indicative of the condition of system in question exist, may certainly be prevented by care in the mode of living from the moment the first evidence of disturbed action becomes manifest; and, if already established, the condition may be mitigated or cured by judicious treatment persisted in for a sufficient time. To affect advantageous change in inveterate cases, appropriate treatment should be persisted in for a considerable period of time. Benefit, unquestionably, results from the annual visit to baths, and the altered diet and washing out to which the body is subjected for six weeks or two months, but in too many instances the good obtained is soon neutralized by the patient's return to the injudicious habits which originally occasioned the departure from health, and which if continued will certainly lead to the establishment of pathological changes beyond the possibility of

cure.

Rules cannot be laid down which will apply to all cases, and it will be sufficient to indicate the general principles upon which the treatment of such a case should be conducted. It is advantageous, if not necessary, that the patient himself should be acquainted with these, in order that he may know how to manage himself from day to day, and, if possible, prevent any changes that would interfere with steady improvement. I have often been surprised at the length of the period over which decided, and perhaps, uninterrupted advance towards the healthy state extends. An unmistakable indication of the general disturbance of nutrition, and departure from the normal state of the blood, is often afforded by the presence of patches of eczematous eruption, or of psoriasis in various parts of the body. These morbid conditions of the skin are very obstinate, though they may be slight. It is no uncommon thing to see patches of rough cuticle, as large as a shilling, to the number of ten or twenty in different parts of the body, not unfrequently attended with irritation and itching, especially in the evening and at night, when the cutaneous surface gets warm. They may persist for years now better now worse. Everything that can be thought of may be tried in vain, and advisers of every kind have, perhaps, been consulted, one after the other, without avail. The

fact is, for the cure of such cases much time is required. The patient may have been put on the right course many times, but treatment for a month or two only is useless, or nearly so. It is only by degrees that health can be restored. Obstinate derangement of the liver and large bowel probably has an important influence in keeping up the state of blood and of the nerve centres which favor the deranged state of nutrition of the cuticle. We may, undoubtedly, help the patient by prescribing small doses of gray powder, or other mercurial now and then, and by the judicious use of alkaline and purgative remedies, with a course of iodide of iron, or by sending him to Carlsbad for a month or six weeks, but he will not be cured, and on his return to his usual habits the trouble will return and get worse from year to year. He will come to the conclusion that he must make the best of it, and bear it as best he may, and possibly he will be assured that it is incurable, while, in fact, if he put himself on proper diet, with plenty of air and an occasional warm bath, for twelve months or more, he would not only cure the cutaneous eruption, but would regain general health and vigor to a degree that would surprise him and his friends. It is astonishing how difficult it is to persuade people to act sensibly as regards the management of their bodies continuously for a considerable time. They will try, one after another, all the remedies you recommend ; they will live for a time on the simplest fare, take air and exercise by the clock, and subject themselves to hard hygienic discipline for a few weeks, but to get them to act with good sense for six months seems impossible, and I fear, with all our Health Exhibitions, books, lectures, schools, and instruction far and wide among all classes, we are almost as far as ever from getting people to eat and drink and sleep and dress and take exercise without frequent and open defiance alike of health laws, common sense, and of the ordinary principles of physiology now taught in children's primers.

It cannot be too often mentioned that most of the acute diseases which come on unexpectedly, and the invasion of which seems so sudden, the patient being as it were struck down in the most appalling manner without having been aware up to the very

moment of attack that he was not in ordinary and perfect health, have been threatening for weeks or months. For a long period preceding the attack the blood has been getting out of order, excrementitious matters have been accumulating, the interstices of organs whose free action is necessary to health have become occupied by imperfectly soluble matters, the intertextural channels have become clogged, and for a long while there has been frequent interference with proper action and in an augmenting degree, until at last derangement eventuates in temporary stoppage of action and a sudden and desperate shock to every organ in the body, consequent upon a serious change in the blood which cannot be compensated or controlled, results, and weeks or months must pass before the derangement and perhaps actual damage effected can be repaired. It seems possible that almost up to the moment of the "acute attack" active medical interference, according to well recognized principles, might have warded it off, or enabled the patient to escape with perhaps a violent rigor, followed by very free action of the bowels, the skin, and the kidneys.

It is quite certain that in many derangements of the stomach and intestinal canal the free passage of fluid through them during a period of twenty-four or forty-eight hours is often of great service. The liquid in these cases does not go directly through the canal, but it, or at least the greater part, is absorbed by the stomach, taken into the blood, and again poured out by the secreting glands, and with it some of the excrementitious matters which have been accumulating in the system, perhaps for weeks or months, are got rid of at the same time. In many cases of headache, due to deranged digestion and assimilation, this free dilution of the fluids and washing out of the system is carried out with the greatest benefit, and in many cases a cure is effected in the course of from twelve to twenty-four hours.

As regards the particular diluent, there is often great difficulty in selection. Weak lemonade answers well in many cases; milk or whey and water, or soda water in others; potash water, German Seltzer water, Vals, or other effervescing water may be given, or an effervescing draught of tartrate, or citrate of potash, or

B*

soda. The so-called effervescing citrate of magnesia is also very good, and makes a very cheap and convenient form of effervescing beverage. These may be iced, but not more than about a wineglassful should be swallowed at once. By suddenly swallowing a tumblerful of ice-cold fluid, people often disturb the stomach for hours, but if the tumblerful had been spread over a period of five or ten minutes, so as to allow just time for one mouthful of the cold fluid to be slightly warmed in the stomach before the addition to it of a second, no harm or inconvenience would have resulted. What we effect by this plan is the removal of substances which require much water for their solution and the prevention of the formation of a further quantity. The accumulation of various noxious matters in the blood and fluids of the tissues and among the tissues themselves upsets the balance of physiological change, and leads to the initiation of the disturbance which may eventuate in an attack of acute disease. By free dilution, followed by purgation, diuresis, and sweating, there is reason to think that in many cases the acute disease might have been altogether prevented.

It is often said that water acts as a "diuretic," but perhaps it would be more correct to say as a diluent. Water dilutes the fluids of the body, and serves to dissolve matters which are not very soluble, or dilutes solutions which are in a too concentrated state to undergo the further chemical change requisite for their discharge from the body. It must be obvious that when there is structural disease of the organs through the agency of which many of the most important excrementitious matters are eliminated from the system in solution, it is a point of great consequence that the solids should be constantly presented for excretion in a high degree of dilution, and also that the quantity of solids introduced as food should be reduced to the lowest amount consistent with the needs of the system.

In chronic renal disease a considerable amount of liquid should be taken, large in proportion to the amount of the excreted solids. A weak solution of the organic and inorganic matters will filter through the vascular walls almost without the help of any special secerning action at all. This fact is impressed upon

the mind by many cases of chronic renal degeneration of various kinds. I have known many a patient who has gone on for some months, or even years, with scarcely any of the renal secerning apparatus in an active state. Taking little solid food, but much water, living, in fact, on milk, beef tea, and things containing much water, leading an invalid life, getting plenty of air, but taking little or no exercise-the system of the patient has slowly got into a state in which chemical change is reduced to a minimum; and if tolerably free filtration goes on through the vessels of the urinary apparatus, life may last till some accidental, sudden and exceptional change occurs, or until, by undue accumulation of excrementitious matters, the balance is destroyed, the living matter of the body is poisoned, and death may occur in the course of a few hours, to the dismay of friends, and often to the astonishment of the practitioner.

As a rule, then, urine containing an unusual proportion of water is not a matter of much consequence, for it generally depends upon the rapid separation of a large quantity of water from the blood, and may be preceded and succeeded by the secretion of urine of the usual density. This free and rapid discharge from the blood of considerable quantities of water may be due solely to altered blood pressure in the vessels of the Malpighian body, determined by changes in the nerve centres which govern the contraction of the muscular fibre cells of the extensions of the renal artery. As is well known, this part of the nervous system is much influenced by the emotions. Fright, anxiety, or intense interest may, through this mechanism, determine the secretion of a considerable quantity of pale, watery urine within a few minutes. In cases, however, where the secretion of a large amount of urine of low specific gravity continues for a considerable period of time, it may be a fact of grave import, and probably depends upon serious structural alteration in the kidneys, which may soon result in death. And it is surprising how suddenly the fatal symptoms appear in some of these cases. The patient may seem to be in the state of somewhat weak or impaired health, which has existed for many months, when, without warning, and, as far as can be ascer