the tendency to internal congestion and inflammation, the increase of cough from the irritation of the pharynx and air-passages, induced by the inhalation of cold air; the tendency to hæmoptysis from increased cough, irritability of the mucous membrane, and congestion of the lungs, and deficiency of temperature from the cold. If the patient be restricted to an artificially heated atmosphere, he will have the evils of dryness, stillness, and impurity of the air, and will be apt to have night perspirations from excess of clothing. Indeed, from whatever cause, night perspirations are common in winter. At this season the chief desideratum is the careful adjustment of the clothing, so that whilst the patient shall never be cold, he shall not be fatigued by the weight of many clothes; and the selection of an atmosphere so uniform and moderate in temperature, that he may be able to expose himself, at least under favourable circumstances. He should specially protect the throat, by keeping the mouth closed, and the throat externally covered, when in the open air. The clothing should be the best, and therefore the lightest, of woollen materials. The diet should be abundant, fat, and solid.

The change from the cold of winter to the warmth of early summer is attended by depression of the vital actions, and that in the autumn by the reverse, and the difficulty to be overcome is the inability of the system to adapt itself suddenly to the new conditions. Hence, with the fulness and high activity of spring, there is apt to be congestion of an active kind when the depressing influences of summer first act; and at the end

of the year the tendency is to exhaustion, from the impossibility of the system to increase its vital changes with due rapidity. Hence disturbance of the circulation is common to both, but hæmorrhage is more common in the spring; and internal congestions, with dropsical effusions, in the autumn. Moreover, it has always been observed that vascular congestions are found chiefly in the lungs in the spring, and in the chylopoetic viscera in the autumn. The indication in the spring is clearly to hold back the system, as by rest and the horizontal posture, and to avoid stimulants and excitants; whilst in the autumn the skin must be well protected, the vital powers sustained, and the patient altogether sheltered from the adverse conditions of the weather. It is well known to those who ride much on public conveyances that the horses get out of condition at the end of the year, and are unequal to their duties. Notwithstanding the occurrence of cold weather they perspire profusely, and need unusual protection and stimulating food.

It is needful to add a general remark in reference to the influence of season, that the effects are far more than the evident qualities of season-temperature, and weight of the air-can account for, as we have shown in the Phil. Trans., 1859, and also that an unusual state of the weather in any season induces conditions opposed to those ordinarily found at that season. Thus if, in winter, the temperature should be high, and the air moist, the patients immediately complain of all the conditions of body usually met with in the summer season, as exhaustion, defective appetite,

feebleness, and perspirations. A temperature of 56° in mid-winter produces summer ill-effects, whilst the same at midsummer would render the season winterly. It would appear that with the increase of the temperature from the winter, it is only as the sun increases in altitude and influence that the increase of heat is healthful to phthisical patients, and not simply the warmth which is due to the winds.

CHAPTER XL.

TREATMENT WITHIN HOSPITALS.

THIS subject is one of difficulty on account of its mixed character, for whilst the advantages and disadvantages offered by hospitals are almost fixed and determinate, the conditions required for the benefit of patients are very variable, and hence it would require a most extensive organization to meet the wants of even the great mass of cases.

The general hospitals have solved the problem by cutting, instead of untying the knot, and have rigidly excluded such cases, chiefly on the ground that they are irremediable, but also that the arrangements at such institutions are not favourable to the well-being of these cases. Hence special hospitals have arisen, into which the cases are received, but yet having arrangements almost identical with those of general hospitals.

It must be evident from the foregoing observations, that the class of cases under discussion cannot be efficiently treated in hospitals, unless those institutions have regulations and advantages specially adapted to them. Thus we have urgently recommended abundant and regulated exercise, a tolerably free exposure to the atmosphere, due amusement and occupation for the

mind, abundance of milk for diet, and frequent and small meals, and, in addition, certain plans of ablution and voluntary respiration, which clearly demand the aid of others and the privacy of a separate bed-room. But how are these met even by the best arranged special and general hospitals? The patients are restricted to their rooms, or to long uninteresting corridors which have walls and high windows, or, if allowed to go outside, may saunter about paved yards or gravel walks, wet or dry, exposed to the gaze of passers-by, and with no shelter from the sun, wind, or rain. The space for out-of-door exercise is very limited, and, from the nature of things, the exercise must be of such ordinary kinds as may not attract the attention of others. There is no gymnasium in which regulated muscular exertion may be made, and the mind be pleasantly engaged, nor any system adopted whereby the power of any special set of muscles may be increased. There is no plunging bath, warm or cold, in which the patients may seek tone, strength, and amusement. There are no games but such sedentary ones as draughts, and no bodily employment but such as making small woollen mats, by which a little money may be realised. There is no culture of the mind, except such as the clergyman may periodically offer and a small library afford, nor any such innocent pleasures as that of singing or instrumental music. The meals must be, as a rule, limited to three, or perhaps four, a day, at stated and distant periods, and it is impossible to supply to each patient the large quantity of milk which we have affirmed to be a prime