Wanderings in search of Health; or, medical and meteorological notes on various foreign health resorts ... With illustrations

Front matter

WANDERINGS IN SEARCH OF HEALTH WANDERINGS IN SEARCH OF HEALTH OR MEDICAL AND METEOROLOGICAL NOTES ON VARIOUS FOREIGN HEALTH RESORTS BY H. COUPLAND TAYLOR, M.D. FELLOW OF THE ROYAL METEOROLOGICAL SOCIETY, ETC. " All is but lip wisdom that wants experience."— Sir Philip Sidney. WITH ILLUSTRATIONS LONDON H. K. LEWIS, 136 GOWER -STREET, W.C. 1S90 PRINTED BY H. K. LEWIS, 136 GOWER STREET, LONDON, W.C, D^iratirr. CONJUGI MEÆ DILECTISSIMÆ ITINERUM PARTI MAGNÆ ET COMITI, EORUM HÆC RELICTA DEDICO. CONTENTS. PAGE Introduction .... . . [

Introduction

. Many are the books and monographs on Health Resorts by medical men possessing technical knowledge and experience as to the requirements which such places should supply. Some are by those who have only paid a flying visit to the various localities, and that whilst in health and vigour, and who therefore can scarcely appreciate their several advantages and disadvantages to the invalid ; for it is more especially he who goes in a weakly condition to recover his health, who begins to find out and duly appreciate the merits and faults of any given place. Again, many monographs of localities are written by those who have lived and practised in them, and who are therefore uncon- B INTR ODUC TION. 2 sciously prejudiced in favour of their own locality, not only from their living in the place and seeing many of their patients do well and improve in health, but also from their owing, very probably, their own re stored health to it, therefore they naturally praise it even beyond its deserts, when it is brought into comparison with other places.

It is no doubt hard even for two invalids to entirely agree on the various advantages and disadvantages of a health resort, not only because their maladies and constitutions differ, but also on account of their inherited and acquired tastes ; one feeling moped and bored in a quiet and more or less country place where there is but little gaiety going on, while another will feel far happier there, and far more contented with Nature's sur roundings than with the artificial attractions of a fashionable town with its promenades, balls and theatres. Nevertheless most medical men will agree, more or less entirely at all events, on the broader points of discussion as to the merits of a given place, and as to its suitability as INTR ODUC TION. 3 a health-giving locality for various classes of invalids.

Now it is from a medical man's point of view, who himself is an invalid, and who has been abroad for several years in search of health, but who previously had also travelled a good deal in Europe, America and the Colonies in health, that the following pages have been written ; and he has in them, without favour or malice, and he hopes, too, without giving offence, jotted down his personal impressions of, and his experiences in, various localities for the information and guidance of others. No body can deny that there is still much room for a fuller and better knowledge of the kind of climate and of the nature of the accommo dation and surroundings which invalids and convalescents, who are often indiscriminately sent abroad for change of air, are likely to meet with at foreign resorts. That this is the case amongst not only country practi tioners and those who have never had the opportunity of travelling abroad, but also amongst London consultants, is amply proved by many statements made regarding B INTR ODUC TION. 4 the climate or advantages of some gfiven place, and by the tales of the bitter dis appointments and the disagreeable experiences of many an invalid whom one meets abroad.

The plan of advertising new resorts by interested hotel, railway or steamboat com panies by means of puffing pamphlets, is a great and growing evil, spreading broad cast, as they so frequently do, most mis leading and exaggerated statements, thus causing many of these bitter disappoint ments. Again, the diametrically opposing opinions held in one resort as to the climate and merits of another are quite an amusin^ study. Thus in the Riviera it is said that the Alpine resorts can only be injurious, on account of the long hours patients have to spend indoors in an atmosphere vitiated by hot stoves, and on account of the close con tact of so many phthisical patients in rooms where proper ventilation cannot be properly effected, through the great draughts caused by the coldness of the external air in that climate, and its great contrast to the air of

INTRODUCTION.

. 5 the heated rooms. The difference indeed is often 60 degrees. On the other hand, at Davos it is said that the Riviera is all very well for patients who can never expect to recover, and who only want a mitigating climate to die in ; but that to expect any consumptive, for instance, to be cured, or obtain any permanent benefit, would be the height of absurdity. Again, in Madeira it is said that the cold winds of the Riviera are most injurious to invalids, and that the glowing descriptions often written on the climate experienced there are merely poeti cal rhapsodies as applied to the Mediter ranean littoral, but if taken literally, do exactly describe the climate of Madeira : that what is euphemistically described as " the invigorating and bracing air" of the Riviera really means, if translated into ordinary language, " cold, wintry and windy weather."

So the battle of health resorts proceeds, each locality being praised and decried in turn, so that it is most difficult to come to a satisfactory conclusion as to the real merits of a place, unless it has been actually

INTRODUCTION.

. visited and lived in, and due comparison made with other localities. The following pages are written primarily from the point of view of the poitrinaire, and it is with his wants and requirements that they are chiefly concerned. Nevertheless other ailments may be referred to, and will be more especially named when reference to them is indicated. With regard to the indiscriminate way in which patients are sent abroad, which I have alluded to above, and the sad results of which, one is constantly coming across, Dr. Clifford Allbutt has well said, " it is astounding to see the airy way in which a doctor, who has never been out of England, orders off his patients, this one to Aix, that to Carlsbad, and a third to Davos, and so forth, merely on the knowledge that one is good for rheumatism, the second for liver, and the third for phthisis."

Whereas to advise rightly it requires not only an accurate knowledge of the precise kind of case to be sent, but also some knowledge of the characteristics of the locality itself which is chosen. A knowledge of the mere baro- INTR ODUC TION. 7 metric, thermometric and hygrometric read ings of a place are not sufficient, though of course they are of great value in helping towards a decision. A personal experience ofthe climate, of such a climate as tha: of Davos for instance, should be had, if possible, before a patient who is in at all a critical condition should be sent there. Such cases, again, should only be sent away sparingly from home at all, and by no means as a matter of course. In no disease is this knowledge more needed or of so much importance as in phthisis, for in this complaint a wrong decision may greatly aggravate the malady, and instead of an invalid having all the attention his relations at home could give him, and would often be only too glad to give him, he not unfrequently dies away from home amongst strangers, neglected and uncared for.

Such sad cases are constantly occurring ; some times indeed the invalids die almost imme diately after their arrival, not having sufficient strength even to survive the fatigues of the journey or voyage. A case very much to the point has just come under my notice ; IYVTR OD UC TION. the lady in question having been a patient of a friend of mine. Though her own medical man was against her leaving home, she was advised to do so by a consultant. She was carried from her room to the cab, from thence into the train, and from thence on board a steamer for a passage of some days' duration. On arriving at her destina tion she was carried up to her bedroom at the hotel to die, far away from home and amongst strangers, only four days after her arrival. It is in the endeavour to change the entire surroundings and environment of the patient that the climatic treatment of phthisis becomes so valuable ; thus striking if possible at the cause which has induced the disease, whether it be an unhealthy em ployment, a damp soil, unhygienic surround ings, a vicious mode of life, or what not.

Consumptive patients too generally labour under the error that they have just a little " delicacy ofthe chest," and that a couple of months' holiday will set them all right again, and no doubt they may gain some improve ment in that time; but the disease can be by no means cured, and thus much harm is

INTRODUCTION.

. 9 effected, and they only relapse into a worse state than they were in before. They should be impressed at the outset with the gravity of the complaint, and that without the greatest care and attention to small details they will go from bad to worse, cure then being unattainable, and mere palliation only to be looked for. A patient should therefore be warned at once, and at the outset, that two years at least, and fre quently longer, must in all probability be devoted to regaining his health if a cure is to be obtained and not a mere palliation of the active symptoms. Of course this happy result may be obtained in exceptional cases in a much shorter time. It is universally admitted now that an absolute cure can be, and often is effected, though not many years aeo it used to be considered an incurable disease.

It is impossible, however, to prognosticate with any certainty which cases will recover ; for not unfrequently while one makes a good recovery, an ap parently equally favourable case will steadily tend to a fatal termination in spite of all treatment. INTR0DUCII0N. 10 I must here take the opportunity of returning my most sincere thanks for the great kindness and attention I have person ally received at the hands of my professional brethren in the various places I have visited, whether at home or abroad. I have also to acknowledge my indebted ness to the valuable writings of Dr. Hermann Weber, Dr. Burney Yeo, Dr. Henry Bennet, Dr. Sparks, Dr. Marcet, Dr. Wilson, Dr. Lindsay, Dr. More Madden, etc.

Chapter I

The Ocean as a Health Resort in Phthisis.* The almost world-wide distribution of phthisis, and the large proportion of deaths caused thereby in nearly every country, a few favoured districts and islands alone being exempt, whilst in many parts of the world it stands in the first place as a cause of death, makes it a subject of special in terest to us all. This interest is increased since we find by clinical experience that under careful treatment and favourable cir cumstances, it is certainly a curable disease. There can be no doubt that climate has a most marked influence for good or evil upon the progress of the disease, and therefore the merits of various places, or so-called health resorts, which have a beneficial in fluence on the disease, have frequently been e Reprinted and enlarged from a paper in the Manchester Medical Chronicle for August, 1885. discussed.

The ocean, even from ancient times, has always had its advocates as a health resort. Celsus, for instance, one of the most esteemed of ancient medical authors, writes: — "Opus est si vires pati untur longa navigatione, coeli mutatione, sic ut densius quam id est ex quo dis cedit aeger petatur. Ideoque optissime Alexandriam ex Italia iter. Si id imbe cilletas non sinit, nave tamen sed non longe vectari commodissimum est," i.e., "if the patient's strength allow he must take a long voyage, changing his climate, taking care to seek a denser air than that he leaves, and therefore from Italy to Alexandria is a very suitable change. If the weakness (of the patient) does not allow of that, it is very proper, however, to sail in a ship, but not far." It is now, however, perhaps more popular than ever, though the popularity of the sail ing vessel is perhaps waning in favour of the greater comforts obtainable on the ocean-going steamers.

But very numerous are the patients sent off yearly by both sailing vessel and steamer, to try a long sea voyage to Australia, New Zealand, or other distant part of the world, for various complaints, the chief of which, however, is consumption. Unless a trip be taken in a private yacht, the possibility of taking a voyage in a sailing vessel is now almost confined to the long sea voyage to Australia and New Zealand. It is far otherwise, however, with regard to steamers, for in them a great variety of either long or short voyages may be taken, all in well appointed passenger ships. Perhaps in the way of short voyages, the most satisfactory for the invalid, if only he can refrain from doing too much sight seeing on land at the different points of call, are those which can now be taken in various steam yachts and pleasure steamers to the Mediterranean, to the Canaries, to the Fjords of Norway, and so forth.

One great advantage of these trips is that the pas sengers, and not the cargo or mails, are the first consideration, and thus, for example, such trying and disagreeable necessities as crossing the Tropics are avoided. Now in this, perhaps, as much as in any other class of health resort, is it important to recommend suitable cases. Many and many are sent out yearly in this manner, and unattended by friend or relation, only to be a tie on those around them, and then eventually to succumb before reaching their destination ; or if they do survive, are only in a condition to be drafted into the hospitals. For instance, Dr. Griffith, of Melbourne, in a letter to the British Medical Journal, Feb. gth, 1889, says: — "At the present moment I have several phthisical patients under observation in the wards of the Melbourne Hospital.

These have all arrived recently from London by sailing ship, after a prolonged endurance of hardship and discomfort, and their condition was greatly aggravated by the voyage." Again, he says : — " Last week a gentleman recently arrived from London consulted me. He is suffering from tubercular phthisis, and his condition is quite hopeless ; but he was advised by a London physician to make a voyage in a sailing vessel. He was ninety four days on the voyage, and very nearly died during the cold wet weather ; but in any case he was an unsuitable patient to send abroad for climatic treatment." Medical men too seldom realise what they are advising when they recommend a sea voyage to any but the physically strong ; in theory it is all very well, but in practice it is a very different matter. I have seen cases in the third stage of consumption, and that rapidly progressing, sent on board without a friend or even an attendant, to brave all the difficulties, trials, and often real hardships of a long sea voyage.

At the same time one must not forget that it is often by the patient's own determina tion, and against the will of his medical adviser, that he sets out on a voyage, or makes up his mind to go to some much lauded place of which he has read, where he expects to be cured, in however bad a con dition he may be. Though the commissariat on the Ocean Steamers is fairly good, and on good sailing vessels very much improved from what it used to be, nevertheless it is not at all what an invalid should or would have if he were at some health resort on land. It is admitted that no air is purer, not even that at the top of a mountain, than that far out at sea ; but the difference between it and that of a seaside health resort, well exposed to sea breezes, must be small, and both are laden with the saline particles which are considered so health giving.

Any slight advantage there may be as to the pureness of the air of the ocean is, I maintain, far outweighed by the manifest disadvantages to an invalid at sea, such as the close ill ventilated cabins, the draughty saloons, the weakness and straining caused by sea sick ness, the damp sea fogs, the enforced con finement below during bad weather, and the great trial to an invalid of passing through the tropics. A London consultant sent a friend of the present writer, a short time ago, on a voyage to Australia, though he had a cavity forming in his right lung, saying to him, " Oh ! you will be basking in the sunshine and sleeping out on deck in the fresh air in a few days," little remembering all the above mentioned trials he had first to pass through. And when the wished-for latitude is reached, with its warm nights, the decks are found to be so damp from the heavy dews that no such thing as the anticipated pleasure of sleeping in the open air is at tainable, at all events for an invalid.

The above-named gentleman did survive his voyage, but was scarcely strong enough to walk unaided when he landed in Australia ; and of the ten consumptives on board the same vessel, six, at least, died amongst strangers in various parts of the Colonies shortly after their arrival. Has anyone, may I ask, ever heard of such a mortality as that amongst patients sent to any health resort on land, whether at home or abroad, in so short a period ? On the other hand, many cases with suffi cient strength to withstand the drawbacks which have to be encountered, are greatly benefited by a voyage, and often cured. For instance, H., a professional cricketer, who came under my own notice during a long voyage to Australia, was losing flesh rapidly, and had had haemoptysis and other signs and symptoms of advancing phthisis.

He gained no less than twenty-one pounds c during the voyage, and did not have a bad symptom after the first few days at sea. Now it is such cases as this, which so strongly advocate the cause of the ocean as a health resort ; but we should find, on examination, that it is those in the early stages of the disease to whom it is most beneficial (a remark, as I have elsewhere mentioned, which is applicable to every health resort), whilst it is simply a fatal remedy to those in advanced stages of the disease. If we trace the course of a sailing ship on such a voyage, does it not stand to reason, that a patient to benefit by it, must be strong enough at starting to withstand the frequent inclemencies of the weather to be met with round our coasts and the other drawbacks already mentioned, and after wards the depressing effects of the tropics ; or again, the cold bad weather so often en countered between the Cape and Australia ?

If he has not this stamina left in him, he will almost certainly get an exacerbation of the disease which onlv too frequently ends fatally before the termination of the voyage. Let us now take for example, the case of a ■9 patient sailing in a well appointed ship in September or October, the most favourable time of the year for starting on a voyage to Australia or New Zealand. Not unfrequently the voyage is commenced by having a delay of a day or two in the Thames or in the Channel, on account of a cold clammy fog, which is most injurious to patients ; but if clear, it is generally sharp weather, and the patient finds himself pacing up and down deck to keep himself warm in the cool autumn sea breeze, which frequently neces sitates great coats and pea-jackets even for the healthy. As evening comes on, he has to descend into the saloon, only to find such draughts there as would frighten him or his physician if on land !

Here he has to remain all the evening with his overcoat and cap on, making the best of it ; or if he finds it too unbearable, he tries to take refuge in his private cabin, which he has probably to share with one or two com panions, and which he finds very close and quite lacking the fresh air he would obtain in an airy bedroom on shore. An equinoctial gale is not unusually met c with before getting away from our coasts, with its concomitant miseries of sea sickness and enforced confinement to the lower regions of the ship, with their draughts or want of ventilation, the deck being probabfy too wet and slippery for anything but a struggle to the smoking-room with its oo o vitiated air. This uncertain trying weather generally lasts for the first ten days or even a fortnight, but after this a much more pleasant time usually sets in during the ship's pas sage through what is called the calm belt of Cancer, where the winds are variable and the temperature much more genial.

This belt of calms and variable winds is gene rally called the " Horse latitudes " by sailors, because vessels in old times bound to the West Indies and laden with horses, were so frequently delayed in it that the horses used often to die from want of water. This pleasant weather lasts also through the North East trade winds, which begin to blow steadily at about latitude 300 N., but varying with the time of year, and which carry the ship well into the tropics, till the Doldrums, or belt of equatorial calms, are reached at a latitude of about io° N. And here again the patient has to face another most trying period, and another trial of his strength, in the great depression caused by the heat and moisture of this region of the tropics. There are here con stant falls of heavy rain, and the atmosphere is most steamy and oppressive.

The action of this humid heat results in lessened evaporation from the skin, and diminished exhalation of aqueous vapour from the lungs. A plethoric condition is set up, with a lassitude of the digestive and other functions. The really depressing effect of it may be clearly seen in the healthy, for in the great majority a considerable loss of weight takes place, varying from two to four, or even six pounds, during the period usually spent in the most trying part of the equatorial region. If it is thus felt by the healthy, much more does the patient suffer. If he has been suffering from haemoptysis or night sweats, the former frequently re turns with increased violence, and the latter are rendered much more profuse, and therefore more weakening, while the appetite is almost completely in abeyance.

Such real dangers are these, indeed, that not unfrequently advanced cases terminate fatally in this region. Somewhere a few degrees north of the equator, (about 30 or 40 N. generally), the ship encounters the South-East trade winds, and a most delightful change in the weather takes place, which lasts till a latitude of about 350 S., when a more variable period ensues, till the longitude of the Cape of Good Hope is reached. On entering this part of the voyage the languor of the tropics is thrown off and the patient is braced up ; and if tolerably well, regains in this period of about three weeks, the loss of weight he sustained in the preceding fortnight. The ship now enters the well-known dis trict of the " Roaring-forties," and here trials again await the invalid, for not only is a heavy sea generally met with, but ice is often near at hand, and the cold is so great as to give the majority of patients chills and chilblains, and renders it necessary for the healthy to run about on deck, or take part in athletic exercises to keep warm.

The invalid, being unable to join in such pursuits, has to wrap up and keep himself warm as best he can while on deck ; but when he has to turn in on account of bad weather or nightfall, no warmth, no fire, is to be obtained, and he has to seek his bunk shivering, with the hope of finding the warmth in bed, which he is unable to obtain elsewhere. This trying weather lasts, more or less continually, till the longitude of the western point of Australia is reached, when it becomes decidedly warmer, and the patient is again able to sit on deck and enjoy the sunshine and his moderate and quiet exercise. This fair weather usually lasts at that time of the year (December) till the ship arrives at her destination, whether it be Melbourne, Sydney, or New Zealand. Let it not be thought that I have given a prejudiced account of the voyage through personal illness, for on the contrary, I was in very fair health at the time, being able to be on deck in all weathers, and personally, thoroughly enjoyed the voyage, which was taken in what is probably the best appointed passenger ship sailing to the Antipodes, viz., the Sobraon.

I could not, however, shut my eyes to the sufferings of others, and should now, in a poorer state of health, dread it exceedingly for myself. It is almost use less to give any meteorological table for such a voyage as has been described, as the temperatures actually observed give no idea whatever of the personal feelings of heat and cold experienced at sea. For instance, the heat in the Doldrums rarely exceeds 850 F., which gives no adequate idea of the most depressing feeling of heat experienced there. Again, how inadequately is the bitter cold of the period between the Cape and Aus tralia expressed by a temperature of 40° or 420 F. ! Passenger sailing vessels are now so rapidly becoming superseded by the ocean steamer, that the)* will before long probably become only a thing of the past.

If the voyage is taken in a steamer, instead of a sailing vessel, several advantages are no doubt obtained, but at the same time there are decided disadvantages connected with it. The saloons of the steamers are more com modious and frequently can be warmed in cold weather ; the food is fresher and better, the tropics are more quickly passed through, and the danger of being becalmed in the Doldrums is obviated. On the other hand, the cabin space is sacrificed for the engines and large dining-saloon, and four passengers are not unfrequently crammed into a cabin of about the same size as would be allowed for two only, on a sailing vessel ; not only so, there are many cabins which have not even any access to the outside air at all, having only a borrowed light. Again, the transition from cold to warm, and conversely from warm to cold climates is very much more rapid, and therefore much more trying to the invalid than in the case of the sailing vessel ; and thus one of the main characteristics of the ocean climate, viz., its equa bility, is lost, while the incessant vibration ofthe screw is most annoying to many.

Another feature of long sea voyages which has recently come prominently forward in the medical journals is the absolute danger, besides the mere unpleasantness, of a person being shut up with a phthisical travelling companion in a close, ill-ventilated cabin, for so many hours nightly for weeks together. Dr. Henry Bennet, of Mentone, in the British Medical Journal of Feb., 1889, relates a case which came under his own notice, very much to the point and demonstrating the great risk and real danger that may be run. His patient was a captain in the army, aged 27, who had been a model of health and strength all his life, and had scarcely ever known a day's illness. His family history was in every way excellent, with no taint whatever of phthisis. He had been serving in New Zealand and came home in a sailing vessel which took about four months on the voyage, occupying the same cabin with his wife who was in an advanced stage of consumption, and who died three weeks before their arrival in England.

Till her death the port-hole was rarely open, and the cabin was consequently most ill-ventilated. He evidently became infected, for within a few weeks after his arrival in England, he developed symptoms of phthisis, and was in an advanced stage of the disease when he consulted Dr. Bennet in the autumn, who soon after heard of his death. As Dr. Bennet well says, "a dis eased person has no right to infect the sound public, in endeavouring to save him self," which principle is recognised in com pelling isolation in many infectious diseases, such as small-pox ; though of course as to the contagiousness of phthisis it does not compare in degree with them, still the danger does exist, as is proved by the above well authenticated case. It seems to me that there should be a largely increased number of single berthed cabins, and that the ship's surgeon should have the power ot moving any advanced case of phthisis, and of certain other diseases to a single berthed cabin, both in the interests of the patient himself and of his travelling companion.