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and she hardly thinks she is ill; but she cannot forego the satisfaction of a daily chat with her doctor, to whom she punctually hands a brace of guineas. This is not so bad as what the Saturday Review mentioned of a physician taking his fifteen guineas for each such visit. Then again, there are some hypochondriacs who are not really ill, but make themselves just as wretched as if they were. Then again, there are some gentle chronic cases, of an interesting and even quasi-poetical nature, and who would almost be loath to lose the ailments which confer so many privileges. They are something like the old gentleman who, having a long painless illness, declared that he had never been truly happy and comfortable till then, and announced his intention of keeping his bed or his room for the rest of his life. There are many graver cases, on which I do not care to dwell. Mr. Warren, in his Diary of a Late Physician, says there are cases so horrible, that the man who hears of them might almost fall on his knees and pray that he might forget. Once I thought that this was an exaggeration, but I hardly think so now.

the Curability of Illness supposed



NE day, going into the London Library, I took

up a book which had been presented to us by that constant visitor, Mr. John Stuart Mill, which treated on the curability of phthisis. Every now and then, in medicine, some idea is brought before us in the simplicity and vastness of a great discovery. We seem to be trembling on the verge of some mighty disclosure of the mysteries of Nature which has baffled us for ages, and yet whose simplicity makes us wonder that it has ever baffled us at all, and whose curative effect must make a large addition to the average of human life. It would be almost impossible to number up the remedies that have been discovered from those diseases of the chest which are almost the special domain of empirics and enthusiasts. Dr. MacCormack, of Belfast, in this work I have mentioned, writes with an honesty and earnestness which make us long to

1 Consumption, etc. By Henry MacCormack, M.D. Second edition. London : Longmans.

believe that the great medical discovery of the age has been made. And yet we cannot with sincerity say that we think so. There is much, indeed, in his book which ought to be shouted aloud upon the house-tops, but, as usual, this would be the enunciation of old truth, not the promulgation of new. Air, air, fresh air, is the burden of Dr. MacCormack's work, and all physiologists would desire to echo the cry with the utmost intensity. But here we stay. The doctor says that tubercle, which he calls the 'analogue of soot,' is engendered by rebreathed air and consequent arrest of the unconsumed carbonaceous waste, and this doctrine he preaches everywhere with all the zeal of a propagandist. He not only, as all medical men do, preaches on fresh air and free respiration, but he declares that tubercle is deposited by the blood that has not been oxidised, because the same air has been rebreathed. The detention of carbon in the blood is the sole cause of the mischief. This may possibly be, but his case is not strengthened by the way in which he puts some of the details. He recommends all people, however weak, to sleep with their windows open at night; which is healthy enough for strong people, but against which the instinct of invalids revolts. He declares that cod-liver oil is utterly inane and useless in phthisis. We believe that if this is the case, there is an utter end of all evidence and all reasoning in medical science. We are able, from our

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own observation, to correct a serious misstatement of Dr. MacCormack's. He takes the Scilly Isles, where consumption is, without doubt, alarmingly prevalent, and he says that the reason is, because the inhabitants sleep in chambers, every window closed. We do not think, from our own observation, that this is at all more true of the pretty and prosperous little town in St. Mary's Island than of any large English village. The causes are not far to seek. In the first placeand this alone is sufficient-close intermarriages have prevailed on the islands for generations, and all the inhabitants are related. In addition to this, the atmosphere is very heavily charged with moisture, and what is curious, there seemed to be an immense quantity of floating particles of sand in the air, which must be as deleterious as the dust which is inhaled in so many noxious trades. With the moral of always seeking to breathe pure sweet unprebreathed air, we, of course, thoroughly agree, but many of this writer's statements appear to us to be exaggerated and unsubstantiated.

In a country with a climate like our own, phthisis will always possess an absorbing interest for the public. In our judgment, by far the most important contribution to this subject made of late years is that series of papers which appeared in the Lancet, by the late Dr. C. J. B. Williams, and his son, Dr. C. Theodore Williams. This is a subject on which Dr. Williams spoke with pre-eminent authority; and these papers give the brightest and most hopeful view that we have ever seen advanced on authentic testimony. They are based on the experience of a large private practice which Dr. Williams for many years enjoyed. They are much more hopeful than hospital reports, and, generally speaking, hospital cases succeed much less often than house cases, which surely implies that future hospitals ought to be constructed on the plan of a series of houses. Dr. Williams now greatly lengthens the average duration of life under consumption. It has always been known that phthisis could be occasionally prolonged to an extraordinary extent. Sir William Watson, in his famous work, quotes the late Dr. Gregory (Edinburgh), to the effect that he knew a man who died at seventy-two, who had been ill of phthisis all his life. Sir William adds: It has been my melancholy task to watch the long decline and the death, at last, of a statesman who served his country well and strenuously, yet of whose years and health a precisely similar description to this would be true.'

Such prolongation is altogether wonderful and abnormal, on which not one in a myriad can count. Those great authorities, Louis and Laennec, put down the

average duration at two years, as the limit of the life of the consumptive. Dr. Williams' tables bring out for the first time much more favourable results in the milder forms of consumption than those hitherto attained. He says that, under careful treatment, life



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