of a most obstinate and intractable character do get well, but that considerable time is required for the change to be fully completed. How absurd, therefore, is the system of ordering in such cases a few bottles of medicine. We have been driven to this ridiculous practice partly by the ignorant, who still half believe in the value of touches, and spells, and charms, partly by absurd affectation of the possession of some universal and anti-morbific power on the part of some very confident medical advisers, who would have it supposed that they possessed some means of cure not at the command of the rest of us, and of powers of prescribing, wonderful and exceptional, if not in a sense actually miraculous. Patients with chronic maladies, and especially those affecting cutaneous or mucous surfaces, must have patience with the physician, and must, if they are to get well, submit to a definite course of treatment, resting upon well ascertained principles, but requiring, perhaps, considerable time and steady perseverance. Instead of this, we find patients ready to pay anything for a mere promise of quick cure, however impossible this may be, resorting first to one nostrum and then to another, flying from one infallible healer to another, from quackery to reason and from reason back again to quackery, until their patience or their purse is exhausted, and they pass into the condition of therapeutic unbelief and despair, as unreasonable and as unfounded as was the conviction that they would be cured in a few days by swallowing so many doses of some wonderful compound.

Of the value of iodide of potassium, iodide of iron, bichloride of mercury, arsenic, glycerine, cod-liver oil, in proper doses kept up for a sufficient time, in very chronic forms of disease of the skin and mucous membranes, there can be no question. Who can doubt that alkalies and purgatives do good in many forms of gout and rheumatism, or that congestion of the vessels of the liver and kidneys is relieved by taking alkaline and other waters, or that many disturbances of health affecting the organs of circulation, respiration, digestion, and the whole excretory system, to say nothing of those derangements of the sympathetic nerves and ganglia which cause such distress, are not sometimes

completely cured by thorough change in the habits and in the mode of living? How many cases do we not meet of well-to-do people who have been wretched for twenty years or more, from leading a sedentary life in London, and eating and drinking too well, who get completely cured by living in a good part of the country, twenty or thirty miles from town, where they can be much out of doors, eat less than half as much as they formerly consumed, and drink water, milk, and tea or coffee only. Such facts, and the conclusions which naturally flow from their consideration, indicate surely enough how important it is to try to persuade persons who are suffering from various chronic ailments to give themselves a chance of getting well, by placing the weak part for some time under conditions, external and internal, which will favor or will determine its return to the normal state. In no department have such considerations a more practical significance than in the management of chronic changes in the mucous membrane, and in the epithelial surface of the urinary organs.

Many of the maladies in question which may have been pronounced incurable are but chronic changes which have not gone too far to be checked, and although there are tissue changes and infiltrations of lymph in the interstices of the tissue to such an extent as to interfere with or prevent its action, it is probable that in the course of weeks or months the normal state may return. One cannot but be struck at the character and extent of the morbid changes which have occurred in many scrofulous and syphilitic affections, possibly even involving the demolition of parts of important tissues and organs, and which, nevertheless, not only cease, but are soon followed by a reparative process, rendering the tissue or organ, perhaps not what it once was, but causing its restoration to a condition which is not only not incompatible with work, but in which the active parts resume their activity and continue to discharge their functions during the ordinary period of life, if only they are carefully protected from overwork, and kept from being unduly strained. Of late years we have so energetically studied the advanced morbid changes of tissues and organs, that the mind has been led to dwell perhaps

too much upon the degenerated, the unchangeable, and the irreparable, and to take a too despairing view of morbid alterations in general. Every now and then we see an example of return to health, or to a condition approaching it, in cases of long-standing disease which have been despaired of in consequence of very distinct evidence of structural change, which, however, had been too hastily regarded as being completely beyond any reparative or reconstructive operation.

Many troublesome affections of the epithelium of the skin and mucous membranes may be cured, if only the patient can be persuaded to persist in the proper treatment for a sufficient length of time. Witness the effects of a long-continued course of mercury, of iodide of potassium, or of iodide of iron. In many cases the course of the nutritive process has not only to be changed, but changed for a considerable time. Any alteration of the kind required must in many cases necessarily be very slow, although the disturbances and derangements may have been effected very quickly. Improvement must first take place in the young particles which are growing and multiplying at some distance below the surface, and no very obvious alteration can be effected upon the surface itself until these young cells have passed through their several phases of development and have reached maturity.

The beneficial action of local applications must likewise in many instances require considerable time for its full development, for the substance applied can only act by the influence it exerts upon the young cells, and it can only reach these by passing through the minute channels between the old cells on the surface. In its passage it may lose much of its strength, and the frequent repetition of the local application daily, or many times daily, may be necessary before the desired effect can possibly be produced. But not a few of our remedies which influence epithelial growth act through the blood, either indirectly through the intervention of the nerves distributed to the capillaries, or directly by passing from the blood with the nutrient fluid which. traverses the capillary wall, and which comes into contact with the cells themselves.

G*

Epithelium of the Kidney.—The epithelium of the kidney differs somewhat in its characters in different parts of the tube, and also at different ages. That in the convoluted or secreting portion of the tube is described as being polygonal; it projects into the tube to the extent of one-third of its calibre. The epithelium in the straight portion of the tube is flatter, and approaches to the tessellated variety. Although the convoluted portion of the tube is much wider than the straight portion, the diameter of the channel is much wider in the latter position than in the former, in consequence of the much greater thickness of the epithelium in the secreting portion of the tube. Epithelium from the convoluted portion of the uriniferous tube is represented in "100 Urinary Deposits," Pl. II, Fig. 27. In healthy human kidneys the outline of the secreting cells is not to be seen so distinctly as it is usually figured in anatomical works, or indeed in my own figures. The round body, usually termed the nucleus, is very, clear and well defined, and this seems to be surrounded by a quantity of soft granular matter which varies in amount under different circumstances. Although sometimes there appears to be a cell wall, no such structure really exists, and the apparent line is not due to the existence of a membrane, but is caused by the action of water and various agents upon the external surface of the soft granular matter, of which the bulk of the so-called cell consists. In many cases of disease, the round central bodies or nuclei are all that can be made out; and sometimes these are found in great number in the urine. The round "cells" (bioplasts or masses of germinal matter) present in the urine, in cases of acute nephritis, are generally the so-called "nuclei,” which have grown in size and have increased in number in consequence of the very free supply of nutrient material. By the action of acetic acid, "nucleoli" will be rendered evident in the "nuclei.” It would seem as if the granular matter external to the rounded granular body (nucleus) became altered in character under certain circumstances. The spherical masses of germinal or living matter, or bioplasts, the so-called "nuclei," are embedded in a granular material, which they have produced, and by which they are separated from each other by nearly equal distances, as repre

sented in the upper part of Fig. 27, Pl. II, "100 Urinary Deposits."

If, instead of using the terms nucleus, cell-wall and cell-contents, we call the central mass germinal or living matter or bioplasm, and the outer granular matter formed material, the changes actually observed can be described without any difficulty or confusion. The formed material is rendered transparent by acetic acid, as represented to the left of the figure in "100 Urinary Deposits," and during life it is slowly converted into soluble substances by the action of the oxygen dissolved in the water discharged from the Malpighian capillaries. The secreting epithelium probably acts in this way: the bioplasm or germinal matter takes up certain constituents from the blood, and thus new bioplasm is formed; but the mass does not increase in size because, at the same time that matters are taken up from the blood, a portion of the bioplasm already formed undergoes conversion into formed material; nor in a normal state does the formed material accumulate, because that which is already formed becomes disintegrated by the action of water and oxygen, and is resolved into urinary constituents which escape in solution in the water.

The renal epithelium, as above remarked, readily undergoes great change. In health the outermost part of the soft granular material is perhaps a little firmer in consistence than that which is more central. In some chronic diseases all may become hard and firm, so that the bioplasm (nucleus) in the centre of the cell cannot be easily dislodged from its position. More commonly, however, the outer part breaks down, and the masses of bioplasm being set free, grow and multiply, and pass into the urine in great number. See "100 Urinary Deposits." The epithelium in the straight portion of the tube is much flatter than that in the convoluted part, and probably serves the office of a protective covering. It is doubtful if it takes part in secretion, but there is some reason for thinking, with Virchow, that at least in certain cases albumen escapes from the blood into this portion of the uriniferous tube.

The epithelial cells from the ureter are columnar and spindleshaped. In form and in general appearance they so closely re