants. — Remarks 
 on the Constitution of the Air, and its modus operandi on 
 the Solids and Fluids of the body; also, of the Disorders 
 induced by its inclemency, and the sudden vicissitudes to 
 which it is liable. — Of the effects of Sailing on the Sys- 
 tem, and the peculiar kind of Nausea, Vomiting, and Ex- 
 ercise, arising from it. — Observations tending to prove 
 that a change of Climate may reasonably be expected to 
 cure many obstinate Chronick Diseases, and more especi- 
 ally those Endemical to the inhabitants of Great Britain. 
 
 Many of the diseases which afflict the human race, 
 are endcmial to certain countries; while in others 
 they rarely, or perhaps never occur. The tempera- 
 ture of the atmosphere certainly produces various 
 affections of the human system, so that the most of 
 those disorders may be easily attributed to the per- 
 
 C 
 
• 18 
 
 hicious properties of the air, aided in their operatioa 
 on the body, by the influeHce of climate. There is a 
 surprising difference in the mental constitutions, as 
 well as in the corporeal systems, of the inhabitants of 
 different countries; and in addition to this circum- 
 stance, each revolution of the seasons of the year is 
 accompanied by a train of diseases peculiar to itself, 
 which it ushers in on its approach. Climate, and 
 the state of the air, manifesdy induce a predisposi- 
 tion to many disorders, and copiously abound also, 
 as is very evident, with the exciting causes of dis- 
 ease. We well know that winter produces various 
 chronick complaints, which resist every medicine that 
 may be exhibited for their relief, during a continu- 
 ance of that season; yet these very disorders are 
 cured with the utmost facility on the approach of 
 summer. It is a well ascertained fact too, that there 
 is so great a variation in the state of the air in dif- 
 ferent countries, nay, even in the same country dur- 
 ing the different seasons of the year, that the effects 
 it produces on the system, are entirely dissimilar. 
 Hence it is evident, that many disorders originating 
 from an intemperate climate, might be prevented and 
 cured by a change of air. That this is incontroverti- 
 bly true, we infer from the fact: that innumerable 
 
1^ 
 
 maladies, after having baffled all the powers of the 
 medicines that had been employed for their cure, 
 disappear spontaneously, or become mitigated, by 
 changing the climate,^ or upon a revolution of the 
 season; and we are confirmed in the verity of this 
 proposition, by the opinions of the physicians of an- 
 cient times, who accord with those of our own day, 
 in believing that a change of climate will prove emi- 
 nently beneficial in a variety of complaints, that ar« 
 curable with difficulty by any other means. 
 
 In this essay, we shall attempt to advance some 
 opinions relative to certain disorders endemial to our 
 climate, and respecting the feasibility of their cure 
 by a change of air. We will, however, previously 
 
 1 Every naval surgeon must have had occasioA to observe, 
 what it has repeatedly happened to me to see: that almost all 
 patients on ship-board, labouring under obstinate chronick 
 complaints, which could in no way be managed or subdued 
 in port, are cured spontaneously after a voyage of a week or 
 two; especially if the vessel should have sailed from a port 
 open to turbulent winds and intemperate weather, to a milder 
 climate: or to another place, screened from the piercing 
 blasts that sweep away the unfortunate victims of breast 
 complaints, from the sick-bays of our ships during the win- 
 ler season. 
 
20 
 
 offer some remarks respecting the manner in which 
 the climate of this country, in particular, injures the 
 constitution. 
 
 Observations hav^ clearly ascertained that coun- 
 tries which enjoy a moderate, mild, and equable cli- 
 mate, are the most salubrious; and those that are hot, 
 cold, or humid, the most pernicious to health, espe- 
 cially if they should be subject to sudden vicissitudes 
 of the weather. Celsus long since remarked, that 
 countries equably warm, or uniformly cold: and such 
 seasons of the year as are remarkable for a like uni- 
 formity in heat or coldness, are the most favourable 
 to health; whilst those on the other hand, characte- 
 rized by excessive variableness, are highly injurious. 
 The truth of this observation is evidenced in the 
 island of Great Britain, where the air during the four 
 or five summer months is moderate and generally 
 bland, dry, and equable; hence during this period it 
 is universally agreeable and salubrious; all the re- 
 maining part of the year, however, it is cold, humid, 
 and variable; and consequently productive of exces- 
 sive unhealthiness.^ 
 
 « The climate of Great Britain is a peculiar one, and the 
 state of the air variable in the extreme. A momentary glance 
 
21 
 
 Physiology teaches us, that a due motion and cir- 
 culation of the fluids throughout the whole system, 
 are necessary to ensure the health of every part. 
 Whatever therefore has a tendency to impede this 
 healthy action, will accordingly derange the system. 
 
 at its geographical situation, will explain the cause of this 
 versatility of the weather, as well as of the turbulence of the 
 prevailing winds throughout the year: and the almost con- 
 stant haziness of the atmosphere during the winter, autumn 
 and spring months. Being an island pretty far north, and not 
 any part of it being much more than sixty miles from the 
 sea, the air is generally cold and moist, and though the sea 
 air itself from its moisture, has no unhealthful effect on the 
 constitution even of a valetudinarian, yet it has always been 
 remarked that places lying immediately in the face of its in- 
 fluence, are rendered unhealthy by it. Hence it would seem 
 that the insalubrity of the air in the vicinity of the sea is de- 
 rived from some adventitious quality which it somehow re- 
 ceives in its passage over the land. We may form some 
 idea of the degree of moisture the atmosphere of an island 
 like Great Britain, surrounded by the sea, must be endued 
 with, when it is computed that from the Mediterranean 
 Sea only, 5280 millions of tons of vapour rise in a summer 
 day; it is true the evaporating causes are not so powerful in 
 the sea surrounding Great Britain; but yet the moisture 
 must be considerable. In Great Britain the winds two-thirds 
 of the year are in the southerly and westerly quarters. 
 
 Dr. 
 
Now, cold air, especially if it be humid, has a power- 
 ful effect in checking perspiration and in impeding 
 
 Dr. Campbell, in Lancaster, (England,) in the course af 
 seven years found the winds to be in this proportion: 
 
 Westerly, 216 days in the year. 
 Easterly, 1 49 
 
 The direction of the winds was observed at Dover for 
 three years, and they were 
 
 Westerly, 321 
 Easterly, 173 
 
 In the city of Edinburgh the winds were observed to blow 
 as follows: 
 
 Anno 1797. West 256 days — East 109 days. 
 1798. West 250 days— East 115 days. 
 Vide Transactions Roy. Soc. Edin. 
 
 There is some similarity between the climate of England 
 and the United States during the spring and winter seasons. 
 The sudden transitions of the weather from the extremes of 
 heat to cold, and vice versa, are as remarkable here as in 
 Great Britain: and from actual observation I have found that 
 the effects of these vicissitudes on valetudinarians on ship- 
 board, are singularly similar and fatal, in both countries. 
 There is this difference however in the relative state of the 
 
23 
 
 the circulation of the blood through the external 
 parts of the body. For the external application of 
 
 atmosphere, that in England it is always more humid, espe- 
 cially during the winter time, a circumstance undoubtedly 
 owing to the vicinity of the sea. And though in the interiour 
 of our country, and in the Atlantic states, at the distance of 
 eighty or an hundred miles from the ocean, the air is gene- 
 rally dry; yet in the tracts of country lying immediately on 
 the sea-board, it is marked by the same humidity as that of 
 England. Whether the state of the atmosphere in the United 
 States is actually purer than that of Great Britain, is, I think, 
 problematical, although Dr. Williamson leans to the opinion 
 that the air of America is more pure than that of the coun- 
 tries of Europe. This he infers from the circumstance of our 
 repeated and successive clear blue skies, which may be ob- 
 served night after night in the United States, adorned by 
 countless stars; and these he remarks are seldom equalled 
 in those parts of Europe frequented by travellers. (See 
 his Essay on the Climate of America, Sec, page 175.) From 
 this similarity of climate we may naturally expect that 
 the diseases of this country will also be allied, and accord- 
 ingly we find consumption and affections of the breast, very 
 common in the eastern states. Hence we may infer that in 
 cases similar to those for which Dr. Gregory recommends 
 a voyage to a milder climate, much advantage may be de- 
 riyed from travelling, either hy land, or by sea, from the 
 northern and middle states to those of Carolina and Georgia. 
 
24 
 
 of cold constricts the vessels and pores of the skin, 
 while excessive moisture relaxes the muscular fibres, 
 weakens the contractile powers of the heart, and cer- 
 tainly diminishes the action of the arteries. The 
 blood, consequently, is not propelled to the external 
 parts of the body with due force. Whether this how- 
 ever be the cause of the diminution, or whether it 
 arises from other sources, it is unquestionable, that 
 the perspiration is very considerably diminished dur- 
 ing the prevalence of cold or moisture. 
 
 The most imminent danger, however, arises from 
 the sudden changes of the weather, which occur so 
 frequently, nay, we might almost say daily, in this 
 island.^ It is by the effect of these transitions, that 
 
 3 Whether this inconstant state of the air has really a 
 prejudicial influence on the corporeal strength and health, 
 seems to be doubted by highly respectable authorities. We 
 are told, by Dr. Rush, in his account of the climate of Penn- 
 sylvania, that " its variable nature does not render it neces- 
 sarily unhealthy." In substantiation of this opinion, he quotes 
 Dr. Huxham, who has, he says, " taught us that the healthi- 
 est seasons in Great Britain have often been accompanied 
 by the most variable vreather. His words,'* continues Dr. 
 Rush, " convey a reason for the fact." < When the constit«- 
 
25 
 
 the circulation of the fluids is most disturbed; for 
 when the external surface of the body becomes sud- 
 denly chilled, and the extreme vessels consequently 
 constricted, the blood flowing freely and 4irectly to 
 
 tions of the year are frequently changing, so that by the con- 
 frast a sort of equilibrium is kept up, and health with it; ^nd 
 that, especially if persons are careful to guard themselves 
 well against these sudden changes.' f Huxham'sObservations 
 on the Air and Epidemic Diseases, Vol. I. p. 5.]'* Whatever 
 be the physical operation of these vicissitudes on the body, 
 on land, it is very certain that their eifects at sea on the sys- 
 tem, are neither trifling nor salutary; for I have never failed 
 to remark, during my practice in the navy, that sailors al- 
 ways suffered more or less from the sudden transitions of 
 the weather. I must not omit to mention, however, that 
 these effects of the quick changes of the weather, were sel- 
 dom so frequent among the officers, and other persons on 
 board, however great their exposure might be, who took 
 more precautions to guard against danger than the impro- 
 vident sailor can ever be brought to do. One thing is certain, 
 that the changes of the weather in a climate where heat and 
 cold prevail alternately, to a great degree, during the differ- 
 ent seasons of the year, have no little influence on the moral 
 state of the system. " The eifects of a climate of this kind," 
 says Dr. Falconer,* « have not, as far as I know, been re- 
 
 * Remarks on the influence of Climate, &c. on the Disposition, Manners, 
 &c. &c. of Mankind, 4to, p. 24. 
 
 D 
 
' 26 
 
 the superficial parts is checked, and impelled imme- 
 diately from them, inwardly, producing a copious 
 and violent regurgitation. In like manner, when the 
 invisible (;utaneous pores are clogged up, the perspi- 
 ration is checked; and this is undoubtedly the most 
 indispensable of all the excretions. These are the 
 causes that produce internal congestion of the blood, 
 which is frequently followed by inflammations and 
 hemorrhages; they likewise engender fevers, and a 
 
 marked by any modern writers, but did not escape the ob- 
 servation of Hippocrates; though the countries he seems to 
 rank in this class are, indeed, such as undergo considerable 
 varieties in temperature at the different seasons; many parts 
 of Europe for instance; but are still what are at present es- 
 teemed to be in a moderate climate, and by no means sub- 
 ject to such vicissitudes as a great part of North America, 
 and that vast continent between Asia and Europe, called Si- 
 beria and Tartary. Hippocrates observes, (Hippocrates de 
 aeribus, aquis, et locis, § 39. 53, 54, 55.) that in such a cli- 
 mate, the shape and character of the people are much less 
 uniform, than in either a hot or cold country. This appears 
 very probable, as the climate partakes of the extremes of 
 both. He also thinks, that ' variations of climate make men 
 more active in the affairs of life, more brave and resolute in 
 their conduct, and more austere and rugged, though more 
 upright and just in their behaviour.' " 
 
27 
 
 great many other diseases. It is not surprising, there- 
 fore, that our climate should be productive of a va- 
 riety of dangerous maladies, nor that persons of the 
 strongest constitutions should be afflicted with se- 
 rious disorders. Generally, however, with the assist- 
 ance of nature, we can easily guard, in healthy and 
 vigorous temperaments, against every danger accru- 
 ing from the climate, so that no disease will ensue 
 from its effects, and even should any disorder affect 
 the system, it will be of short duration. 
 
 In many cases of dangerous disease, nature her- 
 self^ as every physician knows, spontaneously affords 
 the best remedy; and she certainly prevents by her 
 powers, the accession, — or banishes when they may 
 have arisen — innumerable disorders that could scarce- 
 ly be cured by any other means. This happens in the 
 case under our consideration at this moment, for as 
 soon as the impetus of blood to the external parts is 
 checked by the operation of cold, the action of the 
 heart and arteries is simultaneously increased, and 
 the pulse augmented in frequency and force. In con- 
 sequence of this increase in the contractions and di- 
 latations of the heart, the constriction of the extreme 
 vessels which impeded the natural motion of the 
 
2» 
 
 blood is soon overcome and entirely removed; hence 
 the customary distribution of the fluids, and the 
 wonted equilibrium of the circulation are perfectly 
 restored. But if the constitution shall have previously 
 become feeble and enervated, or predisposed to any 
 disease, it will not be able to bear the same unsea- 
 sonable transitions of climate without injury. The 
 vires medicatr ices naturae ^ which, under more pro- 
 pitious circumstances, guarded the system against 
 danger, and restored it from disease to health, are 
 inefficient here. And it is very probable, that some 
 particular part of the body which may have been pre- 
 viously weakened or disordered, and which, conse- 
 quently, has become incapable of sustaining the 
 shock, — will be rendered the subject of an incurable 
 malady. 
 
 Thus it is, that the human constitution, provided 
 indeed it be vigorous and sound, accommodates it- 
 self so surprisingly to all variations of climate, from 
 the coldest to the temperate, and the more fervid; 
 that for the most part it suffers no injury from their 
 diverse temperatures.'* Cold and moist air, such as 
 
 *• " Perhaps no climate or country is unhealthy, where 
 men acquire from experience, or tradition, the arts of ac- 
 
29 
 
 prevails in treat Britain, is the least favourable to 
 perspiration, and an equable distribution of the fluids; 
 but nature has so amply provided for that inconve- 
 nience, that the natural circulation of the fluids, in so 
 far as is essential to health, is sufiiciently promoted: 
 consequently, those who are blest with sound and 
 robust constitutions, suffer little or no detriment 
 from this cause. Yet we see, notwithstanding, many 
 instances, in which the healthiest temperament af- 
 fords no barrier to the hurtful incursions of the cli- 
 mate of this country. It is probable, that there are 
 critical and dangerous periods in some constitutions, 
 and without doubt there are idiosyncracies arising 
 from peculiarities in the manner of living, as well as 
 from the various conditions of men, and from other 
 causes not accurately investigated, which render per- 
 sons who are in other respects perfectly vigorous, 
 liable to diseases incidental to climate. It should be 
 remarked, however, that although the irregular and 
 Unseasonable variations of the weather, do certainly 
 
 commodating themseh^es to it. The history of all the nations 
 of the world, whether savage, barbarous, or civilized, pre- 
 vious to a mixture of their manners by an intercourse witK 
 strangers, seems to favour tins opinion." — Rush on the Cli- 
 mate of Pennsijlvania. 
 
30 
 
 exert most powerful effects on the consiitution, and 
 tend to produce many serious disorders; yet it hap- 
 pens, not unfrequently, that evils are imputed to the 
 influence of chmate, which in fact it has but little 
 agency in generating; and which really derive their 
 origin altogether from other sources. For in every 
 clime, however variable and insalubrious it may 
 be, we find inhabitants enjoying perfect health; and 
 no portion of the terraqueous globe gives birth to 
 any race of beings, that are liable to be annihila- 
 ted by the destructive effects of the climate they in- 
 habit. It has not ever been observed either, that other 
 animals are injured by the influence of their native 
 clime, however insalubrious and intemperate it may 
 be, and even under circumstances of the greatest pos- 
 sible exposure to the power of its severity. We surely 
 cannot doubt then, that men may be able to endure 
 the irreguiar transitions of climate without either in- 
 jury or danger, provided they live temperately. Nor 
 can we for a moment beUeve, as we should by ad- 
 mitting a contrary position to be true: that the creator 
 and preserver of the human race would subject man- 
 kind to a condition so rigorous and unjust. Besides, 
 those men who are accustomed to a rude, and labo- 
 
31 
 
 l-ious life, who are but little regardful of the u'nsea- 
 sonableness of the weather, to the vicissitudes of 
 which they are continually exposing themselves, cer- 
 tainly live in the enjoyment of health and vigour 
 like other animals; nor was it till he discovered and 
 brought to perfection, artificial means of defending 
 the body generally, from the extremities of the sea- 
 sons, that man was subdued by the severity of his 
 native cHme. Those, therefore, who are unskilled in 
 the means of avoiding or guarding against tlie extre- 
 mities of weather, seldom suffer any inconvenience 
 from it; and it is only in proportion as men become 
 afraid of exposing themselves to the intemperance of 
 the air, and sedulously endeavour to avoid it — that 
 they are rendered very susceptible of its effects. 
 There is certainly but one method, by which men 
 are enabled to defend themselves against the rigour 
 of an unhealthy climate; namely, by rendering their 
 constitutions so vigorous and robust, that they are 
 in a situation to encounter and endure, the danger 
 and inconvenience they cannot shun. It is not sur- 
 prising therefore, that those who are accustomed to 
 polished life, and to indulgence in various luxuries, 
 should be solicitous to elude the rigorous excesses 
 of the weather. For if, from the causes we have men- 
 
32 
 
 tioned, we find that men in other respects very ro- 
 bust, and in the full enjoyment of perfect health, can 
 scarcely endure this severity without annoyance; 
 how much danger is not to be dreaded for those 
 who have inherited from nature, less healthy consti- 
 tutions — who, from living intemperately, or other- 
 wise unhealthfully, have rendered their systems sub- 
 ject to various disorders — who from ill health, or from 
 whatever cause are broken down and exhausted in 
 strength — or finally, for those advanced in years, or 
 continually inclined to depression of spirits, and in 
 whom all the natural powers of the mind and the 
 body are wasting away by degrees! 
 
 It is in cases then of this nature, that we should 
 seek another climate blest with the cheering aspect 
 of a clear and serene sky, assisted in its happy effect 
 upon the feelings by the genial influence of soft 
 breathing zephyrs. Where the prevalence of pleasant 
 and more agreeable manners and livelier scenes are 
 calculated to soothe the feelings, to promote cheer- 
 fulness, and to revive the declining powers of na- 
 ture.* But let us pass on to the consideration of other 
 
 ^ Dr. Cheyne in his most excellent work, on health and 
 long life, tells us with singular brevity and quaintness, that 
 
33 
 
 arguments tending to prove the efficacy of a change 
 of climate in many diseases. 
 
 How limited is human knowledge! How rarely 
 does it scrutinize the unerring and indispensable 
 causes of things! Even on our art, the light of sci- 
 ence has, as yet, but coruscated! For as yet the na- 
 ture of many diseases, as well as their remote and 
 proximate causes, are either totally unknown to us, 
 or at least but imperfectly comprehended. When- 
 ever, therefore, we observe a disease endemial to any 
 country, which seldom occurs under another sun, 
 it is highly probable that this disorder is caused by 
 
 " if the aged would lengthen out their days, they should re- 
 move to a warmer climate, by which they may live as long 
 as a croiv!^* — London edition of 1725, page 206. 
 
 We are told too, that " the citizens of Rome who had worn 
 down jtheJr constitutions by intemperance, addedjmany years 
 to their lives, by migrating to Naples, and enjoying there, 
 in a warmer sun, the pure air of the Mediterranean. And Sir 
 William Temple says the Portuguese obtain the same be- 
 nefit by transporting themselves to the Brasils, after medi- 
 cine and diet cease to impart vigour to their constitutions in 
 their native country."— i?wsA*5 Obser, on Gout. Inquiries^ 
 Vol. II. p. 319. 
 
 E 
 
34 
 
 the influence of climate, and we may reasonably ex- 
 pect that the patient labouring under such complaint 
 will be benefited by travelling into a country ex- 
 empt from the same disorder. And from the want of 
 other and more certain sources of reasoning, I have 
 supposed that an argument in favour of my opinion, 
 might be deduced from this principle, and though 
 indeed it is an uncertain one, yet I cannot think it 
 altogether contemptible. 
 
 In many diseases indeed, the proximate causes of 
 which we are acquainted with — the curative indica- 
 tion consists in promoting the perspiration, and re- 
 storing the due circulation of the blood to the ex- 
 ternal surface of the body, so that an excessive 
 determination to the internal parts may be prevent- 
 ed; or, if it shall have already taken place, that it 
 may be immediately removed. Now I do not know 
 of any remedy by which all these objects can be 
 more speedily, more safely, or more agreeably ac- 
 complished, than by a change of climate; and this 
 change must be effected by means of a journey into 
 a country enjoying a moderate degree of warmth. A 
 new climate is preferable as a remedy, to every thing 
 else, because the patient can derive the benefit of it 
 
^5 
 
 not only for a few hours together, but for many 
 months, nay, should it be necessary — for many 
 years; and it is well known to physicians that many 
 of those diseases which are denominated chronick, 
 are so obstinate and difficult of cure, that a great 
 length of time is required to subdue and remove 
 them, even when the best and most efficacious me- 
 dicines are daily employed; nor are they unacquaint- 
 ed with the fact, that many medicines which act with 
 great power on the system, will not bear to be fre- 
 quently repeated for any length of time. The con- 
 tinual exhibition of such active medicines for a long 
 while injures the constitution, and in fact induces 
 new disorders. Some, by continued use, lose their 
 pristine virtues, and then consequently they produce 
 no beneficial effect on the system; others, though 
 safe and efficacious, become by long repetition so 
 extremely unpleasant and ungrateful to the sick, that 
 rarely is a patient \Yilling to persist in their use suf- 
 ficiently long to receive any benefit. But this remedy 
 may be continued for a considerable time, not only 
 without danger, but actually with the greatest ad- 
 vantage! It neither injures tlie constitution — nor loses 
 its virtues by repetition — nor does it become un- 
 pleasant to the sick! It is on thq^ contrary, for various 
 
36 
 
 reasons, truly grateful. Neither does it debilitate the 
 system, but, for the most part, greatly strengthens it. 
 And lastly, if a change of climate is not of itself suf- 
 ficient to remove the disorder, we should seek the 
 adventitious aid of all the other remedies which have 
 been useful at home. For all things are to be found 
 in a happier clime, and they are often rendered more 
 efficacious under the genial influence of a foreign 
 sun. 
 
 But there are some maladies, whose proximate 
 causes, if they be not altogether hidden from our 
 view, are at least veiled in uncertainty: while their 
 remote, predisposing and occasional causes are suffi- 
 ciently obvious. And it is evident to the observation 
 of medical men, that the remote predisposing and ex- 
 citing causes of many diseases, ai:ise from the influ- 
 ence of our climate. That is to say, in the colder coun- 
 tries you will find a certain tendency to inflamma- 
 tion in diseases, usually denominated phlogistic dia- 
 thesis, prevailing almost universally among the in- 
 habitants, especially during the winter and in the 
 spring. But in warmer countries, as is the case also 
 with us in the summer season, this inflammatory dis- 
 position is not so common. Hence we may reasona- 
 
37 
 
 bly expect, that this disposition, whatever it may be, 
 will either be entirely obliterated by a change of cli- 
 mate, or at least that it will be greatly mitigated. 
 
 In cold countries too, especially in those where a 
 cloudy, moist and gloomy atmosphere depresses the 
 spirits, all the faculties of the mind, as well as the 
 powers of the body, grow feeble and enervated.^ The 
 system becomes weak, languid and inactive, while the 
 spirits grow dull, dejected and apathetick, of course 
 the disposition is inclined rather to melancholy than 
 
 * This position in, I think, questionable; and that it is so 
 may be inferred from an attentive consideration of the direct 
 action of cold upon the body, and its indirect effect upon the 
 mind and disposition. The indirect action of external or ai- 
 mospherick cold on the mind and feelings, is produced 
 through the influence of its immediate effects on the corpo- 
 real system. These effects are palpable to the senses, and 
 simultaneous with the application of this powerful agent to 
 the external surface of the body. Cold evidently blunts the 
 acuteness of feeling; and this it does by so wrinkling the 
 skin, that the cutaneous pores are corrugated and contract- 
 ed in diameter. It operates also upon the cutaneous glands, 
 by closing-^or clogging up their orifices, so that the free ad- 
 mission of the irritating matter which in this or some other 
 way, causes sensation, is prevented. Hence the intensity of 
 • utaneous feeling, is considerably diminished. The external 
 
38 
 
 cheerfulness. Hence is produced, as I shall after- 
 wards have occasion to show, a tendency in the 
 
 action of cold on the skin diminishes the quantity of perspi- 
 ration. It also aflPects its tenuity, rendering it thick and more 
 viscid. These combined effects produce a powerful influence 
 on the mind, rendering it less sensible of the external im- 
 pressions on the body; and by thus blunting the power of 
 feeling, it renders the general system more insensible. The 
 physiological operation of cold on the mind, and conse- 
 quently its effects upon the temper, the disposition, and the 
 feelings, cannot appear ambiguous, when we advert to its 
 evident effects on the body as just described. That the cha- 
 racter would in some measure be affected by these causes, 
 seems natural to suppose. Accordingly it has been deci- 
 sively asserted, and I believe with no little truth, that the 
 inhabitants of cold countries are not subject to those violent 
 vicissitudes of temper and that versatility of disposition, 
 which characterize those of hot climates, where the highly 
 excited sensibility of the system, and the almost morbid ten- 
 derness of feeling, render the people susceptible of every 
 varying impression to which the constitution is physically 
 exposed. Hence the disposition of the inhabitants of cold 
 countries, is more faithful, immutable and brave, and the 
 behaviour more consistent, than that of people dwelling 
 under the enervating influence of a fervid sun, and ever 
 liable to the vascillancy of a mutable and capricious cli- 
 mate. Though these peculiarities in the constitutional tem- 
 
39 
 
 system to be affected by certain diseases. Now it 
 is universally known that the case is exceedingly dif- 
 
 per of the inhabitants of cold countries, are generally as- 
 cribed, exclusively to the positive and direct action of the 
 frigid air: yet it must not be forgotten that there ate other 
 causes indirectly generated by the coldness of the climate, 
 and some that are wholly independent of any such influ- 
 ence — ^that have no little agency in assisting and confirming 
 the eff'ects of air upon the physical and moral constitutions: 
 such for example are food, clothing and exercise; as well as 
 religion, government and laws. But even allowing for the 
 adventitious aid of all these causes, the dominion of the 
 effects of climate over the form, stature, and health of the 
 body, is active, evident, unequivocal. Some writers, however, 
 have leapt beyond the possible effect of the causes which 
 are derived from climate, in the overstrained hypotheses 
 they have promulgated, and which they have predicated on 
 the physical and moral influence of climate on the human 
 subject. In these ingenious though sometimes crude, un- 
 philosophick, and not unfrequently chimerical theories, 
 which indeed ought only to be viewed as the effusions of 
 vivid and fanciful minds, they have not hesitated to refer all 
 the variations in human constitution, form, stature and com- 
 plexion: as well as all the inflections of the variable, nay, 
 even changing human character; together with all the grades 
 in morals, from the turpitude of vice to the beauty of virtue 
 — to the effect of climate alone! While this subject is before 
 
40 
 
 fercnt in countries moderately warm, dry and clear; 
 for the inhabitants, at least generally, possess great 
 activity of body, and enjoy an equable flow of spi- 
 
 "me, I cannot refrain from quoting a passage from the inge- 
 nious and learned inaugural dissertation of my friend Dr. 
 Gibson, now Professor of Surgery in the Baltimore Col- 
 lege of Medicine. Its pertinency to the subject of the pre- 
 ceding remarks, is, I trust, a sufficient excuse for the cita- 
 tion: 
 
 " Praeter diaetam et artificium, sunt et aliae causae quae ad 
 figuram corporis humani mutandam aliquantulum conferre 
 possunt: hue spectant imitatio, varia exercitationis genera, 
 vestimenta, scientia, religio, animi pathemata, coelum, et 
 quaedam alia. Non forsan alienum erit pauca de coeli effec- 
 tibus monere, etsi meo quidem judicio, in mutationibus fi- 
 gurae animantium inducendis multo minus valet, quam non- 
 nullis persuasum est. Dicitur staturam admodum humilem 
 Indorum Eskimotarum, et quarundam aliarum gentium sep- 
 tentrionalium deberl frigori maxime intenso, cui perpetue 
 objiciuntur in iis regionibus quas ibcolunt. Tschutski tamen 
 in terrae plaga aeque frigida saltern, si non revera frigidiorc, 
 degunt, nihilominus inter homines procerissimos jure re- 
 censentur. Minutam Eskimotarum staturam e genere cibi 
 potissimum pendere colligerem, oleo enim Phocae Vitulinae, 
 et Phocaenae maxime aluntur.* Hippocrates cceli regionem 
 
 * Ellis' Voyage, &c. 
 
4t 
 
 rits. It is not difficult to believe then, that travelling 
 in such countries would greatly correct and improve 
 the gloomy disposition of which we have just spoken, 
 and perhaps banish it entirely. There is another ad- 
 vantage that we certainly derive from a change of 
 climate, and it is one of great importance, namely, 
 guarding against the occasional causes of many dis- 
 eases. It is generally known that many severe dis- 
 orders generated in this island, originate in the sud- 
 
 in figura mutanda non parum valuisse opinatur, sic enim 
 pergit, * Quicunque autcm altam habitant regioncm, planam, 
 ventis expositam et aquosam, eorum formse magnae ac invi- 
 cem similes et erectse. Qui vero macra, aquis carentia, et 
 nuda loca tenent, horum formas necisse est esse asperas et 
 vegetas.'* " Vitruvius qiioque huic sententise addictus est, 
 verba ejus citare liceat," ' Ex roscido sere sub septentrioni- 
 bus nutriuntur gentes immanibus corporibus, candidis colo- 
 ribus, directo capillo et rufo, oculis caesiis, sanguine 
 multo, quoniam ab humoris plenitate, coeli refrigerationibus 
 sunt conformati. Qui autem sunt proximi ad axem meri- 
 dianum, subjectique solis cursui, brevioribus corporibus, 
 colore fusco, crispo capillo, oculis nigris, cruribus invali- 
 dis, sanguine exiguo, solis impetu perficiuntur/f — Bisser- 
 tatio Physica de Forma Ossium Gentilitia^ auctore Gulielmo 
 Gibson, p. 92. 
 
 * De iEre, Aqua, et Locis. f Vitruvius de Architectura, torn. yi. 
 
42 . . 
 
 den changes of the weather; and the danger arising 
 from this source is scarcely evitable any other way 
 than by travelling into temperate countries, where 
 the weather, even of the winter season, is not at all 
 liable to such sudden transitions. It follows therefore, 
 that all the remote causes of such diseases as arise 
 from the effects of our climate, may be avoided or 
 abated in their pernicious effects by a change of air; 
 and we all know of how much importance it is in the 
 cure, we might almost say, of every malady, that 
 these causes should be quickly removed/ A disorder 
 
 "f A striking instance of the efficacy of removing patients 
 from the place where the disease is produced, is related by 
 Mr. Volney. It goes far to prove, tlmt sometimes a very 
 circumscribed space is within sphere of the action of the 
 remote causes of a disease, and consequently that a removal 
 of the patient to a little distance only, from this local influ- 
 ence, may oftentimes have a very beneficial effect. I will 
 cite the passage in his own words: " In Corsica, fevers of 
 the same kind regularly annoy several military posts in the 
 island every year, and among others the little harbour of 
 San Fiorenzo, bordering on a pestilential marsh of forty-five 
 acres. Toward the end of summer, and in the first six weeks 
 of autumn, they assume a putrid and malignant character, 
 in consequence of the intensity of the heat and the exhala- 
 tion; and it is necessary to relieve the French garrisons 
 
43 
 
 frequently meets with a speedy cure after the removal 
 of its remote causes, without the administration of 
 
 every fifteen or twenty days, either wholly or in part, other- 
 wise the soldiers would sink under their serious and ulti- 
 mately mortal effects. Our physicians, after trying many re- 
 medies, remarked, that two posts alone in the whole island 
 were absolutely exempt, and that no fever ever approached 
 forts Vivario and Vitzavona on Bogognano. Chance, as fre- 
 quently happens, rendered the salubrious and even curative 
 quality of these two situations more striking. A Swiss officer 
 from the Orisons fell dangerously ill of the fever at San 
 Fiorenzo, and having requested to be removed to fort Vi- 
 vario, the garrison of which belonged to his own regiment, 
 he was restored to life and health in less than a fortnight. 
 The physician having repeated the experiment on some 
 French soldiers in the hospital, it succeeded so well, that it 
 has become the established practice, to send thither all the 
 desperate cases of fever, which appear to be past the power 
 of medicine; and if is observed, that the fever has never held 
 out there beyond the eleventh day."— Fo/net/ on the Climate 
 and Soil of the U. States, p. 289. 
 
 In addition to the above fact, 1 can state from my own 
 knowledge, two circumstances no less illustrative of the po- 
 sition advanced by Dr. Gregory in the text. They occurred 
 on board of the late United States Frigate Essex, while I 
 was surgeon of that vessel. We were anchored in Plymouth 
 
44 
 
 any medicines whatever; for the powers of nature are 
 alone sufficient to cure diseases, when every obstacle 
 
 sound (England) from the 11th of January, 1811, till the 
 14th of February following, and although we arrived there 
 after a cold and stormy passage of fourteen days from Port 
 Louis roads, in France, we had but fourteen cases on the 
 sick list.* Plymouth sound is exposed to the piercing cold 
 and moist winds from the British channel, as well as the 
 frigid blasts from the bleak shores of Cornwall and Devon- 
 shire; the number of sick of consequence soon increased, 
 and in fact in a few days the sick list, which was daily aug- 
 mented, was crowded with many cases of pleurisy, violent 
 inflammatory catarrhs, and numbers of bad colds, all of 
 which I found it difficult to subdue. On the fifteenth of Feb- 
 ruary, the ship was got under weigh and moored in Barn- 
 pool, immediately under the elevated shores of Mount Edg- 
 cumbe, which effectually sheltered the decks from the chan- 
 nel winds, while the neighbouring mountains on the other 
 side, screened them from the penetrating shore-blasts. A 
 day or two after this, all the patients began to mend, and in 
 a few more they were quite recovered. The other fact is not 
 less interesting, and is as follows: We arrived in Cowes 
 Roads, Isle of Wight, on the 12th of April, 181 1, from Cher- 
 
 * Four of this number were consumptive patients received from a French 
 hospital, of whose cases I shall afterwards have occasion to say something, 
 two of Catarrh, one of Scrophula, one of Hydrops Articuli, two of Syphilis^ 
 three of Chronick Rheumatism, and one of Contusion. 
 
45 
 
 to the recovery of the patient is taken away. Some- 
 times however, the injury which the system. has rc- 
 
 bourg, in France, having only anchored after our passage 
 from that place one night at St. Helens. At this time we had 
 but eleven on the sick list, although a day or two after I 
 learned that the British fleet at Spithead, no great distance 
 from us, had been visited by an epidemick catarrh, or in- 
 fluenza, which was rapidly extending itself.* The air was 
 
 * The following was the state of the sick list after the day of oiu- arrival at 
 
 Cowesj: — 
 
 
 
 On the 13th of April there were sick, 
 
 14 
 
 14th, also. 
 
 - 
 
 14 
 
 15th, 
 
 - 
 
 IS 
 
 16th, 
 
 - 
 
 14 
 
 17th, 
 
 - 
 
 14 
 
 18th, - 
 
 - 
 
 16 
 
 19th, 
 
 - 
 
 15 
 
 20th, - 
 
 - 
 
 13 
 
 21st, 
 
 
 IS 
 
 22d, 
 
 . 
 
 13 
 
 23d, 
 
 . 
 
 14 
 
 24th, - - - 
 
 - 
 
 14 
 
 26th, 
 
 . 
 
 10 
 
 27th, - 
 
 . 
 
 9 
 
 28th, 
 
 . 
 
 9 
 
 29th, - - _ - 
 
 - 
 
 10 
 
 SOth, 
 
 - 
 
 10 
 
 1st of May, 
 
 - 
 
 11 
 
 2d, 3d, 4th, 5th, & 6th, 
 
 same, 
 
 11 
 
 7th, 
 
 - 
 
 70 
 
 8tli, - 
 
 . 
 
 78 
 
 9th, some chronick cases dis- 
 
 
 charged, [- 
 
 - 
 
 Vo 
 
 10th, .... 
 
 . 
 
 .77 
 
 nth. 
 
 . 
 
 99— sailed fromCowes Roads. 
 
46 
 
 ceived from these causes is so extensive, that even 
 m the event of the patient being removed beyond 
 
 moist, cold and hazy, and the wind very variable. In a few 
 days this influenza appeared on board of the Essex, and the 
 sick list increased till the eleventh of May when it was at its 
 maximum, there being on it 99 cases of violent inflamma- 
 tory catarrh. This complaint had been daily extending itself 
 throughout the ship, and had we not left that anchorage I 
 have no doubt but that in a few days, every creature on 
 board would have been afl*ected with it. On the eleventh 
 however we sailed from Cowes and anchored in the afternoon 
 of that day in Yarmouth roads, Isle of Wight. I found all 
 the patients better on the next morning, and discharged 
 forty-four. We left Yarmouth that morning, aiTd saited out of 
 the English Channel at mid-day on the thirteenth. From this 
 time the list rapidly decreased, so that on the seventeenth 
 following there were but fourteen sick. I must not omit to 
 mention that the same plan of treatment was pursued 
 throughout, so that the change of place, assisted perhaps 
 by the motion of the vessel, and the sea-sickness, effected the 
 
 12th of May, 44 discharged, 55 — Yarmouth Roads. 
 
 13th, 6 more discharged, 49 remaining. 
 
 14th, 7 discharged, 42 remaining, 
 
 15th, 3 discharged, 39 remaining. 
 
 16th, 6 discharged, 33 remaining. 
 
 17th, 19 discharged, and 14 remaining. 
 
 The sick Hst remained pretty nearly in this state, and on the first of June 
 there remained on it hut twelve, and most of those were chronick cases, and 
 contusions from accidents. 
 
47 
 
 the sphere of their influence, it requires the judicious 
 use of proper medicines for a long course of time, 
 before the constitution can be restored to its former 
 healthiness. Yet even in these instances, the same 
 caution is necessary to be observed in the curative 
 intention, namely, the removal of the remote causes; 
 for the cure of no disease can ever be reasonably 
 expected, while its causes continue to operate — since 
 they daily renew and augment the mischief they first 
 produced. 
 
 Lastly, there are remedies which are nearly allied 
 in their action upon the system, to the effects of a 
 warm climate. For instance: the warm bath, mild di- 
 aphoretics, especially diluents, warmer and more 
 abundant clothing than common, particularly flannel 
 jackets worn next to the skin, frictions, frequent and 
 moderate exercise — all excite perspiration, and pro- 
 mote an equable circulation of the fluids. Remedies 
 of this kind, as well as moderate heat, such as pre- 
 vails in this island during the summer season, are of 
 great use in various disorders. And since a moderately 
 warm climate is observed to produce similar effects, 
 is it not very reasonable to advise a journey into coun- 
 tries enjoying such a climate? Thus thtn from ana- 
 
48 
 
 logy of the effects produced by the remedies we have 
 mentioned, it may easily be inferred, that a change 
 of climate promises, in many disorders, great advan- 
 tages. 
 
 Finally, from attentive consideration of those cir- 
 cumstances which have an injurious effect upon any 
 particular disorder, we may plainly deduce the infer- 
 ence: that a change of climate will prove a useful re- 
 medy. For example: cold air inspired into the lungs 
 excites coughing by producing an oppression of the 
 chest; now this very agent increases the disease. Gouty 
 persons also suffer not a little inconvenience from the 
 same cause (to wit, cold air.) Yet persons so affected 
 have it not in their power to avoid such an inconve- 
 nience without going abroad into other countries, 
 since their continuance in this island subjects them 
 to perpetual exposure to its noxious atmosphere. Ex- 
 perience proves therefore, that in these and similar 
 cases there is something in our climate prejudicial to 
 the sick, and though it may not absolutely be the 
 cause of the malady, yet we may reasonably con- 
 clude that a change of air would be of advantage: 
 since great inconvenience and hazard, scarcely evita- 
 ble in any other manner, will be easily warded off. 
 
49 
 
 For these reasons particularly, if I am not mista- 
 ken, a change of air by means of a journey into coun- 
 tries that have the advantage of a moderately warm, 
 dry, mild, and uniform climate, will be of infinite 
 service in m^ny diseases incidental to this island. It 
 must be observed however, that whatever benefit the 
 sick derive from such a journey, must not be at- 
 tributed altogether to a change of air and climate, 
 since they receive at the same time the advantage of 
 gentle and long continued exercise, which itself acts 
 as a remedy scarcely less efficacious, in many com- 
 plaints at least, than a change of sun. When the situ- 
 ation of our patients is such as to require a milder 
 climate, they are often obliged to perform a long 
 journey of many weeks; and all physicians know that 
 such journies produce powerful and often salutary 
 effects on the human system. In a dissertation on the 
 effects of a change of climate, the virtues of exer- 
 cise are not indeed particularly to come under con- 
 sideration; yet I do not think it foreign to the pur- 
 pose to say a few words on this subject. In fact it 
 cannot be deemed irrelevant to our reasoning; for 
 the effect of exercise should always be taken into 
 consideration when we recommend a change of cli- 
 mate. The effects of both indeed are synchronous, 
 
 G 
 
50 
 
 and they produce nearly the same consequences, at 
 least in the generality of cases, on the constitution. 
 Besides, both reason and experience satisfactorily 
 prove, that moderate and continual exercise, such as 
 arises from a long journeys—promotes perspiration 
 and a determination of the fluids to the surface; and 
 there is no doubt but that many sick persons derive 
 great relief from the effect of this exercise alone. 
 Further than this, I am much mistaken if the cures 
 of many diseases which are commonly imputed to 
 a change of air,^ are not to be attributed to the in- 
 fluence of this exercise. 
 
 » The common practice in this and other countries of ad- 
 vising valetudinarians to repair to vs^atering places for the 
 benefit of the chalybeate waters, is proved by experience to 
 be a judicious one. Yet so great is the advantage frequently 
 resulting from these visits, that it would be unreasonable to 
 impute it solely to the effect of drinking the waters. To the 
 journey itself undoubtedly, and the exercise and change of 
 scene and air resulting from it, as well as to the invigorat- 
 ing influence of pleasant company and the hilarity derived 
 from new and sometimes facetious companions, is to be re- 
 ferred, all the good effects of these trials. Dr. Rush remarks 
 in his essay on pulmonary consumption, that " the sulphu- 
 rous and saline air of Libya between Mount Vesuvius, and 
 ihe Mediterranean Sea, and the effluvia of the pine forests 
 
51 
 
 When it is judged expedient to make trial of a 
 change of cHmate with a view to its effects as a reme- 
 dy, a question arises whether the patient should travel 
 by sea or by land? It clearly appears from the observa- 
 tions of many physicians of ancient times as well as of 
 modern days, that a voyage alone, avails in no incon- 
 siderable degree, in many complaints. The celebrat- 
 ed Gilchrist published a beautiful dissertation a few 
 years since, on the medical use of sea voyages, in 
 which he plainly proves the remediate effects of sail- 
 ing, and indeed it appears from his work, that in 
 many diseases it acts as a most efficacious remedy. 
 He relates the histories of many invalids who evident- 
 ly were snatched from the very jaws of the grave, as 
 it were, by the salutary operation of this remedy. 
 Many things which occur during a voyage combine 
 without doubt, in producing such an effect; and I am 
 
 of Libya, were supposed in ancient times to be powerful 
 remedies in consumptive complaints; but it is probable 
 the exercise used in travelling to those countries, contribu- 
 ted chiefly to the cures which were ascribed to foreign mat- 
 ters acting upon the lungs." — Medical Inquiries, Vol. II. 
 Page 145. 
 
52 
 
 not disposed to denys that the moisture and equal 
 temperature of sea air, the saline vapours, and other 
 
 9 The temperature of sea-air is unquestionably more uni- 
 form, and warmer than the atmosphere of land. It has 
 also been proved to be purer. Dr. Ingenhousz in a short 
 voyage, instituted a series of experiments with a view to 
 ascertain this fact. These are related in the 70th vol. of the 
 Philosophical Transactions. He is of opinion, that the air 
 of the sea, is, caeteris paribus, purer than that of land. His 
 observations however were not made in different latitudes. 
 In an ingenious paper by Dr. Adam Seybert containing ob- 
 servations on land and sea air, published in the Transactions 
 of the American Philosophical Society (Vol. 4. p. 262, No. 
 32) we have the results of some experiments performed by 
 the doctor in different latitudes, and during different hours 
 of the day. I will give these results in the words of the au- 
 thor: 
 
 " My experiments at sea sufficiently prove that the at- 
 mosphere is considerably purer there than it is on land. 
 Though there are some trifling differences in the results of 
 sevei'al experiments, I have no reason to believe that they 
 were owing to the different situation in point of latitude or 
 longitude in which they were performed. I can form no sys- 
 tem respecting such variations. Winds, temperature, rain^ 
 &;c. do not seem to have produced them. As they did not ob- 
 serve any regularity in their occurrence, they may perhaps 
 
53 
 
 advantages, may have a good effect. But it is my opi- 
 nion that whatever benefit is derived from sailing is 
 to be imputed especially to exercise itself. Gilchrist 
 has happily shown that sailing produces a sufficient 
 degree of exercise for health, especially if the vessel 
 be small and the sea rough. He shows also that this 
 
 be attributed to certain unperceived errors which are una- 
 voidably attendant on such trials. 
 
 " That the air at sea should appear nearly of the same pu- 
 rity in different latitudes does by no means astonish me; for 
 if land air has certain matters mixed with it they are fierhafis 
 absorbed; and if my supposition be true, that the influence 
 of the sun's rays on the water tends to increase its purity, 
 the opinion I entertain is not surprising. For when once 
 purified, there are perhaps none, or few causes to render the 
 air noxious aftdr it is wafted from our towns and cities over 
 a large body of water. 
 
 " It occurred to me that probably the purity of the air at 
 sea varied at different periods of the day; to satisfy myself 
 on this point I made several trials on the 10th and 17th of 
 June last. On the 10th I performed them at 9 o.clock A. M. 
 at 12, and at 6 o'clock P. M. On the 17th at 9 A. M. and at 
 12 o'clock. The result of all the experiments of the same 
 day was exactly similar, at least not perceptibly different." 
 
54 
 
 exercise possesses certain advantages peci\liar to it- 
 self, and in particular cases, far excels all other kinds. ^'^ 
 
 w I am sure it will not be uninteresting to give at length, 
 the observations of Dr. Gilchrist on the peculiar kind of ex- 
 ercise produced by sailing. They are so pertinent and true, 
 that I need offer no apology for the quotation. 
 
 " Sailing seems to correspond with most other exercises 
 in their manner of acting, or their effects, and indeed to 
 .comprehend them all. When it is not vehement it resembles 
 walking, in the gentle continued action of the muscles with 
 which that exercise is accompanied, when used in a mode- 
 rate degree. The benefit derived from riding depends upon 
 the continued succussion which the body suffers, and on be- 
 ing carried with considerable quickness through the air. 
 Now, in sailing, there is a greater succussion from the vo- 
 miting; and in a ship driven by winds, a person is carried 
 through the air with greater quickness tham in any other 
 ordinary exercise. Again, at sea a various action of tiie mus- 
 cles is produced by the motion of the ship, and the constant 
 efforts that must be used to prevent falling; by which the 
 body is put into all that variety of constrained, ever-chang'- 
 ing attitudes observed in bowling, skating, rowing, and the 
 like exercises, and in common labour. Exercise in a swing, 
 or a coach, which sometimes causes vomiting, comes nearest 
 to sailing, as does likewise our first exercise, the cradle. 
 
 " Sailing 
 
55 
 
 Another remedy indeed besides exercise is obtained 
 by sailing, namely, that denominated sea- sickness", 
 
 " Sailing then is an exeixise compounded of gestation, and 
 that of a particular kind; a preternatural spasmodic motion 
 in vomiting; and a singular action of the air: nor can any- 
 other exercise lay claim to so many and such peculiar ad- 
 vantages. 
 
 « It is constant: for as the ship is in perpetual motion, day 
 and night, sleeping and waking, one or other of these causes 
 always takes place, contrary to all other exercises, in which 
 the sick are usually employed but a short while together, 
 and the intervals between the times of exercise are long. 
 
 « Though sailing, considered in all its complex circum- 
 stances, and powerful effects, is reckoned among the highest 
 exercises, so as in some to cause great perturbation, it is 
 really, after being a little used to it, the most gentle, and 
 excites no irregular motion, or undue impetus of the fluids, 
 with subsequent waste of them. Therefore it is not attended 
 with lassitude, or lowness of spirits, with hurry and confu- 
 sion, as other exercises often are. A man may sit or stand, 
 walk, lean, or lie, as he likes best, and so relieve his body 
 by a frequent change of posture, and prevent weariness. 
 Other exercises of efficacy cannot be undertaken by those 
 
 [For Note 11, see next Page,] 
 
56 
 
 which frequently excites nausea and vomiting. This 
 produces powerful, and in some diseases most benc- 
 
 \ 
 who are weak and wasted, under fever and inflammation, or 
 in a colliquative state, and many other such cases; and lower 
 exercises are insufficient for any great purpose of cure. But 
 sailing is of mighty energy, yet safe; and, excepting the sea- 
 sickness at first, is easily sustained. Scarce any circumstance 
 of a disease in which it is proper, can forbid its use, while 
 the frame of the body or mind is not too much broken, nor 
 any part corrupted: nay, even in this last case it is often 
 highly proper. 
 
 " To all these, as farther advantages, we may add, that at 
 sea, you constantly breathe a peculiarly salutary air; and 
 that the action of the air is greater, and increased by your 
 being often carried through it with uncommon velocity. 
 There is likewise a greater action of the muscles, of all 
 the muscles of the body, of muscles not exercised in any 
 other ordinary exercise, or not exercised in the same man- 
 ner, nor so forcibly, nor with such effects and continu- 
 ance. Nor is there occasion, in undertaking a voyage, for so 
 many precautions as are necessary to be observed in other 
 exercises."— -Gi/cAns? on the Use of Sea Voyages in Medi- 
 cine^ p. 17. 
 
 1* The prominent features of the nausea maritima are 
 Striking and deserving of much consideration. When a per- 
 
57 
 
 ficial effects. It was known a long time ago to physir 
 cians, that nausea and vomiting were eminently us^- 
 
 son goes to sea for the first time, he is commonly affected 
 immediately upon his coming into blue water, as sailors term 
 it, with slight giddiness of the head and a sense of tightness 
 across the forehead; considerable and distressing nausea; a 
 sense of motion in the stomach, and soon after violent, 
 copious and convulsive vomiting. These effects generally 
 continue for a few days, during which time they are most 
 aggravated by an upright position of the body below decks, 
 and less severe while inhaling the free air on deck, and 
 in an horizontal position of the body when below. The nau- 
 sea is always painfully increased by the odour of cooked 
 meats, and especially by the disagreeable and peculiar smell 
 of the bilge water pumped up at a regular hour, every evening. 
 The odour from this putrid water is so nauseous and subtle, 
 that it insinuates itself into all parts of the vessel, and while 
 its power on the surrounding air is at its height it equally 
 affects with disagreeable feelings, the veteran seaman and 
 the tyro in sailing, producing on the latter however, infalli- 
 bly, the most violent and convulsive puking. The motion of 
 a vessel through the water is vehement, rapid, sometimes 
 irregular, and in turbulent weather much interrupted by 
 sudden lurches. That a violent commotion is communicated 
 to the system by these combined motions, must seem evident 
 to every one, but the peculiar effects and operation of it upon 
 the mind ajid body of the person who may be the subject of 
 
 H 
 
58 
 
 ful in exciting perspiration, and in promoting and 
 restoring the due circulation of the fluids to the ex- 
 it, can only be thoroughly known by those who have expe- 
 rienced it in their own persons. It must seem clear however, 
 to every reflecting mind, that as this motion of the vessel is 
 constant, though in a greater or less degree, a person at 
 sea must be sensible of some permanent effect on the 
 system, liable to augmentation and diminution in propor- 
 tion as the weather is calm or turbulent. This accordingly 
 is the case, and there are few persons who are not affected 
 by costiveness, not only immediately after going to sea, but 
 in some degree subject to it all the time they continue there. 
 This effect I believe to be in no way dependant on, or in con- 
 sequence of the peculiar aliment that is generally eaten at 
 sea, but owing solely to the continual impulse communicated 
 to the stomach and intestines by the rolling, tossing about and 
 pitching of the vessel. I infer this from the fact that this cos- 
 tiveness exists in a greater degree, in persons sailing in small 
 vessels, of which the motion is short, quick, and pitching, 
 than in larger vessels, as in frigates, where it is long and less 
 often repeated in a given time Now though the more vio- 
 lent affection of the stomach for the most part goes off after 
 four or five days, or at farthest in a week or ten days, there 
 is nevertheless a certain kind of affection of that organ, and 
 which indeed is in a degree communicated to the system 
 generally, that comes on during every heavy blow: namely a 
 sensation when the ship lurches or pitches forwards as if one 
 
59 
 
 ternal parts. They act powerfully also in promoting 
 expectoration, when the lungs are oppressed with 
 
 was falling, and upon the rising of the vessel upon the waves 
 again, as if one was raised with it. This sensation, which is 
 felt in the greatest degree when there is a cross or head 
 sea, or when the ship, going before the wind, lurches from 
 side to side, communicates to the abdominal muscles a con- 
 vulsive and sudden action, so that the whole contents of the 
 abdomen are compressed and expanded alternately with the 
 rising and falling of the ship. This compression consequently 
 operates on the diaphragm, forcing that muscle upwards in 
 the same violent and convulsive manner, so that the visdera 
 of the thorax are also sensibly compressed and expanded 
 with the lurching and righting of the vessel. These ef- 
 fects as I have before remarked are produced with every 
 new turbulence of the sea, and as they are totally indepen- 
 dent of the nausea and sickness before mentioned, may be 
 considered as the more permanent effects of sailing. One 
 other effect of the vessel's motion, is the constant and novel 
 action of the muscles of the body, principally those of the 
 lower extremities, to preserve an equipoise and to prevent 
 falling. The centre of gravity constantly altering as res- 
 pects locality, a continual and corresponding action of the 
 muscles to preserve an equilibrium, is of course necessary; 
 and this continual action of the muscles, novel, sudden and 
 cnergetick, is the most permanent of the effects of sail-* 
 ing. It is the exercise arising from this action of the mus- 
 
phlegm* A vomiting of this kind however cannot be 
 long employed unless produced by sailing; in this 
 
 cles, that brings such invigoration to the debilitated patient; 
 fifid this action never ceases to be necessary during the 
 slightest motion of the sea, except in a horizontal position of 
 the body, and even then, in blowing weather one is frequently 
 awakened from sleep by an involuntary exertion to avoid 
 being thrown from the berth. I have uniformly observed that 
 those persons who were slightly affected, or affected not at 
 all, with vomiting, or nausea, suffered excessively from an 
 affection of the mind and frequently from acute pain in the 
 head, which was always considerably aggravated by the vio- 
 lent pitching of the ship* Such are the effects of sailing upon 
 the system as I have observed them, both in small vessels 
 as packets, sloops of war, and in larger ones as frigates. I 
 have never witnessed but three very distressing cases of 
 sea-sickness, one a landman on board of the frigate United- 
 States, in whom great emaciation, loss of appetite, and a ha- 
 bitual convulsive retching: which continued after the ship 
 came to anchor: and the other two, which were on board of 
 the Essex, are particularly mentioned in my " Treatise on 
 Marine Hospitals, &c." p. 153. 
 
 The exercise of sailing is not only performed in a fine 
 healthy and pure air, but it is constant in itself. The veteran 
 seaman has the same continual action of nearly all the mus- 
 cles of the body, perpetually exerting its salutary effects on 
 the system, as the young sailor is subject to. But the mind 
 
manner it is not uncommonly excited for many days 
 in succession, or during entire weeks; and experience 
 
 loses in the first instance, by the influence of habit, its con- 
 sciousness of this continued exertion of the muscles. In the 
 latter case the exercise and consequences of sailing, are so 
 novel and positive, that the mind dwells on them with more 
 attention, until time and habit produce also on the new sailor, 
 the same unconsciousness of the perpetual exertions of the 
 body to preserve its proper position and to prevent falling 
 prostrate with every pitch of the vessel. The same uncon- 
 sciousness of the operations of the mind and the synchronous 
 action of the muscles of the body, takes place in many of 
 our common actions, which from long practice are so adroitly 
 performed that we frequently are inclined to believe them, 
 and they ordinarily appear to others to be involuntary; 
 Thus for example the successive rapid and almost imper- 
 ceptible movements of the fingers, and the synchronous 
 actions of the muscles of the tongue, mouth and lips, in 
 playing on the German flute, seem after long practice, 
 to be independent of any act of the mind, since we are 
 inclined to think it cannot produce such vehement and 
 rapid operations. Yet here, each movement of the fingers 
 and every action of the muscles before mentioned, are the 
 effect of a distinct and vivid act of volition. 
 
 This continual exercise of the muscles then when a ship 
 is under sail, and which I have, before remarked is in some 
 
62 
 
 proves that no danger or injury arises from it. Yet 
 can I hardly believe, that a similar sickness produced 
 by the operation of artificial emcticks, could be ex- 
 cited for any time, without danger. At least few phy- 
 sicians woiild recommend the experiment, nor would 
 any patients follow such advice, but on the contrary 
 would shrink with fear from so disagreeable a reme- 
 dy. After the sickness has gone off, persons at sea 
 enjoy excellent health, and have a keen appetite, not- 
 withstanding they are almost without any other ex- 
 ercise than what is derived from the motion of the 
 ship itself. This motion as Gilchrist has properly re- 
 marked, although a kind of gestation, performs the 
 
 measure performed even during sleep, is one of the most 
 salutary effects of sailing. By means then of this gentle and 
 regular exercise, the circulation of the blood is vigorously 
 promoted through every part of the body, producing so 
 healthy an action in the minute vessels of the surface, that a 
 uniform and copious perspiration is effected. This is carried 
 off as fast as it is exhaled from the surface of the body, by 
 the change of atmosphere and the perpetual succession of 
 its stimulating effects on the skin. Hence it is that ther.e is 
 always so intense and impatient an appetite felt at sea; for 
 the food taken into the system after undergoing the cus- 
 tomary alterations, speedily passes off, that is, the liquid 
 portion of it, by perspiration. 
 
63 
 
 office of exercise, and promotes the healthy circula- 
 tion of the fluids. Besides this, another and natural 
 exercise is accomplished by sailing. For according 
 as the ship rises on the waves and is tossed about, a 
 synchronous motion of the body is required, so that 
 its position and equipoise may be subservient to the 
 vascillation of the vessel; otherwise no person would 
 be able to move, or scarcely to- stand or sit. In order 
 to perform this motion, a moderate, frequent, and 
 scarcely sensible exercise of almost all the muscles 
 of the body is required; and this exercise is perform- 
 ed without any intermission; so that, whenever any 
 one takes a voyage he has the benefit of exercise, or 
 at least of gestation, all the time he lies down in bed, 
 or sleeps. Whatever good therefore is derived from 
 regular moderate and continual exercise, in any dis- 
 ease, is reasonably to be expected from sailing in 
 preference to all other exercises. I am by no means 
 ignorant that this remedy has been ineffectually tried 
 in many cases; but I know that the most advantage- 
 ous effects have been reaped from it, in others. And 
 if any one will reflect upon the nature of those cases 
 in which it has generally been employed, he will not 
 be at all surprised that it has not always succeeded 
 as might have been wished. For a trial of it is 
 
64 
 
 rarely ever resorted to except in very dangerous, and 
 not uncommonly altogether incurable diseases, as 
 pulmonary consumption for example: indeed it often 
 happens that the patients do not undertake the voy- 
 age, until they are in the last stage of the disease, 
 and all medical men know that when this complaint 
 has continued for any length of time, the lungs arc 
 so affected as to be almost incurable. ^^ 
 
 " It appears that Dr. Gregory attributes to the effects of 
 exercise alone, all the good derived from sea-voyages, while 
 Dr. Thomas Reid on the contrary attributes their beneficial 
 effects in pulmonary consumption, solely to the action cre- 
 ated in the stomach, by the rolling and tossing of the vessel. 
 Indeed ih this opinion he is confirmed by the histories 
 related by Gilchrist, who has proved that many persons la- 
 bouring under a pulmonary affection were cured by short 
 voyages, some of a few hours only, where of course the ex- 
 ercise, however advantageous it may in general be, was not 
 sufficiently long continued to have had any share in these 
 surprising cures. In this place it may not be amiss to men- 
 tion that a French writer speaking of the effects of sea-voy- 
 ages and the vomitings they produce, in pulmonary con- 
 sumption, advances a theory relative to the cause of these 
 vomitings, different from the generally received opinion. 
 His words are as follow: " Je crois que le mal de mer, qui 
 consist^e dans des vomissemens qui se continuent pendant 
 
65 
 
 We all know that other kinds of exercise, as for 
 instance, riding on horse-back, or gestation in a car- 
 riage, upon which many medical writers, and parti- 
 cularly Sydenham, bestow such commendations, al- 
 though they have sometimes been very successful, 
 are, nevertheless, often tried in vain. Sailing however 
 possesses a great advantage over all other exercises: 
 that is, that it can frequently be used when every 
 other kind is prohibited on account of the debility 
 of the patient. For this is so gentle and mild, that for 
 the most part the invalid himself is scarcely sensible 
 of it; and the sick can bear it without danger, how- 
 ever feeble they may be. Indeed there are some in- 
 stances of valetudinarians, already broken down by 
 disease, and so weak, that they were not able to 
 move themselves, who, after being carried on board 
 ship, and having performed a voyage, have recovered 
 
 plusieurs jours, et qui meme, chez quelques individus, sc 
 font sentir pendant tout le trajet, depend autant de cette 
 exaltation des forces internes qui s'irritent de la presence 
 des fluides qui devaient appartenir d la transpiration cuta- 
 nee, que de la march.e vacillante et du roulis du vaisseau.*' 
 Traits sur la Xature et le Traitment de la Phthisic Piilmo- 
 naire, par Julien Bonnafox-Demalet^ M. D. p. 169. 
 
66 
 
 both their health and strength." In those cases there- 
 fore, where the patients can neither bear riding on 
 horseback nor gestation in a carriage, and when conse- 
 quently they are incapable of performing joiirnies by 
 land, a voyage certainly ought to be tried. But when 
 the sick are able to travel by land to countries suita- 
 ble to their condition, it is a matter of doubt whether 
 a voyage should be preferred for this purpose. If it 
 should be long, many inconveniences will arise from 
 it, particularly on account of the food, for some in- 
 valids require a diet consisting of milk" and fruit, 
 
 13 For a history of many interesting cases of this nature I 
 beg leave to refer the reader who may desire further infor- 
 mation on this subject, to the inestimable work of Gilchrist. 
 
 1* With regard to the necessity of milk as an essential 
 constituent of the diet of any invalids whom it may be deem- 
 ed proper to send to sea for their health, it may not be amiss 
 to remark that as this article was chiefly prescribed in pul- 
 monary consumption by physicians some time back, and as 
 it is now esteemed rather a pernicious than an useful diet in 
 this disease, no solid objection can arise from the want of it 
 on ship-board, to the expediency of taking a voyage. Whe- 
 ther the milk of the ass possesses any real virtues not com- 
 mon to the milk of the cow and other animals, seems, in the 
 opinion of physicians of this day, notwithstanding the ex- 
 
67 
 
 which can scarcely be had during the whole of a 
 long voyage; besides which the privations arising 
 from it affect with dread and disgust, the feelings of 
 men accustomed to the refinements and luxuries of 
 polished life.** I would hardly venture to assert 
 
 travagant commendations of it by the practitioners who 
 preceded them by a few years, to be very problematical. 
 But it appears to be agreed on all sides, that any kind of 
 milk, taken by a consumptive patient in sufficient quantity 
 to produce any positive effect, will for the most part do 
 harm. Professor Barton in his lectures on the Practice of 
 Physick, speaks of this article in strong terms of disappro- 
 bation, so far as regards its employment as a diet in phthisis; 
 and says he has known many instances of its producing a 
 distressing fulness and oppression of the chest. 
 
 " I confess this objection to sea voyages arising from the 
 privations that must be endured, strike my mind with 
 peculiar force. Objections predicated upon such grounds 
 are formidable indeed. No human being can be susceptible 
 of stronger emotions of disgust and wearisomeness of life, 
 than I have felt at sea, from the necessity of encountering 
 the privations of retirement, of peace, of social felicity, for 
 months at a time together. Such was the gloom and des- 
 pondency with which I was constantly affected during the 
 prevalence of bad weather, that I was always firmly con- 
 vinced if ever I should have fallen ill at sea, that the debili- 
 
68 
 
 that the other advantages derived from sailing can 
 compensate for this inconvenience; nor will I deny 
 
 tating effect of a dejected mind, would inevitably have pre- 
 vented my recovery. Knowing then that such feelings have 
 existed in others, and having experienced them in myself, 
 I think we should do well to deliberate seriously and long, 
 on the temper and disposition of our patients, before we 
 venture to prescribe a sea voyage for their relief. There 
 are unaccountable repugnancies to the turbulent vexations 
 of a sea life, as well as lively disgusts at the inevitable 
 want of cleanliness that depends on it, which many men feel 
 acutely. Would it not be a precarious practice to send such 
 to sea? And if the stronger sex be frequently the victims of 
 such deep-rooted and unconquerablea versions, how much 
 more frequently must we not expect to find the fragile and 
 delicate female, accustomed in her indisposition to the so- 
 lacing comforts derived from the society of her friends, 
 perhaps her children: as well as to the kind solicitude of 
 an attentive nurse — loathing with painful disgust the very 
 idea of existence, while the distressing sea-sickness de- 
 prives her of energy, of spirits, and of the attention of 
 her attendants whom a similar sickness perhaps renders 
 nearly as much in want of assistance as herself? Nor can 
 I subscribe to the beneficial eifect attributed by some to 
 the transitions of the feelings from hope to fear and vice 
 versa, so justly said to be common at sea. Dr. Gilchrist in 
 his work on sea-voyages, (p. 67.) says, " living at sea must 
 
69 
 
 that a journey on land, performed in a carriage, 
 produces highly beneficial effects, resembling those 
 
 be considered as having a mighty influence on the miQcl, 
 which, by consent, will powerfully affect the body. In sailing 
 there is a strange mixture of passions; and these are some- 
 times in extremes. Sea-faring people are frequently agita- 
 ted between hope and fear; are sometimes merry, sometimes 
 sad; exulting with joy when safe, and at rest; and in danger 
 thrown into the utmost despair. Such variations and budden 
 transitions of passions, are capable of removing the most in- 
 veterate diseases, and such as are not curable by any other 
 method.*'* I will venture to assert that the learned author 
 whom I have just quoted, never practised mddicine exten- 
 sively on ship-board at sea. I have never failed to observe 
 the prejudicial nay, I may say in some instances, the fatal 
 effects on my patients at sea of the violent and sudden ebul- 
 litions of hope succeeded by dejection and despair, so fre- 
 quently produced from the interest almost all persons take 
 in the safety and comfort of the ship and the state of the 
 weather. I have known a paroxysm of an intermittent acce- 
 lerated by a " head-wind" being announced to the unfortu- 
 nate subject of the disease, whose-hopes of happiness, of 
 
 * Venim gestatio per pelagus vehementissiroa est, et mutationes plurimas, et 
 maximas facit Nimirum cum anima mLxtos affectus habeat, ex tristitia et spe, 
 tiinore et j)ericuIo; modo gaudentibus et latis, modo in agone existentibus na- 
 vigantibus. Omnia hsec composita sufficientem vim habent omaem veterena 
 xnorbum exigei di, et e eorpore exoludendi." — *Mtiu8 Medicin, contract, 
 tetrab. prim. serm. 3. cap. 6. 
 
70 
 
 too, that arise from sailing. Those therefore who are 
 in affluent circumstances, and who retain strength 
 
 health, of joy, depended on the speedy arrival of the vessel 
 " at the haven v^here she would be.** Can the debilitating 
 effect of depressing emotions be less active at sea than on 
 land, under similar circumstances? Or is the excitability of 
 the system less alive to impressions there? Surely not. Since 
 then these vicissitudes in feeling are found to be so preju- 
 dicial to the morbid constitution on land, we may natu- 
 rally conclude that they exert no less unwholesome effects 
 on the debile system at sea. I have been much at sea, and 
 am a strong advocate for the use of sea-voyages in medi- 
 cine. I kno'Uf their efficacy, for I h^ve been an eye-witness 
 to their power in relieving those who were beyond the reach 
 of medicine. I have seen the last scintillating light of life, 
 fanned into a bright and burning flame, by means of this 
 mighty influence; but I would yet discourage the too hasty 
 recourse to this remedy. I know it has done good, I believe 
 it may do harm. In speaking as I have done respecting the 
 dejection of mind that a sea-voyage sometimes produces, I 
 am not ignorant that highly respectable, nay celebrated au- 
 thors have maintained a contrary opinion. With deference I 
 have ventured to oppose the powerful current that flows 
 against me; and I can only say that what I have advanced is 
 grounded upon a strict and unwearied attention to the ef- 
 fects of the sea life upon all those with whom from time to 
 time I have sailed. I have been for months together at sea 
 
71 
 
 enough for the purpose, should pursue the more 
 agreeable path, and travel by land. To others whose 
 limited pecuniary resources, and completely enerva- 
 ted constitutions deprive them of that choice, a re- 
 medy not less efficacious is held forth, by means of 
 a sea- voyage. 
 
 Lastly, a question yet remains: when it is deemed 
 convenient to make a change of climate, what places 
 are the most proper for the purpose? With regard to 
 the advantages or disadvantages of different places, I 
 shall not venture to state any thing positively, for in 
 fact I am very little conversant in these things. How- 
 ever, this much 1 may say with certainty, that a clear, 
 dry, and at least in most cases, an uniform climate, is 
 required. The southern countries of Europe, — Spain, 
 the greater part of Italy, the southern parts of France, 
 enjoy such a climate; so also does Madeira,^^ and the 
 Bermuda Islands. It is my intention in a future part 
 
 with four hundred and once with near five hundred souls. 
 Among such a number I could not fail of making many ob- 
 servations, and what I have advanced is the result of them. 
 
 VI 
 
 '» It was formerly very common for physicians who ad- 
 sed a change of climate for the purpose of relieving their 
 
 /' 
 
of this work, to say a few words on the use which 
 the physician can make even of the hottest climates, 
 with a view to their remediate eflfects in diseases. 
 
 These things being premised, I may now treat 
 more in detail of certain disorders arising from our 
 
 consumptive patients, to send them to the island of Madeira. 
 The high opinion entertained of the salubrity of that place, 
 will appeal from the following passage from Dr. Fothergiii's 
 observations on consumptions.* " Of all the places we are 
 acquainted with, perhaps the island of Madeira enjoys the 
 most equal temperature; but the voyage and other circum- 
 stances attending it, afford very formidable objections;" and 
 Dr. Thomas Reid, in the first edition of his valuable work on 
 pulmonary consumption, recommends Madeira in preference 
 to Lisbon, " as being at a greater distance, more to the south- 
 ward, and the air, from its insular situation, purer and infi- 
 nitely more healthy." In the second edition of his work, 
 however, Dr. Reid tells us that the recommendation of Ma- 
 deira as above stated, was made on the authority of a medi- 
 cal friend who had sent phthisical patients to that island with 
 success, as well as in consequence of what Dr. Fothergill 
 had said respecting it; but tells us that having subsequently 
 made some inquiries on the subject, he " was not a little 
 surprised to hear, that it (the island of Madeira) was believ- 
 
 • Med. Obser. and Inquir. Vol. V. p. 368. Ann. 1776. 
 
?3 
 
 climate. It is by no means my intention to descant 
 upon all the diseases emanating from this source. It 
 
 ed to be particularly prejudicial to the consumptive." He 
 quotes a letter from Dr. Gordon of Madeira, dated 28th 
 April, 1784, in answer to his inquiries, with a view to as- 
 certain the truth.* Since this place still retains the reputa- 
 tion of being peculiarly suitable for consumptive patients, 
 with some physicians: and since to my knowledge a few pa- 
 tients! have been sent from this country to that island, who 
 died there, it may not be amiss to publish this extract, for 
 the information of those who may be disposed to follow the 
 same practice. Such observations as this letter contains, 
 coming as they do from a physician residing in the island, 
 a physician too of reputation, and enjoying the confidence of 
 some of the first medical men of London at that time: must 
 be read with interest, and cannot fail to receive the attention 
 they merit. 
 
 " Sir John Pringle, and some others of my medical ac- 
 quaintance in London, did me the honour about eight or 
 nine years ago, to send some of their consumptive patients 
 under my care, of which few recovered; and I was induced 
 to discourage them from sending any more to our island, 
 especially as the generality of these cases are in the last 
 
 * Reid on Consumption. 2d Edit. p. 271. 
 
 \ Two from Philadelphia, and one from Virginia, 
 
 K 
 
74 
 
 will be sufficient to take into consideration those in 
 ^rhich a change of climate avails most, and the dan- 
 ger and inconvenience of which particularly demand 
 the assistance of this remedy. 
 
 The diseases which may be ascribed to the effects 
 of our climate, vary according to the age of the per- 
 
 stage of the disease before they leave Britain. And unless 
 they are particularly recommended to some British mer- 
 chant's house, they have no alternative, but to take up their 
 quarters in a publick-house, which are very indifferent in this 
 place, and by no means calculated for their reception. No 
 pecuniary consideration whatever will induce the natives to 
 accommodate phthisical patients. Our provisions in general 
 are not bad, though it is often difficult to procure proper 
 diet for the valetudinarians, by having no kind of market 
 established. Our roads all over the island are very indif- 
 ferent, and not shaded. The society is very good for those 
 in health. A great scarcity of asses milk, and no such thing 
 as nurses, or proper people to attend the sick. Add to all 
 these objections, I am of opinion, that our air is too fine and 
 fienetrating for hectic complaints^ and should imagine the 
 south of France a much better climate, or even the High- 
 lands in some of our West India isles. Am sorry the situa- 
 tion of Madeira will not permit me to give you better en- 
 couragement on the propriety of sending consumptive pa- 
 tients here." 
 
75 
 
 son affected. Diseases of the breast, principally hae- 
 moptysis, and pulmonary consumption which often 
 supervenes upon it, occur for the most part in youth. 
 In more advanced age these complaints are rarely 
 observed, when various affections of the abdominal 
 viscera, and especially of the stomach, succeed. Gout 
 and hypochondriasis are frequently produced by these 
 affections, and sometimes they are found combined 
 with them. In the decline of life when all the powers 
 of the system have become degenerated, the intem- 
 perate climate falls upon those already debilitated and 
 nearly worn out by old age, — racks every part of the 
 system with innumerable pains, embitters life, and 
 accelerates the approach of death. It is my intention 
 in the following pages to observe the natural order of 
 diseases; and therefore, I ought to begin with pul- 
 monary consumption, which, for the most part, oc- 
 curs in youth. 
 
76 
 
 SECTION IL 
 
 Of the nature and symptoms of Pulmonary Consumption, and 
 its similarity or identity with Scrophula. — Of the different 
 -tiotions of physicians respecting the curableness and in- 
 curableness of genuine Phthisis. — Of the effects of Wounds 
 and other Injuries of the Lungs, on that Viscus. — Of the 
 remote and proximate causes of Consumption, and the rea- 
 sons that may be deduced from them, in favour of a change 
 of Climate upon the Disease. — Of the curative effects of 
 Travelling, Riding on Horseback and Sea-Voyages. 
 
 There is perhaps no disease generated in this 
 island, whether we behold its devastations or those 
 subjected to its ravages, more deserving of attention 
 than pulmonary consumption. If we may credit the 
 London bills of mortality, a fourth part of our popula- 
 tion is carried off by consumption." This prodigious 
 
 17 « In the London bills of mortality, the number said to die 
 of consumptions, is generally between four and five thousand 
 annually; exclusive of those not buried in parochial church- 
 yards, and in every other part of the kingdom. Though the 
 
77 
 
 destruction of the human race falls especially upon 
 the youth, often on the most beautiful, particularly of 
 
 manner of forming these registers, is liable to such uncer- 
 tainty, as calls loudly for reformation; and the term consump- 
 
 
 
 tion is applied to many different diseases; yet it will serrc 
 to demonstrate, that a great number yearly die of this dis- 
 ease. 
 
 « By a register of the parish of Holy cross in Salop, from 
 the year 1770 to 1780, kept by the Rev. Mr. William Gor- 
 such, it appears, that three hundred and eleven died in the 
 ten years by disease and casualties; out of which sixty-two 
 died of consumption; sixty-four of a natural decay, without 
 any apparent distemper, and thirteen by accidents. So that 
 the deaths by consumption are somewhat more than one in 
 four. By an actual survey made in the year 1780, the inha- 
 bitants were eleven hundred and thirteen. Philosofih. Trans, 
 vol. 72, for 1782."* 
 
 It will appear from the above account of the bills of mor- 
 tality of the city of London, that the fatality of phthisis is 
 prodigiously extensive; and from what has been advanced in 
 the text, that the disease is endemial to the climate of Great 
 Britain. Now it is a fact that the prevalence and fatality of 
 
 Reid on Consumption, p. yii. 
 
78 
 
 the fair sex, and on those who are conspicuous for wit 
 and the elegancy of their minds and persons. Should 
 
 consumption in some portions' jf the United States is no less 
 conspicuous and demonstrable than in England. Volney ob- 
 serves that « all travellers in the United States have spoken 
 of the frequency of this fatal disease, which cuts off chiefly 
 young married women and girls in the flower of youth and 
 beauty. It is more common in New England and the middle 
 states, than in the states to the south-west."* 
 
 Dr. Spalding, in his bills of mortality drawn up at Ports- 
 mouth in New Hampshire, has proved, that as great a num- 
 ber of persons die of consumption, in a given time and in a 
 given population, in the New England states, as die from 
 malignant fevers in the southern states of Carolinas and 
 Georgia. What then is the probable cause of this great pre- 
 valence of pulmonary consumption in these states? I have 
 before (Note 2) hinted at the similarity of our climate to 
 that of Great Britain, and said that a corresponding simili- 
 tude in the constitution of the endemial diseases might rea- 
 sonably be expected to prevail. Let us now take a more 
 extensive view of the nature of this climate with regard 
 to the probable light it may throw on the cause of the dis- 
 ease as above stated. And first let me remark that the un- 
 healthiness of the countries adjacent to our lakes, as well as 
 
 * Volney*s View of the Climate and SoU of the United States, p. 280. 
 
79 
 
 any one however be disposed to doubt that such a 
 deplorable loss can arise from the ravages of a single 
 
 of some of our eastern sea ports, lying exposed to the sea 
 blasts, seems to be in opposition to the notion of Sir John 
 Pringle, who conjectured that " great bodies of water, such 
 as seas and lakes, are conducive to the health of animals by- 
 purifying and cleansing the air contaminated by their breath- 
 ing in it."* 
 
 There is no doubt that the different complexion of the 
 diseases of the New England states, from those of the 
 southern, is owing chiefly to the rigour of the climate, ac- 
 companied by rapid and unexpected changes of the weather. 
 These changes of course are ushered in by variations in the 
 winds. In the state of Vermont for example they are gene- 
 rally from the south-west to the north-east, and the most 
 prevalent winds, according to Williams,! are either " paral- 
 lel with or perpendicular to this course." He further states 
 that there the west and north-west winds are dry, cooling and 
 clastick, while those from the south and south-west are more 
 warm, moist and relaxing. In the sudden changes then of winds 
 possessing such different properties, we will find a fruitful 
 source of colds and catarrhs, the forerunners of consumption. 
 
 What 
 
 * Anniversary Discourse before the Boyal Society, in the yetr 1773. 
 f History of Verraontj p. 48. 
 
80 
 
 disease, let him inspect the bills of mortality of the 
 city of London. Even supposing their calculations 
 
 What has been just said respectmg the climate and winds 
 of the state of Vermont, is true, generally, of all the northern 
 and eastern states. Yet so versatile is the constitution of the 
 climate of this country, that it is almost impossible to de- 
 fine, by any positive language, its general character. This 
 diversity is not confined to any particular state, or tract of 
 country, but is frequently evidenced in different parts of the 
 same state, and in the same latitude. To understand then tho- 
 roughly the nature of the American climate, one ought to be 
 able to view it in all its multifarious changes throughout the 
 continent. In general it has been remarked that in our win- 
 ters, when a steady cold prevailed from Christmas till March, 
 with much snow and little thaw, and uniformly cold elastick 
 winds: but little tendency to disease was observable; and the 
 diseases occurring during such a state of the weather, were 
 manageable. In a variable winter however, when a warm 
 mid-day sun and rapid thaws are generally succeeded by the 
 nipping frosts of night, and particularly when much rain 
 falls: colds are very rife, and consequently consumptions 
 follow. The greatest danger in this climate however, is to be 
 feared in the months of spring. This is a deceitful season, 
 and never fails to make unperceivcd and deadly inroads on 
 the constitutions of persons predisposed to phthisical com- 
 plaints. Volney has asserted that " throughout the continent 
 
81 
 
 are double what they should be, how extensive and in- 
 deed lamentable a destruction of the human race, 
 
 of North America, there is no spring.'"* This assertion, no- 
 vel as it may at first sight seem to be, is really well founded. 
 There is no part of the United States north of the state of 
 Maryland, where three hours fair weather may be depended 
 on, in the months of March and April; and though Mayf is 
 less variable, yet its excessive heats, and sometimes unsea- 
 sonable frosts, render it so unpleasant a month generally, 
 that it can hardly be considered as spring weather. Compara- 
 tively with Europe, according to M. Volney,| there falls 
 " more rain in the United States, generally speaking, in 
 fewer days, and there are fewer cloudy days, more fair days,§ 
 
 * On the Climate and Soil of the United States, page i£K). 
 
 f " The month of May, 1786, will long be remembered, for having fur- 
 nished a very uncommon instance of the absence of the sun for fourteen days, 
 and of constant damp or rainy weather.'* Rush's Account of the Climate of 
 Pennsylvania. 
 
 + View of the Climate and Soil of the United States, p. 24i, 242, 243. 
 
 § ** The climate of much the greater portion of the United States furnishes 
 great degrees of heat and cold, in their respective seasons; but neither of the 
 extremes is of long continuance. Our climate is also very variable, the tem-t 
 perature of the atmosphere being liable to great and sudden vicissitudes. Ne- 
 vertheless, taking the whole routine of the seasons, we enjoy a large pro- 
 portion of fine and moderate weather, -with more days of stm-shine and serene 
 sky, than, perhaps, any part of Europe exhibits." — Observations on the 
 duration of Human Life, &c., in a letter from Wm. Barton, Esq., to Dr. Bit- 
 tenhouse. Trans. Am. Phil. Soc. Vol. 3. p. 51, paper No. vii. 
 
 L 
 
 V 
 
\ 
 
 82 
 
 •V 
 
 must we not attribute to pulmonary consumption! If 
 it was worth the trouble of an accurate computation, 
 
 and more evaporation.*** It is owing to this powerful evapo- 
 ration in the United States, that we have such heavy dews, 
 which are unknown in the temperate climates of Europe. 
 The reason of this rapid evaporation M. Volney believes is 
 « because the winds are pure, in consequence of the general 
 plainness of the surface, and because one of them, the north- 
 west, which is extremely dry, prevails for two-fifths of the 
 year.**t Hence we have another cause for the prevalence of 
 
 * Mr. J. (now General) Williams* found by a series of experi- 
 ments and researches that the mean quantity of evaporation, at Cam- Inches. 
 bridge, near Boston, for a term of seven years, was - - - 36 
 
 While in seven German and Italian cities, on a mean of twenty 
 years, it was only --- 49 
 
 Which leaves a difference of-- 7 
 
 Yet the cities of Italy are in a latitude much more favourable to evaporation 
 than the vicinity of Boston, adjacent to the Atlantic Ocean. 
 
 Fair Days. 
 
 In one year there were at Salem 173 
 
 At twenty cities in Europe - : 64 
 
 ' ■ Cloudy Bays. 
 
 At these same twenty cities there were in 1785 - - - 113 
 
 At Cambridge, near Boston - - - 69 
 
 At Salem, taking the medium of seven years - - ' - - 9l> 
 
 t View of the Climate and Soil of the United States, p. 244. 
 
 Transactions of the American Phil. Soc. 
 
83 
 
 it would not be in the least difficult to show, that 
 twenty-five thousand men are annually destroyed in 
 
 consumption. The warm mid-day suns produce copious per- 
 spiration in the spring, and the sudden evaporation of it pro- 
 duces catarrhs. The air of America abounds more in electrick 
 fluid than that of Europe; this fact, which evidences an exces- 
 sive dryness of the air, and which really is only observable dur- 
 ing the continuance of the dry and healthy winds, is remark- 
 ably demonstrated in the appearance of the silk tassels worn 
 on boots, especially when they come frequently in contact 
 with the silk linings of our surtouts. It is constantly observed 
 too, flying off* in sparks, when we pull off worsted or silk 
 stockings. 
 
 When the atmosphere is thus surcharged with electrick 
 fluid, it is highly salutary. Every degree of diminution in 
 the quantity of this fluid, is an evidence of an increased de- 
 gree of dampness in the air, and consequently, argues a less 
 wholesome quality in it. The changes from this state of air 
 to excessive humidity, are very common, and not unfre- 
 quently very sudden. Hence a reason why we should guard 
 against the colds consequent to them, by changing or in- 
 creasing the quantity of our clothing. The female portion 
 of the population of the middle and northern states, is said 
 to be more subject to consumption than the male. If this be 
 actually the case, and I am inclined to believe it is, we need 
 look no further for the cause, than the recklessness with 
 
84 
 
 Great Britain by this disease. The celebrated Syden- 
 ham advanced an opinion respecting this malady, not 
 
 which the women, and young girls, particularly those ac- 
 customed to move in the gay circles of high life, indulge 
 themselves in imprudent changes of clothing. This is at all 
 times ill-proportioned to the severity of our climate; and 
 when the little degree of comfort and protection it is ca- 
 pable of affording, is wantonly sacrificed at the shrine of 
 fashion, need we be surprised to hear the reiterated com- 
 plaints of colds they make; or can we doubt the assertion, 
 that this sex is peculiarly liable to phthisical complaints. 
 This last circumstance is said by M. Volney to be owing 
 to their " light and airy dress." He says that in the course of 
 two winters, he observed a great number of people of fashion 
 had four or five relapses, " for the rich are particularly lia- 
 ble to colds."* " In the cities on the coast," he continues, 
 " where the people are eager to imitate Europeans, these 
 colds have other causes in overheated apartments, balls, tea- 
 parties, and feather beds; sometimes indeed in the German 
 fashion, that is, a feather bed to sleep on, and another as a 
 coverlid." — The circumstance above stated, respecting the 
 greater prevalence of colds among people of fashion, (for 
 such I presume M. Volney alludes to when he says « th6 
 rich,") is a notorious fact; and among these, there is no 
 
 * Volney's View, ke. p. 279 and 280. 
 
85 
 
 widely differing from this; namely, that two-thirds 
 of those that fall victims to chronick diseases, arc 
 
 doubt that the women are more frequently afflicted than the 
 men. It is a fact as notorious too, that it is a common prac- 
 tice among the young girls of this and other cities, to throw 
 off a flannel garment which they have worn all day in the 
 house, and in a warm room, when they go to a dance or 
 tea-party in the evening. This circumstance* of itself would 
 be a fruitful source of consumption, in such a climate as 
 this: but when we add to it the thin and scanty dress which 
 supplies its place, — the imprudent exposure to the cold air 
 while in profuse perspiration after dancing, and what has 
 equally an injurious effect, the thoughtlessness of eating 
 ice-creams while overheated by this violent exercise,— ought 
 we not rather to be surprised that consumption does not 
 sweep away the fairest portion of our population entirely, 
 than doubt the verity of the assertion: that women and young 
 girls in the United States are more liable to consumptions 
 and colds, than any other persons? If then this change of 
 clothing, this imprudent exposure while so thinly clad; and 
 
 * '* A learned author supposes the imprudent changing of garment destroys 
 more than the plague, famine, or the sword; one would think the ladies 
 dressed in those days as now; wrapping themselves up in the day, and ex- 
 posing their persons to the cold, damp night-air."— Thos. Reid on Consump- 
 tion, p. 394. 
 
86 
 
 carried off by pulmonary consumption. In another 
 place he asserts that chronick diseases destroy almost 
 
 this more than imprudent exposure while overheated by- 
 warm rooms and dancing, are sufficient to produc e such 
 evils in this delicate sex — what fatal danger must they not ex- 
 pose themselves to, by encountering all these hazardous cir- 
 cumstances at particular times, when the constitutional econo- 
 my requires infinitely more care than during the interval of 
 these periods: and when the system, even of the most ro- 
 bust female, is always more or less debilitated and disor- 
 dered! 
 
 From the foregoing observations therefore, it follows: that 
 the cause of the prevalence of consumption in some portions 
 of the United States is to be found in the inconstant state of 
 the climate as demonstrated in the sudden and excessive 
 transitions of the weather;* the great evaporation and heavy 
 
 * The range of the thermometer in these states, is not unfrequently from 
 80** of Fahrenheit in summer to zero, or one or two degrees below it, in 
 winter. And in the present month, (Feb. 1815,) the mercury stood at from 
 5** to 16® below zero of Fahrenheit in different parts of the United States. 
 My father mentions, that " Mr. Rittenhouse had noticed, that, at his Norriton 
 observatory, (in lat. 40" 9' 31" N.)'the mercury in Fahrenheit's thermometer, 
 not exposed to the sun-shine, but open to the air, was at 941 30', on the 5tli 
 of July, 1769; * which,' says he, ' was the greatest height it had ever been ob- 
 served to rise to, at that place.' But the wnter is informed by a judicious and 
 attentive observer, that at Lancaster, Pennsylvania, w^hich is in lat. 40« 2' 
 39'' N. (the long, of this borough-town is 5» 1' 4" W. from Greenw.) the 
 mercuiy rose by Fahrenheit's scale, on the 7th of July, 1811, to 97* 30'. 
 Admitting this to be correct, if 1» 30' be then deducted, for the extra heat of 
 
87 
 
 a third part of mankind. From these proportions as 
 data, it would appear that pulmonary consumption de- 
 stroys forty thousand men and more, annually in this 
 island. There is however, no occasion to descant upon 
 the devastations of this malady. For there are few of 
 us, who have not to lament the death of acquaintances, 
 
 dews which follow it; the frequency of checked perspiration 
 by cold winds after rapid thaws of snow; the disproportioned 
 quantity of clothing at all times, particularly of the females, 
 to the rigour of the climate, and the imprudent change of it 
 during the winter season; as well as the careless exposure of 
 the system to the intemperance of the spring weather, by the 
 premature alteration of winter dress, particularly the imprudent 
 change of flannel garments. Among these causes, it is evident 
 that the physical constitution of the country has a most power- 
 ful operation, yet it is equally plain that the defects of climate 
 are assisted in their unhealthy consequences, by the artificial 
 deficiencies in clothing. This proves that with greater atten- 
 tion to the state of the weather, and more care in adapting the 
 the covering of our bodies, to its inclemencies and its ea- 
 pricies: the prevalence of this destructive disease would be in- 
 finitely diminished, and in all probability its violence and fatality- 
 lessened. 
 
 so large a town as Lancaster in comparison with a country situation, there is 
 in this case the great range of 118" by Fahrenheit's scale, for the extremes 
 of heat and cold in Pennsylvania." — Barton's Memoirs of Kittenhouse, note, 
 p. 13f^. 
 
88 
 
 associates, or friends, who have been snatched from 
 us by this destructive complaint. Relentless, cruel 
 and unfeeling — this deadly consumer of human 
 health, glutting itself perpetually upon the young 
 and delicate, fills our country with sorrow and de- 
 vastation! 
 
 Pulmonary consumption is esteemed an endemial 
 disease in our climate, and not improperly; for per- 
 haps there is no country on the globe in which it 
 produces such fatality. All physicians confess that 
 the most efficient remedies are administered in this 
 disease in vain, at least, in the generality of cases; 
 and that when it is of long standing, a radical cure 
 must be despaired of. The cure even of incipient 
 phthisis, is a precarious and difficult undertaking. 
 No remedy succeeds better in this disease than a 
 change of climate, by means of a seasonable journey 
 into warm countries. Whatever therefore seems to 
 promise any assistance in so dangerous a malady, 
 is worthy of the highest attention. Its mode of action 
 is now to be investigated. By an attention to the 
 symptoms, and to the remote and proximate causes 
 of the disease, as well as from analogy of those things 
 which have the effect of yielding succour to the ma- 
 
S9 
 
 lady, we may learn how that remedy operates bene- 
 ficially. 
 
 Pulmonary consumption may be known for the 
 most part, by the following symptoms: a slow ema- 
 ciation of the whole body, accompanied with hcctick 
 fever; a sense of weight or constriction, or pain, in 
 the breast, with difficulty of breathing; a frequent 
 and troublesome cough, which in the beginning is 
 dry, but after the disease has progressed, generally 
 accompanied with purulent spitting. The symptoms 
 which denote incipient consumption, vary according 
 to the causes which produce it, as for instance, pleu- 
 risy, catarrh, haemoptysis, &c. The proximate cause 
 of this disease is well known. Dissections of the bo- 
 dies of persons who have died of consumption, have 
 almost always exhibited tubercles, vomicas and ul- 
 cerations of the lungs, by which sometimes nearly 
 the whole of that viscus is consumed. I say that 
 these morbid phaenomena will almost always occur, 
 for I would not venture to assert that they will al- 
 ways be found. There are many physician^^ of no little 
 reputation, who strenuously contend, that sometimes 
 neither an ulcer nor any other visible injury is to be 
 discovered in the lungs of those who have had co- 
 
 M 
 
90 
 
 pious purulent spitting, and other symptoms of con- 
 sumption, and who had evidently died of this disease. 
 It is agreed on all hands however, that instances of 
 this kind are very rare, while it is generally allowed 
 that true consumption arises from an ulcer, or rather 
 ulcers in the lungs. The dissections indeed of dead 
 bodies satisfactorily demonstrate, that not only a sin- 
 gle ulcer or tubercle, but sometimes congregations 
 of them had produced the disease, and that these had 
 become inflamed and had suppurated. The proxi- 
 mate cause therefore being known, the curative in- 
 dication would seem to consist in dissipating the 
 tubercles, or if they shall have already passed into sup- 
 puration, to heal the ulceration in the first place. This 
 effect however is to be accomplished by the healing 
 powers of nature, and not by the assistance of phy- 
 sicians; and I must confess that in this stage of the 
 disease I see nothing which justifies the expectation 
 of any benefit being likely to result from a change of 
 climate. If the general habit of body is sound, ulcers 
 in any other part are usually healed with facility by 
 the mere efforts of nature; and in such cases physi- 
 cians might easily retard, though they could scarcely 
 promote, the cure. For I do not know any reme- 
 dies which, by any specifick power, can produce 
 
91 > 
 
 that healing process. It is well known, that many re- 
 medies which have been administered ^vith that in- 
 tention, have had altogether a contrary effect, and 
 not only did not do any good, but often proved very 
 injurious, — such as natural and artificial balsams: and 
 these are now rarely employed. 
 
 Yet there are certain indolent ulcers, which re- 
 quire the assistance of the physician and the surgeon; 
 and many ulcers that do not heal spontaneously, arc 
 easily cured by the administration of proper reme- 
 dies. By analogy, various remedies have been tried 
 in depraved and obstinate ulcers, consuming the 
 lungs. Of the manner in which the remedies that 
 assist the cure of external ulcers act, it is easy to 
 give the rationale. They divide themselves into two 
 classes: — into external and local, which are applied 
 immediately to the ulcer, and affect that only: and 
 into internal and general, which act upon the whole 
 system, and do good, not only to the ulcer, but also 
 remove any taint pervading the general system. 
 The first are of the greatest utility in curing that par- 
 ticular state of ulcers, which from experience we 
 know retards their cure. As for example, incisions or 
 cscaroticks for destroying fungous flesh, or removing 
 callous parts, or inducing a new and favourable sup- 
 
92 • 
 
 puration, which are evidently required in healing an 
 ulcer. But it is impracticable to administer reme- 
 dies of this kind in consumption; and even if they 
 could be employed, I know of no symptom by which 
 such a condition of the ulcers could be ascertained, 
 so that either one or other of these remedies could 
 be pointed out as necessary. 
 
 The other class of remedies (to wit, the general 
 and internal,) exert scarcely less power in curing 
 those ulcers which arise from some general taint. Such 
 are the syphilitick or scorbutick ulcers, which for 
 the most part we may vainly expect to heal by purely 
 local means, unless, at the same time^ internal and 
 general remedies adapted to the cure of those dis- 
 eases, are carefully administered. By analogy, there- 
 fore, in this malady, arising from ulcers difficult to 
 to heal, remedies should be administered for curing 
 that taint, of whatever sort it may be, which impedes 
 the curing of such ulcers. In order properly to ac- 
 complish this purpose, it is necessary to ascertain 
 the remote causes of the disease. It is not necessary 
 to expatiate largely on the subject, to show that con- 
 sumption does not, at least? generally, arise from a 
 inere injury or even from suppuration of the lungs. 
 
93 
 
 unless some morbid predisposition or taint shall pre- 
 viously have existed in that viscus, or in the general 
 system. What that taint is, will hereafter be investi- 
 gated. It is known, however, that this disease gene- 
 rally supervenes upon haemoptysis; so that whenever 
 a young person is aflected with a spitting of blood 
 from the lungs, his case is hopeless. Sometimes 
 also, consumption follows a badly treated peripneu - 
 mony or pleurisy which has terminated in suppura- 
 tion. Sometimes too, though rarely, it arises from 
 some great external violence, inflicted on the breast or 
 the lungs themselves. These things having been ob- 
 served to take place, it has been hastily concluded, 
 that an injury and a certain depraved suppuration of 
 the lungs, as well as an incurable ulcer, and conse- 
 quendy a mortal consumption, were produced. Physi- 
 cians have referred the cause of this injury, to the na- 
 ture and construction of the lungs, and their office. In 
 support of this opinion they have remarked, that the 
 blood flows with great force through the lungs, 
 and that they themselves are agitated by a perpetual 
 motion, namely of respiration, which by alternately 
 weakening and irritating its parts, was believed to 
 impede the cure of a wound. And finally they have 
 adduced another reason from the analogy of external 
 
94 
 
 wounds, which are difficultly cured when exposed to 
 the air. Now the air, say they, is received into all i>arts 
 of the lungs; if therefore there be any ulcers there, 
 they are necessarily exposed continually to it. But all 
 these circumstances are not sufficient to solve the dif- 
 ficulty. The motion of the individual parts of the lungs 
 is always inconsiderable, and except in a full inspira- 
 tion, scarcely sensible. It seems hardly probable, 
 therefore, that such injury should arise from this 
 cause. And no effect should be attributed to the ad- 
 mission of air; for, although it is received into the 
 lungs, it never comes in immediate contact with them, 
 since the internal surface of this viscus is always lubri- 
 cated with mucus, which would naturally defend any 
 wound from the air. Besides, we know that the exter- 
 nal wounds of dogs, and many other animals, heal after 
 being licked; for this very reason, that the saliva and 
 mucus mixed with it, sufficiently defend the wounds 
 from the action of the air. All arguments therefore, 
 tending to show that an injury of the lungs ought to 
 produce consumption, go for nothing. And besides, 
 experience proves that the fact is not so. For there 
 are innumerable examples of cures, where, after the 
 most manifest injuries, nay, even suppuration, of the 
 
95 
 
 lungs, no consumption ensued. ^^ Many persons also 
 have been affected with haemoptysis, without con- 
 
 ^8 A very remarkable instance of entire recovery from a 
 wound into tlie cavity of the lungs, is related by Dr. May,* of 
 Plymouth, in England. The case was that of a British officer, 
 who was wounded in a duel. The pistol ball passed in the di- 
 rection of the right lobe of the lungs, through which it was 
 supposed to have perforated. Considerable external haemor- 
 rhage and bloody expectoration with difficulty of breathing 
 came on; these were followed by a cough and symptoms of 
 violent inflammation. The antiphlogistick plan of treatment 
 was pursued. Blood was discharged for many days by coughing, 
 and purulent expectoration supervened. Symptoms of conva- 
 lescence soon after appeared, and the patient in a short time 
 entirely recovered. Dr. May says he was indebted for this fact to 
 Mr. Adams, of Likeard, an ingenious surgeon of the navy, who 
 was an eye witness of the circumstance. That the ball actually 
 perforated the lungs in this case, was proved by a circum- 
 stance which subsequently occurred. A piece of woollen 
 cloth, enveloped in a clot of blood and pus, was brought up by 
 coughing. That consumption did not follow seems plain, but 
 in all likelihood the patient owed his escape from it, to 
 a circumstance which, though no mention is made of it, in 
 all human probability really existed: I mean a sound and 
 robust constitution, unblemished by any latent pulmonary 
 taint. I am the more inclined to this opinion, from having had 
 
 • Essay on Pulmonary Consumption, b) Wm. May, M. D. Intror'. p. xiu. 
 
96 
 
 sumption supervening. Many ^fter an attack of badly 
 treated peripneumony, have had an extensive suppu- 
 
 under my own care a case strikingly similar, as far as respects 
 the nature of the wound, though followed by very dissimilar 
 results. As this kind of wounds of the lungs is always inte- 
 resting, I will briefly relate the instance I allude to, which 1 
 the more willingly do, as perhaps I shall never have another 
 fit opportunity of making it publick. While I was surgeon of 
 the frigate United States, in the year 1809, being on shore at 
 Norfolk, where the ship was then stationed, I was called to 
 visit midshipman L h, whom I had but an hour before seen 
 on board, in perfect health. He was so unfortunate as to have 
 been under the necessity of meeting a brother officer in the 
 field. »His antagonist's ball (being one of the largest pistol- 
 size, since the arms used were ship*s arms) had entered the 
 ieft side of the breast and had passed entirely out under the 
 inferiour edge of the scapula; its direction being obliquely 
 upwards and backwards from the point where the ball en- 
 tered to the place of its exit. I found him bleeding pretty 
 largely from the external wound in the breast, and copiously 
 expectorating blood, likewise coughing it up at short inter- 
 vals, in large clots. He was labouring under great difficulty 
 of respiration, and at times seemed nearly to be suffocated 
 with the rapid and extensive internal haemorrhage. His coun- 
 tenance had a ghastly paleness, which, together with the 
 deadly hue of his lips, and other symptoms, seemed to in- 
 dicate that he was fast approaching dissolution. It is needless 
 to go into the detail of the treatment pursued. Suffice it tosay* 
 
97 
 
 ration in the lungs, which being entirely rejected by 
 spitting, was soon cured. And finally, examples 
 
 that it was rig^orously calculated to allay the great irritation 
 of the system while it continued, and subsequently modified 
 and altered as the exigencies of the case required. In a short 
 time, extensive suppuration, with a constant cough came on, 
 and continued for a long time to weaken the patient. Hectick 
 fever with colliquative night sweats now succeeded, and 
 seemed to threaten a fatal termination to the life of this inte- 
 resting youth. He however survived the accident, a circum- 
 stance chiefly owing to the kind and close attention of his 
 brother officers of the ship, whom commodore Decatur per- 
 mitted to be as much on shore to nurse and watch with him, 
 as the duty of the ship could admit of: an office, as he was 
 much beloved, that they all cheerfully performed, and in 
 ■which they showed their usefulness by a prompt and correct 
 execution of the directions of his medical attendants. In the 
 month of February, 1810, the United States proceeded to sea, 
 and Mr. L. was s6nt to the Marine Hospital under the care of 
 Dr. Barraud, who showed him every possible attention and 
 kindness. In the month of April, 1812, while visiting the navy- 
 yard at Washington, I accidentally met him. He had been 
 with his friends in the country, and his general health was 
 considerably mended, though it was plain to me that he la- 
 boured under a pulmonary affection. He is still living, I be- 
 lieve, though I fear he will never shake off the disastrous 
 consequences of his accident. His stature, the confof- 
 
 N 
 
98 
 
 daily occur where the lungs are injured by external 
 violence, or wounded, and yet consumption rarely 
 arises from these causes. If the wound be extensive, 
 sudden death entirely prevents all danger of con- 
 sumption: if it be slight, it is soon healed. Indeed, 
 there is one instance of a wound in the lungs proving 
 
 mation of his chest, his voice, his complexion, even in health, 
 strongly indicated I think, a predisposition to phthisis. Conse- 
 quently no one will be surprised to hear that it supervened 
 eventually. This might with propriety be classed with the 
 phthisis ab vulnere of Sauvage, and the " phthisic par bles- 
 sure de poitrine" of Bonnafox Demalet.* Drs. Barraud, Sel- 
 den and Hansford, physicians of Norfolk, saw this gentleman 
 with me in the first instance: he had then been wounded 
 about half or three quarters of an hour. The two first and my- 
 self continued to see him for two weeks or more, and the 
 latter part of the time Dr. Selden and myself continued in at- 
 tendance together. The case of this young man is well known 
 to Dr. Gerard Dayers, now surgeon of the Congress frigate, 
 and Dr. William Clarke, at present surgeon of the Wasp 
 sloop of war: both at that period my mates on board the 
 United States. 
 
 * This nosological writer places this variety of consumption, as the sixtli 
 species of the third genus of the disease. His first genus contains four species; 
 his second, ten; his third, six. — Vide " Traite sur la nature et le traUement de 
 la Phthisic Pulmonaire," by this author. 
 
99 
 
 a cure instead of the cause, of , phthisis. A military 
 commander who was believed to labour under a pul- 
 monary consumption, was wounded in an engage- 
 ment, the ball having passed through his lungs. 
 This remedy, a harsh and dangerous one it must be 
 confessed, succeeded most happily; and the man 
 lived many years afterwards, and is yet living, free 
 from every consumptive symptom. Consequently^ 
 in order to cure a suppuration of the lungs, there 
 is no necessity for the use of remedies which pro- 
 mote directly the healing of the ulcer itself, if any 
 there be, endowed with such a virtue. And we see 
 nothing in an ulcer of this nature, requiring a change 
 of climate. The assistance ofthe physician is no further 
 necessary, than in seeing that the morbid taint which 
 renders the ulcer incurable, whether affecting tlie 
 lungs only, or contaminating the general system, be 
 first removed: when that is banished, the ulcer will 
 be easily healed. For the healing powers of nature 
 alone effect the cure of an ulcer in the lungs, as 
 in other parts of the body, when every obstacle is 
 removed. 
 
 All these facts plainly prove, if I am not mistaken, 
 that a simple injury of tlie lungs, and a rupture of 
 their vessels, can never induce an incurable ulcer 
 
100 
 
 and pulmonary consumption, unless the lungs them- 
 selves or the general habit, have previously become 
 contaminated by some taint. But the nature of this 
 predisposing vice can only be ascertained from ob- 
 servations of the causes of the disease. Experience 
 therefore teaches us, that those persons will be most 
 liable to consumption, who have received an here- 
 ditary taint from their parents; who are between the 
 age of puberty and thirty-five years; who have a deli- 
 cate and weak habit, a contracted and narrow chest, 
 a deformed spine, and shoulders projecting dispropor- 
 tionably beyond the arms; who have a white and 
 smooth skin and delicate complexion, long neck, 
 weak voice, and frequent hoarseness from slight 
 causes, together with a sanguineous, phlegmatick 
 temperament: and finally, those in whom there is a 
 scrofulous and hasmorrhagick disposition, and who 
 are very liable to catarrhs. These signs, indeed, give 
 evidence of the weak habit of the whole system: but 
 especially denote a mal-conformation of the lungs. 
 The chief and most frequent causes of consumption, 
 however, if I am not mistaken, may be reduced to 
 three; to wit: a scrofulous disposition, haemoptysis, 
 and catarrh. From whichever of these the disease 
 
101 
 
 arises, I shall endeavour to show, that a change oi" 
 climate promises great assistance. 
 
 All physicians know that this complaint very fre- 
 quently arises from a scrofulous disposition. The illus- 
 trious Mead advanced that opinion many years ago. 
 Indeed, we owe to Sydenham a memorable remark, 
 which seems to have suggested this; namely, that in 
 some consumptive persons who had been cured by 
 riding^on horseback, glandular tumours in the neck 
 which bore a strong resemblance to scrofulous swel- 
 lings, have been observed after that disease had left 
 them. No doubt, however, remains on this subject 
 among physicians of the present day. Observations 
 have satisfactorily ascertained the fact, that persons 
 of scrofulous habit are more subject to consump- 
 tion than others, and that the greatest part of con- 
 sumptive people evidently have this disposition. 
 There are some physicians too, of no little reputation, 
 who, out of every hundred patients carried off by con- 
 sumption, reckon the proportion of ninety at least, 
 to be scrofulous. Besides, there is certainly a great 
 similarity and affinity between the tubercles and con- 
 sumptive ulcers of the lungs, and scrofulous tu- 
 mours and abscesses in other parts of the body. 
 
102 
 
 They also have the same external, and, if they be 
 cut by the knife, the same internal appearance; the 
 same thickness and hardness. In the same way they 
 often increase by degrees from a small* beginning 
 to a large tumour, and generally without much pain 
 or inconvenience; they suppurate tardily and with 
 difficulty, and never pass into a healthy suppura- 
 tion, but are resolved into offensive and almost in- 
 curable ulcers. Both appear at the same seasons of 
 the year, that is, in winter and the spring; upon the 
 approach of summer they are mitigated or discussed; 
 and on the return of spring both often reappear. And 
 lastly, in dissecting the dead bodies of those who evi- 
 dently died of scrofula, scrofulous tumours in all 
 parts of the bodies, and tubercles in the lungs of 
 the same kind, have not unfrequcntly been found; 
 this it has happened to me to see twice or thrice. 
 From all these things il is sufficiently evident, 
 that consumption of the lungs often arises from a 
 scrofulous disposition, and that it is a true scrofulous 
 disease. Wherefore, when consumption occurs in 
 those, who are either manifestly scrofulous them- 
 selves, or born of scrofulous parents, it is generally 
 to be attributed to this cause. 
 
103 
 
 Perhaps some may believe that it would not avail 
 much in this complaint, that its cause should be es- 
 tablished by the most unequivocal symptoms. For 
 scarcely any disease is more obscure or more diffi- 
 cultly cured than scrofula, even when it affects exter- 
 nal parts, to which remedies adapted to the disorder, 
 can be directly applied. Indeed I honestly confess that 
 almost all remedies are for the most part exhibited 
 in vain, and from their effects I have never been able 
 to collect any thing that argued a probable advantage 
 from a change of climate. Neither can much be ga- 
 thered from the causes, for nothing is more obscure 
 than they. 
 
 There are various opinions with regard to the 
 proximate cause of scrofula: some attribute the dis- 
 ease to a lentor and other vitiated properties of the 
 lymph; others think the vice is not in the lymph, but 
 ' depending on the lymphatick vessels themselves, and 
 which they believe arises from various causes, as debi- 
 lity, laxity, and preternatural enlargement. Others 
 think the disease arises from some morbid matter, 
 either engendered in the system, or received from pa- 
 rents, which by some .inexplicable process is secreted 
 from healthy fluids, and deposited in particular parts 
 
104 
 
 of the body, especially the lymphatick glands. There 
 is no necessity to expatiate in this place upon these 
 diverse notions; for whether they be correct or incor- 
 rect, unless they be more accurately investigated, no 
 curative indication arises out of them, which calls for a 
 change of climate. The remote causes of this disease 
 are not any better understood; for it is not agreed 
 among physicians whether a slender diet, consisting 
 principally of fruits and the like, similar to that of the 
 poor, and especially of the country people, should be 
 freely used; or wliether a more generous diet and 
 abounding in the luxuries of the rich, is best suited 
 to this disease. I will not venture to assert that scro- 
 fula arises from the effects of any particular climate: 
 for it is scattered throughout the terraqueous globe. 
 It is known in all regions, whether cold, or warm, or 
 temperate; and every age has witnessed it. Universal 
 as this plague is, yet, if I be not deceived, it is most 
 common in cold moist countries; and of rare occur- 
 rence in temperate and dry ones. From the observa- 
 tions of some of our physicians who have travelled in 
 Italy, this disease is more rare there than in our 
 island. It is also more rare in Spain. A very intelli- 
 gent man, who practised medicine many years in 
 Cadiz, replied to my enquiries on this subject, that 
 
105 
 
 he had seen very few persons there labouring under 
 this complaint, ^nd none affected with rickets, a dis- 
 ease which many physicians imagine to be nearly al- 
 lied to scrofula. But I have known other physicians to 
 affirm that scrofula was quite frequent in Spain. From 
 these things, therefore, scarcely any thing can be ga- 
 thered until the fact is more accurately investigated. 
 There are some who strenuously declare that this 
 complaint is more frequent in Ireland than in Great 
 Britain; and in the western parts of this island than 
 in the eastern; a circumstance that can be attributed 
 to no other cause than the greater humidity of those 
 parts. And indeed in this island, so far as I am able 
 to ascertain, it is more frequent in moist places than 
 in dry. It is therefore probable enough that a scrofu- 
 lous patient would receive some relief from travelling 
 into dry and moderately warm countries. This will 
 perhaps appear a very uncertain expectation; but if I 
 am not much deceived, it is greaUy strengthened 
 by the history of the disease, and by analogy of those 
 things that have an useful or pernicious influence. 
 
 Although scrofula rarely falls upon the lungs be- 
 fore the patient has reached the fifteenth year of his 
 age, yet generally it is found much earlier in other 
 
 O 
 
106 
 
 parts of the body, especially in the glands of the 
 neck. Sometimes indeed, and not rarely, no symp- 
 tom of scrofula is observable, until tubercles arc 
 formed in the lungs, and consumption has com- 
 menced, which doubtless had arisen from this source 
 if the patient should have had an hereditary taint, that 
 is to say, born of scrofulous parents. When scrofula 
 shows itself in external parts of the body, it is for the 
 most part between the fifth and twelfth year, and some- 
 times, though rarely, it aiRicts the unfortunate vic- 
 tim even from its infancy. Sometimes also, but very 
 rarely, it appears in more advanced age. When the dis- 
 ease occurs but once, mostly about the age of puberty, 
 it is cured by the efforts of nature, and spontaneously 
 disappears; and never after does it trouble the pa- 
 tient, unless unfortunately it falls upon the lungs, 
 and produces consumption. How this relief is effected, 
 I confess I do not know. Great changes are pro- 
 duced in the human constitution at that period, 
 which are not accurately understood: but by these 
 changes alone, many diseases are entirely cured. 
 This is a remedy therefore that we can with difficulty 
 comprehend, and never be able to imitate. But another 
 most efficacious remedy in this disease, and not an 
 artificial one but produced by nature, it is acknow- 
 
107 
 
 ledged we'can imitate by a change of climate. It is uni- 
 versally known, that external scrofulous tumours are 
 not always stationary, but at one time are augmented, 
 at another diminished; sometimes vanish, and after- 
 wards reappear. These changes are observed to be 
 produced by the different seasons of the year. Scro- 
 fulous swellings begin, for the most part, about the 
 winter solstice; in the spring they are increased; but 
 upon the approach of summer their augmentation 
 ceases; during the summer and autumn they disap- 
 pear, or at least become very much diminished; 
 and on the return of winter they are reproduced. 
 Frequently too, when these tumours suppurate and 
 produce foul ulcers, they will not yield to any reme- 
 dies, but, on the approach of summer, they sponta- 
 neously heal. Now tubercles in the lungs, as far as 
 we are able to learn from various symptoms, are ob- 
 served to be affected in the same way by the different 
 seasons of the year. For the patients in the winter or 
 spring are often affected with a slight, frequent, trou- 
 blesome, and dry cough, and difficult respiration. 
 From these symptoms, especially in those of scrofu- 
 lous disposition, consumption is always to be feared. 
 Yet not unfrequently they spontaneously recede dur- 
 ing the summer season, but return in autumn or in 
 
108 
 
 winter; and upon the advance of spring, death carries 
 off the patient. 
 
 Is it not therefore highly probable, that the winter 
 season is extremely injurious to all ulcers and scrofu- 
 lous tumours wherever they may be seated? It is not 
 altogether unlikely either, that the severity of a cold 
 climate supplies certain remote causes, both ex- 
 citing and predisposing, of the disease. And if we ad- 
 mit this, by analogy it must be granted: that sum- 
 mer, or a moderately warm climate will remove, or 
 guard against those remote causes, so that every 
 obstacle to the resolution of the tumours and the 
 healing of the ulcers being removed, the healing 
 powers of nature would overcome the disorder. The 
 disease lurking in the constitution generally falls upon 
 the weak parts. Now, moderately warm air is favoura- 
 ble to respiration, and invigorates the lungs: why then 
 should we not think that a moderately warm climate 
 would in this manner overcome consumption, or in 
 some other hidden way would ward off the proxi- 
 mate causes of the disease? But in whatever manner 
 the injury has arisen; whether winter gives rise to the 
 remote causes of the complaint, or only exerts an 
 injurious effect upon the disease already existing: it 
 
109 
 
 is clearly evident, that the danger can be avoided in no 
 other way than in flying from the intemperance of the 
 winter season, by travelling into warmer countries. 
 If the patient should undertake a journey into suita- 
 ble countries, where he could sojourn for a sufficiently 
 long time: he might enjoy a perpetual summer 
 throughout the whole year, or if necessary, for many 
 years together. Thus might all the inconveniences 
 of our long winter be avoided; and whatever good is 
 received from our summer, might be thus derived at 
 pleasure from the summer season of foreign countries; 
 and we might expect, not only that a stock of health 
 would be procured, but also that it would be greatly 
 augmented. And indeed to me it does not by any 
 means appear absurd to expect, that if a summer 
 lasting for four months exerts so powerful an influ- 
 ence as to heal scrofulous ulcers, dissipate tumours, 
 and in fine, drive away the disease for many months; 
 a perpetual summer would not only hinder the 
 return of the complaint for a long time, but also 
 change the whole habit of body, and radically extir- 
 pate the scrofulous disposition, so that all danger 
 of scrofulous consumption afterwards supervening, 
 would be entirely prevented. It cannot be objected to 
 these arguments, that scrofula is sometimes found 
 
110 
 
 in warm countries: for it is well known that climate 
 exerts much more powerful eifects upon foreigners 
 than upon natives. When the constitution is accus- 
 tomed to much heat, certainly it does not derive 
 much advantage or inconvenience from it. If there- 
 fore heat is a remedy for the disease, the more one is 
 accustomed to it, the higher is the degree of it 
 that may be employed; and perhaps nothing else is 
 requisite to cure the scrofula of Spain, than a journey 
 into a still warmer climate. 
 
 All these circumstances are greatl} confirmed by 
 observation of the effects which experience shows to 
 result from a change of climate, in curing or pre- 
 venting incipient consumption. Many of our inhabi- 
 tants every year, who have every symptom of inci- 
 pient tubercles in the lungs, seek milder climates upon 
 the approach of cold weather, where they remain one 
 or two winters. Some are relieved altogether from 
 the disease, and return to their native country healthy 
 and robust, and never afterwards perceive any sign of 
 consumption. Whilst others, who have tarried abroad 
 only one winter, return home believing themselves 
 cured: but in the first winter they are seized with 
 their former complaint, and die in a short time. If 
 
Ill 
 
 then a change of climate exerts such a mighty in- 
 fluence in curing this disease, that it can remove or 
 dissipate tubercles already formed: how much more 
 powerfully ought it hot to operate, in preventing 
 them. And so the fact is: for though scrofula some- 
 times occurs in the warmer climates,'^ yet consump- 
 tion of the lungs is rarely observed. It is reasonable 
 therefore to expect, that our scrofulous patients who 
 have gone abroad into such countries before the 
 phthisical age, will be free from consumption. From 
 all these facts it appears very evident to me, that a 
 change of climate promises the most advantageous 
 effects in curing and preventing phthisis pulmonalis, 
 arising from scrofula; but certainly it is much better 
 to guard against a disease so dangerous, than to con- 
 tend with it when already formed. — The learned 
 Mead long ago advanced a similar opinion, in his most 
 excellent medical maxims and precepts, respecting 
 the use of a change of climate in guarding against 
 
 *^ This disease is very common in Mexico. Indeed it appears 
 to be a more common complaint than is generally imagined. 
 Professor Barton says, in his lectures on the Practice of Phy- 
 sick, that it is an extremely common disease among our 
 North American Indians. This fact, which the professor has 
 
112 
 
 consumption in persons of scrofulous habit. I shall 
 here quote his words: ** A change of climate often 
 
 substantiated by the most satisfactory proof, seems, if we ad- 
 mit the identity of scrofula and consumption, in direct 
 opposition to the assertion of his predecessor in that chair, 
 the late Professor Rush, who says this last disease " is un- 
 known among the Indians in North America."* Dr. Bar- 
 ton says, that it is a complaint very rife among those tribes 
 the most remote, and who have little or no intercourse 
 with the whites, and that its fatality among the Onon- 
 dago Indians of the state of New York, has nearly extermi- 
 nated that tribe. There is every reason in favour of this asser- 
 tion; for, that scrofula does afflict them is incontiovertibly 
 proved, and where this disease is found, phthisis pulmonalis 
 cannot be a stranger. It will appear from the text above, that 
 Dr. Gregory was not very sanguine in his expectations of the 
 radical cure of scrofula by a change of climate; and in those 
 particular stages of the disease in which he hints its ineffi- 
 cacy, there will be found but little indeed, to cause a difference 
 in opinion from this learned author. The basis of the hope of 
 curing scrofula by a change of climate, rests undoubtedly on 
 the fact, that an atmosphere surcharged with moisture, is 
 highly favourable to the production or evolution of scrofulous 
 symptoms, when they have not yet appeared, and to the evi- 
 dent aggravation of them, when the disease is already formed. 
 The change from a climate possessing such unpropitious 
 
 *• Thoughts on the Cmuse and Cure of Pulmonary Consumption. 
 
113 
 
 affords heafth, especially if there should be danger of 
 the disease (that is scrofula) falling tipon the Itihgs; 
 
 qualities fot* the scrofulous, to one endowed with an irhiforia 
 dryness and elasticity with a view to cure or alleviate the 
 disease, is far from chimerical. In my practice on ship boardf, 
 I have seen actual benefit from such a change, and have 
 had one or two cases of very troublesome scrofulous ulcers ol 
 the arms and legs, which resisted pertinaciously every cflRor^ 
 to heal them, but rapidly healed under the same remedies 
 after a change of climate, and even under the disadvantageous 
 effects of a less healthy and pure diet, than that Which the? 
 patient had used in port. The experience I have had withf 
 this disease is indeed but limited, for scrofula is far from tf 
 common complaint among sailors, though more frequent thstrf 
 consumption: yet it has been such as to induce me to believd 
 that more relief m^y reasonably be expected from a changed 
 of Climate, even in the more advanced stages of the disease, 
 than Dr. Gregory is inclined to think. I know not indeed, 
 whether the sea-sickness itself has any good effect on obstinate 
 scrofulous ulcers— perhaps not — but this I know, that in the' 
 cases 1 allude to, the ulcers exhibited very soon after going 
 to sea, a much more healthy aspect. I know further, that 
 glandular tumours are undoubtedly diminished by this sick- 
 ness. I have four or five times seen the detumescence of swel- 
 lings in the neck which I apprehended were strumous, takd 
 place during a few days of rough weather, and twenty ti'me^ 
 and more have I observed the dissipation of venereal buboes- 
 
 p 
 
114 
 
 provided that the patient chooses a country not too 
 warm, nor too cold, nor an unhealthy season, for the 
 
 from the same cause. I have remarked too that in those cases 
 where these buboes became diminished, the subjects of the 
 disease were mostly landmen^ who having been never before to 
 sea, were violently affected by the motion of the ship, being 
 for days together vomiting, scarcely without intermission. 
 Dr. Barton mentions in his lectures, the case of a young 
 gentleman who came under his care in this city, for a 
 goitrous swelling. The doctor, after recommending a va- 
 riety of remedies, which were ineffectually tried, advised a 
 sea voyage. This was performed, but without any relief; 
 another was undertaken to New Orleans, where the pa- 
 tient, after being attacked by a malignant fever, reeovered 
 from his first complaint. The disease of goitre bears no 
 small relation to scrofula, and a moist atmosphere has 
 no little agency in generating it. The theory of Dr. Barton 
 with respect to this complaint, and which the Doctor has ve- 
 rified by a few but strong corroborative facts, refers its origin 
 to the same* causes which produce intermittent and other 
 fevers. The activity of moisture in marsh exhalations, is well 
 known. How reasonable then the hope that this singular and, 
 in the female sex particularly, this very unseemly complaint, 
 would derive much benefit from a change of climate to one of 
 a dry atmosphere! But to return to scrofula. I have said the 
 foundation of the hope of relieving scrofulous patients by a 
 
 * Vide Memoir concerning the Disease of Goitre, &c. Philad. 1800. p. 57. 
 
115 
 
 change." Under the protection of such a name, I 
 repeat my opinion with confidence; nor am I 
 
 change of climate^ is built on the acknowledged pernicious 
 agency of moisture on the disease. In corroboration of this, I 
 will quote a passage from Dr. Russel's* valuable work on 
 this complaint. ^< The disadvantages of a bad climate, and of 
 an unfavourable local situation, can only be radically sur- 
 mounted by changing the place of residence to one more sa- 
 lubrious; or, if such a change is not practicable, by adopting 
 the best artificial substitute to correct the inconvenience. As 
 cold and moist air is found to be so highly prejudicial in scro- 
 fula, we endeavour to substitute an artificial atmosphere, 
 which may be warm and dry, and which therefore may, as far 
 as possible, counteract the pernicious tendency of an inhos- 
 pitable climate. Artificial fires are equal to support a mode- 
 rate and proper temperature within doors, and persons of de- 
 licate constitutions, who are threatened with an attack of scrp- 
 fula, ought to be permitted to go abroad in winter only for a 
 short time at once, so that they may not be chilled, nor suffer 
 any injury from long continued exposure to cold and damp 
 air." In another placet l^r. Russel attributes so much good 
 effect to the influence of regular and continued exercise in 
 preventing scrofula, that it would seem as if the doctor had 
 kept in his mind the exercise produced by the motion of a 
 
 ♦ Treatise on Scrofula. Edinburgh, 1808. p. 59. 
 t Ibid. p. 52. 
 
11.6 
 
 ashamed that my conclusions should be rendered 
 sound in this manner. With regard to the benefit 
 that may be expected in scrofulous consumption, 
 from the exercise itself of the journey, I shall not pre- 
 sume to advance any thing from experience. But 
 cases related by Sydenham show, that exercise pro- 
 duces the happiest effects on this complaint. Relief 
 and assistance therefore, might be expected from 
 the exercise of the journey itself, in this, as in many- 
 other diseases. 
 
 Another, and not unfrequent cause, of consump- 
 tion, in this island at least, is hasmoptysis. How it pro- 
 duces consumption, I shall not undertake thoroughly 
 to explain; since however, experience has taught 
 that phthisis pulmonalis generally succeeds haemop. 
 tysis, I have no doubt but that this might be as- 
 
 vessel at sea, when he wrote as follows: << The exercise of per- 
 sons studious to ward off an attack of scrofula, ought to be re- 
 gular, moderate, and long continued, sufficient to dispose 
 them to rest, but not of incurring that degree of fatigue whiph 
 would excite a temporary fever, or permanently impair the 
 strength. It seems immaterial what kind of bodily exercise is 
 preferred, provided the above-mentioned circumstances be 
 properly attended to by the patient." 
 
U7 
 
 signed as the cause of consumption. Certain physi- 
 cians, as we have mentioned above, think that a mere 
 rupture of the blood-vessels, such as occurs at least 
 generally in haemoptysis, produces an incurable 
 ulcer and consumption; for by the violent circulation 
 of the blood in the lungs, and their continual motion 
 in respiration, and the free access of air, the wound 
 is kept open, and its healing perpetually obstructed. 
 It is not necessary to repeat the arguments by which 
 this opinion is refuted. Experience satisfactorily 
 proves, that consumption does not happen at least in 
 piost cases, from a mere rupture of a blood-vessel 
 in the lungs, nor indeed from suppuration itself, pro- 
 vided that viscus had been previously sound. Others 
 assign another and indeed much more probable cause 
 of the disease: namely, that the blood effused 
 into the lungs from ruptured vessels is not intirely 
 ^ejected by coughing, but some portion of it remain- 
 ing in the lungs, is there putrefied, and irritates and 
 corrodes the neighbouring parts, and at length pro- 
 duces a foul and incurable ulcer. I do not doubt, but 
 a great deal of injury might arise from this source: 
 yet if I am not mistaken, that injury rarely happens, 
 unless the lungs have been previously affected with 
 some taint. Fpr in other parts of the body, provided 
 
118 
 
 the constitution be sound and vigorous, blood 
 effused in the cellular texture, is soon absorbed with- 
 out any injury or danger. I have seen the arm, after 
 blood-letting unskilfully performed, covered with a 
 livid hue from the wrist up to the shoulder: yet 
 neither suppuration nor gangrene arose from it; the 
 the blood spontaneously disappeared, so that after 
 twenty days no trace of the affection was left. Often 
 also, there are no ulcers formed in the lungs after 
 haemoptysis, although it is hardly probable that 
 all the blood effused ,in them is expectorated by 
 coughing. If therefore no such injury is produced 
 after haemoptysis, it is probable that the effused 
 blood not rejected by spitting, has been taken 
 up by the absorbent vessels. But if, from some 
 cause or other this is not effected, we may readily 
 believe, that an ulcer and other bad consequences 
 might arise from the putrefaction of blood effused 
 into the cellular substance of the lungs. Besides, 
 such a load in the lungs would without doubt excite 
 frequent coughing, than which nothing contributes 
 more to produce consumption, as will afterwards 
 be proved. 
 
 Lastly, there are some who inculcate the notion 
 
119 
 
 that haemoptysis is not the cause of consumption, 
 but only a sign and effect of its cause.^° They be- 
 lieve that phthisis arises from tubercles in the lungs 
 which had for a long time existed before haemop- 
 tysis begun, and which they affirm, brought on that 
 disease, or rather symptom; in other words, the blood- 
 vessels being so compressed by their own mass, that 
 the blood is disembogued either by transudation or 
 from ruptured vessels, into the lungs. Dissections 
 also of dead bodies plainly show, that tubercles, 
 whether scrofulous or produced by other causes, are a 
 frequent cause of consumption, or at least accompany 
 it; and it appears from observations that tubercles 
 
 20 An ingenious French writer, whom I have before quoted, 
 and who has taken particular pains to refute the reasoning and 
 arguments advanced by Dr. Thomas Reid and others, in fa- 
 vour of the use of sea-voyages in pulmonary consumption, 
 after strenuously opposing the mode of cure recommended by 
 Dr. Reid, by means of emeticks, and asserting that it is pre- 
 dicated on a false theory of the disease, asks with a tone of 
 great self-conviction: ** quel est le medecin a gut il soit encore 
 fiermis dHgnorer que cea fihlegmes^ que cea mucoaites, que ces 
 oollea aont l^ effect et non la cauae de la phthisic? — Traite sur la 
 Nature et le Traitement de la Phthisic Pulmonaire, par Julien 
 BounafoK Demalet, p. 170. 
 
120 
 
 arise in the lungs from other causes besides a Scro- 
 fulous disposition. Certain mechauicks are very 
 much exposed to dust from the nature of thtrf 
 trades; as for example, those engaged in grinding 
 flour, cutting stones, hackling flax, and other similar 
 occupations, arc very liable to tubercles in the lungs 
 and to pulmonary consumption; nor can this be im- 
 puted to any other cause than the dust which they 
 daily receive into the lungs. Yet I can by no means 
 believe, that consumption does not arise from hae- 
 moptysis, unless tubercles have previously existed 
 in the lungs: for in the dissections of the bodies 
 of those who died of this disease, a large ulcer is 
 often found, but no tubercles; many phthisical pa- 
 tients also, after an attack of haemoptysis, are 
 carried off*, who before this seized them, had never 
 exhibited any signs of tubercles. Sometimes also, 
 after a badly treated peripneumony whic h has ter- 
 minated in suppuration, a genuine consumption of 
 the lungs follows, although there had before been n6 
 signs of tubercles. And sometimes, though rarely, 
 consumption is produced by great external force in- 
 flicted on the lungs. 
 
 In the proximate and remote causes of hsemop- 
 
121 
 
 tysis then, and in the state not only of the lungs, but 
 of the whole system, which precedes and accompa- 
 nies it — is to be sought the reason why phthisis pul- 
 monahs succeeds this complaint. 
 
 From the observations of physicians it satisfacto- 
 rily appears, that a disposition to haemoptysis is often 
 received from parents; hence it is evident, that the 
 disease does not derive its origin from any slight or 
 accidental cause, but from the formation and peculiar 
 constitution, as well of the lungs, as of the whole 
 body. For it is well known that parents often transmit 
 their temperament and peculiar conformation, to their 
 offspring: and, at least in many cases, we see by an 
 evident deformity of the chest, that a defective struc- 
 ture of the lungs exists. Wherever such a formation 
 occurs, the lungs are never properly distended, and 
 the motion of the blood through them is obstructed; 
 hence arise an irregular circulation and congestion 
 which weaken and distend the blood-vessels, and 
 render them liable to rupture. Many of the exciting 
 causes which frequently produce haemoptysis, evi- 
 dently induce a congestion of blood in the lungs. 
 For example: violent exercise, or great straining of 
 the body as in running, or in lifting great weights; 
 
 Q 
 
122 - 
 
 immoderate coughing, vociferation, singing, &c. Be- 
 fore the blood is discharged, the most evident symp- 
 toms of irregular determination and turgescence of 
 blood in the lungs, are almost always observed: such 
 as a sense of weight, or heat, or uneasiness, or pain 
 in the breast, and a redness of the cheeks. Upon the 
 discharge of blood, all these spontaneously, and 
 generally very soon, disappear; and often by a 
 seasonable blood-letting, the haemorrhage is alto- 
 gether prevented. It has been observed also, that 
 signs of spasmodick constriction of the extreme ves- 
 sels, precede and accompany haemoptysis. Some- 
 times a sudden application of cold to external parts, 
 especially if the body has been previously heated, 
 produces haemoptysis: and all physicians know that 
 nothing conduces more to prevent and cure this, 
 than promoting and restoring the due determination 
 of the fluids to the surface of the body. It appears 
 plain therefore, that an irregular determination and 
 congestion of the blood in the lungs, produces hae- 
 moptysis; wherefore it is now to be inquired, how 
 that irregular action is produced, and why the blood 
 is determined to the lungs in such an increased 
 \^ quantity. 
 
123 
 
 Experience shows that haemoptysis happens es- 
 pecially to those who are accustomed to high living, 
 and who have changed from a more active kind of 
 life, to one of an indolent and more sedentary na- 
 ture; but most of all to those in whom some cus- 
 tomary excretions, particularly of blood, existing 
 either naturally or preternaturally, have ceased: and 
 of this kind, haemorrhages from the nose, and in 
 females, the menses, are the principal; to these might 
 be added an omission of a customary blood-letting, 
 and sometimes, though rarely, suppressed piles. Hae- 
 moptysis also is observed to happen oftener in the 
 spring of the year than at any other time; and for the 
 most part to men only between the eighteenth, and 
 thirtieth, or thirty-fifth years of age, in which period 
 a plethorick state is known to exist from various 
 symptoms. It cannot then be doubted, that haemop- 
 tysis may arise like all other haemorrhages, from 
 plethora, and therefore the causes of that plethora 
 which produces this complaint, will now be briefly 
 related. 
 
 During infancy, when the body is daily growing, 
 there is the greatest abundance of healthy blood, 
 which is required for nourishing the system, and sup- 
 
124 
 
 porting its growth. This indeed is a true plethora, yet 
 never of an unhealthy kind. At that period, the ves- 
 sels easily yield, and are dilated, until the body has 
 arrived at its proper size; but when the vessels have 
 become stronger, and resist the blood, then plethora 
 is perceived, and haemorrhages and other diseases are 
 produced by it. 
 
 From the observations and experiments of the ce- 
 lebrated Winthringham, junior, it appears: that a 
 different proportion of thickness and strength of the 
 arteries and veins takes place at different periods of 
 life. In infancy, and also in youth, the veins possess 
 much more strength and thickness than the arteries: 
 in more advanced age, the arteries obtain in their 
 turn the greatest strength. The proper equilibrium 
 is observed to take place about the thirtieth or thirty- 
 fifth year. Hence, if plethora exists in the system 
 before the patient has reached his thirtieth year, it 
 shows itself only in the arteries, or at least particu- 
 larly in them; because the veins, from their greater 
 thickness and strength, are able to resist an exces- 
 sive fulness of blood: but the arteries, from their 
 greater laxity and weakness, receive too great a 
 proportion of blood, and therefore become distended. 
 
125 
 
 Thence arises congestion; and upon any sudden and 
 violent action which greatly disturbs the distribu- 
 tion of the blood, a rupture of the arteries and con- 
 sequent haemorrhage is produced. After the thirty- 
 fifth year, haemorrhages of the veins generally occur, 
 but rarely of the arteries. 
 
 When the increased arteries are full of blood, 
 and yield naturally and equally to the strength of 
 the veins, and all parts of the body daily increase, 
 no inconvenience can arise from that natural ple- 
 thora. But when the growth of the body ceases, 
 and morbid plethora follows, haemorrhages ought 
 first to appear in that part of the system which has 
 first reached its proper size. Hence at that period 
 haemorrhages are to be expected in the head, because 
 this part, as is well known to all physicians, painters, 
 and statuaries, receives its full growth before the 
 other parts. And this is the fact: for haemorrhages of 
 the nose are found to occur before any others, and 
 generally indeed, from the fifth to the eighth year. 
 But when all parts of the body have attained their 
 full size, the reason for haemorrhages happening 
 most frequently in the head, ceases to exist. Then 
 the veins, possessing as yet more strength than the 
 
126 
 
 arteries, haemorrhages ought to happen especially in 
 those parts in which the blood flows with the greatest 
 fulness and force. Hence appears the reason why 
 they happen at that period in the lungs: for the same 
 quantity of blood flows through the lungs as circu- 
 lates through all the rest of the body. If therefore, 
 the distribution and equable circulation of the fluids 
 should from any cause be very much disturbed, it is 
 evident that all the ill consequences arising thence, 
 would be felt particularly in the lungs: for however 
 small that viscus may be, its blood-vessels always 
 contain a great quantity of blood. A still larg(^r quan- 
 tity, or even a greater impetus of the blood, could not 
 be borne without danger. They are consequently 
 easily ruptured, and hence arises haemoptysis. But 
 afterwards, when the arterial system has received 
 more strength than the venous system, that is, when 
 man has passed his thirty-fifth year, hzemorrhages 
 from the lungs, and indeed from the arteries in any 
 part of the system, should not any more happen. And 
 the plethora, if any exists in the system, is felt par- 
 ticularly or altogether in the veins. This disorder, 
 and its consequences, most frequently happen in 
 parts of the body where the motion of the blood in 
 the veins is most slow. Hence in advanced age the 
 
127 
 
 flowing of blood occurs oftenest from the hsemor- 
 rhoidal veins; for the blood in them which is greatly 
 retarded, does not in fact return to the heart, but 
 passes through the vena portarum, and flows through 
 the liver. Besides, the haemorrhoidal veins have but 
 little assistance from muscular motion, and want 
 valves altogether. Hence follow frequent and great 
 congestion, and not seldom, tumours or varices of 
 the veins, and ruptures and effusions of blood. 
 From similar causes congestion and effusion of 
 blood often happen in the brain at the same age, 
 and paralysis and apoplexy (which Hoffman calls 
 hasmorrhage of the brain) are produced. 
 
 From all these circumstances we may certainly, 
 if r be not mistaken, conclude that a plethorick state 
 of the whole system and an excessive determination 
 and congestion of blood in the lungs, is the cause of 
 haemoptysis. Yet it is often observed, that neither 
 haemoptysis nor other haemorrhages, nor any other 
 inconveniences arise from that plethorick state which 
 succeeds the cessation of growth in the body; nor 
 from the excessive thickness of the veins and laxity 
 of the arteries, provided the constitution shall have 
 been sound and vigorous: unless some powerful ex- 
 
128 
 
 citing cause concurs at the same time. For most 
 men and other animals are free from these inconve- 
 niences. But when a morbid disposition has already- 
 existed in the system, especially weakness of the 
 lungs, either derived from parents, or generated by 
 a malformation of the chest, or arising from other 
 more obscure causes: haemoptysis is frequently pro- 
 duced. And although no bad conformation may exist, 
 particularly in the lungs, if only the habit of the 
 whole system be weak, if a plethorick state should 
 supervene, or if some sudden and violent external 
 cause greatly disturbs the distribution of the blood, 
 the bad consequences arising thence, are felt for the 
 most part in the lungs. Experience evidently shows, 
 that from haemoptysis accompanied by such a deter- 
 mination and congestion of blood in the lungs, that 
 viscus receives such an injury, that an incurable 
 ulcer and consumption arise from it, although a 
 simple wound would never be able to induce such 
 bad consequences. 
 
 I can by no means accurately explain what changes 
 are produced from a congestion of blood in the lungs, 
 and why an incurable ulcer or wound should occur 
 during the existence of such a state of this viscus. We 
 
1S6 
 
 understand indeed that such a state of the lungs is 
 far from being heahhy and natural; and if it be ne- 
 cessary for curing a wound or an ulcer, that the con- 
 stitution of the whole body or any part of it, should 
 be healthy and strong, it is no wonder in this 
 case, when the lungs were already somewhat dis- 
 eased, that a wound in them would be difficult to 
 heal. Perhaps an excessive fulness of blood, and 
 weakness of the vessels and of other solid parts, im- 
 pede the absorption of effused blood, or a healthy 
 suppuration of an ulcer. Whenever the pathology of 
 this viscus shall be better understood, we may be 
 able to explain this circumstance more accurately. In 
 Jthe mean time, in my opinion, it is fair to attribute 
 consurnption succeeding hsemoptysis, to a praeter- 
 natural determination of blood to the lungs. For this 
 not only gives evidence of incipient phthisis, but ac- 
 companies the disease through almost its whole course, 
 to its last stages, and in proportion to the greater or 
 less force of this determination, the complaint is aug- 
 mented or relieved. Thus all remedies which are 
 agreed to be useful in preventing, mitigating or curing 
 consumption, manifestly tend to diminish the abun- 
 dance of blood, moderate its force, remove the conges- 
 tion, and promote an equal distribution. There is no 
 
 R 
 
130 
 
 occasion to say much to show how my opinion 
 is confirmed; it naturally arises from the theory of 
 haemorrhages, and especially of haemoptysis. Who 
 does not know that hght diet, consisting of milk and 
 fruits, and frequent blood-letting, are of great ser- 
 vice? The summer season, warm clothing, flannel 
 shirts, frequent and moderate exercise, riding on 
 horseback, gestation in a carriage, and sailing, — only 
 do good by diminishing the congestion of blood in 
 the lungs, and promoting a determination to other, 
 especially to external parts. 
 
 We have already said enough with regard to 
 the effect of the different seasons of the year in 
 scrofulous consumption: the same thing happens in 
 phthisis arising from haemoptysis. There are some 
 persons who in the spring of every year, have all the 
 signs of congestion of blood in the lungs and inci- 
 cipient phthisis; an abscess is formed in the lungs, 
 it bursts, and pus is expectorated. On the approach 
 of summer however, the complaint ceases, and the pa- 
 tients enjoy the appearance of health. But on the re- 
 turn of winter, the disease recurs again and again. 
 In this way life is sometimes protracted for twenty 
 years and more. 
 
131 
 
 Although summer is very favourable to the con- 
 sumptive, yet winter is by no means the most dan- 
 gerous season. All agree that spring and autumn are 
 much the most injurious to them; because, in those 
 seasons the distribution of the blood is most dis- 
 turbed, by the great and sudden changes of the 
 weather. The perspiration is copious in the sum- 
 mer from the heat of the air, and a due distribution 
 to the surface of the body is promoted: the determi- 
 nation however to the kidnies, and the quantity of 
 urine, is diminished. But in the winter time, the ex- 
 ternal cold checks perspiration, and drives the blood 
 from the surface; and then the quantity of urine is 
 much greater. There is a kind of equilibrium there- 
 fore, between the skin and the kidnies, so that when 
 the excretion by one is checked, it is augmented by 
 the other. Hence many inconveniences arising from 
 the heat of summer, and especially from the cold of 
 winter, are happily avoided. But in the spring and in 
 autumn that equilibrium is vascillating; hence if an 
 excessive determination to the lungs or any other 
 part shall already have occurred at those times, es- 
 pecially by the action of the exciting cause, which 
 the sudden changes of the weather afford, it ought to 
 be greatly augmented. When however a fixed deter- 
 
132 
 
 raination of blood takes place, either to the surface of 
 the body, or to the kidnies, the irregular determina- 
 tion to the lungs is lessened: and theri fore the con- 
 sumptive feel much less inconvenience from the dis- 
 ease in summer and in winter, when these determi- 
 nations are regular and constant. Indeed, instances 
 have frequently occurred which plainly show of how 
 much consequence it is, for preventing, or curing, 
 or alleviating this disease, that the determination of 
 blood should be averted from the lungs. All physi- 
 cians know that while women are pregnant they 
 rarely die of consumption of the lungs. Nay, if a 
 woman already decaying in a consumption becomes 
 pregnant, the progress of the disease is generally ar- 
 rested, or at least greatly retarded, until she brings 
 forth her child. Yet often in a short time after par- 
 turition, sometimes in a few weeks, sometimes in a 
 few days only, they die of consumption. All these 
 facts, if 1 am not deceived, are to be attributed for 
 the most part to the diflferent distribution of the 
 blood. During gestation, a great quantity of blood 
 flows to the uterus, for the nourishment and forma- 
 tion of the foetus. Hence its determination to the 
 lungs is averted; the congestion in them is lessened 
 or removed, and all the evils arising from it, greatly 
 
mitigated, or altogether cured But in a short time 
 after parturition, that natural and healthy determina- 
 tion to the uterus, ceases. It is not surprising, there- 
 fore, that the congestion of blood should afterwards be 
 incrtastd in the lungs, and that the disease arising 
 from it, should grow worse. We might indeed be- 
 lieve a priori^ that those unfortunate women had 
 but one hope left, which nature spontaneously ex- 
 tended for their relief. If that great determination to 
 the uterus should suddenly cease, and no other natural 
 one was to succeed, it is evident that the disease in 
 the lungs would be greatly augmented, and that the 
 greatest danger must arise thence. But it is known, 
 that in a short time, generally a few hours only after 
 parturition, a great determination naturally takes place 
 to the breasts. It is reasonable enough then to expect, 
 that this new determination would have the happiest 
 effects, provided it should be promoted in the way 
 nature intended, that is, by the woman suckling 
 her child: for the congestion in the lungs ought to 
 be diminished or altogether taken away, and life be 
 protracted until the disease be cured by the powers 
 of nature. And in fact, I have obtained from the 
 highest authority some examples, and have seen 
 one myself, in which this experiment was made, 
 
134 
 
 and consumption of the lungs was most evidently 
 cured altogether, without the use of any other reme- 
 dies whatever. And I do not doubt but that this re- 
 medy might cure many piidiisical persons, especially 
 if the disease has not arrived at its last stages. But the 
 experiment is rarely tried, for there are few who would 
 believe that a woman already consumptive and nearly 
 dying, could give milk to an infant without danger 
 to herself and the child. Yet experience teaches that 
 such women bear children and nourish them, not 
 only without injury or danger, but with the greatest 
 benefit. The children also, at least in the generality 
 of cases, are never weak nor sickly, nor are they ob- 
 served to experience any inconvenience from the 
 disease under which their mothers laboured. I 
 can hardly believe, therefore, if women suckle their 
 own children, that any danger would arise from it, 
 either to the child or parent; and I am clearly of 
 opinion that it might have the happiest effects; it is 
 better surely in so dangerous a disease, to try an un- 
 certain remedy, than leave the patient to certain 
 death. — But to return to the subject. 
 
 Although the determination to the kidnies is 
 greater in winter than in summer; yet it is never 
 
135 
 
 constant: for it is often disturbed by the sudden 
 changes of the weather, which generally occur in 
 winter very frequently. But if the winter's cold be 
 ever so continued, the distribution of the blood would 
 be daily disturbed, unless the air of the chamber and 
 the external air should be of the same temperature. 
 When the external air is excessively cold, the air of 
 a room is equal to or greater than summer heat; hence 
 arise great and sudden changes of the distribution of 
 the blood. The reason then is clear why the summer 
 is more salubrious to the consumptive than winter: 
 for the determination to the surface of the body which 
 occurs in summer, is almost continual; and although 
 the perspiration should be at one time more and ano- 
 ther less, the determination of blood, unless from 
 some sudden and violent cause which rarely hap- 
 pens, is wholly changed. The same reason may 
 be given for the effects of seatons, of issues, and 
 of blisters, which not unfrequently give relief to the 
 consumptive. 
 
 There remains therefore, one method by which we 
 can always hope to remove the congestion of blood 
 in the lungs; namely, by promoting a determination 
 to the surface of the body. Yet this, as we have often 
 
1^6 
 
 already observed, is most effectually and most certain- 
 ly performed, by a moderate, uniform, and constant 
 warm air. But our climate possesses such an air only 
 for a few months. A milder climate should therefore 
 be sought by the consumptive: and daily experience 
 confirms sufficiently the propriety of this advice; for 
 many of our inhabitants are annually snatched from 
 death, which under other circumstances would ine- 
 vitably happen. Warm clothing and moderate exer- 
 cise, are somewhat similar to this remedy; and what- 
 ever good is derived from them is, in my opinion, to 
 be attributed entirely to a change in the distri!)ution 
 of blood. With regard to clothing, there are a few 
 things to be observed. It is well known that flannel 
 shirts are exceedingly beneficial in this disease. 
 This is surely a most simple remedy, and certainly 
 there is nothing more plain than that it will directly 
 promote the determination of blood to the surface of 
 the body. Linen shirts, when there is a profuse per- 
 spiration, soon become wet and feel cold; hence 
 perspiration is checked. But flannel shirts easily ab- 
 sorb sweat or moisture, and do not become wet with- 
 out there is a prodigious perspiration: hence the skin 
 remains dry and warm, and the perspiration is greatly 
 promoted. It is known to every one, that exercise 
 
137 
 
 has a similar effect; it plainly appears therefore, how 
 it could diminish or remove a congestion in the lungs. 
 Indeed at first blush it would not be unreaspnable to 
 apprehend dangerous consequences from exercise, by 
 reason of the effect it has in increasing the impetus of 
 blood. If the exercise should be violent, it would with- 
 out doubt prove very injurious; for walking, riding, 
 and similar more powerful exercises, immediately in- 
 crease the difficulty of respiration, and other symp- 
 toms. But experience has very clearly proved > that 
 moderate exercise, sailing, gestation in a carriage, and 
 not unfi-equently riding on horseback, — diminish or 
 remove the congestion of blood in the lungs, and other 
 injuries arising from it. This is evidently to be attri- 
 buted to the increased determination of blood to the 
 surface of the body. The celebrated CuUen, has men- 
 tioned in his lectures a singular case, which satisfac- 
 torily confirms this theory. It was that of a man who 
 laboured under haemoptysis, who, while he remained 
 at home, and used no exercise, was affected very 
 badly, and suffered many returns of the complaint. 
 Yet fi-om riding on horseback he always derived re- 
 lief; and sometimes, when the disease greatly troubled 
 him, he mounted his horse and rode for some time, 
 with the effect of being freed from the complaint, for 
 
 S 
 
138 
 
 a time at least. Gilchrist relates other examples of a 
 like nature, from the effect of sailing. 
 
 But Sydenham extols this remedy more than all other 
 physicians; and not only in the slight and incipient 
 form of phthisis, but even in the last stages of the 
 complaint, when that species of diarrhoea with night 
 sweats termed colliquative, has already come on, and 
 which is generally soon followed by death: " However 
 fatal consumption may be, (says this writer,) yet I 
 firmly maintain, that neither mercury in the venereal 
 dist^ase, nor Peruvian bark in intermittent fever, arc 
 more efficacious, than the exercise already com* 
 mended, (that is, riding on horseback,) is in curing 
 consumption; provided the patient takes care to have 
 his sheets or bed clothes properly dried, and also, 
 that he protracts his ride to a long journey. This I 
 have learned from numerous experiments in which it 
 scarcely ever failed. And although riding on horse- 
 back is peculiarly suitable for consumption, yet 
 journies performed in a carriage, when they have been 
 judiciously taken, have had the happiest effects."" 
 
 31 Bishop Burnet says, that the lawyers of his time were 
 (caeteris paribus) longer-lived than other people; and attributes 
 
139 
 
 Later physicians do not bestow such praises upon 
 this exercise; yet ail agree that it is often of the 
 greatest use. It is evident therefore, how much ben^:fit 
 consumptive patients, labouring under hered'tiry 
 hsemoptysis, might derive from the exercise itself of 
 travelling. 
 
 The third, and indeed the most frequent cause of 
 consumption, yet remains to be noticed: namely, ca- 
 tarrh. Every one knows that consumption of the lungs 
 not unfrequently succeeds a protracted catarrh: but it 
 is often difficult to distinguish catarrh from genuine 
 incipient consumption produced by tubercles in the 
 lungs: for the principal symptom, that is the cough, 
 occurs in both; and I do not doubt but that many 
 consumptions attributed to catarrh derive their ori- 
 gin from tubercles. But it is clear enough that catarrh 
 not unfrequently induces true consumption, when no 
 tubercles had previously existed in the lungs. For 
 there are many instances where, after the most evident 
 
 this to their riding the circuits on horseback: but this is un- 
 doubtedly too violent an exprtion, except in the first stages of 
 phthisis. There are few physicians of the present day, I be- 
 lieve, who would recommend their patients to try this jolting 
 remedy, in any other period of the complaint. 
 
140 
 
 symptoms of catarrh arising from common causes, 
 (that is, cold some how applied to the body,) a ge- 
 nuine and fatal consumption of the lungs followed; 
 although there were no previous signs of tubercles, 
 or any disease in the lungs, and where there was no 
 suspicion that a scrofulous disposition existed in the 
 system. Sometimes also, and not seldom, consump- 
 tion of the lungs arises from whooping cough. 
 
 Since therefore, there is not the least doubt of the 
 fact, that long continued catarrh produces consump- 
 tion, the rationale may now be given; and if I mis- 
 take not, the same which we have above advanced 
 respecting haemoptysis, may be easily applied to 
 consumption arising from catarrh. If congestion of 
 blood in the lungs renders them liable to consump- 
 tion, we may easily understand how a frequent and 
 violent cough might excite that injury: for it is evi- 
 dent that a cough of this kind impedes the motion of 
 the blood and produces a great turgescence. Perhaps 
 the mucous nriembrane (which is particularly affected 
 in catarrh) may receive some injury from the disease, 
 which might induce the mischievous consequences. 
 But what that affection is, (if any in fact there be,) 
 I shall not undertake to explain. If the lungs therefore 
 
141 
 
 are weak or diseased, if a defective and contracted 
 structure of the chest exists, or if any taint lurks in the 
 constitution: it is no wonder that a protracted catarrh 
 should produce consumption at that age, in which 
 the greatest determination of blood to the lungs 
 occurs. 
 
 When consumption is produced by catarrh, all 
 the symptoms of turgescence of blood in the lungs 
 come on, and sometimes haemoptysis takes place. 
 The history and progress of the disease is nearly the 
 * same, whether it arises from haemoptysis or catarrh; 
 the same things afford relief and do injury, and the 
 mode of cure is the same. There is not, therefore, 
 the least necessity to repeat in this place what has 
 already been said. If congestion in the lungs be the 
 source and cause of this complaint, that should with- 
 out doubt be removed in the first place. And this 
 effect is best achieved by means of the remedies be- 
 fore enumerated, and especially by a change of 
 climate. 
 
 Of these three most frequent causes of consump- 
 tion, (or rather two; for haemoptysis and catarrh 
 might be considered as one,) we have treated sepa« 
 
142 
 
 ratdy, as if the disease might arise from one or the 
 other only- But it is evident enough that all those 
 causes may concur or be conjoined in the same pa- 
 tient. Catarrh often induces haemoptysis: perhaps 
 also it weakens the lungs, and renders them liable to 
 scrofulous tubercles. Blood effused from haemoptysis, 
 and not absorbed, might form tubercles, which in pro- 
 gress of time, might induce inflammation and suppu- 
 ration. And from compression of the blood-vessels by 
 scrofulous tubercles, effusion of blood, either by tran- 
 sudation or from ruptured vessels might be produced, 
 be followed by haemoptysis, and cause a frequent and 
 troublesome cough. What has been particularly and 
 separately said of these two causes, * may easily be 
 applied to all conjoined. From all these facts and 
 arguments, it may be concluded, if I be not mis- 
 taken, that a change of climate would be of the 
 greatest importance in preventing and curing con- 
 sumption of the lungs.^^ 
 
 22 It seems then agreed, that a change of climate exerts 
 powerful and beneficial effects upon phthisis pulmonalis, whe- 
 ther it arises from hereditary predisposition, concealed scro- 
 fula, haemoptysis or catarrh, and the suppurative terminations 
 of pneumonia. But it seems not to be so unanimously con- 
 ceded, that this change of climate is always to be made by 
 
143 
 
 It is now our intention to treat of certain diseases 
 which occur in more advanced age, and which arise, 
 
 means of a sea voyage, in preference to a journey by land. The 
 opinions on the usefulness, nay curative effects of sailing in 
 this disastrous complaint, are various and diametrically oppo- 
 site. The late professor Rush was wont to teach the inefficacy 
 of this species of exercise, unconnected with other things, in 
 consumption, from his chair; and the following are his senti- 
 ments as delivered in one of his publications: " sea voyages 
 have cured consumption, but it has only been when they have 
 been so long, or so frequent, as to substitute the long con- 
 tinued gentle to the violent degrees of exercise, of a shorter 
 duration, or where they have been accompanied by some de- 
 gree of the labour and care of navigating the ship."* On the 
 other hand Dr. Gilchrist, who wrote particularly on the me- 
 dical use of sea voyages, extols them in the highest terms, 
 as a remedy for phthisis; and relates many cases to prove the 
 justice of his encomiums. He asserts that in some instances 
 a voyage of a few hours has accomplished the most marvel- 
 ous change in the disease for the better. Dr. Rush, in speaking 
 of a change of climate as a cure for consumption, says, " I do 
 not recollect an instance of its having succeeded, except when 
 it has been accompanied by exercise, as in travelling, or by 
 some active laborious pursuit;**! and with respect to travelling 
 
 * Inquiries, vol. ii. p. 64, on Pulmonarj' Consumption, 
 t Ibid. 
 
144 
 
 at least in part, from the effects of our climate, and 
 might be cured or relieved by a change of air* 
 
 by land, he has the following remarks: " journies have often 
 performed cures in the consumption, but it has been chiefly 
 when they have been long, and accompanied by difficulties 
 which have roused and invigorated the powers of the mind 
 and body."* Cullen believes it probable that some benefit 
 would be derived from the great purity and more equal 
 temperature of sea air than that of land, in consumption. Dr. 
 Gourlay of Madeira says, that the itinerant consumptive 
 patients who visit that island for their health, seldom re- 
 cover; but attributes this to the backwardness which people 
 feel to repair thither, until the disease has gained such an as- 
 cendancy, that neither change of climate nor any other 
 remedy could have any good effect. I believe there are few 
 points in medicine that have undergone more disputation and 
 admitted more contrariety of reasoning and opinion, than the 
 curableness of pulmonary consumption, and the efficacy of a 
 change of climate, travelling, and sea voyages. It is, certainly, 
 not for me to presume at an attempt even to reconcile the 
 jarring testimonies of venerable and eminent authorities. But 
 as I have in a preceding note, when speaking of the general 
 efficacy of sailing at sea, in the treatment and cure of diseases, 
 asserted that I had seen decided advantages resulting from 
 
 Inquiries, voT.ii. p. 64, on Pulmonary Consumption. 
 
145 
 
 These fall particularly on the abdominal viscera, 
 especially the stomach and intestines, and greatly 
 
 it, I will now mention one or two cases of pulmonary con- 
 sumption which I then had in view. Previously to doing this 
 however, it may not be irrelevant to remark, in favour of the 
 sea life upon consumptive people, some facts, which prove 
 that the disease is rarely incident to ^hat life. Dr. Lind* 
 says, "that out of 5741 sailors, who were admitted into the 
 Naval Hospital at Haslar, near Portsmouth, in two years, only 
 360 of them had consumptions; and in one fourth of these," he 
 continues, " it was brought on by bruises or falls." Hence it 
 may be concluded, that the exercise of sailing invigorates 
 the lungs, and fortifies them against accidents. In addition 
 to this fact, I may state that out of 1045 patients who 
 came under my care from the 1st of June 1809 to the first of 
 June 1811, from among four hundred men exposed to a va- 
 riety of climates in different parts of the United States, in 
 the bay of Biscay, the British Channel, the Atlantic ocean, 
 and in different sea-port towns,— there were only mjc cases of 
 pulmonary consumption. These six, exclusive of four other 
 cases of phthisis, received from a French hospital. The 
 record book from which 1 take this account, exhibits a multi- 
 farious variety of diseases; among them many cases of pleu- 
 risy, and nearly three hundred of catarrh, which so frequently 
 causes consumption. It appears then from this fact, that the 
 ' " * ' ' II I I. ■ I i»i* 
 
 * Essay on the means of preserving the Health of Seamen. 
 
 T 
 
14a 
 
 obstruct their functions. Hence they are not only 
 experienced in those parts, but affect the whole 
 
 disease of phthisis pulmonalis is not only a rare complaint at 
 sea, but that the acute diseases which so frequently terminate 
 in or produce it on shore, have not the same fatal tendency 
 when they occur under the influence of the sea air. 
 
 Of the four cases I have just alluded to, I may remark, that 
 two out of the four died in a few weeks after they were re- 
 ceived on board from the hospital. The other two recovered. 
 These patients were evidently in a deep consumption of the 
 lungs. Every symptom that characterizes this complaint, 
 was evident in each of ihem. The passage across the channel 
 considerably relieved them, and in the course, one of four and 
 the other of six weeks of the voyage, both entirely recovered. 
 The recovery of these patients was as unexpected to me as it 
 was to themselves; and I believe their only hope in coming on 
 board was, that they might survive long enough to reach their 
 
 native shores^ and die with their friends. 
 f 
 
 Since writing the note containing a quotation from Dr. Gor- 
 don's letter respecting the climate of Madeira, the work of 
 Dr. Gourlay has fallen into my hands. This writer men- 
 tions,* the disease of phthisis pulmonalis as an endemick of 
 
 * Observations on the Natural History, Climate, and Diseases of Madeira, 
 daring a period of eighteen years, by Wm. Gourlay, M. D. London, 1811, • 
 
147 
 
 system, and often produce many serious, and indeed 
 most obstinate disorders. But we shall here only 
 
 . that island. He says its fatality is prodigious among the inha- 
 bitants. He reprobates the practice of sending consumptive 
 patients to the island, so far advanced in the disease that their 
 death, which is inevitable, can only be protracted for some 
 time. He thinks the summer in that climate too hot for con- 
 sumptive persons. " Under all circumstances," says Dr. Gour- 
 lay,* *'in Madeira, the fittest season for invalids, is from 
 November to the beginning of June. This was the opinion of 
 the late Dr. Cullen, who, in his lectures on this disease, was 
 wont to observe, in directing a change of climate, that it was 
 as pernicious for phthisical patients to pass the summer in a 
 very warm climate, such as Madeira, as to remain in England 
 in winter; and indeed that the most benign climate in such 
 cases, was found in the south of England, and in the winter of 
 southern latitudes." From the assertion of Dr. Gourlay re- 
 specting the fatality of consumption in Madeira, and the ex? 
 treme frequency of the disease among the inhabitants who 
 have never been out of the island, I think it is evident, that the 
 climate must contain some vice that is inimical to the con- 
 sumptive. How that place received the high character it has 
 obtained among physicians, and among consumptive patients, 
 I know not: certain it is, that it is wholly unmerited. 
 
 Since 
 
 * Observations on the Natural History, &c. of Madeira, by Dr. Gourlay^ p. 93. 
 
148 
 
 treat of two complaints of this nature: viz., of hypo- 
 chondriasis and gout. 
 
 Since the above went to press, the " Introductory Dis- 
 course"* of Mr. De Witt Clinton, of New York, has fallen into 
 my hands. From it I shall make the following interesting ab- 
 stract, and I will venture to do so, without any other apology 
 than to say the matter is very pertinent to the subject of this 
 work, and is already so condensed into a few well-written pa- 
 ragraphs that I could not give the substance of the remarks, 
 without detailing them in the words of the author. 
 
 " The comparative mortality of London has not only greatly 
 diminished within the last fifty or sixty years, but a number 
 of diseases which, previous to that period, were very destruc- 
 tive, have almost entirely disappeared; for instance, the plague, 
 the rickets and the scurvy: while others that were formerly 
 considered very mortal, are now viewed as no longer formida- 
 ble; such as the small pox, the dysentery and intermittent 
 fevers. 
 
 « Other diseases, supposed to be less dependent on the phy- 
 sical than on the moral and political changes which Great 
 Britain has undergone, have increased in number and fatality; 
 and are attributed, chiefly, to the increase of manufactures; 
 
 * Delivered before the Literary and Philosophical Society of the State of 
 New York, on the 4th of May, 18U. 
 
14^ 
 
 and, consequently, of the number of sedentary and otherwise 
 unwholesome occupations; to the augmentation of the national 
 wealth, and with it, of luxury and high feeding; and to the 
 fluctuations in the conditions of life, attendant on the spirit of 
 commercial speculation. To the first of these sources is as- 
 cribed, in part, the regular increase of the consumption, dur- 
 ing the last century; to the second, the more inconsiderable, 
 but scarcely less regular, increase of apoplexy, palsy, gout) 
 and sudden deaths; and to the last, the more frequent occur- 
 rence of insanity in its different forms: and the increase of in- 
 temperance and vice, in a large and populous city, doubt- 
 less contributes much to the augmentation of all these dis- 
 eases. 
 
 " Dr. Heberden states the proportion of these three classes 
 of disease, at the beginning, middle, and end, of the eighteenth 
 century, to have been as follows: 
 
 Beginning. 
 Consumption, 3,000 
 
 Palsy, apoplexy, &c, 157 
 Lunatic, " 27 
 
 « If we compare the mortality from consumption, at those 
 three periods, with the total mortality, we find, that in 1669 
 the deaths, from consumption, were, to the whole, as 
 1 to about 6 2 
 
 In 1749, 1 5 5 
 
 1799, I 3 8 
 
 1808, 1 3 6 
 
 "The 
 
 Middle. 
 
 End. 
 
 4,000 
 
 5,000 
 
 280 
 
 300 
 
 75 
 
 70 
 
150 
 
 " The reports of consumption, in other parts of Great Britain, 
 correspond, in a great degree, with the accounts of its preva- 
 lence ill London, and, therefore, render this ascription of its 
 causes and origin unbatisfactory. 
 
 " Dr. Lettsom, however, in a letter to Dr. Hosack, on the 
 diseases of London, (yifner. Med. and Phil. Reg. vol. 2.) says, 
 *' Whilst the phthisis p\jlmonalis is rapidly increasing in 
 America, and in the European continent, it is diminishiiig 
 here. The croup is less fatal, in consequence of the imme- 
 diate and free use of the lancet, and of leeches, with pur- 
 gatives, than heretofore; nor is angina scarlatina either so 
 frequent or so fatal. The typhus is almost extinct, and the cho- 
 lera morbus is unfrequent; and, as far as my experience ex- 
 tends, the syphilis is milder or easier cured; and, lately, such 
 has been the prolongation of health and life as to lessen the 
 premiums of insurance considerably." 
 
 "Out of 19,954 deaths, in London, in 1808, 5,220 are as- 
 cribed to the consumption. The christenings, in that year, 
 were 19,906, nearly equal to the burials. 
 
 " In 1809, the healthiest year which London ever enjoyed, 
 there were 16,680 deaths, 4,570 of which were produced 
 by the consumption; the number of christenings was 19,612, 
 making the excess of births above tTie deaths nearly 3,000. 
 (See the London Annual Medical Review and Register, for 
 1808 and 1809») 
 
 " Dr. James 
 
151 
 
 *< Dr. James E. Smith says, that " in Italy, consumptions 
 are found to be very contagious, thoiijjh less evidently so in 
 England." It is intimated, if my memory serves me, in that 
 excellent work, the Emporium, that the general use of cotton 
 shirts, 8cc. may have a pernicious influence in producin* the 
 disease. Its increased fatality in Europe, as well as in America, 
 is, probably, owing to a complication of causes; and, indeed, 
 the periodical prevalence and disappearance of certain dis- 
 eases, must be classed among those aixana which providence 
 has concealed from man. 
 
 «' Salubrious as the climate of Madeira is generally reck- 
 oned, we find, that even there pulmonary diseases cut ofF a 
 great number of the inhabitants. Of the various districts of 
 North America, New York has been considered, by many, as 
 being especially favoured with regard to the mildness of its 
 seasons; and the changes of its weather were referred chiefly 
 to the diff*erence in the prevailing winds. Among a series 
 of interestng remarks on the climate and diseases of New 
 York, made by Lieutenant-governor Golden, about seventy 
 years ago, and inserted in the American Medical and Philo- 
 sophical Register, vol. I., this medical philosopher observes, 
 " The air of the country being almost always clear, and its 
 spring strong, we have few consumptions, or diseases of the 
 lungs." " People inclined to be consumptive in England, are 
 often perfectly cured by our fine air; but if there be ulcei's 
 formed they die. The climate grows every day better, as the 
 country is cleared of the woods; and more healthy, as all the 
 people that have lived long here testify. This has even been sen- 
 sible to me, though I have been but, about twelve years in this 
 
15Q 
 
 country; /, therefore, doubt not but it will, in time, become one of 
 the most agreeable and healthy climates on the face of the earth. 
 As it is at present, I prefer it to the climate of England, and, 
 I believe, most people that have lived any considerable time 
 here, and have returned to England, will confirm this." 
 
 " If the climate of New York was formerly thus mild 
 and healihy, and a constant amelioration in its tempera- 
 ture is consequent upon our numerous settlements and 
 improvements, as has been maintained by many distin- 
 guished writers, to what shall we ascribe the extraordi- 
 nary mortality occasioned by pulmonary consumption at the 
 present day. None will deny this disorder to be influenced by 
 climate, and independent of eflccts arising from particular 
 employments, and modes of living; but we will, perhaps, find 
 the most satisfactory answer to this question, in considering 
 phthisis in its various forms as the off'spring rather of in- 
 creased dissipation, of great imprudence in dress, and of con- 
 sequent exposure to sudden changes of temperature, than of 
 any peculiarity in our climate and seasons."* 
 
 Since writing note 18, I have received a letter from 
 Dr. Gerard Dayers, formerly surgeon's mate of the United 
 States, when I was surgeon of that ship. It enables me to add 
 the case of a favourable termination of a wound into the ca- 
 
 * Note N. N. p. 1«0. 
 
153 
 
 vity of the lungs, which I would have related in that note, but 
 could not at that time assert positively the favourable nature 
 of the result. I however will subjoin it in this place, though 
 not immediately connected with ihe preceding matter. I 
 was called while on shore, to see a man by the name of 
 Tindell, then one of the United States* boat's crew. He had 
 been wounded in three or four places by a pretty large couteau- 
 de-c/iasse, in an affray with a Portuguese sailor. I found him 
 lying on his left side in Dr. Balfour's shop in Norfolk, whither 
 he had been carried by some of his companions. Upon exami- 
 nation of his wounds, I perceived that the severest perforated 
 the left lobe of tlie lungs. Through this wound he was bleed- 
 ing freely, and also expectorating blood. After taking a good 
 deal of blood from his arm, I had him removed to comfortable 
 quarters in Water street, where I again bled him in the evening 
 and very largely on the following morning. He was kept ex- 
 ceedingly low for the space perhaps often days, and as I was 
 about to sail in another ship for France, I left him with the 
 most favourable symptoms in the careof one of my mates, who 
 from his experience and knowledge was well able to give him 
 every judicious and necessary assistance. I accordingly sailed 
 the next day, and heard no more after my return, of the par- 
 ticulars of his fate, than that he had recovered. The case ex- 
 cited considerable interest among the physicians of Norfolk, 
 from whom I frequently had inquiries respecting his condition; 
 it must therefore be well known to those gentlemen, as I 
 am sure it is to commodore Decatur, and the officers of his 
 ship. The following is a brief account of this man's case, after 
 I left him in the hands of Dr. Dayers, (now surgeon of the 
 Congress,) from a late letter received from that gentleman. 
 
 u 
 
154 
 
 *• U. S. Frigate Congress, Portsmouth, N. H., 
 March 7th, 1815. 
 
 * * * * " As respects the surgieal case, I lost all my books, 
 notes, 8cc. at the time the English made an attack on the U. S. 
 ship Adams at Hampden in Maine, but as far as memory will 
 assist me, I will give you the symptoms and mode of treatment 
 
 " In the case of Tindell, who was wounded in the lungs by 
 a sword, the breathing was very much obstructed, there was 
 bloody expectorationv&c; he was bled onee after he came un- 
 der my care: in conjunction with this important remedy, he 
 was kept perfectly at rest, cooling laxatives were adminis- 
 tered, and a low diet observed. Under this treatment he got 
 perfectly well, since then I have heard nothing of him. 
 
 V 
 
 ** I hope you will pardon the concise account that I have 
 given you; but what I have mentioned is strictly so, as far as 
 my recollection serves me. The treatment previous to his 
 coming under my particular care, I have very little know- 
 ledge of: but I suppose you have, as you attended him for a 
 short time. 
 
 " Yours, with great esteem, 
 
 « GERARD D AYERS." 
 
 The instrument by which the wound just related was made, 
 fell into my hands. It was at least one inch broad, and very 
 thick on the back edge, at the point up to which it must have 
 been thrust into the body. The perfect and speedy recovery 
 of this man, is another convincing proof that violent wounds 
 may be made into the lungs, without inducing pulmonary 
 consumption, or any other material injury. 
 
155 
 
 sp:ction hi. 
 
 Of the causes of Hypochondria, especially its origin from 
 the effects of climate, diet, and mode of life. Its various 
 symptoms. Its connection with the haemorrhoidal flux 
 and its affinity to this disease, deduced from the similarity 
 of its causes. The general absence of any praeternatural ap- 
 pearances in the dissection of the dead bodies of hypochon- 
 driacks. Sometimes turgescence in the mesenterick veins 
 observable. The different remedies for this disease. The be- 
 neficial effects of riding on horseback, especially when 
 conjoined with a change of climate. 
 
 Hypochondria is well known to all physicians, 
 for there is not any chronick disease scarcely, of 
 more frequent occurrence than this, at least in the 
 island of great Britain. Various, and indeeed innu- 
 merable symptoms, both of mind and body, accom- 
 pany this complaint. But especially a lassitude and 
 torpor of the whole system, depression of spirits, fear, 
 and anxiety, together with a derangement of the func- 
 tions of the stomach and intestines. This diversified 
 disease appears to originate from the effects of our 
 climate; for it is most frequent in cold moist coun- 
 tries; while in those that are temperate or warm, it is 
 either very rare, or altogether unknown. It is ob- 
 
156 
 
 served also, that the hypochondriack are much better 
 in summer than in winter. Hence it is probable that 
 the disease might be relieved or cured by a change 
 of climate. Indeed it is difficult and perhaps impos- 
 sible to assign a satisfactory and accurate reason for 
 all the symptoms which occur in this disease. For 
 many have a connexion with nervous affections, the 
 nature of which is not sufficiently investigated to ena- 
 ble us to understand the complaint. Many depend on a 
 certain incomprehensible sympathy, which exists be- 
 .tween the different parts of the system, and between 
 the mind and the body. But this sympathy is veiled 
 in the darkest obscurity. Such symptoms, therefore, 
 I shall not attempt to explain. I shall endeavour only 
 to investigate the sensible causes of the disease, both 
 proximate and remote; and to show from them and 
 from analogy of the effects of such things as do harm 
 or good, how the complaint may be cured by a 
 change of climate, or at least that it can be rendered 
 milder. 
 
 It can scarcely be doubted that the proximate 
 cause of this disease exists in the alimentary canal; 
 for the most of the symptoms by which hypochon- 
 driacks are troubled, evidently arise from the dis- 
 turbed functions of the stomach and intestines. Such 
 
157 
 
 as, anorexia, nausea, vomiting, eructation, rumina- 
 tion, cardialgia, gastrodynia, flatulency, tormina, 
 sometimes diarrhoea, but ofteaer costiveness of the 
 bowels. All these are to be attributed, without 
 doubt, to debility or want of tone in th'j alimentary 
 canal. The affections of the mind too, which consti- 
 tute so considerable a portion of this complaint at 
 least in most cases, are clearly produced by the same 
 weakness of the stomach and intestines; although 
 sometimes, the affections of the mind are observed 
 to bring on debility of the stomach and intestines, 
 and true hypochondria. 
 
 A very difficult question now presents itself: if 
 certain affections of the mind aris« from weakness 
 of the intestines, how happens it, that the debility 
 often occurs, without such mental disorders? For 
 there are many instances where the sick are dis- 
 tressingly troubled with all the diseases of the stomach 
 and intestines which happen to hypochondriacks, 
 while the mind is in no way affected. I confess my 
 inability to^ solve this difficulty: indeed I doubt 
 whether it can be explained until the reciprocal ac- 
 tion of the mind and body upon each other, is more 
 accurately investigated. It has never been properly 
 
158 
 
 understood, how the diseases of the stomach affect 
 the mind; it is hardly to be expected therefore that a 
 reason can be given why this should happen only in 
 some cases. Perhaps a peculiar disposition in the 
 nervous system, or in the mind itself is necessary, 
 in order that those, affections may be produced. 
 What this disposition is, I confess I do not know. Yet 
 it is evident that the affections of the mind often de- 
 pend on the morbid state of the stomach and intes- 
 tines; since it generally happens that when this dis- 
 eased condition is removed, the mind is restored to 
 its former healthiness. 
 
 We have said that the disease, or rather the cause 
 of the diseases of the intestines is debility, or want 
 of tone. Many reasons confirm this opinion. Those 
 symptoms above enumerated, evidently indicate a 
 debility of the stomach and intestines; a weakness of 
 the whole system accompanies the disease, and not 
 unfrequently appears to produce it; many causes 
 which debilitate the whole body, but especially the 
 intestines, often bring on the disease; and whatever 
 invigorates the intestines or the general system, is 
 beneficial to hypochondriacks. But besides these, 
 if I am not mistaken, another evil often exists in 
 
159 
 
 the system, which increases the debility and want of 
 tone in the alimentary canal, as well as the hypochon- 
 dria, and perhaps also it might bring on the disease; 
 namely, a tardy circulation of the blood, and also 
 congestion in the abdomen. If a free and natural dis- 
 tribution of blood is necessary for sustaining the 
 health and strength of the whole system, or any of 
 its parts, it may easily be credited that from an im- 
 peded motion of this fluid in the abdominal viscera, 
 the intestines would receive such an injury, that they 
 would be rendered liable to various disorders. Or, if 
 they should already have been debilitated and dis- 
 eased, and the distribution of the blood disturbed, 
 it is probable that the injury would fall especially on 
 them. Finally, it is evident that if the circulation of 
 the blood should languish in consequence of a want 
 of exercise, or from other causes, although it would 
 affect the whole system, yet the evils arising from it 
 would be particularly felt in the abdomen; for the 
 motion of the venous blood is naturall}' most slow 
 there, on account of the long circuit it makes through 
 the liver before it returns to the heart. 
 
 This opinion, that hypochondria arises from a tardy 
 circulation and also congestion of the blood in the 
 abdomen, is by no means inconsistent with reason, 
 
160 
 
 and we shall now see how it is confirmed by observa- 
 tion of the remote causes of the disease, and those 
 things which are beneficial or hurtful to the hypo- 
 chondriack. 
 
 The different causes which bring on hypo- 
 chondria, are observed to injure directly and imme- 
 diately, the stomach and intestines. Others again 
 impede in the first place the motion of the fluids, and 
 debilitate in this way perhaps, the abdominal viscera, 
 and in our opinion cause hypochondria. Some indeed, 
 have evidently both those effects. We have said that 
 a cold moist climate, like that which occurs in our 
 northern countries, especially in the winter season, 
 produces a disposition to hypochondria. The most 
 manifest effect of such a climate is, to check the 
 perspiration and hinder the distribution of the fluids 
 to the surface of the body. Hence internal congestion 
 is to be feared. I do not intend to deny, that a cold 
 and humid climate can directly affect the stomach 
 and nervous system, and finally the mind itself, even 
 if it should not disturb the motion of the fluids. It is 
 known that moist air relaxes and weakens the mus- 
 cular fibres of the whole body. It is not surprising 
 therefore, that the stomach and intestines should 
 suffer from the same effects. The inhabitants of damp 
 
161 
 
 cold countries are languid, inactive, and inclined to 
 melancholy; for that reason perhaps, they are liable 
 to this disease. Nor is it unreasonable to attribute 
 this distressing disposition of mind and body to ob* 
 structed perspiration. For Sanctorius has declared in 
 his established aphorisms, that cheerfulness of mind 
 is produced during a very free perspiration by the sur- 
 face of the body; and on the other hand, that a sense 
 of heaviness in the body and sadness of mind is per- 
 ceived when the perspiration is obstructed. Almost 
 all persons, however healthy and robust they may be, 
 and free from the hypochondriack disease, observe 
 the most evident effects both on the mind and body, 
 to follow different changes of the weather. When it 
 is temperate, dry and clear, the body receives new 
 strength and activity, and the mind increased cheer- 
 fulness. But on the other hand, when the atmosphere 
 is cold, humid, cloudy and dark, the body becomes 
 weak and languid, and the mind dull and gloomy. 
 These differences are perhaps to be attributed to 
 the effects of climate on the nervous system; for 
 there is no doubt but that it does exert powerful 
 effects in this way. But if I be not mistaken, the 
 greatest part of these differences in the feelings is to 
 be ascribed to the disturbed distribution of the fluids; 
 X 
 
162 
 
 for if this is properly promoted by a due degree of 
 exercise, neither sadness of mind nor lassitude of 
 body is for the most part produced by the effects of 
 a cold moist climate upon the nervous system. 
 
 Another, and indeed the most frequent cause of 
 this complaint, is an indolent and sedentary life. Most 
 men devoted to study, or occupied with other 
 business, which requires a continual and close ap- 
 plication of the mind, and hardly any exercise of 
 body, are more or less troubled with this disorder. 
 This kind of life can do harm in two ways, and pro- 
 duce a disposition to hypochondria: in the first place, 
 a sluggish motion of the blood is produced by it, in 
 consequence of a want of natural exercise: for phy- 
 sicians know, that the action of the muscles is ne- 
 cessary, in order to promote duly the circulation of 
 the blood. Hence also perspiration and a determina- 
 tion to the surface is diminished; consequently ple- 
 thora is produced in the system; congestion in the in- 
 ternal parts; and we have already shown that the evils 
 arising from this source would especially affect the 
 abdomen in this period of life. Besides, when the 
 muscles are not properly exercised, they soon lose 
 their former and natural strength, the moving powers 
 
163 
 
 in a sedendary life, necessarily languish, and the 
 whole body becomes debilitated; hence perhaps the 
 stomach and intestines, by sympathy or consent, de- 
 rive a similar debility or want of tone. But my opi- 
 nion is, that hypochondria arising from a sedentary 
 life, is rather to be attributed to an obstructed dis- 
 tribution of the fluids to external parts, than to a weak- 
 ness and want of tone in the muscles; though this 
 want of tone may doubtless increase the evil. For in 
 warm countries, where the perspiration and deter- 
 mination to the surface is sufiiciently promoted by 
 the heat of the air alone, hypochondria rarely occurs, 
 although debility and want of tone are common 
 enough, and the inhabitants do not use much ex- 
 ercise. 
 
 Certain affections of the mind which we call de- 
 pressing passions, especially grief, and continual and 
 distressing anxiety, often cause hypochondria. But 
 it is well known, that all serious affections of the 
 mind affect the stomach in some degree, and vice 
 versa, the mind is disturbed by the different diseases 
 of the stomach. For it has been observed, that sad- 
 ness of mind, and other effects of this nature, not 
 only debilitate in a surprising manner the stomach 
 
164 
 
 and whole body, but also greatly obstruct perspi- 
 ration. When therefore, the motion of the blood be- 
 comes languid, and the deter mihation to the surface 
 is in this manner diverted, and the stomach and in- 
 testines from their consent with the mind are debili- 
 tated by the same cause: is it not probable that 
 congestion in the abdominal vicera will succeed that 
 debility, and would be the cause of hypochondria fol- 
 lowing? 
 
 Many causes in fact produce this disease, by debi- 
 litating the stomach, the intestines, and the general 
 system, which do not appear directly or particularly 
 to affect the distribution of the fluids. Such are large, 
 and especially slaw evacuations, the menstrual flux, 
 fluor albus, sometimes excessive venery: these give 
 rise to a debility of the whole system. Other causes 
 particularly weaken the stomach and intestines: such 
 are the excessive use of tea, tobacco or opium, and 
 of other narcoticks; or the frequent repetition of the 
 more powerful emeticks and catharticks, diarrhoea or 
 continual binding of the bowels. 
 
 Other causes however, which produce hypochon- 
 dria or at least a disposition to it, evidently appear to 
 
165 
 
 cause a sluggish motion and congestion of blood in 
 the abdomen. Plethora without doubt in many cases 
 contributes not a little to produce this disease. For 
 men who use a full and generous diet, and lead an 
 indolent and sedentary life, are very much inclined 
 to hypochondria, and it can hardly be doubted but 
 that a plethorick state may exist in the system of such 
 persons, and may create the greatest part of the dis- 
 order; especially when we consider the remedies 
 which give relief to such patients. For a lighter 
 and more spare diet, or one consisting of fruits; 
 frequent and constant exercise, and sometimes the 
 loss of blood, — greatly relieve them; and all these evi- 
 dently and directly diminish or remove plethora. We 
 have before explained why plethora, if any exists in 
 the system, particularly shows itself in the abdomen. 
 For hypochondria only occurs in advanced age: in 
 infancy it is altogether unknown; it is most frequently 
 met with after the thirtieth or thirty-fifth year. 
 
 The disease also not unfrequently arises from 
 those tumours in tl^ spleen or liver, which are some- 
 times observed after intermittents that have been 
 imperfectly cured. Tumours of this kind evident!} 
 
166 
 
 obstruct the free motion of the blood in the abdomen, 
 and consequently produce congestion. 
 
 It arises too, and not rarely, from a haemorrhagick 
 disposition, when the haemorrhages haie ceased. It 
 appears from observations that those who have had 
 haemorrhages, are greatly inclined to this disease. 
 Those who have had the haemorrhoidal flux checked, 
 are particularly liable to hypochondria. And from 
 this source hypochondria often arises. It appears 
 evident to every one that a suppression of that flux, 
 produces a congestion of blood in the abdomen. 
 There is a very remarkable connexion between hy- 
 pochondria and the hsemorrhoidal flux: the same 
 age; the same climate and season of the year; the 
 same mode of living; as for instance a full and gross 
 diet, and an indolent and sedentary life, a plethorick 
 habit, a haemorrhagick disposition, and costiveness 
 of the bowels, — equally induce both. They occur not 
 unfrequently in the same patient, and occasionally at 
 the same time; and hypochondria is often produced 
 by a suppression of the haemorrhoidal flux; when 
 that is restored, this in its turn is released. But the 
 haemorrhoidal flux arises without doubt from con- 
 gestion of blood in the abdomen: from this fact there- 
 
167 
 
 fore, another argument arises which tends to prove 
 that at least in many cases, hypochondria derives its 
 origin from the same source. 
 
 Nothing of consequence can be learned on this 
 subject by dissecting dead bodies; for hypochondria, 
 however troublesome and difficult of cure it may be, 
 and notwithstanding it distressingly torments many 
 persons during the greatest part of life, yet it is 
 scarcely ever fatal, unless sometimes when it brings 
 on other diseases, as dropsy for example, or a cachec- 
 tick state of the system. In some of the dead bodies 
 of hypochondriacks however, a congestion of blood 
 has been plainly observed in the mesenterick veins. 
 
 There is every reason I am persuaded, to deduce 
 two principal causes of hypochondria, viz. a debility 
 and want of tone in the stomach and intestines, and 
 a congestion of blood in the abdomen. The mode 
 of curing the disease then, according to this theory, 
 renders it necessary, before attempting any thing else, 
 to invigorate the stomach and intestines, remove the 
 congestion of blood from the abdomen, and promote 
 the free motion and distribution of this fluid. To the 
 first intention, many remedies are adapted; and often 
 
168 
 
 not a little benefit is derived from tonick medicines, 
 cither taken internally or otherwise applied. Of this 
 kind are the Peruvian bark, steel, bitters, the cold 
 bath. But these remedies rarely effect a perfect cure 
 of the disease, unless others are at the same time 
 exhibited, which answer the other intention of cure, 
 namely, to restore the due motion and distribution 
 of the fluids. Now this is best effected by exercise 
 in the warm air, especially by riding on horseback, 
 than which nothing gives greater relief to those 
 labouring under hypochondria. The commendations 
 which Sydenham has bestowed upon the exercise of 
 riding on horseback, as a cure for consumption, 
 might perhaps be more properly applied to the hy- 
 pochondria. It does not only effect a due distribution 
 of the fluids, — promote the motion of the blood to 
 the smallest vessels of extreme parts, — afford activity 
 to the moving powers of the system and to the whole 
 body, — but especially benefits the stomach and the 
 other abdominal viscera. No other kind of exercise 
 affords such concussion, by which the circulation of 
 the blood in the abdomen is equally promoted, and 
 it thus seems to increase the peristaltick motion and 
 strength of the intestines. Hence all the excretions 
 of the fluids which are so essentially useful for the 
 
169 
 
 digestion of food, are promoted, and the nutriment 
 is properly and perfectly concocted. The intestines 
 being rendered healthy in this way, the mind by its 
 peculiar sympathy with the stomach, receives its ac- 
 customed activity and cheerfulness. 
 
 This important remedy is rendered still more effi- 
 / cacious when conjoined to a change of climate. Wc 
 have already said enough with regard to the effects 
 of a moderately warm climate, in promoting the due 
 distribution of the fluids, which we have endeavour- 
 ed to prove, is of the greatest utility also in hypo- 
 chondria. But since this disease affects the mind in 
 a great degree, and often derives its origin from it, 
 it is evident, that a temperate and pleasant climate, 
 and indeed a change of place itself, would be ex- 
 ceedingly useful to the sick. A finer climate than 
 that of our own country, gayer manners, new and 
 pleasant scenes, all occupy the mind agreeably, and 
 delightfully divert the imagination. By these means 
 also, when the disease has but just begun to affect 
 the mind, the patient would experience the greatest 
 relief by reason of the sympathy that exists be- 
 tween the mind and the abdominal viscera. 
 
 Y 
 
170 
 
 But a change of place and the journey itself, be- 
 sides the benefit arising from long continued exer- 
 cise, produce other most powerful effects. A certain 
 connexion exists between distance and time, estimat- 
 ed by the remarkable incidents of our life, which ex- 
 erts happy effects on the mind. Travelling (from the 
 number of interesting occurrences that happen al- 
 most daily) produces similar effects, and causes an 
 oblivion of our sorrows, just as the lapse of years 
 produces sooner or later relief to all diseased or 
 melancholy minds. Distance from our home, also, 
 removes every thing from our view, which might 
 recall to the imagination the past sorrows of the 
 mind. Those little troubles too, which arise from 
 domestick concerns, and which often solicit too much 
 attention from hypochondriacks, are thus far removed 
 from their sight. 
 
 Finally, that lazy disposition in which hypochon- 
 driacks indulge at home, is necessarily banished in 
 travelling. Inactivity and gloominess of mind con- 
 stitute the greatest part of this disease: whatever 
 therefore engages the attention, would, it is evi- 
 dent, be very useful; and all exertions of the mind, 
 
171 
 
 although forced and irksome at first, occupy its at- 
 tcntion, and serve to introduce a new train of ideas. 
 
 By these means the mind is gradually restored to 
 its wonted cheerfulness, the intestines take on their 
 former healthy action^^, and each reciprocally imparts 
 its proper vigour. 
 
 *3 The new and healthy change produced in the morbid 
 $tate of the stomach and intestines, which occurs in the dis- 
 tressing disease of hypochondria, is undoubtedly one of the 
 most efficient and potent effects of travelling, as a remedy for 
 this complaint. In hypochondria. Dr. Gregory has pretermit- 
 ted any mention of a sea-voyage, and wisely indeed has he 
 done so. I have heard of this means of changing place and 
 scene, recommended in this complaint, than which no advice 
 could be more irrational and disastrous. It is somewhat re- 
 markable that an exercise so efficacious as that derived from 
 a sea-voyage, in many other complaints, should not prove 
 equally beneficial in all where a change of place is proper. 
 Put it can only be attributed to the mental uneasiness I have 
 before mentioned (note 1 5), produced by the tumultuous vexa- 
 tions of a sea life, combined with the want of other comforts, 
 as cleanliness of person, and changes of dress, which are the 
 inevitable concommitants of a voyage, particularly of a long 
 one. A change of dress may seem a matter of trivial impor- 
 tance; but in hypochondria it is fur from being so; and I 
 well know from actual observation that this disease^ which 
 
172 
 
 as I shall presently say, is common on ship-board, is al- 
 ways benefited for a time, by a change of dress. This disorder 
 is generated by the monotony of a sea life, and generally 
 affects landmen and those whose habitual occupations of 
 reading or amusement on shore, are interrupted or entirely 
 prevented, by the noisy din of a ship. I never failed to ob- 
 serve such persons better after muster on a Sunday morning, 
 when the regulations of the ship compelled every one on 
 board to pass inspection, in a clean and fresh attire. But a 
 sea-voyage, if it exceeds a day or two, must be injurious to 
 hypochondriacks for the reasons I have mentioned. As th©; 
 effect of travelling on the bowels, in producing a new and 
 healthy action in them, has just been mentioned, it may here 
 not be amiss to take notice of some of those affections of them, 
 which are generated by particular climates, and which con- 
 sequently we may reasonably hope to cure, by flying from the 
 place where they received existence. 
 
 In all cases of disorder of the intestines depending on an 
 undue secretion of bile, or on a deficiency of this secretion, or 
 an unhealthy state of il, a change of climate by means of a 
 sea-voyage, may undoubtedly be expected to do good. " Sea- 
 sickness, and a sea-voyage," says an able writer, " contribute 
 very much to restore the secretion of healthy bile, so neces- 
 sary to the welfare of the animal economy; and symptoms of 
 dyspepsia and diminished secretion, which are now rendered 
 more conspicuous among females from their sedentary life, 
 are most effectually removed by the means already suggest- 
 
173 
 
 cd.*** It is however, only in cases where these affections, as 
 just specified, are unconnected with any mental uneasiness 
 such as occurs in hypochondria, that any reasonable depen- 
 dance can be placed on a sea-voyage. I am the more inclined 
 to this opinion, because I have seen decided inconveniences, 
 nay bad consequences, arising from the influence of a sea life 
 on hypochondriacks; chiefly because it aggravates a prominent 
 symptom of this disease, viz. costiveness. 
 
 It is well known that the inhabitants of hot countries, are 
 liable to many diseases which have their sole origin in the de- 
 rangement of the functions of the liver, produced by the 
 heat of the air. The most common of these, are the complaints 
 generated by the increased secretion of bile, either causing a 
 regurgitation of it to the stomach, or an excessive determina- 
 tion of it to the firimce via. Hence obstinate dysenteries and 
 diarrhoeas arise, which becoming, as they very frequently do, 
 chronick — produce a state of general ill health, and a perpe- 
 tual want of tone in the stomach and intestines. Such a situa- 
 tion calls for a change of climate. By means of this, the su- 
 perabundant secretion of the bile is reduced to the healthy 
 and requisite portion, its activity on the alimentary system 
 consequently very much lessened, and the wonted vigour 
 of the stomach reproduced. With the healthiness of this 
 organ, the intestines receive a simultaneous invigoration, and 
 the evils arising from the disturbed functions of both, are 
 speedily and effectually banished from the system. The dis- 
 orders above enumerated, as they are engendered by a warm 
 
 * Suund«r3 «n the Liver, duodec. p. 148. 
 
174 
 
 climate, require a change to a colder region; and this change 
 effected by means of a sea-voyage, effectually restores the 
 constitution to health and perhaps to vigour — provided indeed 
 the hot climate had not made such pernicious inroads on the 
 system, as to leave the liver and abdominal vicera in a radi- 
 cally unsound condition. The practice of seeking relief for 
 violent affections of the vicera of the abdomen, produced by 
 the vices of particular climes, is of very old date; hence we 
 are told that the ancient Carribean Indians, who were subject 
 to palsy in consequence of the violent convulsive cholicks 
 common to all the natives of the torrid zone, had themselves 
 conveyed to countries colder than their own, when they could 
 not resort to the hot baths in the northern parts of Jamaica; 
 and this change of climate was always followed by the most 
 beneficial effects.* The present professor of the practice of 
 physick in this university, says in his lectures, that he has 
 known diarrhoeas of the West Indies cured by the patient^s 
 coming to the United States. 
 
 Besides the use of a change of climate in the disorders of 
 the bowels, produced by an intensely warm climate: we may 
 safely recommend such change in the obstinate affections to 
 which they are liable in our own country. On the authority 
 of the professor just mentioned, I may state, that obstinate 
 chronick diarrhoeas contracted in the United States, have 
 been perfectly cured by a voyage to the West Indies. 
 
 In 
 
 * Neale on Consumption, p. 205, 
 
175 
 
 In cholera infantum we know it to be the common practice 
 of physicians, to send the little patients into the country, 
 and this is not unfrequently done, with scarcely a ray of hope 
 either in the minds of the parent or physician, that a recovery 
 will be the consequence; and yet a few weeks, and not unfre- 
 quently « few days only, have been known to snatch the pa- 
 tient from the jaws of death as it were. In this disease the 
 sea-air seems peculiarly favourable. In proof of this, profes- 
 sor Barton says that it is a very common and mortal com- 
 plaint, in the town of Dover, in Delaware; while in the town 
 of Lewis in the same state, but on the very borders of it, and 
 exposed to the constant influence of sea-air, — it is altogether 
 unknown. AH these facts prove, that a change of climate is 
 highly beneficial in the disorders of the bowels; to which I 
 may add that I have seen unequivocal advantages arising from 
 a sea voyage, in all the chronick affections of the intestines to 
 which seamen are so liable from the frequent changes in their 
 diet. 
 
176 
 
 SECTION IV, 
 
 Of Gout. — Of the effects of a cold and humid climate on 
 arthritick constitutions, and the general inefficacy of the 
 remedies used in this disease. — The advantage of a change 
 of climate over all other remedies in this complaint, parti- 
 cularly from a cold to a warm one, deduced from the effects 
 of travelling and warm air, in promoting a free and healthy 
 determination of the fluids to the skin, especially in old 
 persons. — Also the beneficial effects of a mild climate on the 
 disorders of the stomach, so intimately connected and al- 
 most always combined with gout. — Arguments in favour of 
 a change of climate in gout, inferred from a consideration 
 of the remote causes of the disease.— Of its effects in avert- 
 ing the ill consequences of repressed gout, which generally 
 succeed the use of other remedies. 
 
 A FEW observations will be made on the subject 
 of gout, not only because we are of opinion that this 
 disease is to be ascribed to the effects of climate, nor 
 because we expect that a change of climate alone, 
 without the use of other remedies, will perform a 
 perfect cure: but, on account of the variety of rea- 
 sons which incline us to the opinion, that our cold, 
 humid and variable climate is extremely hurtful to 
 gouty persons, and, on the contrary, that warmer 
 
177 
 
 countries would often be of the greatest service to 
 them. All physicians confess that but a small num- 
 ber of remedies are truly useful in this disease; 
 scarcely any that can radically extirpate it, and few 
 that can assuage the agony of its miserable victims. 
 Of those too, which hold forth the prospect of re- 
 lieving pain or curing the disease, some become so 
 unpleasant to the patients, that they are soon rejected. 
 Few men are endowed with sufficient fortitude to be 
 willing to persist for any length of time, in the use 
 of disagreeable medicines, especially if they be not 
 administered during the actual existence of the vio- 
 lent paroxysms, but only given during the intervals 
 of the disease, when the patient experiences neither 
 inconveniences, nor pains, nor sickness. All physi- 
 cians agree, that frequent and powerful exercise and 
 slender diet, are the only remedies by which the 
 cure of gout can be safely looked for. But the sick 
 universally reprobate remedies of this nature; nor 
 can they so far overcome the force of habit, as to 
 consent to be cured of their disorder on such condi- 
 tions. But the disease evidently deprives many per- 
 sons of the use of the limbs, so that exercise is ren- 
 dered impossible; while others, on account of their 
 debilitated state, or from other causes, absolutely 
 
 Z 
 
178 
 
 stand in need of a generous diet. A pleasant, effica- 
 cious and safe remedy for this disease, is therefore 
 an important desideratum; and I entertain the greatest 
 hopes that a warm climate is gifted with these ad- 
 vantages. There are some remedies indeed which 
 mitigate, for a short time, the excruciating pains of 
 gout, and others which seem to drive the disease 
 from the whole system; but they are often observed 
 to bring upon the wretched patients, new and more 
 distressing disorders, or even death itself. Of this 
 kind are the various remedies applied to the pained 
 parts, especially discutients, or cold, or such as are 
 composed of spirit of wine and the like; certain me- 
 dicines also, taken into the stomach, and particularly 
 aromaticks and bitters, such as compose the Portland 
 powder. Since therefore, gout not unfrequently acts 
 in some way as a remedy for other and more afflict- 
 ing diseases, it surely ought not to be cured, with- 
 out we could at the same time prevent the evils 
 which usually arise from repressed gout: and this 
 too is best effected by a change of climate. 
 
 It is not my intention to treat fully and particu- 
 larly of gout: it will be sufficient to show the useful- 
 ness of a change of climate, by noticing some of the 
 
17^ 
 
 remote causes of the disease, and from our experi- 
 ence of those things which are beneficial or hurtful. 
 I am not able to draw any conclusion of this nature 
 from the proximate cause of the disorder, since it is 
 so very obscure. Some of the remote causes indeed, 
 are scarcely better understood, and particularly the 
 predisposition, strictly called, or the germ of the dis- 
 ease. Something of this kind exists we well know; 
 for the most of the remote causes, either predispos- 
 ing or occasional, produce gout only in some persons, 
 while in others they have not the effect of generating 
 any disease at all, or one of an entirely different na- 
 ture. But the nature of that predisposition or the 
 seeds of the disease which are transmitted from pa- 
 rents to their offspring, remains as yet in obscurity. 
 We must seek in other sources of reasoning then, 
 further exposition. The other predisposing causes 
 are, particularly, advanced age, too full a habit of 
 body, with corpulency, plethora, rich living, drunk- 
 enness, premature and immoderate venery, and above 
 all, an indolent and sedentary life. With respect to 
 the occasional or exciting causes, there is no occa- 
 sion to say much. I can hardly believe that gout is 
 ever produced by any sudden or violent cause, un- 
 less a strong disposition to it had previously existed 
 
180 
 
 in the system; and, when that disposition does exists 
 the disease generally recurs periodically without any 
 evident exciting cause. Sometimes indeed a pa- 
 roxysm is brought on by powerful affections of the 
 mind, (though not unfrequently it is banished by the 
 same); sometimes the infliction of external violence, 
 particularly on the lower limbs, a sprain, or fatigue; 
 occasionally, an omission of an accustomed exercise, 
 or a suppression of a customary evacuation; often im- 
 proper food, gluttony, a surfeit, and whatever pro- 
 duces indigestion and acidity in the stomach. For it 
 is well known that affections of this kind, are almost 
 always the precursors of a paroxysm of gout. 
 
 But besides this, the exciting causes, and perhaps 
 also the predisposing, often arise from the state of 
 the air. Regular gout, which, when it has begun, 
 generally recurs about the same time of the year: 
 afflicts the patient first in the spring; for the most 
 part in the end of January or beginning of February; 
 never in summer time, unless from some sudden 
 and violent exciting cause. After the disease has ad- 
 vanced, when the patient suflTcrs two paroxysms dur- 
 ing the year, one happens in the spring and the other 
 in the autumn: but in summer the patient is entirely 
 
181 
 
 exempt from the complaint. Finally, in those cases 
 when the patient is so very severely afflicted, as to 
 lose the use of his limbs, and is confined to bed for 
 a considerable portion of the year, he derives the 
 greatest relief from the summer season. Those ex- 
 cruciating pains which medicine can scarcely touch, 
 are always greatly relieved by the provision of nature, 
 and generally cease altogether during these three or 
 four months of the year. Reasoning from this fact, a 
 change of climate promises the highest advantages 
 in this disease. 
 
 Cold air is doubtless injurious to gouty persons; 
 for they carefully cover the parts particularly affected 
 with the disease, and derive some relief from this 
 practice. The most judicious physicians indeed do 
 not permit any other remedy to be applied to the 
 pained limb, than woollen cloth, or something of a 
 similar kind. It is agreed too that sudden applica- 
 tion of cold to the body, not unfrequently brings on 
 a gouty paroxysm. And gouty persons frequently 
 feel slight arthritick pains when any degree of cold 
 is applied to the feet. Physicians well know also, 
 that a checking of the customary sweat or perspira- 
 tion of the feet, is often the forerunner of a gouty pa- 
 
182 
 
 roxysm. Slight paroxysms too, which produce seve. 
 rer ones, are dissipated by gentle bathing of the feet 
 or sometimes of the whole body. Hence therefore, 
 it is very probable that suppressed perspiration is 
 injurious to the gouty patients, while a free discharge 
 by the skin is beneficial. In spring and in autumn 
 when the weather is very variable, the disease is 
 greatly aggravatedi and in summer, as we have be- 
 fore remarked, it ceases. To avoid therefore the re- 
 mote causes, either predisposing or occasional, aris- 
 ing from the air, a change of climate is strenuously 
 to be recommended. We shall now notice in what 
 way a favourable climate promises to overcome the 
 other remote causes. 
 
 Disorders of the stomach almost always precede a 
 paroxysm of gout, and indeed afflict most gouty 
 persons, and constitute a great part of the disease. 
 When speaking of hypochondria we remarked that 
 warm climates are not much disposed to produce 
 these diseases, and indeed with us they occur rarely 
 in the summer season. To whatever causes therefore 
 that relief of the diseases of the stomach which arises 
 from a mild atmosphere, is to be ascribed; whether 
 to its direct action on the nervous system or to its 
 
183 
 
 effects in promoting and distributing the fluids — it is 
 evident that a change of climate is of the greatest 
 advantage in those affections — and as they are cured 
 or relieved, it is reasonable to expect, that gout 
 would derive infinite benefit from the same sources. 
 
 Gout, as we have before observed, generally at- 
 tacks those who have passed the prime of life, that 
 is, who have reached the thirtieth or thirty- fifth year 
 of age. In infancy it is almost altogether unknown, 
 and in boyhood is exceedingly rare: But in more ad- 
 vanced age the perspiration is sensibly diminished; 
 for many minute vessels and cutaneous pores, are 
 contracted in process of time, and coalesce. Old 
 men generally neglect to take their accustomed and 
 necessary exercise, for the pristine activity of miriU 
 and body are then wanting; and they are often engag- 
 ed in sedentary employments. In such men therefore, 
 travelling into warm countries, if I am not mistaken, 
 would prove very successful, and restore the distri- 
 bution to the surface and the excretion by the skin, 
 and perhaps might in this way relieve this disease. 
 
 Gout generally attacks those who indulge in high 
 living, and are given to the excessive Ose of wine 
 
184 
 
 and other spiritous liquors. To these therefore, 
 above all other men, we believe that the freest per- 
 spiration by the skin is necessary; for a certain equi- 
 librium between what is taken in and passed out of 
 the system, is required for health. Now this balance 
 is evidently disturbed, if any one uses too full a diet, 
 and leads an indolent and sedentary life. Experience 
 satisfactorily shows, that various diseases are pro- 
 duced by this cause, and especially gout. Men who 
 use a temperate and light diet, although they may 
 lead an inactive life, are rarely attacked by gout: and 
 those who use powerful and frequent exercise, espe- 
 cially those who get an appetite by hard and con- 
 tinual labour, although they daily consume a great 
 quantity of gross food, nay, and indulge in spiritous 
 liquors — are rarely troubled with this complaint. 
 There are some examples even, of men having suf- 
 fered hereditary gout (which is generally esteemed 
 the worst, and the most difficult of cure) for many 
 years, being reduced to poverty, and obliged to seek 
 a livelihood by hard labour — have been entirely 
 cured. Examples of this kind very clearly show of 
 how much importance it is for relieving or curing 
 this disease, that the freest determination of the fluids 
 to the surface of the body should be promoted. I 
 
185 
 
 am by no means ignorant, that another and altogether 
 different reason might be given on this subject, and 
 attributed to the benefit received by exercise and its 
 effects on the solid parts. Exercise without doubt 
 not only promotes a free distribution of the fluids, 
 but also procures strength and vigour to the mus- 
 cles and the general constitution, preserves and in- 
 creases it. I will not contend that exercise would 
 not in this way be beneficial to ttie gouty, especially 
 to those already broken and debilitated by the dis- 
 ease. 
 
 But there are arguments arising from the history 
 of the disease, and from analogy of those things that 
 are useful, which show that the benefit derived from 
 exercise is to be attributed at least in a great mea- 
 sure, to its effects in promoting a due distribution of 
 the fluids. From what has been said above, if I be 
 not mistaken, it plainly appears — that obstructed per- 
 spiration is very hurtful to the gouty. And the dif- 
 ferent things which relieve these patients, can hardly 
 act in any other way, than by promoting the perspi- 
 ration and due distribution to the surface. Of this 
 kind are plentiful and warm clothing, especially to 
 the pained parts, from which almost all gouty per- 
 
 2 A 
 
186 
 
 sons experience relief: also the tepid and even the 
 hot bath, and frequent and powerful frictions, from 
 which many derive the greatest assistance; and some, 
 very much broken by the disease, have recovered 
 the use of their limbs which they had almost lost. 
 There is no occasion to repeat what has already been 
 said respecting the benefit accruing in this dreadful 
 disease, from the summer heat. It may be reason- 
 ably collected from all these facts, as it seems to me, 
 that a free perspiration is especially necessary in 
 curing this disease; and we have before proved, that 
 a climate moderately warm, eminently effects that 
 purpose, because the sick, however greatly broken 
 down and debilitated, can receive the advantage of 
 it as long as they please without danger or detri- 
 ment. I would therefore recommend a change of 
 climate to the gouty, for these reasons particularly: 
 that all the injury which arises from our winter, may 
 be avoided, and the advantage, whatever it may be, 
 which the summer season affords, might be continu- 
 ed, and so that the perspiration and due determina- 
 tion of the fluids to the surface, might be promoted; 
 or if it should have been checked, so that it might 
 be restored. 
 
187 
 
 Another argument may be added to these, 
 and though it is an uncertain one, and does not 
 appear at all accurate, yet I do not think on that ac- 
 count that it is irrelevant. We have before observed 
 that the seeds of gout exist in the constitution of 
 some persons; but since the nature of this predispo- 
 sition as yet is concealed, it can hardly be expected 
 that a powerful remedy will be found by which it 
 can be corrected or extirpated. ** For since in this 
 disease (as Sydenham has judiciously mentioned) its 
 cause exerts such an influence over the constitution 
 as to render its very nature, new as it were, no ra- 
 tional being could suppose that a slight or temporary 
 alteration either produced by medicines, or by a par- 
 ticular diet, could produce a radical cure; but the 
 general habit of body must be brought into a different 
 condition, and the entire man as it were subsequently 
 re-organized." But if the condition of the system is 
 entirely or almost entirely changed, it is not impro- 
 bable that the peculiar disposition would be altered 
 or corrected. It is known, that certain changes which 
 the constitution undergoes, bring that disposition 
 into view: for in the state of infancy or boyhood, it 
 rarely shows itself; while the disease generally makes 
 its attacks in manhood. The constitution therefore 
 
188 
 
 undergoes in that age, certain changes favourable to 
 this disposition. Therefore we might hope that other 
 changes would be able to expel or correct a gouty 
 disposition. Now the constitution of the system is 
 most altered by a change of climate: and experience 
 plainly shows that travelling into warm countries 
 would be not only safe in this disease, but even very 
 useful and pleasant to the patients. 
 
 There is a very remarkable case, and very appo- 
 site to these observations, which the celebrated Van 
 Swieten has mentioned in his Commentaries, of a 
 man who in the thirty-first year of his age, laboured 
 severely under gout, and lost almost entirely the use 
 of his hands and feet. In this condition he took a voy- 
 age to the East Indies, with a view to derive benefit 
 from the climate. He returned to his native country 
 after a lapse of three years, and in consequence of 
 the heat of the air, without the use of any other re- 
 medies, he lived healthy and perfectly free from gout. 
 
 A similar case is related by the illustrious Haller, 
 of Lord de Poihcy, who when an old man, and al- 
 ready severely afflicted with gout, went to the warm 
 islands of America, where he lived many years with 
 
189 
 
 the effect of being freed from gout and all the other 
 evils of old age, and recovered his former health. 
 
 A case similar to this I received from a very learn- 
 ed physician, who often saw the patient while he 
 lived abroad. A nobleman laboured for many years 
 under gout, until at length the disease so much in- 
 creased, that he was grievously afflicted the greatest 
 part of the year. The patient had used many reme- 
 dies without effect. He lived for a long time on a 
 diet of milk alone. The disease however daily grew 
 worse. He made a journey into Italy, where in a short 
 time he had a most severe paroxysm, (though of 
 short duration). Afterwards, however, he lived free 
 from the disease, and still lives after many years. It 
 must be observed, that this patient remained only two 
 years in Italy, and while he staid there he indulged 
 in a somewhat more generous diet than before. 
 
190 
 
 SECTION V. 
 
 Of invigorating old age. — The signs and effects of declining 
 life in old persons, and the particular consequences of the 
 depreciated functions of the system. — Reasons why a change 
 of climate may be expected to relieve them, and produce a 
 general invigoration of the fading body. — Of the injurious 
 effect of a cold and humid climate upon old people, and the 
 advantages to be derived from travelling to warm countries. 
 
 I MAY advance in this place, a few observations 
 respecting the relief of old age, and protracting hu- 
 man life beyond its ordinary limits, by means of the 
 influence of a change of climate. They will neither 
 be useless nor foreign to the subject of this discourse. 
 Some physicians of eminence suppose, that old age 
 itself is a true disease, which can derive relief from 
 our art. Others indeed, contend that old age is a 
 natural and inevitable condition of life, and that there- 
 fore it can neither, be relieved nor rendered a disease, 
 by means of human art. It is not my intention to 
 enter into a discussion of this question, for it would 
 be both useless and impertinent to my subject, to 
 
 I 
 
191 
 
 do so. Whether it be a disease, or a natural state, it 
 is very certain that old age brings with it many in- 
 conveniences, renders the system liable to many dis- 
 orders, evidently diminishes all the natural powers 
 both of mind and body, and sooner or later brings on 
 death itself. This state therefore, stands in great 
 need of all the precautions and assistance that medi- 
 cine can afford. For it is the province of physicians 
 not only to cure diseases, but to maintain health, 
 and as far as is allowed to mortals, to preserve and 
 prolong life. The science of medicine would conse- 
 quently be very imperfect, if it could not supply any 
 remedies calculated to accomplish this end. Espe- 
 cially since there are some evil disposed persons, 
 who contend that our healing art, sometimes shortens 
 the span of human life. 
 
 I am not indeed acquainted with any remedies, 
 which are endued with the power of making us 
 young again: yet I do not at all doubt, that reme- 
 dies might be found sufficiently efficacious to be able 
 to ward off immediate old age, and to prolong life 
 for some years beyond its natural bounds, as well as 
 to keep the health and powers of the system but 
 little impaired. But such a virtue cannot be expect- 
 
192 
 
 cd from the use of medicine for a short time. To 
 achieve such an effect on the system, it is not only 
 necessary that an efficacious remedy should be em- 
 ployed, but that it should be long continued, and 
 that the general constitution should undergo a proper 
 and almost entire revolution. 
 
 In many cases, where the general system is con- 
 taminated by some vice, and is threatened with some 
 serious danger, a change of the whole habit of body, 
 often succeeds very happily. It is very well known to 
 every one, than an intemperate or improper mode of 
 life, often brings on a protracted state of ill health, 
 and premature old age. Reason and experience there- 
 fore both prove, that a proper kind of life can pre- 
 vent those inconveniences, maintain health, and re- 
 tard the approach of old age, as well as protract 
 life. How much a proper change in the mode of life 
 conduces to this effect, Cornaro has very clearly evi- 
 denced. After having past his fortieth year, he felt 
 that his constitution was in a manner broken down, 
 and debilitated by his intemperate kind of life: he 
 took leave of his former habits, led a sober and tem- 
 perate life, recovered his pristine vigour, and com- 
 
193 
 
 pleted his hundredth year, without the health of his 
 body or the faculties of his mind being impaired. 
 
 We have before said that a change of climate pro- 
 duces powerful effects on the human body: and 
 if a man should live sufficiently long under another 
 sun, it is not improbable that his constitution would 
 be entirely changed. Various are the arguments 
 which influence me in adopting the opinion, that a 
 change to a warm climate would be very useful to 
 most old persons. No rational creature can suppose 
 that a change of climate, or any other remedy, will 
 banish old age forever, or that it could prolong hu- 
 man life to eternity, or even for a long series of 
 years. I shall not promise so miraculous a remedy. 
 But there are many who find their health broken, 
 and their powers impaired, and who feel death close 
 upon them, who would seize with the greatest eager- 
 ness a remedy, by which life could be extended only 
 for a few years, and which might in some measure 
 regenerate the languid and impaired powers of the 
 system. 
 
 In our opinion, there are some obstacles to the 
 long continuance of human life, in every part of the 
 2B 
 
194 
 
 globe; but if there be any difference, they are greater 
 in our northern countries than in the regions of the 
 torrid zone. But we have before remarked, that a 
 warm climate produces much more powerful effects 
 upon travellers, than upon men who live continually 
 under its influence. If any one is continually accus- 
 tomed to the useful remedy it affords, he evidently 
 loses whatever degree of benefit might be expected 
 from its operation. Nay, I could easily believe, that 
 the immoderate use of this remedy, would not only 
 do no good, but would, in many cases, prove very 
 injurious. If any one of our inhabitants, healthy 
 and robust, and in the bloom of life, was to seek 
 more fervid climates, where he might live, his life 
 would not only not be prolonged, but perhaps would 
 be curtailed, and he would prepare for himself a pre- 
 mature old age — melancholy examples of this kind, 
 are daily presented to our view. We should sedu- 
 lously attend, respecting this remedy, to what Celsus 
 formerly judiciously admonished, with regard to 
 others; namely, that we should take care lest in our 
 efforts to preserve health, its real interests were not 
 destroyed by injurious cautions. 
 
 I shall endeavour therefore to show, what changes 
 
195 
 
 occur in old age, the way in which our climate is 
 pernicious to old persons, and the reason why tra- 
 velling into warm countries should be recommended 
 to them. I do not design to treat here of all the evils 
 particularly, to which old age, in these northern 
 countries, is subject, and which might be prevented, 
 relieved or cured, by a change of climate. 1 intend 
 to make some remarks only upon those changes and 
 differences that are natural to old age, and which 
 attack sooner or later the healthiest and most vigor- 
 ous, break down and waste away the constitution, 
 and finally sweep them from the busy scenes of life. 
 
 In the progress of years, the human body suffers 
 various alterations which injure all the powers and 
 natural functions of the system; consequently many 
 inconveniences are brought upon the aged. These 
 changes affect the whole system, and undermine and 
 weaken it in every part; they especially affect the 
 nervous system, blunt the understanding, diminish 
 the strength and energy of the mind and body, ren- 
 der the solid parts stiff and hard, and greatly impede 
 the motion and distribution of the fluids. All these 
 evils evidently increase by degrees; yet it is very 
 difficult to explain their beginning and origin, or t© 
 
196 
 
 detect which is the cause of the others. If we begin 
 from the impeded distribution of the fluids, a ques- 
 tion arises, why this is disturbed, if the solid parts 
 and the moving powers remain sound, natural and 
 entire? Or, if we begin from the induration and 
 atony of solid parts, and especially of the arteries and 
 muscles, it will be difficult to assign a reason why 
 these have become indurated, and have lost their 
 powers, if the distribution of the fluids is properly 
 promoted, and the nervous energy not diminished. 
 Finally, if we begin from a defiiciency of the nervous 
 power itself, (whence doubtless all the other evils 
 spontaneously flow), we should explain, why this is 
 deficient, if the motion of the blood and the rest of 
 the functions of the animal machine are performed 
 properly and in the usual manner. For the action of 
 the heart and the nervous energy reciprocally sup- 
 port each other. It must therefore be acknowledged, 
 that the human body is a circle, the beginning and 
 the end of which are as yet concealed, and perhaps for 
 a long time will continue unexplored. All things that 
 are necessary to life and for the health and increase 
 of the body, are not accurately understood; it can 
 hardly be expected therefore that the cause of any 
 default in them, should be nicely comprehended. 
 
197 
 
 Yet we do know many things that are necessary to 
 life and growth, and which support the strength and 
 hcahh of the body; we are acquainted too with rriany 
 which are inimical to all these, which diminish the 
 powers, destroy the health, waste the body, and 
 pave the way for death itself. We know moreover 
 that all these increase each other, so that the consti. 
 tution is daily running into a worse condition. 
 
 But all the changes which arise from old age, may 
 be reduced to three heads; to impaired nervous en- 
 ergy, and induration of the solid parts, and an ob- 
 struction of the free distribution of the fluids. Of 
 each of these effects we shall now proceed to treat 
 more particularly. The first signs which generally 
 accompany and denote incipient old age, are observ- 
 ed to arise from impaired nervous power. All the 
 senses both external and internal, by degrees are 
 rendered more obtuse. Sight, hearing, smelling, 
 taste, are sensibly deficient; hence most old persons 
 dislike light and unadulterated food, which they be- 
 fore were fond of — and crave a more savoury, salt 
 and high seasoned diet. The cheerfulness of youth 
 gives way by degrees to the gravity of age. The 
 strength and activity of the body, are also sensibly 
 
198 
 
 diminished; hence most old men leave off all the 
 more powerful exercises, and very willingly ex- 
 change the toil of business for a life of tranquillity 
 and ease. Upon still more advanced age, the strength 
 of the muscles is daily more and more diminished, 
 until at length confirmed old age causes a loss 
 of almost all the uses of the limbs. The faculties of 
 the mind also by degrees waste away. The imagina- 
 tion is depressed, and memory totters; at first in- 
 deed, recent ideas easily escape it, although old ones 
 which it formerly imbibed it very tenaciously retains. 
 But afterwards all ideas, both old and recent, are 
 dropt from the memory altogether, and then the 
 judgment is destroyed. — The solid parts of the body 
 become hard: the cellular texture is not only harder 
 so as to resist the knife, but has obtained a greater 
 power of adhering. Hence the skin, which in youth 
 was soft, smooth, and equal, by degrees becomes 
 hard, and rough. The numberless invisible pores 
 are contracted, and altogether closed up; hence per- 
 spiration is obstructed, and the skin acquires a pecu- 
 liar dryness. The arteries of old persons become 
 thicker, more rigid, and even narrower, and many 
 of the smaller ones are gradually closed up. The 
 veins also acquire a greater thickness and strength 
 
199 
 
 than in youth, but never in the same proportion as 
 the arteries. Hence, from the greater resistance and 
 diminished impetus, (to wit, by the moving powers 
 being now impaired), the motion of the blood is 
 slower; so that the veins of old persons become 
 larger and not unfrequenily varicose. From this 
 cause also, and the diminished irritability of the 
 heart, (from a defect of nervous energy), the pulses 
 beat more slowly. The brain itself, the nerves, all 
 the viscera — become indurated, so that the muscular 
 fibres often become almost altogether converted into 
 a very hard tendinous substance. This induration 
 evidently arises from a deficiency of the fluids, 
 which cannot now, as formerly, flow through the 
 smallest vessels, by this time contracted and closed. 
 The same reason might chiefly be given, for the de- 
 bility of the muscles, and the decrease of the whole 
 body, which are observed in old age: For however 
 large, corpulent and robust bodies may be in the 
 first stage of old age, they become in the last, in- 
 active, and ahogether debilitated. If the vessels 
 which used to carry blood to any part, are contract- 
 ed, or closed, so as to convey no blood, or but an 
 inconsiderable quantity, it is evident that such part 
 cannot be nourished as before; it is not surprising 
 
200 ' 
 
 therefore, that it pines away, and loses the powers 
 which it formerly possessed. Besides, many vessels, 
 and lacteal glands of the mesentery, are obliterated in 
 extreme old age; and thence perhaps it is probable that 
 a much less quantity of nutriment will be conveyed 
 to the blood, from the same food. — With regard to 
 the obstructed motion and distribution of the blood, 
 there is no doubt. A defect of nervous energy in 
 consequence of the debility of the moving parts, the 
 greater resistance of the arteries, and from the con- 
 striction or choaking of innumerable minute vessels, 
 and cutaneous pores, — it is evident that the blood 
 does not flow freely through the whole body, as be- 
 fore. All, nearly, of the minute excretions, and some 
 suppressed ones, the dryness and fading and hard- 
 ness of the body, demonstrate the fact beyond the 
 possibility of doubt. The perspiration in old persons 
 is very much lessened, and often almost watery. 
 Their bowels also are generally observed to be 
 slow or inactive. Hence, according to many and 
 very celebrated authors, an acrimony of the fluids 
 is produced, from a retention of those parts which 
 ought to be excreted and passed out. But the na- 
 ture of this acrimony, so far as I know, is not ac- 
 curately understood. I will not deny that many 
 
201 
 
 disorders happen in the fluids of old persons: And 
 from the deficiency of the other natural powers, 
 which were wont to prepare properly the blood, it is 
 not improbable, that it will become feeble or other- 
 wise diseased. Old persons are sometimes liable to 
 disease, evidently the consequence of a defect in the 
 motion of the blood, namely, necrosis, or gangrene, 
 which generally attacks first the feet, afterwards the 
 legs, and induces though slow, yet certain death. 
 
 The reason therefore is plain, why our cold, moist, 
 and variable climate is unfriendly to old people. In 
 the first place it injures the nervous system, and 
 diminishes the power and activity both of body and 
 mind: Hence the due distribution of the fluids is 
 impeded, and the atony and hardness of the solid 
 parts increased. Moreover, cold and moist air (as 
 we have already remarked) obstructs, directly and 
 immediately, the perspiration, and the free determi- 
 nation to the surface. Cold also causes an induration 
 and stiffness of the external skin, and the other solid 
 parts. But all these things occur naturally to old 
 persons, and when they do happen (as wc have re- 
 marked above) they increase each other. 
 
 2C 
 
202 
 
 From the history of old age it may be gathered, 
 that the evils which occur to it, especially require 
 three things: namely, to sustain and nourish the ner- 
 vous power, or, if it is already depreciated, to re- 
 store it: to prevent or remove an excessive hardness 
 of the solid parts, and promote the due distribution 
 of the blood. If all these things can be exactly ac- 
 complished as we would desire, there is no doubt 
 but that the former vigour and complete youth would 
 be restored. But if they are only partially achieved, 
 the energy and power will be renovated in some 
 measure, delay the immediate approach of old age, 
 and perhaps prolong life for many years. I do not 
 know any remedies which answer these intentions 
 better than a change of climate, by travelling in 
 warm countries. 
 
 Nor is it a matter of small importance that this 
 remedy is both safe and pleasant at the same .time, 
 for all the evils of old age. We plainly see that all 
 these disorders increase each other; yet we never 
 know which one is the cause of the rest. It is of 
 the greatest importance in curing any disease, that 
 a remedy should be applied in the first place to its 
 causes. But if to any of the evils to which old persons 
 
203 
 
 are subject a remedy can be applied, it is but rea- 
 sonable to expect that the general system would de- 
 rive benefit from thence; in this way the powers of 
 nature might be somewhat recruited, and the other 
 evils of old age, might, in some measure, be re- 
 lieved. 
 
 There is no occasion to sny of how much use 
 warm air is in exciting and nourishing the nervous 
 energy. The healthiest and most robust, who stand 
 in need of no such assistance, experience new ac- 
 tivity both of mind and body, from this source. But 
 to the debilitated and the feeble, worn out by old 
 age, it restores the decaying powers, and as it were, 
 fills up the chasm of wasted life. It replenishes and 
 preserves the powers of the muscles, sharpens the 
 obtunded senses, stirs up the languid and almost 
 stagnant circulation of the blood, quickens the pulses 
 (in old persons slow) and promotes the due motion 
 and distribution of the fluids throughout the whole 
 system. It restores also all the secretions and excre- 
 tions, now diminished and almost suppressed, more 
 especially the perspiration. In this manner, therefore, 
 it would be greatly beneficial to old persons. 
 
204 
 
 Nor does it exert less power in preventing or cur- 
 ing that hardness of the skin and all the solid parts, 
 which brings such evils upon the aged. Cold con- 
 stricts and hardens the skin and solid parts; but mo- 
 derate heat relaxes and softens them, as we plainly 
 see. If an old person therefore would go abroad into 
 moderately warm countries, the mild air would sen- 
 sibly render his hard, rough, dry, and almost imper- 
 vious skin, smooth and penetrable; again, it would 
 open the numberless more minute vessels now con- 
 tracted, and almost closed, and open the way for the 
 blood and other humours to many parts of the body, 
 almost dried up for the want of the vital fluid. Hence 
 all the natural secretions and excretions now defi- 
 cient, are promoted, and the power, contractility and 
 softness are restored to the indurated and tendinous 
 muscles, now trembling, weak, and almost paraly- 
 tick. Nor is there any doubt but that the nervous 
 system derives the happiest effects, from this reno- 
 vation of all the powers of the body. It is known 
 that to most persons, a free distribution of the fluids 
 and perspiration, ensures the greatest strength and 
 activity of mind and body. Nor would it happen 
 otherwise in old persons. In consequence of the ner- 
 vous system being in this way regenerated, the whole 
 
205 
 
 system would be reanimated. Hence as before, the 
 hardness of the solid parts, and especially of the skin 
 and arteries, is in some way or other overcome, the 
 powers of the system are increased, the return of blood 
 to the heart is accelerated in consequence of the di- 
 minished resistance, the pulses beat quicker, and the 
 blood is properly propelled through the minute and 
 extreme vessels; so that it opens for itself a passage 
 through the almost closed up vessels, and renders 
 the hard, stiff and dry parts, soft, flexible, and ener- 
 getick as before. 
 
 Now if this may be effected by the perspiration and 
 distribution to the surface being greatly promoted, it 
 appears reasonable how a change of climate might be 
 of service to the aged. For free perspiration, how- 
 ever excited, relaxes and moistens the skin; hence 
 its hardness and dryness in old age is diminished or 
 corrected, and the distribution of blood is rendered 
 more easy to the external parts. It increases the 
 powers of nature therefore, and replenishes defi- 
 ciences. It is also very favourable to the nervous 
 system, and produces energy of body and cheerful- 
 ness of mind. It perfectly answers the three indica- 
 tions for cure which we have advanced, and these 
 
206 
 
 also reciprocally promote each other. From all these 
 circumstances then, it may be collected, a priori, 
 that a change of climate would be of infinite service 
 to the aged. 
 
 This theory is confirmed, from analogy of many 
 things which are beneficial to old persons, and 
 which may clearly be referred to our indications. 
 We recommend in the first place to nourish and 
 support the nervous energy: now the liberal use of 
 wine tends to produce this effect; and experience 
 satisfactorily proves, that wine, however injurious it 
 may be to young persons, is, when moderately used, 
 not only safe for the aged, but of the greatest utility; 
 so that it has been esteemed, and not unjustly, the 
 milk of old age. To confirm this it is hardly neces- 
 sary to adduce the authority of great names. If how- 
 ever there were occasion for such adventitious assis^ 
 tance, the most renowned Sangrado (of whose fame 
 there is no one that has not heard), affords remark- 
 able proof. For after waging, th'-ough the course of 
 a whole life, a fierce and implacable war against all 
 generous drink, upon the advance of years, he was 
 vanquished in the fight, and, forced by dire neces- 
 sity, he implored favour and protection from his 
 
207 
 
 « 
 
 former execrated enemy. If any one is disposed to 
 reject the instance of Sangrado, let him yield to the 
 wise Le Sage, who was not less deeply versed in the 
 medical art than in a knowledge of mankind. To 
 the other indication, of promoting the perspiration 
 and distribution of the fluids to the external parts, 
 warm clothing is evidently necessary. And it is well 
 known to every person, that this is extremely useful 
 to old people, who should use flannel shirts. Fric- 
 tions also, and moderate exercise, especially gestation, 
 which tends to the same effect, is greatly serviceable 
 to old people: so also is the tepid or warm bath, 
 from which many aged persons derive great help. 
 
 But the benefits which the summer season brings 
 to old people, strengthen the theory more than any 
 thing else, and are the best proof of the utility to be 
 expected from a warm climate. Upon the approach 
 of summer all the evils which harass the aged in the 
 winter, disappear almost entirely, and old age being 
 kept a little in check, the scintillating and almost 
 extinguished flame of life, is seen to be animated in 
 them anew. Upon the return of winter, the former 
 evils again, and now more grievously, press upon 
 them. If any benefit therefore is derived from our 
 
208 
 
 summer, a climate enjoying a perpetual summer, 
 promises much more permanent assistance. 
 
 Finally, experience proves that this hope of reliev- 
 ing old age in some degree, and extending life be- 
 yond its natural termination, is neither vain nor 
 futile* For there are many instances of old persons 
 having gone into warmer countries, and having de- 
 rived new vigour from the change, and prolonged 
 their ebbing life. Some Europeans who have gone 
 to India, experienced unexpectedly this beneficial 
 relief. It is said that the Spaniards and Portuguese, 
 when they feel the presages of old age, not unfre- 
 quently go to Brazil or other parts of South Ame- 
 rica, and thus revive their wasted strength, and 
 sometimes protract life for twenty years or more. 
 " The fame of the healthiness of Brazil (says Piso 
 in his natural and medical history of Brazil) invited 
 formerly not a few old persons and others in ill 
 health, to take advantage of the air and water of the 
 country, as though they were two of the most pow- 
 erful preservatives of life and health. For the inha- 
 bitants soon arrive at maturity: grow old slowly, and 
 without hoariness or baldness. Hence it is that long 
 after the hundreth year of age, they enjoy, not only 
 
209 
 
 the American, but even Europeans themselves, a 
 green old age, so that the whole country deserves to 
 be called the country of longevity.'' Nay it is said 
 that lost fecundity is restored in the warm islands 
 of America. Which if it be true, plainly proves how 
 powerfully warm air acts in reviving the powers of 
 the system. 
 
 A question yet remains to be considered: at what 
 age travelling into warm countries may be under- 
 taken with the greatest benefit. I doubt whether 
 any age can be particularly designated; for the use 
 of travelling depends on the state of the constitu- 
 tion and not on particular periods of life; besides, 
 some grow old sooner and others later. Authors 
 divide old age into incipient or green, and decrepit. 
 They calculate the first from the forty-ninth year, 
 or from the time when men begin to grow gray, 
 and use spectacles, that is to say, from the grand 
 climacterick of life; the other is computed from the 
 end of this to the last hour of existence. In the first, 
 but few and slight inconveniences are experienced; 
 yet, they may be easily observed, and plainly indicate 
 universal and approaching decay. But all the facul- 
 ties both of the mind and body, as yet remain. 
 
 2D 
 
210 
 
 Muscular motion is but little diminished; the facul- 
 ty of generating, and the appetite for food and di- 
 gestion, continue: while in decrepit old age all these 
 quickly run on to deterioration. All the powers of 
 the mind are daily diminished, and at length alto- 
 gether disappear; all the functions of the body lan- 
 guish, and at length cease to operate. It is however 
 observed, that these changes happen sometimes 
 sooner and sometimes later; some retain all their 
 powers and functions, even the faculty of genera- 
 ting, almost to the hundredth year; some preserve 
 the form of the body and all the senses both exter- 
 nal and internal, unimpaired till the seventieth or 
 eightieth year. Many persons most manifestly 
 suffer a deterioration of all their powers, before the 
 seventieth year. Before the fiftieth year however, 
 scarcely any sensible alteration takes place. I can 
 hardly believe then, that a change of climate is re- 
 quired before the fiftieth year; but after it, there is 
 no doubt that in many cases it would be of the 
 greatest service. It is much easier in this, if I be 
 not mistaken, as in other instances, to prevent the 
 evils than to cure them; and therefore travelling 
 may be begun with the greatest advantage between 
 the fiftieth and sixty-fifth years of age, for the most 
 
211 
 
 part perhaps about the sixtieth, and sooner or later 
 according to the strength and constitution of the 
 person. But this depends on different circumstances, 
 as a congenital and perhaps hereditary constitution; 
 for longevity is much more frequent in some fami- 
 lies than in others; yet it principally depends upon 
 the mode of life, and innumerable other adventitious 
 causes. — Yet I do not in the least doubt that travel- 
 ling into warm countries, would be extremely bene- 
 ficial to old persons already become decrepit, and 
 it is perhaps, the only remedy by which their pow- 
 ers may be restored, and their lives prolonged. 
 
 Lastly, it is to be inquired how this curative in- 
 tention derived from climate, is to be answered, and 
 what particular countries should be sought by the 
 aged. A country warmer than our native clime, en- 
 joying a pure, mild and benign air, and in other 
 respects healthy, should always be chosen: again, 
 upon the approach of old age, a still warmer country 
 should be sought: nor do I think that an old person 
 should despair altogether till even the hottest climates 
 have been tried. If any one of our inhabitants who 
 is growing old, should go to Spain or Italy and re- 
 side there, I have no doubt but that he would expe- 
 
2\^ 
 
 rience the most beneficial effects from the change, 
 and would banish old age, or at least all the evils of 
 old age, for many years. But in process of time, 
 these would doubtless assail him again; when, if he 
 should seek a still hotter climate, he would by the 
 same reason, receive new vigour from it; so that 
 when old in Spain he might, by being transported 
 into South America, derive assistance from that 
 change, and be again renovated. 
 
 Thus we may indulge the pleasing expectation, 
 that health may.be procured even in the hottest 
 climes on earth; that man, when threatened with the 
 decrepitudes of old age, may avert, or at least alle- 
 viate them, by deserting his native soil; and that he 
 might prolong a life, the shortness of which is a 
 source of perpetual and querulous regret, for twenty 
 or perhaps for thirty years, by availing himself of 
 the friendly influence of a foreign and more genial 
 sun. 
 
 THE END. 
 
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