bodily disturbance, the former cannot become a fixture abode, a bore-we say it with perfect reverence-for in the mind until the corporeal powers are seriously impaired. Despine has well said that, "Les sensations physiques de plaisir et de douleur qui accompagnent les impressions de l'âme pendant les manifestations des sentiments et des passions, devaient donc avoir pour siége primitif un organe nerveux autre que la cerveau: c'est principalement aux nerfs du grand sympathique qu'appartient cette fonction; et, comme tous les phénoménes auxquels préside ce système sont indépendants de la volonté, les phenomènes de l'emotion le sont aussi." Psychologie Naturelle, Tome I, p. 439.* This being obviously the case, the ordinary exciting causes of emotional insanity, as fear, grief, anxiety, vexation, disappointment, etc., through their influence in depressing the functions of the grand sympathetic, must permanently impair the functions of the bodily organs ere the morbid effect of such exciting causes would be able to make a fixed and permanent impression on the higher cerebral centres. Griesinger, himself, has recognized this fact in admitting that when we are influenced by "external causes capable of exciting an emotion, *** very much depends upon these exciting, habitual or transient cerebral states which are excited by the bodily conditions, whether the emotion will be constant." It is obvious that in good health it would not become fixed, but be altogether transient, else we should all become insane at the loss of a friend, or go mad when crossed in love. Do we sufficiently appreciate, therefore, man's depenence on his organism, the lower organism, that part of his being which it was the fashion in times past to affect to despise, for sanity-for that without which life would be hardly worth the living? The pleasures of existence are so closely related to the things of time and sense, to love and appetite, joy and hate, getting and beget ting, that without them earth would be a barren and cheerless waste to the most of mankind. What perennial happiness is that which springs from the association of parent and child, husband and wife, brother and sister, friend and friend, kindred and neighbor! What lovely and exalting emotions are engendered of conjugal love! The felicity of maternity and paternity: the pleasures of the senses-of seeing, hearing, eating and drinking; the sentiment of love and worship, which contribute so much to ennoble the character and fill up the cup of life's joys. These are the things that render life a boon of priceless value; that make a heaven for man on earth. Nevertheless they have an originthey take their rise, receive their inspiration, from his bodily organs, chiefly in his viscera, unpoetic as is the idea! We may becloud our faculties in tracing the phenomena of reflex" and "automatic" actions, and confuse the meaning of the grand facts of our earth-life with learned disquisitions upon this function or that process; but then, when we have succeeded in reducing the phenomena of organic life to that of a machine, less simple and cunningly devised than that which turns brass into wires and wires into pins; or that which records the fluctuations of the gold market with such marvellous skill and rapidity; the truth is reflected back upon us, with something like its old force and significance. that within man's body-we might properly say his abdomen-springs that depth of feeling and wealth of emotion which makes healthy human life the supreme joy and satisfaction it is. A heaven, in which the sympathetic system and its dependenciesthe abdominal viscera--are excluded, would be a dreary "The physical sensations of pleasure and pain which accompany the impressions of the soul during the manifestations of the sentiments and passions, must therefore have for their primitive seat a nervous organ other than the brain; it is principally to the nerves of the grand sympathetic that this function belongs; and as all the phenomena over which this system presides are independent of the will, the phenomena of emotion are so also." Mtal Pathology, etc., p. 57. any soul worthy of immorality. Let those deride the body and put off its crowning, therefore, whose faith is conserved thereby, but its symmetry and harmony, organic and functional, must be preserved if the kingdom of heaven is ever to be established upon earth! The more one observes the phenomena of human life and studies the influence of the graud sympathetic upon them, the greater importance must one attach to the preservation of the normal condition of the corporeal organs. We very much doubt if bowels ever yearned with compassion, whose condition was abnormal. While, on the other hand, a well-developed, healthy viscera is the source of more inspiration that is truly divine than the people commonly suppose, we would have no one believe that the visceral organs are the exclusive source of divine inspiration. But we like to see inculcated an increased respect for that kind of inspiration which comes from sound visceral organs. So close an analogy is there between a man's moral philosophy and the state of his abdomen, that one can make a diagnosis of the latter from an examination of the former. Does not the sulphurous philosophy of John Calvin bespeak the yellow skin and stunted form of that small-livered man? Do not the sermons of a Beecher, an Edwards, or a Bethune indicate striking peculiarities of organizations. "On the other hand, he whose moral teaching partakes of the tints of the sunbeam is full of beautiful prophecy, of loving and merciful sentiments, has good digestion, to say the least, though his brain be below mediocrity. He is the successful preacher, albeit his inspiration may come from beneath his diaphragm. The large abdomened preacher is generally the one that draws the crowd and pays off the church debt, though he be devoid of a moral philo sophy of logical consistency, and can read neither Calvin nor Chrysostom in the original.” * It will be obvious to every one who reflects upon the bearings of this subject that physical disease is a unity, having two sides. It occurs to us that physiciansespecially those of the very old school-we believe there is no new school in medicine to-day--are accustomed to view disease from one side only-the objectivephysical. Thus have they divided diseases into two great kingdoms, according to their location. If in the head, and confined to the sensorial centres, it is psychical. If elsewhere, it is physical. This is a very grave error--which is due to over-absorption in the details of practice rather than to a lack of comprehending the subject-an error against which Samuel Hahnemann, the peer among peerless physicians, expressly--to his lasting honor be it said though as it seems, vainly, guarded his followers and coadjutors. Let us reaffirm that all the phenomena of a living body are altogether psychical; in health, normal; in disease, abnormal, but still psychical-and we may say, still physical, for the twain are one and inseparable. The division of the phenomena of health and disease into physical and psychical is a convenience for the benefit of the observer. In actual observation, and when dealing with either class of phenomena, normal or abnormal, care should be taken to reunite the physical and psychical phenomena of each class into one totality. The medical observer will often get a clearer insight of the etiology of organic disorder if he brings to his aid the so-called reflex symptoms, the psychical phenomena exhibited by it, and which are characteristic of the disorder under observation, and be able thereby, it is believed, to cure a malady, or at least to comprehend it, when otherwise he would fail to do either. Griesinger has observed that the anatomical changes which indicate insanity, that is, which produce psychical anomalies are naturally to be sought for within the cranium, in the brain and its membranes. If it be true Divine and Human Agency.-National Quarterly Review, April, 1878. When we remember that these words of Professor Griesinger were penned more than thirty years ago, it must materially increase our admiration of the rare sagacity and scientific spirit which animated the soul of this great German physician. His prediction has very naturally come true. Pathologists of to-day are able to descend into anatomical minute to a degree which would have amazed a Pinel, or an Esquirol, or even the Griesinger of thirty years ago. But even now, with their finer aids and facilities of observation and their vastly increased knowledge and appreciation of morbid molecular changes, he would write himself down an idiot who would claim that the last degree of molecular analysis had been reached, and that there were no greater depths in that direction to which the microscope could conduct the human mind. Nevertheless, a position has been reached in the department of the morbid anatomy of the brain, when the pathologist may confidently assert, without fear of contradiction, that mania and abnormal changes in the brainsubstance or its vessels are constant concomitants of each other. Analogy, long since, forced this conviction upon the medical mind, but the proofs have come with paintui slowness. The scientific spirit, however, can wait for verification. Like the Eternal, whose child it is, science is in no hurry with its processes, and can afford to advance slowly and with infinite patience. that structure and function are coexistent and inter- vestigation to which they were confined. We must dependent in pathological, as we have seen that they consider," says Griesinger, "how easily many very are in physiological, phenomena,* we should naturally minute but important changes-even exclusive of those expect to find the proximate cause of all disease to which are only microscopically appreciable—may elude consist in abnormal changes of structure and function mere ordinary attention; and we ought, as a rule, to in corresponding parts of the physical organism. And accept statements regarding the normal, or abnormal, this is true no less in so-called psychical disease than condition of the brain from those only who, by the in so-called physical disease. In those forms of insanity, whole spirit of their writings, show that they are actherefore, which involve the derangement of the cere- quainted with pathological anatomy, that they acknowlbral substance, the proximate cause of such derange-edge this pre-eminently, and that they know what is to ment may be confidently looked for in the seat of those be looked for and what is to be esteemed." Then he functions, or in parts in intimate. sympathy with it; for observes that recent discoveries of previously unknown if psychical anomalies can exist independent of the changes have added new light on the pathological condition of their seat and source there is no basis for anatomy of the brain, and adds: "Just as we know psychological medicine, and the magnificent super- for certainty that much that is important was overstructure bearing that name, which the centuries of looked by the older investigators, so may we anticipate industrial research have reared, must fall to the ground still greater results from still more searching and minfor the want of a rational support and be again suc- ute investigations in the future."* ceeded by that horrible nightmare in philosophy-de monology-and the sooner the better. Nor is this result all that would follow as a logical sequence of the independence of psychical disease of the physical environment. The revival of the belief in bodiless forms, spooks, spectres, spirits, angels, imps and devils, would naturally revive imposture medicine and bring back to mankind the sorcerer and conjurer. The doctor would be compelled to give way to the priest; physic to charms; the pellet to the amulet; the appliances of art to prayers and invocations. For mania, we should have possession of an evil spirit; and the idea of medicine for a mind diseased would become an absurdity as great as it was in the time of Shakspeare. If we have securely ridden ourselves of the influence of this spectral philosophy in interpreting the phenomena of living beings in disease, as well as in health, it is due, permit us to observe, to the growth of a belief in the invariable certainty of the relation of cause and effect in the human economy and the adequacy of reason to interpret that relation. Many forms of insanity, notably melancholy, hysterical, and cataleptic mania, are not local disorders, or if local, they are identified with bodily disease in the first place, even if the brainsubstance and its membranes become involved in their later stages. Idiopathic insanity, or psychical derangement, involving the organs and functions of the higher nerve-centres, the seat of the moral and intellectual powers, must, we believe, depend on abnormal changes in those centres, either functional and temporary, or organic and permanent. Careful dissection of the supposed seat of those centres has not always revealed the existence of such pathological changes, it is true. But how much such failures are due to the want of the means of detecting them; or of sufficient diligence and skill in the search for them; or of knowledge adequate to recognize and appreciate them; or to all these causes together, it is difficult to decide. The progress of discovery in this direction within a few years, since the invention and perfection of the microscope and other instruments of diagnostic investigation, is such that we may reasonably assume that the repeated failures of the anatomist to find the proximate causes of mania in the brain were due to errors of observation, and not to the absence there of those causes. Then, when we reflect how wonderfully delicate are those I nerve-cells and nerve-fibres, of which the cortex and medullary of the brain are constituted, and how slight are the molecular deviations requisite to produce psychical anomalies, we cannot think it at all surprising that even such observers as Pinel, Morel, and Esquirol should report cases of serious mental derangement occurring in persons whose brains were apparently sound. The surprise is rather that they were able to detect pathological changes in the cerebra of so many of the insane, in view of the inadequacy of the means of in | Schroeder van der Kolk, after an experience in the study of pathological anatomy of more than thirty years, says that he does "not remember during the last twenty-five years the dissection of an insane person who did not afford a satisfactory explanation of the phenomena during life." "On many occasions," he continues, "I was able accurately to foretell what we should find." Maudsley's experience in the same direction, however, evidently does not justify him in making so strong an assertion. He writes: "The cases of chronic insanity, in which all anatomical lesions are wanting, are rare. The longer the insanity has lasted the more evident they usually are." Nothing could be more natural; but between a lesion, or a perceptible morbid change in the brain tissues, and a morbid molecular change in them, there is an infinity of distance; and the inference is perfectly logical that, at the outset, or in the small beginnings of the disease, before even the symptoms of it were sufficiently prominent to excite apprehension, much less alarm, the local morbid changes might be absolutely unrecognizable, even were the brain of such a person open to inspection. By means of the ophthalmoscope, however, many minute pathological changes in the nerve-tissue in such cases are recognizable now during life, which before were impossible. The condition of the brain and the tissues of the ence * Mental Pathology, etc., p. 409. + Minute Structure and Funct on of the Medulla Oblongata, P. 231. Cited from Maudsley's Physiology, and Pathology of the Mind, p. 392. phalon in acute insanity affords the most conclusive testimony in support of the physical character of psychical disease. Even in cases that do not disclose some defect, lesion, or malformation of the membranes of the encephalon, or of the ganglionic bodies associated with the structure of the hemispheres, there is constantly to be found hyperæmia of the pia mater and arachnoid sometimes inflammation of both these membranes; discoloration and extravasation of blood in the cortical layer, or gray substance, and frequently softening. The white substance of the brain discloses, also, the same hyperæmic tendency in the manifest increase of the puncta vasculosa. Dr. Maudsley has reported a case of acute insanity of which dissection showed some of the above characteristics. The arachnoid, however, "was slightly clouded, like glass gently breathed upon, and streaked with a delicate milky opacity along the lines of the vessels, while it was bulged at the sulci by a clear, serous fluid beneath."* The author regrets that the examination of this case could not have been carried further by a competent miscroscopist. Fiad it been, he feels certain that the cortical gray, the supposed ideational substance, would have exhibited the same, or a similar hyperemic condition. There is something peculiarly significant in the fact that mania, whether acute or chronic, is so generally associated with disease of the serous envelope of the brain, involving at the same time, of course, the pia mater, which lies in close contact with the cerebral cortex, or dome of thought, and supplies its circulation. The anatomical relation of the par ́s show conclusively that the effect of any deviation on the part of the arach noid and pia mater, especially the latter, from their normal condition, would be at once reflected upon the cortical substance, and naturally interfere with the harmonious play of its function; thus deranging the normal procession of ideas, and inducing morbid fancies or wild delirium, so characteristic of insanity. The strange fancies or actual delirium which are such familiar concomitants of simple or inflammatory fever, find, in the intimate sympathy of the pia mater and the cortex, or gray substance of the brain, an easy and sat isfactory explanation. The same fact also explains, in a manner equally conclusive, why insanity may exist, in its early stages at least, and leave no visible trace of its presence in the cerebral substance; its functions only being impaired by disease of its contiguous membranes, the adjacent ganglia, or the connecting commissures. Indeed, the sympathy Between the cortical substance and the pia mater is so close, its dependence cn it for nutrition and molecular life even, we may say, is so great, that its function could not but be greatly influenced, or entirely controlled by the condition of that vascular envelope. And Griesinger declares, on the strength of the facts brought to light by autopsies of the insane, "that the most important and most constant changes in the insane consist in diffuse diseases of the external layers of the cortical substance- that is, of the surfaces of the brain and of the membranes covering them." In the encephalon of the chronically insane, how ever, as well as the incurably wicked and depraved, every form of malformation is found to which living tissue is liable. Osseous tumors of the cranial bones; stalactites and exostoses of their plates and internal surfaces; hypertrophy and induration of all the membranes of the brain; atrophy, induration, anæmia, extravasation of blood and softening of the medullary substance; cysts, tubercles, cancer growths and cystircercuses within its substance; fatty degeneration, etc.; atrophy, thickening, distortion, malformation, or entire absence of the corpus collosum and other commissury bodies; the pineal and other glands; the various ganglia of the brain; atheroma, rigidity, calcification, and aneurisms of the arteries, both large and small, even of * Physiology and Pathology of Mind, p. 347. + Mental Pathology, e c., p. 411. The italics are his. the microscopic arteries; thrombosis and contraction of the sinuses; fibrous deposits; incomplete, distorted, and unsymmetrical development of the hemispheres and their convolutions and sulci, etc., are a few of the pathological degenerations found within the cranium of those unfortunate creatures who have died insane. The list, partial and incomplete though it be, is more significant than entertaining. Let no one suppose, moreover-among the unsophisticated in medical subjects, we mean-that lesions, or malformations in insanity are confined to the head. He who is insane in the head, is insane all over him— deranged and distorted in every part. We do not now refer to, nor include, those cases of acute mental derangement which so frequently supervene upon adequate exciting causes-causes which would rack and cause to totter in its dome the reason of the strongest : but to those cases of idiopathic, constitutional insanity, of which the asylums are full to-day. Their bodies as well as their brains are abnormal in every part; and herein is the important lesson of our essay. Even those cases of monomania-cases of mere eccentricity of character, have generally some want of symmetry in the contour of the physique. It may be of small importance by itself; it may consist, for example, of stubbed fingers; distorted or ingrowing nails; growing together of the toes; turning in of the toes in walking; a noticeable difference in the halves of the body, of the head, limbs, etc. These physical peculiarities are common to eccentric people the world over, and we have seldom failed to discover something of the kind in them when we have had an opportunity to look for it; and, in general, the graver the form and degree of the eccentricity, the graver will be the physical defect. The pronounced insane, and those viciously wicked people who fill our jails and penitentiaries, and the hosts of other people in society, who, if they had their just deserts, in the superficial estimation of their judges, would be in jail—if enough jails there were to hold them-are physically disordered and malformed. There is a want of symmetry in their bodies everywhere; a decided deflection from the ideal type of the human form, quite noticeable. The muscles are frequently unequally developed the skin is wanting its normal sensibility and texture; is often coarse-grained, with copious development of moles and hair; wanting in delicacy of sensation, and is not unfrequently anæsthetic. The special senses are likewise affected--sometimes preternaturally acute, or dull, sometimes entirely wanting. The structure of the eyes is imperfect, and the eyes often possess unequal sight, one being myopic, the other presbyopie. Other peculiarities, as strabismus, squinting, opacity, cataract, etc.. may be frequently observed. Not unfrequently, also, may be found deformed joints, deformed nails; cars disproportionately small, or disproportionately large; congenital varices; nævuses; hair-lip; cycosic excrescences; wens and warts; a superfluity of fingers; unequal length of the limbs; unequal size of the hands and feet. Sometimes all these members are abnormally small; sometimes they are abnormally large. The physiognomy is inharmonious and graceless. Then, there is often to be observed a want of the full power of muscular co-ordination, which destroys the harmony of gait and manner. The walk may be shuffling and awkward, wanting in grace, ease, and elasticity. The hands unwieldy and acquire dexterity or cunning with difficulty. There is stuttering, or confused speech; an uneasy, restless eye; an unsteady, faltering, purposeless movement; or a quiet, dull apathetic manner. With these external marks of bodily dissymmetry, if we may use the word, are generally found internal defects in keeping with them. Some of the organs are preternaturally large; others preternaturally small. Defects of the sexual system are very common. Displacement and other abnormal changes of the womb, ovaries, and of the testes, with unequal development of appointment; whatever be the condition of our body, healthy or diseased, deformed or symmetrical, sane or insane, no labored argument is required to satisfy the reason of men of learning to-day, that the human body, like the universe, of which it is the epitome and evolu tion, is under the laws of mind, and is in form and substance mind's supreme incarnation and visble embodiment. them, or absence of some of them, are not unfrequently vivifying all the sensibilities. It is capable of restoring met with in the eccentric or insane. Then, there are life to the infirm and renewing the youth of the aged. atheroma and aneurism of the arteries; malformation of Whatever be the circumstances under which we live, the heart and its valves; tumors in the stomach and intes-joy or sorrow, adversity or prosperity, success or distines, worms, chronic diarrhoea, or inveterate constipation, etc. But the most common and constant defect of the viscera in insanity is tubercle in the lungs. All observers agree, so far as we know, that tubercular consumption of the lungs is the most common corpo. real disease with which the insane are afflicted, and, indeed, the most common cause from which they die. We have seen many cases in private practice that we believe were saved from insanity only to die of con sumption of the lungs. Were it possible for these physical anomalies to subsist in the absence of corresponding psychical anomalies, one might conclude, with some show of reason, that the mind or soul of man was independent of, and sustained an existence apart from, its environment or visibility. The truth is, the twin anomalies are never dissociated except under certain exceptional circumstances, susceptible of an explanation entirely consistent with their essential unity. In conclusion, we observe that if additional evidence of the mutual dependence of mind and matter be required, it is afforded by the phenomena of growth, maturity and decline. Mental and physical develop in perfect accord, from childhood to old age. The immature mind is invariably associated with an immature body; mental defects with the defects of the physique; and if, by reason of disease or accident the development of the cerebrum is arrested, the powers of mind are arrested also, as shown in the case of anIt has been urged in contradiction of this doctrine of encephalic idiots, several instances of which have been the independence of mind on the physique, that in cited in the course of these pages.* Not only in brainmany and well attested instances, individuals of infirm less creatures, but also in creatures whose brains are bodies have possessed extraordinary mentality. And conditioned well or ill, does one observe a correspondsuch instance would seem, at first view, to be inconsisting degree of mentality. The feeble-brained lad is ent with the physiology of the subject. But the incon- proverbially stupid; the "brainy" lad is quick-witted, sistency is more apparent than real. Instead of being and if he be precocious his physique affords abundant an injury, it not unfrequently happens that a so-called evidence of the fact, as well as reason for it. physical disease is of signal benefit to one's mental powers. Novalis was a stupid lad until after a course of fever; and his poetic genius was never so brilliant as when he was dying of consumption of the lungs. Theodore Parker's experience was not altogether dissimilar; and the mind of the celebrated Pascal was relieved rather than burdened by bodily infirmity. Similar examples might be adduced in great numbers; and they go far to show the kindly intent of nature in the institution of disease and in guiding its directionproducing a local affection to relieve the economy of a constitutional disorder. In cases, for example, of a tubercular diathesis, consumption of the lungs may afford its victims a happy escape from a worse fate that of mania. Discase is never an unmitigated evil; given the requisite conditions, it is, indeed, never an evil. It is always a sequence rational and legitimate in its institution, and of course, wisely conservative in its results. The limit of our space forbids that we should, in this place, reverse our procedure and show the morbid influence of a deranged cerebro-spinal system on the corporeal functions. Everybody knows the withering influence of grief, how it dries the very bones; the effect of fear, how it bristles the hair, reduces the temperature, and paralyzes the sympathetic centres of the heart; of anxiety, how it arrests the secretions and wrinkles the skin; of remorse, how it consumes the body as with a never-ending tire; of disappointment and thwart ing of the affections, how life's warm currents are checked in their course, and the natural tendency of life's energies reversed by it. All nature within one, when hope is fled, engages in as slow persistent suicide. Joy reverses this process, bringing back the heart's action and restoring the respiration; while jealousy, it is said, produces spasms in the heart and chest, and anger gives rise to the premonitory symptoms of appoplexy. Witness," says Feuchtersleben," the storm in the veins of the angry one; his inflamed countenance, his gasping breath, his beating pulse, wild expressions and all the premonitory symptoms of appoplexy!" Fear blanches the cheek and dispondency slows the respiration and the pulse-beat. Shame causes the cheeks to blush and the eyes to drop. The influence of love, on the other hand, is like an exhilirating elixir, Dietetics of the Soul, p. 106. In maturity the physique has reached the zenith of its development, and the mind attained the height of its powers. From this point decline of both begins. And while it is true that, for obvious reasons, all the faculties and powers of the mind do not equally lose their vigor with the decline of the physique, it is true that the decadence of mentality as a whole, keeps even pace with that of the body. The advance of old age brings signs of decrepitude. The special senses become dull; the eyes lose their ordinary keenness of sight; the hearing is less acute; the smell is impaired; the taste is blunted; the touch fails. With these obvious signs of decay come impairment of the functions of digestion and assimilation. The form bends as if under too heavy a weight; the complexion loses its freshness; the skin becomes too large for its contents, and hangs in wrinkles here and there, showing the outline of the muscles beneath. These part with their tone, and the form which they support loses its suppleness. these processes are advancing, the mental faculties show evident indications of sharing in the general decline. The memory is less retentive, and loses its sensibility to impressions. The animal instincts decline and die. The reasoning powers, perhaps the last to feel the approach of life's great enemy, death, possess less force and grasp, if they do not fade out completely before the final dissolution. Should disease invade the organism, and involve the brain or its meninges, the light of the mind goes out prematurely. The unhappy victim of brain-softening loses while he yet lives, moves, and has a kind of being, that which was his chiefest and most distinguishing glory-mind. While While these things are self-evident, their significance, strange to say, is very generally misapprehended. It is customary to transpose the relation of cause and sequence in respect of the relation of mind and body, and to place that second which, in the order of nature, is first. If brain be regarded as a mere instrument for the manifestation of mind, played on by mind as one plays on a musical instrument, as we are too often told, and does not of itself co-ordinate such manifestations, we may reasonably pause to wonder why the flaccid brain of an infant should not furnish a more flexible "instrument" for the mind to play on than the cumbersome brain of the sturdy adult? * The Monism of Man. National Quarterly Review. December, 1876. In view of all the facts, interpreted by the light which science reflects upon them, he "instrument" hypothesis, we fear, will have to go where so many other similar hypotheses have gone. If infancy ever exhibited the mental strength of maturity; if a babe in the arms were ever capable of calculating an eclipse, or making an induction from observed data; if the genius of a man of average intelligence were ever discovered full-orbed in the cradle, then might we logically conclude, either that a miracle had been wrought, or that mind was distinct from, and independent of, states of the physique. A CONTRIBUTION ON THE TREATMENT MONALIS. BY BUKK G. CARLETON, M.D., Pathologist and Curator to the Homœo, Hosp., W. I. [CONTINUED FROM LAST ISSUE.] should be taken two or three times per week, the water being at a temperature of from 64° to 68° F., and containing a little alcohol and salt. After bathing, the surface should be thoroughly dried with a coarse towel, whose meshes have been filled with salt by dipping it in a strong solution, allowing the water to evaporate. This rubbing quickens the cutaneous circulation and causes an agreeable glow, keeping the the skin in good condition and enabling it to perform, in addition to its proper work, a portion of that to which the lungs are incompetent, besides diminishing the liability to taking cold. This latter effect is accounted for by Runge, as follows: The vessels of the skin, when exposed to cold, contract rapidly, and under the influence of heat as rapidly expand, but when both these agents are removed they at once return to their normal condition. In addition to the bath, massage should be employed, over the entire body daily, as an efficient aid in increasing cellular activity and restoring the capillary circulation to a healthy state. As a safeguard against sudden chills, flannel should be worn next the skin the year round. The outer garments should be suited to the season and the weather, without regard to the dictates of fashion. Our previous remarks on prophylaxis are equally applicable in the treatment of the disease itself. HYGIENIC TREATMENT.-The rooms occupied by a phthisical patient should always be large, light, and well ventilated. They should be kept perfectly clean and without an unnecessary quantity of upholstered furni ture. Their temperature ought to vary but slightly during the twenty-four hours. The quality of the air they contain, as well as its quantity, should be carefully at tended to. If impure, it should be purified, or else the patient should be removed; and here it may be as well to remark that bedding and bedclothes ought to be thoroughly aired twice a week at least. The bedroom should be large enough to allow of the patient's sleeping with the windows closed, without the air becoming impure, but the window of a communicating room may be left open during the night, so as to secure sufficient ventilation without risk from draughts or sudden changes of weather, a proper average temperature being maintained by means of a fire when needful. What ever means of heating are adopted, special precaution should be taken against an undue accumulation of carbonic acid gas in the atmosphere of the chamber, otherwise pulmonary hyperæmia may be produced, giving rise to a broncho-pneumonia or bronchial hemorrhage. The rooms should never look to the north-eating, we will only say that food should be taken but always to the south or west. Phthisical patients should spend as much time as possible in the open air. By this I do not mean that they should take their daily quantum of exercise with out paying any regard to the state of the weather, for by enforcing such an inflexible rule we should undoubtedly do more harm than good. Even admitting that some cases given up by competent physicians have recovered after taking to this course, still it by no means follows that all who try it would be equally fortunate, for we know that whenever a patient of this class returns from a walk or ride in a chilled condition it will very probably result in more or less hyperæmia of the pulmonary tissue, which may prove decidedly injurious-leading to the conclusion that it would have been better had he taken his exercise in a large and well ventilated room. During every pleasant day, however, he should be out of doors as much as his strength will allow. The exercise should have some enlivening object in view, as in hunting, fishing, riding, etc., for if taken merely from a sense of duty it will be of little or no service. But climbing high hills, getting overheated, or carrying exertion to the point of fatigue, without resting, should always be avoided. The pulmonary calisthenics described under the head of prophylactic treatment should be practised every morning, but the upper extremities should at first be only moderately exercised, and the use of heavy dumb-bells should be prohibited. A sponge bath DIET should be of the most nutritious description. Animal food is indispensable as long as it can be properly digested and assimilated. Should the stomach fail on account of acidity, a few grains of pepsin twice daily will impart renewed vigor. A judicious variety in the bill of fare is advisable, but "high living should never be allowed. The particular aliments best adapted to phthisical patients are undoubtedly milk and cream. The yolk of an egg beaten up with milk and a little brandy is often useful as affording temporary support in the last stage of the disease. If, owing to marked acidity of the stomach, the milk is not retained, it may be taken with a saccharated solution of lime, in the proportion of a teaspoonful to a tumbler, which will insure its easy passage into the duodenum. Numerous patients of this class have been greatly benefited by living on milk alone but, as a rule, milk, cream, meats, the farinaceous vegetables, sugar and starch should be combined in various proportions according to individual appetites. In regard to times of whenever the system calls for it, whether that be three or six times per day. Alcoholic liquors are recommended by some authorities and condemned by others. Prof. Flint believes in their usefulness, and gives the following rule for their administration: They may be given, in reference to a curative effect, as freely as they can be taken without causing discomfort, a sense of weakness, or an indisposition to exercise, and without undue excitement of the circulatory or nervous system. From this treatment he reports some cures. My own observation, however, while acting as House Physician at W. I. Homœopathic Hospital, has led me to a different conclusion. I there divided the phthisical patients into two equally numerous classes, one of which was placed on an allowance of various kinds of alcoholic liquors, while the other was treated without them. It was found that the latter division improved much more rapidly than the former-and since that time we have rarely administered alcoholic liquors in such cases. Prof. Loomis says there is strong reason to believe that all cases of phthisis in which recovery has been attributed to the use of alcohol would have done as well without it, and in much less time-while to my own knowledge it has aroused an appetite which has hurried its victims to a drunkard's grave. Malt liquors are much less injurious, and are of great use in some cases where slight stimulation is required. The malt extracts have assumed a very important position in the treatment of this class of patients within the past fou |