SIR JAMES CLARK says, “It may be fairly questioned, whether the proportion of cures of confirmed consumption is greater at the present day than in the time of Hippocrates; and although the public may continue to be the dupes of boasting charlatans, I am persuaded that no essential progress has been made or can be made in the cure of consumption, until the disease has been treated upon different principles from what it hitherto has been. If the labor and ingenuity, which have been misapplied in fruitless efforts to cure an irremediable condition of the lungs, had been rightly directed to the investigation of the causes and nature of tuberculous disease, the subject of our inquiry would have been regarded in a very different light from that in which it is at the present period.”
While I shall not attempt a discussion of all the causes of phthisis pulmonalis, I shall, in a brief and familiar way, consider the more obvious sources of this terrible malady, and particularly those which all classes—even the poorest—may remove or avoid.
IMPURE AIR A CAUSE OF CONSUMPTION.—In discussing the causes of a disease, whose principal expression is in the lungs, nothing can be more legitimate than a consideration of the air we breathe. In full respiration, it penetrates every one of the many millions of air-cells.
DUST.—Every species of dust must prove injurious. Workers in those factories where tools are ground and polished, soon die of pulmonary disease. The dust of cotton and woolen factories, that of the street, and that which is constantly rising from our carpets, are all mischievous. M. Benoiston found among cotton spinners the mortality from consumption, 18 per thousand per annum; coal men, 41; those breathing an atmosphere charged with mineral dust, 30; dust from animal matter, as hair, wool, bristles, feathers, 54 per thousand; of these last the greatest mortality was among workers in feathers; least among workers in wool. The average liability to consumption among22persons breathing the kinds of dust named, was 24 per thousand, or 2-40 per cent. In a community where many flints were made, there was great mortality from consumption, the average length of life being only 19 years.
Gases.—Among the poisonous gases which infect our atmosphere, carbonic acid deserves special consideration. The principal result of all respiration and combustion, it exists in minute quantities everywhere, but when it accumulates to the extent of two or three per cent., it seriously compromises health. I have seen the last half of an eloquent sermon entirely lost upon the congregation. Carbonic acid had so accumulated, that it operated like a moderate dose of opium. No peroration would arouse them. Nothing but open windows could start life’s currents. In lectures before Lyceums, I often have a quarrel with the managers about ventilation. There is, even among the more intelligent, a strange indifference to the subject.
As this work is not designed to guide architects in the construction of buildings, I will not indicate, as I have done in another work, the best known means for ventilation.
The following fact graphically illustrates the influence of carbonic acid on human life.
THE SUICIDE.— A young Frenchman, M. Deal, finding his hopes of cutting a figure in the world rather dubious, resolved to commit suicide, but, that he might not leave the world without producing a sensation, and flourishing in the newspapers, he resolved to kill himself with carbonic acid. So, shutting himself in a close room, he succeeded in his purpose, leaving to the world the following account, which was found near his dead body the next morning:
“I have thought it useful in the interest of science, to make known the effects of charcoal upon man. I place a lamp, a candle, and a watch on my table, and commence the ceremony. “It is a quarter past ten; I have just lighted the stove; the charcoal burns feebly.
“Twenty minutes past ten; the pulse is calm, and beats at its usual rate.
“Thirty minutes past ten; a thick vapor gradually fills the room: the candle is nearly extinguished; I begin to feel a violent headache; my eyes fill with tears; I feel a general sense of discomfort; the pulse is agitated.
“Forty minutes past ten; my candle has gone out; the lamp still burns; the veins at my temple throb as if they would burst; I feel very sleepy; I suffer horribly in the stomach; my pulse is at eighty.
“Fifty minutes past ten; I am almost stifled; strange ideas assail me. . . . I can scarcely breathe. . . . I shall not go far. . . . There are symptoms of madness. . . .”
“Sixty minutes past ten; I can scarcely write . . . my sight is troubled. . . . My lamp is going out. . . . I did not think it would be such agony to die. . . . Ten . . . Here followed some quite illegible characters. Life had ebbed. On the following morning he was found on the floor.”
THE BLACK HOLE OF CALCUTTA.—The famous case of the “Black Hole of Calcutta” has been so universally read that the facts are new to none; but the version of that terrible affair, by Mr. HOLWELL, may be new to some of my readers. I believe no similar fact serves so well to impress the subject upon the public mind, and therefore reproduce his account, which appeared in the Annual Register for 1758.
“Figure to yourself the situation of a hundred and forty-six wretches, exhausted by continual fatigue and action, crammed together in a cube of eighteen feet, in a close sultry night in Bengal, shut up to the eastward and southward (the only quarters whence air could reach us) by dead walls, and by a wall and door to the north, open only to the westward by two windows strongly barred with iron, from which we could receive scarce any circulation of fresh air. We had been but a few minutes confined before every one fell into a perspiration so profuse, you can form no idea24of it. This brought on a raging thirst, which increased in proportion as the body was drained of its moisture. Various expedients were thought of to give more room and air. To gain the former it was moved to put off their clothes; this was approved as a happy motion, and in a few moments every one was stripped—myself, Mr. Court, and the two young gentlemen by me, excepted. For a little while they flattered themselves with having gained a mighty advantage; every hat was put in motion to gain a circulation of air, and Mr. Baillie proposed that every man should sit down on his hams. This expedient was several times put in practice, and at each time many of the poor creatures, whose natural strength was less than that of others, or who had been more exhausted, and could not immediately recover their legs when the word was given to rise—fell to rise no more, for they were instantly trod to death or suffocated. When the whole body sat down, they were so closely wedged together, that they were obliged to use many efforts before they could get up again. Before nine o’clock every man’s thirst grew intolerable, and respiration difficult. Efforts were made to force the door, but in vain. Many insults were used to the guard to provoke them to fire on us. For my own part, I hitherto felt little pain or uneasiness, but what resulted from my anxiety for the sufferings of those within. By keeping my face close between two of the bars, I obtained air enough to give my lungs easy play, though my perspiration was excessive, and thirst commencing. At this period, so strong a urinous volatile effluvia came from the prison, that I was not able to turn my head that way for more than a few seconds at a time.
Now everybody, except those situated in and near the windows, began to grow outrageous, and many delirious. Water! water! became the general cry. An old Jemmandaar, taking pity on us, ordered the people to bring us some skins of water. This was what I dreaded. I foresaw it would prove the ruin of the small chance left us, and essayed many times to speak to him privately to forbid it being brought; but the clamor was so loud it became impossible. The25water appeared. Words cannot paint the universal agitation and raving, the sight of it threw us into. I flattered myself that some, by preserving an equal temper of mind, might outlive the night; but now the reflection that gave me the greatest pain was, that I saw no possibility of one escaping to tell the dismal tale. Until the water came, I had not myself suffered much from thirst, which instantly grew excessive. We had no means of conveying it into the prison but by hats forced through the bars; and thus myself, and Coles, and Scott, supplied them as fast as possible. But those who have experienced intense thirst, or are acquainted with the cause and nature of this appetite, will be sufficiently sensible it could receive no more than a momentary alleviation; the cause still subsisted. Though we brought full hats through the bars, there ensued such violent struggles and frequent contests to get it, that before it reached the lips of any one, there would be scarcely a small teacupful left in them. These supplies, like sprinkling water on fire, only seemed to feed the flame. Oh! my dear sir, how shall I give you a just conception of what I felt at the cries and cravings of those in the remoter parts of the prison, who could not entertain a probable hope of obtaining a drop, yet could not divest themselves of expectation, however unavailing, calling on me by the tender considerations of affection and friendship. The confusion now became general and horrid. Several quitted the other window (the only chance they had for life) to force their way to the water, and the throng and press upon the window was beyond bearing; many, forcing their way from the further part of the room, pressed down those in their passage who had less strength, and trampled them to death.
From about nine to eleven I sustained this cruel scene, still supplying them with water, though my legs were almost broke with the weight against them. By this time I myself was nearly pressed to death, and my two companions, with Mr. Parker, who had forced himself to the window, were really so. At last I became so pressed and wedged up, I was deprived of all motion. Determined now to give everything up,26I called to them, as a last instance of their regard, that they would relieve the pressure upon me, and permit me to retire out of the window to die in quiet. They gave way, and with much difficulty I forced a passage into the center of the prison, where the throng was less by the many dead, amounting to one-third, and the numbers who flocked to the windows; for by this time they had water also at the other window. I laid myself down on some of the dead, and recommending myself to Heaven, had the comfort of thinking my sufferings could have no long duration. My thirst now grew insupportable, and the difficulty of breathing much increased; and I had not remained in this situation ten minutes before I was seized with a pain in my breast, and palpitation of heart, both to the most exquisite degree. These obliged me to get up again, but still the pain, palpitation, and difficulty of breathing increased. I retained my senses notwithstanding, and had the grief to see death not so near me as I had hoped, but could no longer bear the pains I suffered, without attempting a relief, which I knew fresh air would and could only give me. I instantly determined to push for the window opposite me, and by an effort of double the strength I ever before possessed, gained the third rank at it—with one hand seized a bar, and by that means gained a second, though I think there were at least six or seven ranks between me and the window. In a few moments the pain, palpitation, and difficulty of breathing ceased, but the thirst continued intolerable. I called aloud, ‘Water, for God’s sake!’ I had been concluded dead; but as soon as the men found me amongst them, they still had the respect and tenderness for me to cry out, ‘Give him water!’ nor would one of them at the window attempt to touch it till I had drunk. But from the water I had no relief; my thirst rather increased by it; so I determined to drink no more, but patiently wait the event. I kept my mouth moist from time to time by sucking the perspiration out of my shirt sleeves, and catching the drops as they fell like heavy rain from my head and face; you can hardly imagine how unhappy I was if any of them escaped my mouth. . . . I was27observed by one of my companions on the right, in the expedient of allaying my thirst by sucking my shirt sleeve. He took the hint, and robbed me from time to time of a considerable part of my store, though after I detected him, I had the address to begin on that sleeve first when I thought my reservoirs were sufficiently replenished, and our mouths and noses often met in contact. This man was one of the few who escaped death, and he has since paid me the compliment of assuring me, he believed he owed his life to the many comfortable draughts he had from my sleeves. No Bristol water could be more soft or pleasant than what arose from perspiration.
“By half-past eleven, the much greater number of those living were in an outrageous delirium, and others quite ungovernable; few retaining any calmness but the ranks near the windows. They now all found that water, instead of relieving their uneasiness, rather heightened it, and Air! air! was the general cry. Every insult that could be devised against the guard was repeated to provoke them to fire on us, every man that could, rushing tumultuously towards the windows with eager hopes of meeting the first shot. But these failing, they, whose strength and spirits were quite exhausted, laid themselves down, and quietly expired upon their fellows; others, who had yet some strength and vigor left, made a last effort for the windows, and several succeeded by leaping and scrambling over the backs and heads of those in the first ranks, and got hold of the bars, from which there was no removing them. Many to the right and left sunk with the violent pressure, and were soon suffocated; for now a steam arose from the living and the dead, which affected us in all its circumstances, as if we were forcibly held by our heads over a bowl of strong volatile spirit of hartshorn until suffocated; nor could the effluvia of the one be distinguished from the other. I need not ask your commiseration when I tell you in this plight, from half an hour after eleven till two in the morning, I sustained the weight of a heavy man with his knees on my back, and the pressure of his whole body on my head; a Dutch sergeant, who had taken his28seat on my left shoulder, and a black soldier bearing on my right: all which nothing would have enabled me to support, but the props and pressure equally sustaining me all round. The two latter I frequently dislodged by shifting my hold on the bars, and driving my knuckles into their ribs; but my friend above stuck fast, and, as he held by two bars, was immovable. The repeated trials I made to dislodge this insufferable incumbrance upon me, at last quite exhausted me, and toward two o’clock, finding I must quit the window or sink where I was, I resolved on the former, having borne truly, for the sake of others, infinitely more for life than the best of it is worth.”
“I was at this time sensible of no pain, and little uneasiness. I found a stupor coming on apace, and laid myself down by that gallant old man, the Rev. Jervas Bellamy, who lay dead with his son, the lieutenant, hand in hand, near the southernmost wall of the prison. Of what passed in the interval, to the time of resurrection from this hole of horrors, I can give you no account.”
At six in the morning the door was opened, when only twenty-three out of the hundred and forty-six still breathed. These were subsequently revived.
As the subject of ventilation stands first in importance among those bearing on the prevention of consumption, I give one additional fact.
STEAMER “LONDONDERRY.” This steamer left Liverpool for Sligo, on Friday, Dec. 2d, 1848, with two hundred passengers, mostly emigrants. A storm soon came on. The Captain ordered the passengers into the steerage cabin, which was eighteen feet long, eleven wide, and seven high. The hatches were closed, and a tarpaulin fastened over this only entrance to the cabin.
The poor creatures were now condemned to breathe the same air over and over again. Then followed a dreadful scene. The groans of the dying, the curses and shrieks of those not yet in the agonies of death, must have been inconceivably horrible. The struggling mass at length burst open the hatches, and the mate was called to gaze at the fearful spectacle. Seventy-two29were already dead, many were dying, their bodies convulsed, the blood starting from their nostrils, eyes and ears.
It does not appear that the Captain designed to suffocate his passengers, but that he was simply ignorant of the fact that air which has passed to and fro in the lungs, becomes a deadly poison.
The “Black Hole of Calcutta,” the “Steamer Londonderry,” and a thousand other instances where immediate death has resulted from carbonic acid, constitute a terrible chapter in human suffering and death; but they are all as nothing compared with the millions who nightly sleep in unventilated rooms, from which they escape with life, but not without serious injury. As a medical man, I have visited thousands of sick rooms, and have not found in one hundred of them a pure atmosphere. I have often returned from church, seriously doubting whether I had not committed a sin, in exposing myself to its poisonous air. There are in our great cities, churches costing $50,000, in the construction of which not fifty cents were expended in providing means for ventilation. Ten thousand dollars for ornament, but not ten cents for pure air. Parlors with furnace heat and many gas-burners (each of which consumes as much oxygen as several men) are made as close as possible, and a party of ladies and gentlemen spend half the night in them. In 1861 I visited a Legislative Hall. The Legislature was in session. I remained half an hour in the most impure air I ever attempted to breathe. If the laws, which emanated from such an atmosphere, were good, it is a remarkable instance of the mental and moral rising above a depraved physical.
Our school-houses are, some of them, so vile in this respect, that I would prefer to have my son remain in utter ignorance of books, rather than to breathe during six hours of every day, such a poisonous atmosphere. Theatres and Concert rooms are so foul, that only reckless people continue to visit them. Twelve hours in a railway car exhaust one, not because of the sitting, but because of the devitalized air. While crossing the ocean in the Cunard “Africa,” and again30in the Collins “Baltic,” I was constantly amazed that men who knew enough to construct such noble ships, did not know enough to furnish air to the passengers. The distresses of sea-sickness are greatly intensified by the sickening atmosphere which pervades the ship. Were carbonic acid black, what a contrast would be presented between the air of our hotels and their elaborate ornamentation.
It is hardly necessary to say, that every place I have mentioned, might be cheaply and completely ventilated.
A writer in Chambers’ Journal, in reviewing the first volume of the Health of Town’s Commission, says: “The startling facts brought forward as to the creation, we may call it, of scrofulous affections by impure air, are new, and present some of the gloomiest features of the volume, inasmuch as they prove the fatal effects of the pernicious influences complained of, in the existence of a deteriorating population, diseased in themselves, and bequeathing disease to a still more wretched posterity. Joseph Toynbee, Esq., one of the witnesses examined, appears to have devoted special attention to this part of the subject. On being asked as to his observation of ‘the effect of defective ventilation,’ he replies—‘The defective ventilation appears to me to be the principal cause of the scrofulous affections, which abound to an enormous extent amongst our patients. When I have had a scrofulous patient come before me, I have always been able to trace this as one of the agents.’ He cites the work of a French physician, M. Boudeloque, in which it is stated ‘that the repeated respiration of the same atmosphere is the cause of scrofula; that, if there be entirely pure air, there may be bad food, bad clothing, and want of personal cleanliness, but that scrofulous disease cannot exist.’ The following facts are further quoted:—‘The development of scrofula is constantly preceded by the sojourn, more or less prolonged, in air which is not sufficiently freshened. It is impossible to deny that hereditary disposition, the lymphatic temperament, uncleanliness, want of clothing, bad food, cold and humid air, are of themselves circumstances non-effective for the production of scrofula.’”
“When it is seen, on the other hand, that this disease never attacks persons who pass their lives in the open air, and manifests itself always when they abide in an air which is unrenewed, and this, whatever may be the extent of other causes, it appears evident that the non-renewal of the air is a necessary condition in the production of scrofula. Invariably, it will be found on examination, that a truly scrofulous disease is caused by a vitiated air, and it is not always necessary that there should have been a prolonged stay in such an atmosphere. Often a few hours each day is sufficient; and it is thus that persons may live in the most healthy country, pass the greater part of the day in the open air, and yet become scrofulous, because of sleeping in a confined place, where the air has not been renewed. This is the case with many shepherds. It is usual to attribute scrofula, in their case, to exposure to storms, and atmospheric changes, and to humidity. But attention has not been paid to the circumstance that they pass the night in a confined hut, which they transport from place to place, and which protects them from wet; this hut has only a small door, which is closed when they enter, and remains closed also during the day; six or eight hours passed daily in a vitiated air, and which no draught ever renews, is the true cause of their disease. I have spoken of the bad habit of sleeping with the head under the clothes, and the insalubrity of the classes where a number of children are assembled together.”
An instance is adduced in corroboration: ‘At three leagues from Amiens, lies the village of Oresmeaux; it is situated in a vast plain, open on every side, and elevated more than 100 feet above the neighboring valleys. About sixty years ago, most of the houses were built of clay, and had no windows; they were lighted by one or two panes of glass fixed in the wall; none of the floors, sometimes many feet below the level of the street, were paved. The ceilings were low; the greater part of the inhabitants were engaged in weaving. A few holes in the wall, which were closed at will by means of a plank, scarcely permitted the air and light to penetrate into the workshop. Humidity32was thought necessary to keep the threads fresh. Nearly all the inhabitants were seized with scrofula, and many families, continually ravaged by that malady, became extinct; their last members, as they write me, died, rotten with scrofula.’
“A fire destroyed nearly a third of the village; the houses were re-built in a more salubrious manner, and by degrees scrofula became less common, and disappeared from that part.’ Other facts are brought forward, all tending to prove the fatal effects of vitiated air, and the beneficial results of a constantly pure atmosphere, not only on the health, but on the morals of the people. Other authorities—Dr. Blacke, Dr. Blakely Brown, Dr. Duncan, and Professor Alison—fully confirm these statements; in addition to which we are informed that ‘defective ventilation may be considered one great cause of all the diseases of the joints which we so frequently meet with, as well as of the diseases of the eye and skin—shingles, lepra, and porrigo, or ringworm. Besides the eye, the ear is injuriously affected by vitiated air, which thus becomes the cause of many cases of deafness. It is a fact, that at least two times more of the children of the laboring classes are affected by the earache and deafness, than of children of the rich and better conditioned classes, less exposed to like influences.’
Every population throws off insensibly an atmosphere of organic matter excessively rare in country and towns, but less rare in dense than in open districts; and this atmosphere hangs over cities like a light cloud, slowly spreading, driven about, falling, dispersed by winds, washed down by showers. It is not vitalis halitus, except by origin, but matter which has lived, is dead, has left the body, and is undergoing, by oxydation, decomposition into simpler than organic elements. The exhalations from sewers, church-yards, vaults, slaughter-houses, cess-pools, commingle in the atmosphere, as polluted waters enter the Thames; and notwithstanding the wonderful provision of nature for the speedy oxydation of organic matter in water and air, accumulate, and the density of the poison (for in the33transition of decay, it is a poison) is sufficient to impress its destructive action on the living, to receive and impart the processes of zymotic principles, to convert, by a subtile, sickly, deadly medium, the people agglomerated in narrow streets and courts, down which no wind blows, and upon which the sun seldom shines.”
“A small quantity of organic matter can only escape with the carbon and aqueous vapor (37½ ounces daily, according to Dalton) from the skin and lungs. The presence of a putrid atmosphere is perceived by the senses in parts of all towns; and Liebig, by operating on large masses of the atmosphere, has obtained ammonia, which is a product of the putrification of animal matter. The existence, therefore, in the atmosphere of animal matter, is incontestible; and, as it must be most dense in the densest districts, where it is produced in the greatest quantities, and the facilities for decomposing it in the sunshine, and sweeping it away by currents of wind, are the least, its effects—disease and death—will be most evident in towns, and in the most crowded districts of towns. It is to this cause that the high mortality of towns is to be ascribed.”
Consumption originates in the tubercular diathesis. This diathesis is produced by those agencies which deprave the blood and waste vitality. Of these agencies none is so universal and potent as impure air. When we consider that besides mingling momentarily with the blood of the entire system, it is in direct and constant contact with every part of the lungs, we cannot fail to deduce, that foul air must play a most important part in that local expression of the tubercular taint known as pulmonary consumption.
Dr. Guy, in his examination before the Commissioners, in regard to consumption, affirms: “This (deficient ventilation) I believe to be more fatal than all other causes put together.” Dr. Guy showed that consumption was nearly twice as common among tradesmen as among the gentry, which he attributes to the bad ventilation of their stores.
Some of my lady friends in Boston, who are accustomed34to pure air at home, greatly dread to “shop,” because of the bad atmosphere found in the stores. I am not acquainted with three stores in Boston that are well ventilated. It is really touching to see the poor clerks, of either sex, with their pale, wan faces, languidly moving about in an atmosphere which is slowly poisoning them.
The distinguished Dr. Carpenter says: “Again the due elaboration of the fibrin of the blood is undoubtedly prevented by an habitually deficient respiration, and various diseases which result from the imperfect performance of this elaboration, consequently manifest themselves. The scrofulous (consumptive) diathesis is thus frequently connected with an unusually small capacity of the chest, (or lack of oxygen in the air.)”
Dr. Griscom says: “Now it is not disputed, that matter, carried from the digestive organs, and thrown into the circulation, cannot be perfectly nutritive unless it be perfectly aerated or oxygenated. This fact is fully established. A very small quantity of food, even when it is to a certain extent unwholesome, may possibly be assimilated, and with a due supply of air to ventilate it when it arrives in the lungs, may become highly nutritive; but the largest conceivable quantity of what is called nutritious food, taken into the stomach and there digested, can never be elaborated into nutritive blood without a due supply of air to arterialize it.”
Prof. Alison, one of the highest authorities on this subject, remarks: “It is hardly possible to observe separately the effects on the animal economy of deficiency of exercise and of fresh air, these two causes being applied together, and often in connection with imperfect nourishment. But it is perfectly ascertained, on an extensive scale, in regard to the inhabitants of large and crowded cities as compared with the rural population of the same climate; first, that their mortality is very much greater, especially in early life, and the probability of life very much less; and secondly, that of this great early mortality in large towns, a very large proportion is caused by scrofulous disease. And from these two facts, it evidently follows that deficiency of fresh air and of exercise, are among35the most important, because the most remediable of the causes from which the scrofulous diathesis arises.”
Dr. Griscom concludes his excellent work on the “Uses and Abuses” of air, with the following remarks: “To those who have the care and instruction of the rising generation—the future fathers and mothers of men—this subject (ventilation) commends itself with an interest surpassing that of any other. Nothing can more convincingly establish the belief of the existence of something essentially and vitally wrong in the habits and circumstances of civilized life, than the appalling fact, that one-fourth of all who are born, die before reaching the fifth year, and that one-half the deaths of mankind occur under the twentieth year.
Let those who have these things in charge, answer to their own consciences how they have discharged their duty, in supplying to the young, the responsibility of whose lives they have assumed—A PURE ATMOSPHERE—THE FIRST REQUISITE FOR HEALTHY BODIES AND SOUND MINDS.”
Claude Bernard’s Experiments. This eminent man made some interesting experiments upon animals, which illustrate an apparent paradox often observed in human life.
A sparrow placed in a bell-glass of given size, lived three hours; but at the end of the second hour, when there was still oxygen enough to sustain the bird another hour, if a fresh sparrow were introduced it expired immediately. Or if at the end of the second hour the sparrow was taken out of the bell-glass and allowed to fly about in pure air a few moments, and was then placed in the bell-glass again, where, but for this removal it would have lived an hour, it was instantly killed.
Some time since I had occasion to visit an establishment where one hundred and fifty girls, in a single room, were engaged in needle-work. Pale faced, with low vitality and feeble circulation, they seemed unconscious that they were breathing an atmosphere which at once produced in myself dizziness and a sense of suffocation. If I had remained a week, like36them, I should have become unconscious of the vileness of the atmosphere.
Lewes mentions that two French women, one sick with typhoid fever, were in a room heated by a coke stove. The gas escaped from the stove. The well woman was suffocated and fell senseless on the floor, but the sick one retained her consciousness, and by loud cries brought assistance.
Lewes, in explaining this paradox, says, “vitiated air will suffice for the respiration of a depressed organism as it would for that of a cold-blooded animal. In this depressed condition, less oxygen is absorbed, and therefore less is required in the air. When we enter a vitiated air, the breathing becomes laborious; the consequence is a depression of all the organic functions, and then the breathing becomes easy again, because we no longer require so much oxygen, and we no longer produce so much carbonic acid. Were it not for this adjustment of the organism to the surrounding medium, by a gradual depression of the functions, continued existence in a vitiated air would be impossible. We see the vigorous bird perish instantly in air which would sustain an enfeebled bird for more than an hour.”
Put a bird and a snake into an air-tight bell-glass. After a little time the bird will fall from its perch, dead. The air has been so exhausted that it no longer contains sufficient oxygen to maintain life in the warm-blooded animal, but the cold-blooded snake still lives and continues to live, until the oxygen is reduced to less than three per cent.
A young woman, exuberant with life, comes from the country to visit her city cousins. She finds them with pale faces, cold extremities, and general debility, but, apparently comfortable in a furnace-heated, unventilated house, in which she must almost gasp for breath.
I frequently observe in the street-cars, ladies, with contracted waists and feeble vitality, breathing with indifference an atmosphere from which I am compelled to escape to the platform, even though I must stand in the rain.
In each and all of these cases, the unconsciousness does not save from mischievous consequences. The poison operates, not only in lowering the vital tone, but in shortening the life, and in the production of numerous maladies.
FOUL AND DAMP CELLARS. The atmosphere of nearly every house is contaminated by emanations from a foul and damp cellar. If you breathe the air of an ordinary cellar, with senses fully awake, you are conscious it is far from pure. This air is constantly making its way into the rooms above. Without doubt, disease of the lungs, the organs most exposed to atmospheric poisons, may often depend, to some extent, upon this cellar atmosphere. The emanations from decaying potatoes, cabbages, turnips and other vegetable substances in a cellar, have often produced grave fevers. That these poisonous gases may affect the lungs I cannot doubt.
The thoughtful and earnest, will ask at once, “What can be done to remove this source of disease?” I reply: Line your cellars with cement, ventilate and drain them carefully, and keep them scrupulously clean. The frequent use of whitewash upon the walls, and over head, will prove an efficient antiseptic. The occasional use of a solution of chloride of lime in the corners and out-of-the-way places would prove an important addition.
important addition.
But the true policy for those who reside in the country, is, to construct out-door cellars, in which the vegetables may be preserved. Once a week, what are needed for the house, may be brought in and deposited in a large box, so constructed as to preserve its contents from freezing. As the articles of food usually kept in a cellar are, in town and cities, purchased in small quantities, the out-of-doors cellar is there unnecessary.
The ground, about nearly every house, should be thoroughly underdrained, to the depth of three feet, with round two-inch tile, such as are used for agricultural purposes. The drains should be connected, and terminate in a common outlet a few rods from the house. This should be carefully guarded by grating,38to prevent its being obstructed. The drains can be connected with the eave-gutters, so as to receive all the water that falls on the roof, not needed for the cistern. By such means, the ground near the house is kept dry; and, besides the greater healthfulness secured, is much improved for garden, lawn, fruit-yard and grapery. The soil under the house, preparatory to building, should be excavated as for a cellar, to the depth of one foot, and the open space filled with sand and charcoal. The part corresponding to the center of the house, should be elevated one or two feet above the line corresponding to the walls, and when the house is erected, the space under the walls should be left open, that the air may circulate freely under the building. It is very easy with ornamental wood or iron work to conceal the open space without lessening the circulation of the air. To keep the lower floor warm, it should be double, with an intervening space of a foot in which to pack some nonconductor.
If a cellar be suspected and is not susceptible of purification, it might be filled with sand, gravel and charcoal.
Dr. Bowditch, in his able address before the Mass. Medical Society, declared it as his conviction that a moist soil is a most fruitful source of consumption. In the light of such authority, the importance I have given to the subject of cellars—which are almost invariably damp—will not be deemed an exaggeration.
Dr. Bowditch arrives at the following conclusions:
First, Consumption is not equally distributed over New England.
Second, Its greater or less prevalence depends very much upon the characteristics of the soil on, or near which the patients, affected with it, have resided.
Third, Moisture of the soil is the only known characteristic that, so far as our present investigations have gone, is connected with the consumption-breeding districts.
Dr. B. earnestly deprecates the indifference of the State, and the profession, to the question of location for towns. In another place he says:
“The public should correct its own views upon the39whole subject of the planting of cities and villages. It should not allow speculators to run the risk of contaminating every family that may subsequently colonize a spot best fitted, perhaps, for the promotion of consumption. Now, the track of a railway, or the wit or reckless energy of the owner of some swamp, may be the sole reason for erecting a station house, and thereby promoting the early erection of dwelling houses near by, on localities totally unfit for human habitation.”
In arousing the profession to its obligations, he uses the following language:
“We may meet with a patient, suffering under what is sometimes inaptly called the “pretubercular condition,” where there is in the system—a good-for-nothingness—a languor, in fact, of body and soul, perhaps a slight dyspepsia, some emaciation and debility—a little cough, but without physical signs of pulmonary disease. If a patient has been residing under the circumstances named in this address, as promotive of consumption, it will be our first duty to urge him to leave the spot.”
“Still more should a removal be urged, if any, even the most trivial, of physical signs of pulmonary disease be found. A short distance, even half or quarter of a mile, may do much good; but I should prefer to have such a patient remove at once to one of the places already known, or which may hereafter be found to be drier and more favorable for him.”
I take the liberty to express the hope that Dr. Bowditch will bring to the investigation of other causes of consumption his discrimination and patience.
MOISTURE IN THE ATMOSPHERE. It is the common belief that a dry atmosphere is most favorable to the consumptive. Many medical authors have advanced this assumption. It is, nevertheless, an error. In the British Isles, and in France, outside the cities and manufactories, the mortality from pulmonary diseases is much less than among the agricultural classes of this country. And, on the western shores of this continent, consumption is comparatively unknown.