Part 3

The non-professional predilection in favour of a warm climate for consumption, may be referred, we suspect, to the analogy that exists between the earlier stages of that disease and those of a common cold. In fact, in most cases in this country, consumption is for a long time styled a cold; then it becomes a bad cold; then a worse; till it is impossible to withhold from it the more formidable name. A cold, however, it should be considered, occurs as frequently in summer as in winter; and in neither is it owing to the temperature, whether high or low, but to the _atmospheric changes_. The warmer the weather is, the greater will be the morbific effect of a cold draught of air. That a warm climate _in itself_ is neither prevention nor cure in consumption, may be inferred from the prevalence of the complaint in all latitudes. In India and in Africa it is as rife as in any part of Europe. By the Army Reports from Malta, we find that upwards of 30 per cent. of the whole number of deaths throughout the year is caused by phthisis. In Madeira, according to Dr Heineken, Dr Gourlay, and Dr Mason, no disease is more common among the natives than pulmonary consumption. At Nice, it is stated by Dr Meryon, more natives die annually of consumption than in any town in England of the same amount of population. In Genoa, one of the most prevalent and fatal of the indigenous diseases is pulmonary consumption. In Florence, pneumonia is marked by a suffocating character, and rapid progress towards its last stage. In Naples, 1 death from consumption occurs in a mortality of 2-1/3; while in the hospitals of Paris, where phthisis is notoriously prevalent, the proportion is only 1 in 3-1/4. In short, in all the celebrated sanatoria to which we fly for relief, we find the disease as firmly established as at home.

If we examine the analogies presented by the history of the inferior animals, we find no argument in favour of a foreign climate. The fishes, birds, and wild beasts of one region, die in another. 'Man, although endowed in a remarkable degree, and more so than any other animal, with the faculty of enduring such unnatural transitions, nevertheless becomes sensible of their injurious results. For familiar illustrations of this influence, we have only to look to the broken-down constitutions of our Indian officers, or to the emaciated frame of the shivering Hindoo who sweeps the crossings of the streets of London. The child of the European, although born in India, must be sent home in early life to the climate of his ancestors, or to one closely resembling it, in order to escape incurable disease, if not premature death. Again, the offspring of Asiatics born in this country pine and dwindle into one or other of the twin cachexiæ--scrofula and consumption; and, if the individual survives, lives in a state of passive existence, stunted in growth, and incapable of enduring fatigue. If such extreme changes of climate prove obnoxious to the health of individuals having naturally a sound constitution, how are we to expect persons in a state of organic disease to be thereby benefited? In fact, view the subject in whatever light we may, we must eventually arrive at the natural and rational conclusion--that nature has adapted the constitution of man to the climate of his ancestors. The accident of birth does not constitute the title to any given climate. The natural climate of man is that in which not only he himself was born, but likewise his blood-relations for several generations. This is his natural climate, as well in health as when his constitution is broken down by positive disease, or unhinged by long-continued neglect of the common rules of hygiene.' It is Dr Burgess's theory, therefore, that when change is necessary, a modification of the patient's own climate--that is to say, change of air in the same climate--is more in accordance with the laws of nature, and more likely to effect good, than a violent transition to warmer countries.

With regard to the curability of this disease, there is now, we believe, no doubt of the fact, although, unfortunately the process has not yet come completely into the hands of the physician. That a cure has frequently taken place, somehow or other, even in advanced stages of pulmonary consumption, has been demonstrated by _post-mortem_ examinations; but nature herself seems, in these cases, to have been her own doctor, for no mode of treatment of general applicability has been discovered. Some think that the progress of tubercles may be arrested in the first stage--others, that nothing can be effected till the second. Some resort to the water-cure--others, to the still more marvellous Spanish baths of Panticosa; and others, again, swear by cod-liver oil. As to the last remedy, our author quotes the statements of Dr Williams, 'that the pure fresh oil from the liver of the cod is more beneficial in the treatment of pulmonary consumption than any agent, medicinal, dietetic, or regimenal, that has yet been employed. Out of 234 cases carefully recorded, the oil disagreed, and was discontinued, in only 9 instances. In 19, although taken, it appeared to do no good; whilst in the larger proportion of 206 out of 234, its use was followed by marked and unequivocal improvement--this improvement varying in degree in different cases, from a temporary retardation of the progress of the disease, and a mitigation of distressing symptoms, up to a more or less complete restoration to apparent health. The most numerous examples of decided and lasting improvement, amounting to nearly 100, have occurred in patients in the second stage of the disease, in which the tuberculous deposits begin to undergo the process of softening. The most striking instance of the beneficial operation of cod-liver oil in phthisis, is to be found in cases in the _third_ stage--even those far advanced, where consumption has not only excavated the lungs, but is rapidly wasting the whole body with copious purulent expectoration, hectic, night-sweats, colliquative diarrhoea, and other elements of that destructive process by which, in a few weeks, the finest and fairest of the human family may be sunk to the grave. The power of staying the demon of destruction sometimes displayed by the cod-liver oil is marvellous.' Dr Burgess, however, although witnessing the same results even in far-gone cases, limits their duration to a year or eighteen months, after which the medicine lost its effect. Although the oil, therefore, is serviceable through the process of nutrition, he considers it no specific, and concludes on the subject thus: 'All that our present knowledge enables us to state positively on the subject is this: cod-liver oil is the most effectual stay to the progress of consumption, in a great majority of cases, that we possess; this salutary action is not always lasting, and there are cases in which its administration cannot be borne, and others in which it produces no good effects whatever. In those cases in which the stomach rejects the pure oil, if it be given in combination with phosphoric acid, it will generally be borne easily, and the acid will assist the tonic action of the oil.'

The non-professional notion respecting the curative powers of climate is, that by breathing a mild and soothing atmosphere, the phthisical patient withdraws irritation, and leaves nature at liberty to effect her own cure. But this, it seems, is entirely erroneous, inasmuch as it is through the skin, not the lungs, that a warm climate acts beneficially. When an atmospheric change takes place so as to produce a chill, 'whereby the cutaneous transpiration is instantly checked, the skin then becomes dry and hard, so that the respiratory organs suffer from the excessive action they now undergo, for the matter of transpiration must be eliminated through the lungs if the action of the skin be interrupted.' This is illustrated by the instantaneous relief usually afforded by free perspiration in cases where difficult breathing and oppression of the chest have been occasioned by artificial heat. What really soothes, therefore, is _equability_ of climate, not high temperature. Some authors even think that a cold climate is more suitable for consumption than a warm one, and point to Upper Canada, with its pure, dry, tonic atmosphere, affording hardly any trace of the complaint at all.

Here we might stop, as the nature of our work precludes our following Dr Burgess in his exposition of the action of climate on the lungs and skin; but it may be useful, and at any rate amusing, to trace his iconoclastic progress through the popular shrines of Hygiea on the continent.

Malta is a famous resort for phthisical patients, although during the winter and spring the weather is cold and variable, and in autumn the sirocco is frequent. When a sirocco has blown for some days, it lulls suddenly, and is succeeded by an equally strong breeze from the north-west, contrasting violently with the former in temperature and everything else. The extremes of heat and cold are as great here and in other places in the Mediterranean as in London. In Malta, our author saw five or six cases of bronchitis, which in a single month terminated in incurable phthisis; and in two cases, six weeks only elapsed between the first signs of the tuberculous deposit and the death of the patients.

Madeira, a still more popular sanatorium for this disease, is a complete delusion. Instead of the climate being essentially dry, it is saturated with humidity during a great part of the year; and the peculiar sirocco of the place is of a hot, dry, irritating nature. An intelligent medical author, who had resorted to Madeira for change of air, remarks, that 'very frequent and remarkable variations in a given series of years, incontestably prove that Madeira is no more to be relied on than any other place for certainty of fine weather, and that it has equally its annual variations of temperature.... From what has been stated by writers, a person might be led to believe that disease was scarcely known there; but I am afraid, that were the subject thoroughly investigated, as it ought to be, few places would be found where the system is more liable to general disorder; while, at the same time, I suspect that the average duration of life would turn out to be inferior to that of our own country.'

Our author knows no place more unfavourable to patients suffering from organic diseases of the lungs, than the far-famed sanatoria--Aix and Montpellier. The atmosphere is pure, but ever and anon keen and piercing, and the _bise_ and _marin_--one cold and cutting, and the other damp--irritate the lungs, and excite coughing. Add to this, that Provence is proverbially the land of dust, and, what is worse, the land of the _mistral_--a wind from the north-west, which carries stones, men, and carriages before it. 'For several days in spring the climate may no doubt be delicious, although, however, always too warm about mid-day, when suddenly the mistral, of evil celebrity, begins to blow. It is difficult to give an adequate idea of the change, or of the injurious effects of the climate under the influence of this scourge. The same sun shines in the same bright blue sky, but the temperature is glacial. The sun is there only to glare and dazzle, and seems to have no more power in producing warmth, than a rushlight against the boisterous winds, which chill the very marrow in one's bones. During the prevalence of this wind, it is impossible to stir out of doors without getting the mouth and nostrils filled with dust. All nature seems shrivelled and dried up under its baneful influence.'

Nice, likewise, is scourged by the mistral, which there, however, divides its empire with winds from the north and north-east. 'But one of the greatest vices characterising the climate of Nice, if not the greatest, is the remarkable variation of temperature noticed between day and night--in the sun and in the shade. The land or continental winds prevail during the night; the southerly or maritime during the day. The former are cold and dry; the latter, soft and humid. As soon, therefore, as the former subside, and the sun rises in the horizon, the humidity commences to shew itself in the atmosphere; whilst, on the contrary, when the diurnal winds cease, and the sun sets, the above hygrometric condition of the air disappears.' M. Carrière cannot conceive why our countrymen prefer Nice to a milder climate, and considers that the annual mortality in the English colony ought to discourage other hectic invalids from going thither.

Central Lombardy is, in general, characterised by marshy swamps poisoning the whole atmosphere with their miasmatic exhalations. The meteoric influences are decidedly cold and variable; and the 'extremes of temperature increase in proportion as we approach the valleys at the foot of the Central Alps, especially those most distant from the Adriatic coast.' This climate, our author tells us, cannot afford more benefit to the consumptive than that of the fens of Lincolnshire, or of the marshes of Holland. Brescia, Pavia, Mantua, and other Lombard towns, also share in this character; and at Verona, Mr B. Honan writes, that of all humbugs, the humbug of an Italian climate is the most intolerable.

At Genoa, although the air is pure and transparent in fine weather, it is liable to sudden gusts of wind and violent transitions dangerous to the invalid.

'In no part of England could a climate be found more unfavourable for consumptive invalids than that of Florence, a town built in a deep ravine, almost surrounded by the Apennines, and intersected by a squalid river.... Extreme cold in winter, great heat in summer, the prevalence of the northerly winds, the chilling effects of which are not always neutralised by the antagonistic winds, rapid and violent transitions, profoundly affecting the system, even in healthy persons; and combined with these violent atmospheric and thermal variations are also, in similar proportions, hygrometric and electric ever-changing influences.' Leghorn, the seaport of Tuscany, is built in a sunk locality, in the midst of a marshy country. Beggars, galley-slaves, assassins, smugglers, these are the picturesque portions of the inhabitants; and the promenade is an arid beach, anything but soothing to the respiratory organs. The English cemetery is a touching spectacle, with its numerous monuments of brilliant marble; among which stands conspicuous the tomb of Smollett.

Of Pisa, the grand central depôt of Italy for foreign consumptive patients, Dr Burgess says: 'The excess of humidity and warm temperature of the Pisan climate depress the vital force, induce an overwhelming lassitude, and are, in my opinion, most unfavourable elements in a climate so generally recommended for pulmonary consumption. Whatever effect the humid mildness of the air may have in diminishing excitability, and in allaying pulmonary irritation in patients of a nervous temperament, it is decidedly injurious in those of a feeble and lymphatic habit.... The delusion of an Italian climate, as regards the cure or prophylaxis of tubercular consumption, is in no part of that country, so delightful to persons in sound health, more clearly portrayed than at far-famed Pisa. The stagnant life, the death-like silence, the dreary solitude of this dull town, whatever utility these elements may have in allaying the restless irritability of nervous and excitable patients, always produce serious evils upon those consumptive invalids of a melancholy turn of mind, or whose spirit is broken by hope deferred. Brooding over their melancholy condition, in a foreign land, away from the comforts of home, without the solace and cheering influence of friends and relations, they soon break down and perish.' M. Carrière and Sir James Clark consider the climate of Rome adapted only for consumptive patients in the first stage of the complaint; but Dr Burgess, after a train of reasoning founded on scientific facts, comes to a conclusion consonant with his own theory, that it is not adapted for consumption in any stage or form whatever.

It is needless to follow our author to Naples, for this place is admitted by all writers to be injurious in cases of pulmonary consumption; but we may conclude this fragmentary survey by stating that, according to Dr Burgess, the least injurious portions of Italy are the Lake of Como and the city of Venice, _the air in neither of them being warm, but in both equable_. Here we end as we began: 'It is a mistake to suppose that a warm, humid, relaxing atmosphere can benefit pulmonary disease. Cold, dry, and still air, appears a more rational indication, especially for invalids born in temperate regions.' It will be seen that our author differs occasionally from both his great predecessors, Sir James Clark and M. Carrière; but even in so doing, he has at least the merit of fairly opening out a most important subject.

Let it be understood, that we have merely mentioned the nature of the contents of this volume, without attempting to follow Dr Burgess either in his reasonings or in the facts on which these are founded. We have now only to recommend the work as one that will be found highly interesting and suggestive, both by the medical and non-medical reader.[3]

FOOTNOTES:

[2] _Climate of Italy in Relation to Pulmonary Consumption_: with Remarks on the Influence of Foreign Climates upon Invalids. By T. H. Burgess, M. D., &c. London: Longman, Brown, Green, & Longmans. 1852.

[3] We print the above as we received it from a respectable contributor, but without giving any opinion ourselves upon a subject of which we are not qualified to judge.--_Ed. C. J._

THE DEVICE, OR IMPRESS.

If the various works of useful and ornamental art discovered in the sepulchres of nations long since fallen into oblivion, were of no other value, at the present day, than merely to be applied to the purposes which they were originally intended to subserve; if they did not elucidate the manners, customs, and progressional refinement of men with passions and feelings similar to our own; the labour and expense incurred by their exhumation would be thrown away. It is not, then, for the intrinsic value of the specimens to be produced, neither is it for any very particular admiration of the 'good old times,' but to exhibit and illustrate a very general and exceedingly active phase of our ancestors' minds, that, turning over the refuse materials of history, we proceed to disinter, from their worm-eaten pages, the dead and almost forgotten art of Device--an art that once claimed an extensive literature, and canons of criticism, peculiarly its own. From about 250 to 400 years ago, were the high and palmy days of this 'dainty art.' Then, the learned and subtile schoolmen of the age did not disdain to write upon it, with ink scarcely dry upon the pens with which they had been discussing the most abstruse dogmas of theology; then, not unfrequently, the cureless curate, by the concoction of a happy device for a generous patron, found himself a beneficed bishop. Nor is such preferment to be wondered at. The qualifications considered necessary to constitute a device-maker, were fully equal to those which Imlac described to Rasselas as requisite to form a poet. 'Philosophy and poetry,' wrote Père le Moyne, 'history and fable, all that is taught in colleges, all that is learned in the world, are condensed and epitomised in this great pursuit; in short, if there be an art which requires an all-accomplished workman, that art is device-making.' Ruscelli says: 'It belongs only to the most exquisite wits and best-refined judgments to undertake the making of devices.' Yet, though the learned doctors of Padua, Wirtemberg, and the Sorbonne, engaged in deep disquisitions on the emblematical properties, natural and mythical, of cranes and crescents, sunflowers and salamanders, pelicans and porcupines--the length and language of mottoes--how the wind should be pictorially portrayed, with many other equally weighty considerations, still the chivalrous knights of the tournay, and the fair ladies of their _devoirs_, attained proficiency in the art. Wolf of Wolfrath, the lute-player, records, that at a grand tournament held at Vienna in 1560, crowns of laurel were awarded to the knights who wore the wittiest devices, as well as to those who excelled in feats of arms.

'But,' the reader very probably exclaims, 'what was this art of device?'

It consisted in translating an idea into a symbol, and illustrating that symbol by a tersely-expressed motto. 'The object of a device,' according to the Lord of Fossez, 'was to express covertly, by means of a picture and words, a conception of human wit;' and it was distinguished from an emblem, inasmuch as the emblem demonstrated something universal, whereas the device was peculiarly appropriate to the person who wore it. The old writers glory in its antiquity, citing many instances of its having been known and used by both Greeks and Romans. Even during the dark ages it was not entirely lost; it merely slumbered until the _renaissance_, and the invasions of Italy under Charles VIII. and Louis XII., when it awoke to a vigorous existence. Thus, though of much greater antiquity than heraldic blazonry, which only dates from the time of the Crusades, it was not hereditary, could be adopted or changed at pleasure, and did not define the rank of the wearer. Shakspeare, who well understood the nature of the device, distinguishes between it and armorial bearings in the passage where Bolingbroke recounts his injuries:

'Disparked my parks, and felled my forest woods; From my own windows torn my household coat,[4] Razed out my impress'----

The old heralds, however, looked upon the device with but little favour. Camden sneeringly says, that 'Armes were most usual among the nobility in wars till about some hundred years since, when the French and Italians, in the expedition of Naples, beganne to leave armes, haply for that many of them had none, and to bear the curtaines of their mistresses' beddes, their mistresses' colours, as impresses in their banners, shields, and caparisons.' Daniel, one of our earliest English writers on the subject, is worth quoting for a definition of the impress, and to shew the exclusive spirit of the age. He says: '_Impresa_, used of the Italians for an enterprise taken in hand, with a firm and constant intent to bring the same to effect. As if a prince or captaine taking in hand some enterprise of war, or any other perticulaire affaire, desirous by some figure and motto to manifest to the world his intent, this figure and motto together is called an impress, made to signify an enterprise, whereat a noble mind levelling with the aime of a deep desire, strives with a steely intent to game the prize of his purpose. For the valiant and hautie gentlemen, disdayning to conjoine with the vile and base plebeians in any rustique invention, have procured to themselves this one most singulare.'