Between Dr. A.—a Physician, and Mr. B.—an Invalid, on the comparative merits of different Climates, as places of Winter residence.

Mr. B.—In a conversation which we held together in the early part of the summer, you will remember the promise you then gave of affording me such advice, relative to the choice of a winter's residence, as the declining state of my health might require. The autumn is now rapidly advancing, and I feel that no time should be lost in making such arrangements as may enable me to pass the approaching winter with the greatest prospect of benefit.

Dr. A.—I fully acquiesce in the propriety of your resolution, and shall readily afford you any information in my power; but you well know that to a physician there is not a question which he approaches with so much diffidence, or dismisses with such little satisfaction.

Mr. B.—I am well aware of the difficulties to which you refer; circumstances of a moral nature, with which the physician can rarely become sufficiently acquainted, must necessarily have considerable weight in directing the decision; but in my own case it is fortunate that no such embarrassment can impede your judgment. My only object and care is the restoration of health, and my means are sufficient to enable me to pursue it in any way which may give the fairest promise of success.

Dr. A.—You mistake me, it was not to embarrassments of that kind that I was alluding.

Mr. B.—Can then any other source of difficulty exist? To a medical practitioner who is in the habit of sending his patients to all parts of Europe in search of health, the real and comparative advantages of each locality must surely be well known.

Dr. A.—Far otherwise, my dear friend; there are few subjects upon which medical men have more widely differed. It is true that we send our pulmonary sufferers to various parts of the continent, and that we receive from them a multiplicity of reports; but then they are often totally at variance with each other upon those very points which are generally considered as the least questionable; and when we attempt to reconcile this discordance, by an appeal to meteorological records, and registers of prevalent diseases, we are mortified to find that the evidence necessary for forming a safe and practical conclusion, requires a union of industry and accuracy which has not hitherto been found to exist in a sufficient number of collateral observers. Nor must it be forgotten, that the disease, for the cure of which the invalid is persuaded to emigrate, may require a very different atmosphere in its different stages and forms; and after all, how often does it happen that the sufferer is not sent abroad, until every chance of palliation has gone by.

Mr. B.—I do not hesitate to declare that such conduct, on the part of a medical adviser, is as cruel as it is unprincipled; my confidence however in your integrity satisfies me that you will never abandon an unhappy sufferer to such a useless alternative; I must therefore request you to state your opinion, generally, as to the peculiar conditions upon which you consider the eligibility of a climate, in the cure or palliation of pulmonary affections, to depend.

Dr. A.—This I shall do most cheerfully, especially in conversation with one, whose philosophical pursuits will have already instructed him in those principles, from which our conclusions are necessarily deduced.—Congenial warmth, and, above all, equability of temperature, are the first objects of inquiry in the theoretical comparison of climates; but these cannot be practically ascertained, in relation to their effects upon the human body, by the thermometer; because they are constantly liable to be modified by causes of which we have no other indication but that afforded by our sensations.

Mr. B.—That is strange;—and, so gratuitous does the assertion appear to me, that I should be better satisfied were you to support it by some examples.

Dr. A.—Well then, I may instance for your satisfaction, the well known influence of peculiar winds combined with moisture, and which, although they may produce little or no variation in the thermometer will rapidly rob the body of its heat; the north-west winds which so commonly blow in the southern provinces of France are decidedly more mischievous to the pulmonary invalid than the March winds that desolate the more delicate frames in our own country, and yet the thermometer in this case affords no indication of their nature.

Mr. B.—No one who wishes to form a just estimate of a climate, can doubt the propriety of taking the prevalence of wind, and the degree of atmospheric moisture into the account; although reasoning, from analogy, I should not suppose that this latter circumstance would be prejudicial; look at the moist and foggy atmosphere of Holland, and yet I am told that catarrhal affections are extremely rare in that country.

Dr. A.—Moisture must make both heat and cold more sensible; the one, by diminishing perspiration, the other, by increasing the conducting power of the air;[137] humidity therefore may be an injurious, or a salutary condition, according to circumstances; but you are greatly mistaken in supposing that the Dutch owe their immunity from Catarrh to the dampness of their climate, for it is to be imputed to the greater equability of its temperature.

Mr. B. You no doubt place great stress upon the advantage of an equable climate.

Dr. A. I consider equability as the most important condition of all; especially where the temperature ranges at about 60° of Fahrenheit. It not only diminishes the chance of aggravating pulmonary disease by preventing Catarrhs, but it serves to preserve a genial and regular action of the skin, to keep the balance of blood constantly on the surface, and to prevent any undue congestion of it in the lungs. Besides, it is acknowledged on all sides, that consumption is most prevalent in countries and districts which are subject to great and rapid changes of temperature, and that it is comparatively rare in those which are free from the diurnal changes and sudden transitions which so characterise that of our own island.

Mr. B. Nothing can be more convincing than such reasoning;—but tell me for what reason you consider the temperature of 60° as an essential condition under these circumstances.

Dr. A. It is evident that no climate, however equable it may be thermometrically, can be considered as such in a medical point of view, if its temperature ranges much below the degree I have mentioned; because in that case a material change must always occur whenever the invalid quits his apartment, and goes into the open air. So that I consider a cold climate must in effect be always regarded as a variable one.

Mr. B. But cannot this objection be obviated by suitable cloathing?

Dr. A. To a certain extent perhaps, but recollect if you please, that there is no furnishing a great coat for the lungs, to protect their structure against the diminished temperature of the air which is breathed.

Mr. B. What opinion have you formed respecting the effects of a marine atmosphere?

Dr. A. I apprehend that question cannot be fairly answered without a reference to the symptoms and circumstances of each particular case; generally speaking, I am induced to consider the air of the sea as not hostile to diseased lungs, except perhaps in those cases in which Hectic fever is fully established; but then again cases will sometimes occur which would appear to sanction a contrary conclusion. Thus much I should say was certainly true, that in such situations you will always experience more humidity, and that when the air is cold, that cold will in consequence be more intolerable, for the reasons I have before stated. On the other hand you must be aware that a marine situation will enjoy a more equable temperature[138] than one similarly situated, but remote from the ocean, and as far as that goes it will have its advantages.

Mr. B. I should much like to know what the continental physicians think of this circumstance, with reference to their own climate.

Dr. A. Upon that point you may be easily satisfied by referring to Dr. Clark's work on foreign climates.[139] He says that the physicians on the sea coast send their consumptive patients into the interior, and those in the interior to the shores of the Mediterranean or Adriatic. From Genoa they send them into the interior, deeming the sea air injurious to them. From Naples they frequently send such invalids to Rome. From Rome, on the other hand, they send them frequently to CivitÀ Vecchia, on the shores of the Mediterranean; more frequently to the shores of the Adriatic, and, occasionally, even to Naples!

Mr. B. And is this account to satisfy me? why I am plunged deeper in doubt than ever by such testimony. No wonder that the physician should approach the subject of Climate with diffidence when he finds those best able, from experience, to appreciate its merits, so irreconcileably at variance with each other. In the next place, let me ask whether you advocate the advantages of a Sea Voyage?

Dr. A. Not unconditionally. Dr. Young has said, and I believe with much truth, that the greatest possible equability of temperature is to be obtained in a sea voyage to a warm climate; in which the variation will seldom amount to half as much as in the most favourable situation on shore, even on a small island.

Mr. B. The very condition which, of all others, you consider the most beneficial.

Dr. A. Undoubtedly, and if you can make interest with Neptune to push you forward with his trident, and persuade Æolus to slumber quietly in his caverns, lose no time in availing yourself of such advantages; but as long as the wind "bloweth where it listeth," I entreat you, my good friend, to remain on terra firma; depend upon it that experience will fully sanction this advice;—of the great number of patients who have been sent on such an errand, by far the greatest proportion have had the progress of their pectoral complaints rapidly accelerated during the voyage; remember the various kinds of physical injury and distress to which you must be exposed on board of ship, before you can reach a steady and warm climate, from bad weather, and different local causes which it is not necessary to enumerate;—four and twenty hours beating to windward are sufficient to counterbalance all the advantages that might be anticipated.

Mr. B. Why you must surely have been inoculated with the prejudices of Mr. Matthews, who tells us that the fatigue and discomfort of a vessel is much the same thing as being tossed in a blanket during one half of the day, and thrown into a pigsty for the remainder.

Dr. A. I never was more serious. If the weather be bad the patient has but one alternative, he is either half suffocated with smoke or an oppressive atmosphere in the cabin, or exposed on deck to cutting winds, rain, and cold, and to an air by far too free for diseased lungs; then again sea sickness, whatever may have been said to the contrary, reduces his strength rapidly, and if damp sheets are the bug-bears of land travellers, damp clothes of every description are unavoidable at sea, and which in stormy weather can seldom be dried.

Mr. B. Well, you will at least allow that the motion of a ship is preferable to that of a carriage on a rough road.

Dr. A. I will not even concede this point, and were you only to read the interesting case of Dr. Currie, I am sure that you would be soon convinced of the contrary.

Mr. B. The opinion you have now expressed is sufficient; I shall not be readily induced to make the experiment of a sea voyage; suppose me then, if you please, to have been already transported across the channel on a calm day in a Steam-boat, and tell me to what part of the continent I am to direct my steps, in order to find a suitable residence for the winter months. I take it for granted that you consider the English Climate, from June to October as salutary to natives as that of any country in the world.

Dr. A. Beyond question;—but as an invalid who seeks permanent advantage from a foreign climate must be content to remain abroad for, at least, two winters, you will readily perceive that the consideration of his residence during the summer season is not entirely a subject of indifference.

Mr. B. My inclination would lead me to the south of France in preference to a more distant residence, provided the place should meet with your full concurrence.

Dr. A. The places to which English invalids have been more usually sent are Montpellier, Marseilles, Toulon, and Hieres; but I never ventured an opinion with less reserve when I declare, that I regard the very coldest parts of our own country to be less inimical to delicate lungs than the sharp and piercing air of the places which I have just mentioned. As to Montpellier, I am at a loss to understand how it could ever have obtained a reputation for its climate; and yet so universal was the belief, that its very name became, as you must well know, a characteristic epithet to places supposed to be preeminently salubrious.

Mr. B. Is it not remarkable for its clear blue sky, the very idea of which will always carry a charm with it to an Englishman?

Dr. A. Clear and brilliant enough, but the air is at the same time so sharp and biting, that every mouthful irritates the lungs, and produces excessive coughing,—and then you are, moreover, constantly assailed by one or the other of two destructive winds,—the Bize bringing cold, and the Marin, moisture.

Mr. B. And yet to this same Bize, of whose sharpness you so greatly complain, did the Emperor Augustus erect an altar.

Dr. A. Very true, but we are told it was an homage like that which the Indians are said to pay to the infernal deity; to avert its wrath, not to conciliate its favour.

Mr. B. Is the locality of Marseilles less exceptionable?

Dr. A. By no means. Cold winds are always injurious, but they are rendered destructive, in a tenfold proportion, when alternated with heat. At Marseilles the dreaded Mistral of Provence (a north-west wind), which is often accompanied by a clear atmosphere, and a powerful sun, reigns in all its glory. Toulon has the damning fault of Marseilles.

Mr. B. Is Hieres exposed to the same evil?

Dr. A. Not in the same degree. It has generally the credit of being much milder, and I really believe that it is justly preferred to every other place in Provence,—but it is not free from the Mistral. Dr. Clark, however, tells us that about the bases of the hills, there are some sheltered spots, where the invalid might enjoy several hours in the open air on almost every dry day, but then there exists a difficulty in reaching them at those times, when they would be most useful.

Mr. B. I see plainly, that a residence in the south of France would never realize my hopes of recovery; perhaps Nice may be more likely to afford satisfaction?

Dr. A. Nice, as you probably know, was first brought into vogue by our celebrated countryman, Dr. Smollet, who resided there during two winters, and it has been extolled by numerous writers since that period; the northern blasts, which rage with such fury in the south of France, are averted from this favoured valley by the maritime alps. Dr. Smollet, in speaking of its superior mildness, when compared with Provence, says, "the north-west winds blew as cold in Provence as ever I felt them on the mountains of Scotland, whereas Nice is altogether screened from them by mountains."

Mr. B. If I have been correctly informed, the neighbourhood of Nice is on many accounts preferable to the town itself.

Dr. A. The suburbs of the 'Croix de Marbre' have been the favourite residence of the English, and indeed on that account are not unfrequently called the 'Fauxbourg des Anglois'. This spot is situated immediately beyond the river Paglion, which, descending from its Alpine sources, washes the western extremity of the town and falls into the bay of Nice.

Mr. B. What accommodations are to be met with at Nice?

Dr. A. I have always understood that provisions are both good and abundant; some of my patients, however, have complained greatly of the bread as being sour and ill tasted from the leaven. As to the other accommodations, Dr. Clark says that they are also good, making allowance always for the inconveniences which, to an English family, are inseparable from foreign houses, such as smoky apartments, ill provided fire places, &c.

Mr. B. Now state, if you please, the objections that may be urged against Nice.

Dr. A. In the commencement of the winter, this valley is remarkably infested with mosquitoes, which greatly annoy strangers, especially children. During the months of November, December, and January, the climate would seem to embrace all the qualities so favourable to pectoral complaints, but the three following months are by no means unexceptionable. Although Nice be protected from the Mistral, yet in the spring of the year it is infested with cold sharp winds from the east, and north and south-east, which are highly mischievous to the valetudinarian.

Mr. B. It is clear then that he should quit Nice at this season.

Dr. A. That is not so easy as you may suppose, for unless he leaves it by sea, he must not venture to depart by any of the usual roads before the month of May; for should he direct his route to Turin, he will have a very rough and hazardous journey over the "Col de Tende," and may perchance be caught in a snow storm; if on the other hand, he returns by France, he must cross the "Estrelles," and expose himself to the cold winds of Provence.

Mr. B. Well these are strong objections; but taking into consideration all the advantages and disadvantages of Nice, will not the former so greatly preponderate, as to entitle it to the character it has long enjoyed as an eligible winter residence for the consumptive?

Dr. A. I fear that medical experience will not sanction such a conclusion. Catarrhal affections are frequent amongst the inhabitants, and it has been remarked by those best able to investigate the subject, that the progress of pulmonary disease is rather accelerated than retarded by this climate. If you will allow me, I will read a passage from a late work by Dr. Carter, which places this subject in a very striking point of view. "Notwithstanding the mildness of Nice, it appeared to be of little or no service to persons labouring under confirmed consumption; during the winter I was there, I saw no instance of great amendment, and I even doubted whether life was not shortened in some instances by a residence there. Some medical men were clearly of that opinion; and as their interest should have led them to speak well of Nice, they must have been pretty strongly impressed with the conviction of its climate being hurtful to people in confirmed Phthisis, before they could have been induced to make this opinion public."[140]

Mr. B. This is discouraging; but is the testimony of Dr. Carter supported by other authorities?

Dr. A. By many others. Here is a work by Dr. Clark, who is himself resident at Rome, and a physician of great intelligence; he not only confirms the opinion of Dr. Carter, but adduces that of Professor FoderÉ who practised at Nice for more than six years, and who in a conversation with Dr. Clark, made the following strong observation. "There is one thing certain, Sir, you may safely assure your countrymen, that it is a very bad practice to send their consumptive patients to Nice." M. FoderÉ moreover observed, that consumption in this district is not, as in Switzerland, on the banks of the Soane, and in Alsace, a chronic disease; but, on the contrary, he has often seen it terminate in forty days; he says that the physician of the countries just mentioned would be quite astonished at the quickness with which one attack of pulmonary hemorrhage succeeds another, how readily the tubercles suppurate, and how speedily the lungs are destroyed. He is even inclined to believe that there exists, on the shores of the Mediterranean, some source of evil not appreciable by meteorological observations.

Mr. B. Enough of Nice. What of Pisa?

Dr. A. You may perhaps remember that Mr. Matthews, in his comparison of these two places, says, "I believe that Pisa is the very best place on the continent during the winter for complaints of the chest; and Nice, of which I speak from good authority, is perhaps the very worst. The air of the first, which is situated in a low plain, is warm, mild, and muggy; that of the second is pure, keen, and piercing."

Mr. B. To speak honestly, I entertain a very high respect for Mr. Matthews as an intelligent and agreeable tourist, but he is the very last authority upon which I could repose my confidence, with regard to the salubrity of a climate; his observations upon this head are too fretful and petulant to afford satisfaction.

Dr. A. His remarks upon Nice and Pisa will certainly justify the opinion you have formed; for there does not exist such a striking difference in the climate of these places as he has been induced to believe; although the latter town is certainly milder than Nice, and possesses the advantage of having good roads leading to it from all parts of Italy, so that the invalid may leave it with safety much earlier than he could Nice.

Mr. B. Are the spring winds less violent than at Nice?

Dr. A. Scarcely. The site of the houses, however, is better calculated to defend you from their influence. On the northern bank of the Arno, there is a crescent which faces the south, and is well protected from the north winds; this situation ought always to be selected by invalids who winter at Pisa.

Mr. B. If I resolve to winter in Italy, I shall probably prefer Pisa. I confess that I have received a prejudice against Rome, as well as Naples, from the reports of some friends who have lately returned from those places; but I should be glad to hear your opinion upon the subject.

Dr. A. Rome and Naples ought not to be named in the same breath, unless indeed for the sake of contrast. Rome possesses many points of excellence as a winter residence, but as to Naples at this season, I would not recommend an invalid, on any account, to try its climate:—conceive the effects of a hot sun with a winter wind of piercing bitterness! "Vedi Napoli e po' mori," says the proverb, and no wonder that it has received so many illustrations from the English. Upon this one point at least we must all concur with Mr. Matthews: "If," says he, "a man be tired of the slow lingering progress of consumption, let him repair to Naples; and the denouement will be much more rapid."

Mr. B. But what of Rome—of the Eternal City?

Dr. A. That vehemence of expression, my good friend, betrays your polarity; in spite of your avowal I see clearly that your wishes point to the ancient Mistress of the world.

Mr. B. You really mistake me;—depend upon it that I shall undertake no pilgrimage but to the temple of Hygeia.

Dr. A. Rome has, by far, too many temptations for the invalid, and I confess that from the accounts which I have received from my patients, I am unable to discover any advantages equivalent to the risks.

Mr. B. I am even told that the climate of Rome is much colder than that of Nice in the winter.

Dr. A. You have been rightly informed; in addition to which, the streets are damp and chilly, and so variable in temperature, that there is not unfrequently a difference of twenty degrees between one street and another.

Mr. B. In what then does its excellence consist?

Dr. A. It is decidedly the best spring residence in Italy. The air is much more moist than that of Nice; and, at this season, it has the advantage of being less liable to cold winds; although it must be confessed that the Tramontana (a sharp northerly wind,) is sometimes felt with considerable severity, but it does not affect the human body like the dry cold winds of Provence.

Mr. B. The prejudice which exists in my mind against Rome has arisen from the circumstance of many of my friends having suffered severely from head-ache, during their residence there.

Dr. A. Upon that point, I fear my opinion will rather strengthen than remove your prejudice. I have no hesitation in stating, that the same complaint has been frequently made to me; and even Dr. Clark, the English resident physician, confirms the objection.[141]

Mr. B. And then come the frightful Malaria.

Dr. A. The stranger has nothing to fear from these exhalations between October and the middle of May, after which period I should not recommend any invalid to protract his visit.

Mr. B. But suppose his object is to remain two winters at Rome,—where is he to find refuge during these intervals?

Dr. A. In the vicinity of Rome there are many spots which will furnish a very eligible residence during the hot weather, such are Albano, Frascati, Tivoli, Castel Gandolfo.

Mr. B. After what you have said, I think it is scarcely worth while for an invalid to encounter the fatigues of so long a journey; but you have not yet mentioned Florence.

Dr. A. Its climate is almost as changeable as our own, and far more mischievous, as its Siberian winds alternate with a temperature equal to that of our finest days in spring. The summer, however, is delightful, the heat being greatly tempered by the Apennines. Bicchierai, an Italian Physician of eminence, used to say, that he wondered how any body could live at Florence in the winter, or die there in the summer.

Mr. B. Upon the whole you have presented me with a very discouraging view of the Italian Climate; and I have always understood that Lisbon is intolerable to an Englishman from its filth.

Dr. A. Lisbon is out of the question: the character of its climate may be summed up in a few words. Its winter temperature is neither mild nor equable, and its spring is remarkable for dense and cold fogs; and as to what an Englishman calls comfort, there is not a city in the world where it is so systematically neglected.

Mr. B. Suppose I wave the objections to a sea voyage and set sail for Sicily?

Dr. A. In that case you will undoubtedly find a fine climate, superior in most respects to that of the Italian continent. The winter and spring seasons are remarkably mild, provided you select Palermo for your residence; Messina is exposed to cold piercing easterly winds from the mountains of Calabria.

Mr. B. I have heard Catania well spoken of.

Dr. A. Its atmosphere is too sulphureous; in addition to which every egress from the town is difficult and unpleasant, owing to the lava from the Volcano. But there is in my opinion an insuperable objection to the Sicilian climate from the extreme heat of its summer, from which the invalid cannot easily escape.

Mr. B. Well then, Malta.

Dr. A. Dr. Domeier, in his account of this climate, tells us that the thermometer seldom varies in this island more than 6° in the twenty-four hours, or stands below 51°, even in the depth of winter: but then the summer, which is protracted even to the month of November, is extremely mischievous from its heat, the force of which is severely felt in a country where there is scarcely any visible foliage, the place of hedges being universally occupied by stone walls.

Mr. B. Let me hear what you have to say with respect to the other islands which have gained celebrity for their climates, such as Madeira, the Bermudas, Jamaica,—

Dr. A. You must be well aware that these places are, generally speaking, beyond the reach of the ordinary class of English invalids. Madeira has been greatly extolled by Dr. Adams, who even ventures to assert that in cases of consumption, if the patient does not saunter away his time, after his physician has advised him to quit England, we may with certainty promise him a cure. In the West Indies it is agreed by all authors, that consumptive affections are almost unknown, and that scrofula in all its forms is uncommon.

Mr. B. Would you recommend a residence in the West Indies to a person who has free control over his movements?

Dr. A. If we may be allowed to draw any inference from the qualities of a climate, as indicated by the thermometer, or by its effects on the constitution of the inhabitants, there can be but little doubt that a residence in the Bermudas, in a temperate and sheltered part of Jamaica, or in some other of the West India Islands, would present every advantage, towards the recovery of a consumptive patient, that climate alone can bestow.

Mr. B. I thank you sincerely, my good Sir, for the patience and candour with which you have discussed the subject of climate. I am fully sensible of the difficulties with which it is encompassed, and of the utter impossibility of expecting from medical advice a satisfactory solution of the many problems which it involves. Every invalid must, to a certain extent, rely upon his own judgment; but before I finally decide upon the place of my destination, allow me to trespass still farther upon your patience, in order to learn whether, after all, there be not some favoured spot in our own country, where I might seek shelter from the approaching season, and which would supersede the necessity of travelling to a foreign land?

Dr. A. I should say to a person, who had been accustomed to the colder and more exposed parts of our island, try the effects of some more genial situation; and such a change would be as likely to favour convalescence as an emigration to the continent; for although by such a step, he might not obtain an equally favourable atmosphere, he would more than counterbalance the difference by ensuring the advantages of English comforts.

Mr. B. And to what parts of England would you direct him?

Dr. A. There are particular spots on the coast of Hampshire and Sussex which have been long considered as eligible places of winter residence; such are Southampton and Hastings, which are certainly less subject to the effect of the Northern and Eastern winds than many parts of our island; but they are not to be put in competition with Sidmouth, Dawlish, or Torquay in Devonshire, and still less with Penzance in Cornwall, which, after all, is the only situation which can be fairly said to possess any very material advantages from the mildness of its winter. I speak this from well grounded observation and experience. The Climate of Penzance is unlike that of any other part of the island.

Mr. B. I remember having received a favourable impression with respect to the climate of that place, from the perusal of a small work, entitled, a Guide to the Mount's Bay and the Land's End; a copy was lent me by Sir —— ——, and I have since endeavoured to purchase one, but find that it is out of print.

Dr. A. Are you not aware then that you have been conversing with its author?—The book has been for some time out of print, but a second edition is nearly ready for publication; and, with your permission, I shall introduce, as nearly as my memory will serve, the conversation which we have just held together upon the subject of Climate.

Mr. B. By all means;—the questions which I have submitted for your opinion, are such as must naturally suggest themselves to every invalid who is in search of a winter residence, and as your little work, as far as I recollect, is intended for the same class of persons, its practical utility will be materially enhanced by the addition you have just proposed.