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been injudiciously sent to the schools of our metropolis.

The proper protection of the body from the influence of cold is never more essential than at this time, although, like other precautional measures, it is very apt to be overdone; a multitude of coverings, such as hare skins, leathers, etc., being not only unnecessary, but positively hurtful, by keeping the surface of the chest constantly moist with condensed perspiration. Flannel, which may be thinner in summer than in winter, habitually worn next to the skin, will answer every purpose, and form the best "chest protector" that can be employed. The daily practice of sponging the body, or even the chest only, with cold water, is a very good one, and tends to diminish any susceptibility to bronchial inflammation; but in many cases it cannot be borne, the vigour of the system being insufficient to bring about that healthy reaction which is essential to its efficacy and sometimes even to its harmlessness.

At this, as well as at a more advanced age, it is well to avoid, if possible, the use of medicines, and to depend entirely upon general measures. But when, in spite of these, the system continues feeble and relaxed, much good may frequently be effected by medical treatment. Steel, either alone, or in conjunction with some vegetable bitter, is frequently efficacious; the old vinum ferri, the ammonio-citrate of iron, and the citrate of quinine and

iron, are excellent remedies; but the syrupus ferri iodidi, or indeed any other form of steel, may be given with advantage. Cod-liver oil is often eminently successful either alone or in conjunction with iron or some other tonic, and the more so in proportion to the preponderance of scrofulous indications. The choice of medicines, however, must be entirely ruled by the circumstances of each individual case.

The age of puberty in those who have been previously delicate, is one both for anxiety and hope; as by this period either the health is so far established that the critical changes which are beginning tend only to confirm it, or else the new era of life is so ill-adapted to the physical condition, that disease, hitherto kept in abeyance, makes its appearance. It will be seen, on referring back to the table upon the influence of age, how greatly the frequency of phthisis increases about this period.

The choice of occupation now becomes a subject of importance; but after what has been already said upon this as a predisposing cause, the general principles which should regulate it must be selfevident. Everything having a tendency to lower the physical or mental energy should be studiously avoided. Neither a sedentary nor a too active pursuit should be selected; something intermediate, in which, whilst the mind is occupied, the bodily health is cared for, will prove the best pre

ventive to phthisical disease. Perfect idleness, unless indeed circumstances should absolutely demand it, will generally rather increase than diminish the danger. Large towns should never be chosen as places of residence; many of the healthy fall beneath their depressing influences, and experience shows but too plainly how fatal they become to numbers who might probably have attained an average age under the happier circumstances of a country life.

In addition to such general principles as are obviously applicable to every age, nothing, in the adult, is more effective in counteracting a tendency to phthisis than occasional change of air and scene; and when worldly position renders this practicable, it should always be enjoined. Travelling upon the continent, where new objects are constantly opening to the view, and dispelling the gloomy thoughts which result from, and aggravate defective health, should be especially recommended. A few weeks' sojourn in any climate where the warmth is tempered by sea-breezes,— or a sea voyage to some temperate region, at a season of the year when it can be enjoyed, will be found of much service to those with whose tastes they accord. Others, however, who are less disposed to ramble, need not on that account be the sufferers, since our own land will afford everything which change of air can accomplish.

It would be both tedious and unnecessary to

extend this subject. Enough perhaps has been said, to show how greatly the preservation of health and the avoidance of tuberculous diseases are within our own control; and that even when consumption is actually threatened, much may be done towards keeping it in abeyance, if not in actually escaping it.

196

CHAP. II.

TREATMENT OF PHTHISIS BEFORE TUBERCLE IS DEPOSITED.

It is at this very early period, the preliminary stage or dawn, as it may be termed, of phthisis,— that the success of proper treatment is the most frequent and conspicuous. And although the imperfect manner in which this stage is sometimes exhibited, as well as the shortness of its duration, may often prevent the timely interference of remedial measures, there is, nevertheless, in a vast number of cases, some opportunity of trying their efficacy.

During infancy, nothing is so important as judicious feeding; but since the management of this as well as of other points should differ in nothing from that already spoken of as applicable when tubercular disease is only threatened, it is unnecessary to say more upon this head. Good nursing, change of air, and such attention to the general health as common prudence would suggest, afford indeed the only chance of correcting this very early stage of phthisical disease.

As childhood advances, much good may be effected by strict attention to the diet and proper

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