give him no occasion for rejoicing in his comparative exemption from consumption. Neglect of personal cleanliness claims a place amongst those irregularities of living which are connected with the developement, not only of phthisis, but of other diseases also. The skin is not merely a covering to the body, but one of its most important organs; regulating both heat and cold by its secretions, and cleansing the system of matters either superabundant or prejudicial. It is well known that any obstruction to the cutaneous functions involves a more or less increased activity of the pulmonary ones, under which, the lungs are supplied with an undue amount of blood, leading, frequently, to local congestion; and, it is obvious, that if this be coincident with a disturbed condition of the general health and a tendency to generate tubercle, we have the very circumstances most calculated to induce pulmonary tuberculosis. Trivial as this subject might, at first sight, appear, its importance is often practically illustrated in the effect of cold or tepid sponging upon incipient phthisis. When this can be borne, it often improves both the local and general symptoms, and becomes, in certain cases, a useful auxiliary to other treatment. Insufficient or improper food is too common an addition to other evils daily experienced by numbers of our working classes, and must contribute materially towards rendering so many of them the victims of phthisis. This cannot be better exhibited than in the table showing the influence of occupation, those who are proverbially the worst fed, being there seen to be the most numerous; thus, needlewomen, tailors, and shoemakers, whose sufferings in this particular are far greater than is generally supposed, constitute more than oneseventh of the whole number of cases.* It is, nevertheless, surprising to observe how apparently innutritious, and even scanty a diet is sufficient for the well-being of the body, when the general conditions to health are united with it. We see, for example, many of our agricultural poor subsisting upon a fare greatly inferior in every respect to that of numbers of the working classes of the metropolis, yet far excelling them in health and bodily vigour. The depressing habits of life which prevail in large towns seem, indeed, to be the chief agents in rendering a diet prejudicial which might otherwise be salutary; the organizing of new materials, and making them part of ourselves, depending, in fact, as much, or even * It is really the duty of everyone to discourage those cheap advertising establishments, where things are sold at a price which, to pay the seller, must starve the maker. It is recorded in Scottish ballad, that the Leith fishwomen are in the habit of meeting any observation upon the dearness of their fish, by the observation, "but they 're men's lives", thus signifying the risk in catching them. The tickets upon the cheap garments in many of our metropolitan shops, might very aptly bear the same words. more, on the healthfulness and energy of the system itself, than on the kind of material it has to work upon. Repeated inquiries of consumptive persons as to their previous mode of living, have led me to conclude that one description of food, has, in itself, no greater tendency to induce tuberculosis than another; and that those who, either from choice or necessity, are chiefly vegetarians, are not, on that account, more predisposed to consumption than are others who live principally upon animal food. A judicious combination of the two is unquestionably the natural, and consequently, the most proper diet; but it is astonishing how readily the digestive organs accommodate themselves to any particular kind of food, when the body is placed under the influence of healthy conditions. In the early periods of life, however, the function of assimilation is adapted only to the most simple and nutritious substances, and it is to this circumstance being overlooked, that the physician has frequent cause for tracing back to infant life the first germs of phthisis. Children, who are strong and vigorous, the offspring of healthy parents, may often be reared successfully by artificial means, or, as it is termed, "by hand"; but even then there is, I believe, a greater risk of immediate scrofula, or future consumption, than if nature's laws had been strictly pursued; for it is impossible for these to be so closely imitated as to ensure healthy growth, and afford a fair chance of escape from the diseases of nutrition. Nothing is so productive of scrofula as the artificial rearing of weak and sickly infants, or even of those who may appear strong and healthy, but whose parents are scrofulous or otherwise sickly; marasmus, hydrocephalus, phthisis, or some kindred affection, is likely to be the result, or, if the child should himself escape these, there is the prospect of a feebleness of constitution showing itself in a subsequent generation under some form of tuberculous disease. But the evil of improper feeding is not limited to infancy, it is witnessed almost as frequently in childhood and youth. Amongst the rich, thoughtlessness and over-fondness, and amongst the poor, ignorance and credulity, render many a child the early prey to consumption or to some form of scrofula. Pampering the appetite with substances innutritious or injurious-over-feeding-the use of a diet unsuited to the particular age-all act prejudicially, and predispose the system to such diseases, by substituting lowly organized materials for those highly animalized ones essential to the construction of healthy tissues. The fanciful, and almost fashionable habit of excessive abstemiousness adopted by many young females of the middle and upper classes of society, is also highly injurious, and not unfrequently passes, by insensible degrees, into confirmed phthisis. I have seen this happen where there has been no other cause to which the disease could be attributed: dyspepsia of an obstinate form has been first established; the healthy energy of the system has gradually been lost; and consumption has unexpectedly and rapidly followed. Inactivity is another irregularity of life which has often no inconsiderable share in developing the tubercular diathesis. Without properly regulated bodily exercise, the circulation becomes languid; the nervous system is depressed; nutrition is imperfectly performed; the old materials of the body are replaced by new ones of defective organization, and scrofulous matter is liable to be deposited. Amongst the higher classes, this is one of the most fruitful causes of delicate health; and I have seen many cases of threatened phthisis entirely recover, from nothing else than the use of regular and moderate exercise. In the lower and working classes, it is equally productive of evil; and by referring to the table already given, upon the effect of occupation, it will be seen how the sedentary character of any particular pursuit tends to augment the number of phthisical sufferers. Insufficient clothing, more especially over the chest, is popularly considered an active agent in producing phthisis, particularly amongst the poor; but, strange as it may seem, such an idea is not supported by observation. We have seen that those persons who obtain their livelihood in the streets of the metropolis, such as hawkers, out-door |