pleasure trip of a few weeks' duration is all that is necessary; for others a somewhat longer voyage may be better, as that to the Cape and back, or one in which the interest is kept alive by frequent stoppages at interesting spots, as in the voyages to the different parts of the Mediterranean, or to India and back, or to the Brazils, or the still longer voyage to China and Japan; while in some more chronic and troublesome cases, requiring a prolonged period of perfect rest, the long sea voyage to Australia and New Zealand may be most suitable. The natural temperament and disposition of the individual have to be considered, as some bear the inevitable monotony of a long sea voyage badly, and are more benefited by two or three short voyages with longer or shorter intervals.

Instances of slow, protracted, and incomplete convalescence from acute disease, from surgical operations &c. &c., are occasionally greatly helped towards complete recovery by a sea voyage, more especially if the persons concerned have a natural fondness for the sea, and do not contemplate the life on board ship with dread and distaste. To young people approaching adult age and suffering from debility, the consequences of over-growth, or over-educational strain, or dependent on other depressing influences, and which often appears to threaten to terminate in serious disease-to such, a long sea voyage is often of essential service. Young people suffering in this way are often incorrectly regarded as the subjects of what is called 'incipient consumption '-a foolish term, the use of which often excites a most unjustifiable amount of unnecessary alarm. It is chiefly owing to the exceedingly good results which long sea voyages produce in cases such as these, that they owe their great reputation as a cure for consumption. If, however, we were to subtract from the so-called cures of consumption attributed to sea voyages all the instances that were, strictly speaking, never cases of consumption at all, the residue, according to my own experience, would be surprisingly small. As to the propriety of sending cases of undoubted tubercular consumption on a long sea voyage, there is room for much doubt. In the case of young, and still active and vigorous persons, with a very limited area of disease, progressing slowly and without fever, and especially if they have a distinct leaning towards the life at sea, a sea voyage is likely to be of service. But many physicians who have had the best opportunities of forming a sound judgment have repeatedly and justly animadverted on the impropriety, unwisdom, and in some instances the positive cruelty of sending feeble persons, the subjects of advanced consumption, to encounter all the vicissitudes, risks, and occasional hardships of a long sea voyage.

A consumptive medical man, who was induced to try the long sea voyage to Australia, speaks thus of his own experience." Many are sent out yearly in this manner only to be a tie on those around

2 The Ocean as a Health Resort in Phthisis, by Dr. Coupland Taylor.

them, and then eventually to succumb before reaching their destination. I have seen cases rapidly progressing, sent on board without a friend, or even an attendant, to brave all the difficulties, and often real hardships, of a long sea voyage.' He goes on to speak of 'the manifest disadvantages' an invalid encounters at sea,

'such as close hot cabins, the weakness caused by sea-sickness, the damp sea-fogs, the draughty saloons, &c. And when the wished-for latitude is reached, with its warm nights, the decks are found to be running with water from the heavy dews, and no such thing as the anticipated pleasure of sleeping in the open air is obtainable, at all events for an invalid. Of ten consumptives on board the same vessel, six, if not more, died amongst strangers in various parts of the colonies soon after their arrival. It (a long sea voyage) 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 inclemencies of the weather and the other drawbacks already mentioned? Let us take for instance the case of a patient sailing in a well-appointed ship in September for Australia or New Zealand. He finds himself pacing up and down deck to keep warm in the cool autumn sea-breeze, which frequently necessitates greatcoats and pea-jackets, even for the healthy. He goes down into the saloon as evening comes on, and finds such draughts there as would frighten him or his physician if on land. Here he has to remain all the evening, 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 companions, and which he finds very close and lacking the fresh air he would obtain in an airy bedroom on shore. An equinoctial gale is not unusually met with before getting away from our coasts, with all its concomitant miseries of sea-sickness and enforced confinement to the lower regions, with its draughts or want of ventilation, the deck being probably too wet and slippery for anything but a struggle to the smokingroom with its vitiated air.

After this a much more pleasant time usually sets in, lasting through the northeast trades, which carry the ship well into the tropics. During this period the patient usually greatly benefits-that is, if he has been able to brave the first fortnight at sea. But again, he has to face another trial of his strength in the heat and moisture of the tropics. . . . Not infrequently advanced cases terminate fatally in this region. . . . Having successfully passed through this region also, the patient is now braced up again. This is the most delightful run, from about 15° S. to 40° S., through which he is carried by the south-east trades in splendid weather, and which usually lasts till the latitude of the Cape of Good Hope is reached. 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 so great as to give the majority of patients chills and chilblains, and render 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, and when he has to turn in,' 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 gain elsewhere.

This account is certainly that of a delicate person and an invalid, but it is valuable for that reason, and it is quite necessary that the public, and invalids in particular, should know what has to be encountered in a long sea voyage.

There are some differences of opinion as to whether it is better to take a long sea voyage in a steamer or a sailing vessel. In favour

of the steamer it is said there is less monotony of diet, less preserved and more fresh food, less tediousness and more variety of scene, and no liability to be becalmed many days in a trying, tropical atmosphere. In favour of a well-appointed sailing vessel it is urged that the cabins are more spacious, there is plenty of deck-room, no overcrowding, no unpleasant smell of oil from the engines, no jarring and unpleasant vibration from the screw, disturbing rest at night. There is more leisure to enjoy and realise a sea life. The changes of temperature are more gradual, and there is a greater gain to health provided the voyage is not too long and wearisome. A steamer, it is said, hurries invalids too quickly from fog and cold to tropical heat, and from tropical heat to the icebergs of the Southern Ocean.

Recently a warning has been raised by one of the chief medical journals of Australia as to the danger attending the long sea voyage, of a possible communication of consumption between persons who may be shut up together in small cabins during the whole of the voyage from England to that colony; and this warning has been repeated in the columns of an influential medical periodical in this country. The cabins, it is urged, even of the largest ships, are very small, and the consumptive man will have a considerable dread of ventilation, at least such an amount of it as a healthy man would desire; and so, at the very outset, the healthy and ailing find their wishes not in accord,' while the risk of contagion, if realised, must make the enforced companionship anything but agreeable.

Dr. Henry Bennet, of Mentone, who has had perhaps a wider and more varied experience than any physician living, in connection with travelling consumptives, and who admits that he is decidedly predisposed against the general acceptance of the view that this disease is commonly communicated by contagion, yet testifies that he has seen evidence to prove that the danger of contagion from travelling for weeks or months in a confined cabin at sea, badly or not at all ventilated, is a real danger,' and he urges that advanced consumptives ought not to be allowed to travel by sea, unless they can be isolated in single, well-ventilated cabins.' I share Dr. Bennet's opinion, and, as I have said elsewhere, whatever argumentative subtleties may surround the question of the contagion of phthisis in the minds of some English physicians, there can be no manner of doubt that intelligent laymen, with a tendency to trace facts and inferences to their logical conclusion, will be led, by a knowledge of the recent discoveries and investigations in connection with the natural history of pulmonary tuberculosis, to entertain the conviction that it may be and certainly is communicable from person to person under certain definite conditions.'

It will be seen from the foregoing that I am not an enthusiastic advocate of a long sea voyage for consumptive patients, that I think

it attended with many risks and dangers both to themselves and their fellow-travellers.

Finally, something may be said with regard to that 'change of air' which commends itself to so many of us in this country, the winter change as it may be called, the search for warmth and sunshine abroad at that period of the year when they are denied to us at home. I have written frequently and so fully on this subject elsewhere, that what I have to say now will be limited to a few particulars and comments with regard to some winter resorts that have recently come into prominent notice. The Canary Islands especially have received considerable attention lately as affording suitable winter quarters for English invalids; and Orotava in Teneriffe and Las Palmas in Grand Canary have been particularly indicated as the stations most suitable at present for this purpose. I have had the advantage of receiving frequent direct communications from friends of my own, who have, at my suggestion or by their own wish, spent considerable periods of time there, and I have no hesitation in expressing the opinion that as soon as the appropriate resorts in these islands have been thoroughly developed for the purpose of receiving invalids, they will form a most valuable and important addition to our available 'winter quarters.' The beginning of November is as early as invalids should arrive in the Canaries, for in the middle of October the heat has been found somewhat oppressive, unless they go to the high stations in Teneriffe, such as Laguna, 2,000 feet, or Villa Orotava, 1,200 feet, above the sea. At these high stations invalids can pass the whole summer without inconvenience from excessive heat.

Las Palmas, the capital of the Grand Canary, faces nearly due east, and is built on a flat strip of land at the base of some barren hills, the town being distant about four miles from the port. The English hotel has the disadvantage of being in the town itself, but a new hotel is in course of construction outside the town nearer the port, in a much more suitable situation for invalids. There is often a troublesome and difficult landing at Las Palmas, which is an objection to very delicate persons. The east coast of Grand Canary, where Las Palmas is situated, is colder and drier than Teneriffe, as it gets ❝ almost constantly' the gentle, dry, and invigorating breezes' of the north-east trade wind, and it also feels the influences of the North African current, a cold body of water which is 50° F. at Gibraltar, and which passes down the African coast in a band about 100 miles broad. Las Palmas has a fine sandy beach four miles long. On this beach the new hotel referred to above is being erected. It is thought by some to be an advantage to Las Palmas that it is not so close under the mountains as Orotava, for these gather the clouds and so cause occasionally long spells of cloudy, sunless weather.

According to Dr. Mordey Douglas's observations at Las Palmas

from November to June, the greatest mean daily range of temperature was in March (12.23°), and the smallest in May (8·13°), and the mean of all these months was 10.86°. The mean temperature for the whole period was 63·10°; the highest (in May) 79°, and the lowest (in February) 49°; and the extreme daily range in February, March, and April was 18°. The mean of the three coldest months. (December, January, and February) was respectively 62.36°, 60·57°, and 60-55°. The equability of the temperature is remarkable. The climate is moderately dry; the amount of aqueous vapour in the atmosphere varies, however, greatly, ranging from 50 to 70 per cent. It has much sunshine, and beautifully clear skies, and an annual rainfall of only fourteen inches. It has, no doubt, a very fine. climate, but a good deal of illness has occurred at times amongst the visitors there from diarrhoea and typhoid, and at present, and until the new hotel is completed, and some better means of landing are provided, it is scarcely a suitable place to which to send delicate. invalids.

Visitors to Orotava usually land at Santa Cruz, the port and chief town of the island of Teneriffe. Here there has been established a sanatorium, and a competent medical observer thinks it probable that Santa Cruz has the best climate in the island for the months of January, February, and March. It has a southern aspect, and the clouds which so constantly gather in those islands around the high mountains, do not interrupt so much of the sunshine as in those places, such as Orotava, on the north or east sides of the island, and it is protected from the cool north-east winds to which those places are exposed.' It is a six or seven hours' drive from Santa Cruz to Orotava, over the mountains, passing through Laguna at an elevation of 2,000 feet. It is necessary to be prepared to encounter in the winter cold winds, fog, and wet' at that elevation, and warm wraps are needed for the journey. For invalids, Orotava appears to have advantages over Las Palmas. The town is far smaller, and within a very few minutes' walk of any part of it there is a fine seabeach, bounded by a nice level road. The ground rises very rapidly at the back of the town to a sloping plateau, with an elevation of about 300 feet-a splendid site for the future building of villas.' It is here that a grand new hotel of the Americo-European type is being built. Orotava is on the north side of the island, and in the summer months the cool north-east trade winds exercise a grateful, cooling influence on the climate. The annual rainfall, as at Las Palmas, is estimated at 14 inches, and as the ground is very porous, being composed of volcanic scoriæ, it dries quickly. Meteorological observations give 62.8° F. as the mean temperature of the five winter months, nearly the same as the mean summer temperature of London (62.3°). The lowest temperature recorded was 50° F. There

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3 By Dr. Coupland Taylor.