including some in very feeble health, seem wonderfully impervious to cold, but it is equally true that many others do feel it very much indeed. Both in Switzerland and England I have known patients who, during cold weather, never seemed to be comfortably warm in spite of innumerable wraps, hot water bottles, and cushions, and, as far as I could judge, in no such case was any satisfactory progress made. I should always advise any one who is of a chilly nature to spend his winter in some warm climate if he can do so. If not, he should take much forethought as to means and ways of keeping warm, especially as to the feet.

I am sure that this point of warmth is far too little insisted upon. Fresh air is put before everything, and patients are often exposed in shelters, verandahs, &c., where they are in a chronic state of shivers and chilblains, when they would be much better in a comfortable room (of course thoroughly well ventilated) with their feet to a good fire. I do not mean to say that, in all sanatoria, the patients are ruthlessly and injudiciously exposed to cold, but I certainly think that in many cases the importance of comfort in this respect is not sufficiently considered.

In some sanatoria patients are instructed not to change their clothes when they have got a wetting. I have never been able to see the object of this. It is probable that, as a rule, no harm results from sitting in wet clothes as long as one keeps warm and breathes only pure air, but, even so, the feeling of wet, sodden garments and boots is by no means comfortable, and it always seems to me to be well worth while to change into dry things before settling down to "rest hour." When one is but slightly damp it is another matter, and in this I think that every one should act for his own comfort according to his natural instinct.

When standing or walking the body should be kept erect and the head well up, the back of the neck always touching the collar, the chest thrown forward, and the shoulders back. Any tendency to stoop must be fought against, and every effort made to give the chest free play and room for development. For those who are not too weak simple breathing and chest development exercises are very useful.

It is most essential that air should always be inhaled through the nose and not through the mouth so that it may be duly warmed and filtered before it reaches the lungs. This point is of very great importance to all human beings, but naturally most important of all to those who suffer from lung or throat complaints, yet it is wonderful how seldom any doctor thinks of impressing it upon his patients.

It is important to sleep as nearly in the open air as may be. In England this is difficult, especially in such a year as 1903, but in ordinary fine weather, summer or winter arrangements should be made whenever possible to sleep in a shelter as open as weather admits, or, if this is impossible, the head of the bed should be placed close to an open window. The difference between sleeping in a shelter and in the best ventilated room is considerable.

For those who are at home on horseback and who can command a quiet, comfortable hack there is no better exercise than riding. One can get farther afield on horseback than on foot, and the exercise is stimulating and invigorating.

Change of air and scene often work wonders, and any one who feels that he is not getting on will generally do well to try the effect of a move-of course assuming that he can do so comfortably and without undue fatigue. Even a change of a few miles is generally beneficial, especially if a different altitude, soil, &c., can be visited. Often a considerable change of climate can be attained by journeying quite a short distance, such as up or to the other side of a hill. Thus it is a good plan for one who can walk a few miles to start off occasionally in the morning, carrying with him his luncheon to be eaten at a convenient spot as far afield as his walking power admits, the usual rest being, of course, taken before (or before and after) the meal. Or if the railway or other means of transit is convenient one may get still farther afield, the walking being all done in one direction.

So great is the benefit often derived from change of air that I always wonder why the principle is not systematically developed in sanatorium treatment. If, under one management, there were two or more sanatoria in quite different climates, though not necessarily far apart, between which patients could be moved from time to time I am convinced that excellent results would be obtained.

As regards climate, foreign travel, &c. A few years ago when open air sanatoria were new to England a number of writers endeavoured to insist that climatological conditions had very little influence upon the cure of consumption, and that therefore all cases could be as successfully treated in England as they could abroad. This theory is only partially true, that is in so far that, contrary to previously accepted belief, many cases can be, and are, successfully treated in England even during the winter, and that, in certain cases, a well selected locality in England is probably better than any other. But it is absurd to deny that there is a very large proportion of cases

in which some foreign climate is most desirable. Of course, in very many such cases a trip abroad is out of the question, and in many others it is better to forego the benefit which a foreign climate might confer in view of the disadvantages which the journey or the sojourn abroad would entail. The experiment must generally be more or less of a leap in the dark, and it is too often the case that, after a troublesome and expensive journey, the traveller finds himself in uncomfortable surroundings and in a climate which falls far short of his expectations. I have seen many instances of this, especially in South Africa, a country to which hundreds of consumptives have been sent most injudiciously by medical men who knew next to nothing of its resources and domestic economy, but who had heard that many marvellous cures had been effected there, as unquestionably they have. In South Africa, generally speaking, the food is bad and living is dear and uncomfortable, and certainly no one should go there for his health who has not either the means or the opportunities to overcome these disadvantages.

Another form of treatment often very unwisely recommended is a sea voyage. For those who can go to sea in luxurious yachts or in spacious and airy deck cabins there is probably nothing better; but these are the fortunate few. Ordinary folk have to take their chance of cabin and cabin companions. The former may be so placed that its ventilation is practically nil, the latter may be objectionable and dirty in their habits or prone to intoxication and sea sickness. Of a surety a sea voyage is an enterprise to be approached with much circumspection.

My conclusion is therefore that whereas, in very many cases, great benefit is to be looked for from journeys by sea or from residence in favourable localities abroad, it is unwise to leave England without assurance that one is going where the condition of life will be good and comfortable. Most especially is this so in the case of those of small means.

In sanatorium treatment, drugs are used very sparingly and only in special cases. Generally speaking, air, food, and exercise are expected to effect everything. This is probably right according to our present state of knowledge, but I cannot help thinking that more pains should be taken to investigate the possibilities of drugs which are reported to have produced good results in certain cases, e.g., creasote, ichthyol, lacnanthes. Though these and others may not suit all, there is good evidence that, in some cases, they are efficacious, and it is a pity that their merits should not be thoroughly tested. Air, food, and exercise must naturally be our regular forces in the campaign,

but if auxiliaries are available, in the form of drugs, it is surely unwise to despise their assistance. Such articles as cod-liver oil, malt extracts, emulsions, &c., are, properly speaking, foods rather than drugs. They are useful in certain cases, but, as a rule, cream, butter, and honey will produce as good results with less liability to upset the digestive apparatus.

Those who have had actual and visible experience of the great benefit which so many derive from the open-air cure must regret that its scope is not extended to embrace other ailments as well as consumption. The now prevailing idea seems to be that this cure is a special and curious form of treatment for one specific disease. That, as the waters of Carlsbad are indicated in cases of deranged liver or certain baths in cases of rheumatism, so is the open-air régime applicable to cases of consumption and to those only. If, however, we consider a little, we see that the régime consists of nothing else than of living as nearly as possible the life which nature intended that human beings should live, and thereby endeavouring to remedy the physical detriment which has come upon us because we and our ancestors have lived otherwise. If we follow up this train of thought it will occur to us that our violations of nature's laws have brought upon us many other troubles besides consumption, and that to most of these the simple, wholesome life of an open-air sanatorium would be highly antagonistic. Of those who would evidently benefit by such a régime may be mentioned the countless numbers of all classes who habitually work, live, sleep, in an atmosphere more or less close and unwholesome; all who, from errors of diet or other cause, suffer from chronic indigestion; and, perhaps most of all, young people, especially girls, who are growing up weedy and anæmic.

Those who wish for an object-lesson of the benefit of an open-air régime to others besides consumptives should visit a sanatorium and note the appearance of nurses and other attendants. In place of the pasty, anæmic look so often noticeable among domestic servants, they will see bright ruddy cheeks and a general appearance of almost aggressively rude health. If it were more in evidence, such testimony would surely divert a good deal of custom from German baths and spas to the benefit of the national purse and of the national health.

PATIENT.

AMERICAN AFFAIRS

WASHINGTON, March 12, 1904.

WHEN seven years ago the Senate rejected the general treaty of arbitration between Great Britain and the United States, the work of the late Lord Pauncefote and Secretary of State Olney, keen was the disappointment of the British Ambassador. Lord Pauncefote was too well schooled in the subtle silence of diplomacy, too full of courage, and too far-seeing, to permit the public to know of his disappointment. He frankly said that he regretted that the Senate had not, in its infinite wisdom, seen fit to ratify a treaty that would have been an example to other nations, but he yet hoped to live to see the Senate take a more liberal view of arbitration. Having delivered himself of this gentle criticism, if criticism it can be called, he said nothing more in the way of vain regret, and continued along the path which he had mapped out for himself.

In many things Lord Pauncefote was a man of great ability; in one respect at least, in the gift of prescience, he fell little short of genius. He saw-many years in advance of what his own countrymen tardily recognised-the importance of the relation occupied by the United States toward Great Britain and Russia; and he knew that the diplomacy of Russia was at all times exercised to make it impossible for really cordial relations to exist between England and America. Little of the intrigue that went on, that spread from Washington, was unknown to him, although it was often boastfully said by the emissaries of Russia and the enemies of England that he was ignorant of what happened under his very eyes. Never did fatuous conceit and the craft of ignorance indulge in greater illusion. Lord Pauncefote was no blind spectator to the moves of a game which were of such absorbing interest to him, but it suited the part he assumed to let others move the pieces while he looked on.

So long as the American people believed in the disinterested friendship of Russia and distrusted England; so long as in the