posing for the moment that these fluids are present in normal amount and quality in the circulation, which is, of course, far from the truth in this as in most disorders) is in great degree prevented by this same physical obstruction, the "thick layer of dead epithelial cells;" and, moreover, the secretion of fecal matters by the glands of the colon is, in like manner and degree, prevented. (See chapter on "Constipation.")

What have we, then, in summing up, as the effect of this conservative effort of nature to "iron-sheathe and copper-fasten" this most abused alimentary tract, if I may thus characterize the coat which has resulted from the maltreatment of the digestive organs, and but for which the individual would, we may reasonably suppose, have died long ago from some plethoric disease? First: the digestive fluids, being scant and scantily secreted, it results that (2) only a small quantity at best, of the most wholesome food, can be by them digested, and (3) absorption from the small intestines is equally difficult, even supposing that the appropriate "small quantity" of food possible to be digested has not been exceeded, which, in ordinary practice, is anything but a supposable case. Excess is the invariable rule, and therefore (4) the undigested and fermenting food substances, excepting a portion which is absorbed in this poisonous condition, make their sluggish course along the intestines, collect in great masses in the lower bowel, and, finally, (a) either by aid of purgative medicines, or the ordinary stimulating drinks indulged in, (b) the irritating effects of these abnormal accumulations themselves, or (c) by means of

injections, the lower bowel is more or less frequently emptied. These extraordinary evacuations are often described by the patient or friends as "exhausting." That such excreta is not composed of true fecal matters, we may reasonably conclude from the fact that (1) digestion and assimilation are but poorly performed, and but a very small proportion, therefore, of the quantity swallowed (often enough consumptives continue large eaters, gauged by any standard, and, relatively speaking, this is invariably the rule with them) but a small proportion, I repeat, is absorbed into the circulation, and, therefore, undigested food must form the chief share of the so-called fecal matters, and (2) owing to the heavy fur-coat, lining the colon, the secretion of waste matters from the blood is, as just stated, well nigh prohibited.

Hence it results that under the ordinary treatment the consumptive patient is hurried out of the world by a relative, and, often enough, by an actual, exaggeration of the very practices which originated his. disorder. Referring once more to Dr. Fothergill's, which is, to be sure, the regular drug plan: having scoured off the fur, so to say, with drastic purgatives, which have, possibly, cut a little too deep; or when, from whatever cause, instead of the furred coat, "the tongue is raw, bare, and denuded of epithelium, the patient should," he says, "take a mixture of bismuth with an alkali and use a milk diet. Seltzer water and milk will often agree when the milk alone is found to be too heavy and constipating." Here we have a case analogous to that of the robust gourmand

whose dinner of a dozen courses is carried on and out by the aid of his "dinner pill," or the free use of filthy mineral waters: A cup or two of cow's milk (which, at best, is only a natural aliment for the calf, and which is too often drawn from a creature herself suffering from tuberculosis), is, to the depraved consumptive, even more “heavy and constipating" than the grossest diet indulged in ordinarily, to supposably healthy Christians, not to speak of such occasions as church festivals or society "breakfasts." One secret of the difficulty which besets the hygienist in his efforts to prevail upon a consumptive patient to persist in a course of "natural medication," after having once fairly entered upon it, lies in this: There is naturally a letting down, at first, from the stimulated condition, and this is often discouraging; the craving for the customary stimulants is almost as unappeasable as that of the rum-dyspeptic; and what makes the matter worse with the consumptive than with the drunkard, everybody who approaches the former seeks to tempt the appetite: or, in any event, the sight, smell, and hearing of the "good things" renders abstinence from such most difficult; and then, again, after leaving off many objectionable articles of food and drink, and having abstained from them for a few months, we will say, the transient resumption, always imminent, of the use of forbidden fruit operates with renewed force, and the patient finds himself, as he thinks, "gaining a little," and he is thus encouraged to fall back, more or less gradually, into all his old practices. Coffee, for example, which originally proved constipating, after

its first (laxative) effects ceased, having been ab stained from for some months, is now found to

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agree" with and even "help" the patient, who, beginning with a single small cup at breakfast, works up finally to two at each meal; and, altogether, things go on swimmingly for a time. Again, after a period of abstinence from flesh-food, pastry, spices, etc.-to guard against which nature has put the fur-coat upon the intestines, or, perhaps, it should be said that the wear and tear occasioned by all unwholesome articles introduced into the stomach, have produced an effect somewhat analogous to the thickened cuticle result. ing from the constant chafing of an ill-fitting shoe, for example, as the intestinal tract begins to acquire something of its normal condition, there is a point when the resumption of a "generous" diet, in which the aforesaid substances figure largely, will seem to give the patient a fresh impulse healthward: they once more, perhaps, produce the laxative effects simulating that most desirable state of the bowels called "regular." And so on to the end of the chapter, the patient, friends, and perhaps the medical adviser, are misled as to the real state of affairs, until, finally, the end approaches, and the patient who was "improving so nicely" grows worse, and, after a period of intense suffering, which weans him from all desire to live, and reconciles his friends to the change, dies. "He catched cold, it settled on his lungs, and in his weak state"-etc., etc.

Speaking in round terms, the consumptive's digestive ability is about on a par, usually, indeed, inferior

to his muscular powers; and it is as irrational to ex pect him to digest and assimilate several meals a day, as to expect him to saw several cords of wood in the same length of time. Both are alike impossible. The fact that the food disappears, or that there is a craving for it, even, or, again, that it "seems to agree with the stomach," does not change the case. A little food of the simplest sort may be assimilated, a little muscular exercise may be taken, and both prove curative. In common practice, however, the alimentary system is taxed to its own exhaustion and the impairment of the entire organism, while the voluntary muscular system deteriorates by reason of non-use as well as from the general lack of nutrition.

A very grave error, however, is sometimes madeof taking too much exercise; that is, of beginning the change too abruptly. Whatever the state of one's general health, he can only do with advantage about what he has habitually done. If he has all along lived a very active life and is in his usual health, he can take a good deal of exercise without harm, even with advantage; if, on the other hand, his life is sedentary, but little can be taken-beyond the current amount-without doing more harm than good. In either case, however, there may be a gradual increase of muscular exercise, and for many of the latter class this would prove life conserving, (if persisted in as a habit of life), but spasmodic efforts at building up a muscular system will always fail; nature does nothing in that fashion. The rule should be to exercise a little short of fatigue, and it