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over, the purity and dryness of the air in general, the variety in the environs of some places, the antiquities and works of art, the greater freedom of association, &c., are circumstances which cannot but produce a most beneficial effect upon both body and mind. By the facility afforded for taking exercise daily, the muscular system is maintained in healthy tone; the due equilibrium of the vital powers is preserved; and a pernicious concentration of activity towards the brain and abdominal viscera is prevented. The numerous claims upon the attention from the variety of impressions received during out-of-door exercise, likewise counteract abnormal predominance of the sensitive system, by giving rise to fresh ideas. The digestive, respiratory, and cutaneous functions, are consequently more easily performed, the sleep is sounder, the general bien-être is more perfect, and numerous inconveniences resulting from a sedentary life beneath cloudy skies, are avoided.

It is not my intention in this place to enter further into the consideration of the peculiarities presented by various conditions of tubercular disease, especially as I have done so in another work.* I will therefore merely recapitulate in general terms, that where there is delicacy of constitution, with a predisposition to consumption from hereditary tendency, or a strumous diathesis, Nice, Naples, or Malta, according to circumstances, would in most instances be beneficial for the whole or part of the winter; that in other cases occurring in constitutions marked by a greater degree of excitability, Rome, Pisa, Hyères, or Pau, would often be preferable. As respects the former of these towns, it has been considered that localities subject to malaria are beneficial in consumptive cases; this may be so in some instances where perfect repose of the organs of respiration is essential, the air in these localities being generally stagnant, and comparatively little agitated by winds. In a large proportion of cases, however, where an impaired condition of the digestive organs, or other depressing causes, have produced an impoverished condition of the blood, and have laid the foundation for tubercular cachexy, a residence in any such locality would be prejudicial on account of its debilitating effects upon the system. The remarks already made also apply to affections of the bronchia and larynx, which are sometimes difficult to be distinguished from phthisis. In many cases of pulmonary and bronchial disease, the employment of the mineral waters of Cauterets, Eaux Bonnes, Ems, Selters, Weilbach, &c., will be attended with great advantage.

* Nice et son Climat, &c.

Debility or disorder of the digestive organs, when of long duration, not unfrequently gives rise to phthisis and other organic diseases, being like them often occasioned by depressing moral influences, some of which will be briefly adverted to further on. Before, therefore, the supervention of actual disease, its precursors, as evidenced by derangement of digestion or of other functions, or by general feelings of indisposition, should be combated rather by hygienic and moral means than by a too exclusive use of medicaments. Of these means there are none more efficient than travelling; a residence in some locality where the air is pure; the climate such as to admit of daily out-door exercise in winter; when sunshine, the aspect of a cheerful and pleasing country, and agreeable associations, tend to divert the mind from sombre thoughts, and, consequently, to strengthen digestion as well as the other functions of the organism—to prevent sanguineous congestions, by maintaining a due equilibrium between the arterial and venous circulation, the muscular and nervous systems. Under similar circumstances, Nice in some cases, in others the more animated movements of Naples—or even visiting in succession the different towns in Italy possessing resources for recreation-would be attended with the most marked benefit. A properly directed course of mineral waters in the summer season would, in most instances, greatly facilitate the subsequent beneficial influence of climate. When there exists an irritable state of the alimentary canal, with a tendency to inflammatory action, the above-mentioned towns would in general be prejudicial (this effect in a slight degree being not unfrequently superinduced in healthy persons); but Florence, Malta, Rome, Pisa, or Pau, according to individual indications, would generally be preferable. Those persons whose health has been deteriorated by a residence in unhealthy countries, though they may not be labouring under actual disease of any particular organ, will for the most part be greatly benefited by a course of mineralized baths, and subsequently wintering in Italy. Before attempting to reside permanently in England, I have known several, on returning home from India, whose health has become seriously impaired, owing to the too sudden change of climate and mode of living, which those who are in a weak state of health, or in advanced life, are ill calculated to bear; such persons will become better acclimated to Europe, by passing the first winter or two in the south.

The same observations may apply to hypochondriasis, melancholy, and other nervous affections, whether accompanied or not by material derangement of particular organs, Every one is aware of the powerful effects produced upon these patients by the state of the weather, and the varying conditions of the atmosphere; whence may be inferred the benefit which they are likely to derive from sojourning in a locality which ensures that these conditions will be for the most part favourable. The two chief divisions of hypochondriasis, the material and the nervous, may require different remedial treatment, though, climate produces an advantageous influence upon both kinds. In the purely


nervous variety, where the accompanying disordered digestion is the consequence of morbid susceptibility, Nice, Malta, or Naples, would be more recommendable in some cases : in others, especially when an interest is taken in antiquities, sculpture, painting, &c., Rome would be the most preferable locality for a prolonged sojourn. This class of patients will, however, likewise frequently derive more benefit from a division of the winter between two or three of the above-mentioned places, than by remaining for several months in any one of them.

In some relaxed and enervated conditions, giving rise to nervous disorders, the more bracing atmosphere of a northern city, as Munich, or some localities in the south of England, as Brighton, &c., would be preferable to Italy.

Gout and rheumatism must be ranked among the diseases in which the beneficial action of an appropriate climate is the most marked. In the former disease, there is almost always a tendency to venous stagnation, visceral congestion, and renal super-excitation, the amount of cutaneous exhalation being diminished. Many valetudinarians, subjects to gout, escape their periodical attacks by passing their winters in a position possessing facilities for walking exercise, and where the air, warmed by the sun, favours a more active circulation and secretion through the cutaneous vessels, to the great relief of internal organs. A no less favourable effect is produced by the same agency in most rheumatic cases, which are generally induced by the combined action of cold and humidity. Here, also, the choice of a proper locality must be regulated by the special indications in individual cases. In general, either Nice or Rome would be found to be the towns best suited for a winter residence. In these diseases, Sir James Clark recommends Nice in the cachectic rheumatism; where irritability of the digestive organs prevails, Rome is preferable.

Tic and neuralgic affections will be frequently removed by a combination of the means of treatment above specified, viz., mineral waters and climate. It is especially important, in these cases, to guard against exposure to the heat of the sun, to cold winds, or to the night air, which causes are frequently instrumental in inducing a recurrence of the attacks. Nice or Naples may be recommended in some cases; in others these climates would be too exciting, and an atmosphere like Hyères or Pisa would suit better. A prolonged residence at Rome would often be prejudicial; but a visit for a few weeks may generally be made without disadvantage. Florence in November and December would not be objectionable. This city, likewise, agrees well with many patients subject to nervous asthma, which has great analogy with neuralgic complaints.

Paralysis, when dependent upon apoplectic attacks, though perhaps not capable of being removed by any remedial means, may yet frequently be relieved by climate and mineral waters. Sunny skies have a beneficial influence both upon the bodily and mental condition of paralytic patients, who are less subject to cramps and other distressing symptoms than they would be in a less favourable atmosphere. When paralysis of a part supervenes upon repeated attacks of gout or rheumatism, from exposure to wet or cold, from the over-excitation consequent upon excesses, and from the action of malaria, &c., there is great probability of recovery by the judicious employment of these means. In some cases, Rome would be the preferable place for a winter residence, though not when there exists a tendency to determination of blood to the head, or in persons of full habit. In some cases, Pau, Pisa, or Hyères, would agree better; to others, Nice, Naples, or Malta would be more suitable.

Scrofula being, like tubercular cachexy, generally occasioned by living in a damp atmosphere, by imperfect venti


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