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may be prolonged for many years in comfort and usefulness, and in not very few cases the disease is so permanently arrested that it may be called cured. The five hundred cases tabulated by Dr. C. T. Williams are especially interesting and valuable, because it is rare indeed that we obtain so clear an insight into an extensive private practice, where, pretty uniformly, the patients have the power of putting themselves into the most favourable conditions for recovery. Of these cases, upwards of one-half had a duration of upwards of ten years. It is delightful to read so many cases, which ordinarily would be regarded hopeless, lasting for ten, thirteen, sixteen, twenty, twenty-five years, or being permanently cured. Such cases form the very triumph of thoughtful judicious treatment, wide experience, and medical remedies. That instinctive hope which clings to the consumptive may not be altogether without a natural legitimate basis, the instinctive belief that there are remedies in existence
if only they could be found. There is now a large substantial measure of hope-destined, we trust, to be largely increased—which should, most of all, teach, first, caution to anticipate disease, and, secondly, to meet it promptly at once in its earliest stage. sincerely trust that before long these most valuable papers will be gathered into a separate volume.
In the last of them, Dr. Williams gives a summary which, we need hardly say, is most interesting and
instructive. He takes a retrospect of its treatment during the last forty years. In the first decade of that time the only hope seemed to lie in a prolonged voyage to Australia or India. My general recollection of the histories of the developed disease at that time is that of distressing tragedies, in which no means used seemed to have any power to arrest the malady. In the next ten there was a marked improvement. Much was done by the habitual use of mild alterative tonics, but more than all other means put together was the immense good wrought by pure cod-liver oil. This has quadrupled the average duration of life in phthisis, and indeed,' says Dr. Williams, this is below the actual results as calculated by my son, for of the five hundred cases, 380 were still living at the last report, and many of those are likely to live for many years to Dr. Williams has many interesting remarks There is a crumb
on the treatment of consumption. of consolation for sufferers in the fact that this treatment is pretty uniformly of a mild and generous kind. 'Not only the most nutritious food, aided by a judicious use of stimulants and of medicinal tonics, but pure air, with such varied and moderate exercise in it as the strength will bear, and the enlivening influence of bright sunshine and agreeable scenery and cheerful society, are among the means best suited to restore the defective functions and structures of frames prone to decay. From starving the patient,
the tendency of late years has been too much, Dr. Williams thinks, to the opposite extreme of stimulants and full diet. Next to the oil, change of climate is the great desideratum. A warm climate in winter, and a high and dry locality in summer, are the great objects. On this point, Dr. C. T. Williams has issued a little work on the climate of the South of France, which is a valuable addition to the now considerable literature of climatology. He does not think much of the use of foreign waters, which are sometimes much recommended. He does not care much for such places as Cauterets and Ems. Dr. Williams does not hesitate to express his opinion, that continental practitioners are far behind the British in their skill and success in the treatment of disease in general, and of diseases of the chest in particular. Their treatment may be more brilliant, but, unhappily, it is not equally efficacious.
In a country which seems peculiarly selected for the ravages of phthisis, one in eight of all illnesses being this illness, these latest results of medical investigations are peculiarly consolatory. It may be said generally of all disease hitherto supposed incurable, that there is a stage in which such is curable; that in all stages there are palliatives; and that the medical science seems groping through the darkness towards the discovery of specifics which may overtake the influence of what have hitherto seemed to be invincible destroyers.
Sleeplessness and Sleep.
AMONG the minor miseries of human life, where,
however, the misery may come to the maximum point of misery, is that most distressing complaint of insomnia. In these days of highly-strung energies and rapid living, sleeplessness is becoming more and more prevalent among us, a serious thing in itself and serious as a symptom. The subject is obscure and difficult as it is important and interesting; a subject partly physical and partly metaphysical, in which mind and matter, morals and medicine are singularly intermingled. Half our days we pass in the shadow of the earth,' says Sir Thomas Browne, and the burthen of death extracteth a third part of our lives.' Many of my readers will recollect Warton's Latin epigram on Sleep. I cannot lay my hand on it just now, but I can give my own version of it:
'Oh, gentle sleep, thine influence give,
And though like death draw nigh;
And dying, do not die.'
'Blessed is the man,' says Sancho Panza, 'who
invented sleep;' but although Sancho Panza would probably admit that this invention was made in a very early period of the history of the human race, it is remarkable that there is no subject on which opinions are so entirely unsettled as on the subject of sleep. Authors on the subject, within such wide limits as indicated by such authors as Aristotle and Lord Brougham, have failed to unfold to us the mystery; and, if I may be forgiven the remark, I am afraid that those who suffer from sleeplessness must fall back on an empiric mode of treatment.
I sympathise intensely with the sleepless. It is all very well to be moralising and practical, and to say that if we cannot sleep we had better lie awake and think, or strike a light and read or write. I have at least one most interesting letter from a dear fellow, now gone over to the majority, who says he could not sleep, and so has got up to write to me. As a rule, I do not approve of people lying in bed 'thinking,' as they are pleased to term it; they do not think, they only think they think, which is a very different matter. The habit of lying in bed of a morning 'thinking' after it is time to get up is hardly better than dram-drinking. The waking state or the sleeping state are tolerable enough, but the intermediate state, neither waking nor sleeping, is intolerable. If you knew you could not sleep, it would be easy enough to strike a light and read; but you refrain from doing