30. ON CLIMATE – I
MY DEAR EDITH, – There have been many fashions in medicine, and every epoch has had its peculiar panacea. At one time, now, happily, remote, the leech and the lancet were employed indiscriminately alike in surgical and in medical cases, and it was, no doubt, in consequence of this all-prevailing custom that medical practitioners acquired the popular name of “leech,” still preserved in the books of writers on medicine and philosophy from the sixteenth to the eighteenth century. Then followed the age of blisters, cupping, drugging with mercury, and over-heating with heavy bed coverings, during which period it was customary to exclude air from the sick-room by every possible device, to wrap the unhappy patient from head to foot in thick blankets, and to draw damask curtains round his bed, thus enhancing the danger of febrile disturbance when it did not yet exist, and aggravating the mischief when fever had already declared itself. In those days, therefore, smallpox, scarlatina, and other zymotic diseases attained their deadliest percentage, and, where they spared the life, ruined the constitution. Anon appeared another medical fashion – happily of short duration – the method of treatment by alcohol. Wine and brandy were administered in large quantities, and patients were sometimes kept for weeks in a condition of semi-intoxication, under the
impression that alcoholic stimulus imparted strength to the system. All these various practices, and many others almost as deplorable, have now dropped out of medical fashion, and have given way to treatment by sounder and saner methods for which we are indebted to the discovery and definition of the science of hygiene. Hygiene has taught us the necessity of ventilation, of bathing, of cleanliness – personal, domestic, and public– and the very important part played in therapeutics by diet and climate. I have already, in former letters, discussed at some length the question of diet, and have spoken about the various regimens appropriate to different conditions of ill-health and convalescence, besides giving details in regard to cookery for invalids. I have likewise had occasion to write about the necessity of fresh air, sanitation, and exercise, but, as yet, I have not touched on the subject of climate in relation to health and to the treatment of disease, so I propose that we should consider it in the present letter.
Of course it is a matter of common knowledge and experience that invalids are constantly benefited, or the reverse, by change of residence. Physicians are in the habit of sending their well-to-do patients with weak chests to winter in the south of France or elsewhere; while invalids wanting “tone” are despatched to bracing sea-side or moorland resorts; asthmatic or rheumatic subjects to inland towns or alpine levels, and so forth. It will be interesting to devote a few sheets of letter-paper to a study of the scientific rationale of this method of treatment, which is now very generally superseding the old-fashioned employment of drugs in maladies of hereditary and constitutional character. The principal factors of climate are quality of air and quality of soil. Quality of air depends on altitude and position
with regard to the sea or inland waters, and to the propinquity of forests, heaths, and large towns. After height above the sea, the most important consideration is distance from the sea. Sea-air contains a large proportion of moisture and holds various salts in suspension, with, occasionally, small quantities of ozone, a substance which, by combining very readily with organic effluvia, possesses the properly of purifying the air. The proximity of the sea exercises also an equalising influence over the temperature of the land, because during the day the land absorbs heat more quickly than the sea, and by night it cools more rapidly, the sea meanwhile remaining almost as warm as in the daytime. Consequently the breeze blows landward in the daytime, because the hotter the air over the coast the higher it rises, allowing the cooler and heavier air to rush inland from the sea; and at night-time the breeze blows seaward, because the air over the coast is now colder than that over the water, so that the current of the atmosphere is reversed. By these constant exchanges between land and sea the climate of places on the coast is kept at a more equable temperature than that of others, and as, moreover, the air of seaside towns is thus being continually purified and agitated, their advantage over towns where the air is comparatively stagnant is very great indeed.
Altitude affects climate in a different but not less important manner. The higher the altitude of any place the lower its temperature, and also the dryer the air, because the air of mountainous regions is much less dense than that of low-lying levels, and consequently it does not so readily absorb sun-heat, while the absence of vegetation on lofty ground renders the atmosphere less moist. Forest lands attract humidity, and cause abundant rainfalls,
while, inversely, places devoid of vegetation, and at the same time low in altitude, such as deserts, are dryer and hotter than any others in the world. Marshes, lakes, and rivers affect the climate of places in their vicinity by the evaporation which always goes on from their surface, especially in warm weather. Riverside and lakeside towns are usually humid, and often foggy, because the channels of rivers, and the beds of lakes, as a rule, occupy valleys and gorges whence the heavy, mist-laden air cannot get away, so that it remains more or less stagnant, and often becomes loaded with smoke and organic material. Cold places, such as those situated on Alpine heights, are also usually dryer than low-lying places for another reason, which is that cold air dissolves much less water than hot air, and its point of saturation is represented by a much lower figure. For instance, air at the temperature of 64 deg. Fahr. will hold in solution 6 1/2 grains of moisture per cubic foot, and when that quantity is reached, it is said to be saturated; but air at 96 deg. will hold as much as 17 1/2 grains of water in each cubic foot, and air at freezing point (32 deg. Fahr.) only 2 grains of water for the same measure. Therefore cold atmospheres, other things being equal, are far less moist than hot atmospheres, and hot climates are much more rainy than temperate or cold climates. More rain falls at the equator than anywhere else.
You may prove the fact that cold air does not hold in solution so much moisture as warm air, by putting a piece of ice into a wineglass. Dew will very soon be deposited outside the glass, because the surrounding warm air has been lowered in temperature by the cold atmosphere emanating from the glass, and, as this lowering of the temperature changes the saturation point of the air, the moisture it was before capable of holding in solution
is deposited under the form of dew. Now, as this country is an island, and as its atmosphere, even in the Midland counties, is continually charged with a considerable quantity of humidify due to the proximity of the sea on all sides, its cold season is inevitably a time of fog, and hence of clammy and penetrating moisture, because the coldness of the air, while preventing the damp from being maintained in solution, condenses it, and holds it in suspension as mist or fog. On the other hand, Continental countries, however cold, enjoy a much clearer atmosphere on account of their immunity from humidity, and as cold dry air is always much less nipping and keen than cold moist air, the result is, of course, that Continental cold is a great deal pleasanter than insular cold. When cold air is also dry air, as in Switzerland and other places removed from contiguity to large expanses of water, its effect on the skin is not felt as “chilliness,” because it does not tend, as does moist air, to repress evaporation from the cuticle and respiratory surfaces of the body. We lose more heat and less moisture in a damp atmosphere than in a dry one, and therefore in this country diseases caused by chill and insufficient glandular action – as rheumatism, asthma, bronchitis, kidney complaint, and congestion or inflammation of the lungs – are very common in winter time; and in order to escape them delicate people are sent by their medical advisers to such resorts as the Upper Engadine, where the air, although far colder than in England, is dry and clear. There is, moreover, another reason why mountains are beneficial resorts to many delicate persons, especially to those who have not strong lungs. High altitudes have a rarer atmosphere than low-lying regions, and every inspiration of the pulmonary organs in hilly places draws into the chest a less weight
of air than in lower altitudes. Consequently, in order to obtain air enough for the needs of the body, mountaineers breathe more quickly than people living in the lowlands, and obtain thereby more lung exercise. You may gather from this fact that although a sojourn in Alpine districts constitutes an excellent method of treating weak-chested patients by expanding their lung capacity, giving tone and stamina to their mucous surfaces, and helping to invigorate their muscular and circulatory systems, that it is not likely to prove so beneficial whenever the lung complaint is caused or complicated by disease of the heart, for in such a case the heart’s action would also be considerably quickened, and this is not desirable if the organ in question be enfeebled, liable to palpitation, fatty, or dilated.
As for soils, they may be roughly divided into pervious and impervious. The most pervious soils consist of gravel and sand, the least pervious of clay and marl. Pervious soils, being loose and porous, do not retain damp; they permit rain to penetrate through them easily, and therefore are favourable to dryness, while thick, heavy soils hold water as in a basin, and thus hinder drainage, and give rise to ground mist, miasma, and constant humidity. Rocky soils, such as those common in hilly regions, are usually dry, because the water is not absorbed in them, but flows off their surface into natural basins at lower levels. Springs are thus formed in mountainous places, the rain remaining unabsorbed, and running underground along the rock until an outlet is reached, whence it gushes forth as a spring.
Of all the various climates we have been considering, that of the high and dry altitudes is, on the whole, the most healthful and valuable in cases of disease. Consumption, anaemia, rheumatism, neuralgia, asthma, and
malaria, in all their many forms, are frequently amenable to the climate of high altitudes when all other curative means fail to affect them. The rarefied air of Alpine regions stimulates the lungs, and exercises the bronchial functions in a degree impossible in heavy and stagnant atmospheres, while the dryness of mountain air is eminently favourable to patients afflicted with any of the disorders named. Again, sea air is extremely beneficial in cases of convalescence from zymotic complaints, such as measles, scarlatina, or small-pox, on account of the constant interchange of sea and land air, and the presence of the purifying agent, ozone, in the atmosphere. Ozone is oxygen in an electric state, and it is therefore often found in comparatively large quantities in breezes after thunderstorms. It has valuable disinfectant properties, which have been tested and demonstrated chemically as well as physiologically. Sea air is also useful in cases of wasting diseases, rickets, and scrofula, because certain valuable salts – bromides, iodides, chlorides, and others – usually spoken of collectively as “saline particles,” are suspended or dissolved in such air. But generally, when scrofula and strumous disease take the form of skin eruption, it is better to seek mountain than sea air, for chloride of sodium, or sea-salt, is not remedial in such cases. Cholera and kindred complaints have never yet been known to visit very high altitudes; they confine themselves as a rule to low levels, and especially to moist and riverside places. Cholera was born on the brink of the Ganges, and it is always observed to haunt particularly the vicinity of inland waters. Typhoid fevers exhibit the same tendency. Relaxing and warm climates are suitable in some cases of constitutional heart complaint, kidney disease, and certain forms of nervous malady. Formerly it used to be thought that
consumptive patients were benefited by sojourn in such temperatures; but most physicians are now agreed that high and dry climates, such as that of the Engadine, Davos Platz, and other Alpine stations, are best suited to invalids suffering from tubercle uncomplicated by other disease, and in its earlier stages. Such cases, too, are frequently greatly modified, and sometimes cured by residence in or near pine forests, where the atmosphere is laden with the aroma of the trees, and the soil loose and rocky.
In most constitutional complaints the nature of the soil is a highly important consideration. Thick, sodden clay soils are extremely pernicious to persons suffering with rheumatic, neuralgic, or lung diseases, and in such cases very little good can be effected by medical treatment so long as the patient lives over ground of this nature. Intermittent fevers, and all disorders of the ague type also imperatively require the removal of their victim to a dry sandy soil as the first condition of cure.
Moist atmospheres favour the development of obesity, dry atmospheres of leanness; because less evaporation occurs from the bodily tissues in humid atmospheres, and liquid is a principal factor in the production of corpulence. Ergo, – if you want to grow fat, my dear Edith, you should reside in a moist, warm climate.