stated, private villas may be procured at various elevations above the sea, and in them invalids can be very comfortable. This is unquestionably the best plan if it is possible to carry it out; unfortunately Tenerife has comparatively few of the quintas (or sitios as they are called in the Canaries) which exist in such numbers in Madeira. Then there is Laguna, standing nearly two thousand feet above the sea level, with a mean temperature of 58.3° F. in winter, and 68.4° F. in summer. It is undoubtedly a healthy and bracing place, although it has almost a monopoly of such clouds and mists as ever darken the sky of the Fortunate Islands.

The real mountain resort in the island, however, is Vilaflor, or, as it was formerly called, Chasna. This is the health resort par excellence of the natives of Tenerife. It is on the south side of the island, 4,500 feet above the level of the sea, with pine trees covering the hills above it up to a height of 6,000 feet. It is sheltered by the Canadas and the Peak from the north and north-east wind. It boasts a spring of mineral waters which have a high local reputation in disorders of the digestive organs, almost the only form of disease which is endemic in the Canaries. Here phthisis is said to be unknown, and the rate of mortality from all the ills that flesh is heir to is one of the lowest in the world. Under these circumstances it is not surprising to find an enthusiastic physician of La Villa (Dr. Zerolo, Orotava-Vilaflor: Estaciones Sanitarias de Tenerife, p. 24) claiming for Vilaflor the title of the first mountain station in the whole universe'!

The other islands of the Canary group are within easy reach, and the excellent inter-insular service of steamers readily enables even invalids to obtain change of air. Las Palmas in the Grand Canary has a singularly bright winter climate owing to the distance of the central heights. The island of Palma is much more wooded than the Grand Canary, and its climate is Atlantic in character. Gomera, another of the islands, is a little paradise which has hitherto been almost entirely neglected.

From this brief sketch it will be seen that in point of climate Tenerife may not unfairly be described as an epitome of all other health resorts, just as its famous botanical garden is a microcosm of the vegetation of the whole earth. There are excellent roads (carreteras) over a considerable part of the island, so that all the principal climatic centres, if I may call them so, are readily enough accessible.

One slight drawback connected with the climate of Tenerife must be mentioned, and that is the presence of mosquitos. Though they are neither so numerous nor so ferocious as in many other places, they are a thorn in the flesh of visitors nearly everywhere where the elevation is low. At Santa Cruz they are so abundant that all beds are provided with curtains. Dr. Zerolo indignantly denies that there are any (to speak of) at La Villa; but whilst I was at Puerto one gentleman told me that he saw a few, and another that he had killed ten

before getting into bed. The new establishment, owing to its being at a higher level above the sea than the present 'grand' hotel, will probably be free from this nuisance.

4

The main features of the climate of Madeira are much the same as those of Tenerife or, to speak more strictly, of Orotava. The mean annual temperature of Madeira is, however, four or five degrees lower, but on the other hand the daily range of variation is on the average about two degrees less. The climate of Madeira is therefore still more equable than that of Tenerife. It is not so dry, the average number of days on which rain falls being about 70, and the annual rainfall 28 or 29. The relative humidity of the atmosphere is from 76 to 79. The sky is more overcast as a rule than in the Canaries, there being a certain amount of cloudiness nearly every day. The two climates during the last winter underwent a certain amount of change in different directions, the Canary Islands having had less sunshine than they generally have, and the weather in Madeira having been abnormally bright. Dr. Grabham greatly prefers the normal cloudiness, and he has observed that certain acute diseases were more prevalent last winter when the sun played on the island without restraint. The vegetation is similar in type in Madeira and Tenerife, though in the latter island it is rather more African in character. The former has the same advantages as Tenerife as regards residence at different heights, except that in the Portuguese island there are no hotels at an elevation of two thousand feet.

Funchal is situated near the coast, but the best hotels and quintas are built on the crests of the hills which form the spurs of loftier mountains further in the interior. When the weather becomes too hot in the neighbourhood of Funchal patients can go higher up either to the villas on the Palheiro road, or to those below the level of the Mount, over which a Scotch mist not unfrequently rests. Those who wish for a still higher elevation and can afford to hire a villa may spend the summer in Comachio, which is more than 2,000 feet above the sea; there they will find a delicious English summer climate with apple and pear trees growing abundantly. For those who prefer the sea, Santa Cruz at the east end of the island, and in the summer months Santa Anna on the north side, will be found very pleasant. Personally, in spite of all the dithyrambs of Mr. Hart and the guide-book writers, I prefer the scenery of Madeira to that of the Canaries. There is a want of trees and, generally, of natural beauty in these islands which makes them much less agreeable to the eye than Madeira. On the other hand, Tenerife has greatly the advantage of Madeira in point of roads. There is nothing in the latter island corresponding to the carretera. The roads are so steep that ordinary carriages with horses can hardly be used without considerable risk, and the pace is

4 In these statistics the smallest drizzle is counted.

necessarily very slow. The bullock sleighs (or carros as they are called in the island) travel quickly and safely up and down the hills, whilst the hammock affords a very pleasant mode of conveyance. This useful institution has lately been introduced into Tenerife, but the Spaniards have not yet mastered the art of carrying without shaking.

Dr. Grabham, the well-known physician of Madeira, considers that the absence of carriages is an advantage rather than a drawback, as invalids frequently catch cold when out driving, but it is certainly a great inconvenience to other people. Madeira has a great advantage over Tenerife as regards villas, which may be hired by invalids for their sole use; while there are about a hundred and fifty of these near Funchal, there are only some twenty in the Orotava valley. Again, there are six hotels at Madeira, and there will soon be a seventh; they are situated at different levels, and therefore adapted to different cases. There is decidedly more comfort and general convenience in Madeira than in the Canaries, not the least important element in the visitor's happiness in the former being the excellent Portuguese servants who have been trained to English ways from generation to generation for a hundred years. On the other hand, the expense of living is much higher in Madeira than in Tenerife. All ports in the Canary Islands are free, and English goods can be readily introduced. Both Madeira and the Canaries are now almost equally accessible. Tenerife can be reached in five days from Plymouth, but as the steamers now only travel at the rate of about ten knots an hour, I believe the voyage could easily be reduced to three days. Those who object to a long sea passage can go by Spain, Portugal, and Madeira.

It only remains for me to speak of the various complaints for which these climates are suitable, and of the kind of cases to which each of them is, in my own opinion, more particularly beneficial. With reference to the latter point, however, it must be borne in mind that it is impossible to say with certainty what climate will best suit any given case. It is the same with medicines; the idiosyncrasy of the patient may cause a drug like opium, or quinine, ta have little or no effect, or one altogether different from that which is desired. A climate which acts like a charm on one person may not benefit another in what seems to be precisely the same condition. One can only lay down general rules, which are subject to modification by the circumstances of the case. Lung disease, of course, occupies the foreground in all questions of climatic treatment, and with respect to that I do not know that there is much to choose between Madeira and Tenerife. Both seem to be equally beneficial with precisely the same limitations. No climate can cure a patient in an advanced stage of phthisis whose lungs are riddled with cavities and whose vital power is exhausted by hectic. No patient should ever be sent abroad who is obliged to keep his bed. The whole benefit of a new climate consists in its making an open-air life possible. Doctors,

however, are often unjustly blamed for sending hopeless cases to a health resort when the blame rests altogether with the patient, who thinks, if he can only reach some place of which he has heard or read, he will get well. Some years ago I saw an American gentleman, evidently in a dying state, who had set his heart on going to Davos and would not be turned from his purpose. He reached his destination, but only to die the day after his arrival. When the disease is in an early stage, or when there is only some delicacy' of the lungs, a stay at either Madeira or the Canaries for some length of time will in all probability ward off the danger, and perhaps permanently cure the patient. In such cases there is no other place that can be compared to these; and many persons, who would beyond all doubt have died long ago had they stayed at home, have been saved by residence in the Canary Islands or Madeira for three or four years or for longer periods. Several English people have permanently taken up their abode in each of them, and the fiend of 'tubercle' seems to have been completely exorcised. This happy effect is not due, as is sometimes absurdly stated, to the fact that the pure 'balsamic,' 'antiseptic' air kills the minute organisms which are now believed to be concerned in the causation of the disease, but is the result of the general strengthening of the system, which restores to the tissues sufficient vitality to resist the microbes. This building up anew of the constitution is effected by increased use of the lungs, and the only way to secure that is by exercise in the open air. The exercise must, of course, be carefully adapted to the patient's power of endurance. Young invalids often err in this way by wasting their strength under the impression that they acquire stamina thereby. I found, for instance, that some of the patients who had spent the winter at Orotava had climbed the Canadas (a large extinct crater halfway up the Peak), taken long rides, made distant excursions across the island, and even played at tilting. I know several cases in which a serious relapse occurred in consequence of such imprudence. A quiet stroll or sitting in the sun will do good where violent exercise would be simply baneful.

A word of caution is necessary as to the risk involved in the case of a person suffering from advanced disease who goes on a journey, like that to the Canaries, of five days from Plymouth or seven from London in a steamer. The sea-sickness, semi-starvation, and general knocking about may easily rouse the smouldering volcano of chronic disease into activity. Many patients would derive much benefit from the Riviera whom it would not be safe to send to the Canary Islands or to Madeira.

Whilst at Tenerife I saw a good many cases of lung disease in consultation with Dr. George Perez, son of a well-known physician at Orotava, and himself a graduate of the University of London. In most of them there was considerable destruction of tissue in one or both lungs. In all but three of these cases, the reparative process

was very remarkable, and in two of these exceptions great improvement had taken place, but the patients had lost ground again owing to the effects of their own imprudence, or from accidentally taking cold. As all patients coming to Tenerife and leaving it have to pass through Santa Cruz, I thought that a favourable place for making inquiries as to the condition of the visitors at the time of their departure for England. The worst that could be said by a person who had had ample opportunities of seeing every patient who embarked, and who was by no means disposed to be over-friendly to Orotava, was that eight or nine persons had been carried on board.

Orotava with its sunny climate seemed to me to be particularly suitable for cases of consumption still in what is called the first stage.' It is also likely to be beneficial to those in the second stage, especially when there is profuse secretion. When there is constant high temperature, especially if there is a tendency to the spitting of blood, Madeira should be selected. Persons in the third stage of consumption should be restrained from going to either of these places or anywhere else; for them emphatically 'There's no place like home.' Tenerife is also beneficial in cases of bronchitis, when there is much secretion; for 'dry' bronchitis Madeira is better. One of these health resorts may, with great advantage, be made to supplement the other according to the variations in the patient's condition or to the development of different phases of his disease. Dr. Grabham tells me he has for years made use of the Canaries as a change from Madeira in cases of chronic disease, chiefly phthisis, when there is general failure of the vital powers, depression, and loss of appetite. The change is almost invariably most beneficial for a time. If the disease appears to be entering on an inflammatory phase, the sufferer should be sent to Madeira till the febrile symptoms subside. I entirely agree with Dr. Grabham that the slow process of recovery from phthisis may be powerfully aided by this alternation of Madeira with the Canaries. Asthmatic patients as a rule do well at Madeira if an elevation of 300 feet is selected; but most cases, if simple in character, find more relief in the Canaries. This disease, however, is so capricious in all its relations that it is quite impossible to say which place will suit any individual case. I saw one child who was cured of asthma after three or four years' residence at Orotava, and one or two other cases in which improvement had taken place. There is no doubt that in certain varieties of kidney disease much benefit is derived from residence either in the Canaries or Madeira, more particularly the latter. This is not yet, I think, sufficiently realised by English physicians. In cases of convalescence after acute or exhausting illness, especially where protection from chill and sudden changes of temperature is desirable, both Madeira and Tenerife can be recommended. Madeira is for this reason likely to be especially useful in convalescence from scarlet fever.

In addition to what may be termed their peculiar function as