sideration of the more advanced state of the disease, being the same as would be adopted at a later period of life, (allowance being made for difference in age and physical ability,) I may proceed at once to the treatment of this stage of phthisis in the adult. One of the first and most important objects is, to remove the patient from such scenes and associations as may have contributed to his disease: change of air and mental recreation, therefore, should be immediately advised, as, under their influence, the effect of other measures will be surprisingly enhanced. But it now becomes more necessary than before that these should be regulated by the season of the year, and the state of the invalid. When the patient's strength and inclination admit of travelling, this may still be had recourse to. To those who delight in the sea, nothing is better during the hot summer months than a sea voyage; but this should never be sanctioned when it may be feared that every pleasure might be marred by that most distressing of all troubles-sea-sickness, which has no specific action upon the disease, and would only tend to produce debility. More generally, however, at this stage of the malady, both the disposition and ability of the patient are better suited merely to a temporary change of residence. During the summer, and when the physical strength is yet tolerably good, and the cough but trifling, Ramsgate or Margate, or some of those places on the

eastern coast which are cooled by the refreshing breezes from the North Sea, are desirable places of resort; the southern or south-western shore being too relaxing. But when the patient is unable to breathe a moderately bracing air without fatigue or increase of cough, the latter are preferable; and Folkstone, Sandgate, St. Leonard's, Weymouth, etc., or the north coast of the Isle of Wight, may be selected. A bracing but not bleak air is, however, at this time, by far the best whenever it can be borne.

In the colder months of the year, the choice of residence is more limited: some moderately sheltered place upon the southern coast, or in some inland district, is now preferable; but when the strength is yet tolerably good, and the cough not excessive, the usual resorts of consumptive invalids, such as Hastings, Ventnor, and Torquay, should be avoided; for, besides the too great mildness of such places for those who may still be able to bear a more bracing locality, the daily sight of others more advanced in the same disease, very often tells sadly upon their spirits.

Although thus recommending the sea-coast, there are, I am convinced, so many inland parts of England quite as salutary, that the choice between the one and the other may be left entirely to the patient. There are some persons to whom the coast soon becomes wearisome, whilst there are others to whom it affords a never ending source of healthful

amusement; and it is upon considerations of this kind that the selection should rest. The sea air has been thought to possess a specific action upon tubercular diseases; but of this I think there is no evidence, whilst there are circumstances which seem to render it doubtful. Many patients, for example, in the first stage of phthisis, benefit far more by some active and rustic pursuit in the open country, than by the best selected sea-side residence. The great advantage attached to the seaair, appears to me to consist in the bracing climate, and the thorough and salutary change of every condition of life which generally accompany it.

The question of seeking a foreign residence now becomes a grave one, since, if entertained at all, it should be during this stage; for when the disease is more advanced, it will be found not only unavailing, but positively injurious. But I am firmly impressed with the belief that, even at this period, no advantage is to be obtained from the muchvaunted foreign climates, which cannot equally be found in our own native land. This subject, however, is of so much importance, and involves so many points the discussion of which would here be irrelevant, that I shall reserve it for separate consideration.

I have spoken thus early of change of air and scene, believing that it is amongst the most useful remedial agents at this and every other stage of phthisis, and, whenever attainable, should be the

one first adopted. In too many instances, it is beyond the reach of the consumptive patient. Much good, however, may nevertheless be effected by judicious regulations with respect to residence and occupation:-the close and unhealthy home may be exchanged or improved ;—the employment which has been hitherto so baneful, may be made less so by attention to sanitary laws;-and there is no one, however poor, who may not be benefited, to a greater or less degree, by attention to the same principles, which would be pursued, only to a fuller extent, by his more wealthy fellow-sufferers.

Fresh air and exercise form equally important parts of treatment. It was formerly the practice when persons had a cough, and were considered phthisical, to confine them to the house, or even to one room, and to avoid the slightest change of temperature, by carefully closed windows, and sundry other arrangements; but this has happily been almost dissipated, by the improved system of modern practice. Whenever the strength will permit, daily out-door exercise should be strictly enjoined. When walking would be too fatiguing, driving in a close or open carriage, according to the season of the year, may be substituted; but proper days and occasions should be selected, and nothing done which would induce exhaustion. If the temperature be low, or if the change of atmosphere should excite coughing, the respirator may be worn; but it is well not to have recourse to this, unless exer

cise in the open air is otherwise impracticable. I cannot but think that the constant habit of using respirators of any kind is quite as injurious, by making patients the more susceptible to atmospheric changes which they cannot always avoid, as their employment is frequently serviceable during the colder seasons of the year, and upon occasions of unusual exposure. Every case of phthisis, however, must be ruled by its own particular symptoms: I am far from advocating the indiscriminate use of out-door exercise, and am anxious only to express my conviction that, under proper regulations, it constitutes one of the most essential parts of treatment.

The diet is another important subject, and one very often misunderstood. From a fear of increasing the cough or exciting fever, many patients are scrupulously interdicted every kind of nourishing diet, and are fed upon what are usually and very significantly called 'slops'. In this In this way they become more feeble, the tubercular deposit increases, the softening process is accelerated, and, when too late, the error becomes apparent. Unless there should exist some inflammatory complication, or urgent dyspepsia, everyone at this stage of phthisis needs support, and should live generously, taking a full amount of animal food, as well as ale or porter or wine. Such a system of diet, far from aggravating the cough, generally lessens it; and although it may at first induce some slight fever