Chambers's Edinburgh Journal, No. 444 / Volume 18, New Series, July 3, 1852

by Various

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 diarrhœa, 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.