Archibald Smith

On Climate and Disease.—Panama, Guayaquil, Peru, and Chile.

For those who propose to cross the Isthmus of Panama, or visit the shores of the Pacific, it may be interesting to be made in some degree acquainted with the influence of particular climates, and the sort of illness which they are most likely to experience at the principal commercial ports, particularly to the south of the line. On this account the author now offers some general hints on these subjects, having it in view to publish as a separate treatise a practical account of the diseases of Peru, described as they occur at different altitudes, in the diversified climate of that country.

The seasons at Panama are divided into wet and dry: the rainy season begins towards the latter end of May, and continues till November; and from November to June, or the latter end of May, is the dry season. At Panama, agues, fevers, bilious and gastric complaints are common in the wet season; but the yellow fever, or “Vomito negro,” very rarely has been known to pass the mountain barriers which separate the Atlantic from the Pacific. At Cruces the traveller may enjoy a better and safer climate, during the wet and unhealthy months, (when the thermometer never, perhaps, falls below 90°,) than either at Panama or Chagres.

To the north of the Isthmus, along the shores of Central America and Mexico, as far at least as the northern tropic, the climate is considered “malsano,” or exceedingly unhealthy; a fact well known to those who trade with Realejo, San Blas, and Mazatlan, where very dangerous remittent fevers prevail.

To the southward of the Isthmus on the shores of Colombia, in about 2° south latitude, we find the port and city of Guayaquil, of well-known commercial importance. Here, the climate is considered unhealthy during the wet season, when the air is sultry and oppressive; but in the dry season Guayaquil is not reckoned particularly sickly. The rain commences in light showers in December, is very heavy in February, and dwindles away in April. From May to December is the dry season.

The wet season, being the hottest, would naturally be considered as summer; but here, as in other places of seasonal or periodical rains, the wet season is called “invierno,” or winter, and the dry season “verano,” or summer; yet the latter is cooler than the former, and allows one to wear warmer clothing than would be agreeable in the rainy months.

In the rainy season the thermometer ascends to 90° or 96° Fahrenheit; but, during the dry season, it ranges from 65° to 85°, being 65° at night, and rarely exceeding 80°, though it sometimes reaches 85° during the day. The rain usually falls in the afternoon or night, seldom in the forenoon, when the sun is often so powerful as nearly to dry up the pools and streets before the evening rain comes on again; however, there are days when no rain falls. The houses being covered with tiles, and furnished with arcades, are sufficiently defended against sun and rain. The plain extending between mountain and sea is, for ten or twelve leagues inland, well wooded, and intersected here and there with smaller rivers which the natives call esteros or lakes, in allusion probably to their appearance during the wet season, when, teeming with alligators, they inundate the beautiful meadows round about; so that the term “river” is only applied, by way of distinction, to the great navigable river of the city, which is so influenced by the tide, at least in the dry season, as to be quite briny to the taste. Here the natives bathe all the year round,—a practice, we believe, which conduces not a little to the general health and fair and stately form of the Guayaquilenian ladies, who are said to be fonder of town, and the ease of their hammocks, than of country air and exercise. The streets of Guayaquil, being steeped in rain, become contaminated for want of police; insects swarm on every side, and vegetable and animal emanations pollute the atmosphere: malaria abounds; and fevers, dysenteries, and various gastric disorders attack the inhabitants, and especially the imprudent stranger, who, trusting in his youth and strength, and not considering that difference of climate demands corresponding difference of life, perseveres in the same habits under every parallel of latitude through which he passes from one temperate zone to the other.

In warm and humid situations, such as Guayaquil, surrounded by rivers, stagnant pools, lagoons, and exuberant vegetation, atmospherical heat may operate in causing disease, not merely by promoting the production of miasmata, but also by increasing the irritability of the organs of the body, so as to predispose to severe attacks of illness. The affection of the skin commonly known under the name of “prickly heat” is very likely to arise from profuse perspiration while in Guayaquil; and all excess in the cuticular secretion should be avoided by every proper means, such as suitable clothing, temperate living, and moderate bodily exertion, &c. The contrary practice, of encouraging sweat by heating drinks, has a bad tendency, both moral and physical:—physically, it produces, sooner or later, gastric and hepatic diseases;—morally, it furnishes a pretext and excuse for deep potations;—and the end of all is a broken down constitution, and a mind impaired in its noblest powers. In another point of view, without supposing that the fevers which on the shores of the Pacific are termed putrid arise from the want of a due quantity of saline ingredients in the blood, it is not improbable that, when perspiration is excessive and too long continued, it may indeed carry off from the circulation more of these saline portions than can be quite compatible with a state of perfect health. We have sometimes observed horses, when hard pressed on a hot day along the sandy plains of Peru, lie down exhausted and overcome by excessive sweat and muscular exertion; and, on being unsaddled and allowed to cool, the poor animals on such occasions would appear as if covered with hoar-frost, from the quantity of saline matter left behind from the fluids perspired and evaporated.

Moderate transpiration, however, is a cooling process, and a necessary one to the natural condition of the system, when the circulation of the blood is much increased, as is the case under high atmospherical temperature, though at the same time muscular vigour usually becomes much diminished under such circumstances. The functions of the stomach often grow languid as the relaxation of the skin has been great and long continued; but, while the appetite is thus diminished, the flow of bile is apt to be increased, and the bowels often become irregular,—sometimes too lax and irritable, at other times torpid and costive.

In one we may observe that, when the bowels are lax from an overflow of bile, the skin is dry, and that for months together; while in another, exposed to the same changes of climate, the skin is always soft, while the secretion from the kidneys is scanty, and the intestines appear to lack their wonted moisture, and become sluggish, as if deprived of their muscular power of healthy action. But it more usually occurs, on being transported from a cold to a warm and humid climate, that a very notable alteration and increase is observed in both secretions—the biliary and cutaneous, of the liver and of the skin. The state of the bowels therefore requires to be attended to very particularly in all great transitions of climate; because, from undue accumulations in the intestinal passages during warm and sultry weather, irritation and fever may ensue, and a bilious disorder of the bowels, if neglected, or ill-treated, will too readily decline into a fatal dysentery.

Having in the first chapter of the first volume of this work given a sufficiently minute account of the climate of the Peruvian coast, it will now be enough for us to remark that, at its northern extremity, though bordering on the verdant country of the Equatorial Republic, the air of the coast of Peru is less humid than it is at its southern limit, where it joins the desert of Atacama.

The peculiar dryness of the province of Piura is not explained by the fact that in this part of the coast the Andes retire farther inland than in many others; for, from Piura, we have only to pass the river Tumbez, when, as formerly mentioned, the face of nature is quite changed, and the plains of Guayaquil, though at their lower and more maritime parts far distant from the inland piles of mountains, are nevertheless deluged in rain during the wet season; whereas Payta, the sea-port of Piura, has (as we have been informed by a native of those parts, our enlightened and public-spirited friend, Don Santiago Tabara,) not unfrequently, for years in succession,—sometimes as many as ten or twelve years,—not a shower to give life to a single blade of grass.

At Truxillo, again, the capital of a Peruvian province, situated on the coast in lat. 8° 8´ south, the air is much drier than at Lima or Callao in 12° 2´ of south latitude: yet Truxillo is in the vicinity of lofty mountains which run parallel to the coast; and Huanchaco, its sea-port, is situated at the foot of the lofty Bell Mountains. But, to enumerate no more particulars, we think it will be found true as a general proposition that, from the desert of Atacama to the landing-place of Pizarro on the banks of the Tumbez,—from the southern tropic to close upon the line,—there is a progressive diminution of atmospherical humidity.

The difference thus marked in the state of the air appears to influence very materially the character of several diseases, as intermittent fevers or tercianas, which on the northern coast of Peru, or what is called costa de abajo, and more particularly in the eminently dry province of Piura, are of milder type than along the shores of the southern and maritime departments of Peru, known under the name of los intermedios.

The Indian population of Piura are a hardy and healthy race of people, naturally inclined to corpulency; and, indeed, the Indians of Peru in general are constitutionally disposed to a sleek rotundity of form, which it would only require ease and good generous diet to call into full developement, so as to render the bulk of this race as fat as Caciques. Most of the chronic diseases of the Piuranos are said to result from leaving all to nature in the earlier stages of their complaints; and, among these northern provincialists, phthisis, dysentery, tercianas or agues, and typhus mitior,[32] are endemic. The same sort of complaints, varying however in the intensity of attendant symptoms, are met with all along the maritime valleys of the coast; and in the list of prevalent diseases at Lima and elsewhere, visceral obstructions, intestinal hÆmorrhage, disorders of the heart, and asthma, deserve particular notice. There are also a variety of cutaneous eruptions and nervous diseases of frequent occurrence, upon the nature and cure of which it is not at present our purpose to enlarge.

In consumption, which, in all its various forms, is a common disease on the coast of Peru, a portion of the lungs becoming by degrees ulcerated and destroyed, there is consequently an interruption to the proper discharge of the pulmonary functions, accompanied with nocturnal increase of fever and excessive perspiration. But, even in this advanced stage of the disease, changing the air of the coast for that of the mountains or temperate valleys of the Sierra, is found to produce great relief and prolongation of life.

Spitting of blood from the lungs seems in most instances to depend on the presence of tubercular phthisis, or on an inherent constitutional tendency to this disease; and any accidental excitement, as that from cold or undue exposure to atmospherical vicissitudes, may hurry on cases of pulmonary hÆmorrhage to a fatal termination. Suckling, in particular, is known to be apt to occasion spitting of blood, which, if not cured in time, usually ends in those symptoms which characterise consumption of the lungs.

It is curious to observe that, in the warm climates of the coast, cold is the exciting cause of most of the diseases which present themselves, such as catarrh, phthisis, bowel complaints, rheumatism, and even the intermittent and remittent fevers; for we believe that the baneful influence of malaria would not be nearly so often experienced, were its operation in the developement of fever not aided by some check to the perspiration, or what the natives call resfrio.

It is a subject of remark on the sugar estates of CaÑete, and other parts of the coast, that the slave population, though they work in the humid cane-fields, are yet by no means so liable to ague as either the white man or Indian. One reason for this difference appears to be that the sebaceous glands of the dark races, and especially the negro, keep their skin smooth and soft with a supply of unctuous or oily matter, of rather offensive odour, but admirably fitted to guard against the evil effects of atmospherical vicissitudes.

As black surfaces radiate heat better than those of lighter tints, it might be expected that the body of the negro would be excessively chilled when exposed to the night air: but the negroes of the coast of Peru often sleep in the open air, without interrupting the healthy action of the dermal system. This is a fact which we are disposed to refer to the preservative effect of the unctuous exudation, because all oily matters being bad conductors prevent the excessive radiation of internal, and the too rapid communication of external heat; and therefore, by this natural inunction of the negro and zambo skin, nature provides a remedy against the extremes of cold or heat under ordinary circumstances.

We thus learn that flannels or woollens, being bad conductors, are, when worn next the skin, very valuable as preservatives of an equal circulation, and therefore of general health, particularly for the European of finer and unanointed skin when subjected to the influence of tropical climates.

During the hot months of January and February, on the coast of Peru, the irritability of the whole system is increased, and particularly of the mucous membrane of the alimentary passages; and cholera morbus thus becomes an exceedingly common disease, for which the standard remedy is ice, or iced water.

The privilege of selling ice in the capital of Peru belongs to the government, who usually let it out for a term of years to the highest bidder. The empresario, or lessee, conveys the ice on mules from the nearest snow-clad mountains at the back of Lima; and is bound to have always on hand a sufficient quantity for the supply of the capital, and be ready to deliver it at all hours of the day and night. In form of frescos, or cooling drinks, every one uses ice in warm summer weather; and it is considered not merely a luxury or a remedy, but a necessary of life, indispensable for the due preservation of the public health.

The facility of procuring ice renders cholera morbus a disease of easy cure, according to the popular practice of the natives. In the first stage of this malady they administer diluents, such as warm water, linseed or mallow water, with or without a little seasoning of cream of tartar or tamarinds; and these simple drinks they continue to give until they consider that the patient has vomited and voided enough, that is, until all undigested matters be thrown off, and the bowels well unloaded; and then they administer iced water, which produces a powerfully sedative effect.

The death-like coldness of the patient deters neither the vulgar nor the regular practitioner (who sometimes conjoins opiates and iced drinks) from giving this remedy with confidence; and the general consequence of the seasonable use of ice and iced water in this fearful disorder is, that the stage of external coldness is shortened by the early removal of internal heat; and thus the exhausting career of the disease is quickly arrested.

Under this vulgar but satisfactory and long-established treatment of cholera morbus in Lima, where the disease is endemic, though more prevalent in the hot months, vomiting, hiccup, and cramps disappear; reaction is so mild and favourable as never to require the lancet: yet recovery is almost always certain, though cases appear from time to time so intense as to assume the aspect of what is called Asiatic cholera, during which, as a native physician expresses it, the patient is a horrid image of death.

At Ica and various other points to the southward, where vineyards abound, it is observed in vintage-time that to eat freely of the grape on an empty stomach, or without eating bread with the fruit, is one of the most frequent causes of dysentery, which disease is more appalling and fatal on the shores of the Pacific than the cholera morbus to which we have just alluded. It is, however, gratifying to know that, in the form of dysentery which commonly prevails, the calomel and opium plan of treatment, when discreetly conducted, is assuredly the safest and best yet adopted, whether in Lima or in the interior of the country.

Moquegua, which lies a considerable way inwards towards the mountains behind the sea-port of Ilo, is not less famous for its wine and its grapes, than for its dysenteries and violent agues; but Tacna, on the other hand, about seven leagues inward from the port of Arica, is so healthy as to be a place of resort to the people of the port during the terciana, or aguish season, which, over all the coast, is about the vernal and more particularly the autumnal equinox.

The salubrity of climate for which Tacna is distinguished is considered to be partly owing to its vicinity to the cold of the mountains, (for the snowy pass of the Cordillera, which leads to upper Peru, is within four hours’ ride of this town,) and still more to a fine dry plain between it and the sea, which only wants water to become rich in agricultural produce.[33] But in its present state it is free from that malaria which the humidity attendant on irrigation would not fail to engender here as well as in other parts of the coast. In its environs cotton grows spontaneously; and the native women collect it, and make thread from it by means of the spindle, just as we have often seen done in some of the warmer inland valleys, where the cotton is indigenous. It is a fact, not perhaps undeserving of notice, that a bud cut off a cotton-tree in the neighbourhood of Arica or Tacna was hung up in the cabin of an English merchant-ship, preserved its vitality in the navigation round Cape Horn, and opened when about half-way between Peru and England.

The whole coast of upper Peru—now called Bolivia—is arid and desert; so much so, that the celebrated president Santa Cruz—who, much to the prejudice of Arica,[34] made Cobija a free port for the introduction of merchandise,—found that he could not, by sinking pits in the deep sands of Cobija, come at a supply of good water.[35] For want of water and lucern, mules from the interior of Bolivia often die at the sea-port of Cobija; for there is no vegetation within a great distance from this place. The little water that is obtained at Cobija is brackish, like that in the pozo or well of the great castle at Callao,[36] which has invariably been observed to give disorder of the bowels to the soldiers, who, during the sieges which that fortress has sustained, were obliged to drink of it. The same has been observed at Cobija, and therefore there are boats kept there for the purpose of conveying water to it from Paquisa and other distant parts, which makes it an expensive necessary of life.

On several parts of the coast of Peru, water, even for domestic uses, is very scarce; and in the dry season wells are often dug in the beds of dried-up rivers, or in other places in the neighbourhood of irrigated lands. At Port Bermejo and Casma, between nine and ten degrees of south latitude, we are told by the Spanish coasting pilots that, dig where you will, at ten or twelve paces from the sea, you are sure of finding water at the depth of half a fathom that is not very brackish. Wells or pits, however, thus opened in different parts of the coast, are often found to dry up as they do in Lima (where they are common enough) during the dry season, which is the time when they are most required.

In northern Peru the practice of digging pits for water in the beds of rivers is very common; and such is the scarcity of fresh water at the sea-port of Payta, that it is carried to the city on mules, from the distance of several leagues. But on the contrary, at the sea-port of Arica, in southern Peru, good water is found wherever a pit is dug for it; and within two leagues of this port is the fine vale of Asapa, abounding in vines, olives, lucern, corn, &c. and affording a more convenient and copious supply of fresh provisions for shipping than either Payta or Cobija. These facts are of value not only in an economical but medical point of view; since on the quality of the water, as well as of the condition of the atmosphere, in any particular situation, must greatly depend the health of its inhabitants. Thus, in Arequipa, of which Quilca was the old, and Islay the present sea-port, the river-water is said to contain some salts in solution, which render it unwholesome until it is boiled; and this is known to be one of the causes of dysentery, which is a prevalent disease in that city.

The peasantry, who travel with asses between Bolivia and Chile across the deserts of Atacama, pitch their tents by day, to avoid the extreme heat of the sun reflected from the burning sand, and proceed on their journey by night; carrying with them all the water and provisions necessary for the journey. And it may be remarked that the soldiers, sent by order of General Salaverry to invade Cobija, had to march from the landing-place at Iquique over desert sands like these, when under their gallant leader Quirroga they took by surprise the port of Bolivia. These coast marches usually fall to the lot of the Indian infantry, and these hardy natives of the mountains generally prefer performing them between sun-down and sun-rise; for not being constituted, like the sable races, to live in very warm climates, they are more liable to fever when posting over sandy plains during the noon-tide heat; and, if they do but meet with musk or water-melons on their way, they devour them so greedily that they are sure to fall victims to sundry disorders—as intermittents, remittents, dysentery, &c.

In Chile, Nature puts on a different appearance from what she wears in Peru and Bolivia; there, however, as in these countries, the year is divided into wet and dry—the winter and summer. But in Chile it rains, as in Colombia and the Equatorial Republic, at the same season on the mountains and coast; in which respect it differs altogether from Peru and Bolivia. In the southern extremity of this republic, at about 40° of south latitude, the rains are heavier, and of longer continuance, than in the northernmost part, where it joins the great desert of Atacama. On the coast of Chile very severe gales are experienced, when the coast of Peru is only refreshed by light and gentle breezes.

During summer, the sun at noon is felt very powerfully at the capital of Chile, and it is requisite to guard against the risks of insolation; just as happens in Lima in the month of May, when the mornings and evenings are cool and cloudy, but the mid-day so excessively hot that it has become proverbial, and children and others are at this season warned by the older and more wary Limenians to keep out of the sun in these words, “Quitese de este sol que madura duraznos!”—Get out of this sun, hot enough to ripen peaches! an expression probably used in reference to the mode of ripening fruit of various sorts in Lima, by having it stoved. We understand that this is done chiefly to prevent the birds from eating the fruit, which they would not fail to do if it were left to ripen naturally on the tree. The cheremoya is the fruit most commonly stoved.

In July and August the snow sometimes falls around Santiago, when the native of Lima who visits this Chilean capital is peculiarly struck with the novel appearance of the orange-trees in the “patios” or court-yards of the houses, bending under the double weight of fruit and congealed snow; the green leaves forming a remarkable contrast with the sparkling crystals, like the jewel garden of the Incas.[37] It rarely snows in the valleys; but in the winter of 1834, as we were told, a postman and his horse perished in the snow on the road between Santiago and its sea-port Valparaiso,[38] where in the months of June, July, August, and September, it rains a great deal. But during the dry season, though sometimes foggy in the morning, the sky upon the whole is clear, and the climate healthy and agreeable.

In giving an account of the climate and progress of vegetation on the coast of the middle provinces of Chile, it is stated, on good authority, that “the rainy season, as already mentioned, begins in May, and continues to October; the heaviest rains are in June and July. After a few days of rain, there is an interval of fine weather for at least one or two weeks; and the quantity that falls during the season is small, varying from twelve to sixteen inches. In summer the atmosphere is excessively arid, and there is little or no dew. The temperature at noon, in the middle of the rainy season, is generally about 60°; at night, seldom under 40°, though there is occasionally a little frost. In summer the thermometer at noon stands between 70° and 75°; but, during the night, in clear weather, it frequently falls more than 20°.

“During the latter part of summer, vegetation is almost dormant, and scarcely a plant of any kind is to be seen in flower; but, in a very few weeks after the first rains, every part of the country is clothed with verdure.

“In the south of Chile the heavy rains render the road almost impassable; and, as vegetation does not advance so rapidly there as in the north, he” (the naturalist) “can botanise in October, November, December, and January.”[39]

The following observations on atmospherical vicissitudes and miasmatous matter, with the rationale of their effects in the production of disease among the inhabitants of Santiago of Chile, we have pleasure in being able to offer in the form of a translation from an essay in Spanish,[40] published in the year 1828, by Doctor William C. Blest; upon whom, though an Englishman, the Government of Chile conferred the highest professional honours, by nominating him to the protomedical chair, which he fills with credit in that republic.

Dr. Blest, in endeavouring to rouse the attention of those functionaries who preside over the destinies of the republic, to the neglected state of its municipal police, says of Santiago that “The streets, with a few exceptions, have either very bad pavement, or none at all. The canals or water-courses, (las acequias,) which, without doubt, were originally intended to refresh and purify the city, are at present receptacles of every sort of nuisance; and, not having free exit, they terminate in stagnant pools around the city, which are so many laboratories of putrefaction. The cross streets are left in so shameful a state of neglect, that it is impossible to pass along their narrow foot-paths without being shocked at every step.

“The suburbs, where the poorer and more numerous class of the community reside, are so full of dirt and mud, that even on horseback it is difficult to pass through them. In almost every street there are small and confined apartments, without air or light, except that which enters at the door, and these are occupied by whole families of artisans; so that it is not uncommon to see seven or eight persons crowded together in one wretched abode, where dogs and cats add to the nuisance, and still further crowd the family group.

“Such is a true picture of the police of Santiago; and, to convince the curious reader of its accuracy, we need only refer to the aqueducts which pass through the streets and houses,—to the heaps of putrid matter in the cross streets,—to the deep deposits of mire and marshes,—and to the crowded and unventilated dwellings of the poor and labouring classes....

“It is too well and generally known that at all seasons, and for days together in every week, the aqueducts which pass through the houses are so completely blocked up with the quantity of vegetable matter and dead animals collected in them, that they cannot transmit even the smallest stream of water. The subordinate or cross streets, and many of the principal ones, are not less filthy; and any stranger who visits Santiago will be inclined to believe that, of all the towns of South America, it is the dirtiest.[41]

“Sad experience, and especially in recent times, has taught, that during the decomposition of organized matter, whether animal or vegetable, under the action of heat and moisture, certain exhalations take place, which possess properties in the highest degree injurious to the health of man. This is a truth which is attested by a multitude of medical authors. It is the good fortune of the inhabitants of Santiago, that the atmosphere in which they breathe does not so readily absorb, or act upon substances undergoing the process of putrefaction, as to engender those dreadful epidemics, which have carried off millions of lives, and are still reaping their harvest of mortality in various parts of Spain, North America, India, Mexico, Panama, Vera Cruz,[42] and many other regions of the Old and New World.

“Were they not thus favoured by the natural salubrity of their atmosphere, the church-bells of the Chilean capital would be daily heard to toll the mournful knell of death, and every home would present the tearful scene of grief and lamentation.

“But although in Santiago the action of the atmospheric air on substances in a state of putrefaction is not so active as to produce such epidemics as those alluded to, yet it cannot be denied that it is capable of acquiring such properties as make it exercise a most baneful influence on the public health: inducing attacks of dysentery, typhus and other fevers, which, from time to time, appear epidemically. In truth, to some general cause of this nature we must attribute those violent and fatal dysenteries which were so very prevalent in the year 1826, and which recurred in the months of March and April of the present year (1828). To a similar cause must be referred that vexatious sort of puerperal fever which in the year 1827 attacked such a number of women; and also those cases of typhus or chabalongo which abound, with few exceptions, every year.

“Reasoning on the generally received principle that air at a high temperature occasions a greater degree of exhalation from bodies than cool air does, and from what we know the influence of summer heat to be in other countries, we should suppose that diseases caused by miasmatous matter should be here more common in summer than in winter; but our acquaintance with this climate induces us to think differently on this subject.

“Here, in summer, the air of the atmosphere is uniformly clear and cloudless; and the emanations from the earth’s surface, meeting neither clouds nor mists to impede their ascent, mingle with the other atmospherical ingredients, and diffuse themselves freely through the regions of space. The opposite of this takes place in winter. The heat of the sun is always very considerable, or at least sufficient to disengage from heaps of nastiness and rubbish the noxious vapours which putrefaction has generated in them. At sunset these vapours come in contact with the clouds that gather around us, and soon meet the cold air of the approaching night; the consequence of which is, that they are precipitated into the lower strata of the atmosphere, and wafted on the nocturnal breeze into the interior of our habitations. Thus a satisfactory and rational explanation is given, why there should be more sickness in winter than in summer; and by associating this view of the matter with the bad ventilation in the houses of the poor, who from their inability to provide themselves with fuel[43] and warm clothing, are compelled to exclude the free admission of air, we may perceive the reason why at this season the poor are more obnoxious to disease than those whose pecuniary circumstances enable them to protect their homes from the severities of winter by better means than the utter exclusion of the air.

“The generality of persons, overlooking the course of atmospherical changes, imagine that the diminution in the number of cases of sporadic fever observable in summer is owing to the abundant consumption of the fruits of this season. We will not deny that the use of fruit may improve to a considerable extent the health of those persons who in winter and spring have been nourished with strong and stimulating aliment, such as is calculated to disorder the digestive functions; but we are far from thinking that to the use of fruits alone are to be assigned all the good effects which the vulgar fancy they derive from them. We know that in other countries not less bounteously supplied with fruit than Chile, though not favoured with so benign a climate, epidemic diseases prevail more in summer than in winter. For these, and many other reasons which it would be superfluous to detail, we consider ourselves authorized to dissent from public opinion on this subject, and to assign the diminution in the diseases of the character alluded to, during the summer months, to causes more in conformity with medical philosophy: namely, the benign state of the atmosphere in summer; the bodily exercise which the different classes of the community indulge in every summer evening; and the wholesome ventilation which they enjoy at this season, their doors being constantly open, and many of them choosing to sleep even in the open air.”