ince of Climatology and its ally, Demography, which latter is but the expression in terms of the effects of climate and other conditions in modifying human develop

ment.

It is not, of course, the fact that all the cachexia are attributable to climatic influences. Dr. Matthews, of the United States army, has shown that consumption increases among the American Indians under the influence of civilization, climatic conditions being, of course, unchanged and these being normal to them as aborigines. "It is the compulsory endeavor to accommodate them," he says, "to the food and habits of an alien and more advanced race, and that climate is no calculable factor in this increase." The Aryan of to-day returns to India, where his ethnic kin have not only thrived, but have absorbed the Semitic dwellers in the peninsula, while he succumbs to a climate to which he ought to be able to adapt himself as well as they, because he carries with him habits and customs of dress and diet that are unnatural. It is the over-feeding, over-stimulation, the attempted transplantation of the at all times ridiculous and abominable artificialities of our social life, rather than tropical hypæmia, which is fatal to the European.

Hence, ethic as well as atmospheric and telluric influences are factors in demographic changes and cannot be ignored in considering the question of acclimation. The red races of America are perishing in their own climatic home by reason of the vices of civilization, and their Indo-European successors are themselves only saved by fresh intermingling from the same fate, not through the influence of the alien climate, but of the social evils sought to be ingrafted. A century of civilization, our colleague Dr. Woods, of the United States Navy, bears witness, in his paper on the demographic effects of introduced disease among the Hawaiians, has diminished a pure-blooded race, living under unchanged climatic conditions, four-fifths its number. The physical decline of the natives of Rapa-nui (Easter Island) began when French missionaries evolved out of nude, lascivious, dancing savages, timorous, weakly, clothed, pseudo-Christians, for with European religion were introduced European diseases. The Rome that conquered the world and the Rome which the Goths subjugated were the same geographically and climatically. The early settlers on the banks of the Delaware and Chesapeake waxed strong and were fruitful and multiplied, but how many among their descendants are feeble, weak-kneed men and sallow, flat-chested women, whose generative powers are exhausted on two or three sickly imitations of themselves! Their physical decadence is not all the direct effect of climate, although this is often remotely responsible for the ethnic customs that are themselves the immediate cause of impaired health. Reproduction is impeded in America, as in polygamous Turkey, the normal increase of the race in both being prevented by influences to which climate has only remote relation. The premature sexual development in warm climates leads to erotic indulgences, but sexual debility follows upon the constitutional anæmia, which is the effect of climate, and indulgence is restrained by inability. Northern races, in whose vessels the blood courses more briskly and whose virile powers are more pronounced, are those who, in both sexes, most transgress the restraints of moral law. Climate gives them vigor as climate makes the southern woman too indolent to resist, though too indifferent to desire, but it is the old Adam, who "forfeited and losed first in Eden," and not climate, which carries either into harmful excesses.

The climate of the United States is commonly denounced, even by Americans, as pernicious, when, in fact, the most heterogeneous race elements are here being welded on a vast scale, into intimate union, as nowhere else on earth. The mixture doubtless shows the influence of climate. Wheeler says, "The reduction of volume, especially

in chest sounds and the play of the nose in our language seem to be capable of but one explanation and that is that they are a tribute paid to the empire of climate." The seasonal changes which are considered most detrimental are actual elements of healthfulness. In climates where cold is long continued the hyperæmia becomes persistent, not being dissipated by the short summer, and in those where tropical heat prevails man loses that physical vigor on which mental effort and social progress depend. The changes of season of the temperate zone have this advantage, that one season may be said to be remedial to its predecessor and prophylactic to that which follows. Changer du climat, c'est naître à une nouvelle vie," says Michael Lévy, and similarly, change of season is like travel over a new route to one wearied with following the beaten track. Fashion has given endorsement to the annual hegira to maritime, rural and mountain resorts, by which the jaded slaves of society in great cities seek to undo the evil of their winter follies, and the movement of hordes of invalids in Europe and America to mineral springs, elevated plateaus and sheltered seashores is assuming large proportions. Doubtless the climate often receives credit not its due, for the valetudinary, greedy to get the full effect of the healing influence of the place, lives out-doors and derives a benefit he could have had at home by an equal degree of judicious open air exposure. In most instances, undoubtedly, the exercise in the air and sunlight are wonder-workers with persons who, living in great cities, see with indifference their own children condemned to a shorter allowance of fresh air and sunshine in their schools than the criminals of the State in their penitentiaries.

The reciprocal influences of climate and custom are seen in the matter of popular diet. The food of a people largely determines its national characteristics, but climate determines the food. The Chinese of the northern provinces live on millet and wheat and vegetables, because these thrive best in the dry and dusty soil and severe winter, while the moist, hot climate of southern China produces rice, which with fish is the staple aliment of many millions of people. The lack of variety harmonizes with the conservatism of the race and has contributed to that spirit of contentment and domesticity which, as in Japan, are elements of real happiness not enjoyed by nations boasting a higher civilization.

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Man, better than any other animal, is able to adapt himself to climates unlike that of his native habitat, and the several races of men unequally, the Indo-European having the greatest resilience and adaptability. Nevertheless, it is alleged that the Scandinavian colonies in Greenland and Iceland have not thrived; that Egypt is the tomb as well of Europeans as of Asiatics; and that the Algerian sits hopefully waiting for time and climate to wipe out the Gallic intruders. Ah! but the climate will kill them," was the thought of many a fair border-confederate sympathizer when she saw the stalwart regiments of the northwest marching to southern battle-fields. It is claimed that Arab and Turk only increase by intermarriage with their slaves, but manifestly climate has no part in this demographic result. With equal probability, the colonists of Greenland and Iceland would have thrived with the same regard to hygienic measures as the sailors and exploring parties who sustain the monotonous Arctic life without detriment. Rink positively attributes the striking decrease in numbers of the Moravian communities especially not to any accidental or climatic cause, but "merely to the prevailing mortality arising from the miserable condition of the natives belonging to the communities as regards their habitations, clothing and whole mode of life." More men are frozen to death in the United States than at that most frigid spot on earth, Veroynsk, in Siberia, where the thermometer falls to 86° F., and averages -50°. Like the naked natives of the Tierra del

Fuego, they die from smallpox and scurvy, not from cold. The mortality among white settlers on the west coast of Africa, on the Isthmus of Darien, in the jungles of India and the swamps of Whampoa, is largely due to the failure to adapt dress and diet to exaggerated local malefic influences, for creoles of one or two generations are as tolerant of yellow fever and pernicious paludal fever as autochthones. Jew and Gypsy wander all over the earth, and their fruitfulness is evidence of their physical vigor. It is true that the negro cannot be acclimated in regions far north or south of his origin, which, with the fact of the infecundity of his mulatto progeny, indicates structural inferiority and inherent degenerative tendencies, but if black cannot bleach to white, there are abundant ethnic examples where the migrated white has exhibited every shade of discoloration, to the veriest Soudan ebony. The greater adaptability of the Aryan is, therefore, indicative of that higher place he holds in the great scheme of human existence, while the feebler Hamite is doomed to succumb and disappear when removed from those favorable conditions under which he lives at all, like plants, which respond so sensitively to transplantation that some will not grow and others lose their characteristic alkaloids and active principles when cultivated on other than their native soil.

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Climatology, therefore, is an indispensable chapter in the study of the natural history of man, whether our aim be to qualify ourselves to become ministers to the suffering, guardians of the well, or propagandists of that manly excellence to which we should all aspire, for, as Sir James Paget declares, "We want more ambition for renown in health. I should like to see a personal ambition for renown in health as keen as that for success in our athletic games and field sports. I wish there were such an ambition for the most perfect national health as there is for national renown in war, in art, or in commerce." Man's ailments are chiefly lesions of cell nutrition, and these are brought about by the perturbed surroundings. It is not difficult to imagine how marked the influence on human processes, when the mere befouling of the air reverses its polarity, or a change in altitude almost doubles the blood's capacity for absorbing oxygen, or a high atmospheric temperature increases the quantity of the nitrogenous elements of food assimilated. It has been said that if the winds of heaven were but made visible, their myriad movements would present a spectacle sublime beyond comparison. What would it be could we view the seemingly chaotic play of currents in that mysterious medium we term electric fluid, a field of strains and stresses in something not the air yet in and with the air; of lines of forces without breadth and unending," penetrating, permeating, mingling with every created thing, inanimate or living! If atoms, lifeless and dense as those of iron, are made to range end on end, or side by side, and vibrate in longer or shorter paths, so infinitesimal that only millions make their difference measurable by the microscope as this tenuous something sweeps among them, who can doubt that the living, sensitive molecules of blood and body and brain are also influenced by them for weal or woe. It may be that we have been scanning our pharmacopoeias too assiduously for strange plants and complex chemical compounds for healing means. Fortunately, perhaps, much of our vaunted medication has been inert, nature having shut her microscopic mouths to the coarse poisons we would have forced upon her as when in the active stage of typhoid the suspension of the process of assimilation makes beef-tea and drugs alike innocuous-drugs that we do not even know to be what they are, after they have run the gauntlet of sophistication by the wholesale dealer, adulteration in the shop, deterioration, carelessness or ignorance in compounding, inaccuracy of weights and measures, and our own hap-hazard guess of dose. If the imputation of therapeutic fallibility imply ignorance, then, using Lawson Tait's comment upon some old-fash

ioned terms sneered at by modern savants because they serve only to express our ignorance, "The reproach is true; we are ignorant, but it is better to be ignorant and to confess it, than to parade a lot of inaccurate conclusions in the name of science." This, at least, we ought to know, that the energy which can build up the wasted body, fire the sluggish blood, and animate the palsied brain, is not stored in gravimetric dose in powder, pill or tincture, but in potential quantity in the great reservoirs of force by which we are surrounded. It would be too great a digression to dwell here upon the potency of nature's own therapeutic means, for which the climatologist is apothecary. As a naval medical officer, I can testify, perhaps, better than my civil professional brethren, to the kingly tonic touch of earth upon the invalid who has looked for weeks only upon lifeless wooden decks. Side by side with the operating room where the chirurgeon lops off what he cannot mend, let there be the solarium, where ozone-laden air and vivifying sunshine and living plants and running water and the soothing melody of voiceful nature reproduce the conditions of healthful out-door life.

We can only hope to unravel the mystery of disease by seeking its first cause; and though we know how large the share ignorance, sin and folly have had in weaving its meshes, we cannot yet say just where the tangled threads begin to interlock. Are we not fruitlessly piling up sand-hills to stay the torrent of disease, when we might better look far back among its sources for the tiny springs which have strayed from their course? To hope for success we must, like hunters, surround the field at widely distant points, approaching the centre from all sides. We have to look to the results of patient Collective Investigation for data for our generalizations. Systematic inquiry has only recently been undertaken, and while coincident meteorological, morbility and mortality records should be carefully accumulated, etiological research must be our objective point, and symptoms be tracked back to their causes, rather than be looked upon as prognostics of what may happen. It is especially important to determine the climatic causes, though it is hardly probable that the insidious effects of climate in modifying demographic conditions are susceptible of exact numerical expression. In the bulky volumes of Lombard, Foissac and Boudin, there is page after page of industriously computed millièmes, but it is questionable how many of them have been based upon exact data. The vital statistics of communities has, heretofore, been limited to records of births, deaths and marriages, and of these the latter have chiefly a sociological interest, while a numerical exhibit of deaths alone is an untrustworthy index of the vital condition of a people. The Italian military returns represent the mortality from paludal diseases, which are rife in that country, as only .17 per thousand; but this, as well as the similarly small fraction which indicates the deaths per thousand in Washington from malaria, would be a very unequal measure of the miasmatic influence, which leaves its icteroid stamp upon the complexions of the entire community and subjects them to diseases they would have otherwise escaped. A still smaller decimal denotes the deaths recorded from syphilis, but it is easy to imagine myriads instead of millièmes, who, under more reputable designations, have died from venereal infection.

Absolute records of prevailing disease are essential to any system of Vital Statistics of value to the science of medicine, and these cannot be obtained through volunteer effort. Personal rivalries, the disinclination to expose the real extent of a boasted clientèle, indifference and neglect, will always operate to make any work dependent upon individual contribution incomplete and inexact. To insure the accuracy which will give value to returns of diseases, they must be instituted and conducted by government, to which the profession and the public are both entitled to look for

information. The collective investigation as prosecuted by a few earnest, enthusiastic observers has an inestimable clinical value as far as it goes, but collective investigation under the cognizance and by the authority of government, which shall record the precise kinds and number of cases of prevailing diseases, the absolute daily number of men, women and children sick in a community (for sex and age should mark independent parallel lines of inquiry), as well as those born into it and those leaving it by death, is the only one from which it will be possible to tabulate precise results -the only one which will enable us to infer the exact degree of climatic and other influences and, after the lapse of years, determine the changes which these influences are accomplishing in the longevity, vigor, fecundity, morbility and other particulars of the economy of a people, on which depend their health, happiness and prosperity, the sanitary and sociological questions which underlie the science of medicine. The interest of a government in the health of its people, for whom that government is administered, ought to be as great as its concern for commerce, agriculture, education and labor, all of which are represented in the national organization by distinct bureaus. A minister, secretary, commissioner or director at the head of an organized department is so necessary a public functionary, that his absence from the high offices of state in every government is due only to that blindness to their real interests which makes the people acquiesce in the sacrifice of life and means for the defense of monarchical baubles and the maintenance of dynastic wars. Regretable differences hampered the efforts of the National Board of Health opportunely created in this country, but, despite political hindrances, the nucleus of a central controlling office remains for future development, when, in connection with the several State Boards of Health, we may hope to see obligatory collective investigations in the natural history of disease instituted, which will give us accurate information of its remote causes, exhibit the respective share of climate and of personal neglect in its development and in the modification of demographic conditions, and indicate measures for its prevention, or its cure and relief when it cannot be prevented. The study of the natural history of pneumonia has resulted in placing its treatment on a rational basis, displacing one vaunted therapeutic specific after another, until so little has been left for the practitioner that ordinarily he has only to watch that nature have fair play. The studious investigation of the natural history of chronic interstitial nephritis, known as Bright's disease, which Fothergill declares to be especially the disease of the urban population, has shown that the renal changes begin with imperfect blood depuration. "The town dweller," he goes on to say, "works in ill-ventilated rooms, and his amusements are in-door, in a vitiated atmosphere. With an insufficient liver, a meat dietary and insufficient oxidation, he is subject, more than all others, to the uric acid formation, with all its varied consequences. The effect of town life is to produce a distinct retrogression to a smaller, darker, precocious race, of less potentialities than the rustic population. Precocity is seen in early puberty, but reproduction is impaired, and Hayles, Walshe, McCantlie and others have shown that it is wellnigh impossible to find a true Cockney of the fourth generation." Thus, more familiarity with the causal relations of this disease develops, not specific lines of medicinal treatment, but definite preventive measures. No amount of clinical endeavor alone would have accomplished the results in restricting diphtheria which our fellow councillor, Dr. Baker, reports in Michigan, where an average of sixteen cases, of which twenty per centum were fatal, occurring among 102 outbreaks of the disease in that State during the past year, in which restrictive measures were neglected, was reduced, by their enforcement, to three cases, with a mortality of .2 per centum, a practical fruit of organized etiological inquiry by the State Board of Health.