THE
MEDICAL EXAMINER,
AND
RECORD OF MEDICAL SCIENCE.
NEW SERIES.—NO. LXIX.—SEPTEMBER, 1 8 50.
ORIGINAL COMMUNICATIONS.
On Acclimation. An Inaugural Essay presented for the Degree
of Doctor of Medicine in the University of Pennsylvania. By
Philip C. Williams, M. D., of Winchester, Virginia.
. [Coucluded from page 450.]
As already intimated, there are great differences, both in an
individual and national point of view, in the readiness of acclima-
tion and the susceptibility to disease in a new climate.
It is a matter of common observation, says Levy, {op. cit. p.
528) that Northerners, going to the West Indies, suffer from yel-
low fever by the direct influence of an elevated temperature. He
also states that delicate persons of lymphatic temperament have
less to fear in a hot climate, than robust, energetic constitutions.
Another cause of mortality, so graphically described by the same
author, is the dread or panic that takes possession of their minds,
rendering them an easy prey to the violence of the epidemic.
But can none of these disastrous results be avoided? Experi-
ence shows that a strict observance of the following simple
hygienic rules, may greatly mitigate, if not entirely prevent many
of the diseases to which immigrants are now subject.
Bearing in mind the strong predisposition to inflammatory
diseases exhibited by strangers in a hot climate, wTe readily
see the importance of avoiding every thing that, in the least,
tends to increase this predisposition. Hence it becomes of the
highest importance to restrain the activity of the digestive and
respiratory functions. With this view, we must begin as early as
practicable, to change our mode of living, and endeavor to accus-
tom our systems to the diet and habits which we must eventually
adopt in order to secure happiness and comfort. Persons about to
go to a hot climate, should commence this restriction in diet, &c.,
even before leaving home ; and by all means should they exercise
the strictest caution during their voyage ; for it has been ascer-
tained that the health of such persons is very materially affected
by their habits during this period. (Johnson op. cit.') Having
arrived at their destined port, they should bear up against those
feelings of dread and alarm of which I have spoken ; at the same
time taking care not to fall into the opposite extreme of rashness
and imprudence. They should be cautious and temperate both
in food and drink. The diet should consist principally of vegeta-
bles, conjoined with a small quantity of meat.
Owing to the very excited and irritable condition of the intes-
tinal canal, the use of stimulating food, or of condiments of any kind,
should be avoided ; so, also, should the new comers refrain from in-
cautious indulgence in fruits, for to this cause has been attributed
many of the diseases, particularly the cholera-morbus, of these
countries. This danger is greatly increased by the free use of fruits
in the evening. This remark applies with equal force to suppers,
or to any unusual article of food taken at this hour.
The drinks should consist either of pure or slightly acidulated
water, of water mixed with milk, or pure milk, when it agrees
with the person using it. Buttermilk is preferred by some. Cur-
rie and Curtis recommend the use of stimulating drinks, pushed even
to slight intoxication. There need, I think, be but little hesita-
tion in condemning this practice. If such drinks be injurious when
used in cold climates, how much more so must they be, when acting
upon a system already overstimulated by a hot climate? I am
satisfied that many of the disasters formerly attending migration to
hot climates, can be traced to this unfortunate practice.
As this belief is opposed to the teaching of some, and the practice
of many more, it may be well to examine the opinions of medical
men who have had the most ample opportunities of testing the
effects of alcoholic drinks, as a part of tropical hygiene. Johnson
in his “ Tropical Hygiene,” says to those who go to hot climates:
“ the nearer we approach to a perfectly aqueous regimen in drink,
during the first year at least, so much the better chance have we
of avoiding sickness, and the more slowly and gradually we deviate
from this afterwards, so much the more retentive will we be of that
invaluable blessing—health.” The celebrated Dr. Robert Jack-
son, physician general to the British army, thus speaks of himself:
“ I have wandered a good deal about the world, and never follow’ed
prescribed rules in any thing; my health has been tried in all
ways ; and by the aid of temperance and hard work, I have worn
out two armies in two wars, and probably could wear out another,
before my period of old age arrives. I eat no animal food, drink
no wine, nor malt liquors, nor ardent spirits of any kind.”
Dr. Mosely (on Tropical diseases,) says, “ I aver from my own
knowledge and custom, as well as from the custom and observation
of others, that they who drink nothing but water, or make it their
principal drink, are but little affected by the climate and can undergo
the greatest amount of fatigue without inconvenience.” “ The
hardy Arabs of the desert have no habitual drink but water.
(Journal of Health, Vol. 2, p. 49.)
Dr. Marshall, the Deputy Inspector of Hospitals, observes, “ I
have myself marched on foot with troops on actual service, in a
tropical climate whose mean temperature was considerably higher
than that of Jamaica, without any other beverage than water and
occasionally a cup of coffee. So far from being calculated to assist
the human body in enduring fatigue, I have always found that the
strongest liquors are the most enervating, and this in whatever
quantity they are consumed.” (Op.cit. p. 241.) Were it necessary
the argument might be still further strengthened by other equally
cogent examples; but enough has been said to show the deleterious
effects of the use of ardent spirits as a part of tropical, and may
we not say of any kind of hygiene?
We do not, on the other hand, mean to recommend the copious
and indiscriminate use of very cold water. This drink, so refreshing
in small quantities, is attended with considerable risk if the person
have been enfeebled by prolonged exercise or by disease. On this ac-
count it should be used moderately in the latter part of the day. Cold
or even iced water, in limited quantity, is both reviving and salu-
tary, in the heat of the day, when the system is moderately
excited. Its refreshing coolness relieves, or tends to diminish the
heat of the stomach, and in this way somewhat abates the feeling
of languor and debility which are the constant attendants upon pro-
tracted heat. On these accounts we hail with delight the intro-
duction of ice as an article of commerce, thus conferring so great
a boon upon the inhabitants of southern latitudes.
Of Dress.—It is desirable to lay aside linen and put on cotton
garments, as the latter afford a much better protection against
the vicissitudes of temperature, to which all hot climates are lia-
ble. If, as is frequently the case, the temperature at night be much
lower than during the day, it would be advisable to avoid expo-
sure at this time, or make some addition to the clothing. Persons
obliged to labor in the open air and who perspire freely, will find
it safer if not indispensably requisite, to wear next the skin, light
flannel garments, which should be frequently changed, and w7ell
aired and sunned before being again put on.
There are many well authenticated proofs of the efficacy of this
kind of clothing, in protecting its wearers from the deleterious
effects of hot climates under which many have sunk who were not
thus provided for. An interesting example to this effect is related
by Dr. Combe, in his “ Principles of Physiology.” Capt. Murray,
of the British man-of-war Valorous, preserved the health of his
crew, numbering one hundred and fifty men, during a cruize in
which he visited every island of the West Indies and the ports of
the Gulf of Mexico, by making his men wear flannel next the skin,
and by keeping the “ between decks dry by means of stoves.”
Bathing daily in cold water is eminently useful, by guarding the
system against vicissitudes of temperature, as well ashy tending to
restrain excessive perspiration. The best time for its use is
upon rising, in the morning, or at noon, if the system have been
moderately stimulated by exercise. Andral, however, highly recom-
mends its use in the evening,as it may induce sleep; for, as already
mentioned, many suffer extremely from wakefulness. It may be
well to caution against its use at this time, if the system have been
worn out by the fatigues of the day, as it is thereby rendered un-
able to react under the depressing influence of a cold bath. With this
precaution, it may, no doubt, prove beneficial. If, however, the
person’s constitution be at all times too weak to endure the bath, he
may advantageously resort to sponging the whole surface of the body
with salt and water, and follow this by careful and thorough
friction with a coarse towel.
We ought to recommend the observance of regular and
early hours—that is to retire to bed, and to rise early. To sleep
upon a mattress of moss, hair, or something similar, adds much to
one’s comfort.
These habits should be strictly observed for two or three years,
after which the system generally becomes so modified as to bear, if
not to require, a fuller and more nutritious diet. But, extreme caution
should be exercised in making any change from the plain and
simple diet and habits that were adopted during the first period of
acclimation.
I have spoken in considerable detail of the effects and hygiene
of Southern acclimation, though not more so, I trust, than the
interest and importance of the subject demand.
Equally striking as these, are the effects of a northern latitude
upon a southern constitution. We will therefore now, for a short
time, examine northern acclimation.
We have seen that the effects of moderate cold are, indirectly, to
give greater activity to the nutritive functions; we have seen that
it increases the activity of the circulation and respiration ; so that
all of these may assist in the development of animal heat,
sufficient to maintain the temperature requisite for the healthy
action of the different parts of the economy. On the other hand,
we have seen, that, in warm climates, the demand for the evolution
of heat is very limited, owing to the high temperature of the surround-
ing atmosphere. Hence we find calorification modified accordingly.
We may readily imagine, that, if one changes a southern for a
northern latitude, this process and its dependencies must undergo
a change—must be rendered more active, and thus the lungs, in
order to supply the requisite quantity of oxygen, become
stimulated to greater activity. This undue continued stimulation
must result injuriously upon so delicate an organ. Of this
fact we have a familiar illustration in the frequent deaths
occurring in our menageries, among the animals of tropical
regions; and post-mortem examinations reveal pulmonary, and
generally tuberculous diseases.
We see the same tendency exhibited by all strangers who visit
cold climates, or even by the natives of those regions who have been
for a few years living in a warmer climate. Europeans, for example,
who have lived some time in southern latitudes, are, on their re-
turn home, prone to be carried off, either by pneumonia or phthisis,
or by the chronic diseases which they had contracted being changed
into the acute form. Many examples of this tendency to tubercu-
losis, are afforded in the negroes who live far removed from tropi-
cal climates. Pearson relates several instances in which boys
sent from Sierra Leone to England to be educated had died, in two
or three years, of phthisis.
Statistical reports show that, in Canada, the number of deaths
among the negroes from consumption, is such that, were not their
numbers increased by immigration, the whole population would
disappear in a few years.
The modifications of climatic influence, depending upon race,
are very interesting, but unfortunately generally overlooked.
“ We find, then, that the number of deaths among the inha-
bitants of New York, of African descent, is twice as numerous
as that among the whites of the same city. In Philadelphia the
proportion is about three to four.
“If next we take particular classes, represented by equal num-
bers of white and black men, as soldiers for instance ; in the same
place, subject to the same discipline, and supplied with the same
rations, we shall discover that the black troops are, in terrible
disproportion, the greatest sufferers from disease, and furnish the
largest number of deaths. Still following M. Boudin we learn,
that, in Southern Europe, as at Gibraltar, the mortality amongst
the blacks is three times that of the white soldiers ; both of these
corps being strangers to the soil. This immense disproportion is
owing to the predominance of diseases of the respiratory apparatus.
“ The mortality from pulmonary diseases among the negro sol-
diers in the British foreign posts is as follows : (The proportion is
for every thousand.)
“ On the western coast of Africa, it is 6.5 ; in Honduras, 8 ;
in the Bahamas, 9.7; in Jamaica, 10.5; in the Mauritius, 12.5;
in the Wind-ward Islands, 16.5; in Gibraltar, 35.5.” (Penn-
sylvania Journal of Prison Discipline, January, 1850, p. 111.*
[* Since writing the above our attention has been directed to an article in
the Southern Medical Journal, November 1, 1849, by Dr. Pendleton, of Sparta,
Georgia, in which the views we have advanced find confirmation. It is
republished in Dr. Fenner’s Southern Medical Reports. It will be perceived,
says Dr. Pendleton, that the whites are more subject to diseases of rhe
primes vice than the blacks, a fact easily accounted for by their different
modes of living, both as to exercise and diet. But upon what etiological princi-
ple is the latter race so much more subject to pulmonary affections? A little
further on he says: the blacks, notwithstanding their greater exposure, seem
to be less liable than the whites to periodic fevers, and more readily recover.]
1 have neither time nor space to pursue this interesting subject
as far as inclination prompts. I trust, however, that enough has
been said, to show that the effects of a northern climate upon a
southern constitution, are of an injurious, if not of an absolutely
destructive character ; and we are compelled to admit that there
is no such thing as a complete northern acclimation.
In the South, if a person escapes for a few years, he may probably
enjoy good health, at least sufficiently s’o to render life comforta-
ble. But such is not the case in the North ; for if the lungs be
once seriously injured, the continuance of the cause must necessa-
rily only increase the disease of these organs.
Much may, nevertheless, be accomplished,much suffering warded
off, by a proper attention to dress, which should always be suffi-
ciently thick to maintain the requisite temperature of the body.
Flannel should be constantly worn next the skin, and the quantity
of other clothing regulated according to circumstances, so as never
to permit an abiding sense of chilliness.
The food should be as nutritious as possible, and should consist
of animal and azotized substances, in-order that the system may
be supplied with a regular and abundant supply of fat, for this is
found to be the most efficacious of all agents in the development
and retention of animal heat. Proper limits are required even to
this kind of food; and wre should be careful to avoid all excesses, for
this would defeat the object in view. Extreme care should be
taken to keep the digestive and other functions in an active nor-
mal state. Not much is, I believe, to be affected by drinks. Some,
however, recommend the use of tea, coffee, and even alcoholic liquors.
The most that can be claimed for the last mentioned drinks, and
particularly for distilled liquors, is the very moderate use of them.
But actual experiment, both on sea and land, affords results by no
means favorable even to this view7. “ Experience,” says Dr. Bell,
(‘Baths and the Watery Regimen,’ p. 189,) “ has now corrected
the once vulgar and prevalent opinion, that drinks more stimulate
ing than water, and also of an intoxicating nature, such as ardent
spirits, are necessary to enable men to bear great climatic extremes
and vicissitudes. Dr. Miller, of New York, had, long before the
temperance reformation, pointed out the instructive fact, that ‘ in
all the frequent attempts to sustain the intense cold of w’inter in
the Arctic regions, particularly in Hudson’s bay, Greenland, and
Spitzbergen, those crews or companies which had been well
supplied with provisions and liquors, and thus enabled to indulge
in indolence and free drinking, have generally perished; while at
the same time the greatest number of survivors have been uni-
formly found among those, who were accidentally thrown upon
inhospitable shores, destitute of food and spirituous liquors, com-
pelled to maintain an incessant struggle against the vigor of the
climate, in procuring foo3, and obliged to use water alone for
drink.’ ” These facts are too decisive to need any comment.
Cold bathing, if properly borne by the system, w’ill be found
very serviceable, but still more so will be sponging the skin with
salt and water, and afterwards subjecting it to thorough friction
with a coarse towel.
On the subject of hygiene, national habits merit our attention,
if not our imitation. With a winter in our Northern States almost
as cold as that of Russia or Scandinavia, we ought not to lose
sight of the precautions by which the people of those countries
protect themselves, both by the arrangement of their houses and
their clothing.
The regular use of the vapor bath deserves consideration and
attention. On this point I refer to Dr. Bell, (op. dt.) One good
effect, at least, from this practice, must be to excite the skin to a
proper discharge of its functions, and thus relieve the lungs and
kidneys—organs, which we have seen, are so severely and injuri-
ously tasked in cold climates.
The state of the general health should be most carefully watched,
and the slightest tendency to disease particularly of the lungs,
promptly combated.
We next come to the consideration of acclimation as modified
by moisture. This, embracing as it does, the interesting, but ex-
tensive and complicated question of miasm, is too vast a field
to be, in this place, fully explored. There are, however, some
general considerations that demand attention.
In a preceding portion of this essay, I exhibited the picture
drawn by Hippocrates, of the modifying influence of mois-
ture. This is two-fold, and subject to modifications, according
as it is associated with cold or with heat. To both of these I
will briefly allude. The lungs and kidneys, which as we have
said are in a state of minimum activity in a warm climate, are
severely tasked in a cold and moist one. This is not so much owing
to the direct operation of cold, as to its indirect effects, manifested
through the enfeebled and impeded functions of the skin, by which
these organs—the lungs and kidneys—are forced to extraordinary
efforts to eliminate effete matters from the body. Thus it is that
we see so great a tendency to renal diseases, and to tuberculosis
and scrofulosis, which is exhibited in cold, and even during the
winter seasons of temperate climates. This condition is greatly
aggravated by a combination of moisture with cold, and to their
joint agency may be attributed a long list of anginose, .tracheal
and bronchial affections.
Equally deleterious, though in an opposite mode, is the union
of moisture and heat. This is supposed to be the most favorable
condition for the development of miasmata. But as this is be-
coming, more and more, a controverted point, I shall not pretend
to discuss it here.
Whatever may be the decision of this point, we may be quite
sure of one thing, viz. that a hot and moist atmosphere is pecu-
liarly depressing in its operation upon the functions, and renders
the system extremely susceptible, even if it does not originate,
attacks of fever, or of hepatic and splenic diseases. These effects
are most liable to be experienced during the night, in hot and
marshy regions. Among many illustrations may be quoted the
following, as related by Dr. Lind. In 1766 the Phoenix, ship of
war, was returning from the coast of Guinea. The officers and
ship’s company were perfectly healthy, till they touched at the
island of St. Thomas. Here nearly all of them wrnnt on shore.
Sixteen of the number remained for several nights on the island.
Every one of these contracted the disorder (fever), and thirteen of
the sixteen died. The rest of the crew, consisting of two hundred
and eighty men, went in parties of twenty or thirty on shore in
the day, and rambled about the island, &c., but they returned to
the ship at night; and not one of these who so returned, suffered
the slightest indisposition. Exactly similar events occurred the
following year, with the same ship, at the same place, where she
lost eight out of ten men, who imprudently remained out all night
on shore, while the rest of the crew, who after spending the great-
est part of the day on shore, always returned to their vessel before
night, continued in perfect health, (Watson’s Practice p. 450, Am.
edit.) Did time allow, I might refer to other facts to enforce the same
point; but the above are sufficiently conclusive.
Another peculiarity of these situations is to develope diseases
to which persons were predisposed, but in whom they had hitherto
lain dormant. The following affords a striking illustration. Twenty
eight soldiers being exposed, at work, in a malarious district, were
all taken sick ; not with the same disease, but three with cholera
morbus, five with dysentery, four with yellow fever, and the re-
maining sixteen with pernicious intermittent fever.” (Johnson.)
With this necessarily imperfect description of the effects of moist-
ure, I must hasten on to the subject of protective hygiene.
Persons going to such climates should carefully avoid all expo-
sure to night air ; they should not go out early in the morning, nor
remain out late in the evening; and they should only go out after the
sun has risen sufficiently long to dissipate the fogs and mists and to
rarefy the atmosphere. They should avoid all exposure to wet; and
refrain from all excesses in food or drink. Their diet should be
nutritious ; their drinks simple and pure. If the water for drink-
ing be impure, it should be purified and filtered before being used.
They should attend most strictly to their general health ; to per-
sonal cleanliness; and should avoid every thing tending to debili-
tate and exhaust the system. Some recommend that, for a while
at least, the system be kept under the slight influence of some
tonics, particularly bark, or, still better, quinine.
After having, for a time, observed these precautions, and
having overcome the primary excitement incident to hot cli-
mates, a more liberal diet may be adopted, accompanied with the
use of condiments, such as capsicum, ginger, &c. It will be safer
to continue a vegetable diet, combined with a small proportion of
meat, until the acclimation be, in great measure, completed. It is
then that the colonists may imitate, with advantage, the customs and
habits of the natives, and of those who are inured to the climate.
But, in addition to these precautions, there is another of vital
importance, viz. the selection of a site, exposure, &c., of the dwell-
ing. They who are attracted to these countries, merely for the sake
of commerce, and whose stay is short, are not so much concerned
with this ; nor, on the other hand, are they generally able to
exercise such a choice. They who intend to become resi-
dents should give this subject their most careful consideration.
They often have the choice of situation—whether a low or a rising
ground, a valley or a hill, is to be the site of their future abode.
In this case they should always select an elevated and dry position.
If this cannot be obtained — if they are compelled to build
upon a moist situation, near a river, or stream, or still worse,
near a stagnant pool—they must endeavor to discover the preva-
lent directions of the winds, and so place and arrange their houses
that the wind shall blow against that side of the house containing
few or no windows. If there be windows on that side they should
never be opened till the sun has risen, and dissipated the- mists,
fogs, &c.; after which they may be thrown open, so as to ventilate
the house. They should endeavor to screen it from these winds,
by an intervening hill or strips of woods. If foiled in all these
endeavors, and even though they may obtain these advantages,
without the desired result, they may with great benefit keep their
houses always dry and warm, either by furnaces or other conve-
nient methods. There are many well attested instances in which
persons have maintained perfectly their own health and that of
their families, by this means, in the most sickly regions. In this
way persons have been enabled to enjoy good health, even in the
“ Pontine marshes,” and the “ Campagna di Roma,” and in other-
wise uninhabitable regions. The sleeping apartments should never
be on the ground floor; they should always be well aired and
ventilated. For a fuller and more satisfactory exposition of this
important subject, see Levy op. cit. art. “Des Habitations.”
The last variety of acclimation that I shall notice, is that inci-
dent to situations considerably elevated above the level of the sea.
As before stated, this elevation gives rise to greatly accelerated
respiration and circulation ; to pulmonary congestions ; to dysp-
noea ; and sometimes to haemoptysis and other hemorrhages.
It would seem, from the description of their feelings, by
Gay Lussac and others who have ascended to great heights in
balloons, that many of the effects attributed by travellers to their
elevation above the level of the sea, are due, more to the fatigues
of the ascent and the benumbing effects of cold than to a rarefied
atmosphere. It is stated by some author w’hose name I forget,
(possibly Humboldt,) that if we remain perfectly still on these
heights, there is little or no disturbance of the respiration, or cir-
culation ; but if exercise, particularly w’hen at all violent, be
taken, all the symptoms above mentioned are fully developed.
This seems to show that the accelerated respiration, &c.
must be referred to some other cause than cold; for if this were
the explanation, these symptoms ought to be most violent when
the person is at rest!
When we consider that the blood requires a certain proportion
of oxygen to become properly oxygenated; and that in these situ-
ations there is a diminution of the requisite quantity of oxygen,
we can easily conceive the necessity for the increased acceleration
of the respiration to supply the deficiency. Hence we may have
little hesitation in ascribing many of these effects to the rarefac-
tion of the air, as well as to the “ benumbing influences of the
cold.”
This variety of climate is only of interest on account of the fact
that phthisical patients were formerly advised to remove to such
situations. When we bear in mind, however, the variable tem-
perature, and the excessively cold, damp and violent winds, to
which these situations are liable, we cannot fail to admit the in-
jurious effects of residence on them. For persons going to such
places, it is necessary that they should adopt the same hygienic
and other recommendations, suited to cold climates generally.
Did time permit we might speak of the various climates met
with in the different parts of the United States ; and particularly
might we note the peculiarities of the climate of our middle States,
in which occur the two extremes of great cold in winter, and ex-
cessive heat in summer.
These conditions call for different and almost opposite hygienic
precautions, of which many, may I not say most, are neglected.
Necessity forces us to make the requisite changes in clothing
during the extreme seasons; but in the regulation of our food we
still fall far short of the demands of a wise hygiene.
During the period of infantile life, the process of acclimation
must be undergone at each return of our extreme seasons. To
these extremes and transitions is to be traced the melancholy fre-
quency of deaths occurring among infants—during the winter, from
diseases of the pulmonary organs ; during the summer from diseases
of the intestinal canal.
Most fortunate would it be for the welfare of infants, if the pro-
fession regarded, and the mother understood, the peculiarities of our
climate and the laws of acclimation.