any quantity of fatty matter, and to these the above recommendations do not apply; indeed, such can and do sometimes take cream, in addition to the oil, with benefit. Moreover, where much exercise is taken more fat can be tolerated. Bread, eggs, and farinaceous food naturally complete our dietary; but we cannot recommend cheese, as it is somewhat trying to the digestion, and may take the place of more nutritious material.

In cases of very advanced phthisis, when the intestinal canal cannot tolerate, or assimilate solid food, it will be necessary to have recourse to liquid nourishment, in the form of soups, beef-tea, or chicken, mutton, or veal broth, the various meat essences, and panadas, alternating the same with jelly, arrow-root, tous-les-mois, oswego, tapioca, sago, Iceland moss, and other articles of invalid diet, and these last, should be nicely flavoured with lemon or orange-peel, with orange flower or vanilla, so as to render them more tempting. Though we cannot go as far as Dr. Flint in the importance to be attached to the use of stimulants in consumption, yet we highly commend them when taken with food, and not alone, at odd times between meals, as is done by many persons-a custom more sociable than wholesome, and specially injurious to the stomach, for the gastric juice is thus stimulated to secretion, and having no food to digest, acts on the walls of the viscus, giving rise to flatulence and loss of appetite. When the meal time comes, the food is not thoroughly relished, and, on account of the waste of the gastric juice, imperfectly digested.

The two principal uses of stimulants in consumption are, firstly, to increase appetite and promote digestion; secondly, to stimulate the heart's action, and thus obviate the tendency to death by syncope.

For the last purpose it is only required in the very advanced stages of the disease; but in the first lies its

principal utility, the only drawback being that stimulants are apt to increase the cough and local irritation, but they are less liable to do so if mixed with water. As regards the choice of different kinds, much must depend on the state of the organs of digestion and circulation. If the patient be not of a bilious habit and the cough be not troublesome, malt liquor-in the form of bitter ale, table beer, or even stout-is a capital appetiser; but in case of liver disturbance, sherry mixed with water, or hock, or chablis, answers the purpose better. If the cough is at all troublesome, the amount of stimulant should be diminished, and sometimes its use discontinued altogether, but the least irritating to the chest appears to be good wholesome claret; Burgundy and port are rather too fiery for this purpose. Champagne is only to be employed in cases of extreme weakness, and then but for a limited period. Brandy, gin, rum, and whisky, are most useful in the last stages of the disease; but they are best tolerated when combined with nourishment, in the form of brandy and arrow-root, egg-flip, rum and milk, and other numerous combinations which the physician and nurse have to employ to ensure a proper amount of food and stimulant being taken by the patient. The custom of taking a cup of rum and milk in the morning, before dressing, is very beneficial to weak subjects. The thirst often complained of in the feverish stages of the disease may be met by iced toast-and-water, barley-water, tamarind-drink, seltzer-water, soda-water and milk, and other cooling fluids.

Let us now notice a few hygienic measures, without which the treatment of consumption would be incomplete.

Clothing. We need not observe that consumptive patients, who are more susceptible than others to the process called catching cold,' and in whom it often sets. up intercurrent pneumonia and bronchitis, should clothe

warmly, though not to such an extent as to produce perspiration or diseased fat.

The most important point to be attended to is the under-clothing, which for at least eight months of the year should be of flannel, lambs' wool, or some other woollen material, and should not only cover the chest completely, but also encase the whole body and lower extremities. The double-breasted lambs' wool jersey answers the purpose well, and should be worn with drawers of the same material, or of flannel, and with woollen socks or stockings. In the summer months a thinner clothing of merino may be substituted, but the change must be carried out with great caution. Over-clothing is also of consequence, more especially when the patient is driving out in a carriage; and in this particular he can hardly be too careful, for with a weak circulation, and but little means of exciting it, he must prevent the chilling effect of radiation from his body by wrapping up warmly in furs and rugs, and if this should be insufficient, by supplying extra heat by a hot flask to his feet.

Exercise. It may be safely stated, that, in all cases of phthisis, exercise in some form or other is beneficial, and the good derived where the patients are able to avail themselves of it, is very evident, as seen by the increase of appetite, by the quickened circulation, and the sounder sleep which so often follow when exercise is taken by the patient. Whether it should be of the active or passive kind, and what varieties of each are admissible, depends on the stage and type of the disease, and also on the strength of the patient. In the early stages, where the symptoms are not active, where there has been no recent blood-spitting, and where the cough is not hard or frequent, those varieties of active exercise are of most advantage which most effectually expand the upper portions of the chest, thereby bringing into play the upper lobes

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of the lungs, so generally the seat of phthinoplastic lesions; and by causing the blood to circulate freelythrough the pulmonary tissue, they prevent local congestions and fresh deposits, and aid materially in the absorption of old ones.

What are the varieties of exercise which best accomplish this end? Those in which the upper extremities are raised, and the muscles connecting them with the thorax brought into activity. When the arm is raised, the numerous muscles which arise from the ribs and are inserted into the bones of the upper extremity, e.g. the pectoralis major and minor, the sub-clavius, the serratus magnus, &c., in contracting, raise the upper ribs, and thus increase the size of the chest cavity. This necessitates the inspiration of a larger amount of air. Dr. Silvester has called attention to this important principle, and on it has founded his excellent system of restoring respiration in cases of drowning, narcotism, etc. He has also recommended a modification of it in the incipient stages of phthisis. The forms of exercise which carry out this principle are: rowing, particularly the pull and backward movement; the use of the alpenstock in mountain ascents; swinging by the arms from a horizontal bar, or from a trapeze; climbing ladders or trees. Dumb-bells, as commonly used, are calculated to develop the arms more than the chest ; and rather tend to depress the latter by their weight. Various special gymnastic exercises, of which there is a great choice now-a-days, may more or less answer the purpose; but there is one form which is particularly applicable to the object above mentioned, viz. the gymnast invented by Mr. Hodges. To make this instrument answer the purpose of a chest elevator or expander, it should be fixed, not, as it is sometimes done, at the height of the operator, but considerably above his head, in or near the ceiling, with the handles reaching

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down about to his shoulders, then, by holding the handles, and walking a few paces forwards and backwards, the arms are brought into a species of action, which, while it exercises the whole body, especially tends to expand and elevate the upper part of the chest.

Walking exercise, as a rule, does not work the upper extremities or raise the upper ribs, but acts generally on the system by drawing the blood to the extremities and quickening the circulation through the lungs. In mountain ascents and in fast walking the quickening of the circulation brings the whole lungs into play, and in this way the upper lobes come into full use. If the alpenstock be used in mountain climbing, the beneficial local effects of raising the upper ribs may be combined with the general advantages of walking. Walking exercise can be taken in all stages of phthisis, provided there be no active symptoms present. Even where cavities are formed, if there be no recent inflammation, a limited amount, and performed on level ground, is beneficial, but great care must be taken not to overtax the patient's strength.

Passive exercise may be used by the weak and delicate, even in advanced stages of phthisis, or when it is of the inflammatory type. Open carriage exercise, sailing, or being rowed in a boat, or carried in a hammock, are instances in all of which little muscular exercise is involved, and they may be considered as means of supplying a constant change of air, with the least fatigue, while their effect in improving the circulation and appetite, and in promoting sleep, is often very apparent. But even these make some demand on muscular and nervous power, and must not be carried to the extent of producing exhaustion in weak subjects.

Riding exercise, from the time of Sydenham, has been generally acknowledged to be peculiarly beneficial to consumptive patients who are strong enough to bear it;