I do no not intend merely to imply that the mothers of illegitimate children are peculiarly prone to phthisis; but rather that, in the districts where the proportion is high, such a system of morals may be assumed to prevail as must extensively expose the female population to special causes of mental disquietude. The return for Paris, even allowing some deduction for its large foundling hospitals, is remarkably high, and the comparative female mortality of that city from phthisis is singularly predominant. You will agree

with me that, in any district most notorious for the number of children born out of wedlock, the women may be assumed to be least happy in condition, most exposed to hope deferred, unrequited affection, bitter ingratitude, and all the causes which tend to wither the heart of those whose life may be said to ebb and flow with their emotions.

With a view to test the correctness of the conclusion suggested by the few examples above given, I subsequently pursued the inquiry more extensively, and calculated from the Registrar-General's return for 1842 * the per-centage of deaths from phthisis in about twenty places in England, taken without any grounds for preference, as suitable for comparison; and in the table of particulars a column is introduced, giving the per-centage of illegitimate births in relation to the whole births, as registered in the same volume. The order of the places in the list is adjusted according to the excess of female deaths from consumption; and although, as might have been expected, the irregularity of proportion is considerable, the general tendency to diminution of the

* Sixth Annual Report of the Registrar-General.

figures in the last column, conjointly with corresponding reduction in the female mortality, is deserving of notice. In the last five towns the per-centage of female mortality is below that of the males, and is marked with the minus sign. Several contrasts, as for example, between Birmingham and Nottingham, exhibited by the table, will probably attract your attention. Various local peculiarities connected with climate, the kind of occupation, and the degree of education, must doubtless modify the results; but extended investigation deepens my impression that the circumstance to which I have specially alluded, is an important element, and at least one criterion of the conditions tending to swell the female mortality.

I place in a separate table four towns, which present remarkable peculiarities not in harmony with the usual rule:

The great excess of female deaths from phthisis at Stroud and Lincoln, and of male deaths from the same cause at Shrewsbury and Carlisle, is a circumstance well entitled to special investigation.

I extended a similar inquiry into the county sta

tistics, but the results were not sufficiently definite to require detailed notice on this occasion. It may be sufficient to mention that Essex, Herefordshire, and Norfolk, were among the counties most remarkable for female mortality from phthisis; whilst in Cornwall and Cumberland the excess of phthisical mortality is remarkably on the side of the men.

Whatever interpretation, as respects the question which I have proposed, may be attempted of the facts thus presented, there can be no doubt that the tables supply some interesting materials for reflection, in reference to the causes of consumption. Whilst, on the one hand, I cannot doubt the influence of mental depression in conducing to the establishment of phthisis; on the other hand, I cannot resist the force of evidence that cheerful impressions have considerable power in retarding the progress of the disease. I have observed that, on the whole, the patients improve more rapidly, and even that the mortality is less considerable, in the large wards under my care in this hospital, than in the small; although the space allotted is proportional to the number of patients admitted. Such a result is very different to what we observe in diseases associated with morbid poison, and even in epidemic disorders, such as influenza, in which the existence of any special virus is disputed. I may add that the favourable influence of cheerful associations has been most apparent among the female patients.

I would further remark that women, perhaps in consequence of some constitutional peculiarity, bear confinement to the house in phthisis, as well as in some other diseases, better than men ; while men, with certain

precautions, seem even in established phthisis to be the better for out-door exercise. Such a general statement requires no doubt to be accepted with due qualifications; and some discrimination is requisite to determine in any given case, whether exercise in the open air is safe and desirable. In cases which partake of an inflammatory character shelter is usually requisite; but in those which are characterized by a relaxed and debilitated condition out-door exercise is useful. In the recommendation of climates as appropriate to particular patients, I cannot but think that undue importance has been attached to trivial differences of temperature; and that the idea of special physical advantages assumed to belong to sea-side situations, owes its support more to prejudice than to evidence.

It is worthy of consideration, especially in prescribing for the class of patients before us in this institution, that much of the advantage anticipated from a change of climate may be secured by the use of the respirator. This ingenious contrivance, (for which we are indebted to Mr. Jeffreys, an accomplished member of our profession), by means of a suitable arrangement of metallic bars, allows of a free admission of fresh air, which at the same time it tempers and warms. It is important to remember that respirators may be required of different warming powers, according to the temperature of the season; that the medium power, adapted to raise the temperature thirty degrees, is appropriate when the thermometer ranges from thirty to forty degrees; and that the low power, which raises the temperature fifteen or twenty degrees, may be advantageously substituted when the thermo