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It may be expected that something should be said of the modus operandi of this application; but I apprehend the limited number of cases that have hitherto been tried, are not sufficient to warrant any just conclusions. The bath, warm and cold, has been so long used in cases of insanity, that its importance need not be dwelt upon. From the successful result of its application in two or three recent cases, it may be concluded (supposing those patients to have had the bath in the common mode) that the benefit arises from the concussion produced; and it may be effected by cold affusion likewise, while the patient is kept in a warm bath, the affusion being conducted in such a manner as to prevent the cold water from running over the patient's body, which mode of applying it I have recently tried with considerable benefit in a case of mild continued insanity; but from the result of two of the cases above alluded to, and the testimony of many writers on this subject, as well as some cases I have lately seen, it appears that a bath of very high temperature almost always allays the violent paroxysms of mania. The warm bath entirely overcomes the preternatural muscular force which they exert, and by the aid of affusion, if continued a sufficient length of time, produces syncope, and afterwards a propensity to sleep; and yet under these circumstances there is a considerable determination to the surface of the head and face, both becoming highly efflorescent. These appearances would lead one to conclude that some increased action was induced in the head, thereby overcoming any unequal distribution or impeded circulation of the blood in it. It may be supposed from those effects and appearances, that the affusion conducted in this manner must be extremely hazardous in those cases which arise from external injury of the head in such patients the warm bath with cold affusion, and the addition of ice, as I have lately experienced, promises more favorable results; and I suspect this latter mode to be the means so much celebrated in a recent American practice. In those cases in which warm immersion and affusion were used conjointly, profuse diaphoresis was induced, which in one instance appeared to be attended with considerable benefit; in others it had a contrary effect.

These are the principal effects which I have observed from this mode of applying the bath in this malady. How far, and in what species of insanity it will prove of the greatest benefit, remains to be ascertained hereafter; as likewise how far it will secure the wretched objects of these attacks from relapses. E. TARDY.

Marchmont-street, Russell-square,
July 20, 1813.

COLLEC.

COLLECTANEA MEDICA,

CONSISTING OF

ANECDOTES, FACTS, EXTRACTS, ILLUSTRATIONS, QUERIES, SUGGESTIONS, &c.

RELATING TO THE

History or the Art of Medicine, and the Auxiliary Sciences.

A

On the medical Effects of Climates.

COMPLETE system of meteorology, even so far as the properties of climates, with regard to temperature only, are concerned, presents almost as great difficulties as a complete theory of the nature and cure of diseases. In this, as in many other departments of medical knowledge, we perpetually find a multiplicity of accounts, apparently well attested, but totally at variance with each other, which render it desirable to appeal to some more satisfactory testimonials than the results of common. and superficial observation; while the evidence which would be required for forming useful conclusions, upon safe and scientific grounds, although in this case completely within the scope of the human faculties, is still such as to require, for its production, a combination of perseverance and accuracy which has certainly never yet existed, and which, probably, can scarcely ever be expected to be found in a sufficient number of collateral observers. Any voluminous work on the subject, whether systematic or empirical, must unavoidably contain much useless and some erroneous matter; and a short statement of a few facts, which appear to be tolerably well ascertained, first, respecting the physical characters, and secondly, respecting the medical effects of the principal climates which deserve our notice, is all that it will be possible to attempt in the present essay.

The simple indications of a thermometer, however accurately they may be observed, in the most unexceptionable exposure, by no means afford a correct test of the temperature, as it affects the human system; nor is it possible to express the modifications produced by wind and moisture, even supposing them to be easily known, by any numerical measure which shall be applicable to every relative situation of the individual. I have known an atmosphere at 65°, with a thick fog, and a very little wind from the N. E., appear, to a person taking moderate exercise, most oppressively sultry; although a person, sitting long still, might have felt

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of air.

the same air uncomfortably cold. Moisture must make both heat and cold more sensible; the one, by diminishing perspiration, the other, by increasing the conducting power Wind is doubly concerned in affecting the properties of a climate; first, as the great cause of preventing a general accumulation of heat over considerable tracts of country; and secondly, as having a similar effect with respect to the immediate neighbourhood of the person; and its operation is as generally perceptible in the latter way, where we have no precise mode of estimating its magnitude, as in the former, where it is correctly indicated by a thermometer sufficiently exposed: although, in fact, the most shaded fixed thermometer may often be observed to indicate a temperature many degrees higher than that of the breeze which is circulating in the neighbouring country. Still more commonly by the sea side, the wind exhibits the temperature of the water over which it has blown. At Worthing it is seldom above 64° in the hottest weather, although the sea, when the tide flows in at noon, over the heated expanse of sand, is sometimes raised to 78°, where it is several feet deep.

To the inhabitants of these islands, the most important properties of the climates of other countries are those which render them more or less fit for the residence of persons liable to catarrhal or consumptive affections. Hence, warmth and equability of temperature, especially in the winter months, are the first objects of our inquiry in the theoretical comparison of climates. Moisture is supposed, by some, to be favorable, by others, to be unfavorable, to such persons: it may, therefore, be safely neglected, except as tending to increase the evils depending on a want of equability of temperature. The effluvia of moist ground are sufficiently well known as the causes of paludal fevers; further than this they require no particular investigation. Nor can we attempt to assign any reason for peculiarities, which render some situations preferable to others, for some individuals only, laboring under a given disease, as asthma; which is some. times induced by the atmosphere of cities, and sometimes of the country; and which is occasionally mitigated by a residence in places having no marked distinctions from such as are less favorable to it, as Kensington, and perhaps some others.

In the hotter seasons, there are few diseases, and few constitutions, which would require a climate milder than our own in the colder, an increase of the facility of cir. culation, which heat appears to afford, may often be bene

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ficial,

ficial, partly perhaps as exciting perspiration, and partly as preventing too great a congestion of blood in the internal parts of the body. The mean temperature of the six winter months is, therefore, the first point of comparison that requires our attention, and such a comparison may easily be derived from the registers, which are usually kept in circumstances nearly similar.

From October to March.

London, R. S. 1790-4
Edinburgh

Dawlish, Sir W.W. M. S. 1794 (Lond. 44'1°)
Ilfracombe, without doubt incorrect

43.59

40.4

45.3

(55)

Paris

41.2

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Jamaica, Botanic garden at Kingston, Clarke, Dunc.

med. comm. vii. 369

London, 1808-9

From November to March.

Penzance, 1808-9, Stirling, at 10, or about 1°

above the mean

From January to March.

55.5

63

63

68

74.5

42.6°

48.1

43.1° (Jan.37.9°

33.1

46.7 (Dec. 48.7°)

London, 1809
Glasgow, 1809, Stirling, at 10 40.3
Penzance, 1809, Stirling, at 10 48'5
London, 1790-4, 8 or 7 and 2 41.6
Sidmouth, 1800, M. S. R. S.

41.7

39.1

8 and 2

42.3)

February and March.

London, 1805, 7 and 2

41.5

Clifton, 1803, 8 and 2. Carrick

42.5

From October to December.

London, 1811, mean of extremes in each month

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It appears from this comparison, that none of the situations here enumerated, North of Lisbon, except Penzance, has any material advantage over London in the mildness of its winter. The best parts of Devonshire seem to be about a degree

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a degree and a half warmer; Torquay, however, may, perhaps, be a little milder than this; the account which was kept at Ilfracombe must have been taken from a thermometer in

a confined or a sunny situation. But Penzance may be fairly considered as having a temperature 41° higher than London in the coldest months; nor is the journal here employed the only one which allots such a superiority to the climate of this extremity of our island. It is remarkable that the temperature of the three coldest months is the same at Paris as at Edinburgh, being, in both these cities, about three degrees lower than in London. There are, probably, particular spots on the coast of Hampshire or Sussex, which, from their sheltered situation, must be considerably less subject to the effect of the northern and eastern winds, than most other parts of the island; and Hastings, or its neighbourhood, may, perhaps, be reckoned among the most eligible of these; but the further we go up the channel, the more remote we become from the mild gales of the Atlantic, while the prevalent south-westerly winds, in passing over a considerable part of the continent, must have lost much of their warmth. It is scarcely necessary to observe, that both Malta and Madeira present, numerically, a mean temperature for the winter months, as favorable for an invalid as can possibly be desired.

Equability of temperature is a second quality, of no small importance, as tending to diminish the chance of incurring, or aggravating, pulmonary diseases, by repeatedly taking cold. When, indeed, the temperature is much below 60°, the most material changes are those which occur upon going from the house into the open air; so that a cold climate becomes, in some degree, of necessity a changeable one also. The regularity of this change, and the power of avoiding its effects by additional clothing, as well as of obviating them in some measure by exercise, contribute, however, to lessen its influence; and it does not, therefore, altogether supersede the effects of that changeableness, which consists in a great extent of variation of the temperature of two successive days, or of different hours in the course of the same day. The simplest, and, perhaps, the best mode of appreciating the effect of the extent of such a variation, in deteriorating a climate, is to observe, for each month, the greatest variation, at the same hour, in any two successive days within its duration. The mean variation of successive days may also be computed, in order to assist in the comparison; and the mean diurnal range, or the space through which the surface of the mercury moves, in ascending

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