carried to a far lower range, yet the sympathetic action of the cutaneous upon the other functions of the body is, in the aggregate, less with us than in Italy; because during the far greater portion of the year in our climate, the circulation upon the skin is comparatively dormant and suspended; being thus wisely ordered, like the covered seeds of plants of cold latitudes, to accumulate heat in the interior of the body, and prevent its expenditure by evaporation from the surface.

The sudden changes of temperature in Italy, though limited in extent, are, therefore, exceedingly pernicious, and they are caused by the cold blasts from the Alps and the Apennines alternating with the warmer, humid winds from the Mediterranean and the African coast. In the beautiful and much-frequented localities of Nice and Genoa we have particularly noticed these changes. Their position is on the coast, imbosomed within and at the base of the steep declivities of the maritime Alps, where these last and lower ranges touch the coast, and lave their foundations in the green waters of the Mediterranean. Facing the south gives them, also, by the reflected and confined rays of heat within their rocky bed, elevations of temperature more considerable than some other places in Italy. But they are constantly exposed, at the same time, to the sharp, wintry blasts that come from the snow-covered ranges of mountains of greater altitude, that are always visible in their immediate neighbourhood to the north, as they successively rise one above the other like an immense amphitheatre.

We do not mean it to be understood, however, that we discourage a resort to Italy for the promotion of health. It possesses everywhere, in its classical beauties and ruins, charms which few other countries can boast of. Every few miles opens some new and different ob

ject of interest, some ancient memorial, or architectural or sculptural relic, of those hallowed ages when the Romans were masters of the world. And nothing certainly can be more salutary, or even remedial, to the debilitated and wearied mind and exhausted body of the valetudinarian, than these constant and renewed sources of refreshing and agreeable excitement, operating through their moral influence upon the nervous system.

On beauteous Italy, divine in the midst of her sad but glorious monumental ruins, and the yet more mournful ruins of her moral and political grandeur, the heart lingers with sickening emotions. We sympathize with all her sorrow, and gaze upon her ancient temples and her triumphal arches as a part of our own hereditaments, because her history is closely interwoven with modern times. She is the last born and only surviving child of the mysterious past; the link that binds and unites our destiny and our race to the entire chain of human events, back to the ages that are lost in the impenetrable night of time.

But it is a great error to suppose that Italy, with all its fascinations, is suited to the pulmonary invalid. The constant anxiety he feels to visit and examine the antiquities of a country that are exhaustless in variety and attractive beauty, and the intense excitement they occasion when seen, as well as the exposure and fatigue necessarily incurred in visiting them, are, from my own personal knowledge, often injurious to the health of such patients. It must, upon the slightest reflection, occur to the mind of every medical man, that hemorrhages from the lungs will frequently be brought on in such patients under the circumstances we have described; a fact which we have positively known in that country, and which has aggravated the malady and expedited the fatal

U

issue. Even where there is only a strong predisposition to an affection of the lungs, and no incipient disease, the symptoms may thereby become more speedily matured, and positive and fatal mischief be induced. But more especially where actual disorganization exists, the exciting causes before mentioned will be attended with pernicious consequences.

If a pulmonary invalid from a colder country will travel in Italy without incurring exposure to the excitements we have enumerated, he will find its mild climate admirably suited to the mitigation of his malady; far more so, as we have already explained, than to the native Italian afflicted with these complaints.

In the great class of nervous affections, where much debility exists, but unaccompanied with organic mischief, and especially when unconnected with pulmonary disease, the peculiar attractions that are found in Italy are signally remedial and bracing, and invigorating in their influence upon the general health, as we have already remarked, by addressing themselves to the moral and intellectual faculties. Such an invalid may reside for any length of time in any of the delightful cities of Italy, with great profit to his health. But far otherwise with the pulmonary man; he, in our opinion, ought to pursue a very different course. His rule should be a constant change of place, and very little attention, much less close application, to the diversified novelties that present themselves in his travels. The exercise to his body in this climate is far more important to him, than having his mind engaged in fatiguing excitements. Too much care cannot possibly be paid to this advice.

As an illustration of the value of change of place for the pulmonary invalid, we may mention that the inhabitants of Lower Egypt, when threatened with disease of

the lungs, resort to Upper Egypt, Nubia, and Abyssinia for a change of climate, and we know with decided benefit. The inhabitants of Nubia and Abyssinia, on the other hand, when labouring under the same affections, come down to the lower or alluvial country with equal advantage.

There has been much of romance in the pictures that have been drawn of the climate and advantages of Italy. Whatever may be the malady of the patient, he must be prepared to meet with inconveniences which will constantly remind him of what he has lost by leaving home. Except in the capital cities, but few houses will be found with any accommodations that merit the name of what we Anglo-Americans understand by the significant word comfort. Most of them, he will ascertain to his sorrow, are not provided even with the necessaries of life. He must, too, often expect to encounter, after a long day's travel, meager arrangements for fire to counteract the chill of the evening, and a cold stone floor instead of a cheering carpet to tread upon before he can reach his not less comfortless bed.

I must here be permitted to protest against what I deem a reprehensible, if not cruel and wicked practice that some professional men fall into, of recommending or sanctioning, and sometimes even themselves urging the poor sufferer from pulmonary disease, after all the resources of our art have failed, to abandon his home, his family, and his friends, with the vain hope of recovering his health in a foreign land. The moment the disease appears to be confirmed, we have believed it to be our sacred duty to advise every patient to make himself as comfortable as possible in his own country, and within the immediate circle of his own family or relatives, that he may partake, to the fullest extent and up to

the last sad moments of his life, of all the rational and soothing enjoyments of their sympathies, and all the luxuries of home, rather than die in a land of strangers.

We are aware that nothing is more common than a fallacious and flattering hope, which a pulmonary patient is prone to indulge in, and that the future is always painted in his imagination with the warm and glowing tints and rainbow hues of a bright and glorious dawn, even when the night-pall of death is drawing its curtains around, and the unconscious victim has reached even the dark confines of the grave. And however painful to the medical attendant to do or say that which shall chill or dampen the sanguine and delightful anticipations of recovery in his patient, he has but one course to pursue, which is, to do his duty.