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surface, and has less capacity to hold gases in solution, the skin acts freely, the appetite for certain kinds of food fails somewhat, the tissues become relaxed, and the whole state indicates that there is a depression of the vital powers, and a diminution in the vital transformation. This condition is, however, not unfavourable to the deposition of fat in the tissues, provided the defect in the vital powers be not excessive; for we have already shown that a state in which the appetite for food is not greatly lessened, whilst the respiratory function is somewhat diminished in activity, is favourable to the storing up of fat within the system..

Hence, in cases of early phthisis, it is a prime requisite to avoid high temperature, and to permit the patient to live in an atmosphere not above sixty degrees, if it be possible to do so. This, of necessity, depends upon the period of the year, and will be the most difficult of attainment in the summer season. In the winter there is very little danger to be apprehended from the cold, if suitable precautions be taken, except in the cases in which there is inflammatory complications, or an irritable condition of the larynx, and hence no special precautions are needed, but in summer, when the temperature exceeds 65°, it is desirable that there be shelter from the sun during the heat of the day, that the day and night rooms have a free circulation of air admitted from the shady side of the house, and that the residence be in such a position as, by its elevation, northern latitude, or proximity to deep water may reduce the temperature to a medium degree. It was made clear by our own experiments that a medium

temperature, such as that at which we seek to keep our houses through the year, permitted every variation in the degree of vital action according to the other conditions of season, but that as the temperature rose or fell from that central point, the effects of heat were rapidly demonstrated.*

CERTAIN INTIMATE CHEMICAL CHANGES.

This part of our subject is too indefinite and extensive to warrant a lengthened consideration of it on the present occasion, and we purpose only to point out one or two facts which it may be interesting to consider in the treatment of the varied conditions found in early phthisis.

It is important to bear in mind the observation which Baron Von Liebig has so often placed before us as to the importance of a due quantity of alkali in the blood, to enable that fluid to absorb the largest amount of carbonic acid. He has shown that the blood carries carbonic acid by virtue of two qualities, viz., its property of chemical combination, and its power to hold the gas in solution, and it is evident that, in reference to actions of a rapid nature, the latter is by far the most important property. The capacity of solution varies with the nature of the fluid, and the alkaline carbonate, and the phosphate of soda very greatly increase this capacity of solution in the blood. Hence the free administration of alkalies is in many cases well suited to excite or support chemical changes,

* Phil. Trans. 1859.

and thereby to sustain vital transformation. This may possibly be one of the explanations of the beneficial action of alkalies in cases where there is marked acidity in the stomach, the perspiration, and the other excretions.

On the other hand the tissue fluids are invariably acid in their reaction, which seems to indicate that the formative process proceeds under the influence of an acid, and it is very possible that the numerous instances of early phthisis, in which the mineral acids are found to improve nutrition, may receive a part of the benefit in that direction.

M. Fernet * has shown that the excessive use of chloride of sodium will lessen the power of gas-absorption by the blood, since with excess of that salt in the blood the absorbing or carrying power of that fluid is lessened. This may be familiarly seen by the change of colour of black blood, which occurs on the addition of chloride of sodium, when by the disengagement of a portion of the carbonic acid the colour becomes red, and the blood is no longer enabled to retain so large an amount of carbonic acid as before. Hence the use of chloride of sodium in excess is clearly antagonistic to nutrition.

* Thèse, Paris, 1858.

CHAPTER XXX.

REGULATE MENTAL AND BODILY LABOUR.

MENTAL LABOUR.

THE influence of mental labour over the functions of the body must be beneficial if practised within moderate limits, since without wasting the body it engages the attention, and satisfies some of the highest desires of our nature. In the abstract then, as it induces no evil, we have no remedy to offer. But when carried to excess, so that the body is constrained in posture and kept in a closed room during many hours daily, its tendency must be to exhaust the vital power, to prevent due muscular exertion, to lessen the force of the circulation, to render the skin too active, to lessen the functions of assimilation and digestion, and to diminish the appetite for food. Hence in this degree it is precisely fitted to induce the conditions which are observed in the disease under discussion, and demands most serious attention. There is no class of cases in which remedial agents appear to have so little influence, or in which a more decided method and long continuance of treatment are called for, as in those induced by excessive mental work, but not, as we believe, because mental labour increases the elimination of nitrogenous pro

ducts, but because there has been long continued neglect of all the conditions upon which the healthfulness of the body depends. Such a state is one essentially of low vital energy.

Hence we would encourage cheerfulness of spirits and occupation of the mind in every degree compatible with the due exposure of the body to sanitary influences; and so important indeed do we consider this, that we believe it almost impossible to restore the poor man to health, who, without actual inability to labour, believes himself unfit for it, and avoids it, or the young lady who, from depression of nervous energy and bodily feebleness, is allowed to spend the day in a listless manner. A prime condition in an attempt to increase the bodily strength is the happy and moderately continuous occupation of the attention, which at the least permits the hours to pass away during which the body is regaining strength without despondency or querulous regrets; and commonly, in addition, tempts the patient to go into conditions more favourable to health.

But in the same degree do we deprecate that state of mental anxiety which renders persons at all times unhappy, leads them to shun society and the open air, and to court solitude, seclusion in the house, and distressing forebodings. Many there are suffering from early phthisis who may trace their disease to this condition, and who have been in part led into it by the adverse occurrences of life, to which all are more or less subject; and in other part by allowing their anxieties to prevail over their faith and reason; and it frequently happens that the adverse circumstances

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