STATISTICAL RESEARCHES 
RELATIVE TO THE 
ETIOLOGY OF PULMONARY AND RHEUMATIC 
DISEASES, 
ILLUSTRATING THE APPLICATION 
OF THE 
LAWS OF CLIMATE TO THE SCIENCE OF MEDICINE; 
BASED ON THE RECORDS OF THE MEDICAL DEPARTMENT 
AND ADJUTANT GENERAL'S OFFICE. 
BY 
SAMUEL FORRY, M.D., 
ftledical Staff, U. S Army, Honorary Member of the 
Philadelphia Medical Society. 
[Extracted from the American Journal of the Medical Sciences.] 
T. K. & P. G. COLLINS, PRINTERS, 
PHILADELPHIA: 
No. 1 LODGE ALLEY. 
1840. STATISTICAL RESEARCHES 
RELATIVE TO THE 
ETIOLOGY OF PULMONARY AND RHEUMATIC 
DISEASES. 
The object of the author in this paper is, to elucidate the laws which 
obtain in regard to the etiology of pulmonary and rheumatic diseases in the 
several systems of climate pertaining to the United States, and to demon- 
strate the advantages of peninsular Florida as a winter residence for pul- 
monic invalids.* 
Stretching over a vast extent of territory, the United States present a 
corresponding variety of climate, exhibiting, under multiform aspects, the 
animal and vegetable kingdoms. Occupying, as we do, the eastern coast of 
a continent of the northern hemisphere, the human frame is exposed to the 
contrasted seasons of the most excessive clime.f The extreme north has a 
* It may not be amiss to remark that the writer's attention was first attracted to this 
subject, whilst engaged in arranging, by direction of Surgeon General Thomas Lawson, 
the " Army Meteorological Register," just published, and the Medical Statistics of the 
Army, now in course of publication. As a mere statistical work does not admit of the 
disquisition demanded, the subject has been made to constitute a distinct inquiry. 
+ So striking is this difference between our coast and the western coast of Europe, 
that Fort Sullivan, Maine, notwithstanding it is more than 11° south of Edinburg, Scot., 
exhibits a mean annual temperature lower, and Bordeaux, which is parallel with 
Fort Sullivan, has an annual temperature 15° degrees higher. These results find a ready 
explanation in physical causes. Europe is separated from the polar circle by an ocean, 
whilst eastern America stretches northwards at least to the 82° of latitude. The former, 
intersected by seas which temper the climate, moderating alike the excess of heat and 
cold, may be considered a mere prolongation of the eastern continent, whilst the northern 4 
Forry on Pulmonary and Rheumatic Diseases. 
climate in which cold predominates, vexed by winds that have passed over 
interminable snows; the south acknowledges the genial influence of the 
sun; whilst the middle vibrates alternately to both extremes. The climate 
of the United States is, in truth, remarkably inconstant and variable, "pass- 
ing rapidly," says Malte-Brun, " from the frosts of Norway to the scorching 
heats of Africa, and from the humidity of Holland to the drought of Castile." 
So sudden are the vicissitudes of weather in the middle States, that in the 
language of the Spectator, we often "lie down in July and rise in De- 
cember." 
The term climate, which is limited, in its rigorous acceptation, to a mere 
geographical division, and in ordinary parlance to the temperature only of a 
region, possesses, in medical science, a wider signification. It embraces not 
only the temperature of the atmosphere, but all those modifications of it 
which produce a sensible effect on our organs, such as its serenity and 
humidity, changes of electric tension, variations of barometric pressure, the 
admixture of terrestial emanations dissolved in its moisture, and its tran- 
quility as respects both horizontal and vertical currents. Climate, in a word, 
constitutes the aggregate of all the external physical circumstances apper- 
taining to each locality in its relation to organic nature. " To observe," 
lands of the latter, elevated from 3000 to 5000 feet, become a great reservoir of ice and 
snow, which diminish the temperature of adjoining regions. These results gave rise to 
the opinion that the old continent is warmer than the new, but more recent observation 
has shown that the western coast of both has a higher temperature than the eastern, in 
corresponding latitudes. This arises mainly from the steady prevalence of westerly 
winds, between the parallels of 30° and 40°; for there is thus swept from the ocean, which 
never sinks below the freezing point, a humid atmosphere, which, in its passage over the 
land, has a constant tendency to establish an equilibrium of temperature, and as its 
vapour is gradually condensed, it also evolves its latent heat. Philadelphia and Pekin, 
each on the eastern coast of its respective continent, and nearly in latitude 40°, have the 
same mean annual temperature; whilst on the western coast of the old and the new 
world, the same annual temperature is found about the 48th parallel. A striking resem- 
blance is thus apparent in tracing the same isothermal line around the northern hemi- 
sphere, the east side of both continents presenting concave, and the west side convex 
summits. Continuing this comparison, it is seen that the climate of the new world, 
viewed in its general features, is, contrary to common opinion, more mild and uniform 
than that of the old. Taking, for example, the annual temperature of 53°.6O, the eastern 
coast of Asia shows a difference of 55°.8O in the mean temperature of summer and 
winter, whilst the eastern coast of America exhibits a difference only of 43°.60; and, on 
the other hand, the western coasts of Europe and of America present respectively a dif- 
ference of 28°.3O and 23°. Hence, the fallacy of the opinion which ascribes the mild 
climate of Europe to the influence of agricultural improvement, becomes at once appa- 
rent, when it is considered that the region of Oregon, lying west of the Rocky Mountains, 
which continues in a state of nature, has a climate less contrasted than that of Europe in 
similar latitudes, and that consequently it is in a proportionate degree milder than the 
climate of our own region, in which the labours of man in a few ages have almost 
wrought miracles, as well as that of the eastern coast of Asia, which has been under 
cultivation for several thousand years. Forry on Pulmonary and Rheumatic Diseases. 
5 
says Professor Rostan, " the simultaneous effects of light, heat, electricity, 
of the winds, &c., on the organic productions of the different zones of the 
earth, to explore the nature of this earth, to deduce from this knowledge the 
influence which they exercise on the physical and moral state of man, such 
is the wide field which climates present to our investigation." 
The little knowledge that we possess upon these various points, is far 
from being precise. On the one hand, we are ignorant what constitute 
the real elements of climate; and, on the other hand, these complex agents 
act upon living organs still more complex in their functions. Our knowledge 
heretofore has consisted mainly of the unexplained results of experience. 
As the subject does not admit of the precision of the exact sciences, the aid 
of induction and analogy must be invoked. Having once acquired a know- 
ledge of the distinctive characters of different systems of climate and of their 
effects upon the animal economy both in health and disease, the general laws 
regulating such influences may be readily ascertained. In the present 
inquiry, the temperature of the air, and its hygrometrical state-agents 
always supposed to exert a potent influence in the causation of pulmonary 
and rheumatic diseases-will alone be considered. Although it is necessary, 
in attempting to determine the relation subsisting between climate and vital 
action, to take into view the simultaneous influence of all meteorological 
causes; yet, as caloric is the controlling element in the constitution of climate, 
modifying its other properties, its laws, it is believed, will give, so far as the 
present inquiry is concerned, a very correct expression of climatic influence. 
As it is intended to illustrate the application of the laws of temperature to 
the science of medicine, so far as they have relation with pulmonary and 
rheumatic diseases, it will be necessary to advert to those laws in a general 
way. In the northern division of the United States, four systems of climate 
representing two classes may be demonstrated, the one occupying the Atlan- 
tic and the Lakes, and the other, the intermediate region and that beyond the 
lakes. In arranging the medical statistics of the military posts, this classifi- 
cation of them will be adopted, following it up in the Middle and Southern 
divisions of the United States. 
If the phenomena of terrestrial temperature depended solely on the posi- 
tion of the sun, climates might be classified with mathematical precision; but 
the effects produced by solar heat are so much modified by local causes that 
the character of a climate can be determined only by observation; and accord- 
ingly, the following classification, adopted in the present inquiry, is based 
upon particular systems of climate as determined by observation:- 
General Divisions of 
the United States. 
Systems of Climate. 
1. Northern. 
p 1 Class. Posts on the coast of New England, extending 
as far south as the harbor of New York. 
i 2 " Posts on the northern chain of lakes. 
3 " Posts remote from the ocean and inland seas. 6 
Forry on Pulmonary and Rheumatic Diseases. 
General Divisions of 
the United Slates. 
Systems of Climate. 
r 1 Class. Atlantic coast from Delaware Bay to Sayan- 
's nah. 
t 2 " Interior Stations. 
2. Middle. 
3. Southern. 
< 1 Class. Posts on the Lower Mississippi. 
C 2 " Posts in the Peninsula of East Florida. 
It is deemed sufficient to give an outline of the peculiarities of these sys- 
tems of climate, characterized by a greater or less deviation of the isotheral 
and isocheimal lines from the parallels of latitude. The Northern Division 
presents the greatest variety of climate. On the sea-coast of New England, 
the influence of the ocean modifies the range of the thermometer and the 
mean temperature of the seasons. Advancing into the interior, the extreme 
range of temperature increases, and the seasons are violently contrasted. 
Having come within the influence of the great lakes, a climate like that of 
the sea-board is found; and proceeding into the region beyond the modifying 
agency of these inland seas, an excessive climate is again exhibited. The 
variations of the isotheral and isocheimal curves-the lines of equal winter 
and summer temperature-thus afford a happy illustration of the equalizing 
tendency of large bodies of water. 
The chain of vast lakes or inland seas, lying in the course of the St. 
Lawrence, it is estimated, embraces an area of 93,000 square miles. Of 
amazing depth, these ocean-lakes, it has been computed, contain 11,300 
cubic miles of water-a quantity supposed to exceed more than half of all 
the fresh water on the face of the globe. 
The modifying influence of the sea-coast compared with the region beyond 
the lakes, is exhibited in the following table. It presents an average of five 
years, calculated from the data of two posts in each system of climate, the 
mean latitude of the posts on the ocean being 43° 18', and that of those in 
the opposite locality, 43° 10'. 
Region be- 
yond the 
Lakes 
3 
o 
a 
tr. 
e* 
Locality. 
ft 
o 
o 
ft 
o 
X 
Latitude. 
co 
p 
eg 
p 
© 
Mean Annual Tempera- 
ture. 
© 
co 
CD 
Range of 
the 
Thermo- 
meter 
s 
ft 
£ 
io 
21.89 
CO 
Kj 
w 
w 
g 
December. 
Winter. 
00 
3 
24.18 
January. 
to 
ft 
w 
bO 
o 
26.45 34.21 
February. 
ft 
CO 
J-* 
00 
March. 
Spring. 
ft 
ft 
April. 
ft 
§ 
May. 
75.26 
66.55 
Ci 
© 
June- 
a 
c 
B 
3 
$ 
©> 
00 
w 
55 
July. 
ft 
CO 
to 
© 
ft 
August. 
50.40 
50 00 
© 
co 
Ct 
do 
Ct 
Septemb'r. 
Autumn. 
Ct 
t§ 
ft 
October. 
W 
ft 
p 
Novemb'r. Forry on Pulmonary and Rheumatic Diseases. 
7 
In the former, the mean temperature of winter is 6°.05 higher than the 
latter; that of spring is 4°. 13 lower; that of summer is 8°.71 lower; and 
that of autumn 0°.40 lower. This contrast is more strikingly shown by 
comparing the difference in the mean temperature of winter and summer, it 
being on the sea-coast 38°.61, and in the opposite locality 53°.37. It is 
thus apparent, that a classification of climates, having, for its basis mere 
latitude, is wholly inadmissible; for, although there may be little difference 
in the mean annual temperature, yet the distribution of heat among the 
seasons may be extraordinarily unequal. 
These facts are still more strikingly illustrated in the following table, which 
exhibits a comparison between posts on the lakes and those of the same 
region situated beyond their influence. 
Remote 
from the 
Lake? 
(Lakes 
Locality. 
0 
O1 
05 
o 
Latitude. 
©S 
p 
to 
o 
g 
Mean Annual Tempera- 
ture. 
c© 
Ci 
c© 
05 
Range of 
the 
Thermo- 
1 meter. 
& 
M 
to 
s 
17.42 
c© 
CD 
CD 
s 
23.04 
December. 
Winter. 
113 74 
g 
00 
January. 
120.35 
19.85 
February. 
8 
39.73 
05 
CD 
C 
27.20 
March. 
Spring. 
8 
to 
s 
April. 
52.56 
May. 
73.26 
8 
CD 
Ci 
tn 
05 
58.24 
June. 
Summer. 
S 
05 
July. 
to 
0 
QC 
iu 
tn 
tn 
Ot 
cp 
August. 
48.53 
<© 
Peptemb'r 
Autumn. 
07 
c 
de 
47.19 
October. 
I 
& 
b 
Novemb'r. 
It thus appears that the winter of the former, notwithstanding it is 1°.46 
north of the latter, has a mean temperature 2°.54 higher, whilst that of 
summer is 10°.40 lower. In the latter, the mean temperature of spring is 
6°.G5 higher, and that of autumn is 2°.04 higher. The difference in the 
mean temperature of summer and winter, making due allowance for differ- 
ence of latitude, is even greater than in the comparison with the Atlantic 
coast, that of the Lakes being 43°, and that of the opposite locality 55°.84. 
In the former region, the prevailing weather is cloudy, and in the latter fair; 
thus, during the year the proportion of days is- 
Fair. 
Cloudy. 
Rain. 
Snow. 
Remote from lakes, 
216 
73 
46 
29 
Lakes, 
119 
132 
67 
47 
Localities under the influence of the ocean or inland seas, do not exhibit 
great extremes of temperature, but the air is moist, and the changes of season 
are slow, uncertain and variable. On the other hand, the climate of locali- 
ties, removed from such equalizing influences, is characterised by a great 
range of the thermometer, and a corresponding dryness of the atmosphere; 
the mean temperature of winter and summer is strongly contrasted, and the 
seasons change in constant and rapid succession. Other meteorological 8 
Forry on Pulmonary and Rheumatic Diseases. 
phenomena are similarly modified by various causes. Thus in countries 
and seasons, in which solar action is most intense, electrical phenomena are 
most frequent and energetic; and whilst atmospheric moisture favours the 
passage of electricity from the earth to the clouds, the opposite condition 
causes its accumulation in objects on its surface. In the excessive climates 
just described, thunder and lightning are of rare occurrence, and terrestrial 
objects are charged with an unusual portion of electricity; whereas in the 
warm and moist atmosphere of the contrary localities, opposite phenomena 
are witnessed. The atmospheric dryness of the former pertains more par- 
ticularly to latitudes above 40°; it is found, however, even in tropical coun- 
tries remote from the ocean, more especially when high mountains intervene, 
condensing the moisture wafted by the winds from the sea; and in those 
regions in which currents of air traverse extensive tracts of arid soil, the 
dryness is extreme. 
It is evident that the annual quantity of rain that falls upon any point of 
the earth's surface, depending, as it does, upon the amount of evaporation 
and the prevailing winds, is very intimately connected with the character of 
climate. The smallest quantity of rain generally falls in February and 
March, and the greatest amount in July, when the mean monthly tempera- 
ture is highest. As a general rule, the annual quantity increases in propor- 
tion as the equator is approached, more especially in maritime localities and 
places in which ranges of elevated tracts skirt the sea coast; but as this 
augmented quantity falls at a particular season, and in a shorter space of 
time than in colder regions, the annual number of dry days, particularly in 
inland districts, is proportionally increased. In cold or temperate maritime 
localities, on the contrary, the rain, although much less in annual quantity, 
descends much more frequently, but in slighter showers. Consequently, 
the number of wet, foggy and drizzling days, is much greater than in warm 
and inland regions. 
Conformably to these general laws, it is found that the climatic features of 
the coast of New England and of the region of the great lakes, exhibit a 
striking resemblance, whilst those of the third class of the same division are 
very dissimilar. The most characteristic feature consists in the distribution 
of heat among the seasons. These results have already been fully detailed. 
The climate of the third class, comprising the posts remote from the ocean 
and inland seas, is distinguished from the first two by great extremes of 
temperature, by seasons strongly contrasted, and a corresponding dryness of 
the atmosphere. The winters of this class, with the exception of the most 
southern posts, are characterized by extreme severity. From November to 
May, cold weather prevails, the ground being generally covered with snow 
to the depth of three or four feet, and the general range of the thermometer 
being from the freezing point to 30° below zero. The summers are equally 
remarkable for extremes of temperature. The heat is often as oppressive as 
in Florida, the mercury sometimes rising, in June, July and August, to 100° Forry on Pulmonary and Rheumatic Diseases. 
9 
Fahrenheit in the shade. Unlike the two preceding classes, in which the 
air is moist, and the changes of the seasons more slow and uncertain, in 
this one, a constant and rapid succession is observed among the seasons, 
summer succeeds winter so rapidly that there is scarcely any spring, and 
vernal vegetation is developed with remarkable suddenness. 
We possess no exact measurement of the relative quantity of rain that 
falls in our different systems of climate; and as no observations have been 
made upon the hygrometer, their relative degree of humidity cannot be 
determined. The ratio of fair and cloudy weather, in each system of 
climate of the northern division has been ascertained. The proportion of 
rainy and cloudy days on the ocean and the great lakes, it has been seen, is 
nearly twice as great as in the opposite localities; but there is no regular 
difference in the mean annual quantity of rain. 
In the Middle Division, the two systems of climate bear the same meteo- 
rogical relation towards each other as the third class of the Northern Divi- 
sion does to the first two. Notwithstanding the extremes of temperature are 
much more modified in the Middle than in the Northern Division, the former 
is characterized by variableness, whilst in the latter a steady temperature 
predominates. Jefferson Barracks, near St. Louis, Missouri, shows a greater 
contrast in the seasons than Washington city; and on comparing Fort Gib- 
son, Arkansas, with Fort Monroe on the coast of Virginia, notwithstanding 
the latter is 1° 32' north of the former, a similar result is exhibited. 
The Southern Division is characterized by the predominance of high 
temperature. Proceeding South from Canada to Florida, the seasons become 
more uniform in proportion as their annual temperature increases. This is 
strikingly illustrated on comparing the difference between the mean temper- 
ature of summer and winter at Fort Snelling, Iowa, and at Key West, at the 
southern point cf Florida, the former being 55°.51, and the latter only 11° 
.34. The peculiar climatic character of this Division is distinguished less 
by the mean annual temperature than in the manner of its distribution among 
the seasons. This subject will be further elucidated when the climate of the 
peninsula of Florida comes under special consideration-a land in which the 
rigours of winter are unknown, and in which smiling verdure never ceases 
to reign. 
In regard to the remaining elements of climate, such as the admixture of 
terrestrial emanations dissolved in atmospheric moisture, our positive knowl- 
edge is still more limited. This subject, intimately connected with febrile 
endemics, has little relation to the present inquiry. That mysterious agent- 
malaria-although too well recognised in its deleterious effects on the human 
frame, has hitherto remained inscrutable in its nature. Of the two systems 
of climate, the uniform and excessive, the influence of the latter upon man, 
breathing a dry, pure, and cool atmosphere, more especially in regions ele- 
vated high above the sea, is manifested in his being little subject to severe 
and malignant fevers; and although pulmonary diseases are more rife than 10 
Forry on Pulmonary and Rheumatic Diseases. 
in any other system of climate,* he attains the maximum of the mean dura- 
tion of human life. On the sea-coast, and the banks of lakes and rivers, or 
in low and narrow valleys, characterized by a deep, moist and rich soil, 
abounding with organic remains in a state of decomposition, the air is 
humid, sultry and relaxing, and loaded with noxious effluvia. The human 
frame is consequently imperfectly developed, the mortality of children is 
very great, and the mean duration of life is comparatively low. In the 
northern and temperate regions, however, maritime places are not less salu- 
brious than inland districts. A locality, somewhat elevated, with an undu- 
lating surface, a well cultivated soil, and no marshes in the vicinity, presents 
the circumstances most favourable to health and longevity. 
It is thus seen that there are many circumstances besides mere tempera- 
ture, which enter into the constitution of climate. Amongst these, as influ- 
encing organized beings, one of the most important is the nature of soil, the 
formation of which has apparently been the result of the gradual attrition of 
the solid materials composing the crust of the globe. As all animals and 
vegetables, at least all land animals, are dependent for existence on this stra- 
tum of comminuted mineral substances and organic remains, its influence in 
regard, not only to mere health, but the organic modifications which the 
human frame experiences, constitutes an interesting subject of inquiry. 
Having already demonstrated that the regions of the United States on the 
same parallels of latitude, present systems of climate very diverse in charac- 
ter, viz: 1. The regions bordering on the ocean: 2. Those under the influ- 
ence of inland seas; and 3. Those remote from such controlling powers: it 
will be seen that these laws of climate maintain an intimate relation with 
the etiology of pulmonic diseases. It seems to be a well-established law, 
that the prevalence of catarrh and influenza in each system of climate, 
increases and decreases in proportion as the seasons are contrasted, thus 
maintaining an unvarying relation with the extreme range of the thermome- 
ter as connected with the seasons. 
The following table presents in a condensed form, so far as regards the 
catarrhal form of pulmonic lesions, the result of the quarterly sick reports 
of 45 permanent posts, arranged in classes, comprising a period of ten years, 
the details of which are given in Abstract No. If of Appendix:- 
* In the Northern Division of the United States, this law, it will be seen, is limited 
to catarrh and influenza. 
+ This abstract contains, besides the result of the permanent stations, that of 31 tem- 
porary posts in Florida. It is based on an aggregate mean strength of 47,220 and the 
period of observation extends from 1829 to 1838 inclusive. It exhibits the condensation 
of about 1500 quarterly reports of sick, and the mean strength of each post computed 
from monthly returns in the adjutant-general's office. Forry on Pulmonary and Rheumatic Diseases. 
11 
Ratio of Catarrhal Diseases. 
Divisions. 
Systems of Climate. 
Latitude. 
Dift". between 
tbe mean temp, 
of winter and 
summer. 
Ratio treated per 1000 mean 
strength. 
First 
Quarter. 
Second 
Quarter. 
Third 
Quarter. 
Fourth 
Quarter. 
Annual 
result. 
c r 
1 st Class. Posts on the coast of N. Eng., 
43° 18' 
38°.61 
63 
49 
36 
85 
233 
i 
2d Class. Posts on N. chain of Lakes, 
46°27' 
43°.00 
90 
62 
50 
96 
300 
li 
3d Class. Posts N. of 1.39°, and remote 
z I 
from the ocean and inland seas, 
44°53' 
55°84 
175 
120 
86 
169 
552 
1st Class. From Del. Bay to Savannah, 
37°02' 
32°.99 
102 
45 
23 
97 
271 
2d Class. South-western Stations, 
35°47' 
36°.83 
122 
61 
33 
78 
290 
□ / 
1st Class. Posts on lower Mississippi,* 
30°10' 
24°.39 
92 
34 
26 
60 
218 
ce / 
2d Class. Posts in Peninsula of E. Flor., 
24°33' 
11 °.34+ 
45 
24 
40 
33 
143 
Total, 
689 
395 
294 
618 
These seven classes constitute certain systems of climate, each of which 
forms the boundary of a specific ratio in relation to pulmonary affections. 
The three grand divisions are:-1. The Northern region of the U. States, 
in which cold predominates, embraced in the first three classes of the table; 
2. The opposite extreme, the Southern division, in which a high tempe- 
rature prevails; and 3. The Middle region, the temperature of which 
vibrates to both extremes. 
This table, which exhibits the annual and quarterly ratios of each system 
of climate, and serves to elucidate their relations and sequences, affords a 
beautiful illustration of the etiology of catarrhal affections as connected with 
the meteorological laws established. Take, for example, the northern 
division consisting of the first three classes:-On the New England coast, 
as the ocean modifies the atmospheric temperature the annual ratio treated 
per 1000 of mean strength, is as low as 233; on the great lakes, where a 
similar modifying influence is in operation, it is 300; whilst the third class, 
chaiacterized by the extreme range of the thermometer, has a ratio as high 
as 552. But let us follow more narrowly the isotheral and isocheimal lines, 
(representing the mean temperature of summer and winter,) which describe 
four curves within the same space, presenting alternately a mild and an 
excessive climate. As these lines, on the coast of the Atlantic, present com- 
paratively little deviation from the terrestrial parallel, the ratio of catarrhal 
diseases is low; advancing into the interior, the line of equal summer rises 
and that of winter sinks, and the ratio increases proportionally; proceeding 
into the region of the lakes, the lines again converge beneath the controlling 
power of the waters, and the ratio of catarrh and influenza is modified 
* For want of a better arrangement, Augusta Arsenal, Georgia, and Fort Mitchell, 
Alabama, have been included in this class. 
+ This result is obtained from the observations made at Key West. At Fort Brooke, 
Tampa Bay, it is 16°.02. 12 
Forry on Pulmonary and Rheumatic Diseases. 
accordingly; again advancing into the interior beyond these ocean-lakes, the 
average rises in proportion as the isotheral and isocheimal curves tend to 
opposite directions. In the other grand divisions, the same law obtains. 
On the Atlantic coast, between the Delaware and Savannah river, the annual 
ratio is 271,* whilst the average of the interior posts, notwithstanding this 
class lies somewhat farther south than the former, is 290. As most of the 
posts of the first class of the southern division are on the Lower Mississippi, 
and are much under the influence of large bodies of water, the annual ratio 
is as low as 218; whilst the second class, which comprises the mild, insular 
climate of East Florida, has an average of only 143. 
It would seem then that sudden atmospheric vicissitudes combined with 
moisture, do not excite a strong susceptibility to catarrhal diseases, else the 
sea-coast and the lakes should give a higher ratio than the dry and cold 
atmosphere of the opposite localities. The results, on every hand, afford 
satisfactory proof that the ratios of these lesions are highest, when the sea- 
sons are well marked, producing a decided impression upon the animal 
economy, and that they are less dependent upon daily variations of tempe- 
rature than upon its extreme range as connected with the seasons. 
In regard to the climate of the United States, the rule holds good, that 
wherever the seasons are violently contrasted the ratio of catarrh and influ- 
enza is highest, decreasing in proportion as the difference in the mean 
temperature of summer and winter grows less. Thus the ratio on the 
northern chain of lakes is little more than half as high as in the adjoining 
localities removed from the agency of large bodies of water; and accordingly, 
we find that the mean winter temperature of the latter, in the same latitude, 
is three degrees lower, and the summer temperature ten degrees higher, than 
the former, whilst the difference in the mean temperature of winter and 
summer is at least 16° less on ,the Lakes. Although we possess no exact 
measurement of the relative quantity of rain which falls in these two posi- 
tions, nor any precise hygrometic observations; yet we know that the at- 
mosphere of the lakes is much more moist, as the number of rainy and 
cloudy days is nearly twice as great as in the opposite locality. 
Here then are several laws established in meteorology as applied to the 
etiology of disease. But let us test, by a further application of the princi- 
ples, the universality of these physical laws. As the middle division is 
subject to the extremes of the northern and southern latitudes, so it is found 
to be prolific in pulmonic lesions in general. The result of eight military 
stations, (the 1st class of the middle division,) situated on the sea-coast and 
inlets between the Delaware and Savannah, gives an average of catarrhal 
diseases higher than that of the northern coast, where cold prevails, as well 
as that of more southern latitudes, in which a higher temperature predo- 
minates. 
* In this class, Fort Monroe, and in the first class of the northern division, Fort Inde- 
pendence have been excluded, for reasons to be given in the sequel. Forry on Pulmonary and Rheumatic Diseases. 
13 
The annual ratio of the middle coast being higher than either extreme, 
let us see whether it bears the usual relation with the interior region of the 
same latitude. This refers to the south-western posts, of which Jefferson 
Barracks, lat. 38° 28', is the most northern, and Fort Jesup, lat. 31° 30', is 
the most southern point. True to the general law developed, we find that 
the ratio (290 to 271) is in accordance with the augmented difference in the 
mean temperature of summer and winter. 
Before proceeding to the Southern Division, it will be necessary to 
remark that the statistics of Fortress Monroe, on the coast of Virginia, which 
seems to be under the influence of no ordinary laws, have been excluded in 
the calculation of the class to which it belongs. The ratios of catarrh and 
influenza per 1000 of strength, compared with the eight other posts of this 
class, stand as follows:- 
1st Quarter. 
2<7 Quarter. 
3d Quarter. 
4<A Quarter. 
Fortress Monroe. 
225 
146 
94 
339 
Remaining Posts. 
102 
45 
23 
97 
It is thus seen that the averages are from two to fourfold higher than the 
mean ratios of the other posts of the same system of climate. Although the 
results are extraordinary, yet the influence of the seasons is strikingly mani- 
fest. The statistics of this post embrace a period of nine years; and whilst 
the nine fourth quarters, with an aggregate mean strength of 2625, give a 
total of 774 cases of diseases of the respiratory organs, 426 cases are report- 
ed in one of these quarters, with a mean strength of 609. Of these cases, 
372 are registered as " Epidemic influenza," which continued to prevail 
until the following April. In the first quarter of this year, (1832) 259 cases 
of pulmonary disease are reported, 219 being " epidemic catarrh," in a com- 
mand of 570 men; and in the second quarter, in a mean strength of 352, 
154 pulmonic affections are reported, (126 being of the epidemic form,) most 
of which occurred early in the quarter. As these facts, however, are insuffi- 
cient to explain the general result, much may have been owing to the agency 
of local causes; for example, the dampness of the men's quarters, which 
were in the casemates between the ditch of the Fort and the water of the 
Bay. On reference to Abstract No. 1, of Appendix, it will be seen that the 
contrasts are equally great in regard to pleuritis and pneumonia. It may be 
added that a large proportion of the deaths have arisen from this class of dis- 
eases. During the nine years, 102 deaths are reported in the medical 
returns, among which are 17 phthisis pulmonalis, 4 pneumonia, 3 pneumo- 
nia typhoides, 4 influenza, and 1 engorgement of the lungs. The average 
mortality from pulmonary diseases is about twice as high as at the remain- 
ing posts of this class. 
The Southern Division, consisting of two classes, remains to be exa- 
mined. The annual ratios of both these systems of climate are lower than 
that of any other. The first class of this Division is little removed from the 14 
Forry on Pulmonary and Rheumatic Diseases. 
second of the middle division in point of latitude; but, owing to the modify- 
ing agency of the Gulf of Mexico, and the large lakes in the region of the 
Lower Mississippi, it holds an intermediate relation in respect to the south- 
western stations, and the climate peculiar to the peninsula of Florida. These 
annual ratios are as follows-290, 218 and 143. As the climate of East 
Florida is the most mild and equable, possessing all the advantages of the 
most favoured insular regions, so it presents the lowest average of catarrh and 
influenza. 
The numerical results thus far obtained have been not in the least antici- 
pated. If to enter upon an investigation free of preconceived opinions may 
be considered a merit, the claims, in the present instance, are still greater, 
inasmuch as the views of the writer were diametrically adverse to the conclu- 
sions warranted by the data; for we believed, with the rest of mankind, that 
the atmospheric moisture and sudden vicissitudes of temperature ascribed to 
positions on lakes and the ocean, exercise a greater agency than the dry 
and less variable climate of the interior, in the production of catarrhal dis- 
eases. Content to observe facts and to trace their relations and sequences, 
the author has essayed to be a faithful interpreter of nature; and as it is a 
leading principle of the inductive philosophy, to ascertain the universality 
of a fact, these researches will now be continued in a new direction. 
Having obtained thus far unvarying results in regard to the annual ave- 
rage, I shall proceed to an investigation of the quarterly ratios as illustrative 
of the influence of the seasons. Having determined elsewhere the relative 
agency of the seasons in the causation of intermittent fever throughout the 
United States, I am enabled to say that catarrhal affections acknowledge this 
influence in a still more eminent degree. A single glance at the table of the 
" Ratio of Catarrhal Diseases" (p. 21,) will afford a satisfactory explana- 
tion. It will be seen that the ratios of the first and fourth quarters, in obe- 
dience to a general law, are always the highest, and that the third invariably 
presents the lowest average. The second class of the Southern Division, 
which exhibits an apparent exception to this rule, the third quarter having a 
higher ratio than the second or fourth, it will be found, illustrates the ancient 
axiom-exceptio probat regulam. As the Peninsula of Florida affords no 
marked distinctions of seasons, as will be shown more fully, it follows that 
amongst the causes which determine the prevalence of catarrhal lesions, those 
that are secondary in the other systems of climate, become in this the primary 
ones. Finally, the aggregate of each quarter, which gives a fair expression 
of the relative influence of the seasons in the etiology of catarrh and influ- 
enza throughout the United States, as shown in the same table, affords satis- 
factory demonstration of the general laws developed. These ratios stand as 
follows; 
1 sZ Quarter. 
2(7 Quarter. 
3d Quarter- 
4th Quarter. 
689 
395 
294: 
618 
These facts having been determined, the advantage of a winter residence Forry on Pulmonary and Rheumatic Diseases. 
15 
in a more southern latitude to a person labouring under chronic bronchitis, 
becomes at once apparent. If he can avoid the transition of the seasons- 
that meteorological condition of the atmosphere, which stands first among 
the causes which induce catarrhal lesions, he will do much towards control- 
ling his malady. Let us suppose him on the coast of New England, in the 
3d quarter, the ratio being as low as 36, when the sudden transition of the 
season brings it up to 85. The consequences will inevitably be an aggra- 
vation of that disorder to which he is predisposed; for the respiratory organs, 
even when healthy are peculiarly susceptible, at this season, to abnormal 
action. Let us, on the contrary, suppose him gradually moving south with 
the change of the season, and the 4th quarter will find him in a climate 
whose ratio is even lower than that of the preceding quarter in the region 
which he had left. On the coast of New England, the ratio of the 3d quar- 
ter is 36, and that of the fourth is 85, whereas the average of the latter quar- 
ter in peninsular Florida is only 33. These are not isolated facts, but uni- 
form results obtained from ten years' observation. As the same law obtains 
in every system of climate, it is easy to apply the remedy. 
The assemblage of morbid phenomena, usually designated by the term 
consumption or phthisis pulmonalis, it is well known, may arise from 
various pathological conditions of the respiratory organs. In a practical 
point of view, it is important to discriminate these several affections. Vary- 
ing much in the degree of sanability, it is generally conceded that that form 
of consumption which depends upon chronic bronchial inflammation, is by- 
far the most under the control of remedial management. Recoveries are not 
uncommon in those cases in which the mucous tissue remains free from 
ulceration, or the subjacent pulmonic structure has not become consolidated. 
As regards the advantages of change of climate, it will be observed that 
reference is made only to chronic bronchitis as a natural consequence, not- 
withstanding the inference, that similar effects, reasoning from analogy, 
would follow in other forms of consumption, might be warranted. As it is, 
however, the catarrhal or pituitous consumption of authors that probably 
constitutes the majority of the reputed cases of phthisis pulmonalis in 
northern latitudes, and as this is the only form that can be really considered- 
remediable, the importance of determining the comparative influence of 
season and climate in relation to catarrhal lesions, becomes more strikingly 
manifest. 
As the doctrines maintained are conclusively established, a further discus- 
sion were useless. But this subject, at the present day, is invested with 
more than ordinary interest, by reason of the conclusions deduced from the 
" Statistical Reports on the Sickness, Mortality and Invaliding" among the 
British troops stationed in every quarter of the globe. In regard to phthisis 
pulmonalis, the reporter shows by numerical results, that it is more preva- 
lent in southern than northern latitudes, and that it is " by no means likely 
that any beneficial influence can be exerted by climate itself" in pulmonary 
2 16 
Forry on Pulmonary and Rheumatic Diseases. 
affections. The conclusion that pulmonic lesions, as regards the annual 
ratio, are more prevalent in certain systems of climate in southern than 
northern latitudes, is confirmed by the statistics of the United States army; 
but as we proceed in the investigation of this question, in relation to the 
relative influence of the seasons, the general opinions in regard to change of 
climate in pulmonary affections, maintained since the days of Hippocrates, 
will be triumphantly established. Major Tulloch, in his able repoits, has 
in some measure, set the world right in regard to a theoretical error, but has, 
unfortunately led it, at the same time, into apractical one.* It is thus seen 
that his deductions are vitiated by the radical error of basing them on the 
annual results without reference to the influence of the seasons; and, did 
space permit, it were easy to show that the inferences deduced from his 
numerical results are, in many instances, unwarranted, as he has fallen into 
the error not only of taking the mean of the averages given by the stations 
of a command, but into that of comparing the lowest average in one com- 
mand with the highest in another. 
It is not, however, pulmonary diseases alone that augment and diminish 
with the varying seasons-a fact established by the result of statistical data. 
The prevalence of a specific disease, or a class of diseases, constitutes a 
morbid diathesis, which modifies the character of all other lesions. In our 
northern and middle States, pulmonary diseases constitute the prevailing 
diathesis in the first and last quarters of the year, whilst, in the second and 
third quarters, the ratio is not more than one third as high as the average 
given by the diseases of the digestive organs. An invalid labouring under 
chronic bronchitis is, therefore, on the accession of the fourth quarter, doubly 
subject to renewed attacks; whereas by going south in the latter part of the 
third quarter, he leaves a region in which diseases of the digestive organs 
are the reigning lesions, and enters another of the same character; and as 
his system has not been acted upon by the long continued heats of a southern 
summer, he is less susceptible than the residents, to the influence of those 
causes which induce pulmonary affections. The pulmonic of the south, to 
enjoy the full benefit of his own climate, must, therefore, spend his sum- 
mers in more northern latitudes. In Florida, malarial diseases constitute 
the morbid diathesis in every season; and if the old idea, that the air of a 
marshy country is beneficial in consumption, be but partially true, then, 
* The opinion that it is worse than useless to visit southern regions in pulmonary dis- 
eases, has been very generally embraced on the strength of these statistics. The follow- 
ing extract from the Med. Chirurg. Review, may be given as an example:-These 
reports " have given the death blow to the expatriation of invalids affected with pulmonary 
alterations. They serve also to show us the salubrity of our calumniated climate, and to 
lower our aspirations for that ' sweet south,' whose sunny skies and luxuriant plains too 
commonly smile but to betray. Statistics dispel those illusions of poesy, and even prove 
that consumption, the reproach of our fickle seasons, lurks as fatally in the balmy Italian 
zephyr, or the sultry tropical breeze." Forry on Pulmonary and Rheumatic Diseases. 
17 
indeed, must this climate be an infallible remedy. It will be seen, however, 
that among northern troops, stationed at the south through all seasons, con- 
sumption of a tubercular nature frequently supervenes upon febrile diseases, 
more especially in constitutions broken down by intemperance, standing in 
the relation of those other sequelae-dropsy, jaundice, and the various 
chronic lesions of the viscera. 
I have thus concluded the investigation of catarrhal diseases in reference 
to the agency of season and climate; and the results, it is conceived, demon- 
strate conclusively the advantage of a winter residence in the peninsula of 
Florida in cases of chronic bronchitis. In endeavouring to determine, by 
ordinary observation, the influence of meteorological causes in relation to 
disease, the difficulties of the inquiry are very great, owing both to the 
complexity of the agents concerned and that of the organs and functions upon 
which they act. Independently of incidental miasmata, whether gaseous 
admixtures, animal or vegetable products, or other agents still less within 
our knowledge, this inquiry naturally divides itself into four heads-viz: 
The Temperature of the Jlir-Its Hygrometrical Condition-Its Weight 
-and Its Electrical State and Changes. The agency of winds may be 
referred, in a great measure, to some one of these conditions. Although 
little has been done to determine the influence of light, yet seeing what has 
been effected by science in expounding the physical conditions through 
which this great agent operates, and its effects, for example, on the growth 
and economy of plants, many of its relations to the body, there is reason to 
believe, will be heieafter ascertained. The present inquiry embraces in its 
scope the temperature of the air and, in some measure, its hygrometrical 
state. Although we feel these various agents to be in perpetual operation, 
yet it is singular how little real knowledge has been gained in relation to 
their connection with disease, The difficulty of the research is mainly 
enhanced by the circumstance that none of these conditions act singly upon 
the living body; and to meet the perplexity of these questions, meteorology, 
which is itself only taking a place among the exact sciences, has not yet 
accomplished much. To determine these laws, the personal observations 
of a single individual cannot be of much avail. It is only by extending these 
observations through a series of years and over vast masses of individuals, 
upon the principle of the numerical mode of analysis, that correct conclu- 
sions can be attained. It has just been seen that by the application of the 
doctrine of averages, important relations have been disclosed discoverable in 
no other way. The progress of physical science, it is thus seen, is ever 
lending fresh aids to that of pathology; and judging from the character of 
the results now developed, a favourable augury of the future, as the range 
of meteorological science, aided by new instruments, is being enlarged, is 
justly warranted. 
I shall now proceed to the investigation of the laws which obtain in regard 
to pleuritis and pneumonia. As these lesions, it is very probable, are 18 
Forry on Pulmonary and Rheumatic Diseases. 
dependent upon the same metereological causes, the results will be investi- 
gated conjointly. In abstract No. 2 of Appendix, the relative prevalence of 
each is exhibited. The following table presents the quarterly and annual 
ratios of pleuritis and pneumonia in each system of climate:- 
Ratio of Pleuritis and Pneumonia. 
fl 
o 
3 
S 
Systems of Climate. 
Ratio treated per 1000 of mean 
strength. 
First 
Quarter. 
Second 
Quarter. 
Third 
Quarter. 
Fourth 
Quarter. 
Annual 
Results. 
H f 
1st Class. Posts on the coast of New England, 
12 
11 
8 
10 
41 
2d Class. Posts on Northern chain of Lakes, - 
11 
15 
13 
11 
49 
3d Class. Posts north of lat. 39°, and remote from the 
» I 
ocean and inland seas, .... 
14 
11 
7 
12 
45 
1st Class. Coast from Delaware Bay to Savannah, 
21 
11 
8 
16 
57 
S ? 
2d Class. South-western Stations, ..... 
46 
18 
10 
20 
92 
S ) 
1st Class. Posts on the lower Mississippi, 
20 
9 
4 
11 
47 
X 1 
2d Class. Posts in the Peninsula of East Florida, 
14 
9 
8 
6 
39 
Total, 
138 
84 
58 
86 
It hence appears that the laws in regard to pleuritis and pneumonia, as 
expressed by the numerical results, differ, in some points, from those 
peculiar to catarrhal diseases. In the three classes of the Northern Division, 
the modifying agency of the ocean and lakes, is not manifested in the results. 
In the other systems of climate, the laws are the same as in catarrhal affec- 
tions; thus, the difference between the two classes of the middle division is 
very striking, whilst those of the southern division exhibit a remarkable 
decrease in the annual ratio. An examination of the quarterly averages as 
illustrative of the influence of the seasons, compared with catarrh and influ- 
enza, will also show some variation. In the first three classes, notwith- 
standing the third quarter is the lowest, the agency of the seasons is not 
very manifest. In all the others, the difference is very striking; and in 
taking the total of each quarter, which affords a fair expression of the rela- 
tive agency of the seasons in the causation of pneumonia and pleuritis 
throughout the United States, it is found that the law is the same as in 
catarrhal diseases, the first and fourth quarters presenting the highest, and 
the third, the lowest average. Thus:- 
1st Quarter. 
2d Quarter. 
3d Quarter. 
4th Quarter. 
138 
84 
58 
86 
In these calculations, Forts Monroe and Independence have, as before, 
been excluded. On reference to Abstract No. 2 of Appendix, the relative 
prevalence of these diseases at each of these posts may be seen. At Fort 
Independence, the total of pleuritis and pneumonia is eight times as high as Forry on Pulmonary and Rheumatic Diseases. 
19 
that of catarrh, whilst the ratio of the former is nearly twenty times as 
high as that of the remaining posts of this class. As but one death is 
reported among 261 cases of pleuritis and pneumonia, it is reasonable to 
presume that a great majority belonged to the class of catarrhal affections. 
From the table just given, it appears that the average of pleuritis and 
pneumonia is much lower in the cold and variable climate of our northern 
and eastern States than in the middle and southwestern regions of the United 
States. At the southwestern posts the annual ratio is 92, whilst on the 
coast of New England it is only 41. In catarrhal affections, the same law 
obtains so far as the New England coast is concerned; but the second, and 
especially the third class of the northern division exhibit contrary results. 
It has been seen that catarrhal lesions in every system of climate obey the 
law in respect to extremes of temperature as connected with the seasons. 
In pleuritis and pneumonia, this law receives some modification; for example, 
the third class, comprising the posts in the northern division, remote from 
the ocean and inland seas, has a ratio only half as high as that of the south- 
western stations. At Fort Snelling, Iowa, in the former class, the difference 
in the mean temperature of winter and summer, is 55°.51; whilst at Fort 
Gibson, Arkansas, in the latter, it is only 36°.83. In the former, the sum- 
mers, although the mercury rises very high, are short; but in the latter the 
summer heats are both great and long continued. It would seem to be a 
law that in proportion as the high temperature of summer makes an impres- 
sion upon the system, do the lungs become susceptible to the morbific 
agency of the opposite seasons. In the northern division, for example, as 
cold predominates, and no decided impression is made upon the animal 
economy by the short summer, the annual ratio of pleuritis and pneumonia 
is not only low, but there is little difference in the ratios of the seasons; on 
the other hand, at the southwestern posts, remarkable for high and long 
continued summer heats, the annual ratio is about twice as high as in the 
northern States, whilst the difference in the seasons is very considerable, the 
ratio of the third quarter being less than one ninth of the annual average. 
This contrast is rendered still more striking by the fact, that whilst the ratio 
of the first quarter is nearly four times higher at the southwestern than at 
the northern posts, there is no difference in the averages of summer. At 
Fort Gibson-a point at which the mercury rises higher than at any other 
post in the United States, the averages stand thus:-First quarter 71; second 
quarter 19, third quarter 9, fourth quarter 15, the annual ratio being 112. 
On comparing the southwestern stations with the corresponding posts on the 
Atlantic, the general law in reference to the modifying agency of the ocean 
is strikingly manifested. In the first class of the southern division, as the 
seasons grow less contrasted, the annual ratio decreases materially; and 
lastly, in the remaining class (East Florida), in which, for example, at Fort 
Brooke and at Key West, the difference in the mean temperature of winter 
and summer is respectively only 16°.02 and 11°.34, the lowest average is 
2* 20 
Forty on Pulmonary and Rheumatic Diseases. 
presented. It is thus seen that in regard to pleuritis and pneumonia, it 
seems necessary to consider not only the degree of contrast in the seasons, 
but the duration of high temperature. Leaving out of view the three classes 
composing the northern division of the United States, the law is precisely 
the same as in catarrhal lesions. 
The subject of phthisis pulmonalis will next engage attention. The 
quarterly and annual averages, in each system of climate, are shown in the 
annexed table:- 
Ratio of Phthisis Pulmonalis. 
Divisions. 
Systems of Climate. 
Ratio treated per 1000 of mean 
strength. 
First 
Quarter. 
Second 
Quarter. 
Third 
Quarter. 
Fourth 
Quarter. 
Annual 
Results. 
=• r 
1st Class. Posts on the coast of New England, 
2 
3 
2 
3 
9* 
1 
2d Class. Posts on Northern chain of Lakes, - 
3 
2 
2 
2 
9 
si 
3d Class. Posts north of lat. 39°, and remote from the 
& i 
ocean and inland seas, - . . . 
2 
1 
1 
1 
5 
1st Class. Coast from Delaware Bay to Savannah, 
4 
5 
2 
3 
13 
§ t 
2d Class. South-western stations, .... 
3 
3 
4 
2 
11 
□ 5 
1st Class. Posts on the lower Mississippi, 
3 
3 
2 
2 
9 
O J 
2d Class. Posts in the Peninsula of East Florida, 
2 
2 
2 
2 
9 
Total, 
19 
19 
15 
15 
It would not appear that any general laws can be deduced from these 
numerical results. In the northern division, the average of the third class, 
contrary to the general results of the class of diseases of the respiratory 
organs, is much the lowest: but this difference is more apparent than real, 
from the circumstance that nearly all the fatal cases of consumption in this 
division are ascribed to the abuse of ardent spirits. In the third class, for 
example, were the results of West Point, a command consisting mainly of 
officers and cadets, excluded from the calculation, the annual ratio of cases 
per 1000 rises nearly to 7; and the difference still existing is doubtless owing 
to the greater facility of obtaining, at the posts along the sea-board, inebri- 
ating potations. It is more than probable that the ratio of chronic bronchitis, 
follows the laws which obtain in respect to catarrhal lesions; but in regard 
to phthisis pulmonalis in general, these laws cannot be recognised. It is an 
important fact that whilst the averages of catarrh and influenza, pleuritis and 
pneumonia, in the first class of the middle division are reduced nearly 50 
per cent, by excluding Fort Monroe, the ratio of phthisis pulmonalis is 
increased. It confirms the opinion that this disease, although much under 
* A? fractions are not given, and as the mean strength of each quarter varies, the 
annual results do not always correspond with the total of the quartei ly ratios. Forry on Pulmonary and Rheumatic Diseases. 
21 
the influence of season and climate, is still more, especially among troops, 
under the control of other agents. As all causes by which the energies of 
the human frame are sapped, conduce to the development of the tubercular 
form of consumption, so northern constitutions exposed to the chronic dis- 
eases and debilitating heats of a southern latitude, acquire a peculiar suscep- 
tibility. In systems broken down by habits of intemperance, it is very apt 
to supervene upon certain chronic affections, as the sequela of remitting and 
intermitting fever, diarrhoea, &c. Facts of this kind having relation to the 
annual results, without reference to the influence of the seasons, it has been 
seen, led the British reporter into the erroneous conclusion that no change 
of climate is beneficial in any form of consumption. 
The annual results in regard to the class of pulmonary diseases, as well 
as the mortality from each, now come under investigation. As the cause of 
every death is not specified in the quarterly sick-reports, a correct result in 
respect to the mortality can only be approximated. The total of deaths 
given in the following table are those only which occurred among men on 
the sick list-a ratio considerably lower than that of the post returns which 
include the deaths from all causes: 
Northern Region of the United 
States. 
| Mean Strength. 
Ratio of cases per 1000 
of mean strength 
Deaths. 
Catarrh and Influenza. 
| Pneumonia. 
1 
Phthisis Pnlmonalis. 
SB 
£ 
| Catarrh and Influenza 
| Pneumonia. 
| Pleuritis. 
75 
s 
c 
s 
*5 
Pm 
£ 
JS 
Ph 
§• 
1 
= 
Total per Medical Re- 
turns. 
Causes not specified. 
Atlantic Posts, .... 
3130 
233 
22 
26 
9 
290 
1 
15 
140 
16 
Posts on the Lakes, ... 
5973 
300 
19 
30 
9 
358 
1 
4 
9 
65 
12 
Posts remote from the ocean and 
the Lakes, - - . * . 
12604 
552 
23 
5 
602 
3 
1 
22 
1 
119 
16 
Total, 
21707 
439 
18 
28 
7 
490 
1 
8 
1 
46 
1 
324 
44 
Southern Region. 
Coastfrom Delaware to Savannah,* 
3199 
271 
25 
32 
13 
341 
1 
1 
19 
196 
18 
South-western Stations, 
11140 
290 
39 
52 
11 
392 
31 
2 
61 
2 
458 
75 
Posts on the lower Mississippi, - 
33m 1 
218 22 28 
9 
277 
2 
2 
10 
178 
30 
East Florida, 
4607 
143 15 
24 
9 
191 
9 
131 
]7 
Total, 
22327 
246 29 
40 
10 
326 
34 
6 
99 
2 
963 
140 
* Fort Monroe, as before, so far as pulmonary diseases are concerned, is excluded from 
this class. There are reported 102 deaths, of which 4 arose from influenza, 8 from pneu- 
monia, and 17 from phthisis pulmonalis. 22 
Forry on Pulmonary and Rheumatic Diseases. 
It is thus seen that, with the exception of catarrh and influenza, the annual 
ratio of pulmonary diseases is lower in the northern than in the southern 
regions of the United States. It is in the middle districts of the United 
States, however, that pneumonia, pleuritis, and phthisis pulmonalis, are most 
prevalent, the peninsula of Florida having a lower average than any other 
region. It is found too, that the same law obtains in regard to the mortality 
arising from this class of diseases, the deaths per 1000 of mean strength 
being as under:- 
Phthisis Pulmonalis. 
Pneumonia, pleuritic, and catarrh. 
Northern Region. 
2.1 
0.5 
Southern " 
4.4 
1.8 
For the purpose of comparison, these results are deemed sufficiently accu- 
rate; but it is necessary to mention, as appears by the table, that among the 
deaths in the Northern Region, the causes of about one eighth, and in the 
Southern, the causes of one-seventh are not reported. It is known, how- 
ever, that the majority of the deaths, the causes of which are not specified, 
belongs to the class of casualties. 
The high mortality of the southern regions is caused by the Middle Divi- 
sion of the United States, the average on our southern coast being compara- 
tively low. Taking the statistics of the posts in East Florida, and those on 
the Lower Mississippi, the ratio of phthisis puhnonalis is found to be only 
1.7, and that of the remaining lesions of this class to be no more than 0.7 
per 1000 of mean strength. It is also ascertained that these diseases are of 
a more fatal tendency in the Southern than in the Northern Regions. In the 
latter, the ratio of mortality from phthisis pulmonalis is 32, and in the 
former, 42 per hundred cases; and as regards pleuritis and pneumonia, the 
difference is much greater, the average mortality in the Northern being 9, 
and in the Southern, 26 per thousand cases. It is necessary to add, how- 
ever, that this high mortality is limited to the south-western posts, 33 
deaths, (out of 40-the total of the four southern classes,) being reported in 
this class. 
These statistics then show that as regards pneumonia, pleuritis, and 
phthisis pulmonalis, the ratio of cases and deaths is greater in our middle 
regions, including the south-western stations, than at either extreme. In 
endeavouring to account for this result, much may, perhaps, be due to the 
circumstance that the subjects are generally from the Northern States, or 
from Europe. It may be safely asserted, as has been already remarked, that 
the majority of cases of consumption at our southern posts supervene upon 
febrile diseases, more especially in constitutions broken down by intempe- 
rance, bearing the same relation to fevers as those other sequelae-dropsy, 
jaundice, and the various chronic lesions of the viscera. On the Lower 
Mississippi-a class of posts which presents the highest mortality-the 
average of phthisis pulmonalis is low, owing very probably to the circum- Forry on Pulmonary and Rheumatic Diseases. 
23 
stance that fevers are of the most fatal tendency, terminating either in speedy 
death or rapid recovery. At the south-western stations, and those along our 
middle coast, the malarial poison acts more slowly, thus developing, by a 
gradual deterioration of the constitution, a tubercular form of consumption. 
It follows then that a continuous residence in the south, so far from being 
beneficial in this disease, will often hasten its fatal issue. This fact does not, 
however, in the least militate against the doctrine which maintains that ad- 
vantage will be derived from change of climate in the way of a winter resi- 
dence; and so far as regards the propriety of the measure in chronic bron- 
chitis, no reasonable doubt can be entertained. 
Reference has already been made to the British army statistics, the results 
of which, it is alleged, show " a striking contradiction to the popular idea" 
in relation to pulmonary diseases. The conclusion of the reporter that this 
class of diseases is more prevalent in southern than northern latitudes, it has 
been seen, is the result of hasty generalisation. It has been demonstrated, 
for example, that the prevailing low temperature of the coast of New Eng- 
land, and the predominating high temperature of our southern coast, present 
each a lower ratio than the variable climate of the intervening region, charac- 
terized by the extremes of both. Having averred that the reporter's deduc- 
tions are in many respects unwarranted by the numerical results, a proper 
respect for the opinion of others, more especially when emanating from high 
authority, requires, so far as the limits of this paper will admit, a statement 
of the general grounds upon which this declaration rests. 
England has been assumed as the standard of comparison. Now, it is 
well known that the range of the thermometer is not greater in England than 
in Italy, and that the difference in the mean temperature of summer and 
winter is actually less. In regard to the difference of winter and summer, 
the ratios stand thus:-Penzance 15°.84, Edinburg 17°.90, London 23° 
.20, Italy 27°.26 and southwest of France 26°.42. In our own country, 
the results are very different, as Fort Snelling, Iowa, 55°.51, Fort Brady, 
Mich., 40°.87, Washington city 38°.98, Jefferson barracks, Missouri, 41° 
.17, Fort Gibson, Arkansas, 36°.83, Augusta Arsenal, Georgia, 30°.55, Fort 
Brooke, Florida 16°.02, and Key West 11°.34. As the summer heats of 
England never rise so high or are so long continued as to render the animal 
economy very susceptible to the influence of the opposite conditions, it 
follows that the ratio of pulmonic lesions must be low. When this fact is 
taken in connection with another just developed, viz; that positions border- 
ing large bodies of water, by which the extremes of temperature are mode- 
rated, whilst the air is moist and the seasons characterized by variableness, 
exhibit a lower ratio of pulmonary diseases than localities under opposite 
circumstances, the selection of England as a standard of comparison, illus- 
trates strongly the impropriety of basing a classification of climates on mere 
latitude. 
The reporter takes the ground that a comparison of the ratio annually 24 
Forry on Pulmonary and Rheumatic Diseases. 
attacked out of a given number in different countries, presents the most 
accurate method of determining the relative agency of climate in the causa- 
tion of particular diseases, more especially if these investigations extend 
over a long series of years, and include large masses of individuals. Now, 
this remark is true, provided the comparisons, unlike the various British 
commands, are instituted among the natives of each region. 
The reporter has fallen into the error of comparing the lowest average in 
one command with the highest in another, by which all his deductions in 
reference to pulmonary diseases have become vitiated. The fallacy of the 
conclusion that pulmonary consumption is more prevalent and fatal in the 
West Indies than in England, appears from the single fact that he dwells 
particularly upon a comparison of the results afforded by the Windward and 
Leeward command of the former, and the Dragoon guards and Dragoons of 
the latter, thus assuming, on the one hand, the highest, and on the other, 
the lowest mortality as comparative averages. The high ratio of the Foot 
Guards in England is set aside as "an exception," because it appears "attri- 
butable to other causes than the climate of the metropolis," whilst that of 
the Windward and Leeward command stands forth in bold relief, notwith- 
standing he thinks it "not attributable to climate only, but also to some 
peculiarity from which officers are exempt." Taking the aggregate strength 
and aggregate mortality from diseases of the lungs of all the white troops in 
the West Indies and of all the commands in the United Kingdom, the result 
is in favour of the former. Were even the mortality higher than in Eng- 
land, it would not be surprising; for here are men, from a foreign land, 
exposed, through all seasons, to a continuous high temperature. As pulmo- 
nary consumption, in hot climates, is doubtless often induced by the deterio- 
ration which the constitution, especially in cases of intemperate habits, 
undergoes from repeated attacks of febrile and dysenteric lesions, a prolific 
source of mortality is presented in the West Indies. As the prevailing idea 
in regard to the advantages of acclimatization is disproved by statistical inves- 
tigations, not only in the West Indies, but all other climates in which British 
troops are stationed, it follows that the causes assumed as exercising a 
powerful agency in the production of phthisis pulmonalis, in proportion as 
the conservative powers of the constitution give way, are uniformly pro- 
gressive in their fatal tendency. 
At first view, the advantage of a winter residence in the West Indies to a 
pulmonary invalid, may seem problematical; but this deception vanishes 
when we call to mind the fact that these diseases, as a class, are more under 
the influence of the seasons than intermitting fever. A continuous residence 
in these islands would no doubt hasten the fatal issue in a case of tubercular 
consumption, but the objections on this score are wholly limited to the sum- 
mer season. Although the reporter remarks on "the baneful influence of 
the climate of the West Indies in accelerating the progress of consumption," 
yet it is found that the annual ratio of mortality from haemoptysis and Forry on Pulmonary and Rheumatic Diseases. 
25 
phthisis pulmonalis is only 6.1 per 1000, exclusive of those sent home as 
invalids, whilst that of the United Kingdom is 8.2. Now could we insti- 
tute a comparison between the civil population of England and the natives 
of the West Indies, correct results might be obtained. 
If we compare the ratio given by all the commands in England with that 
of the Mediterranean commands, Gibraltar, Malta and the Ionian Islands- 
the result, contrary to every conclusion of the reporter, is decidedly favour- 
able to the latter. In the United Kingdom, the annual ratio of mortality 
from haemoptysis and phthisis pulmonalis is 8-2 per 1000 of the strength; 
whilst at Gibraltar it is only 3.6, at Malta 3.7, and at the Ionian Islands 2.9, 
but as some consumptive patients in the Mediterranean commands were 
invalided, these ratios are somewhat too low. In regard to the civil popula- 
tion of Malta, the reporter adds:-" Nor is the fatal influence of diseases of 
the lungs confined to the troops alone; it extends in a corresponding degree 
to the inhabitants." It will be observed that deaths are reported by the 
Maltese medical practitioners under the different heads of consumption and 
phthisis pulmonalis. "The former," the reporter says, "is understood 
principally to refer to that class of consumptive cases more generally desig- 
nated marasmus, which term has been adopted in the returns since 1831. 
They are understood to have occurred principally among children and old 
persons." Not content to include under the class of diseases of the lungs 
the cases of marasmus reported as consumption prior to 1831, he also takes 
those reported as marasmus subsequently to that period. Excluding the 
cases of marasmus, the ratio of mortality from haemoptysis and phthisis pul- 
monalis is reduced to 1.1, and that from all diseases of the lungs, to 3 per 
1000. The fatality of pleuritis and pneumonia is not half so great as 
among the troops. Consequently, the mortality from all diseases of the 
lungs among the civil population is not more than half as high as among 
the troops, and not one third as great as the average of the several com- 
mands in the United Kingdom. As truth never lies in extremes, so the 
ratio of haemoptysis and phthisis pulmonalis, including one half of the 
cases of marasmus, is 2.2, which is much lower than among the military, 
and only one-fourth of the average in England. 
This view of the results of the several Mediterranean commands, leads to 
conclusions diametrically adverse to those deduced by the reporter. So far 
from the climate being unfavourable to persons predisposed to pulmonary dis- 
eases, it is satisfactorily shown that it is even advantageous as a continuous 
residence. Hence, to the pulmonic invalid of more northern latitudes, who 
seeks this climate merely as a winter retreat, the beneficial results must be 
incalculable. Were even the correctness of the reporter's deductions admit- 
ted, it would not militate against the principles established in relation to the 
influence of the seasons. In no event, then, can the pulmonic of England 
be in error, in visiting the Mediterranean as a winter residence. 
In Nova Scotia and New Brunswick, as well as in Upper and Lower 26 
Forry on Pulmonary and Rheumatic Diseases. 
Canada, the ratio of admissions and deaths from diseases of the lungs is con- 
siderably below that of the United Kingdom. As this is a region in which 
cold predominates, the result is no ways surprising; for, notwithstanding 
" the variation sometimes exceeds 50° in the course of a few hours," it is 
in harmony with, and thus confirms the laws established in relation to, the 
systems of climate pertaining to the United States. 
The results given by Major Tulloch's latest statistical Reports "on the 
sickness, mortality, and invaliding among the troops in Western Africa, 
St. Helena, the Cape of Good Hope, and the Mauritius," afford no confirma- 
tion of his favourite views in regard to pulmonary diseases. We are told, 
for example, "that among 71,850 native troops serving in the Madras Presi- 
dency, the deaths by every description of disease of the lungs did not, on the 
average of five years, exceed one, per thousand of the strength annually. 
Here then, unlike the island of Malta, is presented a fair standard of mor- 
tality from all pulmonary diseases among native troops; and compared with 
the ratio of Great Britain, it is found to be only one-tenth as high. On the 
western coast of Africa, the ratio of mortality from diseases of the lungs 
among British troops, is 4.9 per 1000, in St. Helena 3.2, and at the Cape 
of Good Hope 3.9, whilst at the Mauritius, the average is nearly twice as 
high as the last. As the ratio of the United Kingdom is 10.1, these results, 
like all others, are much in favour of southern latitudes. The ratio of ad- 
missions by the class of pulmonary diseases is much the same at the Cape 
of Good Hope and the Mauritius, the great source of mortality in the latter 
arising from consumption. This fact confirms the oft-repeated opinion, that 
the ratios of phthisis pulmonalis in general and the other diseases of the 
lungs have no apparent relation. 
These general conclusions are confirmed by statistical facts in a recent 
edition of M. Laennec's work, edited by M. Andral. It is found that 
phthisis, as in the middle regions of the United States, is much more fre- 
quent in the temperate regions of Europe, comprised between the 55th and 
the 45th degree of latitude, than it is further to the north. Whilst in Lon- 
don it is calculated that 236 of every 1000 deaths is caused by pulmonary 
phthisis, in Sweden the ratio is only 63. At St. Petersburg and Stockholm, 
it is much less destructive than throughout Germany, and more especially 
at Berlin, Munich, Vienna, and Paris. In the southern parts of Europe, 
from the 45th to the 35th parallel, it is still found to be a very common dis- 
ease. That a cold temperature is not essentially per se favourable to the 
developement of phthisis pulmonalis, as well as pleuritis and pneumonia, 
seems, therefore, an established point. 
No attempt is here made to analyze critically the results of the British 
statistics, but rather to adduce the foregoing facts in confirmation of the doc- 
trines established in reference to the systems of climate pertaining to the 
United States. In the British Commands investigated, the reporter had to 
deal entirely with regions characterised by a mild insular climate, or those Forry on Pulmonary and Rheumatic Diseases. 
27 
in which a low temperature predominates; and as the contrasted seasons of 
an excessive climate like ours was not brought under his observation, his 
means of arriving at truth were restricted. Even when referring for illus- 
trations to the countries of other nations, he falls into a like error; for when 
discussing the climate of Malta in relation to pulmonic affections, he refers 
to Sweden as a region which ought to afford opposite results. Now had 
returns from the middle regions of Europe fallen into his hands, the deduc- 
tions, it has just been seen, would have been widely different. And here 
again, we have meteorological facts that afford mutual corroboration. Moscow, 
for example, in lat. 56°, according to Humboldt, has the same mean summer 
temperature as Loire in France, in lat, 46°; and in Scotland, in lat. 57°, the 
winters are more mild than at Milan, in lat. 45° 28.' 
As rheumatism pertains to that class of diseases for which a winter 
residence in southern latitudes is often recommended, a few inquiries in 
regard to its etiology will be instituted. This subject, like the preceding 
one, is of such a nature that the experience of the civil practitioner is on too 
limited a scale, and too immethodical in its character, to warrant general 
conclusions, and although generally unsafe to disagree with mankind in 
matters of daily observation, yet it would not be surprising were the com- 
monly received opinions upon a question of such magnitude, to prove, when 
submitted to the test of numbers, to be founded in error. The following 
table, condensed from abstract No. 1 of Appendix, exhibits the annual and 
quarterly ratios of rheumatic cases, treated per 1000 of strength, on an 
average of 10 years, in each system of climate:- 
Ratio of Rheumatic Diseases. 
Divisions. 
Systems of Climate. 
Ratio of cases per 1000 of 
strength. 
First 
Quarter. 
Second 
Quarter. 
Third 
Quarter 
Fourth 
Quarter. 
Annual 
Ratio. 
fi 
1st Class. Coast of New England, .... 
24 
28 
29 
30 
110 
i J 
2d Class. Posts on Northern chain of Lakes, - 
41 
37 
36 
38 
151 
o 
3d Class. Posts north of lat. 39°, and remote from the 
£ 
ocean and inland seas, .... 
1st Class. Coast from Delaware Bay to Savannah, 
45 
48 
37 
34 
166 
T3 
37 
36 
27 
24 
126 
2d Class. South-western stations, .... 
1st Class. Posts on the lower Mississippi, 
36 
31 
20 
27 
112 
□ 
28 
16 
22 
23 
90 
o 
tfl 1 
2d Class. Posts in the Peninsula of East Florida, 
38 
23 
30 
26 
119 
Total, 
249 
219 
201 
202 
It thus appears that these diseases, which are generally ascribed to sudden 
variations of temperature conjoined with excess of moisture, are less under 
the influence of atmospheric agency than is commonly supposed. It is 
evident, however, that these affections are, in some measure, controlled by 
3 28 
Forry on Pulmonary and Rheumatic Diseases. 
the same laws which govern pulmonary diseases. Were cold, moisture, 
and sudden alternations of temperature, powerful exciting causes, the highest 
ratio should be given on the New England coast and the northern chain of 
lakes; on the contrary, it is found that, like pulmonic lesions, the disease is 
most rife in the dry and cold atmosphere of the interior, (the third class of 
the Northern division,) characterised by the extreme range of the thermo- 
meter and by seasons strongly contrasted. In the middle division, the first 
class, it is true, is higher than the second; but if the results of Fort Monroe, 
as in the calculations in regard to pulmonary diseases, are excluded, the 
annual average of the former is reduced to 93. In the northern division, 
the annual ratio of cases, per centum of the strength, is 15, whilst the mean 
of the middle and southern division is 11. Among 6257 cases registered, 
only one death is reported. 
Were these affections much under the influence of meteorological causes, 
so far as regards variations of temperature, we should find, as in pulmonic 
lesions, a great contrast in the ratios of the seasons. Taking the totals of 
the four seasons, as shown in the table just given, the first and second 
quarters give the highest averages; but, contrary to the law which governs 
pulmonary diseases, the ratios of the third and the fourth are the same. 
Viewing the whole subject, however, it is found that a similarity obtains in 
the general laws which, on the one hand, govern rheumatic, and, on the 
other, pulmonary, but more especially catarrhal diseases. 
These views are confirmed by the results given in the following abstract 
from the recent reports upon the medical statistics of the British troops:- 
Admissions from Rheu- 
matic Affections annually 
per 1000 of mean strength, 
co 
Jamaica. 
00 
Nova Scotia and 
New Brunswick. 
00 
oo 
Bermudas. 
oo 
Malta. 
Ionian Islands. 
oo 
GO 
Gibraltar. 
Canada. 
o 
Mauritius. 
co 
Windward and 
Leeward Command, 
West Indies. 
o 
United Kingdom. 
On 
Cape of Good Hope. 
The reporter here directs attention to the fact that rheumatic diseases are 
more prevalent in the Mediterranean than in Canada and Nova Scotia, and 
that " though some of the provinces of the Cape of Good Hope have occa- 
sionally been without rain for several years, these diseases are more frequent 
in the dry climate of that command, than in the West Indies where the 
condition of the atmosphere is as remarkably the reverse; yet have extreme 
cold and atmospheric vicissitudes, coupled with excess of moisture, been 
assigned as satisfactory causes for their prevalence." Between the ratio of 
Canada and that of Nova Scotia and New Brunswick, the former being one Forry on Pulmonary and Rheumatic Diseases. 
29 
third higher than the latter, the same law obtains as in the United States. 
Whilst in Canada the cold becomes so intense that the mercury congealed 
in the thermometer, serves no longer to indicate the extreme reduction of 
the temperature; in Nova Scotia, on the contrary, the mercury is seldom 
lower than 6° or 8° below zero in winter, or above 88° in summer-a 
modification arising from the insular character of the province, which is 
likewise so much intersected by lakes and bays, that nearly one third of its 
surface is under water. Notwithstanding the atmosphere is consequently 
exceedingly moist, and fogs are along the coast common throughout the 
year-a circumstance regarded as most favourable for the production of 
rheumatism-yet it is seen that the ratio is lower than in the dry and in- 
tensely cold climate of Canada. If the average of Nova Scotia were given 
distinct from that of New Brunswick, a more striking contrast, it is very 
probable, would be revealed. At all events, the opinion that rheumatic 
affections, like those of the lungs, obey, in some measure, the inflections of 
the isotheral and isocheimal curves, is warranted. 
It will be observed that the annual ratio of rheumatic affections is two 
and three-fold greater among our troops than among the British, and that 
the same relation obtains in regard to pulmonary diseases. This may arise 
in some measure from the mode of reporting. In our service, all cases of 
disease, more especially of late years, are registered-those in hospital as 
well as those in quarters, whilst the British statistics, it would seem, contain 
only cases of admission into hospital. Much, however, is to be ascribed to 
the nature of the region we inhabit, which lies in the middle latitudes of the 
eastern side of a continent prolonged towards the poles. It is, therefore, 
emphatically an excessive climate, exhibiting the greatest range of tempe- 
rature and the most marked distinction of seasons, whilst all the regions of 
the British commands are either mild insular climates or those in which a 
low temperature predominates. 
Among the various systems of climate presentedin the extensive region of the 
United States, that of the Peninsula of Florida is wholly peculiar. Possessing 
an insular temperature not less equable and salubrious in winter than that 
afforded by the south of Europe, it will be seen that invalids requiring a 
mild winter residence, have gone to foreign lands in search of what might 
have been found at home. Florida, therefore, merits the attention of physi- 
cians at the north; for here the pulmonary invalid may exchange for the 
inclement season of the north, or the deteriorated atmosphere of a room to 
which he may be confined, the mild and equable temperature, the soft and 
balmy breezes, of an ever-green land in which wild flowers never cease to 
unfold their petals. 
From the earliest period, change of climate has been regarded as a reme- 
dial agent of great efficacy. This opinion is, indeed, confirmed by daily 
experience. Diseases that have long resisted medical treatment, are fre- 
quently suspended or entirely cured by a removal from a crowded city to an 30 
Forry on Pulmonary and Rheumatic Diseases. 
open country, or are found to yield, under the influence of such a change, 
to remedies that previously produced no impression. 
Although the influence of different climates in the causation as well as 
the alleviation and cure of diseases, is a fact universally conceded; yet there 
is, perhaps, nothing in general science more unsatisfactory than the attempts 
hitherto made to explain the modus operandi of this power. This, how- 
ever, will not be a matter of surprise, when it is recollected that the problem 
of physical climate remains, in a great measure, unsolved. How much 
more complicated then must the subject become, when involved with the 
elements of organic life, and all the complexity of their combinations result- 
ing from health and disease. 
Climate, indeed, modifies both the moral and physical nature of man. 
Each region of the globe presents peculiarities in regard to such organic 
modifications. The inhabitants of the same continent, as the German from 
the French, or the Esquimaux from the Southern Indian, may be readily dis- 
tinguished. In casting one's eye over our National Legislature, the same 
diversity of physiognomy is apparent. The general countenance of each 
State's delegation is, indeed, a pretty sure criterion to judge of its compara- 
tive salubrity. We can at once distinguish the ruddy inhabitant of that 
mountain chain, where health and longevity walk hand in hand, where Jef- 
ferson and Madison inspired its cheerful and invigorating breezes, from the 
blanched resident of the sunny south-that fair and inviting land, whose 
fragrant zephyrs are laden with poison-the dews of whose summer even- 
ings are replete with the seeds of mortality. 
As erroneous impressions pervade the public mind in relation to the cli- 
mate of East Florida as regards its comparative salubrity, it may not be 
inappropriate, before entering upon a special description, to give some gene- 
ral results based upon numerical calculations. These results, like those 
already given, are founded upon official papers on file in the War Depart- 
ment, the details of which constitute an official report on the vital statistics 
of the army, and the medical topography of the military stations. 
According to the regimental returns, the ratio of mortality among the 
troops serving in Florida, from all causes-"ordinary, killed in action, died 
of wounds, and accidental"-during the years 1836, 1837, 1838, 1839, is 
6.1 per cent. The annual average exhibits a progressive decrease, being in 
1836, 11.4; in 1837, 6.9; in 1838, 4.7; and in 1839, 4.7 per cent. The 
ratio of mortality among these troops varies little from that of garrisons 
stationed in the south in lime of peace-a fact established by the results of 
statistical investigations, and confirmed by the subjoined table, which exhi- 
bits, for the period of ten years, the average mortality of the army, com- 
puted by regiments: 
Years. 
1829 1830 1831 1832 1833 1834 1835 1836 1837 1838 Average. 
Ratio of deaths per 1000 of mean j 
strength annually. 
I 36 32 29 68 30 57 49 48 53 42 44 Forry on Pulmonary and Rheumatic Diseases. 
31 
The most conclusive evidence upon this point, is here afforded in the fact 
that although more than one-third of the actual strength of the army served 
in Florida in 1838, yet the mortality of the whole army for that year is only 
4.2 per cent., a ratio lower than the mean of ten years. The ratio of mor- 
tality among the regular troops operating against the Seminoles, on an ave- 
rage of four years, is considerably lower than that of the 4th regiment of 
infantry for the period of the ten years embraced in the table just given. 
This regiment, which has borne the " tug of war" amid ungenial climes, 
presents the highest ratio, 7.6 per cent.; whilst the 5th infantry, which has 
had a kind of home station on the northern lakes, exhibits the lowest mor- 
tality, 1.3 per cent. 
That the mortality among the invalids sent out of Florida will increase the 
ratio, may be supposed; but it is found, on investigation, that the result is 
not materially affected. Amongst the invalids that left Florida during the 
years 1836, 1837, and 1838, no more than 17 deaths can be traced. In- 
cluding these fatal cases, the annual mortality in Florida from all causes, is 
increased from 6.1 to 6.3 per cent. 
Prior to the pending hostilities, four permanent posts wrere maintained in 
East Florida, viz: Forts Marion, King, Brooke, and Key West. The 
annual mortality at the first three is 28 per 1000, and including Key West, 
it rises to 40. Although the climate of this region is treated of merely in 
reference to its fitness as a winter residence, yet it may not be amiss to give 
a general view of the relative mortality of the troops in the different sections 
of the United States, based on an average of 10 years. 
Systems of Climate. 
e mean 
Annual ratio of 
mortality per 
1000 of strength 
73 
c 
3 
a 
o 
rt X5 
cp tn 
'J) 
o = 
• 
m 
a 
< £ 
2 
1st Class. Coast of New England, .... 
4279 
20 
15 
i J 
2d Class. Posts on Northern chain of Lakes, 
6377 
13 
9 
si 
3d Class. Posts north of lat. 39°, and remote from the 
«i 
ocean and inland seas, .... 
12790 
14 
8 
Average, 
23446 
15 
9 
1st Class. Coast from Delaware Bay to Savannah, - 
6740 
34 
30 
s ? 
2d Class. South-western stations, ..... 
11739 
45 
36 
= 
1st Class. Posts on the lower Mississippi, ... 
3810 
53 
44 
2d Class. Posts in the Peninsula of Florida, - 
4781 
39 
26 
Average, 
27070 
42 
34 
Mean of the United States, 
50516 
30 
22 
3* 32 
Forry on Pulmonary and Rheumatic Diseases. 
It thus appears that in the northern division, the mortality, according to 
the Adjutant General's returns, is 1.5 per cent., and, according to the medi- 
cal returns, 0.9 per cent.; and in the middle and southern divisions, according 
to the former, the mean is 4.2, and according to the latter, 3.4, per cent. 
In this calculation, the deaths from epidemic cholera have been excluded 
from both classes of returns; and from the medical reports, such deaths also 
as arose from homicide, suicide, asphyxia from cold, submersion, etc. The 
former exhibits the ratio of mortality from all causes, with the exception of 
Asiatic cholera, as reported in the post returns by the commanding officer; 
whilst the latter, as it shows the mortality arising from diseases chiefly, 
may be regarded as a pretty fair expression of climatic influence. In the 
middle and southern divisions, the ratio of mortality, according to the medical 
returns, is nearly four-fold greater than in the northern, and according to the 
post returns nearly three times higher. Our northern latitudes exhibit little 
variation in the annual mortality; but the southern, in consequence of more 
fatal epidemic visitations, show great extremes. It must be borne in mind 
that in the latter the troops consist mostly of northern constitutions impaired 
by intemperate habits. In the above abstract, the aggregate of deaths is 
1104, more than one half of which may be traced to the effects of inebria- 
tion-a vice which, according to these statistics, may be indulged in our 
northern States as contrasted with the southern, with comparative impunity. 
With the exception of the northern division, the mortality from disease is 
lower in east Florida than in any other class of posts. Forts Marion, King 
and Brooke, which have been kept up for many years, have always been 
esteemed healthy posts. Fevers of the intermittent and remittent type are 
the prevailing diseases. Excepting the southwestern region, the ratio of 
intermittents is higher in this class than in any other; but if the comparison is 
limited, for example, to Fort M'Henry, (Baltimore,) Fort Severn, (Annapolis,) 
and Fort Washington, opposite Mount Vernon, it is found favourable to the 
former, notwithstanding the gairisons of these northern posts generally 
formed summer encampments. As regards remittents in east Florida, the 
annual ratio of cases, which is 102 per IODO of the strength, is lower than the 
three preceding classes in the table, whose respective averages are 181, 180, 
and 196. In the first class of the middle as well as of the southern division, 
febrile action often assumes the high grade of intensity designated yellow 
fever. Whilst the causes of this fatal endemic seem to be annually present 
at Charleston and New Orleans, it has made its appearance but twice at St. 
Augustine within the period of 20 years. 
Fevers of malarial origin are both more prevalent and fatal in that portion 
of Florida which borders on Georgia. Along the coast, and in many parts 
of the interior, salubrious positions are often found. At several posts along 
the eastern coast, a case of fever has sometimes not been reported in three 
or six months. Other localities, the stations being often selected less with Forry on Pulmonary and Rheumatic Diseases. 
33 
reference to salubrity than military advantage, are not unfxequently very 
unhealthy. 
In treating of the climate of Florida, the primary object held in view is, 
to direct attention to its fitness as a ivinter residence for northern invalids. 
In 1833, Professor Dunglison called the attention of the profession, on the 
strength of the meteorological registers kept by the medical staff of the 
army, to the suitableness of St. Augustine and Tampa Bay as a winter 
retreat. An examination of abstract No. 2, of Appendix, showing-1. The 
mean temperature of each month, each season, and the whole year; 2. The 
difference between the mean temperature of each month and season; and 3. 
The annual and monthly ranges of temperature-will, it is believed, not 
only furnish further confirmation of the doctrines already conclusively estab- 
lished, but lead to results of great value to the practical physician. 
The results of the four posts in abstract No. 2 of Appendix, illustrate the 
modifying agency of large bodies of water. Fort King, situated in the 
interior, has a warmer summer and a colder winter than the remaining sta- 
tions, all of which are on the coast. Although Key West is 4°39' south of 
Fort King, and has a mean annual temperature 3°.43 higher, yet the mean 
summer temperature is 2°.81 lower. The equalizing influence of the ocean 
is still further shown by the annual range of the thermometer, the mean of 
the monthly ranges, and the mean difference of successive seasons. During 
the summer months, the morning and evening observations are nearly the 
same at both points, the disparity being caused by the exalted temperature 
of Fort King at mid-day. In each year, July was the hottest month at 
Key West, and the month of June at Fort King. As is usual in southern 
latitudes, there is little variation presented at Key West in the mean tempe- 
rature of the same month in different years. 
There is little difference between the thermometrical phenomena pre- 
sented at Key West and the Ilavanna. Within the period of six years, 
(from 1830 to 1835 inclusive,) the mercury at Key West was never known 
to rise higher than 90°, nor sink lower than 44°. 
The peculiar character of the climate of Florida, as distinguished from 
that of more northern latitudes, consists less in the mean annual temperature 
than in the manner of its distribution throughout the year. At Fort Snelling; 
Iowa, the mean temperature of winter is 17°.29, and of summer, 72°.80, 
whilst at Fort Brooke, Tampa Bay, the former is 65°.02, and the latter 
81°.01 and at Key West, 70°.05 and 81°.39. Notwithstanding the winter 
at Fort Snelling is 52°.76 colder than at Key West, the summer, at the 
latter is only 8°.59 warmer. In like manner, although the mean annual 
temperature of Petite Coquille, La., is nearly 2° lower-that of Augusta 
Arsenal, Ga., nearly 8°-and that of Fort Gibson, Arkansas, upwards of 
10° lower, than that of Fort Brooke; yet at all, the mean summer tempera- 
ture is higher. Between Fort Snelling on the one hand, and Fort Brooke 
and Key West on the other, the relative distribution of temperature stands 34 
Forry on Pulmonary and Rheumatic Diseases. 
thus:-Difference of the mean temperature of summer and winter at the 
former 55°.51, and at the two latter 16°.02 and 11°.34; difference of the 
mean temperature of the warmest and coldest month, 61°. 18 compared 
with 17°.68 and 14°.66; and the mean difference of successive months 
stands as 10°.20 to 2°.97 and 2°.44. At Fort Snelling, the annual range 
of the thermometer is 116°, and at Fort Brooke and Key West it is 56° and 
37°; and the mean of the monthly ranges bears the relation of 50° to 29° 
and 16°. The attention is thus directed merely to a few prominent points, 
as a reference to the tabular abstract will enable any one to trace much 
farther this remarkable equality in the distribution of temperature among 
the seasons in Florida. A comparison with the most favoured situations on 
the continent of Europe, and the islands held in highest estimation for mild- 
ness and equability of climate, affords results no way disparaging. A com- 
parison of the mean temperature of winter and summer, that of the warmest 
and coldest months, and that of successive months and seasons, furnishes 
results generally in favour of the peninsula of Florida. The mean difference 
of successive months stands thus:-Pisa 5°.75, Naples 5°.08, Nice 4°.74, 
Rome 4°.39, Fort King 4°.28, Fort Marion, at St. Augustine, 3°.55, Pen- 
zance, England, 3°.05, Fort Brooke 2°.97, Key West 2°.44, Madeira 2°. 
41. The mean annual range thus;-Fort King 78°, Naples 64°, Rome 62°, 
Nice 60°, Montpellier 59®, St. Augustine 59°, Fort Brooke 56°, Penzance 
49°, Key West 37°, and Maderia 23°.* The island of Madeira is esteemed 
by Dr. Clark as best adapted to consumptive patients. 
In the West India islands, the mean annual temperature near the sea is 
only about 80°. At Barbadoes, the mean temperature of the season is- 
winter 76°, spring 79°, summer 81°, and autumn 80°. The temperature 
is remarkably uniform; for the mean annual range of the thermometer, even 
in the most variable of the'islands, is only 13°, and in some it is not more than 
4°.f Contrast this with Fort Snelling, Iowa, which gives a range of 116°! 
It has been seen that the meteorological agents which determine the 
ratio of pulmonic lesions, causing the first and fourth quarters to present the 
highest averages, and the third the lowest, is the marked distinction of 
season characterized by extremes of temperature. Hence the apparent 
exception to this rule in the system of climate pertaining to East Florida, 
where the third quarter has a higher ratio than the second or fourth, (see 
Table p. 21,) instead of contradicting a general law, corroborates it. As 
Florida is an ever-green land, the influence of the seasons does not impress 
the pulmonary organs sufficiently to derange their functions by their transi- 
tion. Hence the ratio of pulmonic lesions is low; and as the causes which 
are secondary in excessive climates, grow here into primary ones, these 
diseases may be as rife in the summer as in the spring or autumn. 
* Contrary to the numerical ratios furnished in his tables, Dr. Clark says that "the 
mean annual range of temperature is only 14°"-an error which has crept into the writings 
of Dr. Dunglison. 
t According to the British army statistics. Forry on Pulmonary and Rheumatic Diseases. 
35 
The state of the weather as indicated by the course of the winds and the 
proportion of fair and cloudy days, calculated for the same years as abstract 
No. 2 of Appendix, is shown in the following table:- 
Places of 
Observation. 
Course of Winds. 
Prevailing. 
Weather. 
Prevailing. 
N. 
N W. 
N. E. 
E. 
d. E. 
s. 
s. w 
VV. 
Fair. 
Cloudy. 
Rain. 
Days. 
Days. 
Days. 
Days. 
Days. 
Days. 
Days. 
Days. 
Days. 
Days. 
Days. 
St. Augustine, 
1.55 
2.86 
9.08 
1.03 
10.83 
1.11 
2 64 
1.33 
S. E. 
19.02 
5.19 
6.22 
Fair. 
Fort King, 
1.62 
2.79 
3.46 
3.54 
4.37 
5.63 
5.96 
3.08 
s.w. 
25.75 
2.88 
1.89 
Fair. 
Fort Brooke, 
1.53 
3.72 
5.58 
2.89 
4.44 
2.75 
6.42 
3.17 
s.w. 
20.33 
4.47 
5.64 
Fair. 
Key West, 
3.20 
3.13 
10.50 
5.37 
5 37 
0.54 
1.67 
0.38 
N.E. 
21.54 
3-08 
5.92 
Fair. 
The want of hygrometrical observations to indicate the actual or compa- 
rative humidity of the atmosphere is to be regretted. That the air is much 
more humid than in our more northern regions is sufficiently cognizable to 
the senses. The dews, even in the winter, are generally very heavy. To 
guard against the oxidation of metals, as for example surgical instruments, 
is a matter of extreme difficulty. During the summer, books become 
covered with mould, and keys rust in one's pocket. Fungi flourish lux- 
uriantly. The writer has known a substance of this kind spring up in one 
night, and so incorporate itself with the tissue of a woollen garment as to 
render separation impracticable. As general relaxation and lassitude are 
consequent on this prevailing humidity, it may exercise some agency in the 
production of the comparatively high ratio of pulmonic and rheumatic 
affections in the summer season. One of the best safeguards against its 
effects is, to wear flannel next the skin-a custom generally adopted in the 
army. It is, indeed, a hygienic measure no less valuable in warm than in 
cold climates, affording comparative immunity against thermometrical and 
hygrometrical vicissitudes. 
As the rains, however, generally fall at a particular season, so the atmos- 
phere in winter is comparatively dry and serene. The following abstract 
of the monthly fall of rain at Key West, is the mean result of five years' 
observation:- 
r 
Annual 
Jan. 
Feb. March April May 
June 
July 
Jug-. 
Sep. 
Oct. 
Nov. 
Dec. 
average. 
1.82 
1.34 1.98 1.09 6.34 
2.39 
2.34 
3.30 
4.35 
3.33 
1.49 
1.13 
31.40 
It will be observed that during six months, from November to May, 
which is the longest period that a northern invalid should remain in this 
climate, the proportion of rain is but 8.84 inches. It has been already 
remarked that in tropical climates a portion of the year is known as the 
rainy season, and that the same quantity descends in a much shorter space 
of time than in the temperate zone; and that consequently the proportion of 
fair days and clear skies is infinitely in favour of the former. In the table 36 
Forry on Pulmonary and Rheumatic Diseases. 
of the weather just given, in which the ratios are monthly averages, this 
result is strikingly manifested. At Fort King, the annual number of fair 
days is 309, whilst on the northern lakes, it is only 119. On the coast of 
Florida, however, the average is not more than 250 days. 
The influence of temperature on the living body is often indicated more 
accurately by our sensations than the thermometer. The advantages of 
climate as regards its fitness for the pulmonic, not unfrequently depend on 
the mere circumstance of exposure to, or shelter from cold winds. The 
frequency and severity of the winds at St. Augustine constitute a considera- 
ble drawback on the benefits of the climate. The chilly northeast blast, 
surcharged with fogs and saline vapours, sweeping around every angle of 
its ancient and dilapidated walls, often forbids the valetudinarian venturing 
from his domicil. To obviate these disadvantages, a large house was erected 
at Picolata on the St. John's; but during the pending Indian disturbances, 
it has been converted into a barrack and an hospital. 
To persons labouring under an irritable state of the bronchial membrane, 
high winds are particularly injurious. If the consumptive invalid have 
much sensibility to harsh and keen winds, and if the immediate vicinity of 
the sea be known to disagree, Fort King ought to be recommended before 
St. Augustine or even Fort Brooke; but as sea-air is known to be generally 
adapted to a relaxed habit and a languid and oppressed circulation, a favour- 
able position on the coast should, in such cases, be selected as a winter 
residence. 
The natural advantages of position, without reference to extrinsic circum- 
stances are now under discussion. St. Augustine is on the eastern coast; 
Fort Brooke is at the head of Tampa Bay,* about 30 miles from the Gulf of 
Mexico; Fort King is intermediate to these two points; and Key West be- 
longs to the Archipelago south of Cape Sable. The pending hostilities with 
the Aborigines, and the difficulty of obtaining accommodations indispensable 
to the comfort of the invalid, render a winter retreat almost impracticable any 
where but at St. Augustine or Key West. The oldest town in the United 
States, and built mostly of a concrete shelly stone in the Spanish style, St. 
Augustine presents an antiquated appearance, enlivened by beautiful orange- 
groves bending at due season beneath their golden fruit.f The old Spanish 
fort and the tout ensemble of the city, give it more the resemblance of a 
place of defence than of elegance; but it is these circumstances which asso- 
ciate it with history, and render it peculiarly interesting to the American 
traveller. Moreover, the inhabitants extend kindness and hospitality towards 
strangers. Key West, about 60 miles southwest of Cape Sable, is two 
* The old Spanish appellation was Espiritu Santo, or bay of the Holy Ghost, the name 
Tampa being' then restricted to an arm. 
t In 1835, nearly all the orange trees in Florida were destroyed by frost-an occur' 
rence previously unknown in the memory of the oldest inhabitant. Forry on Pulmonary and Rheumatic Diseases. 
37 
miles wide and ten long, and is remarkable as being the most southern set- 
tlement of the United States. Possessing a good harbour, it has been from 
time to time the station of our West India squadron. It contains about 
1400 souls, and is a place of some commerce chiefly in the way of wrecked 
goods. 
In contemplating the scenery of East Florida in the month of January, 
one is apt to forget that it is a winter landscape. Fort Brooke on Tampa 
Bay is a truly delightful spot, in which tropical fruits flourish luxuriantly. 
The lime, the orange, and the fig find there a genial soil, whilst the moss- 
covered* live-oak and the Pride of China, add beauty and variety to the 
scene. Vegetation is continuous through every season, culinary vegetables 
growing in January; and the temperature of the waters in rivers and bays 
will admit of bathing in every month of winter. To the northern man, all 
nature seems changed. Even the birds of the air-the pelican and flamingo 
-indicate to him a climate entirely new. Having accompanied a boat expe- 
dition, the object of which was to explore the sources of the St. Johns, 
the writer found, in the month of January, the high cane-grass which covers 
its banks intertwined with every variety of morning-glory, [convolvulus.) 
The thermometer at mid-day, in the shade, stood at 84° Fahr, and in the 
sun, rose to 100°; and at night we pitched no tents, but lay beneath the 
canopy of heaven with a screen perhaps over the face as a protection against 
the heavy dews. Notwithstanding the day attains such a high temperature, 
the mercury just before day-light often sinks to 45°, causing a very uncom- 
fortable sensation of cold. 
But there are other localities which combine advantages equally important 
to the pulmonary invalid. On the eastern coast of Florida, at New Smyrna 
for example, the warmth and softness of the air wafted from the isles of the 
West Indies across the gulf-stream, in the winter months, are truly grateful 
to the senses lulling them into repose. Even the virtuoso would not be 
without materials for contemplation; for here may be seen the ruins of Dr. 
Turnbull's colony of Greeks, Italians, and Minorcans-his unfinished cas- 
tle, whose dilapidated and mouldering walls are covered with ivy, amid the 
luxuriance of the palm,f orange, mangrove, and magnolia. Cape Sable and 
the coast extending northward towards Key Biscayno, as well as the adja- 
cent islands, would also afford an excellent winter retreat. Adapted to the 
* This parasite, (Tilandsia usneoides,') known by the vulgar name of Spanish moss, 
casts a sombre aspect over the scenery of Florida. Resembling the weeping willow 
clothed in the garniture of hoary age, it has been styled, not inappropriately, the shades 
of death. 
t The cabbage-palm, (cltamarops palmetto,') is a beautiful tree, presenting sometimes a 
straight column of 80 feet without a limb. The trunk is generally enclosed by the foot- 
stalks of the old branches, resembling a coarse net-work. The embryo head is esculent 
bearing the taste of unripe chesnuts. The leaf is used in the manufacture of hats, 
mats and baskets, as well as in the construction of the Indian's wigwam. 38 
Forry on Pulmonary and Rheumatic Diseases. 
cultivation of tropicoid fruits, and abounding in game, fish, and turtle, this 
region, from the prevalence of the sea-breeze or trade-winds, presents a cli- 
mate delightful even in the summer season. Key Biscayno, which is situ- 
ated on the southeastern coast of Florida, affords an excellent harbour of 
safety and protection from the storms which frequently rage along the coast. 
This island is thus described by a medical officer of the army, when sta- 
tioned there six months:- 
" In the midst of summer, the constant prevalence of the sea-breezes ren- 
ders it at all times of the day delightful in the shade. During the winter, 
frost is never known; nor is it ever so cold as to require the use of fire. 
The eastern beach commands a beautiful view of the open sea, and offers, 
especially during low tide, an admirable place for exercise on horseback for 
the distance of four or five miles, and for morning and evening walks. The 
waters around abound in green turtle, and a variety of excellent fish, forming a 
wholesome and nutritious diet, particularly well suited to cases of pulmonary 
disease. There is also an abundance of crawfish and crabs. The mainland is 
only a short distance off", abounding with deer and a variety of other kinds of 
game, affording a fine field for the sport and exercise of hunting; and the 
vicinity of the West India islands will, at all times, present the opportunity 
of procuring the best of the tropical fruits. 
" The proprietor of the island will, in a short time, erect buildings, and 
will establish every means in his power for the convenience and comfort of 
those who may be disposed to visit the place for the recovery of their 
health. There has been not a single case of fever among the troops since I 
have been stationed here, and I have no hesitation in stating my opinion 
that it will be perfectly healthy at all seasons of the year." 
When not exposed to the influence of malaria, the climate of Florida, as 
along the eastern coast, is, even in the season of summer, quite salubrious. 
The sea-breezes, aided by the deposition of moisture from the atmosphere, 
generally render the nights pleasant, even in the hottest months and in the 
centre of the Peninsula. The writer can state from personal knowledge 
that after the middle of August the nights become so cool that a blanket is 
desirable. The climate of the tropics is characterized, as Humboldt justly 
remarks, much more by the duration of heat than its intensity; and it is to 
the action of this unceasing high temperature that much of the injurious 
influence of tropical climes on northern constitutions, is to be ascribed. 
But woe to the invalid that braves the torments of a summer residence 
under the disadvantages of a camp life! Insects are the pest of a tropical 
clime. As to fleas, flies, and ticks, the interior of Florida may well rival 
Egypt in the days of Pharaoh. The chigoes insinuate themselves beneath 
the skin, where they soon establish populous colonies. Flies seem, indeed, 
to form a component part of your food, your drink, and the atmosphere you 
inhale. Lizards, snakes, and scorpions, get into your bed, whilst the industrious 
ant and weevil not only eat your rations, but devour your books-the food Forry on Pulmonary and Rheumatic Diseases. 
39 
of the mind. All nature seems alive; and every hour you observe some 
uncouth living thing, whose family name has scarce been registered by the 
entomologist. In addition to these annoyances, you will have a nightly 
serenade performed by wolves and alligators-a woful concert of whining 
yells and dismal bellowings, constituting the realization of a hoivling wil- 
derness. 
Since a more rational view of the nature and causes of pulmonary diseases 
has prevailed, the beneficial effects of change of climate in certain forms have 
been fully established. Formerly, when consumptive patients were indis- 
criminately condemned to undergo expatriation, the unfortunate invalid often 
sank before he reached his destination, or he was doomed soon to add another 
name to the long and melancholy list of his countrymen, who seem to have 
sought a foreign land, far from friends and home, only to find a premature 
grave. When it is considered, however, that all remedial agents have proved 
so inefficacious in phthisis pulmonalis as to place it emphatically among the 
opprobria medicorum, it is no ways surprising that its victims should seek 
beneath the influence of a more genial clime, the relief, however uncertain, 
denied them in their own. 
The south-western coast of a country is generally mild and humid, and 
consequently soothing but rather relaxing. In diseases accompanied with an 
inflammatory condition of the general system, or dependent on an excited state 
of particular organs, this variety of climate has been found more especially 
beneficial. Decided advantage may reasonably be anticipated in chronic 
inflammatory affections of the trachea and bronchia, attended with a dry 
cough and little expectoration; but when such cases occur in individuals of 
a languid and relaxed state of constitution, accompanied by copious expec- 
toration from the mucous surfaces, the disease is much more likely to be 
aggravated than relieved. These remarks, which are made by Clark " on 
Climate," are equally applicable to all other diseases attended with great 
relaxation of the general system. It is, therefore, manifest that, in recom- 
mending a change of residence to invalids, attention to these distinctions, 
both in regard to varieties of climate and peculiarities of disease, is absolutely 
necessary. 
The climate of Florida has been found beneficial in incipient cases of pul- 
monary consumption, and those threatened with the disease from hereditary 
or acquired predisposition. It is in chronic bronchial affections more parti- 
cularly that it speedily manifests its salutary tendency. To distinguish the 
bronchial from the tubercular form of the disease, often demands considera- 
ble powers of discrimination; and upon this distinction frequently hangs the 
propriety of a removal to a southern clime. The application of the physical 
means of exploration, now so ardently cultivated, has fortunately given a 
greater degree of certainty to our diagnosis. 
But there are other forms of disease in which such a climate as that of 
East Florida is not unfrequently of decided advantage. To this class 
4 40 
Forry on Pulmonary and Rheumatic Diseases. 
belongs asthma. As this term is too commonly applied to every disease in 
which difficulty of respiration is a prominent symptom, let us not prescribe 
for a mere name; but when consulted on the propriety of a change of 
climate, let the pathological condition of the patient be duly estimated. In 
simple spasmodic asthma, unconnected with organic disease, or in that form 
which is complicated with chronic bronchitis, or is symptomatic of primary 
irritation in other viscera, such as the stomach, intestines or uterus, the 
patient is generally much benefited. In asthma connected with affections 
of the heart, a mild climate often affords temporary relief. In this variety 
of complication, a sea-voyage is frequently of striking service- 
in chronic disorders of the digestive organs, when no inflammation exists 
or structural changes have supervened in viscera important to life, but the 
indication is merely to remove disease of a functional character, a winter 
residence promises great benefit; but exercise in the open air, aided by a 
proper regimen, are indispensable adjuvants. 
In many of those obscure affections, called nervous, unconnected with 
inflammation, exercise and travelling, in this climate, are frequently powerful 
and efficient remedies. 
Chronic rheumatism, though apparently much less under the influence 
of meteorological causes than pulmonic affections, will often be benefitted 
by a winter residence in Florida. As these cases often resist the best 
directed efforts of medicine, it is the only remedy which the northern phy- 
sician can recommend with a reasonable prospect of success. When the 
disease is complicated with much derangement of the digestive organs, it is 
customary in Europe to visit such places as combine the additional advan- 
tage of a course of bathing, as the mineral waters of the Pyrenees, those of 
Aix in Savoy, and the various baths of Italy. 
When there exists a general delicacy of the constitution in childhood, 
often the sequel of rubeola or scarlatina, manifesting itself by symptoms 
indicative of a scrofulous disposition, a winter residence in a warm climate 
frequently produces the most salutary effects. At the period of puberty in 
females, a similar condition of the system often arises, preventing the de- 
velopment of those new functions peculiar to this stage of life. This general 
derangement, if not soon corrected, often results in a constitutional disorder 
beyond the resources of our art, denominated by Clark " Tubercular Ca- 
chexy, " the precursor of pulmonary consumption. If the winter can be 
passed in a warm climate, and the patient have the advantage of exercise on 
horseback, warm sea-bathing, and a well regulated diet, the youthful invalid 
may often be rescued from an untimely grave. 
Another form of disease remains to be alluded to, in which change of 
climate promises its healing powers, viz., premature decay of the constitu- 
tion, characterized by general evidence of deteriorated health, whilst some 
tissue or organ important to life commonly manifests symptoms of abnormal 
action. This remarkable change often occurs without any obvious cause, Forry on Pulmonary and Rheumatic Diseases. 
41 
and is not inappropriately termed in common parlance, " a breaking up of 
the constitution." 
Let not the invalid, however, trust too much to a change of climate. 
Unfortunately for the character of the remedy, it has been recommended 
indiscriminately and without proper consideration. It has been too often 
resorted to as a last resource or forlorn hope; or in cases susceptible of 
alleviation or permanent cure, it has been wholly misapplied. One person 
is hurried from his native land with the certainty of having his sufferings 
increased and his life shortened, instead of being allowed to die in peace in 
his own farmly; whilst another, who might derive much advantage from 
the change, is sent abroad wholly uninstructed in regard to the selection of 
a proper residence, or ignorant of the various circumstances by which alone 
the most suitable climate can be rendered beneficial. It is one of our most 
powerful remedial agents, and one too which, in many cases, will admit no 
substitute. But much permanent advantage will result neither from travel- 
ling nor change of climate, nor their combined influence, unless the invalid 
adheres strictly to such regimen as his case may require. This remedy 
must be considered in the light of all other therapeutic means, and to ensure 
its proper action, it is necessary that the requisite conditions be observed. 
At the present time, St. Augustine and Key West are the only places, 
which afford the conveniences required by the wants of an invalid; but 
assuming that proper accommodations can be equally obtained at all points, 
Key Biscayne on the southeastern coast, or Tampa Bay on the Gulf of 
Mexico, claims a decided preference, especially over St. Augustine. As a 
general rule, it would be judicious for the northern physician to direct his 
pulmonary patient to embark about the middle of October for Tampa Bay. 
Braving the perils of the wide ocean, he will realize the healthful excitement 
incident to the fears and hopes of a sea-voyage. Having spent the winter 
months at Tampa, let him proceed early in March to St. Augustine, by 
way of Dade's battle-ground and the old Seminole agency. In addition to 
the corporal exercise, he will find food for mental digestion at every step 
of his journey. Having thus reaped the benefit of a sea-voyage and all the 
advantages to be derived from a change of climate, the valetudinarian may 
return to his anxious friends so much renovated in health and spirits as to 
be capable of enjoying again the blessings of social life. 
As long, however, as predatory Seminole bands retain possession of this 
peninsula, few itinerant invalids will imitate the example of the celebrated 
Spanish adventurer, Ponce de Leon, who, in the wild spirit of the 16th 
century, braved the perils of unknown seas and the dangers of Florida's 
wilds, in search of the far-famed fountain of rejuvenescence. When the 
period, however, of the red man's departure shall have passed, the climate 
of this " land of flowers" will, it may be safely predicted, acquire a celebrity 
as a winter residence not inferior to that of Italy, Madeira, or Southern France. 
Fort Wood, Harbour of New York, September, 1840. . 1 of Appendix, showing the relative influence of the seasons in regard to Pulmonic and Rheumatic Diseases, based on 10 years'1 observations and an aggregate mean 
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119 Places of Observation. 
Yea 
Obser 
rs of 
vation 
Mean 
A nnual 
Temp. 
Mean Temp, of the Seasons. 
Mean Temperature of Each Month. 
Winter. 
Spring. 
Summer 
Autumn. 
Jan. 
Feb. 
Mar. 
April. 
May. 
June. 
July. 
Aug. 
Sept. 
Oct. 
Nov. 
Dec. 
Lat. 29° 50', Long. 81° 27'. 
St. Augustine, 
1825 
-8-30 
72.24 
62.83 
70.55 
82.05 
73.56 
62.15 
64.97 
66.53 68.68 
76.44 
81.12 
82.36 
82.68 
79.56 
73.61 
67.47 
61.38 
Lat. 29° 12, Long. 82° 12'. 
Fort Kina, ... 
1833 
-4 
72.66 
61.78 
72.56 
84.20 
72.08 
60.81 
65.28 
65.56 73.31 
78.81 
84.94 
84.03 
83.63 
81.52 
72.81 
61.98 
59.25 
Lat. 27° 57', Long. 82° 35'. 
Fort Brooke, Tampa Bay, 
1825 
-8-30 
73.19 
65.02 
71.71 
81.04 
74.59 
63.75 
66.56 
66.48 71.27 
77.39 
80.90 
81.43 
80.79 
79.01 
75.04 
69.71 
64.76 
Lat. 24° 33', Long. 81° 52'. 
Key West, - - - 
1831 
-2 
76.09 
70.05 
76.04 
81.39 
76.96 
67.93 
72.15 
73.71 75.69 
79.22 
80.51 
82.59 
81.06 
80.89 
76.76 
73.23 
70.08 
IL The Difference between the Mean Temperature of each Month and Season. 
3 
o i 
d S 
U 'c a.- 
- 5 £ 
« i£ = o Difference of the Successive Seasons, 
a E 
Difference of the Successive Months. 
< e. 
- • 
Ol 
o 
Of 
Of 
Of 
Of 
Jf o 
Of 
Of 
Of 
Of Of 1 o 
Of 
Of 
Places of Observation. 
_ s 
£ = = 
q5 a 
> Winter Spring Summer Autumn 
Jan. 
Feb. Mar. April May 
June 
July Aug. Sept. Oct. Nov. Dec. 
co 
- tggs 
■o c 5 q S and and and 
and 
and 
and a 
nd and and 
and 
and 
md and \ and ant 
and 
rt 
55 c 
5 5 55 
§5 55o Spring. Summer. Autumn. Winter. 
Feb. 
Mar. April May. June 
July. 
Aug. Sept. Oct.; Nov. Dec. Jan. 
St. Augustine, 
72.24 
19.22 21.30 3.55 7.72 11.50 8.49 11.41 
2.82 
1.56 2.15 7.76 4.68 
1.24 
0.32 3.12 5.95 6.14 6.09 0.77 
Fort King, - 
72.66 
22.42 25.69 4.28 10.78 11.64 12.12 10.30 
4.47 
0.28 7.75 5.50 6.13 
0.91 
0.40 2.11 8.71[ 10.83; 2.73 1.56 
|Fort Brooke, 
73.19 
16.02 17.68 2.97 6.69 9.33 6.45 
9.57 
2.81 
0.08 4.79 6.12 3.61 
0.53 
0.64 1.78 3.97 5.33 4.95 1.01 
jKey West, • 
76.09 
11.34 14.66 2.44 5.39 5 35 4.43 
6.91 
4.22 
1.56 1.98 3.53 1.29 
2.08 
1.53 0.17 4.13 3.53 3.15 2.15 
Places of Observation. 
1 Mean Annual 
1 Temp. 
Annual 
Range. 
| Mean of the 
I Monthly ranges 
Jan. 
Feb. 
Mar. 
April. 
May. 
June. 
July. 
Aug. 
Sept. 
Oct. 
Nov. 
Dec. 
| Range. 
1 Maximum. 
| Minimum. | 
| Range. 
| Maximum. 
| Minimum. 
| Range. 
| Max. 
c 
s 
V 
M 
tf 
| Max. 
c 
2 
| Range. 
| Max. 
c 
1 Range. 
* 
rt 
2 
c 
| Range. 
rt 
s 
s 
2 
bl 
tf 
CC 
<E 
c 
§ 
| Range. 
c 
j Range. 
* 
n 
2 
2 
bi 
c 
tf 
1 Max. 
5 
| Range. 
C3 
s 
c 
S 
| Range. 
-5 
St. Augustine, - 
72.24 
59 
93 
34 
23 
35 
78 
43 
30 
79 
49 
25 
78 
53 
31 
80 
49 
20 
88 
68 
17 
90 
73 14 
92 
78 
12 
91 
7914 
86 
72 
22 
82 
60 
22 
78 
56 
36 
77 41 
Fort King, 
72.66 78 
105 
27 
40 
50 
83 
33 
41 
84 
43 
48 
87 
39 
39 
93 
54 
33 
97 
64 
32 
105 
73 29 
102 
73 32 
104 
72 29 
99 
70 
50 
91 
41 
52 
82 
30 
43 
79 36 
Fort Brooke, 
73.19 56 
93 
37 
29 
34 
77 
43 
35 
81 
46 
35 
84 
49 
35 
87 
52 
23 
90 
67 
24 
91 
67 19 
92 
73 19 
92 
73 23 
91 
68 
32 
88 
56 
32 
84 
52 
40 
80 40 
Key West, 
76.09 37 
89 
52 
16 
23 
80 
57 
20 
81 
61 
20 
85 
65 
19 
84 
65 
15 
87 
72 
13 
86|73 11 
88 
77 14 
88 
74 11 
87 
76 
15 
85 
70 
15 
80 
65 
16 
78 62 
Abstract No. 2 of Appendix; showing, I. The Mean Temperature for each Month, each Season, and the whole Year. 
III. The Mean Annual and Monthly Ranges of Temperature.