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importance of the skin, as a means not only of preserving health but also of remedying disease.

The diseases of the skin in the aged are the direct and manifest consequence of the degeneracy of its vascular system—the obliteration of many of its blood-vessels, and of those pores and ducts which give exit to its secretions—the harsh, dry, wrinkled, and discoloured condition so common, if it may not be regarded as in itself a state of disease, is assuredly the cause of painful and dangerous affections. If the blood-vessels of any part be entirely obliterated, and hence the circulation be wholly arrested, that part necessarily dies: and this occasionally occurs in the feet, constituting the disease known as the gangrene of old age; commencing in one or other of the toes, it slowly spreads from toe to toe, to the feet and inwards, until it arrives at a part, the circulation of which is still sufficiently vigorous to preserve its vitality: a line of separation then appears between the dead and living parts, and the former is cast off, (literally rots off,) or, as more frequently occurs, the powers of the constitution succumb, and the individual who has truly been dying by inches, sinks from the fruitless efforts of the constitution to get rid of the dead load.

Prurigo Senilis, an intolerable itching throughout the

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body,' is one of the most tormenting and irremediable diseases of old age. It appears to arise from a condition of skin in which great nervous sensibility exists, although the blood-vessels are partially obliterated, and the pores and ducts very much so. It is, perhaps, too, connected with a deranged state of the organs of digestion, and is by some writers attributed in a great measure to a diminished action of the kidneys.

Analogous with these affections, we may, perhaps, regard Carbuncle, which is not strictly a disease of the skin, but of the cellular membrane immediately subjacent. It is not peculiar to old age, but occurs then more frequently and is more dangerous than at any other period of life, because the local vitality of the parts is diminished and the restorative power of the constitution less vigorous than at an earlier period. In conclusion, I may state that I regard the important disease considered in the next chapter (tussis senilis, the old man's cough) to be intimately connected with, and perhaps largely dependent on, the harsh condition of the skin ; a vicarious action seems to be set up in the bronchial tubes to compensate for the absence of perspiration.

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| Various parts are covered with bran-like scabs, and in one tormenting variety named by systematic writers Prurigo formicans, a number of disgusting insects (a kind of lice,) appear on the skin repeatedly, even in spite of the most careful ablutions.

CHAPTER XII.

TUSSIS SENILIS.

A Severe chronic cough so commonly occurs in old age that it is well known by the name of the Old Man's Cough. It consists in a diseased condition of the smaller bronchial tubes, continuing often through many years, or getting much better or disappearing in summer, but recurring with increased severity when winter returns; or it will often prove fatal when, from imprudent exposure to cold, or from any other cause, active inflammation is induced. It is not a curable affection; and it is probable that any vigorous attempts at cure will rather do harm than good. The continuous and copious expectoration of thick mucus in the catarrhus senilis is to be regarded very much in the same way as the flow of matter from old ulcers, or any other accustomed discharge, as a safety valve to which the system has long been accustomed, and which, although it may be well to control, it would be unwise to" remove altogether. It is not improbable that it supplies in some degree tbe place of the per

spiratory discharge which the arid and harsh condition of the skin has put an end to.

The disease in its most usual form consists in a thickened subinflammatory condition of the bronchial tubes, which give out large quantities of viscid mucus, obstructing respiration, and inducing violent fits of coughing to get rid of it. During such attacks, the face is flushed, and the veins of the head distended; the sufferer gasps for breath, and catches hold of the nearest object for support and to assist his efforts; he seems in imminent danger of immediate suffocation or of apoplexy. After a time, a portion of thick mucus is detached from the bronchial tube and expectorated; the breathing becomes easier, the vascular excitement goes off, and the patient simply seems a little exhausted by the past efforts. Sometimes spasmodic affections of the bronchial tubes come on, especially on sudden changes of temperature, or on some imprudent exposure to a current of cold air. The paroxysm is then more of an asthmatic character; the patient gasps and pants for breath; there is great constriction about the throat; an open space and free air are sought for; there is not any constriction of the vessels of the head, nor flushing of the face, which is usually pale, nor is there any cough during the continuance of the spasm-indeed, as soon as the patient is able to

cough the attack is over, which thus ends, therefore, either in cough and expectoration or in a profuse sweating.

In such cases, the patient should be especially

careful to avoid sudden changes of temperature and

the breathing of impure atmosphere. He must

abstain from stimulating foods and drinks altogether—

from anything which may irritate or inflame the

bronchial surfaces, as they are already in a state of

chronic disease. This, indeed, is the chief reason why

the epidemic influenza is always peculiarly fatal to the

aged. The objects to be kept in view both by the

patient and his physician are—1st, to allay spasmodic

irritation; 2d, to avoid all exciting and irritating

agencies; 3d, to do everything slowly and deliberately,

and remain as much as possible in a moist, warm,

equable atmosphere; 4th, to promote the free and easy

discharge of the mucous secretion, and, if possible, to

diminish its viscidity and acrimony. This disease is

very frequently combined with organic affections of the

heart, and they mutually tend to increase each other,

the thickened and subinflammatory condition of the

tubes and the viscid secretion with which they are filled

impeding the freedom of the circulation, whilst the

want of uniformity and regularity in the force impelling

the blood tends to increase the bronchial disease.

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