Having then taken care to see that the patient is placed in a pure and wholesome atmosphere, and adopted means for securing the proper and healthy action of the skin; and having enjoined that the diet is sufficient, plain, nutritious, unirritating, and suited to the circumstances of the case; we must next direct attention to the clothing, and see that it is properly adapted to the climate and season of the year, so as to maintain a natural, healthy, and equal temperature of the body. Having ordered the kind of exercise best suited to the circumstances; having prohibited the immoderate or injurious use of ardent spirits and other stimulants; having carefully examined for and removed any syphilitic taint, if such should be found to exist; having made every effort to remove depression of the mind, whether caused by grief, or unnatural discharges; I then carefully inquire into the condition of the alimentary canal and the functions of digestion.

I agree with Sir J. Clark, that consumption is very frequently produced at the onset by a disordered stomach, which if we neglect, all means are certain to fail. This must be evident from the fact, that every part of the human body depends upon the stomach for nourishment. In a deranged condition of the stomach, the digestion is impaired, and the chyme, which is absorbed by the lacteals and taken into the veins, is deteriorated in quality, and when poured into the heart, and sent thence into the lungs, does not properly perform the function for which it was intended, and the weak organ naturally suffers. If it be the lungs, tubercles will be formed in them, and if the vitiation of the blood be continued, they will inflame, soften, and break down; or cavity will result, and then no treatment can avail. Should the lungs escape, and the brain be exhausted through incessant

mental toil, the head will suffer. There will be a constant pain in the head, tenderness of the scalp, a feeling of giddiness, deficient memory, flashing before the eyes; a sense of dull lethargy, heat at the top of the head, a tightness, like a cord binding, as patients sometimes tell me; and all those symptoms, which differ in different individuals, and which are too many and too minute to describe. If the head and the lungs go unscathed, the liver may become the seat of mischief. Then there will follow all that group of signs, which mark diseased liver. Perhaps the heart is the weak part. Then, palpitation, and an irregular, intermittent pulse, plainly indicate heart-disease. If neither the lungs, the head, the heart, nor the liver be affected, the evil may settle on the skin in eruptions, which are always difficult to remove; or the kidneys may become seriously implicated and diabetes supervene, a disease invariably springing from a faulty digestion; or we may have degeneration of the kidney with albuminous urine, or stone in the kidney or bladder. All these effects result from a vitiated state of the blood, occasioned by disordered digestion. Suppose two men were to receive precisely the same kind of injury upon the finger, the one a farm labourer having keen digestive powers, and the other a brewer's drayman in London with weakened digestion. In all probability, the labourer would recover in a few days with only the loss of his nail. Healthy blood would, in his case, be at once sent to the part to repair the injury. But the brewer's drayman, with his impoverished and impure blood, would be crippled for months, and the accident would in the end, probably, cost him a portion of his finger. It is similar in all cases. Without the formation of good blood, all means used will be futile. The stomach, then, ought to receive the first attention.

When the stomach is in a state of great irritation, indicated by a red tongue, I have found much benefit arise from hot fomentations. A towel should be well wrung out of hot water, and placed over the pit of the stomach, and covered with gutta percha, to prevent the slightest chilliness. This application ought always to be made, when the stomach is empty. It may be continued with advantage two or three times a-day, until all irritation has ceased. The diet should be plain, simple, and unirritating. Animal food ought to be given cautiously, and always decreased in quantity, if after it is taken there follows oppression. Wine and all stimulants should be strictly forbidden.

Cod-liver oil is a most valuable remedy in consumption, but the administration of it requires care. It ought never to be prescribed when it produces constant eructation, or causes pain and oppression of the stomach. Under such circumstances, instead of strengthening the patient, it only irritates the stomach, and bowels, and does mischief.

The condition of the chest may often be relieved by the following prescriptions:→

R.-Olei Morrhuæ viij

Sum. Cochlear.; amp. c. Mistur.
Sequent Cochlear. i larg.

P.-Acid. Phosphoric dil. 3ij

Tinct. Calumb. 3ss.

Syr. Zingiber 3vj.
Infus. Auran. C. 3viss.

R.-Morphiæ Acet. grij.

Mistur. Acacia.

Glyccirhin. purif. aa 3j.

St. Cochlear. min. urgent tussi.

R.-Acet. Cantharid 3j.

Mistur. Camphor 3ss.

ft. Liniment Pectori applicand.

In the treatment of consumption, as in all other diseases, I cannot believe in the infallibility of any one particular remedy. I have tried all the means so much extolled by their several advocates, and have been disappointed. Consumption, when it has reached the third stage, is incurable. In the earlier stages, it may be prevented; but this will certainly not be by a round of drugging; such as opium to relieve the cough; vegetable or mineral tonics to improve the appetite; purgatives to act upon the bowels, and Dover's powder to induce sleep. The daily use of medicine, so far as I have ever seen it, indiscriminately administered, never fails to produce a disordered stomach, and thus the healthy formation of blood is prevented, the source upon which, after all, we have to depend for the re-establishment of the constitution. Medicine is, no doubt, a most valuable and necessary agent in its place. But it must be used with the greatest caution, and prescribed only when the necessity is imperative.

In the early stages of consumption, change to a warm climate is often beneficial. The place ought, however, to be selected to suit the patient. Many unfortunate persons are sent to Madeira, when it would be much better for them to remain at home. My friend Mr. Wollaston, and his companion Mr. Law, who have so highly distinguished themselves by their researches upon the Island—the former as a naturalist, the latter as a botanist -quite agree with me, that great care should always be taken before recommending patients to that climate. The atmosphere is moist, and only adapted to certain cases of pulmonic affection. Algeria, again, which has, on the contrary, a very dry air, is very beneficial in the commencement of pulmonic affections; but, in their advanced state, it greatly hastens the destruction of the

lung. Indeed, when consumption has arrived at the third stage, it is cruelty to send a patient to any foreign climate. He is sent there, in most cases, only to die. No benefit can result. He is deprived of all the comforts which an Englishman can only procure in England. Those even in good health do not find it pleasurable to live with limited means in a country where the language is unintelligible to them; and it must be worse when there is the additional grievance of ill-health. The annoyances which are continually occurring counteract any good effects the climate might have. Much, I believe, may be done in England by judicious management. Torquay, the south of Ireland, and the back of the Isle of Wight-except in a few rare instances where the patient is in very affluent circumstances,-will benefit much more than a continental residence.

There is a form of indigestion (for distinction's sake I shall call it mental indigestion) which is a most fertile cause of great nervous disorder, and which, if neglected, often produces tubercular consumption. The persons who suffer from it are always those who have had intense anxiety of mind from some cause. Some pecuniary loss has been sustained; shares in some unfortunate railway speculation have proved ruinous; some mining operation, or some joint-stock company has failed, and brought excessive mental worry. Merchants engaged in risky speculations, and tradesmen with small capital obliged to compete with millionnaires, are especially liable to it. The mind is so constantly upon the stretch, that there is no time allowed for the requisite sleep and meals. Exercise, enjoyment, and relaxation, are placed quite out of the question.

The symptoms attending this form of stomach derangement differ entirely from those occasioned by intemperance