The Last Resort

Vladimir Jankovic, “The Last Resort: A British Perspective on the Medical South, 1815-1870,” Journal of Intercultural Studies 27, no. 3 (2006): 271-298.

In this piece on British health travel to the Mediterranean, Jankovic aims to focus on the “…ways in which the medical reasoning and disease etiology impinged on the choice of resorts and regimens, and how such choice meshed with the broad understanding of the region based not only on the geographical and medical documents but also on its changing cultural stereotypes.” (272) He argues that medical opinion explained some aspects of health travel, but not all, as evidenced by the rapidly changing resort hotspots. Though Jankovic asserts that the “career of British climatotherapy… often drew upon the lay rather than scientific consensus and… often passed it verdicts in accordance to the Victorian environmental mores rather than observations, mortality tables or climatological statistics…,” he acknowledges the vital role that the “garb of impartiality and… use of scientific jargon…” played in legitimizing and differentiating different resorts. (272-73)

Explains how temperature was understood to be a determinant of environment-specific physiologies and moralities (environmental determinism) (275)

Some physicians (?) (Sir James Clark) were calling for a more “scientific” approach to health traveling, insisting that “the migration South ought to be based on the knowledge of climatic specificity and the taxonomy of resorts based on morbidity statistics,” but this taxonomy was only beginning to emerge in the 1830s. The prerogative to travel and choice of destination were considered primarily in the context of social factors; “fashion and custom ruled.” (276)

Jankovic touches on the “diseases of civilization,” which, alongside chronic physical illnesses like TB, skin diseases, kidney and liver issues, and cancer, afflicted many health travelers.

Similar to the book on health-seeking in the West by the guy from OU, this article touches on health travel as impetus for territorial/colonial expansion (277)

Science and statistics coming into resort therapy: “From the mid-nineteenth century…[n]ew medical researchers began to seek the attention of the public and the profession by using whatever (quantitative) observations they could put their hands on to dissect climatological hearsay which, in their view, had spurred a facile and unjustified veneration of Southern Europe among the deluded expatriates.” (281)
Use of data to find “truth” in accounts of therapeutic efficacy — attempt to base traveling for health on a scientific epistemology.
“For this emerging group of climatotherapeutic statisticians only a careful attention to meteorological conditions might dispel (or confirm) popular perception and determine which, if any, of the environmental factors could be identified as curative in landscapes of brighter sun, drier air, and warmer breeze.”

Anti-resort therapy science: Discussion of the counter-narrative (exemplified by the work of John Charles Atkinson and Thomas Burgess), which held climatotherapy to be a fad; Atkinson believed that “fresh air” didn’t help cure people and that traveling was dangerous. People were better suited to the climates from whence they came, and modifications in temperature exposure could be conducted in the home by wearing more or less clothes and using heaters, respirators, etc. “Such arguments made understandable the fact that eudiometry (the sciences of measuring the ‘virtue’ of pure air) and chemical analyses failed to discriminate…” between air/water from resorts and from inner cities. Both men used statistics to bolster their arguments against the effectiveness of warm climates on mostly TB. (283-285)

Jankovic uses a controversy over the salubrity of Madeira’s climate to delve into the role of science in determining health benefits/disadvantages. James Mackenzie Bloxam, who traveled to Madeira for health reasons yearly, wrote out against the scientists defaming the resort. “The thrust of Bloxam’s argument was to challenge the validity of scientific methods in identifying the influence of climate on disease, especially when independent means existed by which these influences could be demonstrated… [d]ata might be fictions made up by badly calibrated instruments, and read by people without qualification and experience.” Bloxam was bothered by the total reliance on “meteorological journals and quantitative science,” believing that it should be accompanied by “a clinical picture or patients’ own reports.” “Why use science…[when] common knowledge and personal feeling would suffice? Why call upon meteorologists when patients might be more qualified to pass the climatological verdict?” “Bloxam appealed to tradition and common sense. He thought that the practice of medical travel was sufficiently established to tolerate an ‘expert’ intervention from the outsiders like Burgess.” (288-289)
This is the same sentiment I see in early ads for ES. When science fails to explain therapeutic effects that have been witnessed, the inclination of those who have witnessed it (or just want to believe?) is to question the authority of science in the realm of therapeutics. Is not the patient’s experience a more important component to understanding therapeutic efficacy? Why bring in a scientist to determine the answer to a question that’s already been determined in a much more immediate, real way?

In the end, science (statistics) wins the battle. It gains authority in the field of climatotherapeutics. Despite these misgivings about scientific intrusion, Madeira was obsolete two decades later. Doctors quit sending their patients there. Mounting evidence of the resort’s failure to cure, and even exacerbation of, TB, lent credence to “the quantitative approach to… Mediterranean climatotherapy,” and its propensity to influence “…the medical profession’s judgement on the value of health travel…” “Scientific writers presented their case as a long-overdue audit of a complacent medical opinion that concealed professional idiosyncrasy, anecdotal evidence, and social prejudice. Climatologists staged a putsch using the weapon of impartiality.”

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