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32X

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.11

NATI

Author ol
Ec

Member (

c. w. c

1^' I' "

InX.

CONSUMPTION :

ITS

NATURE, CAUSES AND PREVENTION;

WITH AN OUTLINE OF THE

PRINCIPLES OF TREATMENT,

FOR ALL CLASSES OF READERS.

EDWARD PLAYTER. M.D.

(And Medallist, Toronto Univ.>, M. C. P. & S., Ont.

Author of " Playter's Physiology and Hygiene" (authorized by the Ontario
Education Department), Editor of the "Canada Health Journal";

Member Canadian Medical Association, American Public Health Association,
and American Academy of Political and Social Science,

TORONTO:

WILT^IAM BRIGOS,

WESLEY nUH.DlNGS.

C. W. COATES, Montreal.

S. F. HUESTIS, Halifax.

1895

Entered, aecoi-ding to the Act of the Parliament of Canada in the year one
thousand eight hundred and ninety-five, by William Brioos, Toronto, in the
Office of the Minister of Agriculture, at Ottawa.

PREFACE.

The object of this book is sufficiently indicated in the
title and introductory chapter.

All readers of the book, the author trusts, will
kindly overlook the many imperfections in it.

It is not expected that the book will in any way or
degree supersede the two or three other works which
liave been pubhshed with a like object. The aspira-
tion is to simply assist in the goo<l work.

While the book is intended for all classes of readers,
professional and unpi'ofessional, the author hopes it
will be appreciated and largely read by members of
the medical profession, who are ever foremost in
efforts for promoting the public health, and many of
whom, alas! become victims of consumption.

Being apparently the latest of the books published
on this subject, and, it is believed, " up to date " in
most respects, it may contain something that is in a
measure new: — as in relation to the body or soil factor,
and also to this being the immediate exciting cause of
the disease and the one which it seems desirable and
practicable rather to attack first, or with our principal
forces, in preventive efforts; to the probable and
possible sources, such as that of domestic animals and

PREFACE.

that of a possible open air growth, of the other
principal causative factor, the tubercle bacillus; and
to the nature and degree of the infectiousness, and the
de novo origin, of the disease.

That the book may be instrumental in preventing
human suffering and preserving human health and
life is the earnest hope of

The Author.

Ottawa, November, 1895.

;

TABLE OF CONTENTS.

PART I.
NATURE AND CAUSES OF CONSUMPTION.

CIIAITKR

I. Introductory.

PAGI

Nomenclature — Prevalency and Cost of the Disease —
It is Communicable and Preventable — Two Prime
Essential Causes — Curability of Consumption — Know-
ledge of Breathing Necessary 9-18

II. The Ldnos and Their Functions, or Uses.

What is Respiration ? — The Respiratory Organs : The
Lungs— The Air Tubes and Cilia— The Chest Walls
and Pleura — The Breathing Acts and Lung Capacity —
The Blood and the Breath in the Lungs — The Poisons
in Breathed Air — Poisonous Effects of Prebreathed
Air — The Oxygen in the Body — Important Facts —
Proportionate Chest Dimensions — The Lungs may be
Enlarged 19-37

III. Nature and Characteristics of Tubercular Pul-
monary Consumption. What is Consumption ?

Its Different Forms and Names — What is Tubercle?
— The Tubercle Bacillus — Laboratory Cultivation of
the Bacillus — Sporing and Multiplication — Relations
of the Bacillus to the Disease — Whence Comes the
Tubercle Bacillus ? — Saprophytes and Parasites —
Tubercle in Other Tissues and Animals— Simple Ex-
aniples of Parasitic Diseases— Formation and Progress
of Tubercle — Antagonistic Body Forces— The Changes
are Inflammatory — Diffusion of Tubercle in the Lungs
— Further Diseased Conditions— The Brighter Side . 38-62

CONTENTS.

CHAPTER

IV. CaDSKH of TlUKlKHLAR PlLMONARV CONSl'MPTION.
iMHKItKKT KkSPIKATION AS A CaUSK.

(Jeneml HeinaikH : Half Knmedies — Two KsHontial
Agents : Authorities On — Predisposition : What is
it? — Vegetation autl Soils -Retained Body Excreta:
Carpenter's Theory — Who Take Infectious Diseases '!
— Of the Poisons (ienei'ated in the Hody- Aie Dis-
ease (Jernis Originally Benign ';— EH'ects of Environ-
ment on Disease (Jerms — Dormant or Ljitent (iernis
in the Body — Effects of Imperfect Breathing —
Special Collective Investigations — Experii .ents and
Opinions of Others — Corroborative Evidence — What
may be said Against this View — Bespecting Cause
and Effect— Concluding Facts and Deductions . .

PAOE

63-119

V. Causes ok Consumption Continukd.
AS a Causk.

Hkkedity

General Remarks — Statistics Bearing upon Heredity
— Heredity as Relating to the Tubercle Bacillus —
Heredity and the Body Factor or Soil 120-134

VI. Causes of Consumption Continued. Want of
THE Natural Body Defences as a Cause.

The Protective Walls— The Phagocytes and Blood-
Serum Antidote 135-141

VII. Causes of Consumption Continued. Remote or
Secondary Causes from Habits and Con-
ditions of Life.

Impure, Prebreathed Air — Want of Sunlight a
Cause — The Neglected "Cold": Weather and
Climate — The Soil and Dwelling-House — The Diet-
ary : Cookery — Occupation, Tobacco, etc. . . . 142-156

VIII. Causes of Consumption Continued. The In-
fectiousness AND CoMMUNICABILITY OF THE
Disease.

General Remarks on Infection — History of the In-
fection Theory — Historical Evidence of Infection —

CONTEXTS.

CHAPTICR

Vll

PAOK

[

Statistical Evidence of Infection— Hist )ry of In-
dividual Instancea and Cases — Kxperiuiental Evi-
dence of Infection— Circuin8tancc< Modifying the
Above Evidence — Evidence Opposed to tlie Infec-
tion Theory — A Degree of Infectiousness Fairly
Established 157-184

IX. Causes of Consumption Continued. Sources
AND Dissemination of the Bacilli.

Human Sources of the Bacillus — How tiie Bacilli
Enter the Body: Inhalation — Interconiinunicability:
Infection from Animals — Tlie Bovine Pace a Source
of the Bacillus — Flesh and Milk Source of Infection 185-19.5

X. Causes of Conscmi-tion Continued. De Novo
Okkjin of the Dihkase.

Does the Bacillus Grow Outside the Body? — A Pos-
sible Lower Animal Origin — Consumption not ahva^'s
from Infection — Oversight and Isolation not Suf-
ficient — The Body Factor : Pretubercular Condition
— The Body Condition must be Prevented — Deduc-
tions : Conclusion of Parti 196-211

PART II.
PREVENTION OF CONSUMPTION.

XL Practicability and Facility of Prevention — Prin-
ciples of Prevention : Lines of Action — Pure Im-
pregnable Bodies First -Attention to Minute De-
tails—Division of the Subject 212-225

XII. General Essentials ok Health.

Pure Fresh Air First — The Soil — Dwelling- House —
Ventilation : Its Importance, Cost, etc. — Sunlight
— The Dietary : Foods, Cookery— (ieneral Bathing
and the Skin— Some Other Essentials — Overwork —
Sleep— Rest 226-246

Vlll

CONTENTS.

CHAPTRR rAOB

XIII. Si'KciAL Individual Prbvkntive Mkasures.

General Respiratory Exercise— Special Lung Exer-
cises—How to Keep Out of Doors — Occupation
Considered — Digestive and Nutrient Foods — Pre-
venting "Colds": the Cold Batli— A Few Words to
Parents — Marrying and Giving in Marriage — Avoid-
ing and Preventing Infection — The Spittle and
Other Excretions Protul)ercular Preventive Mea-
sures 247-282

XIV. State and Municipal Prbvkntive Measures.

Lines of Legislation — Preventive Education —
Stricter Measures : Better Inspections — Sub-soil
Drainage - Meat and Milk Regulations — Public
Ba hing Conveniences — School Pupil Management —
Official Management of Cases — Hygiene of Domestic
Animals — Sanatoria or Hospitals for Consumptives. 283-297

XV. Climate and Prevention.

What is Climate ? — The Atmosphere and the Body
Functions— Classification of Climates — Ocean Cli-
mate — High Mountain Climate — Elevation is not
Necessary — Forest Climate — Acclimatization —
Change of Climate Uncertain and Empirical —
Essential Climatic Elements or Conditions— Special
Local Influences and Conditions —Select, Home Cli-
mate — Climate of Canada and Adjacent States . . 298-328

PART III.

XVI. Relating to the Treatment of Consumption.

Diagnosis : Diflferentiation— Some Signs and Symp-
toms of Consumption — Early Treatment : Delay
Most Dangerous — The Patient and Physician —
Indications and Remedies 329-340

CONSUMPTION:

ITS NATURE, CAUSES AND PREVENTION.

PART I,

NATURE AND CAUSES OF CONSUMPTION.

CHAPTER I.
INTRODUCE JRY.

NOMENCLATURE.

In this treatise, it is my purpose tu confine myself
to that "wasting" disease of the lungs commonly
called Consumption (from the Latin \vor<l consumo ;
originally, to take the whole of anything — hence to
eat, waste away, bring to naught — to consume). The
disease is more accurately termed pulmonary con-
sumption — consumption of the lungs (pulmonary,
from the Latin, pulmonis, a lung). Furthermore,
from the peculiar tuber-like or knob-like masses —
tubercles — of disease-substance or tissue, which form
in the lungs in this disease and which are special
characteristics of it, it is yet more accurately and
technically termed tubercular pulmonary consump-
tion. Suck tubercles, moreover — tubercles of pre-
cisely the same history and character — form in many
other organs and tissues of the body as well as in the

CONSUMPTION

lungs, especially in the bowels, and hence the term,
consuTnption of the bowels. Hence, too, the technical
term, tuberculosis, which is gradually coming more
and more into use, particularly with reference tu
domestic animals. Again, in many cases, two or more
or many of the bodily organs become the seat of
these tubercles, or of the disease, at the same time,
and to these cases we apply the term, " general tuber-
culosis." Consumption and tuberculosis are in this
connection synonymous terms. Phthisis, the Greek
word for wasting away, is* another technical, classical
name commonly given to the disease, especially by
physicians.

The term consumption, however, is in most common
use, the disease is best and most generally known ]>y
that name, and it is therefore my purpose to adhere
for the most part to this less technical word. Further-
more, when the word consumption is used herein,
unless otherwise designated or explained, it means
tubercular pulmonary consumption — consumption of
the lungs — this being by far the most common form,
the lungs being the most connnon seat, of the disease.

It w411 be well to observe here, and for the reader
to bear in mind, that, in using means for the pre-
vention of the lung disease w^e at the same time
combat, more or less successfully, all the other forms
of consumption.

PREVALENCY AND COST OF THE DISEASE.

Consumption is such a very prevalent and fatal
disease in almost every country in the world, in both

ITS NATURE, CAUSES AND PREVENTION.

man and the domestic animals, that hardly any
subject can be of greater importance than that
which relates to its prevention. It is a subject which
concerns every individual, of every age, high, low,
rich and poor, almost alike ; for so wide-spread is the
disease that no one is exempt from it or its influences.
As Doctor Irving A. Watson (Sec. Am. Pub, Health
Assoc, in pamph.. Prevent, of Consump.) graphi-
cally gives it ; " In many geographical divisions of
the world it invades almost every community. It
comes with such an insidious and silent tread that its
footfall is unheard. It seizes its victim with such a
gentle and tender grasp that its hand is unfelt till its
finger has painted the hectic flush of its first con([uest ;
and in a few weeks, a few months, or perchance a
few years, it has attained its ultimate victory —
death. There is no life too pure, no face too sweet,
no form too lovely, for its unrequited passion of
destruction. It is the crowned king of mortality
before whose edict we have too long bowed our heads
in ignorant and sometimes reverential submission."
In its various locations in the body, consumption
causes from one-sev^enth to one-fourth, according to
climate and locality and the habits and manner of
life of the people — probably on the average, one-fifth
or more — of all the deaths of the human race, and it
has been aptly termed the " Great White Plague." In
England, pulmonary (lung) consumption alone still
causes about as many deaths every year as did small-
pox a century ago, or about one-tenth of the totals.
Nearly half a century ago, the late Sir James Clark,

^^:

CONSUMPTION :

M.D., wrote (Cyc. of Pract. of Med.) : " It is not
advancing too much to state that, among the whole
range of human infirmities, tuberculous diseases are
the most deserving the study of the physician,
whether we regard their immense frequency or
appalling mortality. Confined to no country, age, sex,
or condition of life, they destroy a larger proportion
of mankind than all other chronic diseases tocfether."

Moreover, with the exception of certain limited
localities in England and on the Continent of
Europe, of armies and navies and a few public insti-
tutions, where from certain or better hygienic regula-
tions and administration in recent years the disease
has been less prevalent, it appears to be generally
increasing in frequency.

From the usual slow progress of the disease, from
the long period of debility, sickness and inability to
work, which almost invariably accompany it, the
actual money outlay for medical attendance, medi-
cine, nursing, etc., which it calls for — aside from the
loss of time and incalculable amount of suffering and
the deaths — is vastly greater than that of any other
disease.

IT IS COMMUNICABLE AND PREVENTABLE.

Consumption is, in a measure, an infectious or
communicable disease ; that is, the seeds or germs of
it sometimes proceed directly from another person
or animal affected with it. This is now almost uni-
versally conceded by authorities. Where, therefore,
no special measures to prevent its spread are made use

ITS NATURE, CAUSES AND PREVENTION.

of it is but natural that it should increase in frequency.
That it is not virulently or highly infectious, how-
ever, is apparent to any observer ; and this probably
for. these reasons: the infective particles or germs are
not given off so abundantly from an infected body
as in the case of many other infectious diseases ;
they multiply slowly ; they have not such great
vitality or virulency as, or they are more easily ren-
dered inert or destroyed by a low or high tempera-
ture than, most other germs ; and they do not so
readily adapt themselves to surrounding conditions,
requiring a more especially adapted, receptive, non-
resisting soil within the human body in which to
develop and grow : just as in ordinary vegetation the
seeds of some plants are much less abundant than of
others, multiply more slowly, are more easily killed,
and will not take root and grow in such soil as the
seeds of other plants will readily spring up in and
I reproduce themselves in abundance. Practically, then,
it need not be treated with such extreme preventive
[or sanitary measures as are necessary in the manage-
[ment of most of our epidemic, infectious diseases.

Consumption is now universally regarded by the

[medical profession as being prevental)le, as are more

especially all diseases which are infectious, or com-

jinuiiicable from one person to another. Moreover,

lanyone who will examine into its now well-known

jcauses cannot fail to see that it is not only prevent-

lable but that it may be more easily and surely

)revented than the more actively infectious diseases

[Vvhich prevail epidemically, the prevention of it being

^mm.

\'U

In 1

liiii

ili

CONSUMPTION

in each case more in the individual's own hands.
Many persons, unhappily, even amongst the more in-
telligent classes, look upon consumption as something
to which certain predisposed human beings are so
naturally subject that prevention in such cases is im-
possible ; yet, when once symptoms of its presence
become manifested in such persons there is usually no
hesitation in at once resorting to means for its cure —
alas ! too often when too late.

It is remarkable, considering the great fatality of
this malady, that more general special attention has not
heretofore been given by sanitarians to its prevention.
Those interested in public health work have bestowed
their thoughts and time chiefly on those diseases
which prevail epidemically and in a short period of
time destroy many lives, while this abiding disease,
ever cutting off, after months and years of almost
hopeless suffering, vast numbers of lives, often the
brightest, most useful, most valuable, frefjuently in
the best period of life, has not received due practical
consideration. " Were the annual deaths from this
affection to occur in a few days instead of a year, the
public would require no urging to be convinced of
the absolute need of strictly observing preventive
measures" (Burt).

Health authorities from time to time issue pamph-
lets of instructions on the prevention of diphtheria,
small-pox and scarlet fever, but very little in this way
has yet been done for the prevention of consumption,
a more preventable and more destructive disea.se. A

ITS NATURE, CAUSES AND PREVENTION.

commencement in this way, however, lian been made
jind tlie prospects are improvinj^.

Statistical evidence is not wanting to prove that the
inortaHty from consumption has been lai'gely reduced
in certain localities by sanitary or preventive measures,
although these measures were not usu dly specially in-
tended to prevent this disease. For example, accord-
ing to Doctor Thorne Thorne, Chief Medical Officer
of the Local Government Board, of England, in the
period 1804-08, the consumption death-rate in Eng-
land and Wales ranged from 2.002 to 2.380 per million
living per annum; whereas, during the period 1884-88,
the corresponding rates had fallen to 1.752 and 1.541
})er million. T^iis marked diminution. Doctor Thorne
ways, though doubtless in part a matter of nomen-
clature — of recognizing and more correctly naming
lung diseases — " has without (juestion been largely
assisted by the improvements that have taken place
ill the general conditions atlecting the population " —
improvements in lodgement, employment, feeding and
clothing, more out-door exercises in the young — " and
; a number of other matters which have gone to diminish
a tendency to catarrhal maladies, the aggravated
I recurrence of which tends to induce a condition favor-
able to the development of pulmonary tubercle."
Again, in the army and navy, by providing more
space per man in housing or barracks and better ven-
tilation, the proportion of deaths from the disease
[amongst the men has been thereby greatl}^ reduce<l.

Now, it will be well to note here, at once, that, in
[the prevention of consumption, there are

mmmmm

CONSUMPTION

liii

Mli:

ilijl

IH!"

TWO PRIME ESSENTIAL CAUSES

or conditions which must always be taken into con-
sideration : namely, ( I ) the germ or seed, the infec-
tion ; and (2) the special, fit soil, the receptive non-
resisting body, in which only the seed can gi'ow.

While it appears clear that no soil, no condition of
the human body, however fitting, can give rise to
tubercular consumption until the special seed — the
infective germ — has been sown or has fallen or found
its way on to it, any more than the most suitable soil
can produce thistles or mustard without the seeds of
these plants, neither can the infection or seed of this
disease develop and grow and give rise to the disease
unless it find or fall upon the special, as it were pre-
pared, soil or condition of body. T^ is is a most
important point to bear in mind in all efiforts for the
prevention of the disease.

CURABILITY OF CONSUMPTION.

While the prevention of the disease should be the
first aim, it should be remembered that consumption
is curable as well as preventable — curable in its
earlier stages. Of this there is abundant convincing
evidence. Some persons are cured of it in general
medical practice, after it had been clearly "seated;"
while many hospital patients who died of other
diseases have given unmistakable evidence, on post-
moi'tem examination, that they had had the disease,
although it had long before ceased to be progressive
and the scars alone were left. Most of the patients,
so far as could be learned from their history, never

I'll!
III!

ITS NATURE, CAUSES AND PREVENTION.

know that they had had it. The cure had been, per-
haps, brought al)Out simply by a change on the part
of the individual from an in-door life to an active one
out in the pure air and sunshine. It is, tlierefore, a
mistake to regard those who have contracted the
disease as being necessarily doomed to die of it sooner
or later and all treatment as only palliative.

There is not, however, it may be here clearly and
positively stated, any specific for the cure of con-
sumption, all the promises of charlatans, as through
misleading advertisements in papers or otherwise, to
the contrary notwithstanding. The treatment of it
by the best physicians is on general principles, in
accordance with the particular condition of each indi-
vidual case, no two being precisely alike ; indeed, it is
almost entirely of a hygienic character, as it is termed,
consisting mainly of such means as, when early em-
ployed, prevent the development of the disease.

KNOWLEDGE OF BREATHING NECESSARY.

In order that consumption may be most success-
fully combated and prevented, it is essential that
every person should know something about the
nature, character and causes of the disease, and there-
fore something, too, about the structure and functions
j of the lungs and the nature of respiration — the func-
tion of breathing.

Nearly all consumptives, if not all, have a propor-
tionately small or limited respiratory capacity or
[action — proportionately small lungs, perhaps, from

heredity, or if not small, the use of them is limited
2

CONSUMPTION :

from habits of life; hence the function of respiration |
in these persons is but imperfectly performed. Much
of this is from ignorance. Few know the nature or I
importance of this function.

Breathing we may regard as the most vital andl
important of all the functions of the body. It is.
therefore, most desirable that every body should
know how to breathe properly. Many persons doj
not know. It will then be best to devote a few pagesl
here to a brief description of the lungs and their uses.
A little knowledge is a " dangerous thing " only toj
those who presume too much on that little, who do|
not use it properly but misuse it.

i!!"

ITS NATURE, CAUSES AND PREVENTION.

CHAPTER II.

V-j-

|THE LUNGS AND THEIR FUNCTIONS, OR USES.

WHAT IS RESPIRATION ?

|Respiration (from the Latin prefix, re, and spirare,
to breathe — i.e., to breathe again) is that function by
"wliich an interchange of gaseous substances takes
)lace between the inner parts of a living body and
the air or water in which it lives. Animal bodies
take in oxygen and give out carbonic acid gas ; vege-
table bodies take in carbonic acid gas and give out
)xygen. In the higher animals the special organs for
this interchange of gases are the lungs ; in fishes, the
rills : in plants, the leaves. As through the stomach
the food eaten gets into the blood, so through the
Jungs, oxygen — gaseous food — gets into the blood.
Int the lungs are something more than nutrient
)rgans; they are largely excretory organs, too, for
throwing off waste matters.

A lung is simply a broad, yet much folded, very
hie, delicately constructed, transparent membrane,
rith one surface exposed to the air in the lungs, while
[he blood in minute vessels is spread out on the other.
50 broad is this membrane that it is said, if it were
bread out its surface would be thirty times that of
[he skin of the body. Gases pass readily through it,

jl^^^K-

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f;()NsrMi»Tiox

just as air passes through fine muslin ; and the oxyjroii|
of the air in the lungs passes through it into the blood
while at the same time carbonic acid and other sul>
stances from the blood pass out and are expelled.

Out-door atmospheric air consists of about 21 1
per cent, of volume of oxygen, and seventy-nin(|
of nitrogen, with varying proportions of watery vapoi-,
less than a two-thousandth part of carbonic acid gas I
and mere traces of ammonia and other gases. Thtl
maintenance of tho higher animal life depends upoiil
and necessitates a continual taking in or absorptioiil
from the air of oxygen and a small proportion ofj
nitrogen, and a throwing off or excretion into the airj
of carbonic acid, with watery vapor and a poisonous
nitrogenous vapor. The object of respiration is thel
interchange of these sub-tances between the bloodj
and the outer atmosphere. The lungs — the speciall
organs of respiration, are most wonderfully and
beautifully constructed for exposing the blood to thel
atmosphere in order that such interchange may take
place. The blood, after it has circulated for a fe\vj
moments throughout the entire body, or has been thtj
round of the greater circulation, is pumped to thti
lungs, and it is necessary that the atmospheric ain
with its oxygen shall flow freely, abundantly, throu^li
the lungs — into them and out of them — to meet ther^
the blood spread out to be bathed and purified b}J
the air.

If this remarkable process by which we take int
the body atmospheric air with its indispensable life]
giving oxygen, and throw off" out of the body carbonii

ITS NATURE, CAUSK8 AND PREVENTION.

ic'ifl and other poisonous excrete matters, l>e suspended,
life is almost at once extinj^uished. IF, iiKlced, the
)rocess be even interfered with, and not ])i'()perly and
[•ompletely carried on, the other vital processes are
SDon obstructed and retarded, all the functions of life
u-e impaired, and want of stamina, general debility
irid ill-health ()uickly follow.

THE RESPIRATORY OR(JANS— THE Ll'X(}S.

The lunj^s are made up, then, of two vast mem-
)ranes — one for each lung — so folded or puckered
IS to form minute cavities, called air cells or air
jhambers, giving great expanse of surface wliile
^'et occupying as little space as possible consistent
kvith their function. Little tubes, called bronchial
tubes, lead to these little cells or chambers from
larger tubes which extend from the wind-pipe — or
[rachea, for conveying air into the chambers. The
lir chambers are of various irregular forms, from
nutual compression or packing together, and each

; covered with a close net-work of minute blood
re.ssels, called capillaries, so that the blood is on the
bter surface of the air chambers, while the air is

nthin them. The air chauibers cluster around the
ittle tubes and branch tubes, somewhat like grapes
ipon their stems. They are so small as to be hardly
fistinguishable by the unaided eye. Arteries and
kins, extending along beside the bronchial tubes,
^ranching again and again, as the tubes branch, con-
[ey the blood to and fro between the blood capillaries
|ii the air chambers and the heart. The two lungs,

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coNsuMnioN :

with the heart and other large vessels, fill the chest.
Each lung is somewhat cone-shaped, with the small
end terminating in a thin edge, called the apex of
the lung, situated behind and a little ahove the collar-
hone, or clavicle.

After air once enters the lungs at birth they always
contain some air, feel spongy or elastic on pressuix-,
and will float on water; hence, the vulgar name,
" lights." The membrane forming the air chambers i.sl
elastic and will stretch considerably, as one will find
on blowing into the lungs of a small animal.

THE AIR TUBES AND CILIA.

The windpipe, or trachea, is a stiff tube, containin*,'
rings of cartilage which resist pressure and prevent
closure of the air pas.sage. Below, it divides into two!
large bronchial tubes, one for each lung, the right and
left bronchi. These divide and divide into smaller
and smaller tubes, which extend to all the air cham-l
bers. Above, near the throat, the trachea swells out|
into a larger tube, or sort of box, called the larynx,
which contains the vocal apparatus.

All the air passages — the windpipe, and large and I
small bronchial tubes — and also the air chambers, are
lined on tlie inner or air surface with a layer of
minute cells, called epithelium. This epithelial layer!
is somewhat similar in structure to the cutis — thel
outer layer of the skin ; but instead of being dry, like
the cutis, it is moist and soft like that lining thel
mouth. Like the cutis, it is gradually shed or worni
off and renewed. On the free surface of it, extending!

ITS NATURE, CAUSES AND PREVENTION.

from the larynx to and throughout the smallest
bronchial tubes, though not into the air chambers, are
most mimite, hair-like processes, set closely together,
i;ull('<l cilia. They are about 1-5,000 of an inch long,
one end being free while the other is attached to the
layer of cells or epithelium, resembling in their
urrungement the pile of velvet. The cilia are in
incessant vibratory motion, which, under the micro-
scopt', gives to the eye of an observer an impression
similar to that given by the surface of a Held of
ripening wheat when moved by the wind. These
movements produce a continued current outward, and
tiuu ' u'eign substances, as particles of dust, or excess
of mucus, as when one has a " cold," coming in con-
tact with the cilia are conveyed from the deeper
parts of the lungs to the windpipe to be coughed up.

! 11

THE CHEST WALLS AND PLEURA.

The walls of the chest are formed chiefly by the

ril»s, with two layers of muscular fibres, the intercostal

muscles, stretching between each pair, for the purpose

[of moving them. Tlie ribs are attached behind to

[the spine, each by a movable joint, and as one may

[see by examining one's own ribs or those of another

I person, they are considerably lower in front than at

[the spine, so that when the front ends are raised by

[the muscles, the breast bone, or sternum, is lifted and

moved forward, and thus the depth of the chest is in-

I creased. The breadth of the chest is at the same time

increased by the rotatory elevation of the central part

of the ribs, at the sides, somewhat as the half-circle

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CONSUMPTION :

handle of an ordinary wooden bucket is raised. The
floor of the chest, dividing it from the belly, or abdo-
men, is formed by a broad, thinnish, but strong muscle,
the diaphragm, which curves up dome-like into the
chest. When its fibres contract, it becomes flatter and
presses downward the contents of the abdomen, as one
can feel by placing one's hand on the stomach when
drawing in air, and the height or length of the chest
is thereljy increased. Thus the depth, breadth and
length of the chest are increased, and by muscular
action.

The atmosphere always pressing on everything
pours into every crack or opening. The chest is
an air-tight chamber, and air cannot get in between
its walls and the lungs. When the ribs are raised, the
diaphragm depressed and the chest thus enlarged, air
enters the lungs freely through the ever-open nostrils,
throat and windpipe, and they are kept stretched
against the chest walls and always just fill the
chamber. The walls of the chest keep the air pressure
from the outside of the lungs, and so these organs
are kept expanded b}'^ the air pressure on the inside
of them. If an accidental opening be made through
the walls of the chest, and especially if one be made
on each side, as by stabs, air enters in between the
chest walls and the lungs, and sometimes so com-
presses them as to make breathing difficult, or quite
impossible and suffocation follows.

Between the walls of the chest and the lung, on
each side, entirely investing the lung, is a delicate
serous membrane having a double layer, one of which

ITS NATURE, CAUSES AND 'PREVENTION.

is spread over and attacticri to the lung, forming its
smooth, slippery covering, the other over the chest
walls. This, like all such membranes, forms a great
closed, irregular-shaped sack with the inner, opposed
but unattached surfaces very smooth, and on which is
a little lubricating fluid that prevents friction during
the movements of the parts on each other in the acts
of breathing. This membrane is called the pleura,
and an inflammation of it is what is termed pleurisy.

THE BREATHING ACTS AND LUNG CAPACITY.

Breathing consists of two acts : first, that of raisiig
the ribs, increasing the size of the chest and permit-
ting air to flow into the lungs ; and, second, that of
lowering the ribs, lessening the size of the chest, and
forcing the air out again. The size of the chest, re-
member, is increased in all dimensions — depth, breadth
and length ; the ribs are raised, chiefly by the outer
layer of the intercostal muscles, making the chest
deeper and broader; the diaphragm is flattened or
drawn down by the contraction of its fibres, making
the chest longer ; and air rushes through the wind-
pipe into tho lungs, keeping them pressed close to the
walls of the chest. This is inspiration. The outer
intercostal muscles and diaphragm now cease to con-
ticict, the ribs are drawn down again, chiefly by the
inner intercostals, and the diaphragm agairi rises
up into the chest, helped up by the, contents of the
abdomen, which are pressed upon by the muscular
walls of that cavity, and the stretched lungs return to
their former size again. This is expiration. We breathe

CONSUMPTION :

I 1
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ijlli

thus from fourteen to twenty times every minute;
from fourteen to twenty times every minute the ribs
rise and the diaphragm descends, and then both return
to their former state again.

The quantity of air drawn into the lungs at each
breath is small when compared with the quantity
they will hold. The lungs are not nearly filled to
their greatest capacity, nor nearly emptied, at each
breath. In a condition of full development and health,
therefore, these organs have not only a sufficient
breathing surface for performing their ordinary
functions, but also sufficient to meet any extra de-
mand, within reasonable limits, that may be made
upon them. The lungs of a full-sized man will hold,
when stretched to their utmost, about or over three
hundred cubic inches of air. But after an or ary
inspiration they actually contain only about two
hundred cubic inches, remember, or two-thirds of
what may be drawn into them by a forced inspiration.
Now, barely one-seventh of this, on an average, or
twenty-five to thirty cubic inches, is pumped in and
out at each respiratory act. After an ordinary ex-
piration, therefore, the lungs still contain probably
one hundred and seventy -five cubic inches of air. In
other words, every time we breathe we change only
about one-seventh of the usual air contents of the
lungs. This one seventh of the air contents of the
lungs which we pump in and out with every breath is
called breathing or tidal air. The quantity of air over
and above the ordinary tidal air which can be drawn in
by a deep or forced inspiration is called complemental

II!

ITS NATURE, CAUSES AND PREVENTION.

air, the amount of which varies greatly in different
individuals. The air remaining in the lungs after
each ordinary expiration of the tidal air — that is, the
other sixth-sevenths of tlie ordinary lung contents —
is called stationary air. By a greatly forced ex-
piration about one-half or more of this stationary
air can be expelled. This is called reserve air. After
tliis, after tlie greatest expiratory effort, a certain
amount of air still remains in the lungs— air which
cannot be expelled by any effort. This is called
residual air, and its amount depends largely on the
size of the chest; but it is estimated at from fifty to
one hundred cubic inches.

Respiratory capacity, the vital capacity of Hutchin-
son, represents the quantity of air which can be ex-
pelled from the lungs by the most prolonged expira-
tion possible after the deepest inspiration possible. It
represents the power of a person to draw air into the
lun^s, and is measured by an instrument called a
spirometer, into which the person breathes. The
vital capacity, the quantity of air expelled, is indi-
cated by the height to which the air chamber of the
spirometer can be raised by the forced expiration of
the experimenter. It expresses the person's breathing
power in emergencies, as in active exercise, etc.

The average lung capacity of a healthy adult
limn, five feet seven inches in height, is about 225
cubic inches. For every inch of stature above this
standard the capacity is found to average about eijht
cubic inches more; and for every inch below, eight
cubic inches less. The influence of weight on the

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CONSUMPTION

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capacity is less manifest. It appears to decrease in
weights above 160 pounds. " By age, the capacity
appears to be increased from about the fifteenth to
the thirty-fifth year, at the rate of five cubic inches
per year ; from thirty-five to sixty-five, it diminishes
at the rate of about one and a half cubic inches per
year; so that the capacity of respiration of a man
sixty years old would be about thirty cubic inches
less than that of a man forty years old, of the same
height and weight" (Hutchinson). " Bourgery cal-
culates that a child of ten years of age, with a weight
three times less than that of a man of eighty, has a
respiratory power eight times greater, due tc the
great difterence in the range of respiratory move-
ments. The old man is able to increase the usual
amount breathed by less than one-half, while the child
may increase it nearly fourteen-fold." The capacity
of the lungs, it appears, is much smaller in females
than in males. The force which can be manifested
by the expiratory act is, on the average, a third
greater than that of the inspiratory act.

There is, then, it must be remembered, usually a
large amount of stationary air (reserve and residual
air) in the lungs. How does the tidal air get down
deep into the air chambers and reach the blood ?

liiii

THE BLOOD AND THE BREATH IN THE LUNGS.

Gases diffuse and mix rapidly. If a jar be filled
with one sort of gas and turned mouth downward
over a jar filled with another sort of gas, the gases
immediately commence to mingle together, and in a

li i

ITS NATURE, CAUSES AND PREVENTION.

short time both jars will be filled with the thoroug^hly
mixed gases. The mixture takes place rapidly and
Mtrainst gravit3^ It is constantly going on in the
lungs. The tidal air we draw in at each breath
(juickly mingles with the stationary air already in
the lungs, and the few cubic inches of air we almost
iiinnediately expel by expiration is not the same we
iiad just drawn in by inspiration, but a mixtitre of
tidal and stationary air : a seventh of it only,
probably, being of that just breathed in.

The blood in the lungs, as it moves along in the
minute vessels covering the air chambers — the lung
capillaries, is thus constantly bafhed with air, which
is partly renewed and purified at every breath. As
often as once every minute, it appears, all the blood
in the body flows through the little ^'essels on the
walls of the air chambers, so numerous are thev.
Blood, before it passes over the air chambers, is dark
purple, and is called venous blood. It has been the
round of the circulation — to all parts of the body, and
has taken in a lot of waste matters, chiefly in the form
of carbonic acid, watery vapor and a poisonous nitro-
genous substance, the carbonic acid making it dark.
In this condition it flows along the veins (hence the
name venous) to the heart, whence it is forced on to the
hmgs. While flowing through the lungs, the blood
oives off to the air in the little air chambers its
l>urden of waste stuffs, and takes up from the air in
the chambers a load of oxygen, and becomes again of
a bright red tint — arterial blood. Thus purified an«l
replenished with oxygen, it flows back to the heart,

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IP:;:;

CONSUMPTION

whence it is again pumped along the arteries to all
parts of the body. It now trickles through the short
capillaries in the tissues into the veins once mor^ for
another trip to the heart. While in the tissues it dis-
charges its oxygen and is loaded with tissue waste.
The oxygen in the l>lood is carried by the red color-
ing matter (haemoglobin) of the red corpuscles.
Magnus has shown that " venous blood contains 25
per cent, of its volume of carbonic acid, and 5 pei-
cent, of oxygen ; and that arterial blood, on the
otlier hand, contains as much as 10 per cent, of
oxygen, and only 23 per cent, of carbonic acid."

The lungs then perform a double function. They
take in the oxygen which the organism requires, and
which, because it is so essential to life, has been called
vital air ; and they cast out a large proportion of the
worn-out waste matters of the body, the prodiTcts
of tissue wear and combustion, which, if retained
in the blood, would soon destroy life.

Furthermore, full breathing promotes the circulation
of the blood, not only through the lungs but through-
out the entire body, aiding in general nutrition.

'mi

THE POISONS IN BREATHED AIK.

Expired or breathed air contains, then, a large
excess of carbonic acid and watery vapor, and perhaps
most important of all, from a health standpoint, the
organic poison, or leucomaine, and much less oxygen
than ordinary air. While ordinary atmospheric air
contains about twenty-one volumes per cent, of oxygen
and .035 per cent, (about 1-30 of 1 per cent.) of

ITS NATURE, CAUSES AND PREVENTION.

ies to all
the short
mori for
les it dis-
iie waste,
•ed color-
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itains 25
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id."

n. They
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prodiTcts
retained

rculation
hrough-
lon.

a large
perhaps
)oint, the
s oxygen
heric air
•f oxygen
cent.) of

carbonic acid, expired air contains only about Ifi
jier cent, of oxygen, and fully 4 per cent, of
carbonic acid, or nearly 120 times as much
more carbonic acid as atmospheric air. A man
consumes about twelve or thirteen cubic feet of
oxygen every twenty-four hours, and throws oft', by
the lungs, in the same period of time, over sixteen
cubic feet of carbonic acid — e((ual to about eight
ounces of solid carbon — and from twenty to forty
ounces of water, in the form of vapor.

If a wineglassful of limewater be put in a half-
pint bottle, and the breath blown two or three
times into the bottle, on shaking it the limewater
will become quite milky from the formation of in-
soluble carbonate of lime (carbonic acid gas and
lime combined), which after a little time will settle on
the bottom of the bottle. Every breath contains a
good deal of moisture, too, as proved when one
breathes on a cold mirror. In cold weather we
breathe more air and oxygen, and give off more car-
bonic acid, than in warm weather, as we do likewise
when taking exercise.

The organic matter in expired air is a most impor-
tant ingredient. It has a disagreeable smell, and is
very poisonous to rebreathe. The fetid odor in
unventilated bedrooms and crowded rooms is owing
to this impurity. It is nitrogenous, yielding ammonia
on decomposition, is but slowly oxidized, and seems
to float in clouds like tobacco smoke. It is most
readily absorbed by wool, feathers, and damp walls,
and has been found in large quantities in the plaster

I :

{m:']

CONSUMPTION

removed from the walla of hospital wards. The l>ar('
thought of inhaling, drawing into our body, tliis
excrete poisonous substance from the lungs of anothei-
person, or even from one's own, is very repulsive.
Yet it is, with the other exhalations from the lung.s,
almost co^.'Stantly and universally breathed by all
classes in-doors. In the open air, or in well- venti-
lated rooms, these substances are soon dissipated and
rendered innoxious by free dilution with the air and
by oxidation.

! Ill

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POISONOUS EFB'ECTS OF PUEBREATHED AIR.

When the waste substances above mentioned ai't-
not sufficiently thrown off by the lungs, but accumu-
late in the blood, as always is the case when respira-
tion is imperfectly performed, they are certain to prove
highly injurious. When, for example, the air breathed
contains a great excess of carbonic acid, as in the
case of breathing air which has been once breathed,
then the quantity of carbonic acid exhaled from the
lungs is much less than usual, much of it, as well as
of the poisonous organic matter, remaining in the
blood. So it is likewise when the breathing acts are
shallow and imperfect.

The total quantit}'^ of air which flows through —
that is, into and out of — the lungs of an adult person
when at rest, every hour, is about 28,000 cubic
inches, or 700,000 cubic inches — 400 cubic feet — in
twenty-four hours: representing a cube of about
seven and a half feet, or th6 full of an apartment
seven and a half feet in each of its dimensions. A

ITS NATURE, CAUSES AND PREVENTION.

man engaged in hard work will breathe more than
double this, or an amount equal to the contents of
a room ten feet square on the floor and eight high.

It is found that in a room crowded with people
many persons suffer from headache, dizziness and
oven nausea, when the carbonic acid in the atmos-
phere of the room reaches one-seventh of 1 per
cent. : the effects being due doubtless to the presence
of the organic vapor or effluvia from the lungs and
the <liminution of ox^'gen, as well as, or more than, to
tlie presence of carbonic acid. According to Parkes,
wlien the carbonic acid in such an atmosphere reaches
to one-half this amount, or one-fourteenth of 1 per
cent., the organic effluvia is distinctly perceptible to
tlie sense of smell of most persons. A man at work
in a close room of the size above mentioned (ten feet
by ten and eight feet high) exhaling, with every
biu'ath of his one thousand breaths an hour, air con-
[taining over 4 per. cent, of carbonic acid, would,
[therefore, in less than one hour, render the air in the
jroom so foul as to cause headache, dizziness, etc., in
I many persons. From experiments of Doctor Snow
upon animals, he concludes that " 5 or 6 per cent.
[by volume of carbonic acid cannot exist in the air
[without danger to human life, and that less than half
jthis amount will soon be fatal when it is formed at
[tlie expense of the oxygen of the aii-," as in respira-
tion. So that a man working in such a room, if it
Were absolutely "air-tight," would not be likely to
survive twonty-four hours. Fortunately rooms are
lever air-tight, though many persons endeavor to
lake those they live in as nearly so as possibly.

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CONSUMPTION :

THE OXYGEN IN THE BODY.

The uses of all the atmospheric oxygen, as taken in
by the red corpuscles — nearly a fourth part of that
drawn in at every breath — is not yet positively
known. Nearly all of it, however, enters into ready
combination with the carbon and hydrogen of the
tissues, in that tissue-change — that breaking down or
" wear " (destructive metabolism)— whicl. is essential
to life : protoplasm constantly being formed of the
food supply going to build up again (constructive
metabolism). This combination of oxygen with car-
bon and hydrogen in the tissues, at the same time,
produces the heat by which the body is kept warm :
just as heat is produced outside the body. The pro-
ducts of the combination, then, carbonic acid and
water (oxygen and hydrogen), are readily conveyed to
the lungs and thrown off, eventually into the outer
air. Probably some of the oxygen unites directly with
the carbon and hydrogen of the food. A portion
doubtless acts as an oxidizer of any poisonous products
in the body. It appears to act, indeed, practically
as the great purifier of the organism.

The distribution of non-oxygenized blood over the
body is " incompatible with life for more than a few
minutes ; the rapidity with which death ensues in
asphyxia being due, more particularly, to the effect of |
non-oxygenized blood on the medulla oblongata, and,
through the coronary arteries, on the muscular sub-
stances of the heart. The excitability of both nerv-
ous and muscular tissue is dependent on a constant |
and large supply of oxygen, and when this is inter-

' ' I

ITS NATURE, CAUSES AND PREVENTION.

fered with, is rapidly lost. The diminution of oxygen
luis a more direct influence in the production of the
usual symptoms of asphyxia (suffocation) than the
increased amount of carbonic acid " (Kirk's Phys.).

THE FOLLOWING! IMPORTANT FACTS

may be summarized here with advantage. Our habits
of life, our daily practice, should be in accordance
witli them.

Air once breathed contains nearly a- fourth less
oxvj^en than atmospheric air, and hence is quite
inadecjuate for the purposes of respiration — unfitted
to l)e breathed again, or to sustain life.

Out of doors, in the momentary pause after expira-
tion, the air just exhaled is usually at once changed —
renewed, before another breath is taken. In very
calm, "close" weather, fans are instinctively used in
a measure for dissipating the breath.

Air once breathed contains, besides the poisonous
organic effluvia and much moisture, above 4 per
cent, of carbonic acid, or 120 times as much as pure
atmospheric air.

When respiration is not perfectly performed — when

the air breathed is not pure, or the lungs are not

habitually fully distended and used — poisonous waste

matters are retained and accumulate in the blood,

I causing derangement and disease.

It will now be easy for the reader to understand

[how very essential it is that only pure, fresh air be

breathed, and that it be breathed not sparingly ; how

essential, for both dwelling-places and the lungs, is

free ventilation.

if
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iiii'

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CONSUMITION :

PROPORTIONATE CHEST DIMENSIONS.

For perfect respiration, well -developed lunj^s, of a
si/e proportionate to that of the other organs of the
body, are indispensahle, and the lun^s must be exer-
cised and used in a rational manner. Many persons
with well-developed lun^^s do not use them as they
should — fully and freely.

In the structure of almost everyone there is, from
hereditary and other influences, a want, small or
j^reater, of due I'elative proportion in the various
ort(ans of the body, some organs not being so well
developed as others. It may be the stomach, or the
heart, the lungs or the brain, which is defective, and
hence the weaker organ. It is very desirable foi*
every person to know the weaker parts.

As regards tlie lungs, the dimensions given in the
following table show the circumference of the chest
of well-developed, vigorous persons of the respective
height and weight given. The size of the chest fur-
nishes a correct index of the size of the lungs, as these
organs with the heart and its large vessels just fill
this cavity.

HKIOHT

CIRCUMFKRENOE OF CHEST ON

AVERACJE

OF INDIVIDUAL.

A LEVEL WITH NIFPLE.

WEIGHT.

MEDIUM.

MAXIMl'M.

5 feet

1 ill

•lies

34.06 inches

40.66 i

aches

120 lbs.

5 II

35.13

41.33

125 1,

5 ,.

35 70

42.00

130 II

5 II

36.26

42.66

135 1.

5 II

36.83

43.33

140 1.

5 II

37.50

44.00

143 ..

5 11

38.16

.44.66

145 .1

5 1,

38.53

45.33

148 11

5 1,

3H.10

46.00

155 .1

5 ..

39.66

46.66

160 ..

.5 M

40.23

47.33

165 .1

a ..

• 1

40.80

II.

48.00

170 M

I i.i.l:,

ITS NATURE. CAt\SKS AND PHFVENTION.

With fho lungs proportionorl al)oiit as above indi-
cated, liabitunlly exercised to the full re(|uirements of
tlu' hody, and takin^^ in only fresh, pure air. tlie
function of respiration is almost certain to he per-
fectly performed, and consumption ])re> ented.

Tllfc I.lJN(iS MAY BE ENLAHCiED.

It nuist not be supposed that for persons l)orn with
pi-oportionately small lungs then; is no remedy. The
.size of the chest and lungs may b<? very materially
increased, just as an extrenuty, the arm or leg, may
be increased by judicious exercise.

Imperfect respiratory action is very common. The
movements of the lungs an«l walls of the chest have
their origin in, and are controlled by, nervous
influence. Breathing is not a voluntary, but an
involuntary act. We breathe witbout knowing it ;
but breathe we must. We can breathe (juicker or
slower, take long breaths or short ones, but we can-
not by any unaided effort of the will stop the l>reath-
ing. B^rom imperfect nervous developmtuit, however,
or derangement of the nervous system, from habit or
want of active exercise, many persons do not com-
monly, perhaps never, fill and distend their lungs to
the full requisite extent. In such circumstances, not
only is the whole function of respiration imperfectly
performed, but the almost unused parts of the lungs,
the distant parts — the extreme upper edges, or
Jipexes, espec'ally — become weakened and eventually
diseased, as any part of the body, an arm, for example,
would, if it were not used for a long time. Consump-
tion usually commences in the apexes. The remedy
is obvious, and in the hands of the persons themselves.

t»i

I i

'!• '^i

(pi;, i-
'""iiiiiih

!"iiiii'iii'

»! Illii

CONSUMPTION :

CHAPTER III.

NATURE AND CHARACTERISTICS OF TUBER

CULAR PULMONARY CONSUMPTION.

WHAT IS CONSUMPTION?

ITS DIFFERENT FORMS AND NAMES.

Consumption is particularly characterized by the
formation in the lungs of what is called tubercular
matter, or "tubercles," with destruction or wasting of
the lung tissues, usually with insidious conimencf-
ment and slow progress.

The disease has been known by different names.
In the human body it has been long commonly called
consumption — wasting, "pining" or "decline." In
the lower animals it has been known as the " grapes '
or " pearl disease," and sometimes the animal has
been called a " waster." The diseased conditions long
recognized by these various names and believed to
be different are now known to be one and the same.

Three forms of pulmonary consumption are some-
times described by authors — the catarrhal, the
fibroid and the tubercular, apparently in accordance
with the respective feature which is most predominant;
whether more catarrhal in character, or more fibrous,
or more abundantly tuberculous. At any rate, the
catarrhal and fibrous forms are not common, and in

ill .

I ■r:iiill|lll

liiti

llliirl

ITS NATURE, CAUSES AND PREVENTION.

the earlier stages, appear to be usually but diseased
states of the lung tissues of a non-specific character,
by which the tissues are brought into a condition
more suitable for the growth of the characteristic
formation — tlie tubercle — of true tubercular pulmon-
ary consumption. There are occasional cases of the
fibroid form in which, from an excessive formation in
the lungs of fibrous tissue, these organs become more
or less solidified and their functions proportionately
destroyed, and in which the symptoms resemble those
of the true tubercular disease, but in which no tubercles
are found. Some authorities contend that these are
not tuberculous. One of the best of them, however,
R. Douglas Powell, M.D. (iEtiol. of Phth.: Dis. of the
Lungs), has quite recently written, — " Further experi-
ence has led me strongly to doubt whether in all cases
of fibroid phthisis tubercle does not tp.ke an essential
part." Practically, the catarrhal and fibroid forms
need not be further noticed here.

• 3 1

WHAT IS TUBERCLE ?

Now, w^hat is this peculiar substance, tubercle ?
When first or recently formed in the body
tissues, or as found resting sessile on tissue, often
" standing out distinctly," it is a little pearl-
like mass, usually rounded where separated from
others, and varying in size from a minute speck
to that of a small shot. It is somewhat sticky,
tough, and difficult to crush or tear. At fi»;t it is
greyish-white and semi-transparent, but later it
becomes slightly yellowish and opaque. These little

IrW

I; '

It '

.':'iH','\

ilii'f'i'i

CONSt^MPTION :

masses, especially wlien numerous and scattered,
from being usually about the size of a millet seed.
have been called " miliary tubercle." By their pearly
appearance, the name " pearl disease," in bovine
animals, was suggested. Sometimes a number of
these little tubercles are found in a cluster. Masses
the size of a walnut or larger are often formed by the
aggregation of the smaller ones. So numerous and
enlarged do these growths sometimes become in bovine
animals that the lungs are thereby increased to thrice
or even five times their natural weight, to from forty
and even sixty pounds. Tubercle has never been
found except in warm-blooded animals.

THE TUHERCLE BACILLUS.

What is the cause of the formation of tubercle (
Whence comes it ? For thousands of years these
questions could not be answered. For only about
half a century now it has been known that tubercle
could be newly developed in certain susceptible ani-
mals by inoculating them with tubercular matter
w^hich had developed in another animal. It appears
that Buhl, in 1857, demonstrated the fact that it was
invariably due to the existence of it or its products
in some other part of the body ; and Villemen, in
1865, made its specific nature still more conclusive by
repeatedly producing tubercles in unaflfected animals
by inoculating them with tubercular matter. It was
only in 1882, however, that Doctor Robert Koch
clearly demonstrated that one immediate, essential and
what is now usually regarded as the directly exciting

rniise o

MMt

I ri;ii|llilllil|l

iiiiiiiiii''iH;i

ITS NATURE. CAUSES AND PREVENTION.

cause of the tubercle formation is a living microscopic
iunmis. akin to those which form moulds and to
the {jerms of other infectious diseases, a species of
bacillus (Latin, haculum : Greek, baktron : a stick or
.staff"), and a variety of bacterium. It is a "parasitic"
(so-called) vegetal organism of the lowest or simplest
form of life, now termed the hacilliis tuherrulosis
(bacillus of tubercle or tubercle bacillus; in the plural,
bacilli), or bacillus of Koch. Each bacillus is from
1-12,000 to 1-8,000 of an inch in length, less than half
tlie diameter of a red blood-corpuscle, or blood-cell,
with a thickness of about one-fifth or one-fourth of
its length. It is usually slightly curved or bent, with
somewhat rounded ends. Jt has no motion, and is
said to exist " better where there is no oxygen " —
Facultative anaerobic (M. V. Ball, M.D.: Essent. of
Bact. ). At a temperature of 86° F. it grows, it ap-
pears, but slowly : and it will not continue to pro-
pagate in decomposing fluids or in the presence of
bacteria of more rapid or more vigorous growth (in
the laboratory). By direct sunlight its vitality has
boen apparently destroyed in two or three hours,
while it is destroyed in a few minutes by a moist
temperature of 128° F. In a dry state, however, as in
sjnitum or spittle, its vitality may be preserved for
months.

fi-

LABORATORY CULTIVATION OF THE BACILLUS.

Although tubercle cannot develop except in a warm-
blooded animal, living cells being essential for its
development, the tubercle bacillus can be cultivated

llipi'ri'

"llli I'Mi

CONSUMPTION :

in the laboratory. If a little of the serum (the watery
part) of ox-blood or other certain prepared liquid be
placed in a test tube (a long, narrow sort of bottle of
thin glass), and sterilized by heat to destroy any
bacteria it may contain, the mouth of the tube being
plugged with sterilized cotton wool to strain the air and
keep out other bacteria, and if when the culture
material — the seruia — becomes solid, a minute particle
of fresh tubercular matter be carefully placed on it,
and the whole kept at blood temperature, or about
100° F., in twelve or fifteen days there may be seen
around the tubercular matter a few minute, very thin,
lustreless, greyish-white, scale-like particles. These
consist of colonies of the tubercle bacillus, which had
grown there from germs in the particle of tubercle
planted. Under the microscope they are seen t
be composed of " many very fine lines containing
the bacilli." The mass " sometimes looks like crumbs
of bread moistened." A Klatsch preparation under
the microscope shows " a thick, curled-up centre,
around which threads are wound in all directions,
the fine lines showing the bacilli in profusion " (Ball).
Again, if a little bit of one of these scaly particles be
selected and placed on a culture material in another test
tube and treated in the same way as the first, in another
twelve or fifteen days numerous scale-like colonies
of bacilli will have again grown up around the
planted " seed." After repeating this transplanting
process a hundred times — cultivating a liundred
generations — the bacilli not only preserve their char-
acteristics, but a purer cultivation or quality i6

.()

i'!i
i'i1lllill!l|i|

niiiiiiiiiiiii!

ITS NATURK, CAUSES AND PREVENTION.

obtained. They can be cultivaterl in air-tij^lit tubes
on sliced potato.

Wlien ])ure bacilli are inoculated into the body of
a .susceptible animal, tubercles form in it, Vieginning
their growth at the point of inoculation, .spreading
along the cour.se of the lymphatic vessels, and cau.sing
the characteristic symptoms of tubercular disease.
The same result follows when the animal is inocu-
lated with a particle of tubercular matter from the
expectoration or spittle of a consumptive person, in
which the b icilli usually exist in great abundance ;
and, also, as sometimes unfortunately happens, when
a linger is accidentally wounded, and so inoculated, in
making a pusf -mortem examination of a tuberculous
l)0(lv of either man or one of the lower animals.

SPOKING AND MULTIPLICATION.

Under a high magnifying power, the tubercle
bacillus .sometimes presents to the v^ew oval sjmces at
intervals within the rod, giving a dotted or beaded
apj)earance, indicating the production of, or breaking
up into, spores ; after the manner of moulds and
messes : by which, it need hardly be said, these low
forms of vegetation multiply themselves, and also
resist influences, such as heat and cold, which destroy
tlie parent plant. That this bacillus is a sporing
organism, although not (juite satisfactorily established
under the microscope, can hardly be doubted. In
order to perpetuate itself it must, it would seem, pro-
duce some smaller, more resistant bodies, practically
spores — something analogous to or corresponding

WTF"

CONSUMPTION

I ! !

mM\

■1,1

with the seeds of the higher plants. According to
Solles and others, if a rabbit be inoculated with a
portion of an old, non-progressing, dried-up mass of
tubercle, as from the apex of the lung of a person
who had had consumption and was practically cured,
and in which no bacilli can be found, the animal will
probably die of tuberculosis, and in the tubercles
formed in it, numerous bacilli mav be found. The
bacilli had dried up and disappeared from the tuber-
cular mass used for inoculation, but left, evidently,
their seeds or spores. Doctor Douglas Powell (as be-
fore cited) says, " It is difficult to escape the conclu-
sion" that such matter contains " abundant tubercular
3p'i .*, as yet undeveloped and unrecognizable." The
bacillus multiplies also by division, or fission, — a
mr^hod ">^ asexual reproduction common amongst
these low organisms. Each bacillus undergoes
cleavage crosswise into two equal parts, which then
become two independent organisms. That spores are
more difficult to destroy by disinfection than the
parent plant is an important point to bear in mind in
the practice of preventive measures.

RELATIONS OF THE BACILLUS TO THE DISEASE.

Very few authorities now question the correctness
of what is termed Koch's theory : — that without the
tubercle bacillus there is no true tubercular matter.
But it is not yet clearly known whether the peculiar
symptoms, local and general, of tubercular or con-
sumptive diseases are caused simply by (1) the con-
stant irritation set up by the local growth and multi-

ITS NATURE, CAUSES AND PREVENTION.

plication of the bacilli in their parasitic or saprophy-
tic life, a local inflammatory action ; or whether they
are caused Vjy (2) the formation or excretion by or
from the micro-organism of a substance having a
jioisonous efiect upon the tissues invaded : or whether
by (•^) the microbes causing in their life action such
cht'inical changes or fermentations in the tissues or
thii<ls as to give rise in this way to a poison, causing,
ill either case, toxic effects upon the entire body.
Possibly the symptoms are caused in a measure by
each and all of tlie three ways. It is known that the
hacilli, in certain conditions, do give rise to a poison-
ous product. The constant local inflannnatory action
set up simply by the presence and multiplication of
tile micro-organism, as a foreign body, however,
\vould seem to be enough to cause the symptoms in
the previously deranged and depressed, if not diseased,
l)o(ly of the host.

However the symptoms may be produced, it seems
to be generally believed by the highest authorities
that a case of tubercular disease, or consumption, of
any kind, will not develop without this bacillus or
its spores, any more than a stalk of wheat or corn
will spring up without the seed or germ-grain in the
soil. Doctor Jane way, of New York, says (Discuss.
N.Y. Acad, of Med., Jan. '91), " There are to-day only
a few physicians who hesitate to accept the bacillus
tuberculosis as the direct exciting cause of tubercular
phthisis." And Doctor J. West Roosevelt (Phys.
Roosevelt and Bellev. Hosp. N.Y., at ann. meet. Assoc.
Am. Phys.) says, " There is no need at this time and

!'i

"riiiil

CONSUMPTION

in the presence of this audience to state that, without
the presence of Koch's bacilhis, there is no tubercu-
losis. Possibly the statement that without tubercu-
losis there is no phthisis nii^ht not yet be so gener-
ally admitted, though it is probably true. . . . Con-
sumption, whether called ' catarrhal ' or ' tubercular
phthisis ' or by any other name, has as part of its
lesion [diseased condition] newly formed tissue
containing the bacillus tuberculosis of Koch."

WHENCE COMES THE TUBEUCLE BACILLUS ?

The special characteristic feature then of consump-
tion is the growth or formation in the lungs of a
peculiar substance called tubercle, an absolutely essen--
tial factor in the formation of which, or an essential
cause of which, is the tubercle bacillus. Now whence,
it may be here asked, comes this bacillus ? As above
observed, it ei.ists in abundance in the expectorated
matter from the lungs of consumptive persons, and
it can be cultivated in the laboratory. Koch's view
appears still to be that it is a " true parasite " and
cannot live outside the body of its host ; and that
it will thrive and multiply only at a temperature
ranging from about 95^ to 105° F. Hence it is
inferred that it can only come from another case of
the disease in man or the lower animals. It is to be
regretted that the more natural or botanical charac-
teristic features of this bacillus, as well as of other
disease germs, indeed, have not been more specially
and deeply studied, along with its laboratory or other
characteristics. It seems possible that it may flourish

111

liiiililiii

ITS NATURE, CAUSES AND PREVENTION.

outside a living animal body, and may be akin to ao-
called " malarial " (n-ganisms. It is well known that
otlicr germs — as the bacillus of " splenic fever," for
example, in its natural state — flourish and " complete
tlieir developmental cycle," as Koch words it, outside
the body, and only at times, in certain conditions,
invade it and become of a parasitic oi* disease-pro-
ducing — pathogenic — character ; as prolably too do
the germs of typhoid (or enteric) fever and of cholera,
and, it ma}^ be, of diphtheria.

Ill 1801, Sir Hugh Beevor, it appears (at Patholog.
Soc, London, Jan. 10th : Lancet), demonstrated that
tlie tubercle bacillus can be cultivated at a temperature
Ik'Iow 60° F., that of ordinary summer weather. In
a book on the " Prevention of Consumption," pub-
lished a few years ago, and later in communications
to the Lancet, Mr. C. Chandler, of Melbourne, Aus.,
contends that the microbe in some form or phase
^a'ows " free in nature," in dark places : especially, he
l)elieves, in dark, foul bedrooms. This is an exceed-
in f^ly important (piestion. Further on, in considering
the causes of consumption, it will Ije again discussed.
At the present time we only know of a certainty that
the source of the bacillus is from a case of consumption.

SAPROPHYTES AND PARASITES.

There are many spe< ies of •small plants, such as
most fungi (with which have been classed most of the
disease germs), called saprophytes (from the Greek,
sapros, rotten), the nature of which is to grow and
flourish only or most naturally on dead organic

:M1

ffir

CONSUMPTION :

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'liiiiai'iiiii
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matter. This is the case, as we know, with some of
the larger forms, such as mushrooms and sonif
moulds. Now, it is possible, even probable, that all,
the disease-producing bacteria, such as the b'^cillus of
tubercle and of typhoid and other fevers, are natur-
ally of this sort, saprophytic, and in their naturul
state live and flourish only or best in, or in association
with, some form of dead matter, either within a livinj;
body or free in the outer atmosphere. It is impro-
bable that a parasitic, disease-producing life is natural
to these micro-organisms, but rather an accidental or
acjpiired state. Indeed, it seems highly probable that
they are rendered virulent and disease-producing l»y
insanitary conditions. Evidence of their transforma-
tion from a saprophytic to a parasitic life accumu-
lates with investigations. In respect to parasitic
diseases of the skin and hair, for example, Leslio
Roberts, M.D. (R. Infirm., Liverpool, Eng.: Brit. M('<1,
Jr.), in a paper read at last year's meeting of the Brit-
ish Medical Association, gave the following valual)lt'
and suggestive information : " I cannot see how it i^
possible to avoid the conclusion that the hair-attackin^^
fungi belong essentially to the saprophytes, and to that
class of saprophytes which may, under certain condi-
tions, adopt the parasitic life. The search for the via
naturae of these fungi, by which they ascend to their
parasitic position on iftan, may be hopefully under-
taken." Again, Doctor Roberts says, " We have seen
that without any change in its saprophytic habitat
the fungus may pass from an inert vegetable soil to
animal tissue or hair." Respecting certain experi-

iiients, li
of a den
vcgctabl
nanu'ly,
A dis
parasitic
organic
former ai
tlu! lattei
of their
niicro-ori
pathogen
organism
parasites
define. ''.
e.xist and
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obtainiuir
used-up, c
|ous funct
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In cert
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4

\^\■ ■■' 'i'li

ITS NATURE, CAUSES AND PREVENTION.

ineiits, ho said, " They point, I think, witli the force
of a (k'lnonstration, to a .source of rinj^worni and other
vo;,^('tabIe parasitic diseases hitherto scarcely suspected,
namely, dead organic matter."

A distinction is made between saprophytic and

parasitic micro-organisms ; the former living on dead

organic matter, the latter on living bodies. The

former are benign organisms — scavengei's, so to speak ;

the; latter feed upon the fluids or tissues of the body

of their host, and may hence cause disease. When

micro-oriranisms cause disease th«'V are then called

pathogones (Greek, pathos, disease), or pathogenic

organisms. The distinction between saprophytes and

parasites is, however, difficult to clearly n)ake out or

define. These most minute forms of plant life may

exist and propagate in living bodies without feeding

upon the living fluids or tissues therein, but instead,

obtaining their nourishment from any excess of the

used-up, eftete, dead products resulting from the vari-

lous functions and processes of life, retained in the

l)ody instead of being thrown off by healthy acting

j excretory organs. Existing in this w^ay, on such food,

I in a living body, such microbes are as strictly sapro-

ipliytic as if living in or upon a dead Ijody. Many of

the organisms living in the human intestines, even the

so-called parasitic worms, are doubtless more of the

nature of saprophytes than parasites, as they do not

[tln-ive in a clean, healthy intestine.

In certain body conditions, which wi- b^ ex-
Iplained in future pages, saprophytic or benign organ-
jisms may become disease-producing or pathogenic.

CONSUMPTION :

To pfivo a HiMiplc illuHtration, — a inicrococcuH natur-
ally un«l coiiunuiily present in the .saliva of liealtliy
human b(!ings, in certain conditions oi' certain persons,
is so virulent as to cause tlie death (if rahbits when
the saliva is injected luider their skin. The saliva is
quite harmless when the cocci are taken from it. It
has been .suggested tliatasuperabundai*"*' of the fluid
may be the cause of the poisonous are of the
microbe in it, but this is probably, at most, a remote
cause. The excess of saliva may give rl.se to some
special con<lition which renders the micrococcus
poi.sonous.

It is still a ([uestion with .some hifj;h authoritic
whether the tubercle bacillu.s ever jijrows and propa-
gates in healthy living Ijody tissues, or, which .seems
much the more probable, only in altered or diseascil,
practically partly dead tissue — tissue containing elo-
ments of dead matter.

TUBERCLE IN OTHER TISSUES AND aNIMALS.

Other tissues besides the lungs, as alrea<ly stated,
are often the seat of tubercular growths. The intes-
tines, the liver, spleen, kidneys and other glandular
organs, the brain membranes, the skin and the bones
are subject to the disease. The muscles (flesh) are but
rarely invaded. As the tubercle increases, the affected
tissues gradually " waste away " and are replaced by
the disease product, which, too, eventually dies and
disappears or dries into a hardened lime-like mass
At the same time there is usually a general wastin;
of all the tissues, We have therefore tuberculosis or

ITS NATT'RK, CAl'SES AM) PHEVENTIOX.

conHumption of many parts of tlie body. Next
fn'(|uency to the lung affection is " con8Uinptit)n of the
l)o\vel.s," chiefly characterized Viy a tubercular dcHtruc-
tion or wasting of the glands along the course of the
intestines. This is more especially common in young
children, and is believed to be frequently caused by the
use as food of the milk of tuberculous cows.

Many of the lower animals ai*e also subject to this

disease. Bovines appear to be moreso than any others.

It is common in poultry, pigeons and other birds.

Horses, pigs, sheep, cats and dogs are less disposed to

it. Rabbits, monkeys, and all menagerie animals

kept caged or housed are very liable to the disease ;

indeed, it is the principal cause of death amongst

these animals. Crisp, it is said, has met with tuber-

jculosis in over one hundred difF» rent species of ani-

jmals, including reptiles. It is very rare, if not quite

[unknown, in animals in a wild state. This indicates

|a (rood deal bearing upon the cause and prevention of

the disease.

SIMPLE EXAMPLES OF PARASITIC DISEASES.

As a simple illustration of parasitic diseases, it will
)e interesting and instructive to briefly notice here
|in affection formerly believed to be tuberculosis, now
technically termed actinomycosis, more commonly
Luown in cattle as "lumpy jaw." It is an infec-
ious disease, common in bovine animals living on
ret soils, as the fen districts of Scotland, and is not
Uncommon on this continent. It is caused by the

I'owth and multiplication in the tissues of the animal

«.'! ■

CONSUMPTION

hll'!'

■iiiii

\1,I0

> 'I-

^ i

of a star-shaped fungiis ; hence the name, Tliis
exists in abscesses formed near the jaw during the
course of the disease, and commonly in the form of
minute granuhir masses, or little grains, the larger of
which can be seen with the unaided eye. Colonies of
the organism, even with slight magnification, present
to the eye a radiate pattern, and with a higher power,
the centre resembles tlie heart of a daisy. Accord-
ing to Jensen, it grows on grain husks or straw.
Many cases of the disease in the human body have
been recorded. Saltmann reported a case in a boy
which was caused by swallowing an awn of barley,
An abscess formed near the throat in which was
discovered the ray fungus.

Another example is the thrush or " white mouth,'
of young infants, especially of those who are hand-
fed, and in badly nourished adults. It is caused by aj
parasitic fungus, oldiuin (dbicanns, and occurs in
two forms : hypha^ (a web) and threads of spores. i)\\\
cut potato it develops into thick white colonies
Injecte<l into the veins of rabbits it causes their deatli
in one or two days, ihe inner organs being tilled]
with the hyphne. This fungus is " specifically iden-
tical with sarcharomyces ijiycodenn a, or 'flowers ofj
wine,' a ferment developed on the surface of liquidsj
which are acid and contain little sugar " (Trouessartlj

FORMATION AND PROGRESS OF TUBERCLE.

The local changes and conditions in the body tissiicl
of the consumptive, and the general progress amlf
symptoms of the disease, vary with the con8titutioii|

ITS NATURE, CAUSES AND PllEVENTlON.

iUid eoiulition of the individual afiV'cted, chii'Hy, and
ill a ineasurc with tlieWirulency or jxHsonous char-
acter (wliicli varies witli certain circumstances) of the
tuljercle baciUus. Into tlie hm^s the bacilli j^ain
ucct.'ss by being drawn in with tlie air in l>reathin^.
When they lodge there, it is usually, first, in the
miiuite bronchial tubules which open «lirectly into the
air chambers. Infection, it aj)pears, usually c(jm-
iiieuces there. If the tissue condition be favorable,
tlie soil suitable, and the bacilli be not too greatly
attenuated (weakened), they " take root," a colony of
tliem forms eventually, and a minute tubercle results.
The manner of formation of tubercle is highly
interesting. In order to understand it one must bear
ill mind that the bacilli are exceedingly minute. One
of the large white blood-corpuscles, — soft, jelly-like
cells, penetrates the wall of a lung capillary, usually,
and, as it were, sucks the newly arrived invading
bacillus into itself with the purpose of digesting
or destroying it ; a process to be noticed further on.
The corpuscle then becomes larger, the bacillus in it
multiplies, other cells are attracted to, and join it,
and a tubercle ^is there formed. A newly formed
primitive tubercle consists of numerous small round
cell!- packed together with a large or " giant cell,"
sciiiietimes two, at the centre, while within the cells
to some extent, and more abundantly between them,
[are the bacilli. From lack of nourishment, as no
j blood vessels form in it and no blood can enter, and it
niay be, too, from the effects of a poison produced by
(the bacilli, destructive changes soon commence in the

CONSUMPTION

|i I

centre of the tubercle, and extend till the whole
degeneration into, or becomes, a mass of yellowish,
fatty granules resembling cheese, and is said to be
cheesy, or caseous. In this disK jlution of the tubercle
the bacilli usually disappear, probably leaving, how-
ever, a crop of living spores.

The time reijuired for the development of tubercle
and its degeneration or decay is very variable. In
the more chronic cases of the disease the little
masses form slowly, and remain small and few in
number for a long time, months and even years,
degenerating slowly, too ; while in ate cases they
may reach the size of a pea in three or four weeks.
Whe^, the subject of them presents a particularly
favorable soil, or when the bacilli are, or become,
very virulent, tubercles form rapidly and in large
numbers throughout both lungs, sometimes giving
rise to rapid exhaustion, much difficulty in breathing
and early death.

ANTAGONISTIC BODY FORCES.

As intimated above, and as will be explained more
at length in another section, certain cells or corpuscles
in the blood resist and endeavor to destroy and cast
out disease germs ; indeed, this is their action with
any foreign substance whatever which has gained an
entrance into any part of the body, as we find to be
the case after the minutest thistle point has pene-
trated the cuticle and gone far enough into the true
skin to cause pain or irritation. Moreover, in indi-
viduals in good health there appears to be in the

ITS NATURE, CAUSES AND PREVENTION.

blood serum a germicidal or antidotal substance
which is detrimental to the life of such foreign bodies
as disease germs in the tissues. However this may
he, tubercle, and indeed the whole disease process,
and its products, in consumption, appear to be the
direct result of a warfare for supremacy l^etween the
invading bacilli on the one side, and the protective
bodily forces on the other, and in which the latter
have been unable, from some cause, to successfully
compete with and destroy the bacilli. The contest
goes on. Too often the invaders maintain their posi-
tions, while they continue to gain new ones, increas-
ing the tubercular formations and xtending their
depredations ; and so the disease progresses. The
minute tubercles formed coalesce and give rise to
clusters of them or larger masses of irregular shape ;
air chambers become blocked up and their walls
thickened, until at length portions of the soft, spongy
lung tissue are replaced by masses of tubercle.

THE CHANGES ARE INFLAMMATORY.

The local disease process is really all through of an
inflammatory, conservative character ; indeed, a series
of circumscribed points of inflammation set up by the
bacilli, varying in degree and extent like the tuber-
cular deposits — chronic or more acute, limited or
more extensive — depending on, or according to, the
constitution and condition of the subject or body
aftected, and the virulence of the bacilli. When a
prickle from a thistle is forced into the skin, a pro-
cess of inflammation is set up at the point and around

CONSUMPTION !

v:< i

lln:';. •:!•

li!

it, by means of which the prickle is eventually forced
out. A fester commonly forms in cases of this kind,
and along with the pus or " matter " discharged from
it the offending prickle is thrown out. In some
good constitutions we find the foreign particle is
removed more naturally, or kindly, or with less irrita-
tion or pain, and in a short 'r period of time, than in
other constitutions, in which the process is more pain-
ful and tedious. Somewhat so it is with the bacilli
in the lung tissue. In a susceptible body — in a person
strongly predisposed to consumption, with impuie,
defective blood and other fluids, and consecjuent
weakened tissues and blood cells, the bacilli, when
they chance to be breathed in sufficient numbers into
the lungs, And there an attractive field — abundance
of suitable food — and make easy conquests, while
they take on a more virulent character. The army
of weakened blood cells or other protective forces
can offer but little resistance. The inflammation sot
up is consequently of a low scrofulous form, against
which the invaders make easy advances. On the
other hand, when the little plant-rods, however viru-
lent, find a resting-place on the mucous membrane of
the minute terminal bronchial tubes of a well-cared-
for healthy body, with good pure blood, a germicidal
intoxicant and an army of vigorous protective cells,
if the invaders be not carried out at once and first by
the cilia on the mucous surface of the tubes (page
23), they are soon attacked by the blood cells: a "rush
of blood" with more cells, if called for, now flows
to the spot, and the process we term inflammation,

ITS NATURE, CAUSES AND PREVENTION.

of tlic simplest kind, is sot up and the unwelcunie
intruders are probably in due time satisfactorily dis-
jioscd of, perhaps without the complete formation of
tubercle at all. Possibly they may be then thrown
out of tlie lung along with mucus, more or less
thickened, by a slight cough. Indeed, it seems pos-
sible that many p >rsons may at one time or another
(hiring life, or perhaps from time to time, and often,
breathe in these bacilli (which are almost ubitjuitous,
tVoni being spread about by the coughing and indis-
eriuiinate spitting of consumptives) and dispose of
them in this way, the whole process or act seeming to
be but the result of a " little cold."

In some cases — in certain constitutions or condi-
tions — after a mass of tubercle has been formed in a
lung, and after the individual has been brought into
a more healthy, vigorous condition, as by medical
treatment or a change to healthier living, then by a
more vigorous, local inflammatory process, a strong
wall of fibrous tissue is built up completely surround-
in;^ the tubercle, cutting it oft" securely and per-
manently from the body tissues and rendering it
iiitirely harmless. In this way other foreign bodies
1 or growths, as a leaden bullet, for example, is some-
j times disposed of by the natural powers of a healthy
vigorous body.

One great difference between the effects of the
[tubercle bacillus and the prickle of a thistle or other
dead particle in the tissues is that, in the former case,
[by reason of the cause of the inflammatory action
having life and power of multiplication, there is, if

I'.

CONSUMPTION

the living microbes be not at once cast out or de-
stroyed, a constant succession of new irritated points
or causes of inflammation that will eventually wear
out, exhaust and destroy the life of, the invaded body.
Again, the bacillus is usually of a much more poison-
ous, irritating nature than the thistle point.

'i..=:«i

DIFFUSION OF TUBERCLE IN THE LUNGS.

If, then, on the first lodgement of virulent bacilli in
a lung they be not at once cast out by the cilia or
soon destroyed or enwalled by the protective germi-
cidal powers of the body invaded, they multiply and
form new centres of colonization and inflammation.
They first, we will sp^^ lodge and colonize, or " take
root," in the upper part or apex of a lung ; tubercle
is formed there, which eventually undergoes degen-
eration, softens, and particles of the softened, cheesy
matter, perhaps sometimes still containing living
bacilli, or, if not, their spores — it may be both — are
conveyed by the cilia on the mucous surfaces toward
the larger bronchial tubes to be coughed up; in
their passage, the cilia not being vigorous in action,
perhaps broken down and destroyed in places, the
germs find lodgement in other and new points, where
more tubercle is formed, which likewise softens and
spreads in like manner. Unless this development of
new tubercle be stopped, gradually more and more
lung tissue becomes involved in the inflammatory
process and its worst consequences, and the function
of perhaps the entire lung is destroyed. Particles of
tubercular matter probably sooner or later find their

ITS NATURE, CAUSES AND PREVENTION.

way into the other hing, and eventually large portions
of both lungs become involved.

FURTHER DISEASED CONDITIONS.

During the progress of the disease it is very com-
mon for the inflammatory action to extend from the
lungs to the pleura, especially to the visceral layer
closely investing the lungs, and for the two opposed,
touching surfaces of this smooth, lubricated mem-
brane (page 25) to become much thickened and grown
or " glued " together by the diseased action set up.
A portion of the lung is then bound down to the wall
of the chest and its action much limited. It is, too,
tlie inflammation of tlie pleura — pleurisy — which in
nearly all cases of consumption causes the pain, more
or less of which is commonly experienced in the chest
during the course of the disease.

Again, the larger tubercular masses formed in the
lungs, perhaps after protective bodily efforts had con-
structed a fibrous wall partly around them — in such
cases almost a fruitless effort — degenerate and dis-
charge their contents, as the smaller tubercles do, as
above stated, and the partial wall remaining, what is
called a "cavity" is formed in the lungs : it is a place
where a tubercle had developed, destroyed the lung
tissue, and then itself degenerated and wasted away.
In advanced stages of the disease it is common to find
cavities in the lungs formed in this way, varying in
size from that of a walnut to that of an orange,
more or less irregular in shape, containing only air.
In favorable ca^es, a cavity may become quiescent

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CONSUMPTION :

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and very jri-aJually contract and close its vvnlls
together, or tliis may take place in a short time. In
either case, eventually, only a cicatrix, or scar,
is left. In less favorable cases the cavity may con-
tinue for a long time, perhaps many years, to secrete
and give off from its walls a creamy pus—" matter.'

And again, from defective inllanimatory action,
ulcers form in the walls of the bronchial tubes, which
remain open, and pus is discharged therefrom
Suppuration in this way is common.

And yet again, gangrene — mortification — of a por-
tion of the lung may take place, the blood supply
having been cut off in some way.

In a few constitutions in which the progress of the
disease is very slow, from the formation of an excess
of fibrous tissue substance, as if intended, but not
used, for encapsuling — constructing a protective wall
around — a tubercle or tubercles, air chambers are, as
it were, glued together, and the entire lung becoiius
less spongy and more dense : finally a large portion
of it may become contracted and solid — fibroid
phthisis (some authorities, as already stated, believing
this may occur without tubercle or the tubercle
bacillus). Occasionally an entire lung becomes solid
ified in this way and quite inactive and useless for
respiratory purposes. It is then commonly said
that the lung is " gone." Entire collapse of clusters
of air chambers — lobules— of the lung may result
from the blocking up of bronchial tubules.

All these conditions are sometimes found in the

lungs of

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ITS NATURE, CAUSES AND PREVENTION.

\nu(fs of a person who lia<l died of coiiHuinption, all
brought about by fruitless protective efforts on the
part of the invaded body to check the progress of the
invaders. We can imagine the contest going on be-
tween the two forces in the lungs of an unfortunate
sufferer from this dread disease — between the count-
less myriads of infinitesimal and now virulent
microbes on the one side, and the blood cells and
other protective or antidotal forces on the other.
Too often, alas, the countless myriads conquer. The
local disease becomes more and more extensive, and
the entire constitutional forces more and more under-
mined and exhausted, until finally one more death
from consumption terminates the struggle.

the

THE BRIGHTER SIDE.

We may here look mentally for a moment at the
brighter side — at a case terminating in recovery. If
at almost any stage of the local disease, while the
general constitutional forces of the affected individual
are not yet too far undermined, there may be reason-
able hope of a practical, permanent cure by the appli-
cation of proper remedies. If enough sound lung
tissue be left on which to build up the natural body
forces, by pure air and other remedies suited to the
individual case, the depredations of the microbes in
the lungs may be arrested and fair health again
established. Sometimes, too, medication may be so
applied as to directly lessen the virulency or vigor of
the microbes, and their destructive work is then the

' 1.

y^ til!

CONSUMPTION :

more easily checked as the natural powers of the
body are gradually built up. In this way improve-
ment may be brought about, slowly it may be, but
surely. All diseased action may be eventually
stopped, and the individual live on for many years: —
with, it may be, a portion, or portions, of one lun^
bound down for life to the chest wall by pleural
adhesion ; or a dried-up cavity in the lung ; or witli
the scar of a healed one ; with, perhaps, an enwalled
mass of dead, dried-up, calcarious, and so harmless,
tubercular matter ; or some collapsed air chambers ;
but w^ithal, no diseased action, no living bacilli or
their spores to cause further destruction — except it
might be through reinfection from without.

|i!

Ill
lis

iilil

ITS NATURE, CAUSES AND PREVENTION.

CHAPTEK IV.

CAUSES OF TUBERCULAR PULMONARY CON-
SUMPTION. IMPERFECT RESPIRATION
AS A CAUSE.

GENERAL REMARKS: HALF REMEDIES.

Having sufficiently explained the nature of couHunip-
tion, the causes of it may be now considered. Why
does this fungus, the tubercle bacillus, grow and mul-
tiply in the lungs and other tissues of certain living
human bodies and give rise therein to tubercle, the
special characteristic of this disease, and not in other
bodies ? In short, what is the cause, or what are the
causes, of consumption ?

It seems evident, as we have seen in considering the
nature of consumption, that the tubercle bacillus is one
cause, indeed an essential cause, of the tubercular
growths, and hence it must be regarded too as one of
the causes of the disease. Practically, there is no con-
sumption without tubercle and the tubercle bacillus.

Unfortunately, since the discovery of this microbe
by Koch, many authorities and writers appear to
regard it as the cause — too often, practically, the only
cause, instead of a cause, of consumption. The conse-
quence is that frequently only half measures are
employed for either the prevention of the disease or

CONSUMPTION :

for trcatinj^ it with a view to cure ; hecuu.si' tlif
incfiHurt'H are applied only, or almost only, to tlif
destruction of tlie bacillus, and the other essential
cause, or collection of causes, which favors its ^I'owth
in the tissues, does not receive sufficient attention.

It is clearly evident that there is another essential
cause of consumption, one at least, ])esides, an<l (luitc
as in«lispensable as, the bacillus; as this orj^anism will
not ^ive rise to tubercle indiscriminately at any time
in anybody's lungs into which it chances to be con-
veyed. True, it is probable that no one is absolutely
exempt from its effects ; that is, exem})t at all times
and in any bodily conditions which may arise. Practi-
cally, however, three-fourths of the human race flo
escape altogether the poisonous effects of this \i})iqui-
tous parasite, although doubtless repeatedly drawing
it into their lungs in breathing. This is not by chance
only. There must be some special cause for it. What
then is it ? What are the conditions or causes which
favor or permit, excite or enable, the bacillus tuber-
culosis to grow, or set up the tubercular process, in tlic
living bodily structures of so large a number of per-
sons ? Again, what are the causes of consumption ?

TWO ESSENTIAL AGENTS: AUTHORITIES ON.

It is plain, then, that in the causation of this disease
there are at least two distinct, immediate factors or
agents, each apparently as important or essential as
the other : ( 1 ) the virulent tubercle bp jilluh -i nfection,
germ or seed, and (2) the a , recepf've, non-

resisting or exciting body soil 'uunonly tci iiied pre-

li !

ITS NATUKE, CAUSES AND PUEVENTION.

(lisj)oaition — that specially fitted condition of the l)ody
tissue.s in which only the seed will develop and cause
tuhcrcic ; and to the preparation or formation of which
ji juiinlxT of mediate or more remote causes contribute.
This is now the almost universal medical helitd": that
tulu'rcular consiunption cannot develop without the
tulx'rcle bacillus, nor can the bacillus oive rise to the
cliiiracteristic tubercle except in specially conditi(med
hodv tissues.

Professor Von Ziemssen, one of the most eminent
uuMJieal teachers and authors in Europe, says(Pulmon.
Tul)erc.i translated by D. J. Doherty, A.M., M.D.:
l)«'tr()it, Geo. S. Davis), " Experience compels us to
iicknowledge that the healthy organism has jrreat
power of resistance to the bacillus, which can make an
cttbctive and permanent settlement in the lun<^s, intes-
tines, etc., only when certain favorable conditions are
})resent. These conditions, this as yet unknown patho-
lon^ical something, we call a pvedlnpos'it'ion, and mean
tlu'rel)y a certain constitution of the tissues which
t'uniishes a suitable soil for the settlement of the
bacilli. We cannot at present get along without the
supposition of such a predisposition, which may be
iitl»er inlierited or acquired. A disposition exists, in
fact, for other infectious diseases, as typhus, cholera,
dysentery, etc., and why should not one be supposed
for the settlement of the tubercle bacilli ^ In what
c'on.sists this predisposition which, next to heredity,
plays the greatest role in the etiology of tuberculosis?
We do not know."

Doctor Thorne Thorne (Med. Off"., Local Gov. Bd.,

%■■'<

CONSUMPTION :

Gt. Brit.: in St. Barthol. Hosp. Rep., Vol. xxvi)
pyrites, " My object is to indicate that, though the
bacillus is one requisite of tuberculosis, the soil —
whether human or other — in which it can flourish is
another necessary one ; and to urge that, whilst we
are taken up with the fascinating research ^es of the
bacteriologist, we may not forget how very usefully we,
as practitioners of medicine, may occupj; ourselves in
restraining the disease by securing the adoption of
measures tending to deprive the bacillus of the pabu-
lum it needs for its life-processes and for the pro-
duction of the mischief involved therein."

The late Sir Andrew Clark, Bart., M.D., etc. (Lect-
ure on C)*.n. Cases of Tuberc. at Lond. Hasp.: Lancet,
July, '92), after reference to Koch's discovery, said,
" Now this brilliant discovery and the theory based
thereon make it plain that there are two factors in
the evolution of tuberculosis — the tubercle bacilli and
the soil on which they grow ; for it is certain that
these bacilli will not flourish on every soil."

The late Professor Austin Flint, of New York,
writes (Pepper's System of Med., Vol. iii), " If we
accept the conclusion that the bacillus [of tubercle] is
the causative agent, it requires certain local condi-
tions. Without these, the parasite is innocuous. T!ie
conditions are to its development aiid multiplication
what the peculiarities of soil are to the production of
different vegetables. We do not know the nature of
these conditions. When they exist the bacillus de-
velops and multiplies; when they are wanting, the
parasite is incapable of development and multiplica-

ITS NATURE, CAUSES AND PREVENTION.

tion. Thi? dependence of the specific morbific agent
upon particular conditions is exemplified in other
infectious diseases. The contagion of the eruptive
fevers, received into the system ever Svi abundantly, is
inoperative in some persons. The contagion has not
lost its vitality; the conditions for its activity are
wanting."

Professoi Osier (Johns Hopkins Univ., Bait., Md.)
records his view in the following apt words (Osier's
System of Med.) : " There are tissue soils in which the
bacilli are, in all probability, killed at once — the seed
has fallen by the wayside. There are others in which
a lodgement is gained and more or less damage done,
but finally the day is with the conservative, protecting
forces — the seed has fallen on stony ground. Third,
thore are tissue soils in which the . bacilli grow
luxuriantlj'" ; caseation and softening, not limitation
and sclerosis, prevail, and the day is with the invaders
— the seed has fallen upon good ground."

Doctor Andrew H. Smith, of New York (at N.Y.
Acad, of Med.), says, "There are two factors to be
taken into consiHftrnfion^ one being the seed, the other
the soil, and in proportion as we make these facts
clear lo the public, will our advice for preventing the
spread of tuberculosis be followed." When asked
why so many escape when the tubercle bacillus is so
plentiful, he answered by this illustration : " Rice
sown on the top of a sandy )iill will never bring forth
a crop ; or, prepare a river bottom ever so well, and
sow no rice, there still will be no crop. It requires the
proper seed, and also the proper soil to reap a harvest.

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CONSUMPTION :

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Applying this to tuberculosis : to prevent dissemin-
ation of the seed is very important, yet of equal
importance is it to obviate preparing a suitable soil."

Doctor Stephen Smith Burt (Prof. Clin. Med., New
York Post-Grad. M'ed. School, at N.Y. Acad, of Med.)
declares that, "As without this parasitic plant, how-
ever depraved the constitution, there will be no tuber-
culosis, also, fortunately, with this morbific agent
there will be no phthisis unless the vitality of the
tissues is first impaired.

And Doctor E. H. Shurly, Detroit, says (Address,
ann. meet. Am. Med. Assoc, '91), in respect to bacilli,
" Their destiny depends upon a favorable nidus (nest)
or pabulum." They " develop only where a previous
abnormal ntate of the body suitable to them exists."

It may be stated here, then, at once, that in our
efforts to prevent consumption it is not enough that
we use means only, or chiefly, for preventing the
spread of the seed and its probable spores. The
incalculable numbers of these germs cast off* by con-
sumptives and existing everywhere render success in
such one-handed efforts practically impossible. If,
however, we at the same time make greater efforts to
prevent the formation of the suitable stinmlating soil
for developing the disease germs, we shall have at
least double the chances of success from our preven-
tive efforts: while, as w^e shall see more clearly further
on, we shall also at the same time promote the develop-
ment and growth of cleaner, healthier and more
vigorous human beings.

mMi

ITS NATURE, CAUSES AND PREVENTION.

PKEDISPOSITION : WHAT IS IT ?

One (.-.sential factor in the causation of consump-
tion, the tnhcicle bacillus, having been sufficiently
iliscuyseti, let us now incjuire carefully into the nature
of that special condition of the human body, or body
tissues and fluids, which constitutes the other essential
factor — the soil, or predisposition — for exciting or
fertilizing the bacillus, and of the causes which give
rise to this condition. Let us, if we can, make plain
why it is that many persons fall ready victims to the
disease, while many more possess the immunity from
it, — resist the destructive influences of the ubiquitous
fungus. Let us, if we can, learn how all may retain
or acquire immunity from consumption regardless or
in spite of the bacillus.

A great deal has been said and written, much of it
long, long ago, on the subject of " susceptibility " or
" predisposition " to, and on " predisposing " causes of,
consumption. Almost all sorts of morbid bodily con-
dition", and the causes of these, have been named and
diseussvd as " predisposing " causes, or as giving rise
to the predisposition : to which condition tiie term
" favorable soil " or " suitable soil " has been more
recently applied. Most of this has been unsatis-
factory; much of it misleading. What the predis-
position is, or the natu. of it, has never been fairly
detined, hardly even in a measure. In his work
recently quoted, Von Ziemssen describes the outward
and visible signs of the inward hody condition. First,
in reply to his own question — " In what consists this
predisposition ? " Von Ziemssen says, " We do not

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CONSUMPTION

know." He then continues : " We know in a general
way how a man looks when he has such an inherited
disposition," and the causes which may engender it ;
" but we do not as yet know its nature or the mor-
phological, chemical or physiological changes to which*
it owes its origin." " Of the slender body, the flat
chest, the thin limbs, the delicate tinge, the vulner-
ability of the vessels of the mucous membrane,
the tendency to nose-bleeding and to catarrhal
inflammation of the larynx, the frequency of
cardiac palpitations and congestions, the circum-
scribed redness of the cheeks, etc.," there is often
" but little to be made." He adds : " How many
robust young people are tuberculous in spite of
their compact l)odies, stout muscles and natural
color ! Here there is still much to be investigated."
Equally unsatisfactory are all explanations respecting
the cause or causes of this predisposing condition of
body which constitutes the tuberculous Hoil.

Heredity has been long the great bugbear in con-
nection with the causation of consumption ; but it is
now well known that, as usually understood, it is not
comparatively a very important factor, or is not so
important as it was until recently supposed to be, as
we shall see further on. Life insurance companies
are less shy of it in applicants than they once were.
Various sorts of depressing influences, such as insuf-
flcent and improper food, exhausting discharges, over-
work (mental or physical), night vigils in care of tho
sick, unhealthy dwellings, alcoholism, atmospheric
dampness and " colds," the eflfects of fevers and other

II i'K':.

I l''1

lllllliiilil:!,!:.

ITS NATURE, CAUSES AND PREVENTION.

diseases, especially those more particularly affecting
the air passages and lungs, as measles and bronchitis,
have all been put down as favoring more or less the
formation of the so-called tuberculous soil.

Breathing foul, prebreathed air in rooms, shops,
schools, etc., from want of ventilation, has been long
regarded by high authorities as a particularly strong
predisposing cause of consumption. Probably this is
more deserving of the charge, and to special con-
sideration, than any other commonly named cause.

In most cases of consumption, many causes and
influences have been in operation. Anything which
lowers the health standard gives rise to a certain
amount or degree of predisposition to all infectious
diseases, and indeed probably to all diseases whatso-
ever, but not in a greater degree to consumption than
any of the others.

Again, persons who are naturally not of vigorous
general make-up or constitution, or who are " weakly,"
or perhaps not in good general health, providing the
lungs a-.e proportionately developed and exercised, are
not particularly liable to consumption. Even anfemic
— " bloodless " — persons have so rarely become sub-
jects of the disease as to have been erroneously re-
garded by some authorities as exempt from it.

It seems impossible to ui^derstand how so many
various kinds of causes can give rise to that special
condition of the living body tissues which fits them
for the growth and propagation therein of this fun-
goid plant, the bacillus of tubercle, which, too, seems
to demand for its growth a soil so peculiar as it

J:'

Ijl

'JONSUMFriOX

Ijlllli!'

evidently does ; and this the more so, because all per-
sons upon whom these various causes operate, even in
full force, or in whom the various conditions named
exist, do not become tuberculous" or consumptive.

A " scrofulous diathesis " or condition, or a " strunj-
ous habit " or condition, are terms commonly applied
to certain persons, mostly young (they often do not
survive adolescence), who are found to be more par-
ticularly disposed to various forms of tuberculosis.
Such persons are marked by the characteristics
quoted from Von Ziemssen, and are subject to gland-
ular enlargements in the neck, to tubercular diseases
of joints and bony structures — " white swellings " —
an 1 prcbably, in well-mark ;d cases, have a thickened
upper-lip, and a partly-ope^. mouth, habitually, from
swollen, obstructed nostrils. But whence or what is
the cause of this condition — the " scrofulous habit ? "
It is often hereditary ; yet often acquired, especially
in cities. High authorities have declared that it
may be caused by breathing a foul, especially a pre-
breathed atmosphere.

This brings us now nearer to what in my opinion
will be found to be most intimately and directly
associated with the special cause of the production of
the tuberculous soil or predisposition — intimately and
directly associated with the second essential factor
in causing consumption: namely, a proportionately
small breathing capacity — small or defective lung
membrane surface — insufficient respiratory action or
function. Consequent on this there is, first of all, a
want of sufficient oxygen in the body for that

perfect
to heal
coniplet
puritica
in the i
matter
For the
intoxiea
future
respirat(
Some
others n
pose to I
breathin
of the 1
Hence tl
And an^
time res<
function-
ing foul
been saic
causes of
(W. S. (
Brit. Mec
tions ten
rickets, p
on the (
morbid c(
Now, ii
factor nii
we may

''ililSii

ITS NAtURE, CAUSES AND PREVENTION.

perfect tissue change or metabolism which is essential
to health and life; practically, insufficient for the
complete oxidation of the waste products of life and
puritication of the blood : and, second, accumulations
in the air chambers, fluids and tissues, of such dead
matter as on decomposition affords inorganic food
for the saprophytic bacteria, as well as, probably,
intoxicating organic substances to be noticed on
future pages, — dead matters which, with a perfect
respiratory function, would be thrown off.

Some of the above-named predisposing causes, and
others now long recognized as such, first of all predis-
])08e to a want of full respiratory action — to shallow
breathing, or a morbid, perhaps thickened, condition
of the lung membrane forming the air chambers.
Hence these are indirect or remote predisposing causes.
And anything which habitually or for a length of
time restricts the breathing or obstructs the breathing
function — the free exchange of gases— such as breath-
ing foul air, is a remote predisposing cause. It has
been said, for example, that "most potent predisposing
causes of tubercle in infants are rickets and measles "
(W. S. Coleman, M.D., M.R.C.P., etc., at ann. meet.
Brit. Med. Assoc, '93). Why ? Because these affec-
tions tend strongly to limit the respiratory function :
rickets, probably chiefly by its contracting influence
on the chest and lungs ; measles, by producing a
morbid condition of the air chamber walls.

Now, is it not possible that this .second causative
factor may be more clearly defined, in order that
we may bring our preventive forces mo directly

roNSUMPTlON

,*^:h

'■ ,if '

against it ? We have learned clearly enough that it
is an absolutely essential causative agent. It seems
highly probable, taking in all the circumstances, that
it is something more definite, special, peculiar, than it
has been generally supposed to be, — something actual,
more than a negation, more than a want, as of vigor
or " tone," more than defective nutrition or lowered
vitality, — that it is a positive substance, antecedent
to these conditions. Is it not probable that it is a
poisonous substance, perhaps of the character of a
ptomaine, produced in the body from the decomposi-
tion of the retained debris of imperfect tissue change
or wear and combustion, consequent on imperfect res-
piration ? and that this, while depressing the vitality
of the entire body, including the protective phagocyte
cells, also, and particularly, acts as a germ excitant
or intoxicant, probably along with a germ nutrient
from the same source, and so gives rise to the virulent
action of the bacillus and the eventual production of
tubercle ? The lowered general physical vitality which
is now looked upon as the effect of the tubercular state,
is probably a pre-tubercular condition, the result of
the action of this substance and not of the bacillus.

It is my purpose to show now that some such sub-
stance is probably produced in the body, and is more
truly the immediate exciting cause of consumption
than is the tubercle bacillus. We may not be able at
the present time to make it clear — to put our finger
upon it, as in the case of the seed — but we may learu
enough to enable us to work more successfully toward
removing this second, personal or body factor, or
preventing its formation, than we are now working.

liii.i-

m,:^

ITS NATURE, CAUSES AND PREVENTION.

VEGETATION AND SOILS.

Before I proceed further to endeavor to bring out
evitknce in support of the theory that a toxine
formed in the body excites th'» tubercle bacillus into
pathogenic action, it will be well to touch very briefly
upon tlie nature of vegetation in general in its rela-
tion to soils ; and more particularly upon the relation
to so-called tissue or body soils, — as well as to various
conditions of circumstance and environment, of these
lowest known forms of plant life to which the tubercle
bacillus and other disease germs belong.

We know that while some of the more highly
organized plants will grow and flourish in some
localities and soils, thev will not in others, as well
illustrated in the quotation given a few pages back
from Doctor Andrew Smith, respecting the growth of
rice. Some seeds will not grow in low damp ground :
others will not in high and dry places. In some soils
there is a want of some certain element which certtiin
plants need, while in others there are elements antag-
onistic to the good gtowth of certain plants. Tem-
perature, of course, has much to do with plant life,
the plants of the tropics not flourishing in northern
climates. Somewhat so it is, doubtless, with the
human body and the parasitic, disease-producing
vegetal organisms called germs or infections. Some
children long escape scarlet fever although often
exposed to its infection, and probably taking it into
their body ; yet they may take it later in life when
in another different, or a special , body condition, or it
may be when exposed to a more virulent infection.

CONSUMPTION :

• 1

fi; ■ ]■

;;i>,,ir-

:!l|liii

Some individuals will not take small-pox even when
much exposed to the disease ; their body does not
provide the special condition in which only the
infection can develop. The vaccine virus will not
" take " in some pei*sons. As Doctor Flint words it,
" the contagion has not lost its vitality ; the con-
ditions for its activity are wanting." Comparatively
few of the population — one-eighth to one-fourth—
take consumption. Why ?

RETAINED BODY EXCRETA: CARPENTER'S THEORY.

It is well known that when the excretory organs of
the body — the skin, kidneys, lungs — are not in a
healthy, active condition, it may be, from overwork
of the organs, then the waste products of life — of tlie
wear and tear of the tissues, of ' the combustion by
which the body is kept warm, and of products of
excess of food consumed — are not thrown out by
these organs, as in health, but instead, accumulate in
the oiood and other fluids and tissues of the body, con-
stituting impurities — dead, decomposing matter, " food
for bacteria." Doctor Burt says, " Waste products
circulating through the organism, not properly oxy-
genated, form an attractive field " for bacteria. " The
food of the tubercle bacillus is the debased blood and
tissue which have been inherited or acquired."

Eighteen years ago, in an address at the annual
meeting of the British Medical Association, Doctor
Alfred Carpenter announced it as his belief that the
retention of used-up waste matter in the blood, from
want of proper activity of the various excretory

irl'^'fliii!

!!.iiii':!;i:'^

ITS NATURE, CAUSES AND PREVENTION.

ororans of the body, is one of the essential causes
in tlie development of infectious diseases. Doctor
Cai'|H'iiter then advanced a theory which is in sucli
exjict accord with my own experience and observation
since that time that I quote his words, at considerable
l(*n^4li, as follows (Can. Health Jour., Vol. ll, Sept.,
76) : " I niich doubt if these living organisms [disease
trerins] could have any effect upon the body if the
recipient of them were perfectly healthy ; if no
impurity existed in the fluids of the body ; if the
lilood contained nothing foreign to a healthy and
natural state. If this be so, a question arises as
from whence these impurities proceed, and how
tlieir effects are to be guarded against. I venture
to put forth an hypothesis for consideration, wliich
will explain much that is difficult to understand on
any other view. Some impurities must exist; they
ai'e the used-up matters, the result of the act of life,
or they may be inherited tendencies, which have
lesulted from former neglect of sanitary law, and
which have depreciated the quality of the stock and
rendered it more susceptible to bad influences. The
impurities naturally increase if there are any defects
in the sanitary arrangement of the individual cor/tun.
Tlieir presence is of no moment if they are not in
excess, and if they are removed from the body as fast
as they are formed, or in the course which they
naturally follow. Let me represent them by x in an
equation in which the factors x, y, z (as a total)
represent any form of infectious disease. The pro-
blem is to assess the value of each factoi i the equa-

IWW

CONSUMPTION :

tion. . . . Let x equal u and e : u being the used-up
material, always in the act of formation, is not iort'i^
matter, and is not in ordinary proportions injurious
to life. It is always being diminished as fast as it is
formed by one or the other of the excretory or^^aus
which exist for the purpose of renioving it. If all the
excretory organs and all the functions are healthy,
and all doing their work properly, the body is in gool
health, there is no excess of used-up material, no debris
of combustion. If, however, one or other of the ex-
cretory organs fails to do its duty from either over-
work or inertness, somethins is left in the humoral
sj'^stem, and e [the second subf actor forming x] is
added. It becomes a positive quantity, and represents
the excess of matter which should have been removed;
u and e equalling x. They have a common origin,
being the debris of the act of living ; e will differ in
quantity as well as quality. It will be modified by
personal character, by actions, by non-actions, and
even by attainments, but especially by attention to,
or neglect of, sanitary and moral laws . . . If e be
absent, x is not complete, and x, y, z [the infectious
disease, or epidemic], cannot arise. . . . The germ
or living organism, z, the particular contagium, the
multiplying focus of infection, has to be introduced
from without, and is capable of modification accord-
ing to the character of the soil into which it may
happen to be transplanted. . . . Just as pencillum
glaucutiL requires the sugar and the temperature
to produce alcohol, So z, the contagium particle [in
order to cause disease], requires the food upon which

II. 1 :: ■:

fi!ln

Jiiiiiti;:'!

ITS NATURE, CAUSES AND PREVENTION.

it increases and multiplies. . . . The severity of the
(iisease will depend, not upon the character of z,
hut upon the quantity of e, which exists in the factor
X : z will be reproduced according to the ([uantity
of food, in the recipient body, upon which it can
increase and multiply. If e be absent, the effect of z
will be nothing ; there is nothing for it to feed upon.
If, therefore, personal cleanliness be attended to, if all
the excretory organs of the body are properly exer-
cis'.'d, . . . the effect of z, whenever it happens to
be introduced into the body, will be reduced to a niini-
muni.and may be so dwarfed as to be unable to effect
a lodgement ; it may die out entirely. It will be by
directing attention to the necessity of diminisliing the
growth of e that we shall prevent infectious diseases
from spreading, rather than by useless attem|)ts to
keep out z." Certain meteorological states, Doctor
Carpenter represents by the factor y, as above given.
These may, it appears, in a measure influence the
body condition, or the infection z, making it less, or
more, virulent, as by atmospheric dryness or moisture,
etc. Doctor Carpenter says, " A municipal authority,
who allows overcrowding, foul air, immoral acts on
the part of the people, impure water or bad food, is
providing an excess of e, and increasing the danger
which may arise from the introduction of z."

' <i

1:f

WHO TAKE INFECTIOUS DISEASES?

Now, who are the people who, as we find in practice,
most commonly " take " infectious diseases ? Not the
clean-skinned and clean-blooded.

CONSUMPTION :

It may be most reasonably and fairly conclurlcd
that the Creator never intended man — that iium
never was desijijned — that it is entirely contrary to
nature for him — to become the easy prey of any of
these low forms of parasitic life so long as he lives in
a proper ^nanner — in reasonable accordance with tlic
requirements of nature or of health ; barring, per-
haps, cases in which ancestors had greatly " sinned."
Charles Denison, A.M., M.D. (Prof. Chest. Dis. ami
Climatol, Univ. of Denver, Col. : Essay, " Exercise for
Pulmonary Invalids ") says, " It must be, indeed,
a peculiar accident which will result in nature's luir-
boring tuberculosis in a physically perfect huiimii
being. But accidents will come, and perfection to
meet them is very seldom or never to l)e found. Vov
this reason are we doctors."

It is well known that besides the great majority
of mankind who are hardly in any way clean, theif
are many persons, many most estimable persons, wlio.
while absolutely clean of skin — clean on tiie outer
surface — from frecjuent and regular bathing are not
clean within : whose blood and other body flui<ls, ami
even tissues, contain an excess, small or greater, of
used-up, waste, dead matters, the refuse of the func
tions of life — the dust f wear and the ash of com))Us-
tion : — which in well-proportioned, well-functioned,
and well-cared- for bodies are cast out gradually as thev
are produced by the excretory organs. Briefly, in a
very large proportion of the people who make up tlic
masses of humankind, on account of some (.n'ganic
defect or bad habit, either inherited or accjuired, such

"""■IP

ITS NATURE, CAUSES AND PREVENTION.

as that of a small chest or habitual shallow breathing,
these waste matters are not in their full measure cast
out, but accumulate in the body, constituting the e
of Carpenter — "attractive food for bacteria."

OF THE POISONS (iENERATEI) IN THE BODY.

There is a great deal yet to be learned concerning
tlie chemical and physiological changes which take
place in the blood and other fluids of the human
body from an excess therein of the waste of the pro-
cesses of life — concerning the leucomaines, ptomaines
and the many other combinations formed thereby ;
and concerning the relations these bear to saprophytic
ami other micro-organisms in the body, and also to
certai'i bodily derangements. It may yet be found
that such combinations constitute special attractive
sustenance for special micro-organisms, which are, or
which may only then become, the germs of disease, —
combinations perhaps poisonous to the body, which
tlie so-called disease germs are benignly designerl to
appropriate — to consume, break up or destroy, for the
preservation of the body. Toxic substances are pro-
li.-'bly thus formed which transform benign micro-
orjxanisms into pathogenic or disease-producing germs.

Only a few years ago the late Sir Andrew Clark
made it clear that anfemia and chlorosis (" green sick-
ness ") are caused by poisons arising from retained
ficcmnnlations of fecal matter in th«' intestines — by
IVcal poisoning or intoxication — a conrlition which
Bouchard designated as stercorfemia : as li. cases of
habitual constipation in young women. There is
I)

;

CONSUMPTION :

;ljijH|

evidence, an<l appears to l)e no doubt, that to^iii* s
from the same .sourcf freoi ntlv^ iriv^e rise to so-call(Ml
" malarial " atteetions, iier. '\lj;ias, " biliousness," and
various forms of headache. Fron» observations and
experiments by Doctor Hattie, of Halifax, Nov., it
appears that ('pil«-ptic seizures sometimes have a
like orifi^in. Docl-'r Hattie's conclusions are sup-
ported by Doctor \'. Romaro (La Sema. Med.: New-
York Med. Jour., Nov. 24, '94) : who, furtliermorc,
has found inhalations of oxygen " very beneficial "
in the treatment of such " convulsive neuroses.
"The oxyg(-' " he says, "counteracts the asphyxial
state of tlie tissues and destroys tlie ptomaint's,
t*"e accumulation of which in the orji^anism is often
responsible for the convulsive paroxysm, " It is
not yet known whetlier these poisonous ptomaines
act on the body directly, or whether they act throu;.'-''
the influence or medium of certain micro-orj^anisi
It is not improbable that the poisons first ati'eet
certain microbes.

It is unlikely that tlie typhoid fever bacillus will
«^ive rise to its poisonous effects except in a foul intes-
tine; nor will the cholera vibrio. Nor is it at all likely
that the tubercle bacillus will give rise to tubercle in a
clean, fully used and well-ventilated lung. The foul,
stagnant air — air loaded with accumulated eft'etc
matter — in the remote recesses of the air chambers of
the lungs, from want of full respiratory action, consti-
tutes a favorable condition for its saprophytic life, ami
where, too, it may be readily influenced and changed- -
made virulent, or more virulent, by abnormal toxincs

ITS NATURE, CAUSES AND PREVENTION.

ARE DISEASE GERMS ORIGINALLY BENIGN

J a

The ^ernis of typhoid fever and consuinption are
uhi(iuitou8. Yet vvith a large iiiajority of persons,
into whose body they an^ doubtless often received,
they are practically harmless. May we not ask, are
they not sometimes, as in their natural, saprophytic
condition, actually even benign organisms — scavengers,
working in accordance with natural, universal law ?
ht'coniing virulent and pathogenic in consequence of
iiian's own unhygienic habits — intoxicated into viru-
letice by poisons generated in the human organism :*

One well-known bacillus, which is, it appears, con-
stantly present in the healthy human intestine, the
bacillus coli communis (common bacillus of the colon —
lower bowel), is in its natural state evidently a benign
ortjanism. Yet the results of investigations make it
hitrhly probable, and to the minds of some of the
liiji^liest authorities, absolutely certain, that it is some-
times in some way, especially in collections of excre-
ment, as in privy pits, and possibly in a foul intestine,
transformed into the virulent bacillus of typhoid
fever : thus satisfactorily explairing the occasional so-
called dc novo origin (arising ane.v, not directly from
another person) of this disease. For that it does some-
times arise in some such way, de novo, has been long
maintained by high authorities ; as apparently also
<lo other infectious diseases, as diphtheria and tyj)hus.

True, Doctor Klein, F.R.S., etc. (address at Sani-
tary Inst., Sept., '94) tends to throw doubt on this.
Vi't the slight though persistent differences Doctor

%!*;

ii'-t

(; *

CONSUMPTION :

1 «

Klein finds between what he believes to be two dis-
tinct organisms (the bac. coli and bac. typhosus) may
on further investigation be reconciled to the view that
the}'' are originally one and the same. The poly-
morphism (change of form) of these low vegetations is
as well known as it is remarkable. We may note tlie
different forms taken by one of the minutest of them,
the micrococcus: — thread-like, spiral, and dumb-bell
forms. From the investigations of Metschnikoff,
Weiber, Wiltschur and others, it appears evidcnit
that the cholera vibrio, the coma bacillus, of Koch,
takes other forms, and under the influence of various
external conditions changes both its morphological
and biological characters so that " it may even
become indistinguishable." And it is asserted that
these changes do not warrant the belief that there is
more than the one variety of cholera germ.

Dickson, of Philadelphia, and other investigators
have obtained thread-like, branched and club-shaped
forms of the tubercle bacillus. In the ostrich,
Crookshank informs us, this bacillus is very lon^^
and sometimes presents a " terminal enlargement "
(Com. to Path. Soc). Klein himself not long ago, it
appears, stated that the bacilli of diphtheria, of
anthrax, and even of tubercle, are variable and not
such well-marked typical bacilli as they have been
supposed to be. Furthermore, since writing the
above, I find in the British Medical Journal (March
9, '95), after some comments on " a detailed account
of the morphology " (form and structure) of the
tubercle bacillus by Coppen Jones, the following, by

^iH

ITS NATURE, CATSES AND PUEVENTIOX.

tlu; L'ditor of that journal : " The polymorphism of
some of the higher funj^i is referred to ami a number
of observations are mentioned, which ten<l to show
that bacteria formerly looked upon as monomorphic
[of one form] are only stjij^es in the development of
more complex forms." Bunge, contrary to Klein's
experience, has found the larger nmnber of Hagella
or cilia (seemingly the motor organs), on the colon
hacillus. Doctor Veranus A. Moore (Bureau of Anim.
Indust., Wjish., D.C.) says, the flagella of such closely
related bacilli as these two and that of hog cholera
" resemble each other so closely that they cannot be
considered as specific characters." It is, then, easy to
believe that the typhoid bacillus, notwithstanding its
(lirterent eftects on milk, etc., as observed by Klein,
may be a transformed cohm bacillus. Cilia may but
l)e pushed out to enable the organisms to reach the
surface of their containing liui<l in order to obtain
oxygen; possibly a temporary change.

However this may be, it is evident that the
common benign bacillus coli is not infrequently
transformed, if not into the true bacillus typhosus,
into an equally virulent <lisease-producing germ.
The editor of Modern Medicine and Bacteriological
Review (Aug., '94), after referring to investiga-
tions by Doctor McWeeney (Prof. Path, and Bac.
Royal Univ. of Ireland), in a case of fever indistin-
j,'uishable from typhoid, but which disclosed no other
infection than the bacillus coli, and also in an epidemic
of typhoid fever at Watcrford, England, remarks :
" Tlie evidence afforded by these observations is, that a

CONSUMPTION

bacillus possessing the characters of both Eberth's
bacillus [of typhoid] and the bacillus coli is capable of
producing typhoid fever, and that a disease indistin-
guishable from typhoid fever may be produced by
a microbe which is unquestionably the bacillus coli."
Doctor Gabriel Valet, indeed, has shown that by cul-
tivation of the bacillus coli in fecal solutions, it may
become more virulent, more poisonous, than the
typhoid bacillus.

Now, what so changes the character of this usually
benign, probably very useful micro-organism, inc.
bacillus coli ? Doubtless some toxic substance formed
in the decomposition of the fecal matter. Is it not
probable that such substance may be formed in the
decomposition of accumulations of fecal matter in tin;
neglected intestine of a living human body, and there
and then produce a like effect upon this bacillus ?

It need hardly be stated that this part of the sub-
ject has Ijeen thus dwelt upon with the view of show-
ing that it is possible the tubercle bacillus may Ix'
influenced and transformed in like manner from a
benign saprophyte into a parasite or pathogene by
the foul air iTi the air chamber's of the lungs, or by
poisons generated therefrom.

It may be here observed that in accepting the
theory of p<ilymorpliism as correct, to the utmost limit,
it is not denied that like produces like, persistently,
in like influences of circumstance and environment.

ITS NATURE, CAUSES AND PREVENTION.

EFFECTS OF ENVIRONMENT ON DISEASE GERMS.

With the view of showing further liow certain
body conditions may affect the tubercle bacillus when
it chances to get into the body of certain persons, and
of drawing more special attention to the l)ody causa-
tive factor, the " personal equation," let us briefly
notice the dij'ect efi'ects, upon some of these low forms
of life, of the conditions in which they are placed or
which surround them, — of oxygen and sunlight, of
cultiv'ation, of soil and temperature, and of the diet
and habits of the host in which the organisms live.

That associated circumstances and conditions — air,
soil, food, etc. — have marked infiuences and effects
on the life and characteristics of all living organisms,
animal and vegetable, is well known, and need not be
t'ui'ther noticed. Man himself is largely a '* creatin*e
of environment."

Crookshank says the importance of environment
on micro-organisms is shown by the morphological
ilitferences obsoi-ved in artificial cultivation under
varying conditions: and, he adds, by the fact that by
successive cultivation the tube-^e bacillus can be
" educated to grow upon n medimu which is unsuit-
able for obtaining primary cultures." And it is well
known that by various foi-ms of cultivation, espe-
cially through the bodies of certain lower animals, tiie
virulency of many disease germs lias been so reduced
as to give rise to the practice of inoculation of the
thus attenuated germs or their milder products as a
preventive measure. Trouessart states that the siime

CONST 'MI»TI(»J

% '

ijf

l;!i;: jI?5SI!1!l|i«.

i '}

result may be obtained by adding various antiseptic
substances to culture liquids, and thus weakening tlie
virulency of the microbes. Doctor Arthur Ransonie,
F.R,S., has reported a series of observations (Proceed.
R. Soc.) to prove that fresh air, light, and a "sandy
soil have a distinct influence in diminishing the viru-
lence of the tubercle bacillus." The soil he appeared
to regard as having a special influence. It has been
long ago observed that consumption is more prevalent
in communities living on impervious, moist soils than
amongst those on open, dry soils : a subject whicli will
be more fully treated in another connection. Trouessart
says, " Certain facts observed in medical practice ha\t'
led to the surmise that whooping-cough may l»e
regarded as an attenuated form of croup, just as
vaccinia is an attenuated form of small -pox." On tlu-
other hand, fowls are not naturally susceptible to
splenic fever, or anthrax (a disease communicable to
man), but Pasteur rendered them susceptible by
immersing them in water for two or three days and
so reducing their temperature, which is higher than
that of mammals. Chauveau has shown that com-
pressed oxygen will considerably modify the virulence
of the bacillus of anthrax ; confirming Pasteur's view
that the oxygen of the air attenuates, and even
extinguishes, the virulence of an infection. The rat,
susceptible to the anthrax infection when subsisting
on a vegetable diet, is not so when on an animal diet.
The house-mouse may be inoculated with septicsemic
(" blood-poisoning ") infection from another house-
mouse, but not from a field-mouse, and vice versa. It

"■iPVi

ITS NATURE, CAUSES AND PKEVENTION.

lias lieen the subject of observation that epidemic and
otlier diseases, Asiatic cholera, for example, are mure
viriih lit a few days after the Sunday feasting in
whicli the masses (jf the population connnonly indulge.
There appears to be now no doubt that the virus of
vaccine matter, the specific infection of the mild cow-
pox used in ordinary vaccinating, is originally the
same as that which gives rise to small-pox in man.
By culture — by passing through the body of the
bovine animal, the viruhuicy of the infection is modi-
fied. Appar^'iitly originally from bovines, it becomes
in some way much more virulent in the lx)dy of man.
On the othei" hand, how is it, it may be asked, in
the case of direct inoculation with lunnan small-pox
infection, from man to man, for producing j nilder
ionn of the disease i — a preventive measure intro-
(luced into western Europe from the East and much
practised a century and a half ago. The individual
to ))e inoculated is subjected to a course of prepara-
tory hygienic treatment, in order apparently to
ck'anse the body from excess of effete matters or
impurities and invigorate the system. Is it not pos-
sible that, if this preparatory treatment were pro-
perly carried out for a sufficient length of time, the
l)0(ly would b(^ then so purified and invigorated
tliroughout that a natural imnnmity would be
thereby brought about as efiectual as by the inocula-
tion process ? — that then the infection when inocu-
lated into the body would not give rise to the disease
at all or produce any noticeable effect ? Is natural
immunity and the usual exemption from a second

■ ]

CONSUMPTION

attack of an infectious diHeasc anything more than
the influence of a complete cleansing and purification
of the body, together with a certain adaptation of
tissues and functions to any future action of the same
infection ?

ii: 1^

DORMANT OR LATENT GERMS IN THE BODY.

A few. words here on this subject will be instruc-
tive. In the case of all infectious diseases a perio<l of
time elapses l)etween the time of taking the infection
into the body and the manifestation of the symp-
toms, or the apparent commencement of the disease.
This is termed the period of incubation, and varies in
the different diseases ; and also, mark, in the different
individuals. That there should be such a period is
easily understood : it being the time required for the
special infective germ to propagate itself — multiply—
and spread its influence. But why does this period
vary so much as it does sometimes in different indi-
viduals in the same disease ? This must be caused
chiefly, if not entirely, by a difference in the condi-
tion of the body fluids and tissues — the body factor ;
the variation in the virulence and fatality of differ-
ent epidemics of the same disease being doubtless due.
in the main, to variations in the virulency or vigor—
the more luxuriant growth — from the start, of the
infecting germ : atmospheric influences, too, some-
times having an efl'ect.

Aside and quite different and distinct from this
incubation period, disease germs sometimes lie in the
human organism, apparently in a latent or dormant

ITS NATURE, CAUSES AND PKEVEXTIOX.

state, doing no harm, for weeks or months and
possibly a longer time. This is not easily accounted
for. It can only be reasonably associated with the
body condition, or explained by variations in that con-
dition. Doctor R. 8. Adams (Med. Rec), in a series of
recent throat examinations, found the bacillus of diph-
theria — the Klebs-Leoffler bacillus — in the healthy
throat, " doing apparently no harm." Trouessart,
believing that the dual nature of the diphtheritic
infection is not yet fully established by the researches
of Klebs and Leoffler, but that the apparently two
organisms are but different phases or forms of one,
explains the origin of a case of the disease in this
way : A child contracts a simple catarrhal angina or
laryngitis (an inflamed condition of the larynx); the
micrococci, which up to this time reinained inert in
the mouth, begin to grow and nuiltipl}^ under the
influence of the inflammatory products which favor
tlieir development; the plant which has been dor-
mant becomes widely diffused. There are many
<legrees, he adds, between croup with malignant
complications and the mildest diphtheritic angina.

From recent investigations by Straus (N. Y. Med.
Jour.), it seems that living tubercle maj'- exist in
the nostrils of healthy persons and not give rise to
any ill effects, although they act virulently when
afterward inoculated into certain guinea-pigs. Dur-
ing an epidemic of measles in Munich, Bollinger had
repeated opportunity " to demonstrate on the bodies
of children who had died of that disease, the presence
of tubercle bacilli in the lymphatic glands, especially

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CONSUMPTION

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of the root of the lung, although previous to the sick-
ness the children had been apparently healthy and
not at all scrofulous." Baumgarten believes children
may be born with the tubercle bacillus or its spores in
their body, and that the future history of the germs
"depends on favorable or unfavorable conditions of the
tissue soil of the host." Solles, taking a similar view
respecting children inheriting the actual seeds, says
that during the first years of life "there seems to exist
a period of variable duration in which the spores of
whe bacillus, although capable of being stiri id into
activity, are yet capable of being thrown off," as by
the excretory organs. (He did not use italics.) Ziems-
sen says, " Cases of unintentional ' tubercular inocu-
lation ' have occurred, where a slight injury (such as
drawing a tooth, a small cut, etc.) has led to secondary
swelling of the neighboring lymphatic glands, and in
these glands, after extirpation, giant cells with tuber-
cle bacilli have been i'ound. Such cases, however,
are of doubtful value, for the bacilli may have dated
from some earlier period and may have merely be-
come manifest by reason of the traumatic lymphaden-
itis [inflammation of the gland caused by the wound].
The value of experimental inoculation must remain
doubtful so long as we have no guarantee that the
lymphatic system was previously free from bacilli,
and for such a guarantee we can scarcely hope. . . .
That tuberculosis may exist and, perhaps, has existed
for years in a child apparently in full health is often
learned accidentally. A single swollen gland, carefully
extirpated from an otherwise blooming and healthy

ITS NATURE, CAUSES AND PREVENIION,

child, has been found to contain giant cells with
bacilli. How long were these in the body ? Are
there other foci of infection in the glands ? Who
can answer ? " There is much truth in the remark of
Doctor Mays, that tubercle, in itself, consequently the
bacillus of tubercle, is not so deadly as it seems to be
when judged from a standpoint of acute pulmonary
tuberculosis. " It would not possess such a great
fatality were it not that it involves and overpowers
organs the full integrity of which is absolutely
essential to life." It is well known, too, that cows
may be apparently in the best of health and condi-
tion, and continue to give abundance of milk, while
in various tissues of the body are numerous tubercles.
Brush says the bovine race can be tuberculous from
birth to old age, and yet not die of this disease.

On the theory that saprophytic or benign micro-
organisms may be transformed into pathogenic germs
— that so-called disease germs in the body doing
apparently no harm may be rendered virulently
active by certain bodily conditions, the various
anomalous cases, or series of cases, of illness occasion-
ally reported, as well as the de novo origin of typhoid
and other fevers, and of consumption, and also certain
other peculiarities in connection with germs, may be
fully and satisfactorily explained.

EFFECTS OF IMPERFECT BREATHING.

Without further discussion or inquiry as

whether or not it be probable or possible that the
tubercle bacillus has ever been, or may still be in

CONSUMPTION

/■'I

■ t

certain circumstances of environment, of a Ijenign or
purely saprophytic character, we will now after these
lengthy and somewhat digressional remarks on micro-
(•rganisms, return to the further consideration of the
so-called predisposition, or soil factor.

Forty years ago, in my early student days, from a
special case which deeply interested me, I received a
strong impression that defective respiration — a want
of full respiratory capacity or activity — constitutes a
particularly important factor in the causation of con-
sumption. The more thought, observation and study
since then given by me to the subject, the more con-
vinced I have become that such is the case. Indeed,
previous to the remarkable developments and dis-
coveries in biological medicine during the last decade
or two, the belief was growing thai; the disease could
be produced solely by want of full expansion and
exercise of the lungs : and it is now my firm belief,
that no one will ever have it so long as pure, cool air,
with abundance of oxygen, passes freely into and out
of, and fully inflates, every air chamber and keeps
them free from the accumulation of the waste matters
dumped into them from the blood. During a third of
a century in practice, I have had many opportunities
of observing and studying, on the one hand, the evil
effects of want of full respiratory capacity, whether
inherited or acquired — tuberculosis being the most
common ultimate result ; and on the other hand, the
good effects, often prompt 'and marked in consumptive
persons, following an improvement or increase in the
respiratory function, I could, would space permit.

!:::.

ITS NATURE, CAUSES AND PREVENTION.

give the detailed history of many cases clearly con-
firmatory of this.

When we bear in mind, what may be here repeated,
that all the blood in one's body, after it has been the
lound of the greater circulation — to every part of the
l)()dy — given up to the tissues its charge of oxygen,
and gathered from the tissues its load of used-up
waste, is sent from the heart to the lungs ; that
there, spread out in the capillaries laid over the air
chamber walls, about once every minute, it all moves
slowly enougli to give off' its load of waste stuffs and
get in exchange its red corpuscles reloaded with life-
giving oxygen, before it flows back to the heart
to be again sent ' ^o all parts of the body ; and
also tliat in natural respiration the air chambers aie
first fully expanded, and then they contract and
force out the waste matters with the breath into the
outer atmosphere : — when we remember this, then it is
easy to understand the evil effects on the system of
shallow breathing with small or cramped, contracted
lungs — of want of full expansion, with free ventila-
tion, of the air chambei-s. When the air in the air
chambers is not renewed in a proper measure as it
should be w^ith every breath, but instead, becomes
stagnant from want of being changed by full breath-
ing, it soon becomes loaded with poisonous materials
from the blood, gathered from all parts of the body.
The blood can then no longer continue to fully unload
itself into the chambers already overcharged with
waste, and so the poisonous substances accumulate in
the blood. Furthermore, the blood corpuscles cannot

«)',

CONSUMPTION

'i !

now get their load of oxygen, for it is not to be had
in sufficient quantity from the foul air in the air
chaniberH. The entire organism then suffers in the
various ways already explained.

It will be well to note here the remarkable fact
that the human body will gradually adapt itself, in
a measure, to various insanitary conditions. For
example, one may in a little time, from use, breathe
an atmosphere, as in a crowded room, which at first
seemed quite unbearable. But as Kirk says (Phy.s.,
Vol. i), " Such an adaptation can only take place at
the expense of a depression of all the vital functions."
In the case of acquired defective respiration, tlie
system often tolerates the injurious effects for a lon^r
time without manifesting any particular symptoms of
injury, — the effects coming on, too, gradually, as the
habit of shallow 1 ireathing gradually increases ; such
respiration is injurious from the first, all the same.

In persons in whom the lungs are relatively small
from heredity, although fairly exercised to their full
capacity, the ultimate effects on the organism are
much the same as in persons with imperfect action of
relatively larger lungs. In the smaller lungs,
although the blood probably circulates more rapidly
through them and the breathing is quicker to com-
pensate for the want of space, yet it seems impossible,
other conditions and circumstances being the same,
that the blood can as completely unload its excess of
refuse and receive its full cargo of oxygen as it can in
relatively larger lungs. The smaller lungs, too, are
more likely to be overtaxed, and are more liable to

ITS NATURE, CAUhES AND PREVENTION.

congestions. Many of this class of p-.rsons exercise
their lunj^s to the full capacity, and with hygienic
care live on to a Ivanced age, in fair, though not in
vigorous health ; yet as will be presently more clearly
sliown, they are more liable to consumption than
persons in whom these organs are better developed.
Many of the class, on the other hand, do not, from
habit or other cause, fully expand and use the small
lungs they possess ; and hence a condition eventually
even worse than in those with imperfectly exercised
larger lungs.

Children born with relatively small lungs are
found to have usually, along with other characteristics,
a more or less puny constitution, with a tendency to
" shortness of breath " and palpitation of the heart,
and to be " thin in flesh." With favorable surround-
ings and habits, they survive the period of infancy
and childhood, and in fair health. They may live so
through the period of school life with its inspiring,
lung-expanding plays and games; sometimes mani-
festing great mental ability, as if to make up fcr
want of physical power. So long as the respiratory
capacity is not overtaxed by tissue change — by labor
or exercise, if the skin be kept active and, above all,
only pure air be breathed, such pereons may enjoy
j]food health to the full average of life. During the
closing years of adolescency, however, at that matur-
ing and somewhat delicate period of life when con-
sumption gathers in its largest harvest, it may be
from a want of the inspiring exercises out of doors,
or from " over study," so-called, indoors, or from tog

■t ,1

■•i V

ifi.

.'ONSI'MITION

much physical labor in un ventilated working places,
respiration, naturally not vigorous, beconjes more and
more inactive and imperfect, the lunj^s and the blood
become foul, tubercle bacilli are inhaled, and eventually
tubercles are formed in the lungs. If now, because of
the symptoms to which the tuberck' gives rise ami
the consequent awakening, anxiety or alarm, pi'opcr
I'emedies be employed, the tubercular process may l)t'
arrested aiul fair health restoi'ed : if not, aiiothcr
death from consumption is eventually the consequence.

SPECIAL COLLblCriVE INVESTIGATIONS.

Over twelve years ago, through the coui'teoiis aid of
a number of the leading medical journals, I sent out to
practising physicians in the United States and Canada
a series of questions, with blanks for replies, respect-
ing the causes of consumption. Replies were received
from physicians throughout many of the Northeiii
States and the Dominion of Canada, and much valu-
able information was obtained relating to the personal
history of a large number of consumptives. 'I'he
replies showed that in all the cases reported upon,
the chest dimensions were less than the average of
well-developed individuals of the same height and
weight, as given by the best authorities (as in table,
page 36) ; the average of the cases being in fact
only about live-sixths of the dimensions demanded
by healthful development. The measurements had
been doubtless taken after the disease had made con-
siderable progress ; but the reduction of the measure-
ments by the tissue waste characteristic of the disease

ITS N'ATURi:, CAUSES AND PREVENTION.

would hardly have l)i;ei» more than three or four
iucluis in each case, or not much more than half of
tlie five-sixtliH shortajj^e.

in Octoher, 1882, a pamphlet was ])uhlished,
giving the results of my investigations in this way,
from which the following is quoted : " One of the
inost marked features, and perhaps the most
important one, brought out in the analyses of the
cases reported, is the evidence that those who die of
the disease under consideration have a proportionately
small pulmonary capacity — a small, contracted chest.
This is shown not only in the average of the cases,
hut in every case ; in not one did the circumference
of the chest closely approximate that of a well-
developed individual of the same height and weight.
Accordinii* to tlie best authorities the circumference of
the ciiest around or on a level with the nipples should
he, for good development, equal to one-half the
lieight, plus one -fifteenth the height, of the individual.
The circumference of the chest, therefore, of one w^hose
stature is 5 feet 5i inches — the average height of the
cases reported — should be, according to that, at least
37 inches ; whereas the average circumference of the
chest in these cases was only 3H inches, or about
five-sixths of that demanded by good natural develop-
ment. In about half the cases the chest was reported
as flat, as well as small in circumference, a form
giving still less capacity than a round chest with the
same circumference. It may be fairly assumed that
the average length of the cavity was not greater than
in well-developed persons. In the larger proportion

I-' »1

100

CONSUMPTION

II .1 M

of cases the trunk was reported as proportionately
long, but probably owing to a long abdominal cavity ;
as in most of the cases the function of digestion
appears to have been usually well performed.

" Now, although small lungs may be more highl}'
organized than larger ones, as often is the case with
other organs — the air cells in the small lungs may be,
relatively, more numerous than in larger ones, and
so give a relatively greater respiratory surface —
we have no evidence that this is the casj, and
although this condition might prevail to a certain
extent, there was, doubtless, in all these cases a
marked want of capacity for the purpose of carrying
on, in a perfect manner, the important function of
respiration. There would be, consequently, in such
circumstances, besides want of personal stamina, from
want of oxygen for active tissue metabolism, a
tendency to accumulations in the blood and other
fluids of the body of waste, used-up matters, and
frequently probably, too, of unassimilated though
perhaps digested food, especially of the carbonaceous
class. . . . The patients had been nearly all small
or moderate eaters, and had used but little fattv food
except butter. They could, for the most part, appar-
ently readily digest all the system could utilize with
its small respiratory capacity.

" Why, it may be asked, should persons with small
lungs most readily fall victims to consumption ?
Many more persons, we cannot doubt, take into their
bodies the germs of consumption, the bacilli, than
manifest symptoms of the disease : just as, doubtless,

ITS NATURE, CAUSES AND PREVENTION.

101

in the case of other infectious diseases. Besides the
exciting cause of any infectious disease, there must
be, before the disease can be developed, a predispos-
ing cause — the seed must have favorable conditions
for its development and multiplication. . . . In a
healthy, vigorous, clean constitution the germs are
harmless, and are probably soon destroyed, or ex-
pelled from the body by the excretory organs."

During the next few years after these investi-
gations I gave a good deal of attention and study to"
tliis factor, a respiratory want, in the causation of con-
sumption, becoming yearly more and more convinced
of its vital importance. In October, 1889, at the Con-
vention in Brooklyn, N.Y., of the American Public
Health Association, in a paper which it was my
privilege to read at one of the meetings, I brought
tliis special subject forward and urged the desirability
of making practical application of the suggestions
which it involved when employing measures for the
prevention of consumption, instead of confining our
chief attention to, and directing almost our entire
forces against, the tubercle bacillus.

EXPERIMENTS AND OPINIONS OF OTHERS.

There are others who have given attention to this
subject, and w^ho, from their recently expressed views,
appear to entertain opinions similar to my own,
especially in respect to the principle involved, as
shown in the following extracts.

In March, 1890, Doctor Stephen Smith Burt (at
New York Acad, of Med.) said, " An acquired inse-

102

CONSUMPTION

■> I

curity from the pathogenic germ [the tubercle bacil-
lus] is due to innumerable causes which conspire to
lower the tone of the system in general, and of tlu-
lungs in particular. One source of structural weak-
ness which has especially impressed me is that tin*
waste products circulating through the organism aif
ofttimes not properly oxygenated on account of
defective respiration, and these form an attractive
field for the harmful bacteria ; whereas, a thorough
daily bath of the tissues in well-purified blood con-
sumes the ptomaines, and by keeping the cells of the
body in a sound condition, starves the germs that
have chanced to gain admission."

In a little book by G. W. Hambleton, M.D. (Pres.
Polytechnic Phys. Develop. 8oc., Gt. Brit.), which
has attracted some attention, the preface of which
dated April, 1890, at London, the . authoi"

writes : " I have experimentally produced con-
sumption [i] by the reduction of the breathing sui-
face of the lungs below a certain point in propor-
tion to the remainder of the body. . . . On one
occasion I took a well-developed chest, and gradual l}'^
submitted it to conditions that tend to reduce the
breathing capacity, and at the same time, so far as
possible, placed impediments to the performance of
compensatory action by other organs. At first there
was a reduction of the chest-girth, a wasting of the
muscles, a loss of the range of extension, the well-
known change in shape, and increased frequency of
breathing. This was soon associated with catarrh,
pain in the chest, steady loss of weight, and hectic ;

ITS NATIKK, ("Arsis AND I'KEVKXTIOX.

iO.S

!Ui(l the process was continued until I was satistied
tluit consumption wns well estalilished [i]. Then I
induced compensatory action \)y other or^^ans, and
sui)niitted the lungs to conditions that tended to
develijp them. 'J'ljis was followed hy great relief in
tlie chest symptoms, which eventually disappeared by
a restoration of tlie general health, a return to the
normal weight, a change in the shape of the chest in
an opposite direction ; an«l I continued the process
till the chest had regaine<l its full development, and
there was sound Iiealtli. Kach step in the experi-
ments was car(!fully verified, the saiu se([Uence of
events was invai'iahly observed, and 1 have both
traced the presence of these condi< i ms andwnlohod
their })rogress in many cases of consumptioii.

But .ew probably would approbate l^ot ..or Hamble-
t(m's experiments in their entirety. He had, doubtless,
implicit faith in the certainty of his remedy. Doctor
Hambleton is one of the very few who do not
yet recognize the generally received theory that the
bacillus tuberculosis is an essential factor in the
causation of tubercular consumption. His theory,
therefore, that consumption is solely produced by
conditions that reduce the breathing capacity below
H certain relative point, is not likely to receive
general recognition. But, and although he does not
inform us whether in the cases of his experiments,
when " consumption was well established," there were
bacilli in the expectoration, his experiments are
nevertheless of considerable value, in showing the
effects of a limited respiratory function.

>M'

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Wft!

Vi ';. ■"

104

C()NSIJMI»TI()N :

i: '■:■':!■'.

i^- ■ :l

J. Edward Squire, M.D., M.R.C.P., etc., Physician
to the N. London Hospital for Consumption, in a
recent bvok (Hygienic Prevention of Connump., '98.
London : Chas. Oriffin & Co.), gives the following
table showing " the average quantity of air expired
after a full inspiration, for different lieights, in health,
compared with that which can be expelled by persons
of similar height in the early stage of phthisis :

Height.

Health.

Early Phthisis.

5 feet 5 inches.

214 cubic inches.

143 cubic inches

o „ 6

222

149 M

5 ,. 7

230

1.54 M

5 ,. 8

238

159 „

5 .. 9

246

165 ..

5 „ 10

2o4

170 M

5 .. 11

262

176 „

This points clearly to a limited respiratory capacity
before the commencement of the disease.

No medical fact is better known, even beyond the
limits of the profession, than that a sedentary life
with a stooping, lung-contracting posture, sr inds high
in the list of causes of consumption ; and also that
those with a narrow, flat chest are much the more
prone to the disease. Why ?

Again, we find the latest authorities, specialists in
chest diseases as well as others, so far as their views
can be obtained, universally recommending chest
expansion, and so increase of lung surface and respi-
ratory capacity, as one of the most important, if not
the most important, of all remedial measures ; indeed
an absolutely essential one, as well as the first of

preventi
kinds m
disease,
various
same obj
purposes
" live in
benefit fi
oxygen,
— has ali
nianded i

Von Z
quoted, a
tuberculo
to weakei
fresh air
The effec'
prisons, ai
rooms" o
but rich
stagnant
imperfect
sedentary
the lungs
tinues. H
flat, with
tion." In
place. .
inspiratio]
or by " re\

Thomas

ITS NATURE, CAUSES AND PREVENTION.

105

jts in
dews

jhest
fespi-
not
Ideed

it of

preventives. The pneumatic chambers of various
kinds now cominor into use in the treatment of the
disease, with other mechanical contrivances, and the
various gymnastic exercises liave, in the main, the
same object, increase of lung surface for respiratory
purposes. 'The advice to " keep out of doors," or to
" live in the open air," in order to get the utmost
benefit from the pure air — the greatest proportion of
oxygen, for both invigorating and purifying the body
— has also the same object, and long and ever com-
manded first place in the list remedial. Again, Why ?

Von Ziemsaen, the higli German authority already
quoted, after giving much the usual list of causes of
tuberculosis, says, " Of all these none are so powerful
to weaken the resistance of tissue cells, as the lack of
fresh air and the insufficiency of out-door exercise."
The effects can be best studied in the " inmates of
prisons, asylums, convents," etc., the air in the "closed
rooms " of which " is not pure," " is poor in oxygen
but rich in carbonic acid" (like what it is in the
stai,^nant air of the air chambers of the lungs in
imperfect shallow breathing). " On account of the
sedentary life, the respiration is not deep enough and
the lungs are not well expanded," Von Ziemssen con-
tinues. He describes the " paralytic thorax,"or chest; —
flat, with " slight elevation of the walls in inspira-
tion." In the treatment, fresh air occupies the first
place. ..." The patient should practise deep
inspirations," as by " climbing any hill or mountain,"
or by " regular gymnastic exercises."

Thomas J. Mays, M.D., Philadelphia (in Pulmon.

f ■ il

' il

■ :ll

i 11

106

CONSUMPTION :

I !

I^.'i

Consump. a Nervous Dis. Detroit : Geo. S. Davis),
after referring to defective expansion of the apexes
of the lungs as being a cause of tuberculosis so often
commencing there, says, " This explains why those
who follow in-door occupations, who habitually become
stoop-shouldered and flat-chested, furnish such a large
contingency to the army of consumptives." Respect-
ing the treatment, he recommends " the inhalation of
oxygen, nitrous oxide and compressed air," and the
practice of " pulmonary gymnastics."

N. S. Davis, jr., A.M., M.D. (Prof. Med. Chig. Med.
Col., Phys. Mercy Hosp., etc.), names the follow-
ing, and in the order given, as the four commonest
causes of acquired predisposition to consumption :
Breathing of closely confined air ; lack of necessary
muscular exercise ; use of food that is not wholesome :
possession of other diseases of the lungs *ind tubes.
Lack of exercise " prevents frequent and deep breath-
ing." " If air be allowed to remain too long in the
lungs it becomes over-filled with waste matter and
ceases to purify the blood ; then all parts of the body
begin to feel the lack of the invigoration which an
abundance of fresh purifying air will give to the
blood, and through it to all the tissues. ... A
person quietly standing or sitting breathes less pei-
minute by several inspirations than one who is walk-
ing or otherwise exercising. In addition to breath-
ing less frequently he breathes less deeply." In both
Avays the amount of air breathed "is made to fall
below the standard." When the body is bent and the
shoulders sag forward, "the amount of air entering and

iiw

ITS NATURE, CAUSES AND PREVENTION.

107

escaping is plainly greatly lessened. A considerable
part contained in the lungs is stagnant. ... Of
special exercises the most important are those that
expand and enlarge the chest and insure thorough
ventilation of the lungs witli clean air. . . . An
erect carriage should be striven for. ... In order
to expand the chest nothing is so important as . . .
enforced and frequent deep and slow inspirations and
expirations. The necessity for such exercises cannot
be too greatly emphasized. . . . Deep breathing
causes better oxygenation of the blood. . . . The
entire lung capacity should be brought into use. In
those parts where the air is rarely changed, waste
matter that should be exhaled accumulates. If disease
exists near, products of the action may be re-absorbed,
and prove poisonous to the body." In concluding, in
respect to different forms of exercise, on which he
dwells, Doctor Davis adds : " With all these exercises
it is best to comlnne systematic and enforced deep
breathing " (Consump. : How to prevent and how
to live with. Phila. : F. A. Davis, Pub., '91).

J. Edward Squire, M.D., etc., London, in the work
above quoted from, remarks, — " The proper develop-
ment of the chest is especially imp<^rtant in those with
a phthisical tendency." Proper carriage " does much to
tlirow out the chest and increase its capacity. . . .
A most important effect of muscular exercise is that
produced on the lungs. . . . The quantity of air
inspired and of carbonic acid eliminated is thereby
greatly increased. . . . Muscular action requires
unimpeded respiration. . . . Many exercises may

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108

CONSUMl»TH)N

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be useless or injurious. The chief aim should be to
expand the chest and increase the respiratory capa-
city of the lungs. ... I am confident that much
benefit would be derived by those with narrow chest,
round shoulders and a constitutional tendency to con-
sumption by a special course of Swedish exercises."

Chas. Denison, A.M., M.D., etc., of Denver, already
quoted, who has had exceptional experience in the
disease under consideration, asks, *' Why is it that
consumption is so often * of the lungs ' ? Is it because
of the non-use of certain portions of the lungs ? . . .
Is it because the ordinary breathing of sedentary
people removes a tenth at a time of the air the lungs
contain, and those portions farthest from the large
tubes are so little disturbed that they become vitiated
and retractive in the self-poisoning process through
which the individual passes? Is it because the bacil-
lus of tubercle nee^s some such vitiated climate, be
it the stagnant, imprisoned air or the chemically
changed secretions, in order to multiply most pro-
lifically ? . . . Settle this question ... as you
will . . . you must come to the decision that it is
natural elimination which is interfered with, and it
is healthful respiration which is wanted. It is action
as opposed to stagnation."

Austin Flint recommends " increased expansion "
and " forced efforts of expansion " of the chest in the
treatment of phthisis.

Finally, H. Weaver, M.D., in a late number of the
New York Medical Journal, brings out the point
very clearly when he writes, — " Every cure of phthisis

ITS NATURE, CAUSES AND PREVEXTIOX.

109

is the result of an increased respiratory activity and
capacity, which is directly antagonistic to the devel-
opment and extension of the disease. . . . Increased
vitfil capacity is the great desideratum without which
there can be no cure of phthisis." By vital capacity
I take it that Doctor Weaver means respiratory
capacity. He quotes Doctor T. J. Mays as showing
that '* apex expansion or ventilation is the most
important factor in the cure of incipient phthisis ; "
a condition "promoted by the highly attenuated
atmosphere of high altitudes." The whole of the
lungs must there be used in order to supply the
re(|uired oxygen, there being less of this element,
bulk for bulk, in the thin mountain air.

In bovine animals we find evidence of the correct-
ness of my theory and contention — that a defective
respiratory function is an absolutely essential factor
in the causation of consumption. We find those ani-
mals bred more especially for the development of the
glandular system — for yielding an abundant supply
of milk, rather than for robustness or vigor of consti-
tution, with well-developed respiratory organs — those
animals with a relatively small chest, and in which the
lungs are not much, or never fully, exercised, as by
a run in the fields, are usually, if not always, the ones
which succumb to tuberculosis.

What does all this signify and teach ? Does it not
clearly and impressively declare that there is in con-
sumptives, all, a want of sufficient, healthy, active lung
surface for the purposes of respiration — a want of
oxygen, with a consequent accumulation in the body
of waste, dead matter?

t !

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110

CONSUMPTION

COHROiiOHATIVE EVIDENCE.

Ill cases ill which, in certain occupationH, consuni))-
tion \h cauHe«l hir^cly, primarily or remotely, by dust,
the cilia are ovei'taxed, {)articleH jjjet into the air
chaml)er.s, and the walls of the chambers from the
irritation set up become thickened, and the respiratory
function curtailed. Besides, persona working in a
dusty atmosphere almost instinctively avoid deep, full
breathing, and rarely fully expand the lungs.

Another point bearing upon this (piestion relates to
the " intimate association " existing between pulmon-
ary disease and the nerves controlling respiration :
the vagi nerves, one (a vagus) on each side. This sub-
ject is fully discussed by Doctor Mays in his treatise,
already named. One can easily understa d that any
disease or injury of the nerves of an organ will influ-
ence its function, and that the respiratory function is
injuriously influenced by disease or injury of the vagi
nerves, as clinical observation and experiments on ani-
mals clearly prove. The first case reported by Doctor
Mays, that of Mrs. W., who manifested "uncommon
nervous s}- mptoms," early showed " want of proper
expansion," and " diminished respiratory motion " of
the chest and lungs, supports my theor}'. So, too.
does the fact brought out in his tabulated history of
cases, that " division, injury, or acute disease of the
vagi always resulted in oedema, hyperaemia, hasmor-
rhage [swelling, congestion or bleeding] or bronchitis,
but never in phthisis— the last disease only being pro-
duced when the vagi were subjected to a slow process

ITS NATURE, CAUSES AND I'UEVEXTIOX.

Ill

of (l(5vitaliz»itioii such as would take place from lonj^-
contiiuu'd presHiirt; or protracted disj^ase of the nerve."
Here the " injury " or " acute distNiHe " would (piickly
affect the respiration; the; "slow <levitalization," j^radu-
ally curtail the reH])iratoiy function, ])roducinf( the hIow
jiuisonino; process necessary for tlu; pi'oduction of the
tul)ei'cular soil. Jt seems possible, too, that a stooping
curved position of the chest and shoulders might cause
such pi-essure on the vagi nerves at the base of the
neck, where they ai*e so near to the iirm walls of the
large arteries, as to interfere in a measure with their
perfect function.

There is yet anothei- })oint,the consideration of which
also appears to give support to my view. For centuries
the breathing of already <jver-breathe<l aii* has been
looked upon as a most connnon and prolific cause of
consumption, as already intimated. This is so gener-
ally recognized that authorities.need har<lly be (pioted
here: this one will suffice. In his "New Medical
Dictionary," Geo. M. Gould, B.A., M.l). (Philadel. :
P. Blakiston, Son & Co.), writes, " Among yet unde-
termined leucomaines are l>ases known to exist in
expired air. . . . The same violent poison is said
to produce ])ulmonary phthisis in confined air by
continuous influence."

It is well known — the records of mortuaiy statistics
proving beyond doubt — that the death-rate from
consumption is much greater in the poorer parts of
cities where the dwellings are overcrowded than in
the less crowded parts. It was shown last year at the
Academic de Medicine, Paris, that one poor disti-ict in

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112

CONSUMPTION

that city, tlie Plaisance, had a death-rate from this dis-
ease nearly ten tiinos j^reater than the Champs Elysdes.
This difference is due in a measure to other causes —
want of sunliglit, improper food, and the spread of tlio
disease by infection : but un( questionably the principal
cause is the breathing of over-respired air in small,
close and crowded rooms, — imperfect respiration.

It need hardly be said that the habitual breathinjjf
of an over-breathed atmosphere, outside the body,
with its reduced proportion of oxygen, excess of car-
bonic acid and organic poison — the " undetermined
leucomaine " — gives rise to the same body condition,
in a degree, small or greater according to circum-
stances, as the stagnant, largely unchanged atmosphere
in the air chambers within the body, arising from
shallow, limited breathing.

Finally : it may be asked, how is it in cases of con-
sumption which are practically cured without special
out-door or lung-expanding treatment, occasionally
in a city hospital ? May it not be somewhat in this
way : symptoms being usually nature's benign efforts
towards health, and cough being a symptom curative
in design, it eventually not only expels irritating sub-
stances on the surface of the air passages, but also
acts as a forcible distender of the lung membrane
and air chambers ; acts practically in a measure as do
lung gymnastics — stretches and attenuates the air
chamber walls, increases tho respiratory capacity and
improves the function ? The act of coughing is
unquestionably remedial, and in certain cases, as in
persons with a good history — no hereditary taint,

ITS NATURE, CAUSES AND PREVENTION.

113

under the improved surrounding conditions in a mod-
ern well-ventilated ward, the best of nutrition, anti-
septics, and perhaps skin-cleansing and stimulation,
tlie cough, with these remedies, at length gives rise to
a reaction, or the turning-point toward health, and the
cure which finally comes about.

WHAT MAY BE SAID AGAINST THIS VIEW.

It may be said that some persons die of consump-
tion who have a well-developed chest. So far as
my observation and experience have gone, they are
muscular persons, perhaps even with a tendency to lay
on fatty tissue, and, withal, a chest measurement large
in proportion to the size of the lungs ; in other words,
the lungs are not so large, perhaps not nearly, as one
might naturally suppose them to be. Besides, it is
possible that the lungs of such persons are less highly
organized, have larger air chambers and fewer of
them proportionately. Some persons, too, with well-
developed lungs have a habit of very shallow breath-
ing ; while the skin is often also neglected.

Again, it appears there are a few so-called " ath-
letes " who habitually for a time fully, probably over,
exercise their fairly developed lungs, yet who fall
victims to consumption. It will be found that in such
men, while the lungs are fairly well developed they
are not sufficiently so to bear the strain of the exces-
sive amount of labor thrown upon them by the per-
haps violent general bodily exercises indulged in, as
of rowing, base-ball, etc., possibly thrown upon them
suddenly at the beginning of the exercises : the train-
8

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114

CONSUMPTION

%' i

ing, especially at the commenceineiit, being bad, tlic
lungs are unable to perform, without strain, the extra
respiratory work demanded of them by the increased
general muscular action. They consequently break
down. Hfiemoptysis (spitting of blood from the lungs),
if not more profuse bleeding, is the probable conse-
quence. The bleeding is probably not caused l)y
tubercle. Eventually, however, with the consequently
restricted respiratory action and capacity usually
following this condition, tubercles are formed.

RESPECTING CAUSE AND EFFECT.

There are scientific physicians of high standing who
do not yet believe that the tubercle bacillus is tlie
cause, or a cause, of consumption ; but that it is
always present as a consequence. The truth appears
to lie between the two views. The bacillus will not
grow and multiply in the body, or the tubercular
matter characteristic of the disease be produced, unless
there be already in the body a certain condition or
substance — a "soil" — practically and actually body
derangement — disease. As a limited respiratory capa-
city seems to invariably precede the tubercular state,
what explanation so natural and reasonable as that
this deranged condition of boily — this so-called soil —
results from excess of waste — debris of tissue wear and
combustion — accumulated in the body by reason of the
imperfect respiration ? This waste in decomposing
would doubtless give formation to such inorganic
elements as would be suitable food for the vegetative
microbe. And as something more than simple food

iliili ,

ITS NATURE, CAUSES AND PKEVEXTION.

115

seems necessary to give rise to the virulent patliogenic
action of the microbe (else most likely more persons
would be affected by it and it would not remain in the
body in a dormant state or be found in a hannless
con<lition), the decomposition of the excess of waste,
in the absence of abundance of oxygen, too, also gives
rise to some more special soil-fitting substance, plus
the inorganic food elements; something toxic to either
tlie body fluids and tissues or the bacillus, or to both,
and which transforms the V)acillus into virulency :
somewhat as the bacillus coli connnunis is transformed
1)V " cultivation "tin " fecal solutions " ; or as other
toxines sometimes formed in the body, it appeai-s, give
rise to headaches, " malarial " sj'^mptoms and even
epileptiform convulsions, possibly, too, through the
action of micro-organisms.

While, on the one hand, then, there can be no
tubercle without the tubercle bacillus, so, on the other,
it seems probable there can be no tubercular consump-
tion without the previous excess of waste in the body
from imperfect respiration. The bacillus is a natural
organism ; the defective breathing and excess of waste
in the body constitute an unnatural condition, which
exists previous to, and seems to be the cause of, the
virulent action of the bacillus : if so, this abnormal
condition, rather than the bacillus, is the actual
exciting cause of consumption, an 1 in pi-eventive
action, demands first consideration. Moreover, were
these bacilli at once all annihilated, those persons pre-
disposed by such condition to harbor them, would not
probably remain long in any better state than if

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116

CONSUMI»TI()N :

|l'< ■'!■

It , 'I

subject to the depreciations of the bacilli ; other germs
would most likely soon invade the inviting field : a
point to be again touched upon.

CONCLUDING FACTS AND DEDUCTIONS,

What are the now generally recognized facts which
bear upon this subject ? They appear to be, briefly,
about as follows :

1. That the tubercle bacillus is an essential factor
in the production of tubercular pulmonary consump-
tion.

2. That the tubercle bacillus does not become a
cause in the production of the tuberculous state, except
in a special condition of the human body — in what is
termed a suitable soil.

3. That the tubercle bacillus, being ubiquitous, is
doubtless often received into the human body, and is
apparently sometimes retained there an indefinite time
and yet produces no ill eft'ects, because the body con-
dition — the so-termed soil — is not then suitable for its
virulent or pathogenic action.

4. That this apparently quiescent, non-virulent
state of the yet living bacillus cannot be satisfactorily
explained on the supposition of an immunity by rea-
son of phagocytic action, or bactericidal properties of
the blood serum ; nor especially can the later activity
and virulence of the bacillus, on the supposition of only
weakened phagocytes or want of the serum antidote.

5. That the virulence of pathogenic micro organ-
isms may be and is increased, and benign micro-

ITS NATUHE, CAISES AND IMIEVEXTION.

117

oi'j^aniama rendered pathofjenie, by certain special
circumstances of condition or environment ; or, in
oilier words, and more definitely, by bein^ brought in
contact with, or under the immediate infiuence of,
certain substances, perhaps in a measure toxic, in
either a living animal body or outside of it, as in cer-
tain decompositions of excremental matter in the case
of the bacillus coli communis.

G. That certain substances, such as ptomaines and
other toxic combinations, are formed in the human
body by the chemical or physiological changes or
decompositions which take place therein in accumula-
tions of used-up, dead, excrete matters; and doubtless
these ^ xic substances exert an influence on micro-
organisms, whether benign, saprophytic or pathogenic,
which are present in the body.

7. That a want of full proportional breathing sur-
face or action necessarily gives rise to accumulations
and excess in the fluids and tissues of the body, as
well as in the lungs, of used-up, effete products of the
functions of life, which, with full respiratory action,
would be thrown out.

8. That as oxygen appears to neutralize or destroy
the effects of ptomaines in the body, and probably
prevents their formation, the want of oxygen conse-
(|uent on a defective respiratory function, doubtless
favors the production of intoxicating ptomaines from
accumulations of the waste products of life.

9. That, therefore, persons with defective respira-
toiy action from any cause are more liable to have

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118

(!ONSUMI»TIO.V

> I

toxic HubHtaiices formed in the body ; and which pro-
bably inrtiienee the action of micro-organisms present
therein, inchiding tubercle bacilli.

10. That the acti(in of the bacillus, which results in
the formation of tubercle in the lungs, seems to hv
invariably associated with a want of full proportionate
breathing function in the individual afi'ected ; or, in
other wor«ls, the so-called soil for the pathogenic
action of this bacillus in the lungs seems to be invari-
ably furnished by persons with a defective breathing
function, as particularly evidenced by the success of
the " out-door " or " pure-air " treatment of the dis-
ease, with special lung expansion for increasing the
breathing function, almost universally recommended.

It has l)een my endeavor not to take a narrow view
of this (juestion, and I do not advance the theory that
I' <lefective respiratory function is the only cause of
consumption ; but in consideration of all the facts it is
a fair and reasonable inference that in persons witli
this function reduced below a certain relative or pro-
portionate healthy limit, there are eventually accunm-
lations in the body of waste, dead matters, the decom-
position of which, while probably providing inorganic
food elements for the tubercle bacillus, also at the
same time gives rise to a certain toxine, which, either
directly or through the tissues, so affects the bacillus
as to render it poisonous and destructive of even fairly
or practically healthy tissue.

The formation of tubercle in parts of the body other
than the lungs would readily arise in the same
manner, from the same cause ; the germ food elements

lafei a

ITS NATUllE, Ci^lISES AND PREVENTION.

119

aufl exciting toxine pervading the entire body. The
(liseaHe would be, liovvever, naturally less frequent in
other parts than in the lungs, the immediate seat of
the defective function and source of the exciting cause.

Have I not novv fairly demonstrated, on the
strongest circumstantial evidence, as intimated in my
pamphlet of thirteen years ago, that a defective
rt'spii-atory function with the consequent retention in
the body of waste or excrete substances and the toxic
compounds generated thereby, is the actual, immediate
or exciting cause of consumption ? It can hardly be
doubted that, imperfect breathing — defective respira-
tion—gives rise to excess of waste products in the
blood and tissues ; that the waste })roducts decompose
and give rise to toxines ; and that the toxines cause
general bodily depression — languor, even want of ap-
petite with dyspeptic symptoms, and, eventually, loss
of body weight, — the too familiar pretubercular state.
Thiy condition is brought about slowly in many cases,
more (piickly in others. What more fitting condition,
or soil, than this for the action of the microbes, or
so-called germs, so far as we now know the nature of
these ? What condition more likely to cause dor-
mant, non-virulent microbes, or saprophytes, to be-
come virulent — rapacious — parasitic, pathogenic ?

The other causes, yet to be discussed, for the most
pai't, but favor imperfect breathing.

I i;

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CHAPTEK V.

CAUSES OF CONSUMPTION CONTINUED.
HEREDITY AS A CAUSE.

(5ENERAL HEM AUKS.

The subject of heredity i.s one which ha.s been in
a large measure niiaunilerstood, or about wliicli tliere
has been much miscompreliension. Sonie lieredi-
tary influence l\a.s lony* or " always " been reg- "'UhI
as a cause of consumption. Take ahuost any Cc.. of
the disease in a man or woman in early or middh'
life, and ask a hundred neighbors the cause of it,
referring to that particular case, and nearly every
one of them will reply, in efl*ect, that it was inherited.
And it is undeniable that the disease is more com-
mon in certain families or strains than in others. As
already has been stated herein, however, less impor-
tance is now attached to heredity as a cause than was
formerly the case.

Previous to the discovery of the tubercle bacillus,
heredity was supposed to be limited to the so-called
predisposition or susceptibility — to some sort of
" idiosyncrasy " — a peculiarity of constitution or tem-
perament, to that condition now regarded as a fitting
soil for the growth of the bacillus. Even then, how-
ever, children of consumptive parents were said to

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ITS NATUIIE, CAUSKS ASU rM{EVE\TI<)\.

121

inherit the " Heeds of the disease " : yet this doubtless
without any specific or particular seeds, as now
known and understood, being generally c^ven sus-
jx'cted as a cause. Since Koch's discovery the (ques-
tion has been nnich discussed as to whether or not it
he possible or common I'or the bacillus or its spores to
i)e directly conununieated by the parent to the
ort'spring. Can the specific living germs, the so-
culled seeds of the disease, be inhei*ited ^

After giving some statistics reflating to heredity in
jri'iieral, we will consider the subject in its two
phases: first, tlu; influence of heredity, as it relates to
the transmission of the bacillus itself: and, second, as
it relates to the predisposition or idiosyncrasy.

STATISTICS HEAI{IX<J I I'ON HEKEDITV.

Statistics, for the most part, asides from reports
of actual events, as births, deaths, etc., are often falla-
cious and misleading, and but rarely interesting, or
only interesting to a small minority of persons. It
will be well, however, to give a few here in order to
illustrate in a general way the extent of hereditary
influence. Statistics })earing on this subject show on
an average that in about one-third of the persons
affected with consumption there is a possible chance
that it was in a measure inherited from parents.

Mays, in his work already referred to (Consump. a
Nervous Dis.), quotes interesting comparative statis-
tics fiom the report of the N. Y. Mutual Life Ins.
Co., for 1877, which show that, of 1,031 cases of con-
sumptives and an ©(pial number of non-consumptives,

122

CONSUMFriOX

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there were among the former 194, and among the
latter 102 family members who were tainted with
the disease. It may be observed in respect to these,
however, that if an equal number of other persons of
each class were selected, (juite different results might
possibly be deduced.

Williams (Pulmon. Consump.) mentions 1,000 con-
sumptive cases of the Brompton Hospital Report,
including only heredity from parents, which gave an
average of 24.4 per cent, in which there was heredi-
tary influence ; 385 cases by Doctor Fuller, em-
bracing also grandparents, uncles and aunts, which
gave 59 per cent.; 1,000 cases by Doctor Cotton,
embracing parents, brothers and sisters, which showed
36.7 per cent.; and 1,200 cases by Doctor Pollock,
similarly estimated, showing 30 per cent. Doctor
Williams' own cases, 1,000 in number, on the same
basis as the latter, gave a percentage of 48.4.

Squire, in his recent work, already quoted from
(Hyg. Prevent, of Consump.), makes the following
statements respecting cases of his own : " The figures
obtained in the ordinary manner probably give far too
high a proportion in favor of heredity. To take a
few illustrations from my hospital case-book : Out of
500 consumptive patients, one or both parents had
been consumptive iii 154 cases, showing possible
heredity in 30.8 per cent., and no phthisis in the par-
ents in 69.2 per cent. This gives a possible chance of
heredity in about one-third of the cases; and this
amongst hospital patients whose mode of life is
unfavorable and unhygienic. In 250 of these cases,

mil).

ITS NATURE, CAUSES AND PI{EVENT1()N.

123

ill which the family history is more fully stated, one
or both parents were consumptive in sixty-two cases,
or only 24.8 per cent. In these sixty-two families the
total number of children amounted to 374, of whom
108 became consumptive — again about one-third. Here
we are only dealing with families in which consump-
tion has shown again in the second generation, so the
proportion is higher than it should be : for if we could
include the families of consumptive parents where all
the children have escaped the disease, the numl)er of
individuals w^ould be increased whilst the nundoer of
consumptives would remain the same.

" In the above sixty-two cases, tlie father was con-
sumptive in twenty-eight cases, and these twenty-
eiirlit families Contained 185 children, of whom
forty-three became consumptive, or about one in four.
In twenty-four other cases the mother was consump-
tive, the total number of children was 152, of whom
forty-seven became consumptive, or nearly one in
three. In the remaining ten families both parents
were consumptive, the total number of children was
tliirty-seven, and of these eighteen, or nearly one-half,
became consumptive.

" This is a small number of cases on which to found
general deductions, but they seem to show that where
the mother is consumptive, the hereditary tendency
to the disease is slightly more intense than when the
father alone is phthisical. When both parents are
consumptive, not only is the number of children much
reduced, but the hereditary tendency is increased.
Against the theory of hereditary predisposition in

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124

CONSUMPTION :

these cases we have to remember the closer connection
of the mother with her family both in infancy anu
in sickness ; " — and a possible chance of infection, he
doubtless hints at.

Some statistics have sliown that nearly twice as
large a proportion of consumptives have tuberculous
brothers and sisters as have tuberculous parents.
This of course points to other causes — habits and
conditions of life and probably infection.

The following concluding quotation is from my own
pamphlet, published thirteen years ago, already referr-
ed to (Etiolog. Statis. Rep. on Causes of Consump.):
" It appears, therefore, that any special influence or
matter of a direct or specific hereditary character, as
a factor in the causation of consumption in adults, or
even in youths, is not of such constancy and impor-
tance as has been commonly supposed. In only little
more than one-half (53 per cent.) had any relatives
been known to have died of the disease ; and in not
much more than one-third (3G per cent.) had any
ancestors — parents or grandparents — died of it. More
than this in favor of heredity could doubtless be said
of scarlet fever and measles. But, in so far as con-
figuration and structure of the body and the relative
size and vigor of diflferent organs are influenced by
parentage, hereditary influence becomes an important
causative factor. Indeed, heredity probably has no
direct influence whatever at the periods of life above
mentioned other than in this way.

ITS NATURE. CAUSES AND PREVENTION.

125

HEREDITY AS RELATING TO THE TUBERCLE BACILLUS.

On this point of the subject there is still a differ-
ence of opinion. The greater weight of authority is
altogether on the side of those who believe that the
bacillus may be, but very rarely is, transmitted from
parent to child, and that the infant may come into the
world with the actual living germ already in its
tissues. There seems now to be the most convincing
evidence of this. As Ziemssen has said, tiie great
difficulty connected with the question lies in the "long
latency of taherculosis in childhood" — its long dor-
mant or concealed state. Baumgarten, it is said, has
in the case of the rabbit observed the bacillus within
the ovum ; and Jonne, of Dresden, in an unborn
(foetal) calf of seven months intra- uterine (in the
womb) growth, found numerous tubercles, showing
that if the ovum had not been infected, the bacillus
must have passed through the placenta (after-birth)
of the mother. Again, it appears that experiments of
inoculating healthy animals with juices of unborn
animals from tuberculous parents have been made
which favor the view that the bacillus or its spores
may pass from the mother to the unborn offspring.
Solles believes that direct hereditary tuberculosis
exists by means of the sporules passing in this way.
In 1891, Birsch-Hirschfeld reported the case of a
woman dying of acute general tuberculosis at the end
of the second month of pregnancy : careful examina-
tion revealed numerous tubercle bacilli in the after-
birth ; and portions of the liver, spleen and kidney of
the unborn offspring transplanted into the abdominal

nwT

126

CONSUMPTION :

'l':vi.

cavity of guinea-pigs and rabbits produced undoubted
tuberculosis. Baunigarten, in a more recent article,
supports tlie view of direct hereditary transmission,
and claims that the bacillus is present at birth in
many of the children born of tuberculous parents,
but that it is latent, and "its future history is depen-
dent in a great measure upon the favorable or
unfavorable condition of the soil offered by its host."
It may in time, he thinks, " lose its vitality ; " or, on
the contrary, under depressed conditions of the sys-
tem, " take on luxuriant growth." A conclusive case,
obsers ed by F. Lehmann, has been recently published
(Berl. Klin. Woch., July 9th, '94: Brit. Med. Jour.,
Dec. 1st, '94). A mother, aged 40, who had been
long phthisical, gave birth to a child, and died on
the third day thereafter. The lungs " showed old
tuberculous disease and miliary deposits." Tlie child
died twenty-four hours after birth. Its lungs,
bronchial, mesenteric and other lymphatic glands and
a kidney were tuberculous.

Birsch-Hirschfeld, and, later, Kockel and Lungwitz
are inclined to the view that the way in which the
bacilli pass from the mother to the foetus is by " grow-
ing through " the after-birth ; i.e., apparently, by the
gradual spread of the disease through it.

On the other hand, Davis, quoted on a previous
page (Consump. : How to Prevent, etc.), says, " From
the facts gathered, we must conclude that the
bacilli are not transmitted to offspring by tuberculous
fathers, and that, while it is possible for such trans-
niission to take place from tuberculous mothers, it

ITS NATURE, CAUSES AND PREVENTION.

127

occurs with the greatest rarity. The disease is
hereditary, because there is transmitted a predisposi-
tion to it, not the bacillus tuberculosis." Professor
Blackader (McGill, Montreal) says, " Pathologists
now tell us that heredity in this i'orni i.s the very rare
exception. In the vast majority of cases heredity in
tuberculosis signifies only an excessive hospitality for
the tubercular microbe, or a deficient capacity for
dealing with it on the part of a too feeble phago-
cyte. ... It may be said, that the view generally
lield is that cases of true heredity are extremely rare,
but that instances may occur, as where the mother
is suffering from general miliary infection or from
definite tuberculous disease of the genital system."
Epstein, in two hundred infants under one year of
age, of tuberculous parents, could not find, upon
examination, signs of tubercle in one. In respect
to animals, Osier (Practice of Med.) states that,
" although, in Berlin abattoirs for some years past,
13 per cent, of the animals slaughtered were tuber-
cular, out of 15,400 calves killed, only four were
found similarly diseased." Professor J. E. Graham
(Toronto University) asserts that the baby guinea-
pigs of tuberculous mothers are never found to be
affected ; and at a large maternity hospital in Paris
(Clin. d'Accouch.), post-mortem examinations were
made in all cases of death of premature or fully
developed children during a period of eight years,
and tuberculosis was never found ; nor had inocula-
tions mr«,de been successful.
It may then be stated that actual heredity in this

if? ^i

128

COXSUMPTION :

sense in pulmonary consumption, as ordinarily seen
in youths and adults, is practically not known. In
young infants tuberculosis is nearly always chiefly in
the glandular system or brain membranes, the lungs
being little or perhaps not at all attected. And
although the inherited bacilli or their spores nmy not
infrequently lie dormant or latent in the tis?"ies for a
long period of time, as some authorities believe, it is
not likely they would so lie for years and first mani-
fest virulency in children of even a few years of age.

HEREDITY AND THE BODY FACTOR OR SOIL.

As already intimated, that which is- inherited in this
disease is usually the constitutional build, or configur-
ation, or the tissue structure, wliich favors the develo])-
ment in the body of that which enables or incites the
bacillus to take part in the production of tubercle.
In other words, it is that which gives rise to the so-
called soil ; or prol)ably, sometimes, the suitable soil
itself — the deteriorated, or even foul, poisoned fluids
and tissues, and perhaps ^' feeble phagocyte " cells
and weakened germicidal properties in the blood. It
is natural for parents to transmit to the off^spring
peculiarities, even defects, of form and tissue condi-
tion, and even of the digestive organs, of the heart,
of the lungs, of the nervous system ; but it is
unnatural for them to hand down to their progeny
the actual living germs of disease. It would seem as
if nature, abhorring this, stopped short of it, or almost
stopped, and permitted it only in a few extreme cases.
It is chiefly because of the inheritability of peculi-
arities and defects of constitution which are in a

lift' ■'<

■wm

ITS NATURE, CAUSES AND PREVENTION.

129

measure favorable to tlie development of eonaumption
tjiat the disease has been lonj^ regarded as hereditary.
When heredity in this disease, or indeed in any other,
is spoken o", usually the reference is made to an
inherited tendency to it ; which may be very marked
or strong, or very slight.

There is a measure of heredity in many, if not all
di.seases. It is well known, for example, that a
tendency to insanity — a defective ])rain structure — is
inherited, and also, to heart disease ; or it may be
only a proportionately small heart that is transmitted,
which by reason of this defect the more readily
becomes diseased. Cancer is believed to V)e, in a
measure, hereditary. And some families are much
more disposed than are others to " take," and to have
in a more virulent and fatal form, even scarlet fever,
measles, and the like. It is because of the exceptional
frequency and fatality of consumption (fatality
usually from early neglect) that heredity in it attracts
more attention.

It is, however, certain that, as W. Roger Williams,
F.R.C.8., writes it (Brit. Med. Jour., Sept. 22, '94),
morbid conditions are never reproduced in the ofi-
spring with the same constancy that normal condi-
tions are. " All diseases tend to die out in trans-
mission." " So great is the preponderating influence
of the previous ancestral balance that even in families
where hereditary tendency to disease is strongest,
most of the members usually escape,"

The influence of heredity as bearing more especially
on this part of the subject is summed up from opinions
9

i ■ r '

»; ^jffi"

130

CONSUMPTION

of " leading biologists " by Doctor Geor^'o Wilson, in
his standard work on Hyj^iene, as follows (Handbook
of Hyif. London : J. Jt A. Churchill) : " The inHuomc
of both parents on the bodily constitution of the ufi'-
spring is manifested in personal resemblances, such as
stature, similarity of features, walk, gesture, color of
hair, etc. Some of the children may bear a greutiT
resemblance to the father, others to the mother: but
it is rare to meet with any instances in which sonic
distinctive characteristics of both parents cannot Ijo
traced. The influence of the other more immediatt;
progenitors on the bodily constitution of the ottspriii<f
is manifested by the resemblances which constitute
the phenomenon known as atavism, which may lio
explained in this way : — A man, for example, dcu-s
not inherit all the characteristics of either his father
or his mother, and of those which he does inherit,
only some are developed, whilst others remain latent,
and are probably developed in a brother or sister.
His son, however, may in turn inherit the same char-
acteristics, but with this difference, that those whicli
were latent in the father become fully developed in
him, so that he comes to bear a stronger resemblance
to a grandparent or some other relative, as an uncle
or aunt, than to Ids father or mother. — (A Physician's
Problems, by I) >ctor Elam.) The influence of race, or
special type, in heredity, is manifested by the con-
stancy of averages, under tolerably constant condi-
tions, from generation to generation. . . . Devia
tions from these averages or from the normal type,
although transmissible, cannot transcend certain lim-
its. As all forms of deterioration or disease may be

ITS XATUHE, CAUSES AND IMIEVENTION.

131

rejrariled as deviations, or yuTvorttMl life-processes,
they are likewise subject to limitation in transmission,
an<l there is the same tendency exiiibited to revert to
normal type under improved conditions. Thus,
all chronic diseases api)ear to be transmissible
either as a morbid tendency or in their general form,
such diseased heritage being well exemplified in the
case of gout, scrofida, phthisis, syphilis, and insanity ;
but by adopting suitable measures, the disease may be
finally eradicated from the family, or the morbid
tendency be overcome. . . . Any particular char-
acteristic, especially if it be of the nature of a
deterioration or taint, when common to both parents,
is liable to be intensified in the offspring. It is on
this account that marriages between blood-relations
are inadvisable, inasmuch as latent morbid tendencies,
should they form part of the organic patrimony of
the family [and only in such case], are almost certain
to become developed in the children."

In consumption, the most noticeable and commonly
inherited feature is the " flat chest," the proportion-
ately small chest. This is universally recognized.
With this defect, the lungs, and hence the respiratory
function, can hardly be otherwise than restricted and
not sufficiently developed for the needs of the organ-
ism. With it, unless it be corrected or modified,
too often eventually follow tlie usual consequences
already depicted. With it we usually find the other
signs already enumerated herein in connection with
the remarks on predisposition, — the slender body and
limbs, the delicate tinge, the want of general vigor :
sometimes the more intense, " scrofulous " condition — a

[s t

132

CONSUMPTION :

liii ''Mil

tendency to inflamed eyes, an irritable state of tlie
nostrils and npper lip, perhaps a swollen appearance
of the countenance and pasty skin, with slu|(f(isli,
indolent habits: all apparently manifesting a want in
the hody of oxygen with its invigorating, purifying
effects U|)on the tissues and fluids and life procosscs.
As already stated, what the precise nature of this
predisposition — this germ fertilizer or intoxicant — is
we do not yet know. Without attempting to enter
further into the subject here with a view of obtaining
a satisfactory explanation of it in the present state of
our knowledge, or rather want of knowledge, of the
remarkably intricate and delicate physiological and
chemical changes which take place, and the combina-
tions of matter formed, in all the various processes of
life constantly going on in the human organism, in
both health and disease, and the relations of these
changes and combinations to living micro-organisms,
whether benign or otherwise, in the body, the question
may be asked, — are the tissues and fluids of the newly-
born infant defective, or " debased," from a want of
completeness in structure — a want of some necessary
condition or element — or do they besides or along
with this contain something of a debasing character,
some practically foreign, toxic substance, incompatible
with perfect, healthy function ? The young creature
while yet in the mother's womb, is entirely nourished
through and by the blood of the motlier. If this
blood be debased by any impurity or poisonous sub-
stance whatever, the blood and tissues of the infant
when born will be, doubtless, debased in like manner.
As the blood and tissues of the mother are, so will be

ITS NATUHE, CAUSES AN!) I'KEVEXTinN.

133

the blood and tisHues of the infant at birth. This
affliction upon the innocent ort'spring seems hard;
yet tliere is no room to doubt that it may occur. And
this indicates the ^reat, serious, indeed criminal,
responsibility which may be placed upon imprudent
parents. Statistics given by Doctor Sijuire, recently
quoted, show that there were over thirty per cent, more
consumptives in the families when the mother was
consumptive than when the disease was only on the
father's side ; yet for many and obvious reasons the
father must be held at least ejjually responsible.

It is, withal, comfV^'ting to know that there is a
tendency in all defective living organisms to revert
— to turn or change back— to the normal, healthy
type, indeed, under improved or favorable conditions,
apparently a tendency to improvement and greater
perfection of type ; therefore, all evil hereditary con-
ditions and tendencies may be overcome and practi-
cally eradicated, and that, too, in a large measure in
a comparatively short period of time.

The principal evil in inherited predisposition to
consumption, that of a defective respiratory function,
with the usual accompanying conditions, may be, in the
less marked cases, often overcome entirely in a few
months. By means of proper special exercises in a
pure, cool, invigorating atmosphere, with abundance
of sunlight, the lungs and chest will gradu ''iy d,nd per-
manently expand, and the respiratory function become
more perfect, the muscles of the body and limbs increase
in size and firmness, the complexion improve, and the
weakly condition of the whole organism will give
place to more general vigor. In the worst so-called

ym'^

ll :

t i ■

134

COxXSUMPTION

scrofulous cases the improvement will not be so rapid
and marked, but by proper managjement, the process
of purification and invigoration will go on gradually
to the establishment of fair health and vigor. It need
hardly be stated that, on the other hand, inherited
tendencies to disease may be very easily and rapidly
intensified by unhygienic habits of life.

It nnist be remembered that this predisposing con-
dition, when not in any degree inherited, may be
ac(juired by unhygienic habits and surroundings. It
is acquired gradually, and may be originated in its
worst form in two or three generations. A few years
of one generation may be sufficient to largely reduce
the breathing capacity and bring on a train of other
evils. An acquired predisposition may be overcome
and removed more easily, or in a shorter period of
time than that which is inherited.

Any reader, then, who has had relatives die of con-
sumption, and feels, even in a measure, doomed to the
same sort of an end, may fairly regard the possession
of any possible hereditary taint in the light of simply
a timely warning to use reasonable precautions for
preventing the disease. With such precautions there
is practically no risk of such a life- ending for anyone.
It is only those who are indifferent or do not adopt
and continue to practise habits of a preventive charac-
ter who fall victims to consumption.

Yet it must not be concluded that one who inherits
the predisposition, however slight, should think
lightly of it ; it should not, however, be a source of
any measure of anxiety ; simply an incentive to the
exercise of due care of the body.

■"^V

CHAPTER VI.

CAUSES OF CONSUMPTION CONTINUED.

WANT OF THE NATURAL BODY

DEFENCES AS A CAUSE.

THE PROTECTIVE WALLS.'

The provisions for the protection of the body from
all forms of disease are remarkable. Not the least so
are the provisions for keeping out, of the body the
germs of infectious diseases.

The structure of the outer protective covering of the
body — the skin — is sufficiently well known to most
persons. Most persons, too, have observed reference to
" the skin without and the skin within," and know that
the irnier cavities of the body are provided with a
similar protective covering, or lining. Not only is the
digestive canal, from the lips throughout, so provided,
but so also is the pulmonary or air cavity. All the
bronchial tubes, great and small, and the air chambers,
as already stated, have the inner or more exposed air
surface of the mucous membrane lining their walls
covered over by a layer of cells, called epithelium,
similar to the cuticle — the skin's outer layer — except
that it varies somewhat in structure (as does this
layer in other localities) and is moist and soft instead
of dry and hard, as in the case of the skin.

U . y

136

CiJNSUMPTION

1* 'i

liim •', ^■■<'\
" '■ :■■(.'

Pi*-

I .^i-'

Now, it seems very unlikely tliat living, disease-
producing micro-organisms, infinitesimal as they are,
can get into the body through the skin if this be sound
— whole, healthy, vigorous and active at every point —
if it do not present even in its outer cuticular layer
any break, opening or weak spot. Hence, the neces-
sity for a break in its integrity in vaccination. The
"pores" of the skin having an action, a sort of current,
from within outward, would hardly take in living
germs ; and should these germs make an entrance, is
it probable that they would get through the sweat
glands Jive ? So, also, a perfectly healthy, vigorous
layer of epithelium on the skin within will almost
certainly prevent the passage or entrance of disease
germs into the body. It is believed there must be a
break, a want of continuity, in this protecting wall or
the germs cannot get through. A few authorities, it
is true, believe that germs may pass through appar-
ently healthy epithelium and tlie other parts of the
mucous membrane : as, for example, the tubercle
bacillus into the lung structure. On the other hand,
high authorities believe differently, and reasonable
probability is on this side. Respecting the germs of
diphtheria, W. H. Park, M.D., in an exhaustive paper,
a " Clinical and Bacteriological Study " of diphtheria
(New York Med. Rec, July 30th and Aug. 6th, '92),
says, Whether this (the diphtheria bacillus) " can be
implanted on the normal mucous membrane in man
is still a question. Undoubtedly a lesion favors it.
When the bacilli are implanted on the normal mucous
membranes of susceptible animals, they do not grow."
Doctor A. Jacobi, of New York, says (at N.Y. Acad, of

ITS NATURE, CAUSES AND I'REVEXTIUN.

137

Med.), " Very seldom does any form of contagion, not
even diphtheria, arise without there being previously
a broken skin or mucous membrane. . . . Tuber-
culosis of the intestinal tract almost always gives a
preceding history of neglected diarrhoea." He also
urges that by reason of the many sources of exposure
to the tubercle bacillus, more special attention should
be given, especially in the case of children, by both
parents and physicians, to catarrhal conditions of the
air passages and intestines, sore mouth, diarrhoeas, etc.
It is, therefore, easy to see the importance of keep-
ing these protective coverings of the body as intact
as possible — in a healthy, vigorous condition. Any
break or want of integrity, even a weak spot, espe-
cially in the epithelial covering of the bronchial tubes,
may open a way for the tubercle bacillus to enter. It
is very desirable, too, it may be here observed, to
keep the surface of these membranes as clean and
active as possible. In the case of the skin, for
example, as being more directly under the control
of the individual, if it be unclean from want of
repeated washing or bathing, disease germs may
adhere to it at some point. And here they may lurk,
as it were, waiting for an opportunity to effect an
entrance. A break in, or a weak or foul — unclean,
condition of, these protective walls may therefore be-
come a cause of consumption, in predisposed persons.

THE PHAGOCYTES AND BLOOD-SERUM ANTIDOTE.

When disease germs do get into the deeper tissue
structures of the body, whether through a weak spot
or break in an investing membrane, or otherwise, if

Hi EH!'

I '

138

CONSUMPTION

the body be in a fairly healthy condition, it is not
even then all free and unobstructed foraging for the
invaders. They are promptly met by a sort of stand-
ing army of blood cells, the peculiar protective cells
already mentioned in connection with the allusion to
the thistle point in the skin. Further, the very
atmosphere within, so to write, a germicidal condition
or property of the everywhere pervading blood-serum,
may depress and weaken the germs.

Four hundred years before our era, Hippocrates
apparently first drew special attention to a natural
protective and curative force within the human body,
upp\ ' ig to it the Greek term, j)hiisis, nature ; the vv^
raedicatrix natura of the Latin and later ages. Two
ii,nd a hf-H' centuries ago, the discerning Van Helmont
advanced the theory of a more definite power in the
body, which he personified as the "Archceus" or "Grand
Regulator," whose throne was the stomach ; Wepfer
designated a like power as the " President of the
nervous system " ; and the bold Stahl attributed such
an influence " directly and entirely to the rational
soul, diffused over the whole body." Only a few
years ago, Doctor Elias Metschnikoff* (Pasteur Inst.)
furnished before our wondering eyes, under the micro-
scope, satisfactory evidence that certain of the
colorless blood-cells, or corpuscles, which he termed
phagocytes, are special defenders of the body tis-
sues from the inroads of the destructive or specific
disease germs. Like other colorless cells, or leuco-
cytes, in the blood and other animal fluids, these
phagocytes are microscopic, jelly-like masses, either

ITS NATURE, CAUSES AND PREVENTION. 139

globular or irregular in form, indeed often changing
their form (amoeboid — polymorphous), without an
investing membrane, and capable of motion.

In that little animal, the water-flea, may be wit-
nessed actual combats between the phagocytes and
pathogenic germs inoculated into the animal. The
phagocj'tes at once attack and devour the intruders,
— take them into their jelly-like body and digest
them. When a germ is too much for a single cell or
phagocyte, others unite — coalesce — with it, and form
a larger or " giant cell," which then struggles more
successfully with the invader. If the phagocytes
overcome the germs, the water-flea lives ; if not, the
^erms soon multiply, overrun the little creature and
it dies. In the liver and intestines of birds that have
died from tuberculosis, the microscope reveals, within
little masses of tubercle, a cluster of minute tubercle
bacilli occupying the centre of a giant cell : as, indeed,
in the formation and structure of tubercle, as already
explained. Doctor J. Bland Sutton compares the action
of this cellular army of defence in the body to that of
a hive of bees : " When an intruder is small it is
quickly stung to death and cast out; when large,
after being killed, it is prevented from giving further
trouble [as from decomposition] by a covering of
wax." Around large foreign substances, tuberculous
or other, in the body, the phagocytes often form a
dense fibrinous covering or wall which protects the
body from further injury by its presence : as men-
tioned in the discussion on the nature of consumption
and the conditions of tubercle as sometimes found in
the lungs.

MimHtlti^'

140

CONSUMPTION

• Most authorities now accept the theory of Metsch-
iiikofF, although some are of opinion that the actual
germicidal or germ-killing power is in the blood, or
blood-serum (the watery part of the blood); which
when in a healthy condition, they hold, destroys the
vitality of the disease germs, while the phagocyte
cells act as scavengei's and remove, destroy or cast
out the disabled invaders, as other leucocyte cells
remove other useless or waste excrete matters. The
truth probably lies in a measure between these two
views. Healthy, " undefiled " blood is, doubtless,
unfavorable to the life of disease germs. The experi-
ments of distinguished investigators have made this
apparently clear. We know, however, that through-
out nature some forms of bacterial germs are actually
destructive of other forms, and it is fair to conclude
that the higher organized bodies contain within them-
selves special living structures or cells capable of
destroying foreign ones which may gain access into
the body. Doctor Adami, of Montreal (Discuss.
Internat. Cong, of Hyg., Lon., 1891), says that those
who are not in the thick of the controversy (as to
the two theories) " must accept both views." It was,
he said, " especially around the phenomena observed
in the rat " that the difference of opinion had arisen.
In the rat, phagocytic action " could be but with diffi-
culty observed, and the rat's blood-serum possessed
bacteria-killing properties in a high degree ; " and " if
we directed our observations aright, it would be
impossible not to be struck by the prevalence of
phagocytosis." The British Medical Journal (March
26th, '92), in an editorial, says, " There is not the

ITS NATURE, CAUSES AND PREVENTION.

141

slightest difficulty in proving, as Metschnikoft" lias
done abundantly, that the auKieboid cells of higher
animals actually pursue, attack and engulf living
bacteria, which they proceed to kill and to digest."

Perhaps the most i)ractical, and not the least inter-
esting, part of this subject of natural protection from
the action of the pathogenic microbes is in the fact
that, in certain conditions of the body, effectual pro-
tection is not afJbrded. The efficiency of the phago-
cytes appears then to be wanting, and the germs are
more likely to gain the victory — to over-run and
destroy the life of the organism. This has been shown
by experiments on the lower animals. Mice under the
influence of chloral, for example, are the more liable
to " take " infections and succumb to disease germs.
Guinea-pigs and rabbits dire'ct from the grassy fields
remain healthy after inoculation with virulent germs,
while those confined for a time in cages succumb.
The want of respiratory expansion from exercise in
the open air, with the less pure air of the cages and
less natural conditions generally, while providing
bacterial nutriment and stimulation, probably depress
the phagocytes and neutralize the antidotal properties
of the blood-serum.

We have already seen, in the explanation of the
conditions of the lungs in consumption, that the pro-
tective forces of the invaded body continue to be exer-
cised, to fight, even to the death. The defensive war
is pushed on as long as the life of the invaded lasts.
Apparently the defensive forces continue to do their
best in the contest in various ways, and without cessa-
tion, to the end.

J F' f J.- ■ , W

CHAPTER VII.

'cii

■■■r

CAUSES OF CONSUMPTION CONTINUED.

REMOTE OR SECONDARY CAUSES FROM

HABITS AND CONDITIONS OF LIFE.

A LARGE number and variety of causes or conditions
help, in a small or (greater degree, to give rise to
a predisposition to consumption. These appear to
produce their effects mainly by a reduction of the
respiratory function. They may .be enumerated as
follows : Impure air, from any insanitary condition,
but more especiallj'^ prebreathed air, from want of
ventilation, or overcrowding in enclosed places ; want
of sunlight ; improper diet, as unsuitable or excess of
food ; certain occupations, causing dust, stooping, etc.;
overwork, mental or physical ; deficient exercise, or
idleness ; mental depression ; worry : improper cloth-
ing; intemperance in the use of spirituous liquors
and, especially, of tobacco ; incontinence ; any habitual
excess ; want of good digestion and assimilation of
food, leading to imperfect nutrition of the body;
neglected or inactive skin, kidneys and bowels; a
humid atmosphere from undrained, damp soil, or a
damp house; the effects of certain diseases or dis-
eased conditions, especially those affecting the air
passages and lungs ; a neglected "cold on the lungs".

ITS NATURE, CAUSKb AND rilEVENTlON.

143

UED.
3M

iitious
:ise to
•ear to
of the
.ted as
dition.
ant of
want
cess of
ig, etc.;
cise, or
clotli-
liqiiors
abitual
tion of
body ;
;vels; a
il, or a
or dis-
he air
lungs";

exliaustive discharges ; rickets, diabetes and syphilis ;
and, in brief, anything that depresses tlie bodily
vigor ; or diminishes the breathing : or vice versa.
Many of these causes need oidy be mentioned here,
while it will be well to further explain others of them.
In considering the subject of prevention, they will
then, too, receive further consideration.

IMPURE, PREBUEATHEl) AIR.

Of all the secondary causes of consumption, as inti-
mated on previous occasions, from its direct association
with one of the two essential causes, a want of
oxygen, from the breathing of impure, prebreathed,
deoxygenated air, is the most common and important.
That eminent physician. Sir James Clark, M.I)., F.R.S.,
etc., wrote as follows (Cyclop, of Pract. Med.): "A
sensible writer on scrofulous diseases considers impure
air as the only real cause of scrofula : other causes
may assist, but this he considers essential to the pro-
duction of the disease. ' Personal experience,' says
Baudelocque [whom Sir James here (juotes] ' read-
ing, reflection on a great nundjer of facts, and tlie
analysis of many observations, have impressed me
with the deep conviction that there exists one princi-
I)al cause of scrofulous diseases, a cause which pre-
dominates over all others, and without which, nerhaps,
the disease would never, or, at least, ' . ;■ rarely
develop itself. This cause consists in particular con-
ditions of the atmosphere in which the individual
I'esides. However ill-chosen or unsubstantial his foo«l
may be, however nmch cleanliness may be neglected,

144

COXSUMITION :

Vfl)! .'"

wliatcv cr hv i\w. nature of his clotliiii^ and its adap-
tion to tlio temperature, whatever the climate in whieli
lie lives, the exercise he tak(»s, or th(^ duration of his
sleep or wakincj^, if the house in which he dwells he
placed in a situation to which the fresh air and the
sun's rays have free and «lirect access, and ^he house
itself he sufficiently airy, lijj^ht and well p ^ jrtione*!
to the number of its inmates, scrofulous disease will
never make its appearance. On the contrary, how-
ever well chosen or nutritious the food, however
minute the attention paid to cleanliness, with what-
ever care the clothino; 1k» adapted to the tempeiature,
or the duration of exercise, sleep and waking he rejjju-
lated, if the houses are so placed that the sun's rays
cannot reach thtjui, or the fresh air be renew^ed with-
out difficulty ; if, in short, they are small, low, dark
and badly aired, sci'ofulous disease will evitahly
su})ervene (Memo, sur les Scrof., Rev. ^ Vol. [).'
Though we are fully satisfied of the pow^erful influ-
ence of impure air in the production of scrofula, we
cainiot entirely coincide with M. Baudelocque. The
disease not infre(|uently affects the inhabitants of ele-
vated and dry countries, wdiere the atmosphere is pure
and the people are occupied in grazing sheep and cattle,
and are hence so much in the open air during the day
that the confined atmosphere of their ill -ventilated
hovels can scarcely be considered the chief cause of
the scrofulous diseases by which they are so often
afflicted. . . . But there can be no doubt that the
habitual respiration of the air of ill- ventilated and
gloomy alleys in large towns, as w^ell as that of many

ITS NATIIIK, CArSKS AND IMIKVENTIOX.

145

iiiHiiut'actonos, workhouses aiul even schools, is a
|)()\vcrt'ul means of auj^nientinj^ hereditary disposition
to HcroFuhi, and even oi' inducinj^ it, de noiut!'

It may )>e observed in res{)eet to tliis, that those
persons (!n«^a((ed in the (piiet occupation of ^razin|^
sheep and cattK% alluded to by Sir James Clark, take
little active lun^-expanding exercise, and the function
of respiration is but imperfectly performed. This,
toj^ether with their " ill-ventilated liovels," deprives
their body of the necessary supply of oxygen, and
the soil for the bacillus is eventually produced. They
may breathe " a very pure air " during the day-time,
yet so little of it as to produce an effect similar to that
of breathitig the foul air. Baudelocque further says,
that a prolonged stay in a foul atmosphere is not
always necessary to give rise lo scrofula ; but that
often a few hours each day is sufficient, as in sleeping
ill a confined room in which the air is not frequently
changed or renewetl. Doctor Squire, in his late work,
reports the case of a y(nuig man, seventeen years
of age, in his (Doctor Squire's) hospital ward (N. Lon-
don, for consumptives), who though belonging to a
consumptive family, was himself " well-grown, and
always strong and healthy up to the age of sixteen.
He then went into service as a footman in Edinburgh,
and shared with another servant a small attic bed-
room, with no fire-place and only a small window
which was rarely opened. After a few months in this
place he developed consumption." The following,
(juoting my own words (Phys. and Hygiene for
Schools), is well accredited : Large numbers of the
10

146

CONSUMPTION

pupils at a school in Norwood, England, some years
ago fell victims to consumption, and on investigation
it was decided that insufficient ventilation and tlie
consequent atmospheric impunity was the cause.
Many years ago, consumption was very prevalent
among the British soldiers. A sanitary commission,
consisting of men of the highest standing, after
investigation, declared that this \\'as caused by over-
crowding and deficient ventilation : — in other words,
by rebreathing breathed air. When this cause was
removed, — more space in barracks and better ventila-
tion provided — the number of cases of this disease
inaterially diminished.

Amongst well-to-do pei"sons as well as the poor wlio
often cainiot well help it, there is nmch household
overcrowding and consetjuent habitual breathing of
foul air. In bedrooms especially, on every hand, in
high-class houses, we daily witness the effects of
breathing over and over again the same air. The
rooms are made as air-tight as possible, and no means
are provided for a change of air. Morning languor
and want of vigor in persons, young and old, who
otherwise would be healthy and strong, are as con)-
mon as the morning awaking, and foul blood and
scrofula are soon or later the individual consequences.

Domesticated animals crowded together in stables,
and wild animals confined in cages, we may again
note, usually die of consumption. And again, the
more dense the population, the higher the death-rate
from this disease.

Many other facts are upon record which prove that

IliB

ITS NATURE, CAUSES AND PREVENTION.

147

the breathing of prebreathed air is a most important
factor in developing a condition favorable to con-
sumption. And it is easy to comprehend this when
we consider the highly poisonous nature of, and the
lack of oxygan in, air which has been once breathed.
Air polluted by various other impurities — dust, foul
gfises, "malaria" and dampness, when breathed, is
well known to produce depressing and other marked
injurious effects upon the human body ; and by most
pei-sons is shunned much more than prebreathed air.

Mi_i

WANT OF SUNLIGHT A CAUSE.

Absence of sunlight is usually associated with
impure air. Air almost anywhere deprived of sun-
light for even a few days becomes impure. It is
fairly well known that there cannot be good health
without abundance of full sunlight, yet many persons
cut it off largely from their dwellings and rooms.
The marked difference between' plants growing in
shaded places and those freely exposed to the sun,
and the paleness and frequent deformities amongst
persons who dwell in dark alleys, " basements " and
mines are w^ell known. A. N. Bell, A.M., M.D., records
the following (Climat. and Min. Waters of U.S. New
York : Wm. Wood & Co.) : Two kittens, one weighing
18 oz. and the other 18i oz. were selected. The
lighter one wtis placed in a well-lighted box and the
lieavier one in a like box but darkened. Both were
fed and cared for alike in every other respect. In
five daj'^s the lighter kitten weighed 22^ oz, and the
other kitten only 20f oz. At the end of the second

148

CONSUMPTION

five days, the former weighed 24 oz. and the latter
Hcarcely 22. Both were then placed in the lighted
box and in five days more each weighed almost 25 oz.
It has been observed that there is more sickness on
the more shady side of streets, and that patients pro-
gress better in the more sunny rooms of hospitals.

Besides its invigorating and purifying effects upon
the entire body, sunlight is directly destructive of
tubercle bacilli, as already stated : largely, probably,
by its great desiccating power. It hf? ' sen suggested
as " an all-sufficient germicide." A wa,.it of sunlight is
therefore at once both favorable to the predisposition,
and to the preservation of the seed.

■ i!

THE NEGLECTED " COLD : WEATHER AND CLIMATE.

A neglected or long-continued " cold on the lungs "
is commonly regarded as, and is, a frequent harbinger
of — an actual provider of a lodging for, consumption.
It gives rise to a congested or an inflamed condition
of the air chamber walls (the alveolar catarrh or
alveolitis of Powell), and thus interferes much with
the respiratory function ; while doubtless it often, at
the same time, causes a break or abrasion in the pro-
tective membranous wall, and so opens a way for the
tubercle bacillus to get into the deeper structure,
where, if there are favorable conditions for it, it may
take root and propagate.

It should be noted here, however, and remembered,
that while the so-called " cold " is in this case the less
remote cause of a predisposition, we may profitably

|i;i(:

ITS XATURE, OAT'SES AND PREVEXTIOX.

149

look back and ask, what is the cause of the cold ?
Not, usually, in the main, is it anything beyond our
control — not so much the weather, nor the climate,
but far more the controllable habits and conditions of
life ; probably breathing an overbreathed atmosphere,
often in an overheated room, with improper clothing,
inattention to the protective outer wall — the skin,
and perhaps overeating. In many cases I have been
able to induce patients, simply by means of a habit of
daily cool bathing adapted to the constitution of the
individual, a cooler atmosphere in living rooms, and
proper clothing and food, to entirely overcome, in a
few ^months' oime, the tendency to " take cold"; a
subject that will be further discussed.

Climate and weather, which give rise to conditions
beyond man's control, are often blamed for causing
colds and consumption when, as just intimated, the
actual cause is, practically, more associated with man's
self-governable habits. The powers of adaptation
and accommodation possessed by mankind in general
are .such that, if we except marshy and malarial and
(lamp or misty districts, hardly any condition of
climate is incompatible with good health, after accli-
matization, in the average, or at least with a large
proportion, of the race. One's natural climate, the
one in which one is born, if not of a particularly
objectionable sort, is usually best adapted for liealth ;
l»ut one can usuall}^ with the practical application of
hygienic knowledge, soon become acclimated to any
country. There is not satisfactory evidence that

W
1

150

CONSUMFTION

there is any considerable number of people, any lar^e
community, in any climate, entirely free from con-
sumption. And, as stated by Douglas Powell in
his late work already (juoted from, consumption " is
essentially a scourge to what we call civilization. Its
rarity amongst nomadic tribes and savage populations
in all climates ; its prevalence in littoral districts, in
river sites, and in industrial as compared with agri-
cultural localities in townships and cities — all point
to social rather than climatic influences as predom-
inant in the cultivation of the disease." Nor can any
climate be regarded as causing consumption. To be
sure, in some localities, as those dry and sunny, the pre-
disposition can be more readily overcome or prevented
than in others.

THE SOIL AND DWELLING-HOUSE.

Dampness of Soil is a subject which may be
more practically and profitably considered, inasmucli
as the dampness may be often remedied or removed
by drainage and cultivation. Many years ago, at about
the same time, the late Doctor (Sir George) Buchanan,
in Great Britain, and Doctor Bowditch, in Massachu-
setts, proved by statistical facts that consumption is
more prevalent amongst a population living on heavy,
impermeable, and hence damp soils, as in low -lying
or high, undrained areas, than on a lighter, more
porous soil susceptible to natural drainage. ' There is
evidence indicating that a barren, sandy soil is inimi-
cal to the life of the tubercle bacillus. Middleton has
shown that the more impure condHion of the damp

ITS NATURE, CAUSES AND PREVENTION.

151

air, usually, is a causative factor. Atmospheric
moisture, when not too cold, doubtless favors bacterial
growth and probably the preservation of virulency
in the tubercle bacillus ; while usually bronchial dis-
turbances are more common in the damper, colder
localities, especially in persons not well acclimated or
not vigorous. In this way the relationship between
damp soils and consumption may be largely explained.
Moreover, the skin is less active, and probably the
respiratory function is less complete, as in respect to
the exhalation of poisonous moisture from the lungs,
for example, in a damp atmosphere. The diminished
prevalence of the disease after drainage of the soil has
been also conclusively shown.

The Dwelling-house as practically an important
factor in the development of consumption is worthy
of notice. In both locality and construction it may
become a remote predisposing cause ; and infected,
too, and so favor the spread of the disease. Doctor
Thorne Thorne (St. Barthol. Hosp. Rep.) sums up
the " conditions of the dwelling-house tending to
the promotion of tubercular consumption," as follows :

1. A soil either (a) naturally damp and cold ; or
(/>) subject to the influence of the rise and fall of a
subsoil water lying within a few feet of the surface.

2. A dwelling-house of which either the foundations,
the area they enclose, or the walls are, by reason of
faulty construction or otherwise, liable to dampness.

3. Such immediate surroundings of the dwelling-
house as tend to prevent the free movement of air
about it and its ample exposure to the influence of

162

CONSUMPTT'.)N

V .

^ 1

sunlight. 4. Such structural defects as would pre-
vent the maintenance within all parts of the dwellinjr-
house of ample movement of air by day and by night,
and free exposure of its habitual rooms to daylight."
Besides the depressing influence of living under cir-
cumstances favoring dampness,, lack of ventilation and
want of exposure to air and sun, such residence is
followed. Doctor Thorne adds, bj^ " bodily lassitude,
which in turn often brings about loss of functional
activity in cer^.ain portions of the lungs — a state whicli
is most grave when battle has to be done with an
extraneous living organism, seeking to obtain and
maintain a habitat th ein." The dust in dwelling-
houses, as well as in shops, offices, etc., is often a source
of lung irritation. Dust is made up of particles of
almost all sorts of substances, organic and inorganic,
and is inconceivably complex in its composition : — of
particles from insec^w and domestic animals, as well
as from the human body, and may, and indeed not
infrecjuently does, contain infections. Much care
should be exercised in keeping dwellings as free from
dust as possible. Furtaer on, evidence will be given
showing that houses may become infected, and then
retain the infection and communicate it to other per-
sons. The following case (Brit. Med. Jour., April 8th,
'93) may be given here as particularly instructive:
" A family of nine persons moved into a house in
Paris inhabited ten years before by two consump-
tives. A short time after, although the whole fam-
ily had always previously been in excellent health,
three among them showed symptoms of tuberculosis.

ITS NATURE, CAinsES AND PREVENTION. 153

They used the same bedroom as the former consump-
tives. Doctor Ducor had pieces of the wall paper and
dust from the ceiling and walls examined, and in both
tubercle bacilli were found."

Workshops, factories, and other enwalled places, as
well as dwellings, may obviously, in like manner,
become causative factors of this disease. '

THE DIETARY: COOKERY.

An improper diet has always held >'' high place in
the list of predisposing causes of consumption. In
respect to it, here, and to bad cookery, I prefer to
again quote Sir James Clark, and also Sir B. W.
Richardson. Among the causes of consumption, Sir
James Clark writes, an " Imper act supply of food
holds a conspicuous place. But we have rarely an
opportunity of seeing the effects of this alone," he
adds, " because when the means 'of procuring proper
nourishment are wanting, there are generally other
causes of the disease in actioh at the same time ; such
as residence in ill-ventilated and dark apartments,
exposure to cold from imperfect clothing, etc., the
whole of which are often coAibined, and hence more
speedily effect the deteriorat'on of the health. Food
in excess, or of a kind too exciting for the digestive
organs, may also induce tubercular cachexia, a cir-
cumstance which is not sufficiently attended to — we
may say not generally understood — even by medical
men ; neverthtless, we hold this to be a frequent
cause of scrofula, and believe that it produces the
same effects on the system as a deficient supply ; the

154

CONSUMrnON

.(■■■•r

■"^^

imperfect digestion and assimilation in the one case
and the inadequate nourishment in the other being
equally injiiriouH ; the form and general characterH
which the disease assumes may differ, but the ulti-
mate result will be the same in both cases. The
adaptation of food, both in quality and quantity, to
the age of the individual, as well as to the powers
of the digestive organs, is too little considered ; and
the evil consetjuences of this neglect are often evident
in the children of the wealthy classes of society, who
are frecjuently allowed an unrestricted use of the
most exciting kinds of animal food."

Bad dietary and bad cookery. Sir B. W. Richardson
remarks (Preventive Med.), " are active causes of dis-
ease in, perhaps, all classes of the community, but
especially amongst the poorer class. ... In cases
where the food is fairly good in (juality as it first
comes to hand, it is so destroyed by the various pro-
cesses of cooking and preparation that half the pro-
portions of it, as digestible, wholesome and sustain-
ing nourishment, are sacrificed. . . . The digestive
system is first injuriously influenced by errors in
dietary ; Imt many other of the vital systsms, includ-
ing specially the circulatory, the nervous, the glandu-
lar, the muscular and the membranous, are injured by
these errors in respect to the supply of food for the
sustenance of the body." Hence, in such circumstances
the body is often not suflliciently nourished, and
general debility follows, with, most likely, lassitude
and imperfect breathing.

^li

iiiitiiii'

ITS NATURE, CAUSES AND PREVENTION. 155

OCCUPATION, TOHACCO, ETC.

Certain dusty and otlier occupations favor a pre-
disposition to consumption. Those which tend in any
way or degree to interfere with a full respiratory
function, — such as give rise to more than the usual
amount of dust in the atmosphere breathed, or in
which certain body positions, more or less necessary,
cramp the chest or limit the full and free expansion of
the lungs, are especially so. Dust is more lung irrita-
ting than it is connnonly supposed to be. In a large
number of manufacturing industries, as of pottery,
cutlery, flour, woollen goods and many others, the dust
produces an irritating effect upon the delicate lung
membrane, which, when continued, interferes greatly
with the respiratory function. Those occupations, too,
in which it is necessary to work where there is not
abundance of sunlight, as in dark rooms and mines ;
and in which the temperature of the air is kept too
high, or above about 60*^ or 65® F.; also, except in the
most vigorous constitutioned persons, such as cause
exposure to inclement weather, or to sudden changes
in it, to irregular habits, broken sleep, confinement in-
doors, etc., favor the predisposition ; and, therefore,
should be avoided by all who are not of full vigorous
constitution.

The use of tobacco, as a remote cause of consump-
tion, is deserving of special notice before concluding
this part of the subject. It is in no way or degree an
essential of life or health to anyone, nor is it ever
contended that it is, but, on the contrary, is an un-

! i i

156

CONSUMPTION :

natural, accjiiired liabit, adopted, it appears, in imita-
tion of an uncivilized people. Whatever may be th»'
soothing effects or germicidal properties of this most
powerfully noxious, depressing weed, and however
many persons may live to advanced age in spite of its
long use, it cannot fail, however moderately used, to
depress, in a proportionate measure, the vit^l functions
and powers. Then, in support of such a natural
theoretical conclusion, we have the recent experiments
of Professor Harley in testing the influence of tobacco
smoking on muscular work, and his declaration, based
thereon, that it " highly diminishes muscular power
and hastens the onset of fatigue." Since the above
(of this paragraph) was written, strong evidence of
the irritating eftects of tobacco in causing tubercle of
the tonsils has been published (M. Tussau, Lyon Med.).
Of the other remote causes of this disease, above
enumerated, it is not difficult for anyone to under-
stand that they indirectly depress, in a certain measure,
the vital powers of the body and so debilitate the
system ; it may be in a measure entirely inappreci-
able for a time, or unknown to, or unrecognized by,
the individual, yet still they debilitate and depress.
Amongst the poor, for example, in their struggles for
existence, and sometimes amongst the well-to-do in
their struggles for wealth, excessive labor prostrates
the vital powers. So, with idleness or inactivity, like
effects are produced, like results follow. TVere is
then with such depression, besides other functional
defects, almost always a tendency to stoop, with con-
sequent lung compression and diminished respiration.

CHAPTEE VIII.

CAUSES OF CONSUMPTION CONTINUED.

THE INFECTIOUSNESS AND COMMUNI-

CABILITY OF THE DISEASE.

■■^

GENERAL REMARKS ON INFECTION.

Some physicians of the highest standing and much
experience still question the infectiousness or "con-
tagiousness of consumption. It would appear as if
this, in a measure, may arise from the very indefinite,
unsettled general application to diseases of these two
terms, infection and contagion.

What an infectious disease is, precisely, or where
the dividing or distinguishing line is between one that
is infectious and one that is not, has never been, in
practice, clearly or satisfactorily explained. Still
more unsatisfactory has been the use of the term con-
tagion. The two terms, too, are commonly used
almost or quite synonymously ; while their practical
application varies somewhat in different countries. It
would be well if some authoritative organization
would fix upon a form of application of them which
could be brought into general use in medicine. The
wide difference between the derivation of the words
— one, infection, from a word signifying, in the orig-
inal, to dye, stain or corrupt ; and the other, to touch

r^-

158

CONSUMJTION

! I

['ii **''

1^1 "'

Hiii^£

(contaction, toucliinf^) — together with the facts that
some H()-calIe«l iufcctiouH diseasoH are of a much more
infectious nature than otliers — more liable to be com-
municated from the sick to the healthy — and that some
diseases regarded as both infectious and contagious
may arise by means other than direct conuimnication
from infected to non-infected persons, make tlie sub-
ject a complex one. The term connnunicable has
therefore come into more gen(;i'al use in this connec-
tion during recent years. Without entering into a
lengthy discussion of the general subject of infection,
a few remarks here on some points of it may be of
practical use.

All infectious diseases have as an associated and
essential factor a specific germ, in each disease of a
kind peculiar to itself. Almost all of them, too, possi-
bly the so-called malarial diseases, are connnunicable
from a person aftected to one not affected ; they are
" taking," and by means of the specific germs, in one
way or another. Some, as hydrophobia and scabies,
are taken only by actual contact ; others, on near
approach to them — atmospheric ; and yet others,
apparently only by means of some solid vehicle, as
food, clothing, etc., or of water.

As to the infectiousness, contagiousness and coin-
municability of small-pox, scarlet fever and measles, for
example, there is no question. Nearly everybody not
protected by a previous attack, on cl< se eA£*usure to
these diseases, becomes infected kcs then? The

exact nature of their respective > eific infec. ms or
germs is not yet known ; but it il|»|»eal•-^ evident that

ITS NATURE, CAUSES AND PKEVENTlON.

159

ll"'

the geririH are given off, and very abundantly, from
tlie surface of the body througli the skin, vvhiK' tlioy
are probably much more minute than tliose of tlie less
iiifectiouH di.seaseH, and so tlie easier get within the
body. If we eouM see them, wt; should perhaps
observe myriads of tlu^m in the air around about and
near to a case of either disease — somewhat, perhaps,
as we see the myriads of spore-carrying particles fly
off from the puff-ball fungus when it is touched, with
which everybody is familiar. Then these germs, like
many ill weeds, take root and* grow in almost any soil :
almost everybody provides, at one time or another,
a suitable soil. These are clear, well-known types of
infectious, or contagious, connnunicable diseases.

On the other hand, good authorities long questioned,
and it appears that a few still (juestion, the infectious-
ness or communicability of typhoid (or enteric) fever.
Especially is this the case in regard to its communica-
bility by means of the medium of air, as distinct from
that of water or milk. It is with this disease as it is
with consumption : comparatively few persons who
are simply exposed to it, take it in the ordinary vvay,
or as in the case of scarlet fever, etc. Both diseases hold
a place intermediate between the more characteristic
infectious diseases and malarial diseases. In both, the
germs are contained, for the most part if not entirely,
in the excreta from the bowels and lungs, respectively :
and although given off abundantly in this way, pro-
bably not in numbers nearly approximating the
numbers given off from the skin in the other diseases
above named, — just as some plants in ordinary vege ta-

il i8

160

coNsuMrrioN

^k-i

Mi
1!5

tioii yi»»M niany more himmIh tluin do v/ther ])lHntH.
'V\\i',y aiv, too, in a condition in wliicli thoy cannot
nearly so rcatiily fly alumt in thc^ atnioHphcrc around
tlu» ptTHons inl'(H5t(Ml. A^ain, tliey are apparently
more tejuler schmIh and will oidy ^rovv in .sp 'ial soils —
" rich" soils, it may he supposed, as already intimated:
as a rule, prohahly only in I'oul conditions of tlie
intestines and lun^s, res|)ectively. As stated on a
pr»»vious pa^e, too, it may he here noted, some hijjjli
authorities helieve, and on ^ood evidence, that typhoid
Fever does not always arise l)y infection, as we coni-
moidy understand this term, hut that it sometinu^s
arises anew, de novo, from f;jcrms which had lost
their virulency hy exposure to air, li^ht, etc., and
which are made ajjfain virulent hy insanitiiry con-
ditions; or, as some helieve, from the transformation
of the heni^n hacillus coli comnumis into the virulent
hacillus typhosus. Similar, it appears to be, with
consumptio!!. Attain, in respect to diphtheria : we
have already v>Kserved Trouessart's belief, that a child
contracting^ a simple (indamed) sore throat, the pro-
duct, or discharge, from which excites into virulent
action diphtheritic micrcK'occi, which up to this time
had remained inert in the mouth, and a form of
diphtheria is proiluced (tbe micix)cocoi being possibly
the early fonn, and the bacilli the adult form, of one
species of micro-organism). Physicians generally, it
appears, believe that this disease may not infrequently
arise in this way, or by means of inert or dormant
germs from some source other than a present case of
the disease — practically de novo. Hence, they habitu-
ally recommend parents to exercise watchfulness cind

"W'^l'"?

ITS NATURE, CAUSES AND IMIEVENTION.

161

lunts.
iDiiot
ound
entiy
)ilH —
latcil:
f the
on a

rphoid
! cuni-
I'tinu'-s
(I lost
;., and
V con-
niatiou
irulent
), with
a: we
a child
lie pro-
iiruleiit
s time
)riu f 1'

care in caseH of Hiinpl(3 Horcj thro.';t in tlujir children.
We would not Hay that ca.se.s arisinj^ in this way had
heen cauH(Ml l>y, or had ari.sen by nMians of, infection
from another person. Some outV)r(;akH of typhus fever
can only be <;xplained in a sonniwhat similar manner.
(Jood authorities look U])on intensity of population or
overcrowdinj^ in a dwellinj^, or a collection of dwell-
ings, as practically the excitinj^ cause of this disease.
The CKsential j^erm or seed is always a factor in the
causation or origin, and j)revious to the outbreak it
had been jj^rowin^ or lui'kinjjf sonn.'where in a non-
virulent state until <'xcited oi* intoxicated into patho-
jjenic action by the foul products of the overcrowding.
(Jonsumptiim, too, as already noted, we must bear in
mind, is analo<(ous to typhus in this respect, and
becomes the UKjre prevalent in jjroportion to increase
or density of population in a ^iven or limited space,
even to tenfold, it is recorded ; as, for example, in a
city's slunjs.

Regarding the infectiousness of consuniption, D(x;tor
H. Douglas Puweil, who does not believe the disease
is infectious " in the ordinary circumstances of life,"
wri*:es as follows (^tiol. of Phth.: J)is. of the Lungs):
" We can practically say, with many of the zymotic
diseases, e.(f., enteric fever, cholera, scarlet fever, that
we have health on the one hand and a specific organism
on the other, and that thi^: latter invades and destroys
Hie first. We can rarely, 'fever, say this of tubercle."
Now, it is (piite possible that this apparently wide
difference between " tubercle "- consumption, and the

oilier diseases named by Doctor Powell is in a large
U

162

CONSUMl^TION

i'i

hi 'I

ii |:f iTiil

measure in the degree — the pert'eetness or otherwise,
of what he terms the " liealth " of the exposed person.
According to Doctor Alfred Carpenter, as we liave
already observed, a person in perfect health — that is,
with all the various organs in full harmonious action,
and hence the body fluids and tissues free from any
excess of used-up, eflfete or excrete waste matter — will
not take, or will not manifest symptoms of, any infec-
tious disease — will not harbor the infection long
enough. Such person provides no soil for what Doctor
Carpenter evidently regards as saprophytic micro-
organisms. It is possible to imagine, perhaps hardly
to attain, such a degree of personal health as would
resist all disease germs. A short step was made, how-
ever, in this direction a century or two ago (even
thousands of years ago, it appears, by Eastern peoples)
when direct inoculation with small-pox virus was
practised on persons previously prepared for it by a
course of hygienic treatment. As already intimated,
with a sufficiently complete system and course of
hygienic preparation of the individual to be inoculated,
possibly the small-pox infection, instead of being only
modified or simplified in its action after such inocula-
tion, might, if not from highly virulent sources, entirely
fail to grow in the purified body from want of natural
imtriment, or be resisted altogether by the natural
forces of the thus prepared individual. So it is pos-
sible that it is only apparent and not absolute healtli
" on the one hand," as Doctor Powell words it, " which
the organism invades and destroys." In other words,
a much greater falling-otf from the health standard of

ll;,..:',^H

ITS NATURE, CAUSES AND PREVENTION.

163

Wise,
rHon.
liavo
at is,
ction,
[I any
—will
infec-

lonK
)octor

nicro-
liarcUy
would
», how-
(even
fcoples)
as was
it by a
Linate<l,
rse of
ulated,
ig only
Inocula-
ntirely
natural
Inatural
is pos-
health
' which
words,
dard of

the individual host seems to be necessary for the action
of th(5 tub- rcle bacillus than for the infectious germs
of otlier diseases.

There are probably very few persons so healthy
and vi'vorous as not to succumb to the effects of inhal-
ing enormous numbers of active virulent tubercle
bacilli ; as in certain experiments by Tapi)ioner with
dogs in a room the air of which was charged with
the bacilli ; to be noticed further on. The germs
would reach the lungs in such numbers that possibly
the phagocyte cells and blood-serum antidote could
not successfully resist them (Orth), Or, what may
be still more likely, germs may sometimes — in certain
conditions and circumstances of environment, as in
certain foul-conditioned human bodies, in a highly
" scrofulous " person iv the case of tubercle bacilli —
l)ecome so virulent, so irritating, so poisonous, that,
when at once conveyed into the body of another and
fairly healthy person, oa any person, they quickly
poii in and destroy tlie life of such an amount of
invaded tissue elements or substance as to provide
themselves — their phagocytic, perhaps now patho-
genic, appetite — with dead matter, and so possibly, if
not most vigorously opposed, be enabled to go on with
their destructive w( V.

It can only be said, then, that the infectiousness of
a disease, or the degree of it, or the frec^uency of its
communicability to others, is largely a question of
(t) the number of active specific germs given off
from the body of the infected person, (6) the degree
of virulency, or of poisonous character, of these germs

, I

IHi!

i'iiiiii

i! liiWiaii-

164

CONSUMPTION :

— as from their source, — ami (c) the body coiKlitioii,
or soil, presented f )r tlie root-takiiif^ or growth of tlic
germs by the non-iafected exposed persons.

HISTOIIY OF THE INFECTION THEORY.

From the period of the earliest records in tlie
liistory of medicine, it appears tliat tlie infectious
nature of consumption — the possibility of it being
canununicated from the consumptive to others — has
been believed in by physicians of the highest repute.
Over two thousand years ago (400 B.C.), in the time
of Father Hippocrates, physicians believed in it.
Aristotle (330 B.C.) wrote that the Greeks in his
day believed in it : and he asks why eonsumpticm,
sore eyes and itch are conunon to persons who asso-
ciate with others suffering from these aliections.
Later (A.I). 180), Galen wrote that it is dangerous
to pass the whole day with a consu^nptive person.
Coming down to much more recent periods, Morton,
over two hundred years ago, wrote of consumption that
•' a contagious principle often propagates this disease,
for, as I have often found by experience, an affected
person may poison a bed-fellow by a kind of miasma
like that of a malignant fever." Riverius, about the
same time, believed contagion to be the " chiefest "
cause of consumption. " We may observe women to
be affected by their husbands," he wrote, *' and men
by their wives, and all the children to die of 'he
same, not only from infection of their parents' setd,
but from the company of liim that was first infected."
The eminent Italian, Valsalva, in the early part of

ITS NATUilE, OAUSES AND PUKVENTIOX.

165

hist century, was hiiiiself prodisposed to consumption,
and avoided bein^ present at dissections ol' the hnigs
of persons who liad died of the disease. V^ilsalva's
illustrious pupil, Morgagni, declared that he made
hut few post-mortem examinations of pei'sons who
had died of this disease for f(»ar of contracting it. A
law once existed in Italy by which the proprietor of a
house in which a consumptive had died could claim
payment for his furniture, which was burnt ; and it
was difficult for a consumptive to obtain lod<(ings.

Over a century ago, a reaction connnenced to show
itself. Eventually, in northern Euro})e and America
especially, doubt respecting the infection theory
developed into general disbelief. In the warmer lati-
tudes, however, this was not the case, and at length
there was a change again in the more northern coun-
tries; and with the results of the investigations of
the last few decades, disbelief and doubt have for the
most part disappeared. In 1805, Villemin inserted
mirmte particles of tubercular matter from man and
from the cow under the skin of rabbits, and after
about fifteen days found tubercles in the lungs and
other parts of these animals. In 1807, Doctor Wm.
Budd (Lancet, Oct. 12,) took strong ground in favor
of the infection theory. He concluded that tuber-
culosis is a true zymotic disease of speciHc nature, in
the same sense as typhoid, typhus, and scarlet fevers.
The evidences of this he finds in, — (n) Considerations
based on the pathology, consisting in the evolution
and multiplication in the organism of a specitic, mor-
bid matter. (/>) Actual instances in which there is

Ififi

COl^srMI'TloN :

It f

' : i

evideneo to show eoininiinieiitiotj from one to another
((') Tlie ^eognipliical distrilnition of phthisiH, and
eHpecially its fatality in coinitries vvliich were entirely
free from it wlien first discovered by Europeans.
{d) Its f^reater prevalence in low levels and crowded
communititis, and entire absence, except by importa-
tion, at hi^h levels, (c) Its hi^h rate of prevalence
in convents, barracks, penitentiaries, etc.

IIISTOUICAL EVIDENCE OF INFECTION.

Wlien the South Sea Islands were first discovered,
Doctor Budd says, there v^as no consumption amongst
tiiem : but since they h -ve come in contact with
Europeans, the disease has . ecome so wide-spread as to
threaten their extermination. The late Doctor Rush,
of Philadelphia, who made accurate inquiries, satisfied
himself that there was no consumption amongst tlie
American Indians when America was discovered.
Now it is very common and fatal amongst them. In
Africa, everywhere along the seaboard, says Doctor
Clapp, where the blacks have come into intimate rela-
tions with the whites, there has been a large mortality
from the disease, but in the interior, where there has
been contact with only a few travellers, it has not
been ftmnd. Of this fact. Doctor Livingstone and
other African travellers, it is said, have given Doctor
Budd positive assurance.

It must be remembered, however, that certain
obvious habits of civilized life, introduced amongst the
natives of these countries, have doubtless contributed
largely to the development and spread of the disease

Vi . ■■

ITS^NATURE, CAUSKS AND IMIEVENTIOX. 107

ti,si<le from tlits infoctioUH ^erinH, and licnce cauHed it
to appear more actively infectious than it really is.

In a pamphlet (Con taf(. of Phthis., 1888) by Law-
rence F. Flick, M.D., of Philadelphia, Pa., the author
Hays, •' Those portions of our country which were
s«'ttled by the Spaniards, namely, California, Arizona,
New Mexico, Texas, Florida and Colorado, were
almost absolutely free from consumption until they
became the Sanataria of consumptives from the north
and north-east. Intelligent natives of these countries
will toll you that, prior to the mingling of the
English-speaking people amongst them, the disease
did not occur in their country. In fact, it was the
gerierally acknowledged freedom of these places from
the disease that gave them their reputation as resorts
for the phthisical. . . . The whole Pacific coast,
as well as Florida and Colorado, is accjuiring a doubt- *
ful reputation for consumption. A look at the map
of the United States Census Report for 1880, in
which the topography of phthisis throughout the
United States is indicated, will be apt to shake the
confidence of the searcher after a climate for the cure
of consumption, so far as these countries are con-
cerned, at least. The islands of Bermuda and Madeira
probably underwent the same experience. Both, at
one time, enjoyed the reputation of being ideal
climates for consumptives. They have both lost that
reputation because the disease became too prevalent
there. The history of Madeira is especially interest-
ing. The natives of that island so feared consump-
tion that ' no pecuniary consideration *rhatever would

168

CONSUMPTION :

.'! /»X

tsff

induce them to aceoiiunodiite plitlnHical patients,
wrote Doctor Jolm Gordon, in J 784. And well thev
might fear it, for, after yearg of introduction by the
English, the disease became endemic in the island.
Doctor William (iourlay wrote, in 1811, 'that the
disease of phthisis pulmonalis was an en<lemic in the
island, and that its fatality was prodigious among
the inhabitants.' There is reason to believe that the
Jewish people were free from the disease whilst they
dwelt in the Promised Land. The disease is referred
to in the Old Testament as a disease of Egypt, and is
spoken of as a visitation or plague."

STATISTICAL EVIDENCE OF INFECTION.

In Germany the sick in the hospitals are largely
attended by members of religious sisterhoods, and
these sisters are conseijuently much exposed to the
infection of consumption. "Taking thirty-eight of
these nursing corporations. Cornet found that, during
the last twenty-tive years, of their total mortality,
62.8 per cent., or almost two-thirds, was recorded as
being from tuberculosis ; while of those members of
the corporations dying between the ages of twenty-
tive and thirty-tive, no less than 73 per cent, had
succumbed to this disease."

In his translation of Ziemssen's work on Tubercu-
losis, already quoted from, Doctor Doherty gives, in
an Appendix, reports for the years 1887-88, from
thirteen prisons in the United States in which the
average mortality from consumption had been over
50 per cent, of the total mortality ; more than half

ITS NATURE, CAUSES AND IMtEVENTION.

169

the deaths of the prisoners heiii<»; from this disease.
In the Clinton Prison, N.Y., the mortality was ()6
per cent.: in that of Joliette, III, and the Eastern, of
Pennsylvania, over 77 per cent.

Evidence of the infectiousness of consumption was
broujrht out a few yeai's a^o by Doctor Flick, above
cited. He localized all the deaths occurring from the
disease in one of the wards of that city for a preced-
ing period of twenty-tive years,and showed that nearly
one-third of the houses in that ward had been infected
by previous cases of the disease. In many of these
houses the deaths from it had been numerous, and of
the total number of them in the ward during the
year 1888, more than one-half occurred in the infected
houses although there were more than twice as many
non-infected as infected houses in the war<l, Tlie
infected houses, it should be noted, were, doubtless, in
other insanitary conditions, probably damj) and not
well lighted.

In 1883, a committee was appointed by the British
Medical Association to make collective investigations
respecting the infectiousness of consumption. The
committee sent out circulars to members of the pro-
fession in England asking for reports of facts bearing
upon the subject. Over one thousand answers were
received, in about three-fourths of which the evidence
was negative, while about one-fourth related to
special cases in which the disease was believed to
have been communicated by infection, the majority of
them between husband an- wife.

170

CONSUMPTION :

HISTORV OF INDIVIDUAL INSTANCES AND CASES,

Instances of tlie importation of consumption into
villages in France previously free from it have been
collected by Doctor Allison (Arch, de Med., Sept.,
1885). Respecting these I take the liberty to quote
Doctor Squire's remarks : " Individual members of
healthy families, living in villages where consump-
tion is quite unknown at the time under observation,
visit other localities and stay with phthisical persons.
They become themselves consumptive, and on their
return home other persons in the village, who are on
terms of intimacy, or who live quite close to them,
also become affected. In other cases a phthisical
patient from elsewhere comes to live with healthy
persons in a village previously free from phthisis, and
those with whom he lives become consumptive.
Allison concluded from his observations that phthisis,
intr Juced into previously healthy districts by an
affected person, spreads to those in close contact with
the individual, and having attacked the susceptible,
disappears in that locality until reimported."

The following case, from this series of observations,
is given by Doctor Squire as an example : " A man
aged forty-five years, living in a village in which no
deaths from phthisis had occurred during the pre-
vious ten years, was accustomed every year to visit,
for a week, his brother-in-law who lived at another
village 150 kilometers from his own home, and who
had consumption (pulmonary tuberculosis). In 1880,
the subject of this observation had pleurisy, and on

iiii

ITS NATURE, TAUSES AND PIIEVEXTJON.

171

IiIh return IVoiii liis viHit next year to his brother-in-
law, \vit!i whom he sh'pt, he hiniHelf l)eeaiiie aHected
with plitliisis, and died in 1884. He infected two
other persons in his native viUaj^c " who lived near
him (Hyjr. Prev. of Consump, Lond.: C. (Iriffin & Co.).

An instanc(^ was reported a few years aj^o (Brit.
Med. Jour.) of an apparently infected office in Paris in
which thirteen of the clerks had died of consumption
in four years. Infection was attributed to the prac-
tice which prevailed in the office of spitting on the
floor. A most remarkable instance of house infection
is j^iven by Engelmatni, who relates the history of a
dwelling which for eight years after its erection
remained free from tuberculosis. Then two of the
inmates died of that disease after some months' illness.
From that time onward for the period of twelve years
the dwelling was inhabited by a number of diti'erent
families in succession, and was scarcely at any time
free from consumptive patients. Thirteen fatal cases
occurred in the twelve years. A startling account of
an epidemic of tuberculosis was given at the Paris
Congress of 1890. Of thirty-five workmen in a
certain factory, twenty-seven suffered from tubercu-
losis ; four had the disease previous to admission, and
twenty-three became affected in the factory. The
period of incubation was two months (Prof. J. E.
Graham, M.D., add. Can. Med. Assoc, meet., '92).

Many individual instances of cases ai"e upon record
in which it appears altogether probable, indeed seems
hardly open to doubt, that the diseasf -/as communi-
cated by infection. Want of space prevents the

L -ft

pi'

1^^^

172

(JONSUMITloX :

IS.

■I

(l(3tailH of iiwmy of those bcin^ j^iven herein, but tlic
brief history of a few cjises, as an example, will be
instructive. The following synopsis is from a notable
collection of similar cases by Herbert C. Clapp, A.M.,
M.D., of Boston (Is ('onsump. Conta<?. ^ Boston : Otis
Clapp & Son, 1881): "Twenty-five cases" aw
described which, as the author says, " make mention
of sixty-six persons who became consumptive prob-
ably through contagion." They were collected from
different authorities, the names of which are given in
Doctor Clapp's book.

At Haynin, in Belgium, a woman died of tubercular
consumption of the third stage, having slept with her
husband to the last. The latter, of an originally
sound constitution, and belonging to a family in
which consumption had never been known, took for
a second wife a woman of an equally strong constitu-
tion and of healthy parents. After eighteen months
of wedlock he yielded to pulmonary consumption.
The second wife continued to sleep with him until
his death. A short time after this she married again,
and two years after the second marriage, died of con-
sumption. Her second husband, perfectly robust, and
belonging to a family which had never known an
instance of consumption in it, yielded to this affection
sometime after the death of his wife.

J. had seen his mother, two brothers and a sister
die of pulmonary consumption, and had himself,
on two occasions, haemorrhages from the lungs when
twenty and twenty-one years old. He became a
sailor, married at the age of twenty-seven, and had

ni a

fec'tb

until

anil

thir(

ance

and

The

i!iiaiifei

ITS NATUHE, CAUSES AM) IMlEVENTloN.

173

in all four wives : Fii-st, a woman Iwlonginjj to a per-
fectly healthy family, who enjoyed excellent health
until her third pregnancy, when .she bej^an to couj^h
and grow thin. She died of consumption after her
third continement. The second wife had every apjiear-
ance of health, but at the end of a yc&v began to cough
and spit blood, and soon died of "(piick consumption."
The third wife belonged to an exceptionally healthy
family, consisting of a father, mother, four brothers
and two sistei-s, all living and in good liealth. Seven
weeks after her second confinement she showed
extensive disease in the upper part of the lungs and
(lied shortly after of tubercular consinnj)tioii. The
fourth wife, twenty-three years old, had not a sign of
consumption in her family, and was in the enjo^'ment
of perfect health. Thirteen months later — three
months after her first continement — she began to
cough, and died nine months after. TUe autopsy
showed tubercular lesions in both lungs, intestines,
spleen and liver.

The history of J. is instructive. At two different
times — in 1854 and 1857 — during the illness of his
fourth wife, Doctor Herman Webber, who reported
the cases, had occasion to examine iiim. His general
liealth he (J.) said was excellent. He did not cough,
but expectorated in the mornings (upper part of left
thorax flattened, and less resonant). He continued
to do active duty cls a sailor until 18(59, when he was
forced to keep his bed for some months on account of
a severe fracture ; he then began to cough, consump-
tion developed, and caused his death in 1871.

M-

174

(;()N.suMrri()N :

■'*''. TO

• 'i,

'l§ '■

Mr. H., of a conHUinptiv(! liriouj^t;, inarricMl a. MIhk
H., of a roniarka}>ly hoaltliy family, ijoUmI for loii-
g(!vity. H. continuod to j^radually ^row vvorHC, an<j
<li(Ml at tli<3 oxpiration of «;i^hteon iiioiithH. His wife;
was his coMHtarit companion and nurHo, and Home
three nionUiH hefon; his deatli the premonitary syni])-
tojriH of pythi.siH inanifeHted tlieniHcdves m her, and
some twelve montliH after his death she die<l. One
c!hild was horn of the marriajre, which lived ahout
one year, and died of tubercular meningitis. Mrs. H.
was elo.sely nursed by a sin^^le sister, who, some time;
prior to the d(;ath of Mrs. H. gave unmistakable
evidence of commencitig tuberculosis, and diinl some
twelve months after. The singh; sister was nui^sed
by a younger brotlier, and he only survived liis last
sist(!r's death a fiiw months, dying of the sauM! disease.
The remainder of Mrs. H.'s family HvcmI at a distance,
were seldom at her house during the sickness of any
of those above recorded, and not one of them has
over had any disease of this class. The fath(!r and
mother were living an«l in good health, aged between
eighty and ninety years.

t^ws?.^-^-

EXPEIU.MENTAL KVIDE.NCE OK INFECTION.

TappeiiuT dried and pulverized expectorated matter
from the lungs of consumptive persons and sprayed
tlu^ powder in the atmosphere of a room in which
dogs were contine<l. Dogs tire not very susceptibh;
to tuberculosis, yet in this way they contracted the
disease. Bertheau made like experiments with like
results. It is stated that when Tappeiner was per-

«m|PWH

ITS NATURE, CAUSES AND I'UEVEXTION.

175

foi'iniii^ his (3xperiinentH, a robust servaDt, «f(ofl forty,
lauf^ljod at tlio i(l(!a that couHUinption could be; corn-
iinniicat(Ml in that way, arnl in Hpitc; of all warning
\V(;nt into the inhalinj^ room, breathed the inf<;ction
and died in fourteen w<;ekH of coriHuniption.

(iiVioux put raV>bitH in a elo.se oa^e, and intnxluced
into the cage air jxpired by (if,., the lireath of)
coiiHUinptive persons. In thr(M; months the rabbits
showed marked synijjtoms oi' tuberculosis, and tuber-
cles were found iti many parts of the body — mostly
tin; lungs. Another cage of rabbits he supplied with
the same sort of an atmosphere, exce-pt that he first
filtered the ))reath«^d air through tow charged with
•arlx>lic acid. No signs of tuberculosis in these
animals followed.

The well-known spr(;a*l of tulx-rculosis amongst
the lower animals — in heivls of cows and fl<M;ks of
poultry — and the (!vid(;nc(! to be given in another
chapter r(jHi)ecting the probable intercommunicar»ility
of the disease Ix^twiMjii mankind and the lo\v«'r
animals, afford a<lditional testimony of th<; inf«*(;tious
nature of this disease.

CFRf UMSTANCES MODIFVFXf; THE ABOVE EV/DENV'E.

Then; are modifying circumstunc<'s bearing upon
iimch of the above-mentioned evidence of infecti<jn in
this disease; which it is desirabh; to notice and Ix'ar
in mind; this e'jpecially as I'dating to tlu; <h'gi-e«; of
infectivity or compai'ative fre(|uencv of spread in
this way. For example, in referencj; to the inmates
(»f convents : the bacillus could not infect, were not

176

C()NSUMI»TI()N

i.1;i

I II

the body condition of tin utuiateH spocially favorabli'.
As Zieinssen words it, " t ■>■ privation of fresh air and
the complete lack of bodily exercises which compel
deep ins])irati<>MS are the chief causes of the disease:"
— they are in<l«'i d th»' more important, the exciting,
and the more pr'\«ntable cau>»'H. There are, too,
many other depressinj;, and hence causative, circum-
stances in connection with the sedentary life of such
persons, so obvious that they need not be mentioned,
which help to swell the phthisis mortality amongst
them. Air,ongfst pupils in the lar^e schools and the
imnates of orphanagjes, the moi'tality is higher than
the average of that of the general population, but not
so high as that of persons in convents a.id prisons.
Why ? Because, chieHv, the confinement in the for-
mer cases is not so close, and the younger jieopio
do not remain so long in such places, as in the laC"'-
It is especially noteworthy, too, that the mortality
amongst the inmates of convents and prisons is pro-
portionately greatest, as would naturally be expected,
in those who have been longest in confinement.

Again, criminals, as a rule, both from constitutional
structure and habits of life, are the more likely to
have a predisposition to consumption.

Persons nursing others sufi'ering from this disease,
as a wife a husband, are exposed to other causes of it
as well as to the infection : — the stooping, lung-confin-
ing position often required, the confinement, want of
rest and often of sleep. The close devotion, too, of a
wife or a sister to the nursing of one near and dear,
makes the position a much more trying and exposed
one than in the case of an ordinary nurse.

ITS NATUllE, CAUSES AXD PREVENTION.

177

Finally, re.spticting (iilx)ux's experiments: Had
Giboux cauHed tlie rabbits to breathe only the already
breathed air fjoni persons not consumptive, the result
might have been the same. The toxic effects on the
animals of the usual poisons in expired air might
have caused the distuise in the rabbits, if in any other
way tubercle bacilli, possibly dormant non-virulent
ones, could have gained access into the lungs of the
animals, rendered strongly predisposed — with tissues
providing the exciting cause — from inhaling simply
the foul prebreathed air.

KVIDENCE OIMMJSED TO THE INFECTION THEORY.

Positive evidence against the theory that consump-
tion is sometimes connnunicated by infection is in the
very nature of things difficui't or impossible to obtain.
Kvidence against it nmst ever be, therefore, rather of
ii neutral charactei".

The evidences which is most commonly given in
opposition to the theory is that of statistics of the
Hrompton Hospital for Consumptives, in London.
These extend over a period of more than a third of a
century, and certainly give n ) evidence of infection.
AiiKjng the twenty-nine resident physicians and
assistant physicians of the institution during that
period, there was but one case of consumption, and
the siibject of it was tubercuhms before entering the
hospital. Of one hundred and fifty clinical assistants,
eight died of consumption, but only one of these eight
was free from the disease at the commencement of
the clinical duty. Of one hundred and one nurses,
13

JL ^

1 1

1^ I .

ft " 1

",i;

.:i 1!1

178

CONSUMPTION

only one was consumptive. The variously appointed
servants were alike exempt from the disease. More
recent statistics from the Friedrichshain Hospital,
Berlin, give a like record.

It is very well known that physicians and their
assistants, and even nurses, but rarely take any infec-
tious disease when attending cases of it, even scarlet
fever and diphtheria. They are usually in such a
body condition as not to provide a soil for the germs.
Less frequently do they take typhoid fever and
Asiatic cholera. A few well-auchenticated cases in
which, for example, a healthy, vigorous woman with
a family histoiy free from predisposition to the
disease becomes consumptive a few months after
attendance on a consumptive husband, and dies from
the same cause, tell more in favor of infection as a
cause than any collection of statistics can against
it. Moreover, the fact that many wives nurse con-
sumptive husbands and do not become consumptive
thereafter does not tell very much against the infec-
tion theory. We explain this by supposing that such
wives so live as not to give rise to a strong enough
predisposition, urtd that the infection — the bacillus —
in these cases may be less virulent; as it is well
known that some bacilli are much more virulent than
others, and will " take root " and act as disease germs
in circumstances in which other bacilli will not.

Austin Flint, in relation to 670 cases uf his own
collecting, bearing upon the comuninicability of the
disease between husband and wife, says, "In my
collection of cases . . . five are all that I find in

ITS NATURE, CAUSES AXD PREVENTIOX.

179

which there is room for suspicion" of the (^sease
having been so communicated. And '* it nmsf,, there-
fore, be concluded that the analysis of my cases does
not furnish facts sufficient to render the communica-
bility of phthisis probable " This simply means that
it may be infectious, but Doctor Flint's cases furnish
no positive evidence of it. Mays (before cited) does
not give any statistics of his own but quotes those of
others, and gives other evidence which in his opinion
bear against the infection theory, in which he himself
does not believe.

Sir Benjamin War<l Richardson, M.]3., LL.D., F.R.S.,
editor of the Asclepiad, London, in that classic health
periodical of April, '94, stiites that, aHhough he had
determined in the early part of his professional career,
aliout half a century ago, to " watch intently, without
bias, and persistently," for evi«lence of infection in
plithisis, and in all his experience, thousands of cases
of the disease having come before him (for the most
part dispensary patients), he had not found " i\ single
particle of evidence" that "sustained the contagion
theory," or, strange to relate, " gave on reliable data
the least color to it." Sir Benjamin continues:
"Phthisis pulmonalis will diisappear just as broad
sanitary views are established and brought into
practice. . . . Under the new conditions, with
provision for a better heredity, in which cleanliness
becomes the watchward, in which youths enjoy free
exercise in the open air, and labor in confined places is
reduced to a proper standard, the disease would die
out altogether. ... It is quite practical to take care

180

CONSUMin'ION

that the expectorated secretion of consumptives is
destroyed. . . . But this is merely a matter of clean-
liness, ... of perfect hygiene."

'! 'i"

t:V

A DEGREE OF INFECTIOUSNESS FAIKLY ESTABLISHED.

With all the v^eight of circumstantial evidence —
historical, statistical, and clinical or individual — which
we have in favor of the infectious nature or occasional
communicability of consumption, together with the
fact that the tubercle bacillus, which seems clearly to
be, and is almost universally recognized as, an essentinl
specific cause of the disease and as being present in
all cases of it ; that inoculations of pure cultures of
this bacillus or of tubercular matter will produce the
disease in animals ; and that the disease has been
frequently produced in human beings by the acci-
dental inoculation of such matter in various ways, as
in post-mortem investigations, injury from broken
spittoons, etc. (Heron : Evidence of Com. of Phth.),
it seems difficult to understand how anyone can
doubt that the disease is in a measure infectious —
that it may be, and sometimes is, communicated by
infection, as commoidy urnlerstood by this term, — by
active, virulent germs being conveyed directly from
an infect<3d to a non-infected but susceptible person.
To admit that the bacillus is an essential cause of the
disease, and that the disease nuiy be caused by inocu-
lation of it into the body of a susceptible person, is
surely eijuivalentto admitting that the disease is com-
municable in certain circumstances, and thereiori'
]M*aotically infi^ctious.

'ypw^

ITS NATURE, CAUSES AND PREVENTION.

181

What is the difference, let us here inquire, between
infection and inoculation ? In the latter process the
virus, or infection, is conveyed to the unaffected
person (usually) purposely by a special instrument,
and by it is pushed throu<;h tho cuticle into the fluids
(blood or lymph) of the true skin ; in the former, the
infection is conveyed in an acci<lental manner by air,
food, etc., to the mucous membrane lining the inner
cavities, and, as it were, finds its own way, or is
pushed by some means, probably, through a break in
tlie soft epithelium, or inner cuticle, into the fluids of
fliis membrane. In the case of the more infectious
diseases, the infecting particles are probably the more
iiitiiiitely small, and hence the more easily get through
a l)reak in the wall, or through a minuter one, and so
tlie more surely and frequently infect.

Doctor Herman Weber has said, now Bome years
ago (1885, Croonian Lectures, Lon., Sect. 1), " We
know that it [the tubercle bacillus] thrives in the
bodies of most warm-blooded animals when inocu-
lated; but this does not prove that it will find a
nidus [nest or soil] in healtlr; tissue when merely
brought into contact with it by siUTounding air."
Certainly it does not. But as ah'oady has been inti-
mated, this term " healthy " — whole, clean — practi-
cally defines th(5 difference between persons who
" take " the disease — become dir<>etly infected by it —
and persons who do not ; and a want of health, or
wholeness, the difference between infection and inocu-
lation. With a break in the wall and unclean tissues,
one becomes inoculated and infected.

ht-r

i< "

182

CONSUMPTION

We may ask how many strictly healthy persons in
this sense are there — with absolutely clean, pure
tissues and fluids, whole and sound, with all the various
bodily organs working in complete harmony, who do
not provide intoxicating nutriment for the micro-
organisms, or are able to resist their virulent action !*
How many persons among the masses of the people are
absolutely " healthy " on sucli a standard ? Very few.
Yet is it an unreasonable, impractical standard ? It
is not an impossible one. Hence it is one that may
be fairly aimed at for both individuals and commun-
ities. On the whole, doubtless, a good many persons
are in the enjoyment of such a condition. Why should
not many more, or all, enjoy it eventually ^ True, it
is a standard not attainable and retainable without
care and effort. But it is really worth more than the
care and effort which would be usually required.

In the present condition of the masses, with the
much unhygienic housing, clothing and dieting, and
with the consequent prevalence of catarrhal conditions,
" colds," etc., a large proportion of the people doubtless
present in the walls of their minutest bronchial tubes,
defects or breaks — " nmcous abrasions, upon which
the bacillus can settle," using Doctor Weber's words,
when further on he points out how catarrhs may open
a way for virtual inoculation with the bacillus. At
the same time, from these and other unhygienic con-
ditions, the tissues and fluids of many of these people
ontain such an excess of dead matter as to provi<le
all the conditions — the suitable soil, as already ex-
plained — for the most rapacious, sapropyhtic bacteria,

ITS NATURE, CAUSES AND PREVENTION.

183

and probably even for exciting or transforming non-
vii ulent ones into true disease germs.

What now, let us intjuire, are the clinical facts and
pr<)l)abilities bearing on this point ? A consumptive
person in an advanced stage of the rlisease coughs up
and spits out vast numbers of bacilli : a fact that the
microscope plainly reveals. These germs are often in
a most virulent,, poisonous condition. Without the
utmost care, attached to invisibly minute particles of
mucous, tubercular matter or destroyed tissue, they
get scattered about the sick person and bed. The in-
visible particles, with the germs, soon — probably in a
a few minutes — become diy enough to be carried with
the air breathed into the lungs of an attendant. The
germs have not been exposed to light and air long
enough to have lost any of their vitality or virulency
In the tissues and fluids of the new field — the new
body, rendered susceptible or predisposed by long
vigils, night and day, in probably a close, over-
breathed atmosphere, with many months or a longer
time of limited respiratory action and want of oxygen,
and with a break or abrasion in the defensive wall of
the mucous membrane of the minute brochi, the seeds
Fall upon (to them) fruitful soil. Here, active, full
of venom, — if the figure may be permitted, excited
and gory, fresh from the battle-field — they set up,
probably in spite of much resistance, the inflammatory
action which results in the formation of tubercle. A
case of this nature would be uncjuestionably one of
infection or contagion, or, if another term be preferred,
inoculation. Who can rloubt that such cases not
infrequently occur?

I IP

'■■i -1;

184

coi^suMrrroN

A 'J- 1

i r

III ill i'

With these facts and' probabilities, and with the
many special cases of the disease reported by various
authentic observers as having had, seemingly, their
starting point in this way, at the bedside, is it reason-
able to deny or doubt the infectiousness or direct
communicability of consumption ? Yet, neveiiheless,
as we have seen, some physicians of high standing,
apparently not many, still (juestion it. It seems to
be clearly established, however, and now very gener-
ally believed, that altogether in not a few cases of the
disease, possibly in many in certain localities, countries
or peoples, its gernis had been communicated, and by
means of tlie atmosphere breathed, <lirect from a per-
son affected with the disease, somewhat as above
pointed out. The tlieory of the infectiousness of con-
sumption, therefore,should be considered as established
beyond reasonable doubt. The disease has been clas-
sified with such other infectious diseases as typhoid
fever and Asiatic cholera (Doctor Thomson : New
York Acad, of Med.), as a " non-contagious connnuni-
cable disease." It has been estimated that about eight
hundred tubercle bacilli are necessary in ordinary
circumstances for the successful inoculation of a rabbit.
The number required to infect a human being couUl
hardly be approximated, but would obviously vary
greatly with circumstances, especially with the degree
of virulency of the bacilli and the condition of the
soil or host.

CHAPTER IX.

CAUSES OF CONSUMPTION CONTINUED.

SOURCES AND DISSEMINATION OF

THE BACILLI.

TuiJERCLE bacilli, Jind doubtlt'ss their spores nlso,
are given oft' from a consiiinptiv(» person most abun-
dantly with the expectorated matter couj^hed U[)
fn^n the lungs — the sputa (spit). In consumption of
the bowels, they are given ott' witli the bowel excreta.
There is evidence that they may be cast out by the
perspiration, through the skin, and also with the
lU'ine, and spores possibly pass ofi' with the breath.

Tuberculous animals are a source of the germs.
The flesh and milk contain them : and doubtless the
various excretions also.

With all these known sources of tubercle bacilli,
who can escape taking them, sometimes, or often, into
the body, either by inhalation or swallowing {

There are, too, a number of vvavs in which these
germs, whether active and virulent or dormant and
non-virulent, are spread about — disseminated on every
hand. They may then be conveyed to human bodies
by air currents, especially with and forming part of
the ubiquitous dust, and by solid bodies of almost any
and every kind, — clothing, bedding, money, public

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186

CONSUMPTION :

V'iS-:

conveyances, etc., etc. They are not known to spread
by means of water ; but are doubtless often communi-
cated to human beings by the milk and flesh of tuber-
culous animals used as food.

HUMAN SOURCES OF THE BACILLUS.

The number of tubercle bacilli given off daily by
some consumptive persons is so enormous that it would
hardly be credited v/ere it not that they have been
repeatedly subjected to actual count ; that is, counted
in certain portions of the sputa. The number varies
greatly with the nature of the case and stage of the
disease. Twenty millions is about the lowest estimate.
On the other hand. Osier (Prac. of Med.) records that
a patient of his in the Johns Hopkins Hospital, Balti-
more, Md., " moderately advanced," in sixteen counts,
during a period of a few weeks in January and
February, spat out from one and a half to four and
one-third billions of bacilli daily, contained in from
about a pint to a pint and a half of expectorated
matter. Amongst every one hundred thousand of
the population there are constantly, on an average,
two or three hundred suffering from consumption.
These people cast out thoughtlessly, carelessly, almost
criminally, always most disgustingly, anywhere, every-
where, just as temporary convenience suggests, or
occasion and circumstances permit, or do not forbid
— upon the floors of rooms and shops, public halls
and other places of public assemblage, in public con-
veyances, upon the sidewalks of the streets, and in
back yards — countless billions of the infective bacilli,

ITS NATURE, CAUSES AND PREVENTION.

187

besides their probably still more numerous spores.
The sputa containing them soon dries, and, probably
often encased in and protected by a coating of dried
mucus, they are set free. What becomes of them,
of these countless myriads of invisible particles ?
They are carried by air currents hither and thither,
lighting on our food and flitting with the breath we
draw into our lungs.

Samples of dust were collected by Cornet from
many and various sources, especially from the walls
and floors of wards and rooms which had been occu-
pied by consumptives. Of one hundred and eighteen
samples of that dust, forty were infective and pro-
duced tubercle in animals inoculated with it. Prauss-
nitz collected dust in covpes of trains running on a
road frequented by consumptives. Inoculated into
five guinea-pigs, the dust produced tubercle in two.

In consumption of the bowels, too, doubtless enor-
mous numbers of the germs are cast out by the fecal
discharges, which eventually dry up and set free
particles with living germs. Doctor E. Solles pro-
duced tuberculosis in guinea-pigs by inoculation
with the feces and urine of consumptive persons.
Professor Graham says the bacilli have been found
in considerable numbers in the perspiration. They
adhere to the skin, and are not found when the
surface is kept clean and disinfected. This would
indicate that they come from other sources and settle
on the skin. It is most likely, however, that they are
washed out of the body by the perspiration.

u'lli

5] J 1]

'It

188

OOXSUMPTIOX

HOW THE BACILLI ENTER THE BODY : INHALATIOxV.

There are four avenues by which tubercle bacilli
may get into the body: (1) Inhalation — the air pas-
sage route to the lungs with the air and dust
breathed; (2) Swallowing — the food passage way to
the stomach with the food, or when carried to the
mouth or throat by other possiVjle vehicles, as the
lingers, pins, money, etc. ; (3) By direct inoculation
through the cutis, into or under the skin, as through
a cut or scratch; (4) Congenital means, from a parent.

From the fact that in tuberculosis the lungs are the
organs nmch the most commonly affected, especially
amongst adults, it is generally believed by authorities
that inhalation by the air passages is the most com-
mon way in which the germs of the disease are
received into the body. Some writers have con-
jectured difficulty in the germs thus reaching the
remotest recesses of the lungs, but it is not easy to
understand how there can be any obstacle whatever
to their passage in, along with dust, which is so con-
stantly breathed. That this is one way of entrance has
been fairly proved by the experiments of Tappeiner
and Bertheau upon dogs. The very beginning of tuber-
cular formation, too, is often in the smallest bronchial
tubes, which open direct into the air chambers.

Next in importance is infection by way of the
digestive tract with the food. The microbes may be
conveyed into the mouth in various ways, perhaps by
the air in breathing through the mouth, whence they
are conveyed into the stomach by swallowing. A

ITS NATURE, CAUSES ANJ3 I'llEVENTlON.

189

case has been recorded in wliich the water that
8ome grapes had been washed in produced tubercle in
animals inoculated with it, the grapes having been
outside the door of a fruit store, exposed to street dust.
The most common vehicle, however, in which the
infection is conveyed into the stomach is probably the
tlesh and milk of tuberculous animals, an important
part of this question to be presently discussed.

Direct connnunication of the germs by nccidental
inoculation is not a connnon method of sj)re{.ding
consumption, although a large number of cases, in all,
of this kind have been recorded. Doctor Heron gives
details of many cases of such inoculation, in various
ways. The disease has been communicated many
times to man through a slight wound in making
examination of tubercular dead bodies, of man and
animals. Surgeons have sometimes suffered seriously
in this way. Pfieft'er recoi'ded a case of a veterinary
surgeon who, in 1885, was cut whilst making a post-
mortem examination of a tubercular cow. The wound
healed readily, but six months after, a small tubercle
was found near the part, and some months later the
man presented symptoms of pulmonary tuberculosis ;
of which he died two and a half years after receiving
the wound. A few years ago a case was mentioned
in the British Medical Journal of a young girl who
contracted general tuberculosis from wearing the ear-
rings of a friend who had died of consumption, the
infection having been apparently conmiunicated by
way of the pierced ear.

The communication of the disease by the parent to

'I ii

I ■

V
^\

1' 'I , .

If' , I V

190

CONSUMPTION :

the offspring has been already sufficiently discussed
in connection with the subject ol' heredity.

In whatever way the infection is taken into the
body, it is conniionly spread to other and various
parts of the organism ; and, it appears, by and alon^
the course of the lymphatic vessels rather than by
the blood vessels. Whether the bacillus, after getting
into the body, has any special predilection for the
lungs, is not yet known. It seems evident, however,
that in whatever way the infection gets in, if it give
rise to tubercle, the lungs eventually, in nearly all
cases, become affected with it.

INTERCOMMUNICABILTTY : INFECTION FROM ANIMALS.

That consumption may be communicated from man
to the lower animals and from such animals to man
has long been believed, and now appears to be a well-
established fact. As already has been stated, tuber-
culosis in the bovine race, once known as the " pearl
disease," is now universally regarded as being identical
with the tubercular disease in man. The bacilli in
the two cases are indistinguishable under the micro-
scope, while their growth in various culture substances
attd their biological characteristics are identical, except
that the bovine bacillus is usually smaller than that
of man, although in cow's milk it is as large.

There is conclusive evidence that the disease is
conniiunicable from man to the domestic animals.
Besides instances of observation in which it seems
clear that poultry contracted tuberculosis by eating
tuberculous expectoration from human lungs, the

ft' «> f

It.. ..> 1,'^

ITS NATURE, CAUSES AND PREVENTION.

191

jcussed

ito the
various
1 alonji;
han by
gettin
for the
Dwever,
it give
sarly all

•JIMALS.

•om man
3 to man
3 a well-

, tuber-
|e " pearl

dentical
lacilli in
micro-

Ibstances

,1, except
an that

isease is
I animals.
It seems
eating
Ings, the

disease has been proc* iCed time and time again in
animals by intentional inoculation.

As an example of probable conununication of the
infection from the human body to animals, the follow-
ing will be of interest. In the Lancet (Lond.) of Jan-
uary 16, 1802, J. Armstrong, M.B., of Liverpool, Eng.,
reports that a boy, a patient of his, with a tuberculous
family history, died at the age of fourteen, of con-
sumption. He had a pet dog and a pet rabbit which
were often about and on his bed during his illness.
Both animals soon became affected with cough and
died shortly after. A veterinary surgeon made an
examination of the bodies and pronounced the cause
of death to have been tuberculosis.

THE BOVINE RACE A SOURCE OF THE BACILLUS.

Doctor E. F. Brush, of Mount Vernon, N.Y., who is
a stock raiser, and has long devoted attention to this
subject, believes that tuberculosis " is all derived from
the bovine race" (Paper, N. Y. Med. J.). He suggests
that as the temperature of bovine animals is higher
than that of the human body, the tubercle bacillus
finds in them the most congenial soil. " We are veri-
table parasites on the cow. . . . She has tuber-
culosis and we have tuberculosis. . . . The inhabi-
tants of the steppes of Russia, who have no cows, have
domesticated the horse, using its milk, meat and skin,
and a case of pulmonary tuberculosis has never been
known amongst them. The Esquimaux have neither
cows nor pulmonary phthisis." It appears, according
to Doctor Brush, that where the dairy cow is unknown,

-:i '"V

:!«■*

»• J

■•\iX li

192

CONSUMPTION :

coriHUinption doe-s not prevail, but that on the other
liand, the di.sea.se is connnon where tlie cow is in
common use, and many countries are named to cor-
I'oborate this.

Evidence, too, that a certain amount of rehition
exists between tlie prevalence of this disease in man
and that of bovine animals is afforded by a chart
issued in the year 1881 in Ba<len. The chart applies
to fifty two towns, and shows that where tuberculosis
was prevalent among cattle, it was proportionately
prevalent among the human population, and was
particularly so in towns in which the number of
low-class butchers was greatest. In a debate in Par-
liament in Great Britain, a few years ago, Sir Lyon
Playfair pointed out that it is a " significant fact that
when tuberculosis in cattle increases, consumption of
some form or other — but especially of the mesenteric
and intestinal form — also increases amongst children."
All this at least affords evidence of the communica-
bility of the disease from animals to man.

FLESH AND MILK SOURCE OF INFECTION.

Tiiat consumption could be communicated to the
human body by means of the flesh of tuberculous
animals used as food has been evidently suspected
from the earliest records. There existed strict Mosaic
laws condemnatory and prohibitory of the use of the
flesh of animals affected with the disease. From
that time onward to the present various ordinances
have been instituted with the same object.

It has been argued that there is no direct proof

ITS NATUKK, (JAUSKS AND IMIKVENTION.

193

e other
V is ill
to cor-
relation
in man
a chart
, applies
erculosis
tionately
and was
iinber of

,e in Fal-
si r Lyon
fact that
inption of
lesenteric
children."
munica-

lON.

rect proof

of the transmisHion of tubercle from animals to
man l)y the use of Hesh and milk as food. Such
proof, urtres Professor Walley (Royal Vet. Col. Edin.),
" cannot, for manifest reasons, be obtained, but the
mass of indirect proof in favor of such supposition is
enormous." He mentions a striking example of the
effect of eating tin; Hesh of tuberculous animals,
hrought to light by a French physician, in the case
of a younj( woman who rapidly became consumptive
as the result of eatin^ij the imperfectly cooked bodies
of tuberculous fowls. Doctor C. R. Drysdale, a few
years ago, in the British Medical Journal, drew atten-
tion to a fact in his experience, viz., that in the
Metropolitan Free Hos[)ital, London, " it was very
rare indeed, even in the poor Jewish quarters of
Houndsditch, to meet with Jews afflicted with
phthisis, a disease so prevalent among the ordinary
population of that district." This exception is attri-
huted to the care taken by the Jews in the inspection
and selection of meat.

The question of the infection being conveyed by
milk is, perhaps, of even greater importance than is
that of infection by flesh, for the twofold reason
that it is so largely consumed by infants, and this
generally in an uncooked state. The danger of con-
tamination by milk will be more clearly compre-
hended when it is known that the tubercle bacillus
can be readily detected in the milk of animals in
whose udders tubercular lesions exist; and also, as
shown by Professor Bang, of Copenhagen, in that of

women whose mammary glands are tuVjerculous. Of
13

194

CONSUMPTION

ill'

six hundred cows examined by Doctor Woodhead
and Professor McFadyean (of Gov't. Bd., Gt. Brit.), in
six cases they dernonstratetl the presence of tubercle
bacilli in the milk. Professor Walley says, " In
1872 I lost a child in Edinburgh under circumstances
which allowed but of one explanation, viz., that he had
contracted mesenteric tuberculosis (consumption of
the bowels) through the medium of milk." A Mr.
Cox, of the Army Veterinary Department, England,
has related the particulars of a case which led to the
same conclusions ; as also has Mr. Hopkins, F.R.C.V.S.,
of Manchester. Fleming (Vet. Med.) has referred to
a similar case as occurring in the child of a surgeon
in the United States. Walley reports a case of mesen-
teric tuberculosis from the use of milk which occurred
in the child of a well-known veterinary officer of the
Privy Council. At a meeting a few years ago of
the Edinburgh Medical Society, Doctor Woodhead
referred to some undoubted cases of transmission to
man, and also to the pig, by the medium of milk.
Many other cases of a similar character have been
recorded. A striking case has been reported by
Denune, of Berne (Med. Press & Circ). An infant
aged four months, with no tuberculous tendency, died
of tuberculosis of the bowels, the bacilli being found
in the glands. The child had been fed with only
milk from a cow which was then killed and found to
have tubercles in the lungs, while milk pressed from
the udder contained tubercule bacilli. Finally, quot-
ing the words of Professor Adami (Paper, Montreal
Med. Soc, Mar. '93), " Intestinal and abdominal tuber-

ITS NATURE, CAUSES AND IMtEVEXTION.

195

odhead

rit), ii>
ubercle

^8, "In

istances

b he had

)tion of
A Mr.

Sngland,

;d to the

R.C.V.S.,

ferred to
surgeon

)f mesen-

occurred

^er of the

•8 ago of
oodhead

[lission to
of milk.

tave been
»rted by
n infant
iiicy, died
,ng found
ith only
found to
(sed from
\\y, quot-
Montreal
lal tuber-

culosis is most common, as we all know, in the young,
and the prevalence of milk diet indicates wliat Bang
in Denmark, Bollinger in (Germany, Nocard in France,
and Woodhead and McFadyean in England, have con-
clusively proved to be the case, tliat this intestinal
tuberculosis is very largely brought about by the milk
of tubercular cows."

According to Bang and others, the cream, butter,
cheese and buttermilk from tuberculous cows have
been shown to be as infective as the milk, if not more
so. It seems that the milk may be so sterilized as to
render butter and cheese therefrom comparatively
safe. It is possible that the spores may survive the
sterilizing process. The only absolute safety is, prob-
ably, in healthy cows or inunune human bodies.

I m

CHAPTER X.

■It '
m

,1 K

CAU8KS OF CONSUMPTION CONTINUED.
1>E NOVO ORIGIN OF THE DISEASE.

Now as to wliother coiiHiuiiption always, frequontly,
or only occasionally, arises by way of infection
— communication by virulent jjfernis from another
case of it — and if not always, in what manner do the
other cases arise, is a very important cjuestion, and
one which, so far as I know, has never yet hn'v
specially discussed. In ordinary general pra'^-tice, we
find but comparatively few cases at the most whicli
can be traced to infection; not nearly so many as we
can so trace in cases of outbreaks of typhoid fever, the
least infectious of the febrile diseases. It will be con-
ceded, probably by the most ardent advocates of the
infectiousness of consumption, that at least many
more cases of the disease develop by other means than
by ordinary infection which can be traced. How or in
what manner do these large majority of cases arise i

DOES THE BACILLUS GROW OUTSIDE THE BODY ?

We have seen that there is no consumption without
the tubercle bacillus. It is not known that this
bacillus grows outside the body of a living warm-
blooded animal, except by cultivation in the labora-

IIS XATl'UK, TAKSKS AND I'UKVKNTloN.

li)7

aiRT).

quontly,
nfection
another
jr do the
iion, aiul
yet brf-'Ti

)st which
,ny as we
Ifever, the
111 be con-
ges of the
,st many
leans than
ow or ill
!S arise ^

BODY ?

without

Ithat this

ig warni-

le labora-

tory; wliile it is hclit'VtMl l»y K«k*Ii ami ntlicr liioh
uutliorities that it does not. Tliere is, liowever,
doubtless nmcli yet to be learned in relation to tiiis
micro-organism, especially as to its }>otanieal history.
Sir Hu«^h Heevor has shown that it will ^row at a
temperature of (K) F.: aIthou<fh it is generally sup-
posed that it recjuii'es that oF O.')' or inon'. May it
not, then, like 'lany other, if not all, disea.se jroi-ms,
the life history of which is best known, pi"o})a<^at(; out-
side a wann-blooded body i The bacillus of splenic
fever (anthrax), as alv^'idy .stated, "ordinarily com-
pletes its developmental c\ cle outside tlie animal body"
(Koch); and the baciUus of tvphoid fever and of
cholera probably (h. so, — at least they propai(at(! in
milk and other fluids; vviile it is probable that the
infective organism ol 'li})htheria is also of a like
nature in this respect.

The (question may be asked, is the simple, single
l)acillus, or little stick-like and best known form of
this fungus (the tubercle bacillus), the ultimate, com-
plete, natural form or condition of the vegetation ?
Probably not. Nearly all these simple forms of life
have a more complex and complete state of existence,
if only as a cluster or mass, even zooglo^a— a gluey or
gelatinous clump or colony produced by most bacteria
whenever they are allowed to flourish unmole:ited.
We have seen that the star fungus in actinomycosis,
or " lumpy jaw," of cows, presents a daisy-like form.
Branched and other forms of the tubercle bacillus have
been observed. And in what phase are these bacilli
in the dull, whitish, scale-like growths on blood serum

If r

198

CONSUMPTKJN :

in the to.st-tubo ? Or vvluui appearinjj^, <«m Hall says,
like " criiiiil).s of breatl moistened ; " or as a Klatsch
preparation, with "a thick, curled-up centre around
which threads are wound in all directions ? " It is not
possible for the bacillus to take on any such form in
its parasitic life in a livinj^ body because of the
antagonistic vital forces of the host. Is it then, as
Koch says, always a " true parasite " which " cannot
live without its host / " Or is it only an accidental
or occasional parasitic organism when in its simplest
phase i Has it a more flourishing vegetative con-
dition, approximating the mould formations, for
example: — perhaps on "cultui-e media" of minute
particles of human excreta, as sputa, and in dark,
damp, secluded, confined spots in unhygienic dwellings,
cellars or closets, or elsewhere, outside of dwellings ?
In some such conditions the infection of diphtheria
and of typhoid tever and cholera are supposed to lurk
and flouri.-ih.

Since these pages were vritten, and apropos to
the above, I see in the British Medical Journal (Mar.
9, '95 : Epit. of Current Med. Lit.) editorial comments
on "a detailed account" of the various forms of
this bacillus and its biological position, by Coppen
Jones, already referred to, as follows : " A number
of observations are mentioned, which tend to show
that bacteria . . . are only stages in the develop-
ment of more complex forms. The author thinks we
ought to hesitate before accepting the common view
that the exciter of tuberculosis is a parasitic organism,
which is transmissible only from animal to animal, and

ITS NfATUIlK, ('AUSKS AND PIIEVEXTION'.

199

U Hays,

KlatHch

around

It is not

form in

. of tlie

tlien, as

" cannot

ccitlental

simplest

bive con-

/lons, for

f minute

in (lark,

dwellings,

Iwellings ?

liphtberia

led to lurk

ipropos to

irnal (Mar.

comments

forms of
3y Coppen
A number
d to show
|\e develop-

thinks we
inon view
organism,

Lnimal, and

which i.s without vegetative exi.steTice external to tlie
animal l)ody."

Again, in a paper by Doctor Arthur Ransoine,
F.R.S., in the Procecnlings of the Royal Society, Eng,
(Vol. xcix.), "a series of observations are given to
prove that fresh air and liglit and a dry sandy soil
have a distinct influence in dinuuishing the virulence
of the tubercle bacillus." " Mere exposure to light in
otherwise insanitary conditions does not destroy the
virulence " (Lancet, Jan. 16, '92). Now, why would
the virulence diminish on a dry sandy soil, and not
in " insanitary conditions ? " Is it because such soil
affords no decomposing organic matter, as food for the
saprophytic requirements of the fungus, such as aflbrd-
ed by other soils, or insanitary conditions ? Why, if the
fungus does not grow outside the living animal body ?
We must bear in mind that reliable statistics prove
beyond doubt that consumption is less prevalent on
sandy soils than on heavy damp soils. Doctor Flick,
who has long made a study of the subject of the in-
fectiousness of consumption through the spread of
the bacillus, says (Pamph. on Contag. of Phthis.), " I
have no doubt that it [the bacillus] will propagate in
decaying matter of any kind, and that it can thus
perpetuate itself indefinitely." The opinion of Mr.
Chandler, in his book on Prevention of Consumption
— that it grows " free in nature," outside the body —
has been already mentioned.

Now, if this bacillus in another phase of its exist-
ence, does not grow (and, it maj'^ be, best or most
naturally) free in the open air, like most other fungi,

K>'€?ViA il

200

roxsuMlTloX :

and JiH in the cuhc of tlic .so-enlkMl uialai'ial j^ei'ui.s and
thoHe of .splenic fever, it seems at least possible that in
certain other and more favorable conditions, as in
warm, dark, protected " corners," it may live a Ion*;-
time and multiply or propagate its species. Possibly
it may be a tropical plant an<l not yet fully acclimated
to the frosts of temperate regions.

A J'OSSIHLE LOWER ANIMAL ORKJTN.

In considering the subject of the prevention of con-
sumption, it seems necessary to consider possibilities,
and, indeed, in practice, to act upon possibilities.
There is, therefore, one more closely associated point
to which 1 shall venture to refer in this connection.
It may be generally looked upon as rather speculative,
but perhaps in course of time it may receive more
consideration. It has long seemed to me that all
living so-called disease germs may have been derived
through or from the lower animals. Such of the
microbes as may have lived originally, like most
known saprophytic organisms do, free outside a living
animal body, have become, accidentally, occasional so-
called parasites in certain of these animals ; and, it
may be, only after, and chiefly by reason of, the
less natural and more unhygienic conditions of the
animals arising from domestication. If any there Ih'
of the germs which never had so lived — free, outside
the animal body — then, it may be, they were origin-
ally, when in the animal body previous to domesti-
cation, benign organisms, working out their destiny
in the endless chain of events "which sustains the

ITS XA'n'HK, (Al'SKS AND I'KKVKN'TroN.

201

equilibrium of nature," that notliiiio-, not (ivou a
particle of excrement, Ik; loHt ; and because of the
insanitary conditions associated with domestication
they eventually become poisonous, virulent, parasitic,
pathogenic.

As we have seen, it has been suggested (Doctor
Brush) that the bovine race mjiy be the original
source of tiie tubercle bacillus, as it is apparently of
the infection of vaccinia and small-pox. May it not
be, if this bacillus never has been a free, air-growing
fungus, that in bovine animals, in their more natural
state, it is a benign oi'ganism or saprophyte, some-
what as the bacillus coli communis is, usually, it
appears, in man ? Reference has already been made
herein to the remarkable effects on these micro-
organisms of the diet and other conditions and habits
of life of their host. May not the domestication of
these animals, with the usual unventilated, often
dark, dank and uncleanly byres in which they are
housed, with want of more active, general, and fuller
respiratory exercises, and their changed, more fat-
forming and less invigorating food, have caused the
degradation of the bacillus — the gradual " cultiva-
tion " of it into a virulent, pathogenic organism ^
Becoming virulent and pathogenic in the cow, the
tubercle bacillus, on being con\'eyed into the body of
certain human beings, becomes perhaps still more
poisonous and virulent. The (juestion may be asked,
do not the methods, or the measure of success attend-
ing the methods, by which it is now sought to protect
man from the effects of disease germs — to render him

! '■

202

CONSUMPTION

immune — by inoculations with the diluted products
of various mi^ioljes " cultivated " in the body of
animals, whence possibly they came favor the view
that man originally received them through or from
these animals ?

Again, it may be asked in this connection, what
explanation can be given of the long period of so-
called latency of the tubercle bacillus in the human
body, and especially of the young — the period in
which it apparently does no harm, as referred to else-
where ? Is the microbe, then, absolutely inert, dor-
mant, inactive ? Is it in a condition not at all in
accordance with its nature ? Can this condition of it
arise from any still inherent trace of its benign
nature — be an instance of something like atavism ?
We must await replies to these questions until we
know much more of the botany of the plant.

CONSUMPTION NOT ALWAYS FROM INFECTION.

Now, whether the tubercle bacillus groM^s free out-
side the living warm-blooded animal or not, or
whether or not it comes to us wholly, or only in a
measure, from the domestic animals, there is, in any
case, at the present time a superabundance of the
microbes and their probable spores scattered about
everywhere by consumptive persons. They become
dry, and the air and sunlight modify and eventually,
doubtless, destroy their virulency, although not in all
cases their life, especially in the case of the spores
They are carried about with, or as particles of, the
invisible dust of the atmosphere. Douglas Powell

ITS NATURE, CAUSES AND PREVENTION.

203

id products
le body of
3r the view
igh or from

Bction, what
>eriod of so-
the human
e period in
irred to else-
iy inert, dor-
ot at all in
mdition of it
: its benign
ike atavism ?
ons until we
►lant.

FECTION.

3WS free out-
or not, or
or only in a
re is, in any
lance of the
,tered about
They become
1 eventually,
orh not in all
the spores,
icles of, the
iglas Powell

S4iys, " It cannot be doubted tliat tliey an<l their
spores form some practical proportion of the organic
elements of dust." Nor can it be doubted tliat
most persons, if not all, occasionally, probably often,
draw in with the air breathed one or other form
of the microbe — the parent rods or their si)ores — by
hundreds or thousands. They lodge on the cilia of
the bronchial tubes, possibly on the walls of the air
chambers : this without any harm or inconvenience
whatever to a very large majority — from seven-eighths
to three-fourths — of the population. With the min-
ority — the rest of the people — however, it is quite
different. In these persons who, we say, are in a sus-
ceptible condition of body — predisposed to the disease
— whose fluids and tissues are in a certain favorable
condition, the inhaled bacilli or spores become again
poisonous, virulent, and eventually tubercle — con-
sumption, is produced. Should cases arising in this
way be regarded as having an infectious origin ? The
disease does not so arise in individuals in even fair or
average health, and on exposure to the infection in a
diseased person; nor, be it observed, from germs at the
time virulent or infectious, apparently, for they do not
infect the great majority of persons. The germs are
not communicated as an infection in the ordinary
way. They have Iqst in a measure, if not entirely,
their virulency, or, in ordinary conditions, their infec-
tiousness, by exposure to the oxygen of the air and
to sunlight. A change has taken place in them out-
side the human body. They are practically, even
actually, in another state (if not phase) of existence.

,.«,? ''I

204

CONSUMITIOX :

They are not int'eetious until made so by a certain
condition of, or something within, their host. In
such cases we regard the disease as arising dc. novo —
anew, over again : not without the essential germ,
but from a transformed, modified, non -infectious one.
We have the analogue of this in outbreaks, not
infrequent in crowded parts of cities, of typhus fever.
** Given a sufficient amount of overcrowding, want of
ventilation, and insufficient or bad food and typhfts is
sun; to arise." I'he germs >>diich set up the disease
" in a convenient soil are always present among us."
They "only require the concurrence of the circum-
stances" just mentioned (foul air and bad food) to
" enable them to increase and multiply " (Carpenter).
So, too, the germs of consumption are ever abundant
around us, and only require t > meet with tissues and
fluids surcharged with germ-food and probably toxic
substances formed from the accumulated pro<lucts of
imperfect respiration.

OVERSIGHT AND ISOLATION NOT SUFFICIENT.

Now, to what extent will notification and oversight,
or isolation, with disinfection or destruction of sputa,
prevent or lessen the frequency of cases of consunqi-
tion arising in this way — practically, at any rate, <lr
novo ? A certain amount of oversight for educational
purposes, chiefly, would doul)tless be very useful. In
time, only after decades, probably generations, of
effort, the effect of such measures would be perhaps
clearly apparent; hardly sooner. Consumptives, in
the early stages, careless, indifferent, and also pur-

ITS NATURE, CAUSES AND PREVENTION.

205

posely concealed cases — persons objecting to submit
to even oversight — would continue to provide and
.spread about myriads of the germs, which would con-
tinue to be ubiquitous, almost as at tlie present time.

Furthermore, it must be remembered, as above
intimated, that in the application and exercise of
preventive measures, in order to make sure of success,
and the largest measure of it, we must be prepared
for probabilities, and even possibiUties. It is at least
possible that the tubercle bacillus may grow and pro-
pagate outside the animal body. Of what avail then
tlie destruction of the sputa? True, this point is met
in a measure by general public sanitary administra-
tion promotive of cleanliness, etc.: but in the case of
a possible free, air-growing tubercle bacillus, met only
to a very limited extent.

Now, are we not forced to the consideration of the
body factor, the " personal e(juation ? " This factor
may be fairly, indeed must be, looked upon practi-
cally and actually as the immediate, exciting cause
of the disease.

THE BODY FACTOR : — PRETUBERCULAR CONDITION.

Reason leads to the clear conclusion that in the
human body the tubercle bacillus (alike with other
disease germs) is not "at home." The human body is
not the habitat of the fungus. In an absolutely
healthy human body it will not grow. The body in a
certain diseased state, however, which may be termed
a pretubercular condition, provides a soil — food, etc.,
and so causes the microbe to " take root " and propa-

n-:H

-m,

206

CONSUMPTION :

gate in it. Something of the nature of this diseased
condition, and the cause of it, it has been my endeavor
in the foregoing pages to point out. Briefly, it is
probably caused by, and is the effect of, certain toxic
combinations or substances formed in the body
from respiratory products accumulated therein by
reason of a too limited respiratory function and con-
sequent want of oxygen in the body ; somewhat as
anaemia and chlorosis are effects of certain toxines
formed from intestinal accumulations, and as a
predisposition to typhoid fever or cholera, is caused,
in all probability, by other of this class of toxines.

We have, then, as the earlier effect of the limited
respiratory function, this pretubercular condition — an
actual diseased condition, indeed, which always pre-
cedes the formation of tubercle. This condition is
well and generally recognized, and has been termed
the " pretubercular stage " of the disease, although
the disease — tuberculosis — has not yet commenced. It
is commonly looked upon as following, instead of pre-
ceding, the first formation of tubercle. The symptoms,
or signs — for they are more frequently observed by the
friends than by the individual manifesting them —
of this pretubercular condition are familiar to all. The
three usually most noticeable are a certain amount of
languor and depression with want of energy, a failure
in the appetite for food, and loss of body weight.
Sometimes me of these is first noticed, sometimes
another ; sometimes, probably most commonly, in the
order above named; sometimes the reverse. Treat a
person in this condition with tonics, cod-liver oil

ITS NATUKE, CAUSES AND ritEVENTlON.

207

aiifl other nutrient remedies, and he, or she, will
probably improve for a time, or temporarily, with this
treatment alone, but not permanently or in a marked
degree. Induce such person to inhale an abundance
of oxygen in the pure outer air, and in a few weeks
of this out-door life, and often without any other
remedy or change, the condition is replaced by one of
health. The cause of the condition is hence plain.

THE BODY CONDITION MUST BE PREVENTED.

Sanitarians in their efforts to prevent consumption,
and physicians in tlieir efforts to cure it, must recog-
nize to a greater extent than heretofore this body
factor, and overcome this condition. Indeed, in order
to be most successful in such efforts, this factor must
be regarded as the most important one, and be made
the point of first and most vigorous attack.

Prevent or remove the j)retubercular condition by
increasing the respiratory function, and there will be
no consumption ; but instead, most likely, good health
on the part of these persons. Destroy and prevent
the growth of the germs only, and this pretubercular
condition of the body will develop into something
possibly worse than consumption-^cancer, it may be,
or other specific disease. Some other saprophytic
micro-organisms will take possession of the rich soil
and dwell in it, or make warfare there. We cannot
live unhygienic lives and by simply destroying the
so-called disease germs retain good health. W. Roger
Williams, F.R.C.S., who for some years has given much
attention to the relationship between consumption and

f 1

'A"

III

~a«

208

CONSUMPTION :

cancer, and promises a book bearing on the subject,
writes as follows, although in a different order of
sentences, in a recent number of the British Medical
Journal (Nov. >], '94): "I regard the predisposition to
cancer as closely allied to the tubercular predisposi-
tion, of which in all probability it is but a diluted
form. No heritable ccmdition is more favorable to
the development of cancer than that which predis-
poses to and accompanies tuberch;. A large proportion
of cancer patients are the surviving members of tuber-
culous families. The great increase of cancer during
the last half century has coincided with a remarkable
decline in the death rate from tuberculous diseases,
especially phthisis. It seems to me exceedingly prob-
able, from considerations deriv^ed from the study of
the family history of cancer patients, that a large
proportion of those thus saved from tubercle eventu-
ally perish from cancer and insanity ; and I think the
increase in the latter disease has been largely brought
about in this way."

DEDUCTIONS : CONCLUSION OF PART I.

The following are my conclusions deduced from
the facts and inferences set forth in the preceding
pages :

1. That the tubercle bacillus is an absolutely essen-
tial factor in the causation of tubercular pulmonary
consumption.

2. That the tubercle bacillus will not propagate or
give rise to consumption unless there be already in
the body tissues special soil-food for its growth, and

ll._

ITS NATUUK, CAUSES AND I'HEVENTIDX.

209

also, apparently, .some special morbid condition or
Hiilistance, probably a toxine, which is essential to its
action as a pathogenic parasite.

3. That this special soil-food and probable germ
excitant, or tissue irritant, are produced fn the body
from the decomposition of waste, effete matters ac-
cumulated therein by reason of the respiratory func-
tion being below a certain proportionate health
standard, with a conseciuent limited supply of oxygen.

4. That the tubercle Vmcillus manifests various
degrees of virulency, and in certain conditions, as
when recently from the lungs ot a person in an
advanced active stage of consumption, it may infect
a susceptible person much in contact with such con-
sumptive, as in the case of a devoted nurse ; also,
when in flesh and milk in a recently virulent state, it
is liable to infect susceptible persons using these sub-
stances as foods : many more cases of the disease, how-
ever, arise, practically, de novo — from revived or
transformed non- virulent germs — than arise by such
form of infection.

5. That the practical point is, not so much the pre-
cise nature of the immediate cause of the pretuber-
cular condition, or body factor, as that this arises from,
or by reason of, a diminished respiratory function, and
is, rather than the bacillus, practically the exciting
and more controllable and preventable cause of the
disease, and should be so regarded in preventive effort.

True, a new field for preventive work is above in-
dicated ; yet one not so difficult of successful cultiva-
tion as some may suppose, or on first view it may
H

210

CONSUMPTION :

i ,1

J
si2

!!'fl

I'!;!

II i'!;|

appear io be, as I hope to be able to show in future
pages herein, when on the .subject of prevention.

The fact is, millions of the units of the human
family die, primarily or remotely, and literally, from
" want of breath " — from a want in relation to
breathing — die after years of suffering from this cause.

In the present condition of the masses of the
people, with the limited character of many occupa-
tions, amongst nearly all classes, so many being em-
ployed in-doors and at work in which a stooping lung-
contracting posture is temporarily the easiest, there is
a consequent, connnon, almost universal, limited
breathing movement and function. From this, alf> r
with the too common practice of almost con.stantly
breathing an in-door, already overbreathed atmosphere,
deficient as it is in oxygen as well as befouled, a large
proportion of the masses, while suffering from rebreath-
ing the poison in such atmosphere, suffer incalculably
from a want in the body of that most vitalizing, purify-
ing, invigorating element, oxygen, and the con.seijuent
retention of waste matters in the blood, obstructin<(
all the vital functions. They are deficient in that
vitality which a sufficiency of oxygen (aptly, in the
beginning, by its discoverer, termed *' vital air ")
gives, and which in turn gives zest and enjoyment to
life and makes it " worth living ;" while they are,
too, from the same cause, predisposed, and too often
fall ready victims, to various other forms of disease
as well as to consumption. They are poisoned by
their own excretions — their own used-up, waste
iritters retained in their body. So consequently tluv

ITS NATURE, CAL'SES AND PREVENTION.

211

.mitter on, and eventually die, from a want of that
I'UMiient which, when properly eon.sunied and utili/A'd,
^iveH general healthy, vigorous, unobstructed func-
tional activity — briefly, from " want of breath."

It is true, there are many other concomitant or
conjoined causes which aid in bringing about this
depressed, half-alive, specific disease-producing condi-
tion of so large a proportion of " civilized " mankind.
The foul air is never quite alone in causing disease.
It has many confederates. Boon conjpanions of it
are, commonly, an unclean dormant skin, improper
diet — badly prepared, badly cooked and excess of food,
darkness and dampness in dwellings, incontinence,
tobicco and whiskey. Still, however, the rebreathing,
again and again and again, the already breathed and
rebreathed air of closely enwalled, unventilated sleep-
ing, living and working places and schools, and
Itreathing such an atmosphere with but small or
C(mtracted or half-used lungs — in short, the imperfect
performance of the all -important function of respira-
tion — incomplete exchange of bodily waste for oxygen,
is c6mmonly the starting-point of the too generally
<lepressed vitality and want of full health and vigor
among the masses, and of many other ills as well —
intemperance, insanity and crime — which follow. The
most marked, probably the greatest, health want of
the age is fuller, freer breathing of purer air.

PART II.

PREVENTION OF CONSUMPTION.

CHAPTEK XL

The prevention of consumption is the special object
of this book. It is not the intention that the pre-
ventive measures to be discussed shall be applied
only by and to individuals, or that each indi-
vidual alone may be able to prevent the disease in
his or her own person. There is a much broader
aspect to the question, to be kept in mind. It is a
great public question, involving indeed the eventual
stamping out altogether, practically, of this most
destructive of all diseases. The motto, the rallying
crv, of sanitarians and all who are interested in the
public welfare, or in their own health and that of
those near and dear to them, should be prevention,
always, on every hand and in every way, rather than
cure. Philanthropists give large sums of money for
hospitals for the treatment, with the intention of cure
of disease, too often, alas, only the intention, how-
ever laudable, many cases being too bad or reached
too late. Who will be first to give of their abundance
such sums for direct prevention ?

ITS XATr'HE, (ArsES AND ntEVEXTlOX.

213

PIlACTICAhiLITY AND FACILITY OF FUEVENTION.

•

Particularly in respect to consumption is preventive
rather than curative effort desirable : and For two
reasons: tirst, because of the great fatality and im-
mense pecuniary cost of the disease, and second,
because of the comparative facility with which it may
be prevented. It is, indeed, sini^ular that more special
t'rtbrts have not been made by sanitarians in behalf
of its prevention : one-fifth or more of the human
race, as already stated in the introductory, being
destroyed by it alone, in its various forms, besi<les
its prevalence in domestic animals; while from the
long periods of debility and sicknes^s to which it gives
rise, the loss of time and nioney outlay are much
(jjreater than from any other disease, and all this
besides the direct personal suffering and l)ereavements
from loss of relatives, commonly in manhood's or
womanhood's prime.

Consumption is comparatively easy of prevention
because (a) the body factor in its causation being
essentially more specific than in most other infectious
diseases — the seed recjuiringa more special fitting soil
in which to grow — its intended victims may be in a
large measure picked out from amongst the people
and the armor of prevention thrown around them :
and (6) because the seed or germ is comparatively easy
of destruction. Howard Marsh, F'.R.C.S. (of St. x^arth.
Hosp., Lond.: in Brit. Med. Jr.) recently said, "Pro-
gressive and destructive as the tuberculous |)rocess is,
when the tissues which it involves are suitable for its

■\u

Uf'

ii \'\

!i«

»' It;

i ^'i

I! Ii

214

CONSUMPTION :

development, and when its environment is favorable,
the tubercle bacillus is, nevertheless, an organism of
such low vitality, and so dependent on surrounding^
conditions, that it is frequently placed by influences
with which we are at present imperfectly acquainted,
at a fatal disadvantage, and thus is destroyed and
eradicated by the vital forces by which it is opposed.
That it does frequently, as a matter of fact, thu.s
perish, is well known." Destructive as the bacillus is
when associated with, or stimulated or poisoned by,
man's unliygienic conditions, habits and surroundings,
its effects are usually after all but a mild, timely,
slowly acting penalty for sanitary transgressions.
Without the unhygienic conditions, it would probably
be as harmless as the simplest moul^

. That the predisposition to the difbc^.ie in individ-
uals, whether inherited or acquired, may be in almost
all cases comparatively easily overcome and removed
is well known. It would be easy for me to give thf
detailed history of many individual cases, as doubt-
less it would be, too, for most other physicians, in
which a strongly marked predisposition — even the
pretubercular condition — was entirely overcome in a
comparatively short time by careful, well-directed
hygienic measures.

In England and Wales, by the usual public healtli
measures for the prevention of disease generally, the
mortality from consuntption was reduced in a period
of about twenty -five years (1864-88) by nearly one
third. By more special general and personal pre-
ventive efforts, doubtless the mortality could be much
more largely reduced in a few years and eventually

ITS NATURE, CAUSES AND PREVENTION. 215

the disease practically eradicated. In armies and
navies, too, in Europe the prevalency of the disease
has been greatly lessened by means of provision for
more pure air, alone — more space in barracks and
better ventilation.

Who then will be first to start a fund for the timely
prevention of this " great white plague " ? — let us
say for building sanitaria, or a sanitarium, even one
as a model, for practically teaching people to stand
erect, as by nature or the Creator designed ; to breathe
properly and freely of only pure, sunny air; to
cleanse and invigorate their body by means of baths
and suitable exercise and food as wel/ as by oxygen :
for teaching them how to remove and prevent the
predisposition — the prepared, fitting soil for the
tubercle bacillus — a soil so prevalent on every hand
and especially among the less well-to-do and less
educated of communities who are not in a position
of themselves to so help themselves; for teaching
them, and perhaps first of all, the intrinsic, pecuniary
value as well as comfort of good health. Unquestion-
ably it is in the badly formed, badly functioned, im-
pure human bodies, and not in the simple fungoid
plant, that the root of the evil lies, and where the
axe must be laid ; and it is quite practicable to suc-
cessfully strike at the root.

PRINCIPLES OF PREVENTION: LINES OF ACTION.

The question then is, how may consumption be
most effectually prevented ? The principles of pre-
vention may ))e largely inferred from what has been
recorded herein respecting the causes of the disease.

i.n

,««' 1

CONSUMl^TIOX

It will be remembered that in its causation there art;
two chief or primary factors, namely, (1) the tubercle
bacillus — the infecting agent, and (2) the special
morbid body condition in which onlj'^ the bacillus will
grow and give rise to tubercle ; in other words, the
seed and the fertilized soil. In prevention, the aim
must be to remove or destroy the causes. While we
endeavor with one hand to destroy the bacilli, with
the other we must endeavor to purify, invigorate and
fortify individual bodies in order that there shall be
no fit soil in which, by the growth of the bacilli,
tubercle can be produced.

It appears to me that greater success in preventing
consumption, particularly, while preventing other
diseases, too, will be attained by keeping in mind,
rather than the bacillus, the thousands of defective
human bodies which provide the condition — the soil
— for its growth therein ; and by marshalling oppos-
ing forces mainly against the causes which give rise
to this body condition, whether inherited or acquired.
Let us then first consider, as being the more impor-
tant, methods for preventing the production of that
particular, defective state of human bodies which is
essential for the growth of tubercle bacilli, — how^ we
may best combat the development of the so-called
" predisposition."

Public iiealth bodies, as well as individuals, must
give more attention to this personal or body factor.
It will be my endeavor to point out in future pages
how this, in particular, may be best and most prac-
tically done.

ITS XATURE, CAUSES AND IMIEVEXTION.

217

PURE IMl'REGNAHLE BODIES FIRST.

Up to the present time, special measures for the
prevention of consumption have been ahnost entirely
confined to destruction of the bacillus, and the body
cause has received little or no attention. If we bear
in mind that a consumptive in a " moderately
advanced " stage of the disease has been known to
give off daily in the expectoration from the lungs —in
the spittle, by actual count (in a given proportion),
four billions of bacilli, besides probably countless in-
visible spores, and not including other sources of the
germs, as the domestic animals and a possible open-
air growth, we can readily see that destruction of
these is indeed " no easy task." This is not so much
the point, however. At any rate, extermination of
infections, or seeds, should go on.

The late Sir Andrew Clark (lect. already mentioned)
said, " Would it not be infinitely better for us to spend
less of our time in what seems vain attempts to
destroy those microphytes and more of our time in
studying the character of the soil in which they will
or will not grow !* For all my experience points to the
conclusion that it is mainly, if not entirely, through
the influences which we may become able to exert
upon the soil that we may best hope to control or to
stay the progress of phthisis." Professor BLackader
(of McGill) says, " We feel c(mvinced that nmch
more can be done by us as physicians in the way of
prophylaxis by strengthening the barriers that nature
raises against the intruders, than can be effected by any

'< :' 1

'■'u- :i

218

CONSUMPTION

or all of our subsequent therapeutic, antiseptic or germi-
cidal measures." Doctor Burt, already cited, believes
that, *' In dealing with the disease, r' is of primal
consequence to keep in view the goal for which we
may reasonably strive, namely, to elevate the tone of
the tissues and the fluids that bathe them to a sani-
tary pitch, where they themselves are the best of
germicides. Bacteria do not thrive upon such nourish-
ment." And Doctor Carmichael (Exam. Pub. Health,
Fac. Phys. and Surg., Glasgow) says, " Secure cleanli-
ness, purity of food and of the air of houses, schools
and workshops, and consumption, finding no fitting
soil, will disappear."

In brief, the prevention of consumption consists
principally in means for promoting good health and
vigor — purity and tone of tissue, amongst the masses
of the people. With the highest authorities, although
for the most part looking upon the disease as infec-
tious, the destruction of the infection — the bacilli —
about which so much is being said and written, is of
secondary consideration. The body factor is first.

Furthermore, as the reader has been already re-
minded, by improving the health of the masses
individually, they will be enabled to resist the inroads
of other infectious diseases, as well as consumption
in its various forms ; and, indeed, all diseases, even
chronic " local " affections of the different organs.

Again, on the other hand, if we can materially
reduce the mortality from this disease by extermina-
tion of tubercle bacilli alone, there w411 probably be a

^'a'

. f, ■-'■

ITS NATURE, CAUSES AND PREVENTION.

210

)tic or germi-
ited, believes
is of primal
Dr which we
3 the tone of
m to a sani-
the best of
such nourish-
Pub. Health,
ecure cleanli-
;)uses, schools
uir no fittintr

)tion consists
cl health and
st the masses
ties, although
ease as infec-
-the bacilli —
written, is of
or is first.

already re-
f the masses
st the inroads
consumption
iseases, even
t organs,
m materially
>y extermina-
probably be a

proportionate increase in mortality from some other
disease or diseases. Doctor E. P. Hurd remarks (ann.
meet. Am. Climat. Assoc, '91), " Knowing that tuber-
culosis is simply a blight which smites imperfecth/
nourished tissues, I would urge that the eflbrts of
the therapeutist [and sanitarian] be directed to the
(ilement of cellular weakness rather tlian of chasing
the will-o'-the-wisp of a bacillus. Evict one hungry
brood, and another more voracious and more malig-
nant will take its place." In England, although the
mortality from certain diseases has been reduced, from
others it has about proportionately increased. As
W. Roger Williams has pointed out (already cited),
the increase of cancer has coincided with the decrease
of tuberculosis. While there has been a large reduc-
tion there in the total mortality, from all diseases, this
has been, it appears, almost entirely from prolonging
the life of very young and less vigorous persons ; and
mostly by protecting them from infectious diseases.

Let me here repeat, we cannot have much success
in the prevention of disease simply by destruction of
so-called disease germs, while we continue, either as
individuals in our own personal private acts and
practices, or as communities, to transgress the laws of
health — to live in our daily, hourly habits unhygienic
lives — while we continue to provide in our bodies
impurities — soil, for the growth of the germs. So in-
finitesimal are these and their spores, and so rapid their
multiplication, they will continue to elude us and fall
upon and grow in any good soil presented. Wherever

220

CONSUMn^TOX

on the earth's surface there is " waste " soil, there
weeds, from seeds tlie sources of wliich are often un-
known and unknowable, will spi'ing up, and spring up
in spite of us; hoe them down, nip them in the bud, anH
they come up again or others spring up. Somewhat
so it is with the seeds of disease. Sometimes when
we desire to prevent the growth of weeds or grass
through a gravel walk in our lawn, we endeavor to
destroy the fertility of the soil beneath. Let us act
on a like principle in our efforts to prevent disease,
particularly consumption, the seeds of which are S(j
peculiar in respect to body soil. Where the carcase is,
there will the vultures be gathered together.

As individuals, Doctor E. Brown says, " We ought to
learn to keep our bodies as invulnerable to contagion
as a fireproof building is impervious to fire ; that is,
we should be able to resist such moderate quantities
of disease germs as we ordinarily and necessarily
encounter through life. While I would not detract
one iota from the oft repeated cautions to avoid the
external sources of contagion, I yet believe the mys-
tery why one person escapes while another under
the same exposure becomes a victim to contagion, is
explained in the fact that one carries such a store of
vital energy and pure blood that no lodgment for
disease germs is found ; while another by the im-
purities scattered through blood and tissue, invites
disease to enter." And in the words of the Medical
Record (N.Y.), "There is no greater protection against
disease than a good physical condition, in which the
stomach craves and digests food, the intestines, the

Silliill

ITS NATURE, CAUSES AND PREVENTION.

221

>il, there
)ften un-
pring ii})
bud, arul
Dinewhut
es when
or grass
ieavor to
et us act
; disease,
;h are so
;arcase is,

; ought to
contagion
; that is,
][uantities
ecessarily

detract
ivoid the
the mys-
ler under
tagion, is
a store of
ment for

the im-
e, invites

Medical
►n against
hich the
itines, the

kidneys, the skin, and the lungs remove waste pro-
ducts promptly, the liver elaborates the crude nutri-
ent material into the finished product ready for use
in construction and repair, and secretes in abundance
the antiseptic bile ; and, in short, the whole economy
acts as one compact and well-disciplined army, with
all its branches — the cavalry, the infantry, the artil-
lery, and the engineer corps — working in harmony,
each with the other, and each in its own particular
sphere. Bacilli may then attack, and micrococci may
marshall their forces in vain, the liuman citadel is
impregnable, and tlie garrison within lauglis at the
liHputian host which seeks to do it battle."

It is to be feared that before any great success will
result from the efforts of public health boards or
other authorities to reduce the mortality or improve
the standard of public health, more attention and
care will have to be given in some w^ay to the
hygiene of individual bodies of all members of com-
nmnities, old and young — to personal hygiene. This
is entirely practical so far as instruction of the people
in health requirements can be carried out ; and most
can be done, and doubtless, too, a very great deal, in
this line of action. It is hardly more practicable to
insist on good plumbing than on good ventilation.
Public baths convenient for almost everybody would
incalculably improve the public liealth. And through
the schools much could be done by special measures
for preventing asymmetry of body, and particularly
and easily, between the lungs and other parts.

•#

II J-f

•f^K

222

CONSUMPTION

ATTENTION TO MINUTE DETAILS.

Now, while it is most desirable to avoid anxiety or
worry, in any measure, about the health or the con-
ditions which favor or interfere with it, it is, never-
theless, very desirable, especially for persons in any
way predisposed to consumption, to give habitual
attention to every detail relatir»cr to those essentials of
health which will presently be discussed. To some
persons this is natural, while many others are indif-
ferent or careless and consult mainly their tastes and
inclinations. An act or neglect, perhaps seemingly
of little or no consequence, or a habit seemingly
doing no harm, may exercise a decided influence on
the functions of life, especially in a susceptible deli-
cate constitution. It is well known that it is not
uncommon for one or other of the body organs —
kidneys, stomach, spinal cord — to become the seat of
considerably advanced "local disease," possibly already
incurable, from some act, or seemingly harmless habit,
of the individual, as in respect to diet, occupation, sexual
relations, or perhaps breathing, before any symptoms
sufficient to attract attention are m;inifested.

That eminent abdominal surgeon, Mr. Lawson Tait,
on addressing a meeting of the Canadian Medical As-
sociation, in reply to the question, — to what he attri-
buted his success as an operator, said, in effect, to
giving the closest possible attention to minute details
in everything relating to both the previous condition
of the patient and to the operation, especially as to
{ibaolute cleanliness, So it should be with individual

ITS NATURE, CAUSES. AND PREVENTION.

223

habits and surroundings as they hear upon liyjijieno.
SoiiietiuieH in susceptible non-vigorous persons, and
in others, too, the living out of the natural span, or
even perhaps for a day, depends upon the condition
of a few blood cells. Sometimes there are but a few of
the most elementary particles between life and death :
life "hanging" upon even less than "a thread."

Respecting the struggle which may take place in
the human body between the natural forces and
invading germs. Doctor Lauder Brunton says, " The
result of the struggle may be determined, not by
some powerful agency which weakens or destroys
either the organism or the microl>e, but bv some little
thing which simply inclines the scale in favor of one
or the other. In the potato disease the victory of
the invading microbe and the destruction of the
potato, or the death of the microbe and the health
of the tuber, may depend upon some condition of
moisture or possibly of electrical change in the at-
mosphere which aids the growth of the microbe dis-
proportionately to that of the potato. The conditions
need not necessarily be antagonistic to the potato ;
l)ut if they help the microbe more than the plant,
the microbe will gain the victory." In like manner
it is with the human body — with its unfelt and
unknown physiological conditions, and disease germs.

On the other hand, — as a little indiscretion some-
times weighs down the mortal end of life's balance, so
a little extra effort in respect to the essentials of health
— a little watchfulness, prudence, temperance, on be-
half of our physical organism, easy enough to practise

'■ s;

224

CONSUMFflON :

after a (leterniined endeavor and start, may brin^'
down the other end — health, comfort and a prolonged
and useful life.

After having obtained correct knowledge pertain-
ing to the rules of health, then nearly all the refpiire-
ments come within the range of two mental charac-
teristics, — self-denial and resolution: self-denial, by
which there is no further gratification of any one
of the appetites or passions than is in accordance
with the strictest temperance, in all things ; resolu-
tion, by which there is no neglect of duty in this
behalf, and regularity in the practices or habits of
hygiene — out-door exercise, bathing, etc.

DIVISION OF THE SUBJECT.

All means or measures for the pre ^^ention of con-
sumption may be considered under three heads : first,
general measures by which the essentials of health —
pure air, proper food, means of cleanliness, etc. — are
provided for the entire population — for everybody ;
second, special means applicable to persons who hav(3
inherited or acquired a predisposition to the disease,
who have the limited breathing capacity with the
general well-known features, already enumerated, of
the predisposition; third, means for preventing the
forioation of tubercle in persons who have already
acquii'ed the pretubercular condition and are on the
verge of tuberculosis, commonly heretofore regarded
as the commencing stage of the disease, with loss of
the usual amount of energy and, perhaps, of appetite
for food and of body weight. For the most part, the

ITS NATUUE, C^\1;hES AND PREVENTION.

22r>

preventive ineasureH come within the scope of official
liealth authorities ah well as of individuals. Many
of them, indeed, can only bt; provided and carried out
practically and completely by united effort, as by
state or municipality, and ceHain state preventive
measures will, therefore, be ccmsidered.

Fii-st, we will consider in detail those essentials of
h(»alth and life which should always be provided for
tlie masses of the people. Although relating to general
sanitation and hygiene (as these two terms are now
used in a somewhat different sense, although both
have in the original the same meaning), a good, prac-
tical, popular knowledge of such essentials is indis-
pensable to the successful preventi(m of consumption :
consecjuently they must receive attention in a work
of this kind. All persons in any way predisposed to
this disease, especially, should give them practical
consideration, and, as far as possible, personal appli-
cation.

CHAPTEK XII.

GENERAL ESSENTIALS OF HEALTH.

PURE FRESH AIR FIRST.

.f- j)

i III

if & f-

Tf!

Air may be regarded as the first essential of life in
the higher animals, as pure air is that of health.
The evil effects upon the human body of breathing
impure air have been sufficiently dwelt upon in
Part I. : the evils not only of air which has been
overbreathed, especially, but of air rendered impure
by other insanitary states — from foul gases, dust and
damp air — and how such air interferes with the im-
portant function of respiration. Pure air is indis-
pensable to a perfect respiratory function. For the
most part, or so far as we are practically concerned,
air impurities arise from man's own acts — overcrowd-
ing in dwellings and accumulations of waste products
of life in and around them.

The soil upon which mankind live should be dry
and clean, well drained, and kept free from all waste,
decomposing substances on its surface, otherwise the
surrounding air cannot be pure. Heavy, retentive,
undrained soils are less salubrious than those which
are dry. It would be well if there were some legisla-
tion for preventing the construction of dwellings
upon damp soils, such as some towns are built upon,

ITS NATURE, CAUSES AND PHEVENTION.

227

until after thorough drainage. Marshes and swamps
fire naturally shunned.

The back yard as well as the front of all dwell-
iugs must be kept free from decomposing substances,
excess of slops and the like. It should give growth
to a crop of» clean, healthful vegetation — line grass,
flowers, shrubs, and not foul, rank weeds. " Back
yards," as commonly found and understood, should be
entirely done away with ; as also should the too com-
mon low parts, kitchen and sheds — the " tail " ends —
of dwellings, which extend l)ack into yards, and are
rarely kept like the front parts, within or without.
The back yard should be as nicely kept and as pre-
sentable as the front, or more so.

DwELl.lNG-HOUSE conditions essential to health are
so concisely pointed out by Doctor Thorne Thonie, in a
paper on the Dwelling-house in Relation to Consump-
tion (St. Barth. Hosp. Rep.), that I again take the
liberty to quote his words, as follows : " 1. A soil
[for its foundation] which is dry (a) naturally; or (6)
freed by artificial means from the injurious influence
of dampness, and of the oscillations of the underlying
subsoil water. 2. A dwelling-house so constructe<l as
to be protected against dampness of site, foundations,
and walls. 3. Such open space on at least two
opposite sides of the dwelling-house as shall secure
ample movement of air about it, together with its
free exposure to the influence of sunlight. 4. Such
construction of the dwelling-house as will secure for
its habitable rooms and throughout its interior free
movement of air by day and by night, and the free

W-

£j^r

•'^r

228

CONSUMFnON :

access of daylight " ; — i.e., means for good ventilation,
with abundance of windows unobstructed by curtains.
The necessity for perfect house drains and plumbing
to prevent air poisoning need not be dwelt upon. The
CELLAR as commonly constructed should be also abol-
ished. Cellars should be as scrupulously clean, dry,
well-lighted and ventilated as any other apartment.

The bedroom, as a place where a third part of
one's life is spent, is deserving of special construction
and care. The small, c^ose, badly lighted rooms in
which some fairly well-to-do people sleep are a dis-
grace. Want of knowledge as to the requirements of
health can alone account for such rooms. A bedroom,
for even one person, should be large, well ventilated and
exposed to sunlight. The dread many persons still
have of keeping a window open even a little is also
from ignorance on the subject. NiGHT air, so feared,
is vastly better and less dangerous than the breathed
air of nine-tenths of the bedrooms. A window open
all niijht even in cold winter weather can do no
possible harm if the bed, with abundance of clothing,
be placed aside from any direct draught of cold air. In
very cold weather and for feeble persons, provision
must be made for changing the body clothing night
and morning — for going to bed and getting up with-
out chilliness or too great discomfort. Aside from
this, the cooler the sleeping-room one is accustomed to
the better. If necessary the bed may be first warmed,
as by a bed-warmer. W'len in bed anyone can keep
warm with plenty of clothing under and over the body.

Tenement houses are not infrequently in a danger-

ITS NATURE, CAUSES AND PREVEXTIOX.

220

tilation,
iurtaiiiH.
lumbing
)ii. Tlie
l80 abol-
;an, dry,
tment.
part of
jtruction
:ooms in
i-e a dis-
ments of
bedroom,
lated and
sons still
ie is also
JO feared,
breathed
ow open
do no
clothinj^,
d air. In
3rovision
n^ night
up with-
ide from
tomed to
warmed,
can keep
the body,
a danger-

ous atmospheric condition. In selecting one, much
care should be exercised ; and investigations made
respecting its general construction — walls, drains —
and the health of its previous occupants. Remember,
the infections of consumption, as of other diseases,
may adhere to inner walls. 1 f any doubt, thorough
cleansing and disinfecting would be the wise course.
A brief record should be kept by health authorities of
all tenement houses as relatinj; to sickness and death
in them for public reference.

Offices, shops, factories and schools should be
closely looked to, even by those who are to occupy
them, or by parents, as being most directly interested :
particularly in respect to ventilation, drainage and any
previous infection from the sputa of consumptives, or
other disease. A recorded instance in which thirteen
clerks, employed in an office in Paris, died of con-
sumption in four years, attributed chiefly to infection
from sputa, is mentioned in a previous page. Want of
knowledge, carelessness and indifl'erence, on the part
of proprietors of working places, have sometimes
given rise to most serious consequences. Proper
official inspection of all enclosed places where even
but a few persons are employed, and of schools,
should be provided for.

Dust, as produced in certain manufactories, and
even in many shops, or " stores," should be properly
disposed of. Respii'atory appliances for straining the
dusty air, through cotton, wool, crape or feathers, at
best, soon get clogged and are of little use. Free
ventilation with fans and fl\ies for aiding a strong out
current are the best means for dust disposal.

i \

13:. I'ni

r>y,

230 coxsuMPnoN :

VENTILATION : ITS IMPORTANCE, COST, ETC.

Pure air and ventilation are almost synonymous
terms. We cannot have pure air in enclosed places
without ventilation — change of air. After each
breath — inspiration and expiration — there is a pause
of a few moments before the next inspiration, as if to
give the air just expired time to dissipate or be
removed from near the person before the next inspir-
ation. Out of doors, where there is always some mo-
tion of the air, change takes place readily. In closely
env/alled places, if there be no means of ventilation,
it is quite different. If a man go into an ordinary
closed-up room, the air of which is as pure as outside
air, in a few minutes, from the twenty-five or more
cubic inches of foul, poisonous air he every three or
four seconds empties into it from his lungs, the air is
that much from being as pure as the air outside. How
would it be if he remained in it an hour or two, or
eight hours, without means for changing the air ^
or in case of a diseased man, in which the air is
usually fouled more rapidly ?

The physician advises his patients to " take fresh
air," to " go out " or " keep out of doors." In many
cases it is practically impossible for them to do so.
Let them be advised, helped, shown how, to " take
the fresh air " — the " out-dooi's," into their dwellings,
much more freely than is now usual, with abundance
of sunlight, too. This they can usually contrive to do
when they cannot go out.

The Cost of ventilation, of constantly changing

ITS NATUIIE, CAUSES AND PREVENTION.

2in

re.

>nymous
id places
er each

a pause
, as if to
,e or be
:t inspir-
ome mo-
n closely
[itilation.
ordinary
s outside
; or more
' three or
the air is
de. How
two, or

the air i*
he air is

ike fresh
n many
to do so.
" take
wellinga,
jundance
ive to do

changing

warm breathed air for fresh, is the great obstacle.
But it is much easier and better to pay for extra fuel
tlian costs of sickness : better a fresh air bill than
either a meat or a medicine bill. Householders and
others should count on this as on any essential of
Hfe; and rather first of all : make it the first item in
estimating living expenses, — extra fuel for warming
ahundance of fresh out-door air. If necessary, cut
oflf some luxury, as of clothing, or even of meat, in
part, or tea or coffee ; but provide for pure air.

Thk methods of ventilation cannot be entered into
at length here. The first principle, however, is to let
out or draw off' the breathed air to make room for the
fresh. If a strong enough force or draught be employed
to draw foul air out of a room, enough air will be
forced in to take its place : but this may come from
outside or from an adjoining room or house, it must
be noted. An open grate fire provides excellent ven-
tilation, especially if there be an opening, too, near the
ceiling into the grate-chinmey. In the absence of a
grate, an opening, in size 3 or 4 by 5 or 6 inches, in
the wall of a warmed chimney or even stovepipe,
will draw off" a great deal of the impure air of a room
and give tolerable ventilation for two or three persons.
With a high chimney it affects but little the draught or
fire. The opening should be provided with a sliding
door : and the hotter the fire or colder the weather
the smaller may be the opening. Sometimes enough
fresh air will then come in through the walls or
cracks about doors and windows. If the walls are
tight, with storm window^s, weather strips and every

^32

(JONSIIMPTION

crevice tightly chinked, a special opening must be
provided ; as by raising a lower window-sash, closing
the opening below and allowing air to enter bs'tween
the sashes. When the outside air is very cold a ver\'
small opening may suffice. In warm weather windows
and doors should be kept largely open night and day.

The quantity of fresh air which should enter a
room or any enwalled air-space for each individual
occupant has been estimated by the best authorities
at a minimum of 8,000 cubic feet per hour, in health.
In sickness, more is needed. With less than this, the
air soon becomes manifestly impure : and with 10,000
cubic feet coming in per head per hour the air will not
be as pure as that outside. The ( quantity should be
limited only by the ability to bring it in without per-
ceptible draught and to warm it sufficiently, and the
greater it is the better. The larger the room or cubic
space for each person, the easier it is to prevent
draughts : and it is better to have the air warmed
before it enters the room. To measure air precisely
an air meter is required.

A FORMULA of Montgoliier teaches that, if the tem-
perature of outside air be 82^ F. — the freezing point,
and that inside ii^s" — a difference of 32° — and if a
chimney flue, with its contained " column of air," be
30 feet high, an area of the flue of half a square foot
— 72 inches — i.e., a chimney flue of this size (say, 5x14
in.) would withdraw from a room about 12,000 cubic
feet of air per hour : and of course the same quantity
of fresh air would come in, in some way. The area
of an ordinary stovepipe is only about half that, or

ITS NATURE, CAUS^^S AND IMIEVKNTION.

283

36 inches. If tlie outsidi; air be at zero temperature,
making a difference of 04° F. ])etween it and the
inside air, instead of 32", twice as much air will
flow out of and into the room. A fresh air irdet area
of one scjuare foot, say by means of a window sash
three feet wide being raised four inches, in the clear,
will permit the passage or entrance into a room of five
cubic feet of air per second of time, or 18,000 cubic
feet per hour, if it come in through the window open-
ing at the rate of five feet per second : a rate about
e(iual to the movement of a person walking 3i miles
an hour. This rate would be distinctly perceptible as
a draught at the point of entrance, but throughout
the room it would not be half that rate : at ordinary
temperatures, not usually felt. In the same circum-
stances a window two feet wide, raised the same
height, would permit the inflow of 12,000 cubic feet
of air per hour. These figures indicate but an approxi-
mation, in round numbers, of the recjuirements.

Flushing living, bed, nursing, school and other
rooms at least once a dav in cold weather is a ij^ood
practice, however good the usual ventilation. When
the room is warm, open all doors and windows : if
there be a wind a very few minutes will usually
suffice to materially change the air in it. Occupants
may move about or w^ithdraw from the room. After
the room is closed the fresh air is (piickly warmed by
the warm interior of the room.

Breathe full and deep. Much has been already
written herein on the bad effects of shallow, imperfect
breathing. Every person should habitually hold the

;<i8f

234

CONSUMI'TION :

body erect, sitting or standing, and take full breaths.
Many occupations have a tendency to cause stoop
shoulders, which contracts the lungs and lessens the
breathing capacity. By a little effort this tendency
may be resisted. The stoop is a bad habit, objection-
able in all cases, and in some persons may help much
to give rise to a predisposition to consumption.
Habitually full breathers do not take consumption.

The nose is specially designed and constructed to
be the only natural air passage to the lungs. If there
be any obstruction in it to the free passage of air, as
sometimes is the case in children, a physician should
be consulted. It is dangerous to breathe habitually
through the mouth. Most consumptives and scrofulous
persons do so. By effort the habit may be overcome,
even if it be largely from abnormal structure through
heredity.

THE DIETARY : FOODS, COOKERY.

Well, properly, nourished persons, even animals,
rarely become diseased. No narrow fixed rules of
diet can with safety be laid down. Much depends on
constitutional requirements and individual and ances-
tral habits. The digestion and other functions in each
individual case must be consulted. Any change
should be made gradually. A little experience and
observation is usually sufficient, often essential, in
selecting the most suitable diet, quantity required, etc.

These principles may be, however, laid down: in
all cases the food should be abundantly nutritious
(nature is everywhere and in everything abundant),

ITS NATURE, CAUSES ANU PHEVENTION. 235

yet plain — unmixed, not compound — pure, and digesti-
ble. Rich, compound dishes, however nourishing,
usually overtax the digestive and assimilative powers
in efforts to extract their nutriment. Good bread, not
fresh, of course, of wliole wheat fiour being in most
cases best, milk and fruits, for children, and for older
persons, some flesh meat and " vegetables " if desira-
ble, constitute the best diet. Fried food, new bread,
pastry — pies, cake and the like — and highly seasoned
and mixed dishes, are neither digestible nor whole-
some. Comparatively but little food will sustain life
when one is at leisure, idle ; much more being required
when at steady hard work, mental or physical : more
too in cold weather or a cold climate.

Never hurry at meals, nor eat when over-fatigued
or worried ; unless it be but a little warm fluid food
or a biscuit for refreshment. Starchy foods — potatoes,
bread and fruits, should be thoroughly masticated into
a soft pulp with saliva. This fluid aids much in the
digestion of the starchy parts.

To DRINK much at meals is not a good practice : but
when from the nature of food or other cause there is
a desire for liquids, one may sip them in moderation,
when there is no food in the mouth. It is usually
best to take the bulk of the fluids when the stomach
is empty, as on getting up in the morning or on going
to bed. It is, indeed, a good practice to drink a glass
or two of water at such times, hot or cold. Many
persons do not take enough water for the purposes of
complete excretion — purification.

Regularity in times of eating is desirable. Any

23G

CONSUMPTION :

phy.siological function is easier when performed with
regularity. Hence tlie facility witli wliich some habits
are formed. Tlie NUMBER of meals each day is of less
importance than the total quantity eaten. Many
meals tempt to overeating.

Av^oiD EXCESS OF F(J()D. From long personal and
other experience I have been surprised at the small
quantity of food which will sustain an adult person
in the best of health, especially when not engaged in
hard work, and when it is thoroughly digested. The
excess is liable not only to ferment in the stomach an<l
bowels, and give rise to all sorts and conditions of
local disturbances — " indigestion " — but ])robably also
to poisonous substances — ptomaines, which readily cir-
culate throughout the body and disturb and depress
all its functions; while the excretory organs are over-
taxed in etiorts to dispose of or cast out the excess.

Appetite — natural desire for food — the sensation
of HUNGER, should be a safe guide as to the quantity
required: but in most cases in the present age the
natural appetite is so pampered from early childhood
by over-seasoned or sweetened food, that it is not
often safe to trust to it alone. The desire to gratify
the sense of taste is mistaken for a demand for more
food — for actual hunger. A careful distinction nmst
be made here between the two desires: that to gratify
the gustatory sense, and that to satisfy the needs of
the body. Experience, with careful observation, eating
slowly of only plain food and watching carefully for
the first feeling of satisfaction as distinguished from
satiety, will enable anyone to soon learn the quantity
of food actually needed by the system.

ITS NATURE, CAUSES AND PREVENTION'.

237

ned witli
ne habits
is of less
. Many

onal and
lie small
It person
igage<l in
ied. The
nach and
litions of
bably also
iadilv cir-
d depress
are over-
bxcess.
sensation
juantity
) age the
childhood
it is not
o gratify
for more
ion must
o gratify
needs of
)n, eating
fully for
led from
quantity

Children often receive injustice from parents, all
un^vittingl3^ in being allowed to lay the foundation
for future suttering and disease by indulging their
unsophisticated appetites with focjds too })leaHing to
the taste of the easily tempted little ones, commonly
from excess of sugar. The welfare of all ciiildren is
nncjuestionably best ))romoted l)y the use solely of
the plain foods — bread, milk, fruits in season, fully
ripe and sound, usually best raw, or not cooked with
sugar. These, moreover, are usually highly relislunl
and enjoyed by the little persons with no ac(iuired
appetite for other foods.

Cookery is most intimately associated with the
nourishment of the body ; and bad cookery is respon-
sible for much derangement of the body functions.
It is impossible for anyone to be properly nourished
on badly cooked food. 'I'he art of cooking should be
generally and correctly taught, as in the schools or in
special institutions. Radical reformers, who would
make man again a non-cooking creature, may do good
by denouncing the ai-t of cooking in its present form.
Raw beef, if pure and sound, is probably better than
over, or badly cooked beef- and certainly good ripe
seasonable fruits are better raw than when over-cooked
in the usual w^ay with sugar, forming the too common
preserves and jams of most countries.

Tea, coffee, and alcoholic beverages, it need
hardly be said, should be indulged in only in strict
moderation, if at all, by ever; oody. The intemperate
use of alcohol in any form lowers the vitality : and it
does not take much imbition of it to practically

Wy-

2;i8

(•OXSIJMPTION

ccHistitute inti'inperance with this powerful Htiniulant.
Many young girls, and mothers, too, use much more
strong tea, less frecjuently coffee, than is consistent
with healtli or digestion. Many great sufferers from
over-indulgence in tea have come to my notice.

The watkr and milk supply must .be closely
looked to, and spring, well, or other water kept free
from any form of conte 'tion. If its purity be
doubted it should be boilea. The milk used must be
pure and especially from healthy cows. If at all sus-
pected, it should be sterilized by heat — a little below
the boiling point (or ISO*" F.) will suffice.

.li

GENERAL BATHING AND THE SKIN.

The bath to keep the skin clean and active is an
essential of health which is not generally appreciated.
The importance of the skin, with its probably two
and a quarter millions of s-^^eat glands (Huxley), as a
vast emunctory, has beer ided to. The skin has
been termed " the most important organ in the
human economy" (Baruch). It performs a number
of important functions: (1) that of a strong protec-
tive, sensitive covering to the inner organs ; (f!) that
of touch ; (3) that of excretion — casting out — of car-
bonic acid and urea (as it were, aiding the lungs and
kidneys) besides other waste solids, with a large
amount of water by which, as vapor, in the form of
perspiration, it (4), most important of all, regulates
the body temperature. Every clothed human being,
in order to keep this great defender of the body in a
healthy and sufficiently active condition, should take

!■'

ITS NATUUE, CAl'NES AM) 1M{KVKNTU)N.

239

111 Htiiiiulaiit.
) much more
is consistent
ifferers from
lotice.

i .be closely
er kept free
bs pnrity be
sed must be
If at all sus-
> little below

IN.

active is an
appreciated,
robably two
uxley), as a
le skin has
gan in the
s a number
on^ protec-
18 ; {?.) that
3ut — of car-
e lungs and
th a large
he form of
11, regulates
man being,
e body in a
hould take

a daily bath of sonu- sort — a wash ovri the whole
body surface with after friction : this not only in
warm weather but in cold, when it is most needed.
Tf such a practice could be made univ(>rsal, the
public health .standard would be innnen.sely increased.
Much that would be of int*'rest could In; written
on the history of the bath and value of public bathing
for public cleardiiiess. The difference between the
facilities for, an<l practice of, general bathing amongst
the peoples of the East, ancient and modern — Per-
sians, Hindoos, Egyptians, Turks — when compared
with those of Western Europe and America at the
present time, is as remarkable as it is inexplicable.
In Russia, whatever the sanitary ilefects, the use of
the vapor bath for cleansing the skin, Doctor John
Bell informs us (Treatise on Baths), "is general, from
the Emperor to 'he poorest serf;" and in all northern
Europe " there is no hut so destitute as not to })ossess
its vapor bath." In Tokio, Japan, there are, it is said,
eight hundred public baths (almost as many as Rome
ever could boast of), and the poorest laborer there can
have with facility the luxury of a daily thorough skin
cleaning. The liberal use of soap and water, it is com-
monly said, is a great civilizer. Few persons, if any,
will deny that, as Doctor Simon Baruch (Phys. Man-
hatt. Gen'l Hosp., N.Y.) words it, in a pamphlet, " A
Plea for Public Baths," " Among the agencies which
the experience of the human race in all ages has
demonstrated to conduce to the preservation of
health, personal cleanliness occupies the foj:*emost
position. . . . Cleanliness, perfect, absolute cleanli-
ness" Without a clean, open-pored, flexible, active

i^^^^j^^

240

CONSUMPTION

J f

8*^ "

J^~

skin, no one can be clean within; witliout inner (blood
and tissue) cleanlineHH no one can be' truly healthy.
The eminent Hufeland said, " I repird cleanliness and
cultivation of the skin as the chief means for pro-
lon^in^ life."

How is it in these very countries we regard as
the most civilized ? The great body of the people
are here commonly characterized, by the compara-
tively few who do habitually wash the body surface,
usually in cold water only, as the "great unwashed!"
While cultivating one special feature of Christian
civilization — charity, have; not Christians been guilty
of neglecting a common duty which was intended by
the great Founder of that civilization should not be
neglected — personal cleanliness by more fre(pient
washing? By making baptism {(jVimk, Baptisma :
hapficAi, to dip in water) the first manifest emblem
of Christianity, it could not have been intended that
the then connnon practice of bathing amongst Jews,
as well as Greeks and Egyptians whose priests bathed
two o)* three times a day, should be in any way or
degree neglected or superseded by that " charity,"
now so conspicuous in the provision of almost every
want for the masses of the people except facilities for
ordinary reasonable personal cleanliness — for keeping
clean the living " temple of God " (St. Paul).

The value of public bathing has been clearly dem-
onstrated, practically, in Germany, where in recent
years a system of warm shower or rain b!>ths has
been iytroduced into cert^iin schools and bai'racks for
washing the puj>ils and soldiers. Amongwc these

ITS NATUUK, CAUSES AND PHEVENTION,

^41

|K!r.soiis, HO l>atl)0(l, tlun-e lias been, a.s a consecjuence,
n marked iiuproveineiit in health, vigor and intellec-
tual power, witli a redueed mortality. The Director
of one of th(5se wehools in Weimar reports that,
althouj^h at fir.st l)ut few pupils were disposed to
take the hath, after two luonths, 75 per cent, of them
took it daily, and " tlu; freshnesH and pleasure for
study after the bath, the cultivation of a desire for
cleanliness an* I the promotion of health, offer such
decided results that 1 cannot refi-ain from recom-
mending " the syst(!n> to other schools. Certain
manufacturers there have provided their employees
with facilities for bathing, and the improved health
and more efficient service of the en^.ployees give a good
return for the outlay incurred. At a health congress
a few years ago in Hastings, Kng., Sir Edwin Chad-
wick said, " The Cerman army was the lowest death-
rated of any in Europe" (5 per 1,000 men: England,
H: France, 10; Italy, 11, per 1,000). "One means of
this was the factor of washing with tepid water,
'i'hat, he had shown, in England, was the great means
of reduction of the children's diseases in the district
schools. In Germany half a million soldiers were
being washed with tepid water at the cost of about
()d. a hundred, soap included. He expected to be able
to display a power of washing children with tepid
water at the rate of . . . one ptuniy for a dozen"
(8 minutes for each pupil at each jet or bath). "He
had long ago shown that washed pigs put on one-fifth
more flesh than the unwashed, and more than this
was the result wnth children " (Brit. Med. Jr.).
10

P^wtS.]

242

CONSUMPTION :

Shower baths by sprinkling jets can be provided at
less cost than immersion baths, and the cleaning
effects are better : each batlier while rubbing his body
being under a continuous sprinkle of fresh water. In
the New York Juvenile Asylum, 280 are washed per
hour, each with fresh tepid water.

Until special provision for more general bathing be
provided, there is no one who could not at least wash
all over the surface of the body every day with the
warm hands dipped often in water, just as the face is
commonly washed. TV * constitutes an easy, refresh-
ing, invigorating bath. An occasional warm water or
vapor bath for "opening" — cleaning out, the pores of
the skin is necessary, especially for persons who do
not perspire freely ; for those exposed to dust a good
wash with soap should be taken more than occasionally.

The innek bath, to wash out the tissues, is as
essential as the surface bath. Said Doctor T. Lauder
Brunton, F.R.C.P., etc. (Phys. St. Barth. Hosp.: in
Cavendish lect., 1895), " Water is not only useful to
wash out our closets and flush our drains ; it has a
similar effect in our bodies, and tends to wash away
the waste products from the cells of which our organs
are composed, to clear out the uric acid, urea and
phosphates through our kidneys, . . . and to wash
out our liver, especially an organ which suffers much
from want of water." For the most part, the improved
health resulting from a sojourn at various " springs,"
he, with other high authorities, contends is from
" an abundant supply of water " in the body rather
t!ian from any " medicinal " ingredient in the watei-.

provided ut
e cleaning
ig his body
water. In
vashed per

bathing be
least wash
ly with the
3 the face is
isy, refresh-
rm water or
the pores of
ons who do
dust a good
Dccasionally.
issues, is as
)r T. Lauder
. Hosp.: in
ly useful to
IS ; it has a
wash away
1 our organs
urea and
and to wash
ufFers much
le improved
" springs,"
ids is from
3ody rather
the water.

ITS NATURE, CAUSES AND PREVENTION. 243

SOME OTHER ESSENTIALS.

The CLOTHING should be such as to prevent
chilliness or a feeling of coldness : but on the other
liand, not such as to create sensible perspiration.
When out of doors, one in fair health should keep
warm rather by exercise than by the clothing : reserv-
ing heavy or thick overcoats and mufflers for the
coldest days or for driving in. Woollen is probably
best to wear next the skin at all seasons. It need
not be worn in bed. The garment worn next the
skin during the daj should never be worn in bed.
The oftener the underclothing is clianged, and either
washed or well shaken and exposed to the air and
sun, the cleaner, and better the action of, the skin.
As to the quantity of clothing necessary, habit and
use have, as in everything else, much influence. One
may by wearing much, soon seem to require much, or
on the other hand, habituate themselves gradually
to comparatively little.

Of exercise (physical) the great majority of per-
sons get enough; many too much: many, particularly
women and young children, not enough out of doors.
Large numbers of young men do themselves harm by
engaging too freely in the more active games. Al-
though exercise is highly extolled and reconnnended,
probably the benefit of out-door exercise is often much
more from the out-door part— purer air and sunlight,
than from the exercise in itself. A certain amount is
an essential of life : and all the muscles must be
brought into daily use or they will lose their actual

ilil

244

CONSUMPTION :

I'y^,

ihX%

structure and become soft and weak. Then their
action — their repeated shortening and swelling out, in
producing motion, greatly promotes the circulation of
the blood, and also of the lymph. Lymph, it should
perhaps be stated here, for non-medical readers, is a
thin watery fluid which circulates in very minute
delicate vessels, called lymphatics, about as freely as
does the blood. It seems to be a sort of auxiliary to
the latter in both nutrition and secretion, with an
intermediary function between the blood and true
tissue structures ; a kind of " go-between." The
lymphatic glands exist along the course of these
vessels, and are very liable to become the seat of
tubercle bacilli. Exercise is therefore a necessary
agent in both nutrition and the elimination of waste.
It also promotes respiration, digestion and sleep. A
good many persons — students, writers, sewing girls — do
not get enough active exercise to keep the breathing
function up to the health standard — the " breath
good," and the muscles fairly firm. The remedy is
obvious, and must not be neglected if health and life
are valued. Athletism is the other extreme.

Overwork, on the other hand, is frequently a strong
factor in causing consumption. Some men and many
wives and mothers drudge their life away, joylessly,
the latter usually at in-door household work, probably
baby-nursing, striving to " make ends meet " or per-
haps with the unwise object of saving money. Con-
sumption is more likely than any other disease to be
the consequence of the exhaustion and depression
en used by such a life. What physician after a few

ITS NATIHE, CAl'SKS AND PMEVENTION.

245

years of practice cannot recall the death From this
disease of a mother, caused, remotely but largely, by
liousehold drudgery while suckling an infant { Men
who overwork do so usually in the open air, and
serious consequences follow less fre([uently. Rest
more, busy, active wives and mothers : rest. Lie down,
and calm and rest the mind, too, two or three hours
every day. Let the least important worlc go undone.

Sleep checks and moderates, at fixed poiiods, the
incessant and perpetual stream of vital consuuiption:
said, a hundred years ago, that distinguished philoso-
phic physician, Hufeland. From sleep we "obtain
the happiness of being daily re -born ;" of "passing
every morning into a new and refreshed life." The
importance of getting sufficient sleep need not be
dwelt upon. Probably no one can do well with less
than six hours, or needs. more than eight. The best
hypnotic is a judicious combination of a contented,
un worried mind, a body free from symptoms of in-
digestion, slightly fatigued, and a comfortable bed in
a (juiet, well-ventilated room.

Sunlight is another essential of health, which is
not commonly prized as it should be. A large pro-
portion of men and boys get it freely out of doors,
but many women, young girls and little children
suffer for want of it. Husbands and parents should
see that their wives and little (jnes get more out-in-
the-sun recreation, and more surdight in-doors by
means of uncurtained windows.

Avoid excess in everything, we must, if we would
preserve even a fair degree of health and vigor.

246

CONSUMPTION :

\,m

I W'

[w-

i:^

Intemperance of any kind, soon in some cases, later in
others, depresses the vitality of the whole organism,
and predisposes to consumption.

The excrktory functions must be kept in order.
Usually they will not reiiuire more than attention to
the general instructions herein. Constipation of the
bowels, however, nnist be prevented or removed, as
by the coarser foods or mildest laxatives, with regular
" habit." The kidney excretion, if not free and clear,
may require more water drinking; and the skin,
occasional exercise, to cause free perspiration, — or a
warm or rather hot bath.

All infections should be by all persons, particu-
larly chi'-^ren, carefftlly avoided. It may not be too
Utopian to hope the time will come when from more
perfect public sanitation and personal hygiene, infec-
tions will be practically eradicated. Meantime, the
infected should be kept isolated.

Concluding precepts : make no sudden changes,
but gradual changes, in established habits and uses.
Never neglect a " cold on the lungs," but if it be not
" going ofi'" in a week or so, apply to a physician. In
convalescence, or when not verv well, exercise extra
care in avoiding infections. Do not marry a con-
sumptive, or not until she, or he, is free from marked
predisposition. Avoid night vigils; the depressing
weed, tobacco ; mental worry or depression ; and
endeavor to keep on the peaceful side of all mankind.

CHAPTER XIII.

SPECIAL INDIVIDUAL PREVENTIVE
MEASURES.

We have now considered in sufficient detail the
general essentials of health, applicable individually
to the entire population, for the prevention of disease
generally, or of body derangement of any kind, and
consequently of the development of a predisposition
to consumption. It is safe to say that if the instruc-
tions given in the previous chapter were fairly and
practically carried out by everybody, few if any such
predispositions would ever develop. Lamentably few,
however, of those who know the rules of health follow
them even fairly well, or not until the discomforts or
pains of a deranged or diseased body awaken them
to a realization of the fact, that in order to keep
fairly healthy it is necessary to be guided in our
habits of life, not altogether by our more or less
morbid or sophisticated desires or inclinations, but
rather by certain reasonable health rules or laws :
laws for the most part made known long ago, by
inspiration to man by his Creator, through the great
law dispenser, Moses, the transgression of which
inevitably brings, soon or later, in some form, the
punishment — the consequences of " sin." Then, indeed,

ill

248

CONSIJMI'TION

ill-:

till

the pound of cure is sought for. We shall have,
therefore, for a long time to come, numerous persons
developing a fitting soil for the tubercular seed ; whilo
at the present time there are thousands with soil
already fitted. Let us next, then, consider some
special measures for preventing the development of
the disease in persons who possess, in a greater or h^ss
degree, either from inheritance or habits of life, the
predisposition to it, as already described.

In Part I. of this book the nature and importance of
respiration was explained, and the manner in which
imperfect performance of this function seems to give
rise to a predisposition to consumption. It was also
explained, how the lungs perform a double function —
that of supply (of oxygen) and that of elimination
(of waste), or excretion : how they expose to the
atmospheric air within them the blood which had just
circulated throughout the V)ody, and allow it to get its
load of oxygen and discharge its load of carbonic acid
and watery and other vapors ; how that when the
lung membrane is contracted or thickened and not as
active as it should be, sufficient oxygen is not taken
into the body, and waste matters are not cast out but
accumulate in the blood and tissues ; and that there,
eventually, in their decomposition, they probably give
rise to certain inorganic substances — food for sapro-
phytic, vegetative micro-organisms such as the tubercle
bacillus — and also, to some special organic toxic
compound (or compounds), by which in some way
non-virulent bacilli are transformed into pathogenic
or disease germs, which then constitute an essential

ITS NA'miE, CAIJSES^AND rilEVENTFON. 249

factor in tlie production of tubercle and causation of
consumption. In brief, it seenis highly probable, as it
was my endeavor there to demonstrate, that a certain
condition of body produced by the decomposition of
accumulated waste in th(; blood and tissues consequent
upon defective breathing, is also an essential factor,
indeed, practically, the immediate exciting cause, of
consumption : and that all other causes, excepting
the bacillus, are rather secondary or remote, and for
the most part only help to produce the defect in
respiration. For example : all depressing, debilitating
habits, as in respect to diet, exercise (or want of it),
etc.; debilitated or deranged conditions, as in rickets
and measles ; also, lung adhesions from pleurisy ; and
still more directly, dust and other air impurities,
more especially those from the breath, all contribute
to limit or obstruct the breathing function.

There are many bad breathers ; many persons who
do not breathe enough air ; who from proportionately
small lungs from heredity, or from habitual shallow
breathing with originally well-developed lungs, often
influenced by occupation, perhaps by close study
at school, do not take into the lungs enough air and
oxygen, and consequently do not throw otf the waste
excremental matter which should be thrown off by
the lungs. The system then eventually becomes
poisoned by its own tissue refuse, the dead waste of
imperfect tissue metabolism, or wear, or the toxic
products of the decomposition of this waste. Further-
more, full breathing is essential to the free circulation
of the blood and lymph, and hence also to complete

250

CONSUMPTION

rt^li

i'W

.4' i.

H ,

nutrition; and so shallow breathing contributes in
this way, too, to the general bodily derangement. As
Professor Roberts ( Boston) says, " As a man breathes
so he lives. To half breathe is to only half live."

Now, whether any special bacterial food or trans-
forming toxine be produced or not in persons with a
defective respiratory function, it is from imperfect
breathers that consumption selects its victims ; if not
actually in every instance, practically so. These are
the persons who provide the " good soil " for the
seed ; these are they who take the disease.

No physician now undertakes to treat or cure the
disease, however early the stage, even in the pretuber-
cular condition, without lirst of all making efforts to
improve the respiratory function, — to increase the
intake of oxygen and consequently output of tissue
waste, by at least insisting on the use of the " pure
air " or " out-door " remedy, or an out-door life.
Usually physicians go still further in this way, and
recommend all such patients to breathe deeply and
freely of the pure out-door air, and perhaps with some
special chest exercises ; or as in some cases, the pneu-
matic chamber is employed, or it may be, the inhalation
of oxygen is recommended.

Defective respiration is never alone, it need hardly
be said, never the only cause of the predisposition.
It never works up the special body condition — the fit
soil, by itself. Helping it on are usually impure air,
improper food, depressing habits and other assistants.

The remedy in such cases is simple, chiefly to
improve the breathing function. It is comparatively

ITS NATURE. CAUSES ANB PREVEXTION.

•i.")!

easy to habitually increase the amount of air
breathed, as already stated, whether the defect be
hereditary or ac(|uired. Especially is it easy in youn^
persons. Even in persons advanced in years, and
those in the early stages of consumption, the breath-
ing capacity may be considerably augmented. While
improving res[)iration, other conjoined causes nuist be
removed. Pure air must be breathe* 1, night and day;
the food must be made as suitable as possible ; the
skin especially must be attended to, and so on.

Usually there is no difficulty in any person recog-
nizing the imperfect breather after attention is once
drawn to him, or to her, by the failure in general
health or vigor ; or in case of hereditary defect, by
the general delicate or puny constitution, as ex-
plained in a previous chapter. i

GENERAL RESPIRATORY EXERCISE.

Persons predisposed to consumption particularly
require general exercise, because of the increase in
the circulation of both blood and lymph which it
causes, and the consequent elimination of waste from
the body. But exercise demands force, and force,
digested food; and the strongly predisposed are there-
fore often not able to take much exercise. Hence
the necessity and value in the worst cases and in the
earlier stages of the tubercular state of passive exer-
cises — massage and " Swedish movements ' — given by
another person, without effort by the affected person.
It is necessary then for the predisposed to take exer-
cise only proportionate to the constitutional ability,

2r,2

roNsrMrriox :

hihI without cxliaiiHtinij : to which |)oint i\\v cxcM-nisc
should never ho curricMl, nt)r even to j^reat, on\y to
sliffljt, I'atij^ue. This is important. It i.s safer to eir
on tlie side of too little. Thos<; exercises which tend
more particularly to expand the chest and lung's an?
to be reconnnended.

Erect posture of body, sitting, standing,' and
walking, with the slioulders and head set well back,
as in the following figures, 1 and 3 (from Check ley),

■11

llM

Fig. 2.

Fig. 3.

Fig. 4.

is particularly desirable. A stoop is ver}'^ commonly
a precursor, indeed a cause, of contracted lungs, and
must be promptly and completely counteracted. By
taking the correct posture whenever it can be thought
of, most persons will sooi ' hen strongly impressed
with the import 1' it, acquire a habit of keeping

the body ereci ^t first it ay be tiresome, but by
use the musck. become stronger and the upright

the <'X<n'oiH(>

•eat, only to

safer to en*

whiclj tend

1(1 lungH are

^andinfj and
t well back,
n Check ley),

Fig. 4.

y commonly
d lungs, and
eracted. By
n be thought

y impressed
t of keeping
5ome, but by

the upright

ITS NATUKE, CAUSES AND PUEVENTlOiN.

253

habit unconsciously sustained. Children disposed to
stoop should be encourage«l to keep erect by being
frequently reminded of it. Occasionally shoulder
straps or supports are necessary ; ' but I have very
rarely found it so. When use<l they should be left
off when the upright habit is ac(|uired.

Walking increases largely the respiratory function.
Running produces a moi'e marked effect; and walking
up hill a still more. Hence tennis, golf, crickt.'t and
even baseball are useful exercises. Hoxingand (juoits
are also good. Football and lacrosse are liable to be
too violent. Rowing, if it do not excite too nuich
the heart's action, is goo<l; paddling still better; so
with the more prosaic wood sawing or chop[)ing. In
the latter it is better to have the log or stick raised
up, as on a special " saw horse." WHien bicycles are
so constructed that the rider is required to sit up
erect, bicycling may be indulged in. Horseback ri<l-
ing has been extolled perhaps more than anything as
a mild exercise for consunqitives. It is Ixist to sit
firmly on the saddle with the body and arms in
full play with the trotting horse. When one walks
the arms should swing freely. Any exercise which
greatly increases the heart's action, as to "palpita-
tion," should be avoided. In all cases avoid dust as
much as possible.

SPECIAL LUNG EXERCISES.

A variety of exercises or so-called lung gymnastics
have been recommended by different physicians for
increasing the lung surface and function. Some of

254

CONSUMPTION

h I

^-t-i

|i:i

these require certain appliances, as dumb-bells, chest
weights, etc. ; others are simple or '" free." The use
of most appliances requires the expenditure of more
force than do free exercises. The object is to increase
the respiratory capacity — tue size of the chest and
lungs — first of all, and with the least expenditure of
force. Free exercises are therefore usually best for
non-vigorous persons.

To simply increase the breathing capacity, in cases
with no lung disease, it has been my practice during
the last quarter of a century to recommend the fol-
lowing free exercise, which has proved quii.e satisfac-
tory : In pure air, out-doors when possible, standing
in a correct position, slowly carry the hands from the
sides to meet above the head, well back, and at the
name tiiae draw in air slowly until the whole trunk is
fully distended ; then while slowly bringing the hands
down again let the air out slowly until the trunk is
compressed as much as possible. Breathe two or
three times in tlie ordinary way and repeat the act.
This do five to ten times ; and three or four times a
day or oftener go through a like exercise.

After a little practice endeavor in the acts to dis-
tend the chest as much as possible without straining
ettbrt ; hence slowly. Should slight dizziness occur
at any time, as it may at first with very full disten-
sion, it will soon pass away. In beginning, some
young persons experience difficulty, usually from haste
in the attempts. A little time and patience will give
success, in this as well as in the more complicated
vigor^us ^^xercises to be presently Joscribed,

ITS NATURE, CAUSES AND PREVEXTIOX.

255

Besides increasing the chest capacity, it is desirable
to strengthen the chest muscles that tlie increase maybe
permanent. For this, the six formulas below (chiefly
from Denison, as cited) answer every purpose. The
forms should be practised in the order given : the first,
milder ones for a time, and then the next, and so on,
reaching the more vigorous perhaps only after months
of practice. Each act, as directed in each form, is to
be repeated three or four to ten times in succession
on each occasion, — few times at first, more after
practice, and one, two or three times a day. And one
should always go through them deliberately, not
hurriedly. The latter more severe ones are not indis-
pensable, remember, to gooil health ; but when ratlier
a pleasure than a cause of weai-iness or discomfort,
they usually give greater vigor and resisting power.

The time, place and dress for the exercises are of
importance. An hour or two before or after a meal is
the best time. They shouM always bi taken out in
the pure open air, if at all practicable ; if not, in an
open shed or large, cool, liglit, airy room. Tlie clothing
must all be so louse as to permit the freest possible
movements. This is an indispensable condition Cor-
sets must of course be left oft', (,'specially while exer-
cising, and be worn very loose at all otiier times.

Persons of strongly marked predisposition, and es-
pecially after any blood spitting, must be carefid in
the beginning in even the mildest form, that already
described : r.nd of course, in such cases, under the
guidance of a physician. All the forms are perfectly
sife at any stage when gradually, carefully an<l

lirrr

r '

I'i

! liP

256

CONSUMPTION

moderately practise*!, only mildly at first, with but
few repetitions.

Besides the special forms, or to begin with, it m
well to practise striking the arms out forward, as in
boxing, and sideways, too, with a degree of vigor pro-
portioned to the strength, and for a very short or a
longer time, always breathing deeply.

In all cases or exercises start with, and pause in, the
correct posture or attitude of body.

1. Stretch the arms out, from the side, to the front,
horizontal, then slowly draw the elbows back, close to
and past the sides, as far as possible, and take a long
deep breath at the same time, and repeat.

2. Slowly raise the arms to front horizontal while
taking a deep inspiration ; then hold the breath while
the largest possible circle is made with each hand, both
at the same time, upward and backward, above the
head, and around to the sides again.

3. While settling down on the toes, as represented
in Fig. 5, make a forced expiration; then while rit 'ng
slowly to full height take a full inspiration, and at
the same time move the hands in a circle, downward,
backward and upward, somewhat as in swinnning,
with the arms stiff.

4. While extending arms directly forward to hori-
zontal take a deep breath ; then without moving the
face or feet, move right arm and chest around toward
left as far as possible, keep left knee stiff, bend right
one and couch the floor with fingers, expiring while
returning to correct standing attitude : next, take
another deep breath while raisiiig arms again to front

ill'

ITS NATURE, CAUSES AND PREVENTION.

257

, with but

with, it in

NAvd, as in

vigor pro-

short or a

muse

in, the

50 the front,
ack, close to
take a long

zontal while
breath while
;h hand, both
il, above the

represented
while rit 'ng
ition, and at
J, downward,
swinuning,

r&vd to hori-
moving the
Iround toward
F, bend right
cpiring while
next, take
Lgain to front

horizontal, and then turn left arm and chest to the
right, bending left knee while touching the floor.

5. Extend the arms to side horizontal and walk
thus into a corner of a room, as in Fig. 6, and while
there take from three to ten full inspirations: by

I'.
f

Fig. 5.

Fig. 6.

practice from day to day gradually get a little farther
ftnd fart si- into the corner.

6. Place two chairs about twenty inches apart, and
with the body straight and stiff', rest on the toes and
hands, — Fig. 7 : settle down between the chairs and
take a few deep inspirations and then raise the body
to the height of the extended arms.
17

258

CONSUMPl'IOX :

PI'
111 !

■ I'i:

li'iii
I!
P

}!
Ill

Remember the instruc.tions given in the three or
four paragraphs immediately preceding these for-
mulas: commencing gradually with the first and
simplest exercises, etc.

HOW TO KEEP OUT OF DOORS.

It has been stated that the benefits of an out-door
life are more from the pure air and sunlight than
from exercise. It is commonly believed that in cold
weather one cannot be out much without exercising

Fig. 7.

a good deal or working, in order to keep warm, or
unless well wrapped in a carriage or sleigh. This is
a serious mistake. By putting on sufficient clothing
one may sit or lie down out-doors when the ther-
mometer is below the freezing point. I have per-
suaded patients to sit outside most of the day, and
with a camp-cot or lounge, to occasionally lie down,
with heavy under-flannels and two cr three coats on,
in freezing, December weather, witii great benefit.
Women may contrive to dress equally warm. On
any approach to a feeling of coolness, and before chilli-

wii

ITS NATURE, CAUSES AND PUEVEXT1(>N.

•259

e three or

these for-

3 first and

m out-door
nlight than
that in cohl
t exercising;

p::

eep warm, or
iigh. This is
jient clothing
len the ther-
1 have per-
the day, and
ally lie down,
tree coats on,
reat benefit,
warm. On
before chilli-

ness, a little walking about or arm-swinging is neces-
sary. When one is so circumstanced as to be able to
drive, of course it is pleasanter ; but there is no reason
why one may not keep as warm sitting on a comfort-
able chair or lying «[uietly on a lounge out in the sun-
shine in severe weather, as in an easy open carriage or
sleigh moving about, except it be in the diversion of
the mind by the little change of scene in driving. One
can be " bundled up " just as well on the cliair or
lounge ; and read nmch better. In this way invalids
may safely remain out nmch more than seems possible
to many persons. The feet and hands slumld be well
protected. The chief point is to put on abundance of
clothing on every part of the body. Wraps and
(juilts may be used. Always exercise care that the
breathing be not in any way or degree impeded by
the clothing ; and keep up deep breathing.

OCCUPATION CONSIDERED.

Choice of occupation for the prevention of consump-
tion is a subject perhaps next in importance to that
of provision for breathing abundance of pure air ; for
it closely concerns or bears upon the faciHty or possi-
bility of a perfect respiratory function. All persons
at all predisposed to this disease sliould therefore give
it special consideration. Besi<les too c(mstant confine-
ment in-doors, there are two ways in paiticular in
which occupation may even give rise to the predis-
position : namely, first, by necessitating more or less
strongly certain body positions which cramj) the
chest and prevent habitual full and free expansion of

™*

' i"

jmn

260

CONSUMKriON

the lun^s ; and second, by giving rise to excess of
(lust in the atmosphere. Pei-sons working in a dusty
atmosphere, too, naturally avoid deep breathing.

The influence of occupation upon health and espe-
cially as predisposing to consumption has been long
recognized. Over a third of a century ago, Doctor
(Jreenhovv, a practical sanitarian, in Kngland, drew
attention to the enormous mortality from this disease
in England and Wales, chiefly from the eflects of
dusty occupations. The death rate was particularly
high amongst potters, grinders, fllemakers, printers,
masons, w ol and cotton manufacturers and others
working in dust; also amongst tailors, dry-goods
clerks, groct./s, bakers, carpenters and dressmakers.
In 1860, the medical officer of the Privy Council
reported that. " In proportion as the male and female
populations are severally attracted to in-door branches
of industry, in such proportion, other things being equal,
their respective death rates by lung disease (phthisis)
is increased." Since that time a gi'eat reduction in
the mortality has been effected, as by wet grinding
and free ventilation. • Much yet remains to be done,
however, on this continent, as well as elsewhere.

A practical illustration of the effiicts of occupation
on the consumptive has been recorded by Doctor
Herman Weber (Croonian lect., 1885). Although it
has been many times published, it w^ill be well to
quote it here as briefly as possible. A teacher and
his wife both died of consumption under Doctor
Weber's care. They had had seven children, the
second one of whom had died young of tuberculosis

ITS NATURE, CAUSES AND PREVENTION.

261

of the brain membranes. At the mother's doai/h, four
boys, of twelve, nine, seven and two years of age, and
two girls, of five and one, respectively, were living and
fairly healthy, except the youngest boy who had
rickets. Of eleven cousins of these children, nine
(lied of consumption before the twenty-eighth year of
their life. The prospects of the six orphans looked
gloomy. They were sent to the country — a moun-
tainous district in Silesia, and brought up with nmch
care under Doctor Weber's instructions. The eldest,
up to the age of twenty-three, so long as he lived
mostly out of doors, with probably hill climbing, was
well and strong. " He then became a hard student,
working night and day, having his meals in his
rooms, and taking very little exercise. In eighteen
months afterwar<ls he died of rapid consumption.
The second son was a farmer, and remained healthy
until his twenty-nintli year. He then became tired
of the monotony of country life and went into a mer-
cantile house, where he was engaged for many hours
each day in an office. He worked hard at his books
in his own room during the evenings. After two
years he had repeated iia3morrhages, and in two years
more he died of tuberculosis." The third son became
a cavalry soldier, lived judiciously and remained
liGalthy and strong. The youngest son, who had been
rachitic, was a healthy farmer in Manitoba a year or
two ago ; and his younger sister, a healthy girl, was
keeping house for him. The elder daughter married a
country clergyman and r^»nained quite healthy.
The history of this family, l^octor Weber remarks,

202

CONSI'MI'TION :

hvi'i

ri:

"shows thatl)y favorahle cii'cuiiiHtuncas.even a strongly
marked family tendency may be neutralized. . . ,
It further teaches the serious lesson, that if the strin-
gent rules of health are neglected, even after the
constitution has l)ecome satisfactorily developed, the
disease may suddenly show itself and run a rapid
course," to a fatal termination.

In selecting an occupation for one predispostjd to
consumption, many points must be considered and
weighed. All such as are sedentary and requiring
nnich time in-doors should be avoided. It is not suffi-
cient to be out for a few hours each day. Any occu-
pation which gives rise to dust, or which requires an
unusually high temperature, as in overheated rooms,
or a stooping posture, is highly objectionable. The
occupation should not be laborious ; though as much
general activity as the constitutional strength will
well bear is desirable." "Travelling" (commercial)
on account of the irregularities of such a life is not
usually suitable. Then, in order that the occupation
may be agreeable and of interest, so that success in it
is likely to follow, a selection in this behalf must be
made. All this narrows down the choice. Again,
life in a city, chiefly from the air being less pure, is
less healthful thnn in the country, or small country
town. The city, too, provides a smaller proportion of
out-door occupations.

Agricultuue in some one of its forms, with some
precautions to be named, is probably of all occupations
on the whole the most salubrious ; although a sea-
faring life may be in some cases preferable. Stock or

ITS NATrilK, (AI'SKS AND I'KEVENTION.

2n:i

poultry raising, fruit j^rowin^ or <^ar«l»'iiiii^ may
easily be uuule a sutliciently light or easy einploy-
irient. Certain objectionable features in ordinary
farm life require to be removed in order to obtain the
full advantages of the work. For example, during
the colder season in northern latitudes there is often
too much in-door life ; and worst of all, in unventi-
lated, overheated rooms. The bedrooms, too, are
usually small and unventilated. Some of the work
gives a strong inclination to a stooping posture, and
sometimes there is a dusty atmosphere. Farm-houses
and their surroundings are commonly in a more
insanitary condition than city houses. These objec-
tionable features may be in a large measure or
entirely, and easily, removed. Carpenter work and
brick or stone laying out of doors should not be much
more unhealthy than work on a farm.

Of the learned puofessions, it appears that the
average life of clergymen is the longest, and that of
law the next. From the medical knowledge of
physicians they should live the longest, even subject
as they are to exposures and irregularities. In
country practice, especially if not made too labor-
ious, it should be, as indeed it not infrequently is, pro-
motive of health and longevity. The time of study
required for a profession is an objection ; yet with
due care this may be overcome by persons not of a
strongly phthisical family history. A few persons
study medicine chiefly in the interests of their own
health — for ^he medical knowledge it necessitates.
Surveying and engineering are healthy occupations.

w- 5

264

(.'ONSI'MITION

C,r IR i"^

'Sf

Fou WOMEN, suitable healthy eiiiployinents are still
more difficult to select. There is no reason why
many more women should not engage in the lighter
forms of gardening and flower growing, and in
poultry raising. A few have done so with success.
A large majority are practically forced to household
work with the care of young children. Such work is,
however, sufficiently active and varied, and need not
be made over laborious. If all rooms were well
ventilated and lighted and kept at a proper tempera-
ture — if the air within were kept as pure as it might
easily enough be, if the "out-doors" could be much more
freely brought in, housework would be one of the
most healthy of employments. Tiiis want of pure air
prevails to an equal, sometimes greater, extent in
almost all other occupations for females. In teaching,
in office employment, in shops, dressmaking, millinery,
factory work, there is a like want of pure air.
Women, as suggested in the case of men, should enter
protests against the impure air and dust they are
now in many cases practically forced to breathe.
Husbands should more deeply consider the necessity
for pure air for their wives engaged in housework.

DIGESTIVE AND NUTRIENT FOODS.

Next to a supply of pure air and good respiratory
action is nutrition through the stomach. Hence the
diet must be specially considered. Doctor W. H.
Porter goes so far as to say (at N.Y. Acad, of Med.)
that " V&r the most could be done in eradicating
tuberculosis by feeding properly from infancy up."

ITS NATl'HE, CAl'SKS AND IMIEVENTION.

265

The digestion in many caHCs wlien the predisposi-
tion is marked is |M)or, insufficient for good nutrition.
Out-door exercise will improve it, often sufficiently.
Horseback riding, jogging, is usually particularly
good in these cases. Exercises which bring into
action the muscles of the trunk are also good. It
may be necessary to resort to massage. It is very
desirable to keep the bowels regular.

Simple nutritious food, well cooked, must in all
cases be provided. The best authorities would givt;,
as a rule, only a moderate allowance of animal food.
I have seen a decided phthisical predisposition in
young persons practically eradicated on a d ^t of
milk, bread and fruits, largely of fruits, espc illy
apples. By most authorities Kuch a diet is recom-
mended as best for young children. Why not for
older peraons ? Von Ziemssen says, " The ' grape
cure ' and the ' whey cure ' conjoined with uiountain
air," — doubtless any pure invigorating air, " are ex-
cellent." If such food be excellent for the cure, surely
it would be also good in removing the predisposi-
tion. In the case of some persons, from a diet largely
of fruit, enough nourishment seemingly cannot be
extracted. The addition of plenty of milk and bread
usually makes it sufficiently complete.

Special foods are not often required except in the
more strongly predisposed — in the pretubercular con-
dition — a part of the subject which will be explained
further on. The supply of good rich milk when it
can be digested and assimilated, or of the lean of
meat, beef being best, r.iay be increased if it seem

■I

ill

f' ^ '4

206

CONSHMrriON

desirable, as in some cjuseH it will. OecaHiunally minced
or HCi'aped hief or beef juice i-s necesHary ; or, it may
be, predif^ested food — peptonoid.s or beef meal.

Fats seem to be often indicated, but little beinj^
habitually taken in a numl)er of these cases : hence
the use of cod liver oil ; a fat, from its nature or
.source, u.sually easily assimilated. Sometimes cream
is better, more acceptable to the stomach.

PUEVENTING " COLDS " : THE COLD BATH.

A *' cold on the lungs " frequently gives rise to a
condition favorable to the development of consump-
tion. Persons of a consumptive family being more
than usually liable to such colds, it is most desirable
that every precaution l)e exercised to prevent the
colds. With this, a little of the " hardening " process
is good, to lessen the susceptibility to sudden changes
of temperature. Of all measures for this purpose,
that of keeping the skin active and vigorous by the
daily cool or cold bath is best. The practice of hab-
itual bathing has already been highly commended for
everybody, and all persons disposed to take a cold
easily are particularly urged to adopt it, and in as
cold a form as each individual constitution will well
bear ; on account of the tonic effects. Personal ex-
perience, since early life, and observation of its good
effects in the many cases in which I have enjoined it
on patients in a practice of over a quarter of a cen-
tury, warrant me in strongly recommending it.

The simplest form of cold bath, and which in
nearly all cases is quite sufficient for susceptible non-

ITS MATI'KE, CVrsES A\l> IMtEVFN'TloN.

207

,er of a cen-

vigort)U« pei-Hons, is that ol' a wash tixer the whole
body vvitli the warm hands ivpiNitodly wet in oold
water juHt as inost persons wash tlie face. The
bather may stand on ai sipiaie of oilelotli with a
piece of carpet under tl»e feet. Ahnost any person,
even the least vi^roi-ous, can take this bath, and in
two or three minutes, with but a pint or two of
water. A spon<^e or cloth may be used, but the
hands being warmer, — an<l, if ne(;essary, they may
be first well warmed — feel less uncomfortable to the
beginner. The room for most persons, particularly
at first, shoultl be comfortably warm ; and the quick
wash should be followed by suthcient brisk rubbing
with a dry, ratlier coarse towel to secure good after-
reaction — a warm, smooth, glossy skin with a feeling
of comfort and invigoration. A soft towel, as abs(.)rb-
ing better the water from the skin, may be used for
the drying, and a coarser one for the after friction.

On commencing the practice, or if reaction be not
good — warmth and comfort do not at once follow, a
part only of the body, as the chest, may be exposed
and washed at the one time and another part later,
directly after or otherwise. At first, too, the water
may be tepid, and gradually used colder and colder
from time to time. Delicate persons who never could
take a full bath by immersion, even slowly, in water
only a few degrees colder than the skin, without
much gasping from the mild shock of immersion,
and after discomfort from want of good reaction,
have been, to my personal knowledge, able to take
this hand bath without discomfort, indeed with

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CONSUMPTION :

relVoHliiu^ invinonitiou iiinl tin? Ix'st of after re8ultH,
ofip<!ciuIIy in oxomption from coIiIh. And it has
HurpriHcd nio to find how readily .sonu; non-vigorou.s
pLTHons become able to tak(? tlie l)ath in quite a cold,
alniOHt I'roHty room. Keeble persons on bef^inninjj
may recpiire hel)) in order to take; even a partial
bath (juickly enough : the (piick action of washing
and <lryi!ij^ producinj^ undue » xcitenH^nt. No rash-
ness must be attempted ; cold is a powi-rful remedy.
A little time and care arc^ suffieiiMit to secun^ success.
Som<i more vij^orous persons are more benefited l)y a
sliovver or rain bath, as bein^, when borne, still more
invi^oratinjr. Do not be and>itious to use water too
cold, — rather comfortably cold, with the IwMly warm.

The preferable time for the bath is on rising wai ni
from the bed in the morninj^. It may be taken Just
before goinj^ to bed, or at any time three or four
hours after, and an hour before, a meal,

Ziemssen remarks on this subject, — ** I cannot con-
clude this chapter on prophylaxis without referrin<(
to hydrothera|)y, which occuj)ies a very important
position both for the prevention and cure of tiibercu-
losis. Winternitz, to whom principally we owe
scientific hydrotherapy, has published his experience
relating to its use in this disease in a brief essay,
entitled 'Studies of the Pathology and Hydrotherapy
of Puhnonary Phthisis,' which 1 strongly recommend.
My experience of the ' hardening ' method, where
there is an hereditary or accpiired disposition, agrees
fully with his. Water at suitable temperature is the
best, simplest, most available agent for strengthening

ITS NATDKfc:, (Al'SES AM) IMtKVKNTION'.

20f)

er rcHultH,
1(1 it luis
i-vigorouH
ite a cold,
hcjijinninj^

a partial
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r(^ HuecoHH.
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taken juHt
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aiinot con-
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important
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\vo owe
experience
rief essay,
Irotherapy
Bconimend.
od, where
ion, agrees
ture is the
jngthening

and ' hardening ' a weak luxly or one disposed to
catarrhs and colds. Kven a simple rubbing down of
the entire l)ody with a large; moist cloth, after getting
up in the morning, ac(Mistoms the skin to sudden cool-
ing off. The practice drills the vaso-motor
nerv(\s of the' periplwral arteries to prompt r(\«iction.
It acts on the respiratory, circulatory and digestive
systems. At Hrst, water of about HV}' F. is to be used,
an<l the cloth should bi; well wrung out. On each
succeeding morning the temperature of the water
may be reduced un<'-eighth of a degree."

In weak constitutions where app(!tite and assimi-
lation are poor, Ziemssen recomnn'nds that common
salt be added to the water in considerabh- (piantity.
Should a mon; thorou<rh tnratment be desiralile,
Ziemssen continues, " the. patient may bo sent to a
water cure." (or hydrothei'ap<uitic) establishment:
"necessary in persons deficient in will power." "This
simple [>rocedure overcomes si^nsitiveness to changes
of temperature, wind and dampness, and rende*rs
excessive clothing unnecessary. It ov»'rcomes con-
stant slight j)ersj)ii-ation, nasal and bronchial catarrhs,
rheumatic disposition, etc., ant I gives to the body
frc^shness and elasticity."

For a healthy, vigorous skin, as already stated, its
absolute cleardinesH is indispensable, and, for most per-
sons, a more thorouirh wash should be taken weeklv
or from time to titne. Soap is but rarely necessary,
except at the beginning or for persons engaged in a
dirty occupation. Soft water with friction is u i 'ly
sufficient. For persons with thick, coarse .skin, or

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270

(.'ONSl'MPTION

almost any per.H(;n, an occasional hot-water or vapor
bath for cleans ig and opening the pores is desirable;
and usually it i invigorating to pour a little cool or
cold water over the whole body immediately there-
after. And a weekly hot foot bath with cold water
poured over the feet immediately after, is good for
keeping thf* skin of the feet active and less susceptible
to cold and dampness.

The clothing in its relation to the skin — its changes,
airing, etc., has been already sufficiently treated
(page 243) ; except that non- vigorous persons usually
; quire a little extra clothing; not so much on
the body or chest as on the extremities, even to the
hands and feet. Wear enough on the feet especially
to keep them always comfortwlily warm. In cold
w^eather one pair of stockings is not usually enough.
Rubber should be worn only on the bottom of the
feet — the soles.

Draughts, even very moderate currents of air,
strike too much terror into a large number of persons.
Strong cold draughts are not good. From this the fear
some persons entertain of mild currents has doubtless
arisen. For the most part, any after aches or pains,
or the little "cold" somewhere which many experience
after exposure to a mild draught, arise from so care-
fully or constantly avoiding them, and from absolute
fear. No one will deny that cold, chilling draughts are
bad, and are to be avoided. But any person may in
a little time become so accustomed to mild draughts as
to suffer no inconvenience from them; and any little
discomfort at the beginning would Ix' much more
than compcTisated for by their invigorating effects and

ITS NATUllE, CAUSES AND miiVENTION.

271

the usual greater purity of the air, i\s when coiiiiuj^
from outside into an uiiveiitilated or crow*!*'.? room.
One can often prevent tlie cold effects or chill by wraps
or a screen. A coat collar turncMl up will often suffi-
ciently protect the neck and face : and the hif(h head-
hoard of a bed divert the current. Be not, therefore,
too much afraid of mild, pleasant currents of pure air.
This, too, is advice j^iven from personal experience and
close observation.

A FEW WORDS TO PARENTS.

Parents with a predisposition toconsumptioi. should
above all others be watchful of their children from
birth. Even before the birth, the niother should be
particularly careful in res])ect to her own health, and
to that of hei" unljorn offsprin<^. She shouM breathe
freely of pure out-door air; subsist on i)lain nutritious
food, in judicious moderation, yet in plenty: keej)
the skin healthy by the bath and proper clothing;
exercise or work mo<lerately. newr to <ner-fati^ue ;
secure a full amount of rest and sleep: an<l never
indulge to excess in ant/ of the ])h'aHures of life.

The child, from birth, slumM be es|)ecially cared for,
and as Sollesgive.i it, "on the lines of nature." It nni.st
not be overcared for or cijddled, but rather cautiously
hardened b}' cool bathin<ij: and provide<l with abun-
dance of fresh air, sunlight and .suitable food and
clothing. Above all, the icspiratory function should,
receive attention as eai'ly in life as possil)le. So soon
as the infant can walk well, it may be (>n('ourag«'<l to
run and romp and to climb, as up a stair or hill. As
it grows up there imist be i>o slackening in the care.

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272

CONSUMPTION

Encourage it to run and romp as much as possible
with other healthy children out-doors in the sunshine.
Boys usually get enough of this, but girls often, in-
deed commonly, do not. Encourage them, too, to run
and romp and climb. Encourage all the little ones to
sit, stand, and walk perfectly erect, with head and
shoulders well set back. This adds much to their
good appearance as well as to their vigor. Encourage
them to use their lungs freely ; not to expand and
develop them disproportionately, although hardly
anything need be feared in this way, but to build up
a full chest with good active lungs and heart. Special
light gymnastics may be needed to aid in the
development of the chest. Usually, however, free
romping and climbing with habitual full breathing
suffices. Encourage children early to breathe only
through the nose by keeping the lips closed ; taking
care that the nostrils are not obstructed. Their food
must be always simple and digestible, yet nutritious;
and their rooms — nursery and sleeping — well ven-
tilated and lighted. The skin all through life requires
special attention. It should be kept clean, soft and
active by the bath and friction. When it is coarse
and harsh, an occasional anointing with cod liver
oil, followed the next day by a warm water and soap
bath, will be benetieial, during early life especially.
The school, as relates to its locality, structure and
surroundings — tt) drainage, ventilation, cleanliness,
sunlight, etc., should be looked after by the parents,
and not left altogether to the authorities. Children
of this class should never be sent to any school not

ITS NATURE, CAUSES AND PUEVENTION.

278

possible
sunshine,
often, in-
)o, to run
le ones to
head and
. to their
Encourage
pand and
h hardly
) build up
b. Special
d in the
ever, free
breathing
jathe only
d; taking

heir food
lutritious;

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is coarse

cod liver
and soap

especially.

cture and

leanliness,

e parents,

Children

chool not

perfect in respect to these condition j; and perhaps
above all, parents should see that tlv school is not in
any measure overcrowded. Some boys, and girls too,
acquire at school or elsewhere most rlepressing secret
sexual habits, and this possibility should cause parents
to exercise the most watchful care in tliis behalf. The
choice of occupation nnist })e also well considered.

As there is no doubt that infants may be born with
the actual seeds of consumption — the tubercle bacillus
or its spores — in their bodies, especially if the
mother be in a marked degree tuberculous, then still
more specific preventive measures may be demanded.
!f the infant a[)pear to be puny or the nutrient or
excretory functions not well performed, a physician
should be consulted, an.l proper efforts made to
correct these conditions and build up a more vigorous
organism. Special nutrient food — oils, malt extracts,
phosphates, etc. — may be required. Some of the
imtrient or excretory organs may recjuire stimulating
into action, or be in an irrital)le condition and require
sedative treatment. Only a phyi^ician can decide
these points, and prescribe the re(|uired remedies.

Watch closely for any early, more marked symptoms
of the disease, such as contiiuied failure in appetite
for food and loss in weight: always remembering
that most persons, even children, lose in weight and
take less food in very warm weather.

Early treatment, on the first manifestation of
symptoms of the disease, is in some strongly predis-
posed persons, the onh/ treatment that is likely to
Hucceasfully combat its development and progress,
18

274 CONSUMPTION' :

MARRYING AND GIVING IN MARRIAGE.

No two perHonH, each haviiijr a family tendency to
consumption, should ever unite in wedlock. When
both parents inherit a temlency to any defect, that
defect is usually intensified in the children. Noi-
would it be safe or wise in such a case, of double
heredity, to rely on time and hygienic measures to
remove or destroy tht; predisposition, and marry
later. Yet two such persons ilo sometimes so marry,
and to the almost certain perpetuation of a fatal
disease. That very affection — that love — which
usually attracts to the marriage tie, should of itsell
restrain any man or woman in such circumstances froni
bringing upon the object of love the almost certain
consequences of a diseased progeny. Full knowledge
of the consequences, with a little refiection, should
prevent such unions. Legislation in this behalf has
been suggested. Very little practical good, however,
would come from legal restriction. Parents and friends
may sometimes do something towards preventing the
consummation of unions of this kind. Usuallv all
possible influence is brought to V)ear against misalli-
ance in respect to wealth and social position. If like
influence were exercised on behalf of purity and vigor
of bodily constitution, an aristocracy of health might
hii looked for.

Everyone thinking of marrying should considei-
most seriously not only his or her own ph^'^sical con-
dition and family history in respect to disease, but
also the health and health history of the person of
tbe opposite sex who purposes entering into the

ITS XATCRE, CAUSES AND PREVENTION.

27;

ideiicy t<»
:. When
feet, that
:en. Nor
of double
3asures tt)
1(1 many
so man-y,
of a fatal
^•e — wV»icb
M of itw'lt
nances from
oat certain
knowled^*'
ion, should
behalf has
d, however,
and friendis
venting tin*
Usually all
ust misalli-
)n. If like
V and vigor
ealth might

Id consider
hysical con-
disease, but
\e person oi"
into the

union ; this not alone for the sake of the two con-
tracting persons, but more especially for that of their
probable offspring.

When the predisposition is only on one side — in
only one of tlie contracting persons, and especially
if on the other there be good health and vigor with
a good history, the case is quite different. Burt says,
" A man with a tubercular family history, and possi-
bly a phthisical diathesis, should be made to under-
stand that he is a potential source of much sorrow
and misery if he selects for a wife a woman with a
similar record and constitution. Contrariwise, an
intermarriage with a family free from all such pre-
dispositions will do not a little to curb that downward
tendency. A child with good blood for a legacy, even
from one parent, has every reason to expect immunity
from the disease, if he is reared intelligently." It
should be borne in mind that sometimes by waiting
a year or two the predisposition may be largely ov^er-
come by good living. Indeed in all cases of a pre-
disposition, even on one side, there should be delay in
marriage, with this view.

AVOIDING AND PREVENTING INFECTION.

We have seen that consumption is in a measure
infectious : that in certain circumstances, as when
one person for a lengtli of time nui'ses another
advanced in the disease, the infection — the bacilli,
may be communicated from the diseased body to the
non-infected one, yet one which has become in a
measure predisposed. Anyone, then, having in any
degree a predisposition, either inherited or acquired,

276

CONSUMPTION :

iw'

; )iM

>i.!

should avoid close intercourse with cases of the
disease, as in the same household or family. The best
and safest way to avoid " takin^j " any infection is by
not providing the soil — by keeping the body in health
and vigor. When the soil is favorable, or there is a
predisposition, the only safe way is to avoid sources of
infection, especially close intercourse with the infected.

When a member of a household has the disease, with
cough and expectoration, such person should be in a
measure isolated : provided with a well-lighted, airy
room, or, better, two such rooms, so that he or she
need not mingle with the family. Intelligent con-
sumptives with proper feelings would prefer and
desire this, rather than communicate their affliction
to friends. 'J'he isolation need not be very strict :
this especially if the case be an exceptional one in the
family and the predisposition not marked ; and with
due care in the disinfection of all infected excreta.
Separate rooms to live in — to sit in usually and to
sleep in — are desirable. Other members of the family
need not unkindly shun the afflicted one.

The first essential in preventing the spread of in-
fectious particles is absolute cleanliness : cleanliness
as perfect as can possibly be secured in everything
and every way : — cleanliness or purity of the air
within doors, of the body, of the bed and body
clothing, of every corner and crack, of not only the
sick-room but the whole dwelling. And this means,
in the main, cleanliness from dust, including sputa,
particles of which may soon become dust, as may
almost every form of dirt. In the dust of rooms, it
will be remembered, tubercle bacilli have beep found.

ITS NATURE, f'ArSES AND PREVENTION.

277

Bacilli form a part of the " elomonts of the dust."
For clean, non-dusty air in rooms there must be
thorough ventiUition. In sickness of tliis nature free
vefitihition is domarnled more than at any otlier time.
Yet in practice we commonly find it (juite the con-
trary : and this has cost an incalculable numV>er of
human lives. The unchanged air favors the predis-
[)osition and also the spread of the infection. Doctor
Rjinsome has shown that in the back-to-back houses
in the lar^e cities in En<(land, in which it is impossible
to provide good ventilation, consumption is " ex-
cessively frecjuent ;" and chiefly it is believed from
tliis cause — want of ventilation. It is probable that
in all those individual cases of consumption believed
to have originated in infection, the brief history of
which has been given in Part I., there was a want in
this respect. And it is probable, too, that by perfect
ventilation alone nearly all such cases would be pre-
vented, — infection would hardly occur at all. Squire
remarks, " It is a significant fact that nearly all the
cases of probable direct infection from a phthisical
patient take place in small and ill-ventilated houses,
and are almost unknown in the airy houses of the
well-to-do." Remember, sunlight, too, is essential.

The free flow into the rooms by night as well as by
day of pure outer air will do the consumptive vastly
more good than harm, provi«led he be kept a little to
one side of any perceptible draught and clothed
sufficiently. Patients in hospitals on the continent of
Europe are now placed, well covered in bed, near a
widely open window, aside from draught, in cold wea-
ther, night and day. In the New York Medical Jour-

27S

CONSI'MPTION :

iiul (July 27, '95) we now read, — " M. Roeliurd leinarkH
(Union Med.) that tlie mode of treatment instituted l>y
Doctor Detweiler at tlie Falkenstein Institute was
not at first taken sufficiently in earnest. The idea of
consumptives living in the open air at a low tempera-
ture and allowing currents of air to pass through
their bedrooms at nijjht was looked upon jis eccentric,
l)ut the advantat^es of this treatment have come to be
recognized. The pure, cold air quiets the cough,
lowers the fever, arrests the night-sweats, restores the
appetite, and retards the course of the disease,"

The first principle of ventilation, remember, is to
withdraw the impure air from the room, as by a grate
fire or warm flue, in ortler to make room for the pure
outer air to entor. A layer of muslin, or cotton batting,
in a wire screen, may l>e fastened across or over the
open window, for preventing a too rapid inflow, oi*
strong draught, especially when there is much wind
or the weather is cold.

Floor cracks and corners are notable collectors and
sources of dust and infections. A good moderate-
priced *' sanitary " flooring material is much needed.
The cracks in ordinary floors may be greatly
improved by being carefully filled with paper pulp
and then oiled and varnished. Rooms or wards for
the sick are now made without angular corners, in
walls and ceilings, a cove taking the place of the angle,
and without cornice and base, or any place for dust.

The less furnishings of any kind in sick-rooms the
better, because the easier kept clean. Carpets, window
or other curtains, and most upholstered furniture
are particularly objectionable dust-holders. If they

ITS NATURE, CAl'SES AND PREVENTION.

•270

arc tolt'iutojl at all, thcv shouM Ih' taken out wecklv
or ot'tenor, sliakcn well aiul exposed for a time to huh
1111(1 air. All heddiuii- and l)odv clothintr should be so
treated dailv if it ean l>e done. A few mi's on a well
polislied riooi- ^ive a nnieh better, because a cleaner,
iiioie aj)propriate or artistic, appearanct^ than a carpet.
Dry dustinj^ as usually ])ractise<l stilus up tlie
particles and is of very little benefit. All dustei-s
should be slightly dani))ened In' a sprinklinjjof water,
or a weak .solution of carbolic acid: or, as ])leasanter.
of a diluted tincture of an es.sential oil — cinnamon or
winter^reen. They need not be mad" dam}) enovi<;[h
to ap])reciably dampen furniture. While in use tliey
should be frequently shaken outside; but not, as
often is done, directly in front of an open window
whil<? a current of air cari'ies the dust directly back
into the room. They mav sometimes be shaken out
well down below the window on the ietiward side.
Kverythinjr in the room on which it is po.ssible for
dust to settle niu.st be p)ne ovei*. and the oftener the
better, if properly <lone and without " nuiking a dust."

THE SPFTTLE AND OTHER EXCRETIONS.

The expectoration oi* spittle of consumptives, con-
tainincf as it usually does a fijreat number of germs,
must be carefully disposed of. From it, as we have
seen, active virulent inf<>!ction may directly arise :
particles of it soon drying and becoming a part of the
dust. It may so surround bacilli as to preserve their
virulency for a long time.

Within doors the disposal of this source of infection
is not difficult. Every particle of matter coughed up

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should be carefully received from the mouth in ii
vessel containing a disinfecting solution, or into bits
of rag or soft tougli paper which sliould then be put
into such solution. The cleanest way when the
expectoration is not too copious is to wipe each
sputum carefully and cleanly from the lips by ra^*-
or paper, so that no particle can fly off from the mass
and escape and dry ; as particles often do when out'
spits into a vessel. This, however, may be in a
measure prevented by holding the vessel close up to
the lips when it is used. Even then it is usually
desiiuble to afterwards wipe the lips. Inexpensive
paper cups may now be obtained for receiving sputa,
which after use are destroyed with their contents.
Probably the best way to finally dispose of sputa is
by burning carefully in a large fire, as that of a
furnace : but never in a small fire, as in a cookinu; or
other stove. If thoroughly disinfected it may go to
the sewer through tlie closet, or be buried in earth.
The vessels, if not burned or buried, should be well
scalded. As a disinfectant for receiving the sputa,
corrosive sublimate is commonly recommended, — one
part to 500 of water, or stronger. Carbolic acid, —
one part to twenty of hot water — is an effectual
germicide ; and, if desired, its odor may be largely
overcome by adding oil of cloves first dissolved in
alcohol. These disinfectants are highly poisonous,
and should be very plainly and strikingly so marked.
When out of doors, the consumptive should always
carry rags or paper for receiving the spittle, to
be afterward destroyed, and should never by an\'
chance spit on a floor, sidewalk or other i-oadw^ay,

ITS NATURE, CAUSES AND PUEVENTION.

2.S1

yard or public place whatever. Firtsks for spittiiio-
in which may be cai'ried in the pocket are now madr
and in use. Pocket handkerchiefs for this purpose
are decidedly objectionable. Washing them is not
only disj>;ustin^' Imt dan*(erous, from possible inocula-
tion. Professor Graham mentions a case whicli
came under his observation, in whicli infection was
conmiunicated in this way.

The body surface must be kept strictly clean.
Spores, if not parent bacilli, are said to be thrown
oft* by the skin. The wliole body surface sliould be
well washed daily with water, and the cooler this can
be borne without much discomfort the bettei*.

All other excreta as well as that from the lun^s and
skin should be also carefully disinfected. The moutli
and nostrils shoidd be often cleansed with hot water,
to which some pleasant <leodorant may be added.

After the death of a ])erson fronj tuberculosis, all
apartments which had been occupied by the deceased,
at least, must be carefullv disinfected beibre beinu"
again occupied. Ever^'thing movable shouhl be taken
fi'om the rooms and disinfected by heat, as in boilinof
water, or by, such solutions as already mentioned,
and by free and long exposure to air and sunlight.
The flooi^s, walls, ceilings, and every corner and crack
should then be thoroughlv washed with hot water,
soap and carbolic acid, or the corrosive sublimate solu-
tion, and be long opened up to air and light.

PRETUBERCULAR PREVENTIVE MEASURES.

Persons strongly predisposed to consumption, in
the pretubercular con<lition, with loss of vigor and

282

CONSUMITION

■•'M

I! >,

I? ol

it*

perhaps of appetite for food and of body woijfyht, while
exercising more than usual caution in respect to
infection, should also be more particular in carrying;'
out instructions for increasing the respiratory capacity
l)y lung gymnastics and habitual full breathing, as
already pointed out. This, with an out-door life,
moderate exercise and sufficient rest, judicious cloth-
ing and care of the skin by means of the bath, suit-
able, nutritious food, and a well-ventilated bedroom, is
in many cases sufficient to restore health. In yet more
extreme eases, more special nutrient foods besides
oil, cream, beef preparations and predigested foods, —
such as malt extracts, ale or porter, with phosphates,
etc., may be required, and a physician must be con-
sulted, A change of locality, too, may be desirable.

If space permitted, I should be pleased to give
here, as profitable exanijiles, the history of a few cases
of the pretubereular condition, strongly marked —
in persons thought to be " in a decline,'' in which I
have observed entire recovery by means of increased
lung capacity with attention to the skin, good ordinary
nutritious food, out-door life, and a well- ventilated
bedroom, in a salubrious locality : without any other
remedy. Many such cases have come under my
observation in practice. In a number of them, too,
the patient had previously liv.^d much out of doors, but
with defective respiration. Such cases would well
illustrate the power of simple, natural remedies, while
explaining the cause of the body condition : showing,
too, that it is sometimes enough to remove causes of
illness in order to effect a cure.

CHAPTER XIY.

STATE AND MUNICIPAL PREVENTIVE
MEASURES.

Some measures for the prevention of consumption,
as well as of other diseases, cannot be carried out
by individuals alone, and require united effort, as
through municipal and even state authorities. The
most important of these, as stated, and which promise
the best results, are such as prevent or remove the
individual predisposition to the disease. And most
can be done in this direction by the education of the
masses of the people rather than by coercive measures.
The better education of the masses concerning tlie
ordinary requirements of health is indispensable to
success in the prevention of any disease, certainly not
less so in behalf of this most destructive of all diseases:
education — warnings, directions, encouragements — in
respect to personal habits and surroundings — to
breathing, to foul damp air and sunlight, to cooking,
eating, bathing, sexual relations, and to dirt in its
various forms: education through the schools; by means
of public lectures; and by free distribution of pamph-
lets. In country towns, villages and farm dwellings,
as well as in large cities, sleeping apartments, for
example, commonly, and often living rooms, especially

284

CONSUMPTION :

^ti;.

M 1

those of women and children, are sueJi as should not
be tolerated in this age — small, dark, dank and
unventilated, with an atmosphere laden with poison
from the breath and tobacco smoke. The human
skin, — square miles of it, is so clogged from want of
the bath and from habits of clothing that the lungs
and kidneys are injured in efforts to do the extra
work thrown upon them by the inactive skin. For
the credit of humanity, as well as for pecuniary public
gain and general welfare, there should be a decided
improvement in health regulations and habits every-
where. It should not be forgotten that an entire
connnunity may be seriously injured by the evil
influences — the carelessness, iilthiness, diseased con-
dition, of a very few persons, or even of one ; and that
want of knowledge of the sum of the evil cdnse-
(juences of living unhygienic lives is the principal
cause of the bad surroundings, conditions and habits
almost everywhere met with. There should be more
united effort to help those who are not able to help
themselves to an improved hygiene, and to compel
those to do so who are not willing.

The united efforts now being put forth in some
states and cities for preventing the dissemination of
the seeds of consumption in the spittle of infected
persons, by a certain amount of oversight of those
suffering from the disease and of their dwellings, with
instructions as to what they should do to prevent the
communication of the disease to others, will doubtless
be beneficial — bear good fruit. It is most desirable,
however, that health authorities as well as individuals

ITS NATURE, CAUSES AND PREVENTION.

285

IH ^shoul(l not
, dank and
1 with poison
Tlio human
from want ol'
lat the lungs
lo the extra
/e skin. For
juniary public
be a decided
habits every-
bliat an entire
I by the evil
diseased con-
one ; and that
le evil cc^se-
the principal
ns and habits
lould be more
)t able to help
,nd to compel

"orth in some

semination of

e of infected

iicrht of those

wellings, with

jO prevent the

will doubtless

nost desirable,

as individuals

should strike first, and in a mo* > distinct or marked
way, at the predisposing causes ; treat these as of the
first importance : strike for preventing the develop-
ment of cases requiring oversight. This would be the
true prevention. Public measures for this purpose
are possible and practicable.

Health authorities should never do that which tends
to prevent or lessen individual effort — to prevent per-
sons from using means for individual or family
protection, but on the other hand, should encourage
self-effort for self-preservation.

Individuals must rely largely upon themselves, be
a fortress unto themselves — keep their own body
fortified. We must not expect the police to prevent
our house being robbed if we harbor a robber in the
household.

LINES OF LEGISLATION.

Legislative enactments and municipal by-laws as
now commonly in force and intended for the promo-
tion of the public health generally, tend also to pre-
vent consumption. Enactments and by-laws more
particularly aiming to prevent this disease should be
on such lines as indicated by the following heads :
(1) For the Better Instruction of the People in Special
Preventive Measures ; (2) Prevention of Air Fouling
in every form ; (3) Establishment of Free Public
Baths; (4) Drainage of Retentive Damp Soils; (5)
Inspection of Butchers' Meat and Dairy Products ; (6)
Inspection and Oversight of Schools ; (7) Oversight
in Certain Cases of the Disease ; (8) Hygiene of
Domestic Animals.

286

CONSUMPTION

■J • .

r !i

i li

Unsuitable marriages is a subject which medical
writers have suggested as one upon which there
might well be some legislation. It has been stated
that in Brazil, on account of the increase of " scrof-
uhi, " there some years ago, a law was enacted pro-
viding for the medical examination of persons about
to marry, and for preventing the marriage of those
pronounced unfit. Laws of this kind would have
little terror for those " in love," or who believed
themselves to be. Education and the influence of
parents and friends must yet remain the basis for
preventing the marriage of consumptives.

Already in most countries there are certain legis-
lative provisions applying to some of the above-
named subjects (2, 4 and 5) — air fouling in factories,
lodgings, etc., and drainage and food inspection.
These provisions, however, are for the most part or
generally not enforced as they should be ; and
although of some benefit, are probably in all cases
far from being efficient.

PREVENTIVE EDUCATION.

The public schools provide an excellent means for
instructing, theoretically and practically, the coming
generation, and in a measure the present one, in ways
for preventing consumption, if but taken advantage
of. Almost everything is taught except health pre-
cepts. It would be much better to teach " language "
relating to a good physical constitution than a foreign
language ; and better a health drill than even a. fire
drill. Pupils are not taught even the first essential

1 :

ITS NATURE, CAUSES AND PREVENTION.

287

lich medical
which there
1 been stated
se of " scrof-
enacted pro-
jersons about
iaare of those

would have
A^ho believed

influence of
the basis for

3S.

certain legis-
f the above-
(T in factories,
»d inspection,
most part or
uld be ; and
in all cases

mt means for
■f, the coming
t one, in ways
:en advantage
-pt health pre-
" language "
han a foreign
,n even a lire
first essential

of right living — how to breathe ; and thosij who do
breathe properly do so in a large measure in spite of
school influences tending to impede the respiratory
function, such as foul air and a stooping posture.

Pamphlets with special instructions for preventing
disease and promoting the general health, of both
individuals and communities, might well be freely dis-
tributed, as well as the pamphlets on prevention of
special diseases which health boards commonly dis-
tribute. And if such paniphlets were made more
attractive in both appearance and style of composition,
they would not be so likely to be " pigeon-holed " as
some have been, it is said, on good authority. It must
be remembered that although many good seeds are
sown, comparatively few of any sort fall on good
ground and bear fruit. Two to four page leaflets,
clean, bright looking, large open type, on " How to
Breathe," "How to Let in the Out-doors," "How Not
to Cook," " What Not to Do for Health," and such
like special, striking subjects, scattered freely about
would be read probably by ten or more persons to
every one who would even " look through " the
heavier, dull brochures on the more repulsive diseases.

Popular lectures, particularly on the value of
health, by a fairly good speaker would attract fair
audiences and be largely reported in the local papers.
Local medical officers in England have done some-
thing in this way — given such lectures. Why should
it not be made a part of the duty of such officers on
this continent to give courses of lectures, or " health
talks," in various localities in their jurisdiction '

288

CONSUMPTION

By such means fi^enerally and judiciously carried
out, the great majority of the people, now so ignorant
on this subject, would learn that good vigorous healtli
is worth making an effort to preserve or obtain, and
also, how to prevent disease, especially consumption.

STRICTER MEASURES: BETTER INSPECTIONS.

Stricter legal measures, or stricter enforcement of
present measures, should be brought to bear on pnj-
prietors of all places where persons, whether only two
or three or many, are employed at work — factories,
shops, rooms, and also of tenements and lodging
houses and hotels — for preventing every form of aii*
fouling : from the breath, as in overcrowding with
want of ventilation ; from imperfect drainage and
sewerage ; from excess of dust in any form ; and from
infections. Every employer should be comi^elled
to make such provision as would prevent any
employed person, while actually engaged in his
employ, from being injured in any measure by foul
air, as well as by machinery, or accident ; and ever}^
landlord should be under like compulsion in respect
to every person for whom he provides lodgings,
whether in tenement house, hotel or lodging house.

Compensation for damages sustained by an
employee from impure air, for which his employer is
responsible, it seems possible, might be recoverable at
law even now ; and this subject is well worthy of the
serious consideration of employers. In a number of
instances already the tenant has recovered from the
laridlord, through the courts, compensation for loss
through sickness caused by an insanitary house,

ITS NATURE, CAUSES AND PREVENTION.

289

isly carried
so ignorant
jrous healtli
obtain, and
Huniption.

2T10NS.

orcement oi'
bear on pr(j-
lier only two
k — factories,
and lodgin*;-
1 form of air
owding with
irainage and
•m ; and fron\
)e compelled
irevent any
laged in his
[sure by foul
t ; and every
in in respect
es lodgings,
ing house,
ned by an
employer is
icoverable at
ortliy of the
la number of
red from the
ion for loss
house,

Food inspection as now attempted, especially in
I'espect to meat and milk, is little more than make-
believe : as in th(! case of factory inspection, it is com-
monly done very perfunctorily. In sonie cases the
inspector, often the market constable, probably does
" the best lie knomx how" to do. Meat unfit for food
is sold everywhere : and while watering milk, a com-
paiatively harmless offence, is in a measure prevented,
diseased dairy cows and foul stables, vastly more
harmful than watered milk, exist on everv hand.

SUB-SOIL DRAINAGE.

Thorough drainage of the heavy damp sub-soils on
which cities and towns are often built would probably
be a batter investment — yield larger returns for the
outlay, in improved health and vigoi* of the popula-
tion and the exemption from consumption and other
diseases, than is obtained by even the agriculturist
by the drainage of farm lands. Statistics have proved,
it will be remembered, that consumption is more fatal
on damp than on dry soils. Sewerago, it may be
noted, is in no sense drainaij:e of the soil. The
sewage of a city may be well carried away by house
drains and sewers, and yet the sub-soil remain damp.
Tile drainage, with tiles thickly set, is what retentive
soils need. There should be some means for prevent-
ing the erection of habitations on damp soils.

MEAT AND MILK REGULATIONS.

For preventing the sale, all too common, of tuber-
cular and other diseased meat, public slaughter-houses
19

290

CONSUMPTION :

is:.

iii !

iii

Hhould bo provided in vvhicli all aiiiiiuils intondisd for
food hIiouUI bo killed luvl eut up. Hero all the
aniinala .should be examined by a competent inspector
both before and after .slau^rhter. It is well known
that consumption is less prevalent anion^jjst the Jews
than other people, and this is properly attributed to
the care they bestow in the selection of meat. This
matter is one of serious importance. 'I'he Editor of
the British Medical Journal, in a leading article (June
15, '89), writes, " The subject has a most important
bearing on public health. It is one that must be
taken in hand by sanitary legislators, and the sooner
it is tackled thoroughly and on the broadest po.ssiblc
basis the sooner sliall we obtain a cleaner bill of health
under the heading ' Tuberculosis.' " There has been
considerable agitation for public abattoirs on this
continent, but little has yet been done in this way.
It is now generally conceded that, when an animal
becomes tubercular in any organ, both the meat and
milk are unfit for food, although the flesh and udder
may not be locally diseased. It was so decided in a
strongly contested case in Scotland a few years ago
after the evidence of the highest authorities in Great
Britain liad been heard.

Milk supply regulations are really of greater im-
portance than those applying to meat, because milk
is more commonly used in an uncooked state, is in
many cases the sole food of young children, and dairy
cows are more commonly tubercular than other
bovines. Yet all regulations affecting it are inefficient
and lax. To look after the cows — their health, food,

ITS NATUKE, CAUSES AND I'KEVENTIOX.

291

drinking water and hoiiHiii<ij — Ih by I'jir t.lio iiion! iin-
portaut })art of inHpection. A j^ood iiiodol for nnnii-
('ipalities to adopt is the milk supply systcin in the
city of (/()penlia;^en, probably the most complete
to be found. The regulations are j^iven in tiie
Canada Health Journal of December, 1.S91.

The Royal Commission (Ct. Brit.) aj)p()int(Ml five
years ajjo to encjuire i'lto the (juestion of tubei-culous
food have recently repoi-ted ; in ell'ect, that, — in an
api)reciable j)art of the tuberculosis in man the infec-
tion comes from food, chieH\ !Vom bovines ; tubercu-
lous milk and (hiiry products a] ; (!Xce})tionally active
when fed to animals ; and (contraiy ff^ the decision
in the Scottish case) a jijioat deal A the non-tuber-
culous Jienh of tuberculous anii' ;ds may be eaten if
care be exercised in remo\ in^ all diseased parts and
orpins, and in cooking the flesh.

PUBLIC BATHING CONVENIENCES.

Enough has been written elsewhere herein on the
value of universal or public bathing. As Doctor Simon
Baruch (as before cited) says, " It requires no argu-
ment to prove that every consideration of law, pro-
priety and sanitation demands that our city authorities
take immediate steps to secure to our laboring popu-
lation near their dwellings, and in the school buildings,
station-houses, etc., the means of cleanliness and re-
freshment, health preservation and moral improve-
ment, which the public bath is more capable of fur-
nishing than cny other more costly investments, and
to sustain all benevolent societies who are strivincj in
the same direction."

Mat ' ^

coNsiMrrioN

Unin l»M(l»Mor (i'|>i«l ov not (onrold \v<»trr iirr hy I'm*
tlu» lost I'nrm Tor |)ul>li(' iiHc : tlw inoHt circrdml loi*
clojiniiiif i\\o liody Mini most atti'tU'tivc Ini- iiiomI |m>|'
sons, for wiutiM' nnd sumnu'r use. Tlicy should 1k» in
tho (M'utros of (!><» most populous loo.'diticH. The New-
York StMl(^ Ii(»ifiNlMttjr<' liMs just I'cccMttIv rimct.«M| a
law lu.ikini:' it ujMudntorv lor citit's witli 5(),()()() of n
popul.'itiou or ov«M- to ('stahlisli IVoc puhlic hnths, and
also/ providiuii" for n^ore ctliricnt action in this lu'liall'
l»v the sniallor oitii's. This is a loadinLi" niovcnnMit
which should he followed hy all legislatures.

S»H()OL VVVW. MAXA<iKMKNT.

If every }>iipil on tlie eoniineneenient of school
attiMi<lance w»>r(» e\an\iiied hy a physician, or if ex-
auunaiions weii* n»ade monthly of all new pupils, ami
every one wantiuii' in full hreathino- capacity, or with
a chest j^irth helow the full avera^^i', or perhaps not
above it. and ev(*rvt>ne with a stoop or round shoulders,
wen^ placed for a sut1ici»>nt lenoth ^f time under
special treatment for chest development, the number
of oases of oonsiunption wouhl soon be nnu'h reduced.
Other pliysical ilefects, too. could be nMuedied at the
same time. Such ]>upils, and there are many, could
W treated in classes, usnallv bv the teacher, under
medical ovei*sii>ht. Fuller details than have been
j:::iven elsewhere of the various special exercises rv-
quirod cannot be entered into in this treatise.

A system of tins kiiid, etHcientlv carried out, and
with a stronjj im]>ression made on the mind of the
]>upils as they j^row up. as to the value of a <jood chest

ITS NATI'MK. CAI'SFS AND IMIFA'KVTION.

'im

l\'rtiml lor
• mosi ]>«*>•
houM Ih* ill
'V\w Nt>Nv
r imuu'UmI a

no.ooo «)!* M

' baths, and

tl\is hohall'

; movoMUMit

'(>S.

it nl" S('1U)<)1

in, or it' t'x-
c ]m]>ilH, au»l
oity, or with
porha])S not.
\d slunildors.
tiinc \nul»M-
the number
lU'b iv«Uu*o«l.
unliotl at the
nuiny, couUl
lachor. under
|i have been
oxercises re-
Litise.

Iried out, and
Inind of th*'
a iTooil chest

ami lull breathing, won l«l piobably do more to |»r«'Vfiit
('onHuni|ition than any other inraiiM tlnit could l»;
ado|)t(Ml. Iti this way th(« wry youths prcdiMposcMl to
the disease — marked out as it wrw I'or it, thousands
of them, from whom, only, or almost only. couMumption
eventually di'aws it,s double tithe, would be i-eached
and rendered pr/ietieally imuuine.

OI'I'ICIAI- MANACJKMKNT OK <'AHKS.

Instead of eon»)»ulsory notilieation, rejrJHtration, an<I
even isolation, which has been proj)osed as a measure
for the .sup|)ressi()n of consumption, and which woidd
doubtless create opposition and concealment of cases,
it. would bo probably wi.ser f<»i' health a,tithoi'iti<'s to
adopt the simpler, less extreme plan of leaving the
(juestion of notification lar^^'ely or wholly in the hands
of the nuMlical attendant in individual cases. 'I'Ik;
authorities mi;jjht re(|uest all physicians to^^ive notice
of such cases comin<r under theii* observation as in
their jud^^ment re(piired oversi^lit and a.ssistance in
carryiu}^ out measures foi- ])reventin;^ the spn-ad of
tlu; disease; to cases in which neither jiatietits nor
friends, from want of means, were able of themselves
to can-v out such measures. This would limit notifi-
cation to those to whom tlu^ ai<l of pu})lic ofTicials
would be not only acceptable, but desir<'d. The; public
assistance ^iven wouM more than compensate for tlie
semi-publicitj . This appears to be about as much as
tlie public are prepared to fully sanction ; indeed
about all that is nMjuired, in this line of action.

Supplies of printed instructions shoidd be ^iven

294

CONSUMPTION

rrq

by the health authorities to all phyisicians for putting
in the hands of consumptive patients of all classes or
of the family or friends. Formulas for such instruc-
tion may be easily made up from what has been stated
herein : Chapter xill, preventing infection, etc.

HYGIENE OF DOMESTIC ANIMALS.

This is a subject so directly associated with milk
and meat inspection that it is desirable to touch upon
it here. Were due attention given to the hygienic
care of animals, they would be kept practically free
from disease, and the inspection of these foods would
be a comparatively simple and easy matter. The
following remarks (extracts from a pamphlet on the
subject by the author) may impress upon the reader
the desirability of having more special attention
given by dairymen and others to the health of the
animals, and is all that can be given herein : " Flem-
ing says (Vet. Sci.), ' A rational and well-founded
system of hygiene, by fortifying the body [of animals]
and preserving the different organs in health, is the
most certain safeguard against the development of
disease,' As iii the case of man, so in that of animals,
pure fresh air is lirst in importance. Grognier asserts
that horses and horned cattle suffer more than man
or carnivorous animals when kept in a bad atmos-
phere, and he has described a 'stable fever' in animals
in France, analogous to the now past ' hospital fever '
or ' prison fever ' of man, from breathing the foul
prebreathed air of stables.

" Tlie worst sort of foul air to which domestic

ITS XATrRE, CAUSES AND PREVENTION.

295

['or putting
I classes or
ch instruc-
been stated
, etc.

with milk
touch upon
18 hygienic
3tically free
[oods would
atter. The
)hlet on the
a the reader
il attention
ealth of the
n : " Flem-
ell-founded
[of animals]
alth, is the
elopment of
of animals,
nier asserts
than man
bad atmos-
' in animals
ipital fever '
ig the foul

!h domestic

animals are exposed, and which is most common, is
(1) that which has been breathed, and rebreathed
over and over, again and again, in close unventihxted
stables, and (2) that from manure piles in and near
stables and yards. Fleming (juotes an author as
saying that ' stables should smell no more of the
animal than the dwelling room does of the man.'
Parkes says, ' A horse or cow ought to have from
10,000 to 20,000 cubic feet of fresh air per hour.
It ought to be practically in the open air. . . .
Animals properly fed will thrive better in a well-
ventilated place at a low temperature than in a
warmer place ill-ventilated.' Besides the value of
pure air from a strictly health point of view, reports
have been pul)lished of experiments which prove that)
cows yield more and better milk when kept in clean,
well-ventilated, than in close, foul stables. Cattle do
better on the whole in large open sheds with abund-
ance of straw than with the more modern practice
of ' stabling.' Large sliding doors might be provided
which could V)e used for closing the open side of the
sheds during the hours of a cold storm from that
direction. Cows often require more exercise, prob-
ably a good gallop daily. It might lessen the quan-
tity of milk given, but would improve their respiration,
health arid vigor."

It would be well if heads of families would by
careful inquiry and even personal inspection see that
the cows which furnish the milk supply of the
family were suitaV)ly housed in well-ventilated, well-
lighted, clean, dry apartments and receive only good

f7— f

"""■■III

296

CONSUMPTION

ii^

pure food, pure water and sufficient out-door exer-
cise. Such personal looking after by directly inter-
ested persons would soon improve the milk supply.

SANATORIA OR HOSPITALS FOR CONSUMPTIVES.

These are amongst the most useful means for the
practical prevention of this disease by the State. As
a large proportion of consumptives are of the labor-
ing or poorer classes, who are often not able to pro-
vide for themselves the means of proper treatment, it
is contended that the State should provide institutions
of this kind. To do so would doubtless be a wise
expenditure of public money. In England it is
believed that the hospitals for consumptives there
♦ have contributed in a large measure to the decline in
the mortality from this disease during recent years.
While the hospitals serve to isolate cases and prevent
new ones arising through infection, they also prolong
life and so reduce the annual mortality. Many cases,
too, are practically cured, chiefly by means of the
greatly improved conditions of life in which patients
are placed as compared with their previous conditions.

In the general hospital, consumptives are not only
liable to infect other persons, but they are themselves
under great disadvantages, in many and obvious ways.
When, therefore, it is possible to avoid it, the}'' should
not resort to, or be sent to one.

Sanatoria — a name which to many persons is yet
less Unattractive than the term hospitals, although
these institutions are not nearly so unattractive now
as they were a few decades ago — should provide for

ITS NATURE, CAUSKS AND PREVENTION.

297

door exer-
ictly inter-
: supply.

IPTIVES.

ms for the

State. As
' the labor-
ible to pro-
reatment, it
institutions
3 be a wise
rland it is
)tives there
le decline in
ecent years,
ind prevent

dso prolong

Many cases,
ans of the

ich patients
conditions.

,re not only
themselves

)vious ways.

they should

rsons is yet

~[s, although

[•active now

[provide for

at least two, and better three, classes of cases, —
classitied according to the stage of tlie disease.
For persons in the early stage a separate building
should be provided. If they are treated in one with
advanced cases, not only would there be greater risk
from reinfection, but the mental effect from prox-
imity to the more seriously diseased, sometimes dying
patients, would be decidedly depressing. A second
building should be providecl for persons in the later
stages, with yet hope of recovery : and a third for
incurables, requiring isolation in the public interest.
For the first class, and in the main for the second,
only apartments would be required in which to sleep,
eat, receive baths, massage and other treatment, as
the patients should live mostly in the open air —
lying, sitting, walking, driving, riding, playing at
games, skating, tol>ogganing, coasting, as most suit-
able. It need hardly be stated that such sanatoria
should be in the most select localities, constructed on
the most approved mo lern principles, as to ventila-
tion, sunlight, dryness, etc., and be undei* the constant
supervision of the best medical skill.

There are man\' cases in the early stages of the
disease which need not remain long in a sanatorium.
After being, there, placed in a fair way for recovery,
with proper instructions and injunctions as to their
future course, — after being taught how to live — they
could leave and engage in some suitable employment.
Or, if a farm were connected with each sanatorium,
such patients could be employed on it with profit to
both themselves and the institution.

1^1

i "

CHAPTER XV.

i '

®f

CLIMATE AND PREVENTION.

The somewhat extended remarks on climate in the
following pages need no apology. The subject is a
very important one : change of climate is a remedy
fre(juently resorted to, both as a preventive and cura-
tive, for consumptives. Yet the eff'ects of climate or
of acclimatization on the human functions are not yet
well understood.

WHAT IS CLIMATE ?

Of climate (Greek, H\if.i(V, a slope, — toward the
poles or sun), Parkes says, it is not easy to give a
definition. " Tlie effect of climate on the human body
is the sum of the influences which are connected
either with the solar agencies, the soil, the air, or the
water of a place, and as these influences are in the
highest degree complex, it is not at present possible to
trace out their eftects with any certainty. . . .
Probably we do not know sufficiently the physiological
conditions of the body under ditterent circumstances."
(A. E. Parkes, M.D., F.R.S., Prof. Mil. Hyg., Lond.
Eng. Man. Pract. Hyg., sixth ed. Vol. ll.)

According to Humboldt, " The term climate, taken
in its most general sense, indicates all the changes in
the atmosphere " as to temperature, humidity, purity,

ITS XATTTRE, CAUSES AND PREVEXTION.

209

movement (in winds), variation in the barometrical
pressure, etc., which " sensibly affect the organs " and
influence " the feeHngs and mental condition of man "

Professor Sir Wm. H. Kingston, M.D., D.C.L., etc., in
his " Climate of Canada" (Montreal: Dawson Bros.),
says, the various conditions influencing climate may
be " reduced to two : distance from the equator and
height above the level of the sea." " Heat is the con-
trolling condition ; " but " the atmosphere modifies all
the effects of the sun's rays." And, "It would seem as
if this branch of medicine must ever remain to some
extent conjectural."

Briefly, climate is the condition of the atmosphere
in which we live: which we must breathe. This atmos-
phere, however, is incessantly changing, by reason of
the many and various influences above indicated : — of
the sun ; of the seasons and special fixed aspect of the
earth's surface toward the sun ; of geological and
geographical conditions ; of other or adjoining coun-
tries or localities and of the ocean ; and of influences
of a more local character, — soil, vegetation, subterra-
nean water, etc. So delicate and intricate are some of
the atmospheric or climatic changes that no way or
method has yet been devised for detecting or explain-
ing them : the human body when in health may not :
although when rendered supersensitive by derange-
ment or disease it may perceive them by their effects.

As Doctor Ferrier has remarked, " Nature as if in
ridicule of the attempt to unmask her, has reconciled
contradictions and realized improbabilities with a
mysterious versatility, w^hich inspires the true philoso-

300

CONSrMPTION :

m':.:

^:,"''K--,-

plier with diffideiiet.', and roduces the systematic to
despair."

While on some parts of the earth the atmosphere
is such that man cannot long survive in it, and in
others he cannot live long in health and comfort, in
most parts, with reasonable care, he can live to the
most advanced age. As ali'eady has been intimated,
usually the cjuestion of life and health is more in his
controllable habits of life than in the climate. The
climate is often blamed when man's habits — of diet, of
clothing, of housing — are chiefly at fault. Yet there
are but very few places of which it can be truly said:

" So sweet the air, so moderate the clime,
None sickly lives, or dies before his time."

THE ATMOSPHERE AND THE BODY FUNCTIONS.

Some of the direct effects upon the human body of the
atmosphere surrounding it — tliat is, effects of climatic
conditions, are generally well known. Such are thi'
depression caused by a damp, heavy atmosphere, act-
ing chiefly on, and checking, the function of the skin :
and, on the other hand, the exhilaration produced by
clear, dry, " ozonous " air ; the characteristics of race,
etc. There are certain more specific eftects, too, of
much importance. Stimulation, for example, is the
first effect of heat. This is followed by reaction and
depression, even to collapse. Heat relaxes ; while its
absence, cold, in a measure, gives tone, — we might say
firmness, stiffness. This has led to contrivances for
cooling the air in hot climates or seasons.

ITS NATURE, CAUSES AND PREVENTION.

301

^tt'iiuitic to

itniospher(^

it, and ii>
comfort, in
live to tht'
I intimated,
more in his
imate. The
—of diet, of
. Yet there
e truly said:

IJCTIONS.

n body of the

,s of cUmatic

uch are thi'

^sphere, act-

of the skin:
produced by
sties of race,
tects, too, of

inple, is the

reaction ami
les ; while its
ve might say

rivances for

The wanner the atmosphere tlie less oxygen it con-
tains, bulk for bulk, and the more tlie respiratory
function is reduced ; and usually tlie more active is
the skin. According to Parkes, x\. Katray, M D. (Surg.
R.X.: Procet'd, R. Soc, Lond.), made observations on
tlie weight and lieight of forty -eight naval cadets,
figed from fourteen and a half to seventeen years,
during four successive elianges of climate during a
voyage. The results show that in the tropics they
increased in heiglit more rapidly tlian in cold climates,
Init that they lost weight very considerably, and in
spite of their rapid growth, Ratray concludes that " the
heat impaired the strengtli." Parkes adds, " His figures
seem conclusive on these points, and show the bene-
ficial influence of cold on youtlis belonging to races
long resident in temperate climates."

Cold air, wliile it contains, in a given portion, more
oxygen than warm, also necessarily expands more
while its temperature is being raised to that of the
hings after it is inspire<l, and thus it aids materially
in the distension of tlie lungs.

Frequent exposure of the bo ly to alternate heat and
cold, either by means of air or water, undoubtedly
gives tone and vigor to a weakly pei"son. Much care,
however, must be exercised in the beginning of such
hardening process.

Humidity modifies the effects of the temperature
of the atmosphere and causes it to produce de-
pressing effects upon the body, chiefly by checking
the perspiration. Great humidity with wannth is,
h(nvever, usually bettei- V)orne than with cold. In

It *!■

302

COXSUMPTION

advanced chronic lun^ diseases, a moist, warm atmos-
phere usually allays cough ; while a dry one appears
to often irritate the lun^s. Malarial diseases, it may be
noted, attain their greatest activity with the greatest
humidity of* the atmosphere. Small-pox is checked
by a very dry atmosphere, and cannot be even inocu-
lated, it is stated, in the dry winds in Africa. Humidity
favors the development and spread of infections gener-
ally. It is well known that dry air retards decompo-
sition, and that moist air is favorable to the growth
of fungous plants.

The eifects of movements of the air — winds, depend
on three conditions: temperature, humidity and velo-
city. Calm, dry Arctic air can' often be well borne,
but when moving or moist it becomes unbearable, by
chilling the body.

The lightness or the weight — pressure, density or
thickness, of the atmosphere is a very important con-
dition of it. The pressure of the denser air at sea
level being fifteen pounds to the inch of surface, and
at an elevation of 16,000 feet only about half that, the
air at the latter point contains only half as much
oxygen, bulk for bulk, as at the sea level. At the
moderate elevation of 6,000 feet, the quantity of
oxygen in a certain bulk of air is 20 per cent, less
than at sea level. In order to compensate for this, a
person on ascending must and does breathe a pro-
portionately greater volume of air. One going sud-
denly from a low point to a high one, experiences
shortness of breath, and breathes more rapidly even
when at rest. When the altitude is not great, the

ITS NATUliE, CAUSES AM) PREVENTION.

308

trill atinos-
ne appears
s, it may bo
he greatest
is checked
even inocu-
, Humidity
bions gener-
is decompo-
the growth

inds, depend
by and velo-
j well borne,
bearable, by

i, density or
portant con-
r air at sea
surface, and
alf that, the
If as much
el. At the
[quantity of
ler cent, less
^te for this, a
athe a pro-
going sud-
experiences

•apidly even
.t great, the

brt'athing gradually becomes less frecjucnt, but deeper,
fuller and longer, and remains so. Hence the large
chest of the mountaineers. The ])hysioIogical effects
of the lessened pressure and thinner air, as one
ascends, i» not usually perceptible below 2,000 feet.

Some remarkable effects of altitude on animal life
are mentioned in a report of Medical Inspector Ciibbs,
IT. S. Navy (Climatol. U.S., A. N. Bell, A.M., M.l). New
York : Wm. Wood k Co.). On high mountains in Peru,
almost inider the etjuator, " positive degrees of heat
and cold meet on such sharp lines " that they cause
" violent reflex action, shock, ])aralysis," sevi^re and
sudden pains in men, causing them " to double up ; "
and such etiects on birds while Hviuiif in the air as to
cause them to fall suddenly to the ground <lead.

As in direct contrast to the effects of the thin air of
liigh mountains, it will be well to notice here some
effects of compressed air. For centuries, observations
on these have been made by physicians and others,
in diving-bells and in special air-tight chambers.
The caissons used in recent years in constructing in
deep water the foundations of great bridges have
afforded excellent opportunities for the study of these
effects. Parkes asserts that at a pressure of 1^ to 2
atmospheres the pulse and respirations become slowei-:
and that it is said (Foley) that more oxygen is
absorbed and venous blood becomes red, like arterial
blood. Doctor Andrew H. Smith, of New York
(Phys. Presb. Hosp., late Surg. N.Y. Bridge Co.), in a
work on this subject (Detroit: Geo. S. Davis), remarks
as follows : " Compressed aii* tends to expand the

304

(joNsuMrnoN

I ';

;i|

;;

pulmonary air VL'sicles, increasing thu vital capacity',
and may ))c uhcmI to restore the permeal)ility of aii-
tubes ocelu<le<l bv exudation or otherwise. In its

ft/

cliemico-physiological action, the indications are to hv
found in the increase wliich it occasions in the amount
of oxygen taken up in the hmgs, and the improved
condition of the blood which results. This is shown
in the more rapid oxydation of the tissues, in the
greater activity of the vital processes, and in increased
muscular power. . . . The narrow chest, more oi-
less flattened, . . . with restricted respiratory
movements, ac(|uires under the mechanical action of
the condensed air and the im])roved nutrition of the
respiratory muscles a greater range of excursion ; the
inideveloped aniemic and vulnerable lungs become
more or less expanded ; and the frecpient and super-
ficial respirations less frequent and deeper. . . .
Oertel gives it great prominence, and believes it will
often accomplish much more than change of climate."

CLASSIFICATION OF CLIMATES.

In systematic works a variety of climates is described :
cold and warm ; cold and damp, and cold and dry :
warm and moist, and warm and dry ; ocean climate :
forest climate ; and that of much elevated regions —
elevated climate, distinguished by a thin or rare
atmosphere, cool, dry and changeable. Space will not
permit of details here descriptive of these varieties,
nor of the climates generally recognized as most suit-
able for the different temperaments and constitutions
of consumptives and the various stages of the disease.

^ff*

ITS NATURE, CAUSES AND I'UEVENTIOX.

305

I capacity,
lity of air
li. In its
s are to )>('
he amount
; improved
is is shown
aes, in the
n increased
3Ht, more or
respiratory
al action of
ition of the
jursion; the
nsrs become
t and super-
[eper. . • •
ieves it will
of climate."

is described :
d and dry :
ean climate ;
id regions —
hin or rare
»ace will not
ise varieties,
,s most suit-
ionstitutions
the disease.

A few leading ])ointH, however, may be notice<l as
l»earing more especially on prevention.

A Cold Damp Climate is not favoral»le to hinnan
life and health generally, an«l .slioiild be avoided by
consumptives.

A C()l«l Dry Climate is, on the othei* hand, invigor-
ating and generally acknowledge<l to be best of all for
persons who are pre<lisj)o.sed to the disease, or those
in the earliei* stages who have strength to take con-
si<lerable exercise in the open air : this being more
(Nspecially the case if such be their native climate.
When consumption develops in a cold dry clinuite it
is owing to \ocii\ influences : for the most part to
habits of life therein ; and usually, much more than
to anything else, to housing in close, overheated
rooms and inattention to the skin, bv which extra
work is thrown on the linigs.

In Warm or Tropical Climates there is less outlay
of energy, which suits debilitiited feeble persons.

Warm and Moist Climates, such as those of Florida,
the West Indies, and Madeira, are enervating, and
now u.sually only advanced or excitable cases, or
those with a good deal of cough from bronchial or
laryngeal irritation, are sent to them.

Warm Dry Climates are more resorted to, as being
more suitable to a larger proportion of cases : such
are those of Mexico, southern California and some
parts of the Mediterranean coast. Arizona and
Egypt (upper) afford the more extremes of this sort
of climate. Consumptives in these have no difficulty
in keeping out constantly in the open air, while they
20

306

CONSUMFI'lOX :

•m

^: J.J

get abundance of sunshine. Some persons in tlu^
earlier stages, or when only predisposed to tlu*
disease, derive benefit, which, however, is not infre-
quently only temporary ; especially, in my experience,
in those accustomed to a colder, more tonic atmos-
phere. Within the present year, a nuin, aged forty-five,
a native of Ontario, still well able to attend to his
business, and who with reasonable care in his native
climate might have lived many years, if not to n
fairly advanced age, went to California, near Los
Angeles, and died in less than a year.

OCKAN CLIMATE.

The most notable characteristic of sea air is its
very high degree of purity and freedom from organic
emanations — bacteria, vapors, gases, and from pai'-
ticles of dust, or substances liable to irritate the lungs.
Hence from this alone life at sea is of great benefit
to some consumptives. Usually the air has a calming
effect on the nervous system, too ; its temperature is
more equable than on land; and its oxygen is iiyt-
parently in a most active, invigorating condition, —
highl}'^ electrified and ozonous. Sea air is somewhat
more humid than land air of corresponding latitude :
but so far as this may be objectionable, in itself, in
certain cases, other qualities fully compensate for it.
It is possible that the iodine, chlorine and bromine in
the air at sea may have a beneficial — an "alterative,"
effect on the human organism. Like many other of
the climatic conditions and effects, however, these are
not yet well understood.

ITS NATl RE, CAUSES AXD PREVENTION.

oiiH in tho
iHcd to tbi'
i not infre-
r experience,
onic atnios-
3d t*orty-tiv«\
ttend to lus
in his native
if not to a
ia, near Los

aea air is its
, from organic
nd from par-
bate the lungs.

great benetit
has a calming

nnperature is

,xygen is aP'

o- condition, —

X is somewhat

iding latitude ;

,le, in itself, in

»ensate for it.
,nd bromine in
|n " alterative."
[many other of

ever, these are

Amongst sailors tlie mortality from consum])tion
is comparatively very low. William S. Wilson,
M.R.C.JS.E., etc., in " The Ocean as a Health Kesort,"
has drawii attention to the fact that " the registration
return of deaths amongst sailors of the mercantile
marine show that the pr(j[)ortion of deaths from con-
sumption as compared with those from other causes
is ten times less than it is among.st the English land
|)opnlation," and that between the ages of fifteen and
forty-five, it is " sixteen times less at .sea than on
land." Sir B. W. Richardson has stated that in 1850
Bowden showe<l that, while the dtjaths from consump-
tion in the British army were, in the Line, 8.9, and
in the Guards, 12.5, per 1,000 men, in the Navy,
from 1830 to 1856, only 1.76 per 1,000 died of it.

A life at sea, for one predisposed to phthisis, and
inclined to such n, life, is certainly to be reconnnended,
though rarely absolutely necessary.

A sea voyage, especially a long one, is in some cases
advisable. Cases in which the most decided and
permanent benefit followed a long sea voyage have
come under my oKservation. The risk or seasickness,
however, of undue excitement and anxiety in rough
weather, with the impossilnlity of turning back if the
life proves ol)jectionable, must not be lost sight of.

Modified sea air, as on sea-coasts and islands, is in
some cases of benetit. It is not so pure and uniform
as out-at-sea air, Imt in a few localities is a very good
substitute. The nature of the soil, aspect, prevailing
winds and other conditions, nnist be very carefully
considered in making a selection in any case.

308

CONSUMPTION

HIGH MOUNTAIN CLIMATE.

High mountain air is peculiar in that from its
tliinnesH and smaller oxygen supply it necessitates
greater activity in the breathing movements; an
indispensable condition in both the prevention and
cure of consumption. Elsewhere have been noticed
some effects of altitude on the body functions. By the
fuller breathing, the smaller (luantity of oxygen in
the air appears to be compensated for in suitable
cases, and general permanent benefit follows. A
young man with a proportionately small or inactive
chest, either partly or wholly inherited, or acquired
by habit, and so predisposed to the disease, usually
benefited by residence in a well-elevated locality. A
more active respiratory function is forced upon him :
he is compelled to breathe deeply. The membrane
forming the air chambers instead of continuing in a
measure contracted and thickened, becomes active,
distended, thinner, and positively cleaner, and the
function of respiration is more perfectly carried on.
The lungs become a less-titted soil for tubercular
deposits. If such young person have no particular
home ties or business relations, and would be as con-
tented away from home, and with means to go with-
out deprivation, and make ii home there ; and more
especially if he be somewhat indilierent about his
health or condition, and not disposed, from careless-
ness or other cause, to use special means at home for
removing or overcoming his predisposition, he prob-

ITS NATURE, CAUSES AND PREVENTION.

:iOO

ably should be advise<l to make liis home in an ele-
vated locality. He will there be actually compelled to
take longer, fuller inspirations. These are the sort of
cases that are most benefited by such a climate.

Persons in the earlv stao-e of the disease, not much
debilitated, with little or no fever or consolidation of
the lung tissue, nor bleeding therefrom (luemoptysis),
and especially if the disease b? making* but slow
progress — very chronic, and who are not of an excit-
able or " nervous " temperament, are not infrequently
benefited, and permanently, by an elevated climate.
Those further advanced, or who cannot take consider-
able exercise, or are erethic, easily excited or dis-
turbed, should not risk the change.

It is (|uite generally believed that inhabitants of
high mountains are exempt from consumption. It
appears, however, that development of the disease is
not unconuiion n(jw in some elevated cities in Color-
ado and Mexico. Local influences — overcrowding
and want of ventilation, eventually produce their
predisposing effects in high as well as low cities. Once
introduced, it spreads to the susreptil)le by infection.
On the authority of Parkes (Pract. Hygiene), " Al-
though on the Alps phthisis is arrested in strangers,
in many places Swiss women on the lower heights
suffer greatly from it; the cause is a social one ; . . .
ill- ventilated, low rooms : . . . constrained position,
poqr food. Scrofula is very common." It is now
known, Parkes says, that " great

310

rONSUMPTloX

Liii^i

ELEVATION IS NOT NECESSARY

for the euro of phthiHis." " It would even seem pos-
sible that, after all, it is not indeed elevation and
rarefaction of air, but simply plenty of fresh air
and exercise, which are the great agents in the euro
of phthisis." Neith(?r is it necessary, certainly, for
the prevention of the disease. Ziemssen (Clin, lect.)
says of mountain health resorts, — " Their success
seems to depend not so much, if at all, on elevation
of site as on the purity of air and exercise of the
lungs." Davis, who is decidedly favorable to moun-
tain climate, in his latest work, referring to respira-
tory gymnastics, writes as follows : " The respirator}^
muscles are strengthened and trained to involuntary
mountain deep breathing. The chest can be gradu-
ally thus enlarged quite as much as by high-altitude
life, provided only one will be sufficiently persever-
ing." On another occasion he writes respecting moun-
tain-air : — " It often stinnilates the ambitionleas and
lethargic to take the all-needed exercise," — of the
lungs. Denison (of Denver) says, " The mountain
configuration of most high places invites to hill-
climbing, and the increased radiation of heat due to
rarefaction and drvness is a natural incentive to, or
substitute for, exercise. These agencies are to be
pi'eferred because they are natural ; and besides the
enforced observation of artificial rules is less impera-
tive in high altitudes." It is clearly evident then
that the best authorities, those who have had best
opportunities of knowing, believe that the beneficial

ITS KATFRE, TArSES AND PREVENTION.

311

results of mi elevated climate are produced by an
increased respiratory function in pure air : as Zienis-
sen remarks they depend on the purity of the air
and the exeicise of the lunjrs.

Furthermore, theoretically, we wouM naturally
suppose that tlie lungs could be gradually enlarged
and respiration improved with greater safety — less
i-isk from hfemoirhage, by careful lung exercises at
home, in the native climate, than by a comparatively
sudden change to an elevation. Localities with practi-
cally pure air and other favorable conditions can be
found in almost any country or part thereof,

FOREST CLIMATE.

Forest climate, especially that of pine forests, has
been highly extolled. An abundance of sunlight can
of course be always obtained in a piece of open. The
effects of forests on the atmosphere resemble in some
respects those of the sea : more especially do they
equalize temperature and humidity. Pine and other
balsamic trees produce an aseptic condition of the air
which is thought to be highly salubrious ; while the
pine especially, in its root growth, greatly favors sub-
soil drainage. Doctor A. N. Bell (in Climatology, as
quoted) says, " The effect of forests on the electrical
states of the atmosphere, and the generation of ozone,
is doubtless a force of great influence, adding to
the general salubrity, and under some circumstances
giving them special potency." Forests afford great
protection from the effects of winds, cold or hot ; and
also from " malaria." It is said the interiors of the

812

CONSrMl»TI()N :

great " dismal " swampw of Virginia and the Carolinas
are not insalubriouH, like it is near the treeless borders.
Doctor F. L. Oswald relates (Pop. Sci. Monthly,
Vol. XI ) that the Prince de Ligne wrote an essay
" On the Location of the Earthly Paradise," in which
he calls attention to the fact that " paradise traditions,
in locating the garden of Eden, differ only in longi-
tude, not in latitude. The latitude keeps always near
the snow boundary, a line just south of the regions
where snow may fall, Imt will not stay on the ground.
It passes through Thibet, Cashmere, northern Persia,
and Asia Minor, reaching the meridian of Europe neai-
the centre of the Mediterranean." Doctor Oswald
adds, " We may doubt if in the most favored regions
of the New World, human industry, with all the aids
of modern science, will ever reunite the opportunities
of happiness which Nature once lavished on lands that
now entail only misery on their cultivators," and this
because of the " insane destruction of the forests."

v«.

ACCLIMATIZATION.

Acclimatization is a physiological process the pos-
sible injurious effects of which upon non-vigorous,
debilitated, susceptible persons, it appears to me, are
almost entirely overlooked when considering the ques-
tion of a change of climate. The human body when
in fair health can soon adapt itself to much changed
surrounding circumstances, but not without a certain
expenditure of force or energy. Consumptives have
little or no energy to spare for anything not indis-
pensably necessary. It is well known that the body

ITS XATURE, CAUSES AND PRRVENTION.

:U3

functions of a liealthy vig;oi'ou8 man are sonietinies
much tlisturbetl by tl»e change. The disturbing eti'ects
are probably exerted, in a measure, upon every organ
and function. Can we ever be certain that any bene-
fits whicli may be produced by a change, as, for ex-
ample, from a cold or temperate to a warm climate,
where, it is true, the lungs may be relieved by more
work being thrown upon the skin, will compensate
for any ill effects which the change, particularly at
first, may exert upon other organs of a consumptive ^
Respectnig the change from a temperate to a ti'op-
ic^l climate, Parkes (E. A., as (juoted) says, " How
soon the body, when it has become accustomed by
length of residence for successive generations to one
climate, can accommodate itself to, or bear the con-
ditions of, the climate of another widely <lifferenrt,
place, is a ([uestion which can only be answered when
the influences of climate are better known. •. .
Certainly it would appear that, in India, there is some
evidence to show that the pure race [European], if
not intermixed with the native, does not reach V)e-
yond the third generation." Sir W. Moore (paper
before Epidemilog. Soc. Lond., '91) maintains that
great as is the power of accommodation possessed by
individuals, each race is especially fitted for certain
climatic conditions, which tend sooner or later to
eliminate the unfit. He believes that an infusion of
native blood is essential to the permanent existence
in one climate of immigrants from another and very
diverse one ; and gives examples, in respect to In<lia
and South America (Can. Health Jr., Ap. '91).

.•n4

CONSUMPTION :

U'l

. !

Cluiiij^in^ to a coklei* cliiimte, .strant^e an it may
appear to soiiie persons, seems to prcjduee a ^ood
effect eventually. Respecting Anj^lo-Saxon and Celtic
races ^oinjr to live; in a climate with a lower mean
temperature and greater variations than their own,
Pai'kes ol)serves, " We have the experience of Canada
and some parts of the Northern American States, in
which, if the food is good and plentiful, health is not
only sustained, but is perhaps improved.
Certain it is that in those countries the European not
only enjoys health, but produces a progeny as vigor-
ous, if not more so, than that of tlie parent race."

The intense effects of great altitude upon the body
have been already noticed. At lower levels of course
the effects are less marked. At an altitude of about
3,000 feet they begin to be decidedly perceivable :
(juickened pulse and respirations, lessened spirometric
capacity and increased evaporation from the skin
and lungs (Parkes). Doctor Charles Fayette Taylor
(Proceed. N.Y. Acad, of Med., Oct. '94) informs us that
" Whether it be due to the increased action of the
heart in the rarefied atmosphere, the constant ham-
mering of the nerves by the winds and the fierce sun-
shine, or all these and other causes, people in those
[elevated] regions have a thin and tired look, and it is
found useful and often necessary, especially in cases
of women and children, to visit lower, damper and
more germ-laden regions" in order to recuperate. To
the susceptible " nervous " consumptive such a climate
is not suitable.

ITS NATITUE, CAUSES AND PHEVENTIOX.

n\ri

CHAN(JE OF CLIMATE UXCfcUTAIN AND EMPIRICAL.

With the proscnt want of knowlffl^o ui" tlic relations
to, or efiects upon, the body ot* tlie numerous and vary-
ing conditions of tlie elements of the atmospliere, or
climate, some special conditions of the oxy<(en of whicli
have yet to be referi-ed to, the practical appHcation of
climate to consumptives either as a preventive or ther-
apeutic remedy seems to be in most cases uncertain in
a high degree, and is almost wholly empirical. Over
half a century ago, Sir James Clark, M.D., etc. (Cyclop,
of Med.), wrote, — " Since the nature of phthisis has
been more fully understood, the expectations fronj
climate as a means of cure have greatly abated, hence
it is much more justly considered simply as a pre-
ventive . . . during that peculiar state of deranged
health observed before the disease has manifested itself
in the actual development of tubercle. If it has dis-
appointed as a curative agent, how far can it be relie<l
upon as a preventive ? To be sure, before the in-
creased debility consequent on the formation of
tubercle the patient could the better bear acclimatiza-
tion. One of the latest authorities, Doctor Squire,
already quoted, remarks that, " Years ago Madeira was
the chief health resort of consumptives, and all sorts of
cases were sent there. Next the south of France came
into vogue, and thousands of consumptives flocked to
the Pyrenees or to the Riviera. Then came the turn
of the mountain climates and the Engadine, and the
clear air of the snowy mountains and altitudes of
Switzerland dispute the claims of the dry sandy

S1G

rONSt'MPTlOX

I ' :ct

iii

])lainH ol* K«;y))t juid tlie African hIioioh of ihi" MimH-
terninean or tliose ol' its more attractive northern
coasts." These places, Doctor S(|uire adds, " are all
suituMe health resorts for consumptives, if j)ropei-
selection is made of the kind of case to he sent to
each." Just so: hut with the present limited degree
of knowledge on this suhject, how is the selection to
he safely made ? Doctor Davis (hefore cited) ohserves
that, the selection of a climate is frecjuently made
easier hy watching the effect, in a given patient, of
different kinds of weather, especially of hright, warm,
moist days, and bright, warm, dry ones. And Doctor
F'rank S. Parsons (Ed. " Times and Reg.," med., Phila.)
says, " The only way to test a location " is for the
person to " try the various localities," if practicable,
and make a permanent abode in the one which agrees
best with his individual constitution.

In view of all this, and of well-known highly unsat-
isfactory results from change of climate, especially
from a cold to a warm or thin atmosphere, sliould not,
usually, every other remedy be first tried in all cases
of consumption oi- of predisposition to it ?

ESSENTIAL CLIMATIC ELEMENTS OH CONDITIONS.

There are certain elements of the atmosphere which
are absolutely indispensable for either the successful
treatment of consumption or for removing or over-
coming the predisposition. These relate particularly
to the purity, temperature, humidity and movements
of the air and, perhaps more particularly, to the
condition and proportion of its oxygen.

ITS KATUUE, CAUSES AND PREVENTION.

317

The degree of purity or non-purity of air is now
usually based on the number of bacteria, or genns, it
contains. Gases or vapors from the ground or other
source may perha{)s be sometimes in the air which
produce effects upon the body more important than
those which ordinary bacteria produce, Init alx)ut
which nothing is yet known.

Germless air (practically so) is found only (a) out
at sea, where germs are not developed, (/>) on moun-
tains 5,000 feet high or upward, whence any micro-
organisms which may be developed gravitate readily
through the thin mountain air away to lower, heavier
strata, and (c) on expanses of country, not too near a
city, well covered by snow. As Doctor S(piire says,
" Any snow-covered expanse has for a time — and in
some places, as in parts of Canada, for a long time —
a comparatively gerndess, and so a healthful air ; and
these, though not at any great altitude, help to supply
the want that mountain climates satisfy."

Besides these, there are many rural localities in
most countries sufficiently elevated for good drainage,
with a sandy, gravelly or rocky soil, or a richer soil
with sufficiently abundant, salubrious vegetation, in
which the air is sufficiently pure and restorative.

The temperature of the air is a condition upon
which its suitability for consumptives has been most
largely based. These persons usually require, most of
all, " tone." Warm air is relaxing rather than toning.
The colder the air that can be borne, or within reason-
able limits, the better, the more oxygen it contains,
in a given bulk, while at the same time the more

!!:^:i

i »,

■Y I

p?j

i.i

318

CONSUMPTION :

invigorating this vital olcment HueiiiH in itHelf to 1x3.
The air shouM not 1k^ humid. Tho efiectH of sudden
changes of temperature, as already stated, are invigor-
ating : and Parkes says, " It is astonishing to find how-
well even phthisical persons will bear great changes
of temperature if they are not exposed to winds."
At Nice as the sun approaches the hori/on the ther-
mometer falls 25° F. in an hour. Sudden changes
constitute one of the most marked features of th(»
thin atmosphere of high mountains. At Davos
(Switz.), less than six thousiind feet above the sea
level, a special resort, summer and winter, for con-
sumptives, the uncovered thermometer has registered
166° F. by <lay and fallen at night to 16' F. ; a
"drop" of 150°.

The degree of humidity of the atmosphere is a con-
dition of much importance. In treatment of the pre-
disposition, or excepting cases of irritable cough, a
comparatively dry air seems decidedly most favor-
able, as promoting free transpiration from the skin
and lungs. In relation to this point, especially the
exhalation of moisture from the lungs, Denison (Den-
ver) says, " Does it not stand to reason that this tran-
spiration of surplus vapor is a most admirable vehicle
for carryoig away effete matter, waste tissue and the
germs of disease ^ " Thirst for fluids is greater, and
fluids slio^id be taken freely in a dry atmosphere.

Winds, on account of their directly cooling eft'ect
on the body, are not well borne by the susceptible
consumptive, particularly moist winds. Moderate
m(jvements of air, however, are essential to good
ventilation and the purification of areas pf country,

ITS NATURE, CAUSES AND PREVENTION.

319

as well as of dwellin^H. A locality Homewluit shel-
tered from winds by forest or hill is hest.

Sunshine, direct, when not too stronif, is indispen-
sable ; and abundance of it is most desirable. A
" sunny " climate has vvev been rej^arded as salu-
brious. Herei!! is one of the principal advantaj^es
of mountain climate. A thin, mountain atmosphere
may, however, permit Sol's i-ays to pass too freely and
powerfully. The readiness with which the sun's rays
pass through this thin dry air causes the great difiei*-
ence in temperature l)etween sunshine and night.

The Oxygenic condition of the atmospheres has
undoubtedly a most important bearing upon health
and vigor. There appear to be im[)ortant vital
variations in the quality of this life-giving element,
oxygen, in different localities, as well as in its (|uan-
tity: variations arising doubtless through the influ-
ences of sunlight and electricity, and about which we
yet know but little. To' these variations is ])robably
due, in the main and directly, the well-known dif-
ferent feelings, of exhilaration or the opposite, com-
monly experienced by persons on going from one
limited locality to an adjacent one : some voicing
these feelings by saying, " I feel like a different
person," in such and such a place. It is not improb-
able that the topographical aspect — the slope, of a
limited locality toward the sun, the geological struc-
ture, or the subsoil water, may through the influences
of electricity and sunlight affect and change the
quality of the oxygen over the place. Sir Benjamin
Brodie, Doctor (now Sir) Benjamin W. Richardson
and Schonbein have proved that there are at least

320

CONSUMPl'lON :

ii' 1

two distinct conditions of oxygen. Doctor Richanl-
son has shown that warm-blooded animals become
narcotized and eventually die when forced to breathe
over and over again the same atmosphere, although
by a process of washing, it is kept free from the toxic
products now known to exist in expired air : " The
process of life ceasing, not from the introduction of
a poison, but as by a negation, or a withdrawal of
some principle extant in the primitive oxygen which
is essential to life." (" Field of DivSease," etc. Phila. :
Lea Brothers & Co.) By passing an electric spark
through this oxygen, after it has been breathed, it
acquires again its life-sustaining properties and pro-
duces no ill effects on the animals. These different
states of this element Doctor Richardson distinguished
by the terms vitalized and devitalized oxygen : —
active and negative. It need hardly be stated that,
as a rule, those places in which the oxygen is most
active or vitalized are most salubrious, and most
desirable as places of residence.

SPECIAL LOCAL INFLUENCES AND CONDITIONS.

The most commonly recognized special local condi-
tions which affect the atmosphere over a locality and
give rise to the noted differences, if we except those
which give rise to foul air — " malaria " and other
noxious gases, are (a) the nature of its soil, and
(h) the slope (klima) or aspect of its surface toward
or from the sun. The evaporation of moisture from
the earth's surface absorbs heat ; while the con-
densation of moisture in the air liberates heat.

[jtor Richanl-
imals become
;ed to breathe
lere, although
from the toxic
•ed air: "The
itroduction of
kvithdrawal of
oxygen which
," etc. Pliihi. :
electric spark
n breathed, it
;rties and pro-
rhese different
[1 distinguished
;ed oxygen : —
DC stated that,
xygen is most
)us, and most

)NDITIONS.

lal local condi-
a locality and
except those
ia" and other
its soil, and
irface toward
noisture from
kiile the con-
liberates heat.

ITS NATURE, CAUSES AND PREVENTION.

321

Cloud or moisture in the atmosphere intercepts
both the heat from the sun and that radiated from
the earth's surface. It is easv, therefore, to under-
stand that the air over a locality from which, by
I'eason of a slope, say, toward tlie sun, the water
of a rainfall flows freely and rapidly away, or
(piickly penetrates deeply into a gravelly or sandy
soil, is ditterent from that over a flat-surfaced locality
with a close retentive soil, or from one sloping from
the sun : not to mention many othej' topographic
features which atf'ect atmospheric conditions. Again,
the absorption and accumulation of the sun's heat by
the earth s surface sjil or crust, varies not only with
the natiu'e of the soil and the slope of the sui'face
sunward or otherwise — the angle of incidence, but
also with the nature of the vegetation on the surface —
trees, shrubs, gi-asses, etc. And again, the temperature
of the sul>terranean water, wliethei- manifested by
warm or hot springs, or only by deep wells, aflects the
temperature of the soil and hence the coinlition of the
atmo.sphere. Yet again, as the heating and cooling of
water takes place in accordance witli a law difterent
from that by which land is heated and cooled, a lake
modifies and e<}ualizes the temperature of the ail* in
its vicinity, making it cooler by day and warmer l)y
night. Hence the reconmiendation to place a vessel
of water near house plants at night to lessen the effect
of cold or frost. Forests, too, produce a like modify-
ing effect. It is well known that the temperature in
forests everywhere is higher in v«rinter and lower in
summer than in the open country.
21

322

CONSUMPTION

D <

True it is that the particular air over any one
locaUty is soon changed by the movements of air
going on everywhere and giving rise to winds more
or less perceptible, and is largely replaced with air
from other localities. Still, when the weather is
calm and there is not nmch atmospheric movement,
the air over a given or favored place remains for a
considerable proportion of the time but little changed.
Besides, notwithstanding the movements, as the local
topogi'aphical and geological conditions which influ-
ence and change the air are incessantly operating
and producing their effects, there will always be a
slight difference, as in temperature, humidity, vege-
tative emanations, etc., sufficient to affect electric,
oxygenic, or ozonous conditions. And although these
changes and conditions cannot be detected by any
chemical process or instrument yet known, they may
ba perceptible, as already intimated, to the sensitive
nervous structure of a deranged human body : or
even if not sensibly or clearly perceptible by, they
may yet produce effects upon, such a body.

SELECT, HOME CLIMATE.

What is usually meant by change of climate is a
change to a part of the earth a considerable distance
away : to a warmer or colder, moister or drier, more
equable or sunny, or a more elevated climate. More-
over, the change is made apparently usually as if the
climate of the country in which the consumptive
had recently lived had been the cause, or this in a
measure, of the consumptive condition ; which it is
almost needless to state, is not often, or, alone, never,

'' \

ITS XATUllE, CAUSES AND PKEVENTlOX.

;J2.s

er any one
lents of air
winds more
;ecl with air

weather is
c movement,
iinains i'or a
ittle change'l.
s, as the local
, which influ-
tly operatinjr

always be a
imidity, vege-
attect electric,
although these
fcected by any
,wn, they may

the sensitive
man body: or
l)tible by, they

.dy.

)t' climate is a
irable distance

or drier, more

llimate. More-

mally as if the

le consumptive

L, or this in a

[n; which it is

»r, alone, never,

the case. It is true that in some climates it is not
so easy as in others to overcome or remove a predis-
position to consumption, and some tend more than
others to Favor the development of a predisposition :
in other words, in order to prevent a predisposition,
or increase of it, it is necessary to be more careful in
respect to habits of life in some climates than others.

For reasons already above partly explained, two
localities, adjacent and limited, may have over them
an atmosphere varying in a number of important
characteristics, highly favorable, or much less so, to
life, health and vigor. One may, therefore, often
make a most beneficial change of climate without
going far from home or leaving one's native country,
or even county, to which one is accustomed or accli-
mated. A change especially from a flat, damp, frosty
soil, to a more elevated, sandy or gravelly dry one :
from one much exposed to cold or damp winds and
less to sunshine, to one more protected from storms
and more exposed to the sun : and from an urban
to a rural one, is often absolutely essential, in either
prevention or cure, in consumptive cases. And such
a change is in nearly all cases all that is necessary,
especially on this continent above the forty-fourth
parallel of latitude, inland.

A specially favored, select or ideal locality for a
person predisposed to consumption, or in an early
stage of it, would be one in a rather cold climate,
such as northern Europe, the northern United States,
above the forty-fourth parallel or higher, and Canada,
presenting the following conditions or characteristics :
a somewhat elevated plateau, not too flat, or a hill-

324

CON'SIMPTION

lu t

-I

side, sloping toward the sun, with a sandy or gravelly
soil and choice vegetation, as perhaps balsamic, odor-
ous trees or plants, near a small lake, preferably be-
tween the lake and a forest-covered mountain or hill, —
the latter protecting it from the severity of the usual
prevailing cold winds, and with all, warm subter-
ranean water supplying the lake. In such a place, —
with such salubrious conditions, the usual seasonable
or other objectionable climatic changes would be
reduced to a minimum.

In the countries above mentioned there are many
localities in different sections with characteristics
much .(s just pointed out to which consumptives could
resort. There need then be no leaving home and
friends for distant countries : no risk fron^ acclima-
tization. In the British Isles, surrounded as they are
by the ocean, a sufficiently dry locality for certain cases,
as with a strongly marked predisposition, is hardly
obtainable. In sach, notwithstanding the salubrity
of sea air, a drier, more invigorating climate may be
necessary. Doctor J. E. Squire says, " The influence
of pure dry air, an equable temperature with bright
sunshine, so beneficial to those whose lungs are weak
or already damaged by tubercle, cannot be obtained
throughout the year in this country, and are sought
abroad by those who can afford to travel."

In concluding the general subject of climate, it may
be noted that those peoples who in centuries long
past migrated from the Paradisian belt, along "the
snow-boundary," northward to the colder regions have
<leveloped into greater, more powerful nations than
those who migrated to the warmer latitudes southward.

ITS NATURE, CAl'SES AND PHKVKXTIOX.

:^'2')

or gravelly
uimic, odor-
il'erably be-
linorhill. —
of the usual
anil subter-
i\\ a place, —
il seasonable
ft woukl bo

>re are many
haracteristicH
Bptives could
[ig home and
fron\ acclinui-
id as they are
c certain cases,
ion. is hardly
the salubrity
iiniate may be
The influence
•e with bright
^ngs are weak
jt be obtained
nd are sought

llimate, it may

jenturies long
lit, along "the

tr regions have
nations than

lies southward.

CLIMATE OF CANADA AND ADJACENT STATES.

The particularly salubrious and invigorating climate
of Canada should be more widely known. Tlie mean
elevation of the country is only between 300 and
400 feet : less than half that of this continent, or of
Europe ; and oxygen abounds. It is hardly anywhere
flat, but naturally well drained. The mean tempera-
tiu'e is lower than in those parts of Europe in the same
latitude. The extremes, however, of l)oth cold and
heat, are much modi fled b}'' the great mid-continent
lakes. The two principal seasons are Sunnner and
Winter : the intervening seasons being shorter.

Spring is a very bright pleasant season, but of short
duration, so rapidly does Summer succeed the Winter.
" Leaf and blossom are not unfolded one by one : but
as if by magic," when the snow is gone (Kingston).

In Sunnner there aie rarelv more than three succes-
sive days of great heat, when a copious rainfall, last-
ing at most but a few hours, cools, and also purifles,
the air. During the hottest days, there are almost
constant cool breezes, and one never .suffers from the
heat as do travellers in the East, or even in Southern
Europe. Sunstroke is rare, practically unknown
except in the largest cities. September, October, and
for the most past Novendx'r, constitute a delightful
Autumnal or lingering-summer season, in which rainy
days are not at all numerous.

The Canadian Winter, about which some persons
who have little or no knowledge of it, speak dispar-
agingly, is far from being so trying, either to healtli
or comfort, as many suppose it to be. The cold, like

ft/

I :

I 1

I ll

320

CONSUMPTION

the heat of auminer, wliile extreiiie in degree i.s not
felt to be so. 'J'o persons accustomed to the damp,
raw winter atmosphere of the British Isles the ther-
mometer is a very imperfect indication of the relation
to, or effects upon, the human body of the cold, yet
dry, clear, sparkling, invigorating and cheering atmos-
phere of a Canadian winter. Even the occasional
thermometric-below-zero temperature very rarely lasts
more than three full days, nearly always moderating
before the close of the third.

In illustration : When the sisters of St. Joseph were
founding the Hotel Dieu Hospital in Montreal they
lived twenty years in a building the walls of which
were only a single board in thickness, and when snow
fell in the night, so freely did it come in through the
cracks that it had to be removed in the morning with
shovels. It is related (Relat. <les Jes., pub. by
Govern't) that " Tender, delicate girls who feared a
snowflake in France," where a " slight frost caused
them to take cold," here, a " long winter, armed from
head to foot with snow and ice, produces, apparently,
no other effect than to keep them in good appetite."
Horses and cattle in the North-west, in many instances,
are not housed during winter at all, and gather their
provender from the sappy twigs above, and the grass
beneath, the snow which they paw aside. January,
the coldest month, I have always in my experience
found to be the most healthy. Indeed the winter in
this temperate region is on the whole a moat joyous
Season. It was not of it that Homer wrote :

" . . . Frost, which all the works
Suspends of man and saddens all the flocks."

ITS NATURE, CAUSES AND PREVENTION.

327

n've iH

not

the damp,
js the ther-
bhe relation
tie cold, yet
sring atnios-
B occasional
' rarely lasts

moderating

Joseph were
ontreal they
ills of which
1 when snow
through the
norning with
res., pub. by
v^ho feared a
rost caused
armed from
, apparently,
3od appetite."
any instances,
gather their
and the grass
ie. January,
ly experience
the winter in
most joyous
rote :

The spotless sheet of snow spread over the gi'eater
part of the country during several months of the year
renders the air then practically germless ; while the
rapid vegetation of most of the remainder of the year,
with the dryness of the air, or absence of great
humidity, is unfavorable to so-called " germ " life.
Of all known antiseptics, probably frost and dryness
— desiccation — are the best.

The exhilarating influence of the air in Canada is
doubtless due to its abundance of highly " vitalized
oxygen." In this respect the country is hardly equalled
by any other, except parts of the bordering northern
States. More than a century and a half ago. Father
Charlevoix wrote of it : — " We do not know of a
climate in the world more wholesome; no specific
disease prevails in it ; the fields and woods abound in
wonder working herbs ; and the trees distill balsams
of great virtue."

The records of the British army show that Malta
has been most favorable to the health of the men, with
a mortality of l.l : Canada comes next: Nova Scotia,
1.4 and Ontario and Quebec, 1.5. In Great Britain, it
was 1.7 ; Gibraltar, 2.1 ; Bermudas, 2.9 ; and Bengal,
5.5. It has been said that but for the use of " spirits,"
less necessary in the stimulating air of Canada, the
mortality here would have been still lower.

Life insurance companies accept rates in this coun-
try up to a certain age lower than in Great Britain.

Canadians and natives of the most northern parts,
east and west, of the United States, who become con-
sumptive, need not go abroad for change of climate

flocks.

328

CONSUMPTION

i .

wliile ill the earlier stages of the disease (before the
" softening " of tubercle and formation of cavities).
After that time, it is in nearly all cases better to
remain at home, the chances there being on the
whole usually as good as anywhere, than to go abroad
and die amongst strangers.

Consumptives in other countries, in the earlier
stages, who seek change of climate can but rarely
do better than to come to the cold, dry, bracing air
of Canada. I shall conclude with the following quota-
tion from Kingston's "Climate of Canada" (IJawsons),
to which excellent book I am indebted for many
of the facts given on this subject : " Indian officers
have passed directly to this country, and commonly
with advantage; my memory recalls many, who,
having returned to Europe and had their symptoms
aggravated, found that a short re^iidence in Canada
restored them to comparative comfort. Those esjje-
cially who have come direct from India to Canada in
autumn have noticed this change. One of my former
pupils . . . became surgeon in the line and went
to Bombay, where he contracted phthisis. He was
sent to an elevated station . . . where he experi-
enced temporary relief. He was then invalided and
came back to Canada. In passing through Great
Britain, the humid atmosphere was unbearable, and
his breathing became very labored. In Canada, his
breathing at once became easy. ... He felt, so
he told me, as if he were breathing, not atmospheric
air, but oxygen, so refreshing and invigorating it
seemed to him."

i H

(before the
of cavities).
}S better to
ling on the
to go abroad

tlie earlier
1 but rarely
, bracing air
owing quota-
" (IJawsons),
3cl for many
[idian officers
1(1 commonly
many, who,
eir symptoms
je in Canada
Those es])e-
to Canada in
f my former
ine and went
sis. He was
re he experi-
nvalided and
rough Great
[bearable, and
Canada, his
He felt, so
atmospheric
vigorating it

PART III

CHAPTEK XVI.

JIELATTN(J TO THE TREATMENT OK
CONSUMPTION.

It is not my purpose to enter in this book into details
of treatment, medical or other, nor of the symptoms
and diagnosis, of contirmed cases of consumption, so
far as they relate to the various special means appli-
cable to the difierent stages of the disease, or the differ-
ent constitutional conditions. Preventive measures,
prevention of the extension of the disease, embrace
the principles of what we term " cure," — constitute
the chief part, and an absolutely essential part, of it.
When mischief has resulted, however, and there is
actual destruction of huig tissue from tuberculiza-
tion, then usually measures must be adopted or reme-
dies applied which are never necessary before such
mischief. By the time tubercle has been formed, then
in most cases nutrition has been so far interfered with
and deranged that, while there is no specific remedy
for the tubercular condition, the functions of digestion,
assimilation and excretion require special attention
and management, such as supply of special nutrients.

fell"

|1 i

I* !

:<i ;

III I

330

CONSUMPTION

etc.; and every individual ease retjuires a somewhat
different form or application of remedies.

Persons other than physicians may read these pages,
and it would be in a measure dangerous to give here
details of special remedies, or the indications for them,
lest some such persons might be tempted to so treat
themselves or immediate friends suffering from the
disease, — tempted to apply the remedies without con-
sulting their physician.

The proper treatment of this somewhat peculiar
disease requires the utmost degree of medical know-
ledge, and withal, time, patience and care in applying
that knowledge. Moreover, no two cases of the disease
are precisely alike, and every individual case, as just
intimated, retjuires a special line of treatment, studied
out and carried out. Hence much harm may arise
from any measure of self-" doctoring," and indeed not
infrequently does so arise ; especially from dosing
with the " sure cures " advertised in the " papers."

On the contrary, what it is my purpose to give here
on this part of the subject, while it may, I trust, assist
somewhat the busy general practitioner wdio has not
been able to give sufficient time to fully acquaint
himself with the generally recognized views of the most
recent and highest large hospital authorities respect-
ing treatment, as indicated by the recently increased
knowledge of the causes and etiology of the disease,
it should rather deter anyone not a physician from
running the risk of doing himself or a friend serious
harm by any action in this way based on only "a little
knowledge." It is in such cases where the little know-

ITS XATUHE, CAUSES AND PKEVEXTION.

:VM

a somewhat

,d these pages,
to give here
ions for them,
,6(1 to HO treat
:-ing from the
1 without coii-

vvhat peculiar
medical know-
re in applying
i of the disease
il case, as just
Ltment, studied
irm may arise
,nd indeed not
from dosing
" papers."
\e to give here
, I trust, assist
r who has not
fully acquaint
lews of the most
irities respect-
intly increased
of the disease,
(hysician from
friend serious
•n only "a little
he little know-

ledge becomes the " dangerous tiling " : not in the pre-
vention of the disease by removing and counteracting
well-known causes of it.

In no other circumstances is a small amount of
knowledge so dangerous as in attempts to rectify
a deranged or diseased human body by any sort of
medicinal treatment of it. And probably in no other
disease is it so dangerous as in this peculiar and fatal
one. No one thinks of applying such knowledge to a
deranged or damaged watch.

DIAGNOSIS : DIFFERENTIATION.

The discerning and eminent physician, VanSweeten,
was, it appears, the author of the maxim, "Qui bene
diagnoscit, bene medebiter " ; sometimes translated
as " Diagnosis is half the cure"; but more intelligibly
as, Who accurately diagnoses cases — determines their
exact character accurately, will treat correctly.

Accurate differential diagnosis of consumption in the
early stage requires time ; time to make a most care-
ful, searching, thorough examination of the patient : to
(a) make as certain as possible as to whether the disease
l)e really consumption or not ; if consumption, to (6)
obtain as clear a knowledge as possible of the nature
and extent, or progress, of the local diseased condition
and of the general constitutional effects already pro-
duced ; to (c) learn of the special condition and con-
stitution, history, etc., of the pati* '^ and to (d) find
out the probable or possible more active remote
causes of the pretubercular condition. No two per-
sons, either in health or disease, being exactly alike,

^sam

II J

lV.i'2

CON'SIMHTION

HO, JIM stattMl, i^vi'iy cuHc iT(|uii«'s ji HoiiK'wlmt ditterent
c()Ui'.s(' «)1' ticatiiu'iit, t'HjM'cially us relating to nutrients,
treatimuit of the stomach, bowels, skin, etc., — requires
special medication: this without reference to, or aside
from, the different stages of the disease. It is known
that the most experienced, successful and eminent
[)hysicians, in tlie most exten jractice in London
and other large cities, whom young and less experi-
enced practitioners are naturally inclined to accept in
a measure as examples, devote much time to the
examination of each of their patients and to the
consideration of the special individual states before
prescribing foi' them : especially shovJd this be the
case in connection with consumption.

These remarks seem necessary, because sometimes
with busy practitioners tlu; temptation to make a
somewhat hasty examination a d diagnosis, of what
ap])ears to be a " well-marked ' e, is too great to be
rtisisted, and also because occasKjnal cases have been
treated as those of incipient consumption which were
not of this nature, but which in the hands of other
practitioners were found to be perhaps hydrothor x
(water on the chest, in the sac formed by the two
layers of the pleura); oi* what is worse still, occasional
cases have been treated as other diseases which later
proved to be tul)ercular consumption. Whoever
makes a hurried examination is liable to mistakes
of this sort : such occur for the most part only from
too little time being given to diagnosis. It need
hardly be added that the reputation of the physician
as well as t)ie life of the patient is at stake. As

if" i

ITS X ATI UK, t'Al SES AM) I'HKVENTION.

:i'M\

wliat (litiereiit
^ to nutrionts,
etc., — requircH
ice to, or aside
It is known
and eminent
tice in London
id lesH experi-
ed to accept in
1 time to the
ts and to the
1 states hefoi-e
ad this be the

luse sometimes
ion to make a
krnosis, of what
too great to be
;ases have been
ion which were
lands of other
ps hydrothor ' x
led by the two
still, occasional
ises which later
on. Whoever
>le to mistakes
part only from
losis. It need
k' the physician
at stake. As

Doctor J. K. S((uire says, " Early detection of t)ie dis-
ease being all -important, it is essential tliat skilled
examination should be obtained. . . . And, tir.st.
we must accept the fact that th«* recognition of com-
mencing tubercle in the lung is no easy mattei', only
possible when the chest has been skilfully and car«'-
fully examined, and the sputa, if any, microscopically
investigated" (Hyg. Prevention of Consump.).

The patient is the one most interested, and in case
liis j)hysician, or the one to whom he applies, ai.pears
disposed from any cause to make a hurried exaiuini-
tion, he may very properly courteously draw atten-
tion to this point, and ask for an opinion based on a
most searching investigation ; accepting no other.

There are a few persons, it is true, with "very little
the matter with thcM ' who imajiine they liave con-
sumption. Almost any pliysician to whom such may
apply can usually soon convince himself that there is
no consumption, or even tendency to it, in the case.

SOME SIGNS AND SYMITOMS OF CONSUMPTION.

The general configuration and appearance of a
consumptive patient, even in an early stage, with
the history and certain rea<lily obtained and common
symptoms, will be at once an important guide as to
proliabilities, but will afford no certainty of the
presence of tubercle. If after proper examination
of the sputum, tubercle bacilli are recognized, unmis-
takably, especially if by an expert, it is presumable
that there is then no que.stion as to the nature of the
disease : even although other symptoms and .signs

:]:U

COXSUMPTIOX :

i !

do not .stnjngly indicate tuberculoHis. Zienissen, how-
ever, reminds us of tlie old fundamental maxim, never
to base a diagnosis, not even in such a case, on one
single symptom. Then it will be remembered that,
on the other hand, there may be pulmonary tubei--
culosis without the bacilli being always found in the
spittle ; especially in the acute miliary form and in
cases in which these organisms are encapsuled —
encased in fibrous tissue. Like doubt, as we know,
accompanies the recognition in later stages of the
true elastic fibre ; it is, too, now known that pigment
granules and myelin cells are found in other lung
afi'ections ; and Ziemssen has shown that myodema —
contraction waves of the attenuated pectoral muscles
— may be produced in persons emaciated by other
causes than consumption. This high authority re-
commends the spirometer, and also the scales, as
aids in diagnosis, as well as guides during treatment.
Guided by four years' experience with the former, he
advises that only the i-elation between the volume of
expired air and the stature be taken : then the spir-
ometer serves to corroborate other symptoms. When
the proportion of stature to vital capacity falls below
one inch to three in a man, or one to 2.6 in a woman,
he says, " we may infer a considerable disturbance of
the respiratory organs," the nature of which must be
learned from other symptoms.

EARLY TREATMENT: DELAY MOST DANGEROUS.

It may be laid down as a fact, indeed, a maxim, to
be impressed upon both patient and physician, that
the only treatment that is likely to be s^uccessful

ITS XATUKE, CAUSES AND PUEVENTiON.

:335

iiiissen, how-
laxim, never
case, on one
nbered that,
Dnary tuber-
found in the
form and in
iucapsuled —
aH we know,
:ages of the
that pigment
1 other king
■j myo<lema —
toral muscles
bed by other
Authority re-
16 scales, as
;ig treatment,
he former, he
he volume of
hen the spir-
,oms. When
,y falls below
in a w^oman,
isturbance of
hich must be

NGEROUS.

a maxim, tu
ivsician, that
be successful

in consmnption when it is once established, is
EAKLY treatment. This appears to be more especially
the case with this than almost any other disease.
With early approved treatment, based on sound
diagnosis in respect to all indications an<l re(iuii('-
ments in the case, and properly eai-ried out by the
patient, there need be no anxiety or fear of the result

To the PATIENT, to anyone who has a predisposition
to this disease, and is perhaps at length awakened by
some symptom of it, as loss of appetite for food, some
languor and loss of strength and weight, with perhaps
a little " shortness of breath " on occasions or slight
cough or throat irritation, or to any friend — parent
or other relative, of the same, it may be said, n)ost
emphatically, when conscious of danger, lose not a
day in consulting a physician and applying the
proper remedies. Don't wait in such circumstances
until there is a bad cough, or pain in the chest (often
signifying very little), or perhaps specks or sti'eaks of
blood come up from the lungs with very little etibrt
or with hardly a cough at all. Go at once. The same
respecting delay applies to persons who have had no
marked predisposition, either hereditary or accjuired,
but who have had persistent cough for some weeks,
whether from a " cold " or bronchial trouble, or dust
or other irritation.

Self-treatment, except in so far as it relates to
prevention, as given herein, niay be worse, do more
harm, than delay. All so-called " medicines " publicly
advertised to cure consumption are, without a single
exception, FRAUDS, j)Ui'e and .sinjj>le. However nujch
good or virtue there may be in the " cure " or " dis-

1 m.

, fi

! 51

330

CUXSUMI'TION

coveiy," however much benefit otiier persons may
))o.ssibly liave chanced to derive from it, it is liable to
do the next one much hana on account of the entirely
different body constitution and condition, — liable to
cause direct injury to certain body functions. It
may act as a stimulant and cause a better feeling for
a time, while the disease is progressing, perhaps fast,
all the same ; or it may calm or subdue a cough, when
the cough, as in a measure nature's method of relief,
ought not to he so subdued. I would say to all con-
sumptives, as you value life, . ver be tempted, by
any promises of, or apparent, benefit or " cure," to
incur the risk of subjecting the delicate, deranged
organs and function of your now particularly sus-
ceptible body to the influence of a compound of drugs
about the nature of which you know nothing what-
ever, and moreover, which was originally compounded
l)y one who could not possibly know anything what-
ever about your special case — your body constitution
or condition. Pause, think, consider, and you will
surely see the inconsistency of any such course or
treatment of your case. It w^ould be almost certain
to be worse than delay. Dangerous as is delay, less
harm would likely result from it than from self-
treatment. It is to be hoped that the time is not
far distant when those persons wdio seek to extract
money from their suffering fellow-creatures by prom-
ises of cure through advertisements in the "press" will
be subject to legal action for fraudulent practices.

To the PHYSICIAN who i,;ikes charge of a consump-
tive patient, or of one in whom tubercle is suspected,
it may Iv well to say, put not the patient off* with

i.'-f '1; ! ^

ITS NATURE, CAUSKS AND PREVENTION.

337

mouH may
is liable to
he entirely
— liable to
ctions. It
feeling for
3rhaps fast,
ough, when
)(1 of relief,
r to all con-
ieinptecl, by
• " cure," to
B, deranged
3ularly mus-
md of drugs
thing what-
^ompounded
thing what-
Iconstitution
d vou will
h course or
lost certain
delay, less
from self-
Itime is not
Ik to extract
s by prom-
I" press" will
actices.
a consump-
s suspected,
lit ott' with

only a tonic, a cough mixture or an alterative, for a
day. At once, after due examination and considera-
tion of the case, lay <lown a complete course of
treatment, and impress upon the person most inter-
ested, the surt'er.r or his or her most immediate friend,
the importance of having every detail of it carried
out. Difficulties and discouragements in getting in-
structions fully or properly complied with are all too
commonly encountered by the physician, and much
tact and firmness are often re((uire<l in this behalf.

INDICATIONS AWD REMEDIKS.

These, so far as the specific disease itself is con-
cerned, are yet, and probably always will be, almost
entirely such as are termed hygienic — physio-ther-
apeutic — on the " lines of nature." All authorities
recognize this, now, to the fullest extent, perhaps
more decidedly than ever before. The proposed new
remedies of scientific experimenters, all, I believe, are
regarded as of only secondary importance, — as only
aids, adjuncts, in the treatment When Koch, for
instance, a few years ago, introduced his tuberculin,
he from the first particularly recommended that all
the usual hygienic remedies — abundance of pure out-
door air, sunlight, suitable nutrition, attention to the
skin, etc., be not neglecte<l but enjoined in all cases.
Without these, we can do nothing; without these, to
the full extent, everv other means will fail. Of all
of them, pure out-door air is most important. Hence,
to the now generally recognized treatment is so
fre(|uently prefixed the term "open air," "fresh air"
or "out-door." As Ziemssen says, the " fresh air treat-
22

Ml
1

338

CONSUMPTION

meiit occupies fii-st place." Man}' recent remarkable
recoveries from tu])erculai- peritonitis (tubercle of the
serous membrane investing- the bowels), apparently
from simple exposure of the diseased mend)rane to
atmospheric air by a surgical op<']'ation, seem to indi-
cate, more clearly than ever, that tlie virulence of the
bacillus is destroyed, even when active in the tissues,
by free exposure to the aii-. These I'emarks apply to
the oreat principle of treatment only.

Many othei- remedies, often indicated, in certain
cases and sta(»;es of the <lisease, I'ecjuii'e special con-
sideration in their application to each particular case;
]>ut as stated, cannot be discussed in this book.

A general outline of treatment may he cf)nveniently
noted under the following' divisions :

First of all, it need hardly be said, all the predis-
pcisinj;' causes of the disease, so far as they can be
made out, must be remove<l, as fai' as ])ossible, in
order to prevent their further action or influence.
These relate to occupation — in-door, stooping", dusty;
to location — dampness, impure air: to habits of life
o-enerallv — sedentarv, overworked, breathiuii', diet,
etc : and to any previous morl)id body condition.

Second : An immediate impoi'tant cause, apparently
in all cases, being a want of full respiratory capacity,
efl'orts must be at once made to remove this by
increasing the capacity. Authorities who have given
most attention to this subject recommend special
lung exercises or gynuiastics, or it may be " hill
clim})ing," sometimes pneumatic chaml)ers, for im-
proving the lespiratory fmiction. Inhalation of
oxygen, in order to supply to the tissues and fluids

ITS NATURE, CAUSES AND PREVENTION.

330

■emarkable
rcle of the
apparently
•inbrane to
nn to indi-
ence of the
the tissues,
ks apply to

in certain
special con-
bicular case;
book.
!onvenieiitly

1 the pre«lis-
they can he
possible, in
r influence,
ing, (lusty ;
bits of life
lithino-, diet,
idition.
, apparently
)ry capacity,
)ve this by
have given
lend special
ay be "hill
>rs, for ini-
halation of
's and fluids

a larucr amount of this clement, may be desirable.
Some care is reijuired that not more of this be sup-
plied than is assimilated or used by the system.

Third : Cravfully considered means must be adopted
for the proper nutrition of the body, in accordance
with the powers of di;j;e.stion, and, not forgetting,
assimilation — utilization after digestion : for which
probably a certain amount oi' oxygen is (lemandnl.
Not onlv an; assimilable, nutritious ordinarv f(;ods
re(piired, but not infre«iuejitly s[)ecial foods — minced
beef, cream or oils, malt extracts, phosphates, etc.,
should be provi<led, as the .system retjuires, or the
indications in each indi\ i(liial case point to.

Fourth: Attention must bej-'iNen to the skin, that
it may be clean and active, an<l .so aid in a measure
in the respiratory function, to relieve the lungs.
While the absolute cleanliness and activitv of the
skin are in<lispensable to the best results of treat-
ment, the cool or cold bath, in its various moditied
forms — sponge, hand, rain or sheet — at suitable tem-
peratures, as present indications point to, gives tone
to the entire body and lessens its susceptil)ility to
sudden changes of temperature, and hence to " colds."
Huflicient clothing, preferably light and porous, to pre-
vent chilliness, must be worn : but not too much of it.

Fifth: Attention to derange<l .special, local or gen-
eral functions is often neces.sary, even in the early
stages: — of the stomach, bowels, kidneys, liver, and
of the circulatory, nervous, or muscular system. The
cough may recpiire s[ ecial treatment, as external appli-
cations, or inhalations. " Cough mixtures," it niay
be said, should never be given. In this connection

340

CONSUMPTION : ITS NATURE, ETC.

*-'^o

the question of exercise, active, or passive — as in mas-
sage, to l)e prescribed in accordance with the vigor of
the individual, for improving the circulation, and
through it the nervous and muscular systems, may be
mentioned. As Hippocrates advised, — " the patient
may take his walking exercise if walking agrees with
him ; if not, let him rest as much as possible." Anti-
septics may be indicated. Other conditions or symp-
toms, such as night-sweats, ha3morrhage, diarrh(«a, of
advanced cases, need not be noticed here.

In conclusion, it may be observed that, the simpler
and less complicated the treatment, in respect to any
morbid local couaition, so far as it is at all consistent
with, or meets, the indications, the more successful it
will probably prove to be. Any morbid action or
state that has evidently been the result of the tuber-
cular condition, will usually gradually ' disappear as
the general bo ly condition improves, and may usually
be left in abeyance, if not excessive in degree and
giving too much trouble or inconvenience : such as
mioderate cough, slight pains, nausea. On the other
hand, any such state which has operated as a cause,
may the more likely demand special treatment.

Improvement of the respiratory function will alone
promote nutrition, usually in a large measure. With
a suitable diet, nutrition will be still further pro-
moted and improved. And with proper attention to
the skin, improvement in the circulation and general
invigoration will result. Full, deep breathing of pure
sunny air, proper food, and a vigorously acting skin,
constitute the trinity of treatment for consumption.
Other remedies, often necessary, are quite subordinate.

-as in mas-
)he vigor of
lation, and
snis, may be
the patient
agrees witli
ble." Anti-
ins or synip-
Jiarrhc^a, of

, the simpler
spect to any
ill consistent
Hiiccessful it
lid action or
of the tnber-
disappear as
may usually

deirree and
nee: such as
On the other
d as a cause,
itment.
ion will alone
asure. With

further pro-
r attention to
n and general
,thing of pure
f acting skin,

consumption,
e subordinate.

INDEX.

Accliinati/jjition ....

I'^ffects of -
Air, Compressed

I'me

Thill, rare ....

tubes

Alcoholic hever.i>;es
Animal sources of liacilliis -
Animals, domestic, Hyjfieiie of -

Appetite

Athletes and consumption -
Atinosi»heric air - - . -
Atmosphere and climate
Atmosphere, The, and the body func-
tions - . - - ' - ;500-
Avoidinjf infection . . - 240-

Bacillus, The(oftub.T'j?«^) - - -ID,
Air jfrowth cf - 47,
and soil . - - .
Animal sources of -
Hot any of - - -
coli communis
Cultivation of
Diflferent forms of - 84,
Kffects of environment on
Fla^rella or cilia of •
outside the body -
relations of, to the dis ^ase
Sporing and multiplica

tion of - . -

Typhoid, of -
Sources of
Whence comes
3aciHi, How they enter the body
in dust of rooms, etc.
in flesh and milk - • 18:
Inoculation of

Numbers tfiven off by consump
tives . . . -
lack yard. The - . - -
lathing, general and skin -
lathing and Christianitv

Cold . ." - .

conver iences -
History of - • -
Inner (within the bodv)
Public ....

I'AdK

31-2
.114

ao3

20
3(t2

22
237

2!t4
2;i(i
118
20
2!>!)

30.1
275

, 41

ISKi

1!»9

liX)

4(5

198

199

82
185

40
188
187
192
189

186
227
238
240
266
291
239
242
240

Hath, Uuin or shower -

f%»lt in ...

Value of - • -
Ilwlrooni ....
Blood and respiration

Clean
Blood-serum antidote
Bo<ly factor, Prevention of -
Breathing, Acts of
cai>acitv
Full .
Imjierfcct -
imperfect, Klfects of

Causes of consumption

enumerated
Two essential
Cause and effect -
Canadian climate
Carpenter's theory
Chest walls. The -
Dimensions of
Dimensions of, in disease
Children and food

Management of consum
Cilia of air tubes .
Cilia of bacilli

Civilization and consumjition
Cleanliness, Absolute -

within
Climate ....

Canadian

Canadian, Salubrity of

Classifleation of

Cold ....

defined

Dry ....

Essential elements of

Forest - . - .

(jocal ....

Moist ....

Mountain

Mountain, not necessary

Ocean ....

of United States— northern

Oxygenic conditions of -

Select home

Special, local conditions of

200,

L38-

ptive

239,

I'AOK

292

209

208

228

140

207

233

249

142

114

325

(>-U>2

104

237

271

1.10

276

242

149,

327

parts

298
325
,328
304
305
298
305
316
311
323
305
308
310
306
325
310
322
320

342

INDEX.

'^J

f\ •

. .

1 :;

i \

'n I,

fli

I'AOK

Climate -Warm ;M)5

ClothiiiK 24 :i

Cofffu '2:57

Colds, No.fle(te«l - - - - 14S

I'ri'venti')!! of - - - 260

Cookery 15:{, •l.M

Coiiiprcssed air 3U3

Corniiiiiniiability of conHumptioii 12, 1S4

CoiiHuiiiption, Causes of •• - (W

He iKieo ori^fin of - - 100

Forms and names of ■ ;iH

Nature of ... us

not always from infection 202

I'revention of - - 212

Some signs and sym]i-

toms of - - -

Treatment of

Curability of consumption -

Cure of consumption. No specific for -

Cure, pure air first ....

Cures, fraudulent - - • 'S.W,

•M.i

329

1«

.•i:{7

Deductions respecting: cause
Deductions coricludintr I'art I. -
Deei» breatliin}; ... io;"i-
l)efecti\e respiration -
Defences of the bmly -
Defensive wal s or coverin^rs of bod,
Details of hyj^iene. Attention to -
Diajjnosis of consumption -

its importance
Disinfectants ....

Disinfection of rooms •

Dietary . . . - -

Dormant or latent jrcrms in body

Doniestic animals, Hyj^ieiie of -

Draughts of air -

Dust ......

Bacilli in - - . -
Dusting, dry and damp
Dwelling-house cause. The -

The, in prevention

Kating, A voiding excess in -

slowly ....
with regularity

Kducation. Preventive

Kmpjoyer.'s liabilitj*

Kqiployments, Various

Kssentials of health

Kxces's, Avoid all-
in eating

Excretory functions

Excreta retained in body

Exercise ....
General respiratory
Special respiratory

108,

^',•^,

270,
221).

208
2:}{
110
Kif)
i:i7
222

28(J
281
2:J4
0(1
204
277
270
187
270
150

Facts in respiration
Flat chest, The •

- 2ao

- 23.5
. 235

■ 280

- 288

■ 202
226-243

- 245

- 230

- 240

- 70

- 243

- 251

- 1M

■ 35

- 131

PAOK

Flesh and milk ai.d infection - • lH.5

source of infection • V.f'

Floors, ('racks in, etc - - - . •^•^i

Flushing rooms 2.!:i

Foods IM, •2M

Nutrient, for the predisjwsed • 2);4

Special Hi',

Fresh air, (Quantity of, in ventilation -iM

Oerms, Destruction of, not

enough - - 207, 21

Non-virulency of •

'Health lectures ....
]taniphlets

precepts ....
Heredity and the bacillus -

ami the body factor or predis

position ...

eivsily overcome or eradicated
(ieneral influence of -
Statistics on ...
Hospitals for consumptives

Impregnable bodies first

Impure air a most important cause

, 21!)
203

2.S7
2S7
24ii
1-J

12i
13.i
l:«i
121
290

180,

101,
180-

Intection, Avo ding

of butter and cheese
Elucidation of
from animals
from meat and milk
General remarks on
misunderstood
FreveTition of
Infectiousness of consumption
A degree of, evident -
Cases of, in ])ractice
Clinical facts on
Evidence opposed to the -
Exi»erimental evidence of
History of ...

Historical evidence of
Modifying circumstances in
Statistical evidence of
Inflannnatory action in tuberculosis
Isolation not sufficient
Lmdlord's liability
Latent or dormant germs in body
Lectures en health
Legislation, health. Lines of
Limited re-piratoiy capacity - 09
Lungs, Anatomy of

miy be easily enlarged
Small

the organs most commonly
affected . - . . '

Marrying

Meat and milk, Infectiousness of
Milk and meat, sources of infection

240, 275

'2i:

l4;j

l!).i

Ifii

liW

llfj

l.iT

1;-

27.1

I.H4

l.M
17(i
is:
17:

17!

KiJ
Kit i
17J

lOi

2(i-

2SI (
iX|(

;»;

24;
2
3
97- KK e

isiii

2'
25)
1!)

INDEX.

343

,(1 infection
tjrce of infection
etc -

153,

or tlie prediiiposed
ty of, in ventilation

'Ai.K.I

lV)i
V.f'l

I'l-I I

■SA'i

ion of, not
lency of •

207, 217, 210

I bacillus -

Ddy factor or predis-

conie or eradicated

luence of -

III - - - -

isiunptivcs

KffcctH of, illustrated
Forms of -
2Q|jB>ut-door treatment
■)iit-doors, How to stay
to be let in -
)vercro\vdin(f and death-rate
KerHiifbt of cases
hervvorlt .....
»xy<,', n and climate

in body ....

287

287
241)
12.')

12i
l:i:i

t;f(i

296

ies first

U important catise
iiiK -

;er and cheese
ation of
animals
lieat and milk
il remarks on
[lerstood
ition of
consumption -
)f, evident -
ti ])ractice
c:ts on

)pposed to the -
ital evidence of

- 217

- 14:;
24«, 275

- id;

- IM

189,

lito 'rebreathed air, Klfects of

180-KM

l.-s:)
17
171
Kit

evidence of
circumstances in
evidence of
tion in tuberculosis
fflcient
ity

.nt yerms in body
th

til, Lines of
01 V capacity
of
asily eiilargred .

ms
1 .

most

- 175

- 1C(

■ 5i

- 2(l-

- 28!

- !H

- 28;

- :8;
09, 24!

- 2:

- 3'
97-l(Nl

cotnmonly

■ ISlinitarium

lilk reKulations ....
Iiinicipal preventive measures .
louth, not for breatbiii;,' thioiiffh

Cose, The, the projier air passai^e
notification. Best subsiituie lor

Dccupation as a cause of consumption
Choice of ...

2(!:

'amphlets on health -
'arents and children -
'areiits. Words to
'arasites - . . .
arasilic diseases, Kxainples of
liaj^ocytes - . . .
leura and pleurisy
oisons in blood and tissues

breathed air
'osture. Bad and t'ood

l:*'.' 'iccepts. llealtl
m 'ledisposition, as a tlist cause
1^" Nature of

27n 'retubercular cmdition
1<^1' l*^^ preventive measures

reventability of consumption i;m
171 'revention of consumittion
''■ Division of subject for

Lines of action in ,
Facility of -
Principles of
16|'ure air first in i)reventioii
first in cure

207,

I'AOK

2!iO

28;{

234

234
293

2r,9

2fifi
2(14
337
258
•-;3()
111
'.04
244
319
34

287
272
271

51
138

30
252
143
24 C
210

205
281
214
212
224
21(5
213
215
22()
33

cmedies, FraudiUent

for consumption
emedy, No siieciiflc .
espiration. Defective
espiratory capacity .

exercises, H:eneral
si>ecial

function -

or^^ans
St

Infectiousness of - 29
sources of infection - li)

335
3i8
337
99, 248-250

- 26

- 251
. 253
• 19

- 21
. 245

- 215

Sanitariums, State, public .
Saprophytes aiul parasites -
School pupil manaicement ■
Schools and health
Scrofulous condition •
Skin, The, and bathin^f

Sleep

Soil and prevention

vegetation

Body

Damp

Draiiiatfo of •

(Jround -
Spittle or sjiit, Disposal of -

liacilli in
State preventive measuies -
Sunli},'ht ....

Want of, a cause •

Table of chest dimensions .
I hnifj- capacity

Tea . . . ■ .
Tenement houses
Tobacco as a dejiressant
Trachea (wind-pipe)
Trealmetit, Dangers of self-

Karly, all important
of consumption •
Out-door— pure air
Frinci])les of, only
Pure air
Trinity of -
Tubercle, what it" is
bacillus
Diffusion of -
Formation of
in other tissues and ai
Tuberculosis

Hecovcry from
Spread of, in lunjH's

5, 150,

L'nderclothitiif

Veetation and soils -
Ventilation ....

Cost of

methods

Formula to jfuide in

in sickness

Want of breath -

,,, , . . tliP 1,'reat want

Water, drmkinj,'' . . :

I'ure
Weather and colds
Wind-pipe ■ . . .
Words to parents -

PAOK

- 29«

- 47

- 292
229, 272

- 72

• 238

• 246

■ 220

- 75
09 72

- 150
289
22«

- 279

- 180

■ 283

• 245

• 147

- 36

- 104

• 287

- 228

• 155

22
330, 335
273. 335

• 32!>

- 337
■ 338

- 337

- 340

- 39

- 40

- 58
52
5t»
10
(il
58

.243

75
2:io
230
231
232
•^77

210
211
235
238
149

Q.)

nials