The glandular enlargements, more particularly about the neck, which often complicate these cases, should be but little interfered with locally, especially when there are threatenings of tuberculous deposit elsewhere. I have seen the disappearance of strumous cervical glands in children rapidly followed by scrofulous disease in more important organs; and on the other hand, I have known the supervention of some glandular affection at once check the progress of tubercular disease in other parts. In a vast number of cases, enlargement of the absorbent glands is not really scrofulous, but secondary to some irritation of the mucous membrane, arising from defective health. Under such circumstances, the ordinary local treatment with iodine, etc., is very useful; but whenever it is dependent upon a strumous diathesis, general, rather than local measures are, I am convinced, both safer and more salutary.

As the mind reaches maturity, it constitutes a new and most important channel for treatment, and one which will be found oftentimes more effective than any other. I have seen greater advantage derived at this early stage of the disease, from change of thought, occupation, and external circumstances, than from any other measures; and it is owing quite as much to the comparative facility with which this kind of treatment can be pursued by the upper classes, as to differences in their mode of life, that the disease is in general less intractable amongst the rich than amongst the poor.

The temporary suspension, therefore, of the pursuit under which, whether as a consequence or not, the disease originated, should at once be advised, together with complete change of air and mental relaxation. If sailing be an enjoyment, a sea voyage will be beneficial; but equal advantage is offered by a temporary residence upon the coast, it matters not where, so that the situation be not hot and relaxing. When an inland position is more convenient, it may frequently be resorted to with equal prospect of benefit; but, whichever be selected, regular exercise in the open air, together with such occupations as divert the mind, will be found indispensable to its success. When circumstances favour it, nothing is better than travelling upon the continent, or, a short continental residence; but the invalid, under such circumstances, should be led to consider himself not as banished from, or unfit to live in his own country, but only as seeking health by sojourning in another. Wherever such advantages as these are denied by worldly position, the best must be made of the circumstances which present themselves, by periodical relaxation, daily exercise, and regularity of living; and it is astonishing how much may often be effected simply by these means.

However great may be the benefit thus afforded, it is likely to be increased, and rendered more enduring, by direct medical treatment: and much as the physician may have to regret, at a later stage

of the disease, the feebleness of the agents given for his use, he has now the privilege of frequently seeing their employment followed by the happiest results. The tonics and mineral acids, especially quinine, cinchona, calumba, iron, iodine, and the nitro-hydrochloric acid, judiciously combined, are often of signal benefit. Cod-liver oil, also, alone, or in conjunction with any of the preceding, deserves a high position in the list of remedies. Where there is marked debility, steel and quinine have seemed to me to be of most use; but where emaciation is the more prominent symptom, the oil has appeared most effective; their union, however, is always worth a trial. The iodide of iron, either in the simple form of the syrupus ferri iodidi, or dissolved in glycerine, is also an excellent medicine.

The diet should be plain and nutritious, and consist, in a great measure, of animal food. Wine or beer, in moderate quantity, should be included in the diet list; and I have seen conscientious scruples upon this matter overcome, on many occasions, with marked advantage.

Some

The preliminary stage of phthisis, thus treated, will, in not a few cases, entirely disappear. persons may be disposed to consider such an event as presumptive evidence of the malady never having been of a tuberculous nature; but I have so frequently watched a number of patients, having symptoms of a similar character-some into perfect

health, and others into confirmed pulmonary tuberculosis, that I am quite as satisfied of the curability of this stage of the disease, as of the facility with which it may oftentimes be detected.

· CHAPTER III.

TREATMENT OF PHTHISIS AFTER TUBERCLE HAS BEEN

DEPOSITED.

The First Stage.-Although it is during the preliminary stage that general and medical treatment are of most avail, yet even when this has passed by, and the lungs are decidedly implicated, all hope need not vanish. It has already been stated that the tubercular deposit may, in some cases, be entirely absorbed; that, in others, it may become "cornified" and harmless; whilst in some, it may so long remain quiescent, that but for a knowledge of the lungs still remaining tubercular, and of care being still necessary, the disease might fairly be considered as cured. In numerous instances also, where the result, unhappily, is not so favourable, material relief may nevertheless be afforded, and the fatal termination of the disease postponed. It must, however, be acknowledged, that the chances of recovery are, at this period, considerably lessened; and that by far too many cases rapidly advance, in spite of the best-directed measures.

The general principles of treatment to be pur