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 1848
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          THE   LUNGS;




   THEIR USES AND THE PREVENTION OF




THEIR     DISEASES;



           WITH PRACTICAL REMARKS ON THE



    •  USE   OF  REMEDIES  .



                      BY



            INHALATION.
                      BY   *


                           i

     JAMES  STEWART,  M.D.


   FELLOW 6F THE COLLEGE OF PHYSICIANS AND SURGEONS I

.Author of " A Practical Treatise on the Diseases of Children,

         and " Mints on Pulmonary Diseases."
 Breathing seems to render life to the blon<I. and the blood continues
         it in every p-.irt of the body —jToiin Hunter.


                  —f:    -"^





';$*£ •         *     .NEW YOJJJK:

 ' HW.  H. GRAHAM, TStlBJEJME  BUILDINGS.
1848. 
  1/V/F
StAlL
 I l\°
  Entered, according to Act of Congress, in the year ]848, by

              JAME.S STEWART,

in the Clerk's Office of the District Court fur the Southern District
                  of New York.
*»
R. CRAIGHEAD, PRINTER,
 112 FULTON STREET. 
PREFACE.
   There are no diseases more important  than
those of the  lungs  ; none more  varied  in their
character, and none for the treatment of  which a
more extensive variety of remedies has been  em-
ployed.  It is to bring into notice an almost neg-
lected class of remedies, not however to the exclu-
sion of others, together with  the importance of a
systematic  use of the lungs as  a  preventive of
disease, that  this publication  is made.   The ap-
plication of  remedies  by  inhalation,  is that to
which the writer refers, in connexion  with other
means.  This  has been  his  practice for some
years past, and the  results here stated are from
a considerable amount of experience in their  em-
ployment. Some formidable affections of the lungs
demand all the resources of the physician, while
many others, in  all their forms, will require  no-
thing more than such as can be  employed in re-
spiration.
  With reference to the subject  of a proper use
of the lungs for the prevention of pulmonary  dis-
eases, the author is indebted  chiefly to the obser- 
11
PREFACE.
vations he has made in the personal examination
of about thirteen hundred applicants for life insur-
ance.  A marked  difference was found to exist
among them, and which  could  uniformly be  re-
ferred to the fact that various conditions of life, ha-
bitual occupations,  voluntary employment, etc.,
influence  the powers of respiration, and that the
respiratory function exercises a great control over
the health of the individual.  The hints thus re-
ceived have not passed unheeded by him,  but on
every suitable occasion  have been used to direct
the employment of obvious means to prevent the
invasion of pulmonary affections, or to remove them
in their incipiency, with a success that has often
surprised  him.
   As t!.e  suggestions made in this work, both for
the  prevention and management of  pulmonary
diseases, are the results of much experience, they
are published with a full confidence, that if judi-
ciously followed they will be attended with success
in the treatment of the early stages of some of the
most dreaded maladies with which mankind is af-
flicted.
  Abingdon Square.
      New York, May, 1S4S. 
          ORGANS OF RESPIRATION.

  All animals possess organs  for respira-
tion, adapted to the medium in  which they
live.
  Fishes have the branchiae or gills, over the
delicate fringes of which the water received
by the mouth  passes, imparting  to the blood
circulating  within  the thin  membrane, of
which the branchiae are composed, the vivi-
fying influences of the oxygen, which  the
water as well as the  atmosphere  contains.
Many of the larger fishes have lungs, re-
sembling in many  respects those  of  ter-
restrial animals.   Where these exist, air is
necessary  for  respiration,  and  they  are
obliged to rise to the surface of the  water
in order to breathe.
   Among the animals that respire air, insects
have the simplest arrangement: the air en-
tering the body by means of small openings
in the sides, communicating with longitudi-
nal  air-tubes in  which the  air circulates.
Birds,  mammals, and reptiles have  proper
             1 
2        ORGANS OF RESPIRATION.
lungs ; the first  named class possesses, be-
sides, an arrangement similar to that  of in-
sects, with reference to the circulation of
air  though the body, after it has been intro-
duced into the lungs.   The large amount of
air in their bodies gives them lightness, and
enables  them to rise and support themselves
easily in the air.
  Some of the reptile tribe have gills  at an
early period of their existence  when  living
in the water, and  lungs afterwards  when
they live on the land.
  The lungs in man consist of  a mass of a
light spongy texture, formed of  innumerable
branches of the tube which conducts the air.
These branches terminate in  minute sacs,
composed  of an exceedingly delicate mem-
brane, through which the air acts  upon the
blood beneath.
  The lungs constitute the respiratory organ.
Their natural  stimulant  is  the  atmospheric
air, which passes into them at the moment
they undergo an augmentation  of  their size
by the  expansion of the sides  of the  chest.
The air, received into the deep-seated parts
of the lungs, where the branching air-tubes
terminate  in cells, undergoes a change  in the 
ORGANS  OF RESPIRATION.
3
condition and relation of its  elements, and is
then  expelled by the return of the sides of
the chest  to the comparatively  contracted
state  in which it existed before the introduc-
tion of the air.   From the reciprocal action
of the air  and lungs results  the  function of
respiration, the direct and sensible  effect of
which is the  conversion of the  dark blood,
carried to  the lungs  by the veins, into blood
of a bright red  color, which is returned by
the arteries to the remotest parts of the sys-
tem for the  purpose of repairing the waste
of the body, and maintaining it in its inte-
grity.   When the blood has performed this
office, it again passes into the veins, destitute
of its  bright  color and renovating qualities,
to be  re-transmitted to the lungs, that it may
again  undergo  the  alterations necessary to
carry on the various functions of the differ-
ent parts through which  it uninterruptedly
circulates.   If from any cause this  change
is not effected,  death speedily ensues.
  Before describing the  uses of the lungs,
the nature of the air upon  which all their
movements depend ought to be considered. 
11.
            ATMOSPHERIC AIR.

  The atmospheric air is that elastic  fluid
which envelopes the earth, forming a layer
of about  fifty  miles  in width.   Although
comparatively so thin, constituting scarcely
the  two hundredth  part of the  size of the
globe itself, it nevertheless exercises  upon
the  various phenomena that pass upon the
surface of the earth, influences as varied as
                  •                         t
they are important.
  The atmosphere  then forms  a  spherical
ring, in  the interior  of which is placed the
globe ; so that the movements  upon the axis,
and  those  annually performed  around the
sun, are common to both.
  Although the terms air  and  atmosphere
are  synonymous in  ordinary language, it
should be borne in mind  that the mass  of
gaseous fluid called  the atmosphere, contains
in it, independently of air, water also in every
form in which  it  can  exist, imparting  to
the rays of light and  heat  all  the  modifica-
tions exhibited  in the  various meteorological
phenomena. 
ATMOSPHERIC AIR.
5
  The air,  like all  other  gases,  possesses
weight, compressibility,  and  elasticity.  It
has no color in small  masses, and the blue
appearance which is presented to us in the
space above, and which is called the sky, is
owing to the modifications produced by the
reflexion of the rays of light.
  It is composed of 21 parts of oxygen gas,
and 79 of azote, with a trace, occasionally, of
carbonic acid gas.
  The proportions in which the  oxygen and
azote  exist  to  form pure air have always
been found to be the same in all places; at
sea and  on the  land,  on  mountains and in
valleys, the admixture never  varies.  The
differences which exist in the action of the
air of different  climates, and of different sea-
sons, are attributable to other causes.  They
arise from its  greater or less weight, and
from the modifications which  the air under-
goes from heat, light, electricity, and humidi-
ty; in a word, these variations result from
the presence of new principles—such as occur
in the neighborhood of stagnant water—in
places where many animals  are crowded to-
gether, etc.
  Weight and pressure of the Atmosphere.— 
6           ATMOSPHERIC AIR.
The weight of the atmosphere, depending
partly upon its height and density, are pro-
perties which have been long ascertained by
means  of the ascent of the mercury in the
barometer, and of water in syphons and va-
rious other hydraulic machines.
  It has been found that the pressure of the
atmosphere sustains a column of quicksilver,
in the tube of a barometer, of the height of
about thirty inches ; and hence it follows that
the whole pressure of the atmosphere is equal
to the weight of a column of quicksilver, hav-
ing  an equal base, and about thirty inches in
height.  The weight of a cubic inch of quick-
silver is about 8\ drachms, the weight there-
fore of  30 inches will be  about 15 pounds.
Such is the weight of the atmosphere on every
square inch of surface.  A man's body contains
about fifteen square feet, and he consequently
sustains a weight of 32,343 pounds.
  This  pressure is so great that no animal
could ever exist, if it were not equal  from
above, from below, laterally, and  in every
part; and counterbalanced from the  interior
by the elasticity of some other elastic  fluid,
doubtless the air contained in the circulating
and other fluids. It is thus that the equilibrium 
ATMOSPHERIC  AIR.
7
 is maintained throughout the body equally—
 compression being in every direction.
   Pressure by a high column of air causes
 easy respiration.  The air  from its density
 abounds in renovating principles, and con-
 sequently imparts to the  system all the ad-
 vantages  which  result from the full action
 of this function ;  that is, an  ability to sustain
 violent and continued exercise, a prompt re-
 newal of the blood  that passes through the
 lungs, and  a sensation of vigor throughout
 the whole body.  Whenever this pressure is
 increased by any change in  the condition of
 the air, ascertained by a high state of the ba-
 rometer, there always exists an indescriba-
 ble sensation of strength, for the simple rea-
 son that all the  energies are  increased by
 vigorous respiration.
   Under a pressure  of a column of air a lit-
 tle less than that at  the level of the ocean,
 such as exists upon the top  of  mountains of
 moderate  height, respiration, without  being
more full, becomes more  frequent, the cir-
culation more rapid, the  movements  more
prompt, the muscular development greater,
and the complexion more ruddy, while the ap-
petite and digestion are improved. The supe- 
8            ATMOSPHERIC AIR.

rior physical condition of the inhabitants of
mountainous  regions  arises  from  the  les-
sened pressure of the air, but which is com-
pensated by its density, from the more  uni-
formly low  temperature which there  pre-
vails ; so that the mountaineer, notwithstand-
ing his  elevated situation,  actually respires
more  dense air than is found in the heated
valleys below.
  The weight of the air varies in the same
place  from  periodical causes, which, in  cer-
tain climates within the  tropics  for example,
act with sufficient power to affect  the ba-
rometer at  different  periods  of  the  day.
These are the changes which constitute the
diurnal variations.   It also varies from other
circumstances of an irregular nature, such as
rain, wind, etc., producing  another  order in
the causes  of barometrical changes which
may be  denominated accidental.
  Fluidity of the Air.—The movements of
the air  are owing to its fluidity: it is this
physical property that gives rise to many of
the changes which so rapidly occur around
us, and  which are so quickly supplanted by
an effort to be restored to its former condi-
tions.   The movements of the air constitute 
ATMOSPHERIC  AIR.           9
the winds, depending upon the variations of
temperature.
  When the heat dilates a  portion of  the
air, this portion, lighter than  the other, rises
to a more elevated place and is immediate-
ly replaced by another and a colder portion.
What occurs daily in our apartments, is  but
a counterpart on a small scale of the great
changes in the atmosphere without.
  The sea and land breezes within the tropics
afford a good illustration of the effects of a
comparative  warmth and rarity of the  air.
The heat of the earth from the sun rarifies
the air, and  the  cooler and denser air from
the sea flows in, causing the sea breeze—and
at night the  greater duration  of the warmth
of the sea, which from its being more deeply
heated than  the earth retains its  heat after
the earth has cooled, produces a flow of air
from the land, causing the land breeze.
  The effects of wind upon  the lungs arise
from the temperature and humidity of  the
atmosphere  manifested  in transporting fogs
from the  sea, and from the  distribution of
injurious emanations, etc.
  Temperature.—Although the  quantity of
heat given off from the sun is without doubt 
10
ATMOSPHERIC AIR.
uniform, there  are  nevertheless  a  great
many  circumstances which modify  its ac-
cumulation in the different  parts of the sur-
face of the earth.  Thus the obliquity of the
sun's rays, always increasing as we leave
the equator, is  the principal cause of the pro-
gressive diminution of heat which is remark-
ed in the temperature  in  proportion  to the
increase of the  latitude;  and in the  same
zone, there are numerous conditions  which
exercise a  similar influence.  A  chalky or
sandy soil reflects powerfully the rays of the
sun,  and contributes to the increase of heat.
The temperature decreases in  proportion to
the distance above the level of the sea: un-
der the equator, mountains whose base is ex-
cessively hot, exhibit the  modified  condition
of the temperate zone  at the  middle, while
the summit is covered with perpetual snow.
The inclination of sections of country aug-
ments or diminishes the obliquity of the sun's
rays, and consequently their  temperature.
The evaporation of water influences tempe-
rature ; islands are always more cool than
continents.   Winds cause a variation in tem-
perature according  to the nature  of the 
ATMOSPHERIC AIR.
11
country they traverse, and the humidity they
bear.
  The atmospheric temperature may be ar-
ranged into three divisions : the first between
zero and 40° is cold;  between 40° and 70°
temperate, and  all above hot.  The tempe-
rature in  our climate, in the city of New
York, ranges from zero to 93° ; in the  coun-
try at the North, the thermometer often de-
scends lower.  The influence which  these
states of atmosphere exercise upon the lungs is
closely connected with its humidity ; indeed
the temperature and hygrometric condition
of the air are inseparable when their effects
are to be  studied with reference to their in-
fluence upon the lungs.
  The influence which the air in its various
conditions exerts upon the lungs, in the pro-
duction of disease, will be considered when
we come to the subject of the causes of pul-
monary affections. 
III.
           USES OF  THE LUNGS.

  It is not intended to go into anything like
an investigation of the nature of the chemi-
cal changes which occur in the blood in its
passage through  the lungs,  whereby it  is
submitted to  the  action of the oxygen con-
tained  in  the  air.   Whatever is necessary
for  the comprehension of the facts, which
are evidently connected with the function of
respiration, will be stated  as briefly as the
subject  will  admit,  without  detailing the
elaborate   experiments  or  entering  into
the theories of physiologists.  The uses  of
the lungs  will be exhibited by reference  to
the  effects  produced  upon  the  different
classes of animals by the action  of respira-
tion, and thus a far more  extended field  of
observation will  be spread before us than if
the  investigation  were  confined  to man
alone ; while the whole subject will be kept
within the limits  of well  ascertained facts
and  the  natural inferences which  may  be
drawn from them. 
            USES OF THE LUNGS.          13

  It has  been seen that the air contains  a
considerable portion of  oxygen  gas; this
was formerly denominated vital air from the
absolute necessity of it  to  preserve animal
life.  When this is  absent, animal life can-
not be supported.  All living creatures must
have oxygen—fishes as well as such animals as
live in the atmosphere. Fishes breathe the wa-
ter  through the gills as terrestrial animals
breathe the air; if the water be deprived of its
air, the fish dies.  On examining the gills of the
fish  an exceedingly  delicate  membrane is
found to exist, which lies between the blood
passing through them and the  air which acts
upon it. This is also the case with the lungs ;
the  air reaches the blood only as it comes in
contact with  the  exceedingly fine, transpa-
rent,  and  closely  formed  texture,  which
forms the air cells.   The blood reaches the
lungs of a deep purple color, and sometimes
even almost  black.   After  having been
spread  over  the  internal  surface  of the
membranous part already referred to, and
thereby exposed to the influence  of the air
which has passed  into the lungs by respira-
tion, it is  changed  into  a  bright vermillion
color, and passes again into the heart to be
           2 
14          USES  OF THE LUNGS.

distributed throughout  the  body, while the
air, having performed its office, is passed out
of the lungs by expiration.
  The action of  the atmosphere and  the
blood is reciprocal; for while the blood has
changed  its  color, the air  also has changed
its condition.  The blood has received some-
thing from the air, which renders it fit to re-
visit the remote parts of the body, while the
air has likewise been altered so as to render
it  useless  in the  lungs,  and is therefore
thrown out.   It is evident that the blood has
been so renovated by its circulation through
the lungs, as to place it in a proper condition
to carry  on the  nourishment of the body.
What this change is, we will be better pre-
pared to  understand  when  the  effects  of
respiration and the nutrition of the body are
considered.
  The first effect produced by respiration is
the  influence  of  the  air upon the  colored
portion of the blood.  This colored  part is
ascertained  to consist  of  minute  globules,
which, although existing in every part of the
blood, is  nevertheless capable of being sepa-
rated from it.  When the  blood coagulates,
it forms  into two portions; the thick and 
USES OF THE LUNGS.
15
jelly-like  portion, the  crassamentum,  con-
taining  a highly animalized substance, the
fibrin, and the red  globules ; and the  thin
serous fluid containing the albumen.
  As these  small globular particles are the
only portions of the  blood that possess a red
color, which is the only part that gives visi-
ble evidence of the  change  produced  upon
the blood, it appears reasonable to suppose
that they are  more  readily acted upon by
the air than  the other portions, and  it is
chiefly  from their alterations of color that
we estimate the amount of action of the air
upon  the  blood.  What this action is, it is
difficult to determine.  It has been referred
to the small  amount of iron that they pos-
sess, and  that it is that substance which at-
tracts the oxygen   from  the air.  But to
whatever peculiarity it may be referred, it
is doubtless the part  of the blood upon which
the air more especially acts, as  they possess
the only part known to possess any specific
chemical  qualities ;  the serum having none,
and the fibrin  has  none different from those
of the muscular fibre, which does not appear
to possess any peculiar chemical relations.
  The  amount  of the  red  globules of the 
16         USES  OF THE LUNGS.

blood is in proportion to the powers of respi-
ration  possessed  by the  animal.   Where
respiration is feeble, the blood is less colored
than where it is performed  with vigor.  Red
blood exists in many  fishes, reptiles, in all
other terrestrial animals, and in birds.
  The presence  of the red  globules being
inseparably connected with the development
of the  heat  of the body, and the process of
animal nutrition,  all the  remarks which are
made with reference to the influence of re-
spiration on  these two conditions of the ani-
mal system will equally apply to the forma-
tion  of  the  red  coloring  particles of  the
blood.
  The precise mode by which the heat of
the bodies of animals is produced, is not yet
satisfactorily   explained  by  experimenters,
and it  is unnecessary for  us to state any-
thing beyond  the simple fact of its  depen-
dence  upon respiration,  the object  of this
essay being to illustrate the influence of that
function  upon the  animal  economy.   The
production of heat  and the nutrition of the
body are intimately connected, and depend
for their perfection  upon the proper aeration
of the blood; and heat appears to depend upon 
USES OF THE LUNGS.
17
 the  development  of  the  animal  powers,
 which are all controlled  by the respiratory
 organ.
   To understand the influence of respiration
 in the  production  of heat, we may com-
 mence with the examination of those animals
 which appear to possess  the lowest degree
 of respiratory power; these  have a tempe-
 rature scarcely above the surrounding me-
 dium in which they live.  The muscle, the
 oyster, etc., are  at  the lowest  point of ani-
 mal  temperature.   John  Hunter found  the
 temperature  of the earthworm to be 58^
 degrees when  the  atmosphere was  at 57°.
 Black  slugs  and the garden snail at 55|- in
 an atmosphere  of 54°.  Fishes in general
 have a temperature scarcely exceeding two
 or three  degrees above the water in which
 they live,  and as they have  comparatively
 large respiratory organs, they would seem
 to be an exception ; but this arises from  the
 density of the  fluid  in  which  they  exist,
 which, on this account, rapidly abstracts the
 heat  of their  bodies.
» But even among fishes there are evidences
of the  influence of  largely  formed gills.
 Some of the  salt water fishes with red blood
2* 
18         USES OF THE  LUNGS.
have large gills supplied with nerves of un-
usual  magnitude, and a temperature of 99°,
in the sea at 80^°.  This is found to be the
temperature of the  bonito.  The cetaceous
fishes  have lungs, red blood,  and compara-
tively a large amount of heat.
  Reptiles have larger lungs and a greater
amount of heat.  Thus lizards  have a tem-
perature of 86° in  an atmosphere  of 71°;
the frog 72£° in an air at 68°.
  Insects, birds, and animals possess  much
greater powers of  respiration, and  conse-
quently of maintaining  heat.   That of in-
sects has been  long  since carefully investi-
gated.   These animals in the  larva state ap-
proach nearer to worms  in the amount of
their heat, it  being  scarcely two  degrees
above  the surrounding   air;  but  in  the
perfect state, their temperature ranges from
four to ten degrees above the  atmosphere.
  In all insects the power of producing heat
is not manifested immediately  upon their
emersion from the larva state ;  but  so soon
as they have  acquired  strength,  and  the
whole system is stimulated by their  locomo-
tive powers, and  the respiratory movements
have become  active, great increase  of heat 
USES OF THE LUNGS.
19
 immediately ensues.  These experiments have
 been tried  upon bees,  sphinges, and other
 strong and  active insects, and  the tempera-
 ture observed  to rise five  degrees in  two
 hours.
   Insects forming  the  coleopterous  order,
 such as beetles, have large respiratory or-
 gans, and are among the number that possess
 the largest amount of temperature.
   The heat of insects is greatest among those
 that fly.   Those which pass most of their
 time in an active state upon  the wing evolve
 the most heat, such as bees  and butterflies ;
 activity, increase of respiration, and the evo-
 lution of heat being always associated. Hor-
 nets and wasps are less active, and have less
 heat. Terrestrial insects that do not fly have
 a lower temperature, and among the beetles,
 such as fly, as the cockchafer, have a high-
 er temperature than those of the same order
 that remain  upon the ground.
   Mr.  Newport, in  his curious  experiments
 on bees, gives an account of the generation
 of heat when the nymphs are about to come
 forth from their cells.  This is effected by
the efforts of the " nurse bees " to  increase
the  heat of the nests  and  communicate 
20
USES OF THE  LUNGS.
warmth to the cells. " The manner in which
the nurse bee performs its office is by fixing
itself upon  the cell  of the nymphs, and be-
ginning to respire very gradually ; in a short
time its respiration becomes more and more
frequent, until it sometimes  respires at the
rate of 130 or 140 times in a minute."  In
one  instance,  the  thermometer  introduced
among seven " nurse  bees," stood at 92^°,
whilst  the temperature  of the external air
was but 70°.
  All other animals that  have much exercise
also consume much oxygen, as is evident in
birds.  The  temperature of birds is greater
than that of  terrestrial animals, as  they pos-
sess greater respiratory powers, and  have
more powerful exercise.  The more power-
ful and rapid the flight,  the greater the heat
of the  body, as they respire a larger  quanti-
ty of fresh air.  Ducks and geese have  a
temperature  of  100°  to 107°, while in the
gull and the swallow the temperature  is as
high as lll£°.
   The  organs   of  respiration   in  man
are smaller than those of a large num-
ber of other  animals; his respiration  is
less full,  and  consequently  his heat   is 
USES OF THE  LUNGS.
21
less.  The temperature of the human body
is 97° ; that of nearly all other animals is four
or five degrees higher.
  All animals respire  quickly from inordi-
nate exercise, and  become hotter;  when at
rest they become cool  from the decrease of
respiration.  A  man when asleep respires
less frequently than  when awake, while the
thermometer  indicates  about  two  degrees
less temperature in the skin ; hence the feel-
ing of chilliness so  frequently experienced
after  a  nap taken without covering.
  Where respiration is carried on in its per-
fection, the creature possesses the highest or-
ganization ; when this is imperfect, a corres-
ponding imperfection exists in the nutrition in
every possible degree, according to the ca-
pacity of the lungs to perform their functions.
  The chyme which is the mass of nutritious
matter digested and  prepared in the stomach
and bowels from the  food, before  it enters
the blood, consists essentially of albumen.
  The chyle, also, which is the next degree
of animal digestion,  and is the intermediate
fluid  between the   chyme and the  blood,
although more elaborate, consists principally
of the same elementary substance. 
22
USES OF THE LUNGS.
   Albumen is the most simple of all animal
material and of which  all the others are
formed.  In the  egg it  constitutes all the
white  part and the larger portion of the
yolk;  and  the  embryo  of every animal  is
found  to be  chiefly composed of albumen.
Where independent existence  has  not yet
been established, and the  animal has not as
yet breathed, albumen abounds in every part.
Since therefore  such an imperfect condition
of the  organization  exists before respiration,
it would seem that this function is necessary
for the perfection of the animal structure in
all its parts.
  This will be more apparent when the
chemical constituents of fibrin, which  is al-
bumen in its advanced state of organic per-
fection, are considered.
  Fibrin is highly  organized  albumen.  It
exists abundantly in well  formed blood in a
fluid state, while the muscles consist mostly
of it in a solid form.  Albumen is composed
of 8 equivalents of  carbon, 7 of hydrogen, 3
of oxygen, and  18  of nitrogen; fibrin of 6
equivalents of carbon, 5 of hydrogen, 2 of
oxygen, and 18 of nitrogen. The nitrogen re-
mains the same  in amount, while the relative 
USES OF THE  LUNGS.
23
 quantity of all the other ingredients is di-
 minished.
   This alteration is effected by respiration;
 not always, however, performed exclusively
 by the lungs, as nature is abundant in her re-
 sources, and often acts to a limited extent vi-
 cariously by the skin, liver, etc., when the pro-
 per function of the lungs is impaired.   It has
 been long  remarked that men when hung,
 retain the heat of the body for a much longer
 time than when death occurs from any other
 cause;  the  effort that nature makes to main-
 tain life by  means of the skin and the partial
 effect of the air upon the blood that circu-
 lates in minute vessels beneath  it, maintain-
 ing the  heat.  It is a very common remark,
 that the body  of  a  suicide from hanging,
 when discovered, was " still warm,"  but  the
 inference drawn from this, that death must
 therefore have  been  quite  recent,  is  not
 always correct.   Indeed so important is  re-
 spiration in  the animal economy that some of
 the lower animals respire by the  skin equally
 as well as by the lungs;  that is,  the peculiar
influences of the external air are communi-
cated through  the  skin to the  small  blood-
vessels beneath,  and thus the changes in the 
24
USES OF THE LUNGS.
blood are effected.  The frog, for example,
may be kept alive by means of the respira-
tion  through skin alone.   So  important  is
the skin to this animal that it will die if it is
covered with oil as speedily as if the  lungs
were removed.
  Respiration through the lungs, however, is
the mode whereby most animals produce the
changes  above  mentioned.   The  changes
consist in the excess of nitrogen in the red
and renovated blood, which is thus prepared
for distribution  by means  of innumerable
branches of arteries for the purpose of sup-
plying the waste of the body.   The albumen
of the system is thus supplied with the requi-
site  material for the formation of the more
highly organized materials.
  If respiration be imperfectly  performed,
the organization must be correspondingly de-
fective: if it be fully and efficiently carried on,
the  proper  alterations  are effected in the  '
blood, and perfect nutrition is the result, in the
production of the proper change in the albu-
men for all the  purposes of the animal eco-
nomy.
   If we observe the conditions of the  lower
animals where the respiration is  but an im- 
USES OF THE  LUNGS.
25
 perfect function we  shall find them abound-
 ing in the  simpler principles of animal sub-
 stance—albumen.  Snails, larvae of insects,
 consist chiefly of albumen.   Turtles, lizards,
 serpents, frogs, etc., exhibit  clearly the im-
 perfection  of the nutritive  process, it being
 carried on but sluggishly, while the result is
 but the formation of what is the simplest, and
 comparatively an imperfect state  of animal
 organization.   Albumen and gelatine consti-
 tute a large part of  the  bodies of these ani-
 mals.
   It is  evidently in our  power to  trace the
 influence of a more complete organization in
 the  lower  animals among such  as have a
 more  complete  respiration.   Many for in-
 stance present a larger amount of gelatinous
 matter, which is more perfect in its organiza-
 tion than albumen.   This is the case in many
 fishes where there are  large gills, as the cod,
 the bonito, and the  red  fish  of the Gulf of
 Mexico. In these fishes, and especially in the
 last  mentioned, there is a great  amount of
 the organs for respiration and renovating the
blood, and the flesh approaches both in color
and firmness to that of the more perfect ani-
mals.
           3 
26
USES OF THE LUNGS.
   As we ascend still  higher  in the scale of
animated nature we find firmness of muscu-
lar structure existing in proportion to the
development  of the  organs  of  respiration
and the power which exists for exercising it.
That it does not depend altogether upon the
kind of food  used  by the  animal is certain,
from the fact that all of those that have large
lungs and large respiratory powers live upon
vegetable aliment, which is  much less nutri-
tious than animal food.
   If we seek for examples among quadrupeds,
where  can  we find more striking  examples
than in the ox, or horse, and other herbivorous
animals ? The ox possesses large respiratory
organs, the  throat being  unusually  large ;
each rib is  remarkable for  its  width and
for the large  muscles which move  it, and
no animal possesses a frame  that abounds
more in  nutritious  qualities  and  greater
strength.  The same  remark will apply to
the horse, in which  the  respiratory powers
are very great both in  a wild state and when
trained for  labor  or  for  the race-course.
The huge frame of the elephant also is com-
posed of highly developed  parts remarkable
for their firmness and great strength, while 
USES OF THE  LUNGS.
27
the comparative  size of his lungs is not the
least  of his peculiarities.  Like the ox and
horse, the ribs are very thick, wide, and
strong, and many in number;  the ox having
thirteen pair, the horse eighteen, and the ele-
phant twenty, contrasting remarkably with
many other animals in  the greater  number
and superior strength of these parts.
   This does not arise from the actual size of
the animal, for  many of the smaller animals
have  an equal number with the horse or ox—
the hare, rabbit, guinea pig, and other  small
animals, having  thirteen to fifteen  pairs, all
these animals have a powerful respiration.
   Indeed the respiratory  function and nou-
rishment of the body are perfect exactly in pro-
portion to the perfection of the respiratory
organs.  This  may be  seen by  comparing
these  organs as they exist among cold-blood-
ed animals. Frogs have no ribs; they, how-
ever,  have  a sternum, or breast bone.  Ser-
pents  have a sternum and no ribs ; so with
respect to turtles, crocodiles, lizards, etc.,
some  one or other of these parts is deficient
in them all.
  It has been  seen that man  stands among
the lowest of animals with  respect to the 
28
USES OF THE LUNGS.
heat of his body, and it may be fairly assum-
ed that his powers of nourishment  are also
less, as the analogy is maintained throughout
wherever an opportunity exists for ascertain-
ing it.  While we are now speaking of the
actual anatomy of the mechanical powers of
respiration, it  will not be out  of place to
compare that of man with other animals.  Of
thirty-one animals twenty-seven  possess  a
larger number of ribs than  man, while he
stands among the lowest of animals in  point
of the number of ribs and  the  size of the   i
thorax; the remaining number, five, having
like him, but twelve ribs on each side.
  From this sketch of the effects of respira-
tion in different classes of animals, it appears
that the  production of animal heat and the
control of nutrition  are the  obvious uses of
the lungs ; and that these effects are always  lt
in proportion  to the size and perfection of
these organs.   The  practical use  of  these
facts will  appear when  the  causes and the
prevention of pulmonary diseases are con-
sidered. 
IV.
      CAUSES OF PULMONARY DISEASES.

   The greatest number of the  diseases of
the lungs arise  from the direct effects of the
atmosphere when it possesses some alteration
in its physical condition, whereby it becomes
a  source of irritation to the tender mucous
membrane of the lungs ;  the influence of the
air also is effected through the medium of
the skin, cold and dampness combined  act-
ing often in  this way.
   The diminution of the pressure of the air
is  very  rarely felt by us while remaining in
our usual dwelling places; if it  is, it rarely
produces any effect beyond weariness, lassi-
tude, and in  some  persons a  sensation of
smothering.   These feelings occur  on the
approach of a storm, when the barometer is
low.  In those  already ill with pulmonary
disease, such as consumption, a  low state of
the  barometer  is usually  attended  with  a
great aggravation of most of the distressing
symptoms,  such  as  difficulty  of breathing
and  cough.  It is only on ascending to a great 
30    CAUSES OF PULMONARY DISEASES.

height  that  a  diminution  of pressure  is
found to produce  decided disease.   Under
these circumstances, the respiration becomes
frequent, painful, and labored,  and the pulse
quickened, in connexion with a general feel-
ing of indescribable sinking  and debility.
  A very common effect of rarified air at a
great height is  the dryness of the  throat.
This  is produced by the  rapid evaporation
which takes place in very high regions.
  In the celebrated balloon ascension of M.
Guy Lussac in 1804, the effect on  his throat
was so powerful that it was difficult for him
to swallow a small piece of  bread.   So also
M.  De  Saussure, in his ascent of the Alps,
experienced  the  same inconvenience  and
pain, which was temporarily relieved during
a storm, but which returned when the storm
had ceased.
  Besides these  effects, others of  a more se-
rious nature have occurred, such as bleeding
from the nose, eyes, and ears.   After  one or
two days' sojourn in these elevated regions, the
respiratory  functions   accommodate  them-
selves to the state of the atmosphere by the
enlargement of the   chest and   increased
powers of respiratioii.   While the gas which 
      CAUSES OF PULMONARY  DISEASES.   31

circulates with the  blood, and which was at
first expanded by the  diminished pressure of
the external air, and thereby  caused  the
hemorrhage  above  mentioned,  having  be-
come diminished, the bleeding ceases.
  In  our climate we  do  not  experience any
of those winds which are so  suffocating and
so productive of disease, such as the simoom
or  the  sirocco.  The cold  easterly winds
bring with them an amount of moisture of a
low temperature,   which  is   productive  of
irritation and inflammation of the bronchial
tubes.  High winds are always not only an-
noying, but fraught with  danger to such as
are easily impressed with variations of tem-
perature or weight of the air.
  Temperature.—This must  be  considered
in connexion with  the humidity  of the air;
in the first place we will trace the effects of
heat combined with dryness.
  The first effect  of dry heat is to  furnish
the lungs  with rarified air, which is lighter
than that  ordinarily  inspired, and contains
less respirable materials in a given bulk than
cold  air.   When  the  temperature  is  not
raised to a high degree there is  nothing  ex-
perienced  in  the respiration  beyond a slight 
32    CAUSES OF PULMONARY  DISEASES.

inconvenience, and an acceleration of breath-
ing, as the lungs, receiving at each inspiration
air  insufficient  to  supply the wants of the
system, are obliged to repeat their  move-
ments more frequently.
  The effects of  65°  to  75Q  of  tempe-
rature are  but  a  slight augmentation  of
breathing  and  of  the  circulation,  and a
prompt action of all the functions; such as
are experienced on the return of spring after
a cold winter.  These effects vary in differ-
ent individuals.   Those of large lungs expe-
rience a sensation of fulness  and heat, while
those  in whom the pulmonary development
is small scarcely have any other than a  feel-
ing of agreeable stimulation.
  If the  heat is over 90Q, the air is rarified
to a considerable degree, and there must  be
a very marked diminution of the amount of
respirable materials.  The number of inspi-
rations increases, and a feeling of great dis-
tress  and  suffocation  is  experienced,  and
congestion of the lungs is the result.   This
state  will occur in laboring men during the
great heats of summer,  and especially  among
such  as  abound in blood; death from  this
cause not unfrequently ensues. 
      CAUSES  OF PULMONARY DISEASES.    33

   The  necessity  of confining our  remarks
to the effects of these  agents in producing
diseases of the lungs alone, forbids the ex-
amination of all the consequences of an over-
excited  state of  the  body from excessive
heat.   The  study of the effects upon  the
brain, and  the production of various diseases
by an over stimulated or congested state of
this organ, would itself fill a volume,  and
must here be altogether omitted.
   The next condition of the temperature of
the air  is its union with moisture.
   In all parts of the globe particles of water
unite insensibly with  the  air, constituting
evaporation.  It depends upon  the  caloric
which causes  the expansion  of the water,
which,  when in vapor, unites with the at-
mosphere.
   Evaporation  is more rapid in proportion
to the heat of the  water,  to its agitation,
and to the extension of its surface.
   When the air is very hot it will absorb  a
large quantity of water, without  being sen-
sibly present.   But if the air receives water
from any source, as the surface of the ocean
for example, beyond its capacity of satura-
tion, that is, more than it  can  contain, it  be- 
34    CAUSES OF PULMONARY DISEASES.

comes sensible, and  condenses,  producing
fogs and  mists when near the earth, and
clouds when removed a short distance from
it.
  The effects  of this  state of the air upon
the lungs  are much  the  same as those al-
ready  mentioned,  except  that it  is  more
marked;  under its influence the breathing is
usually more powerful and the feeling of las-
situde greater; the blood  is less completely
renewed, and the whole nervous system ex-
periences a depression. Persons of debilitated
constitution, termed  "delicate," experience
greater inconvenience from a hot and moist
condition of the air than  others.   Such as
are  predisposed  to  acute inflammation  of
the air passages experience a relief in a mo-
derately moist atmosphere.  Besides the di-
rect effects of hot and moist air upon the
lungs, decomposition  of vegetable  and ani-
mal substance is  rapidly effected by it, and
predisposition   to disease is thereby  pro-
duced ; it is also to this cause that many fevers
are to be attributed.
   A cold and  dry  condition of the air is that
which prevails in  the interior and northern
part of the Middle States and parts of New 
      CAUSES OF PULMONARY DISEASES.   35

England.   The effects of this are those pro-
duced  by highly condensed air.  Cold, con-
densing the  air,  supplies abundant invigo-
rating  materials for respiration, and deve-
lopes these organs when properly used.
  Cold, however,  requires that the  indivi-*
dual should possess a certain amount of vi-
gor, be well clothed, and  well  nourished.
Otherwise, cold will produce debility, as is seen
among those of a lymphatic  temperament, or
on those badly fed and clothed. It is injurious to
very young children and to the aged. There
is always an increase of the pulmonary dif-
ficulty of old people in cold weather, and
many die of pneunonia in the winter ; indeed,
five-sixths  of all  the deaths among the in-
mates of the hospitals for the reception of
old  people, are from this disease during the
winter seasons.
  Wet and cold air produces  decidedly bad
effects  upon the  lungs in causing inflamma-
tion of these  organs and the parts appertain-
ing  to  them.  In  delicate  persons  the ab-
straction of heat from the membrane lining.
the  air tubes, greatly deranges  their func-
tions ;  and by the  efforts of nature to return
the  lost balance, active inflammation is pro- 
36    CAUSES OF PULMONARY DISEASES.

duced; and bronchitis, together with more or
less  inflammation of the lungs, is the result.
The breathing of cold damp air is the cause
of many pulmonary affections both directly
and  indirectly induced,  as  it brings out  the
latent predisposition which ol her wise might
have lain a long time inactive.
  Cold and damp act also through the skin
in the production of pulmonary diseases of all
kinds, and a common cause of these affections
is sitting in a draught of cold air especially
when the body is heated, wet feet, or wearing
damp clothing.
  A  very serious source of diseases of  the
lungs is  the minute particles, which float in
the air, such as coal-dust from  the grates in
which there is an imperfect draught.  Many
persons  of  delicate lungs  will  often expe-
rience a great amount of soreness and irrita-
tion about the throat  and in  the interior of
the chest upon stirring the fire of anthracite,
arising from inhaling  the small  particles of
otherwise impalpable powder;  such effects
rarely occur from the  use  of bituminous
coal.
  The effect of the delicate and fine powder
upon the  membrane in the interior  of  the 
      CAUSES OF PULMONARY DISEASES.    37

lungs may be understood by a similar effect
upon the eye by the blowing of dust; were
it not that the  constant closing of the  eye,
and  the  ridge  of stiff hairs that  are  upon
each lid protect the eye from the dust, there
would be a  constant exposure to the irrita-
tion of the dust flying about in the air; when-
ever a small portion reaches the interior of
th 3 eyelid, so  great  is the irritation, that it
very materially interferes with the exercise
of the proper  functions of  the eye, or  even
ultimately destroys its functions altogether.
Certain mechanical particles also drawn into
the nostrils will immediately excite the mem-
brane, and  sneezing and even pain will be
induced.   The mucous membrane  lining the
nose is but a continuation of that which pass-
es  throughout every  part of the  lungs.   But
although these  minute, rough  substances,
finely divided  and drawn by breathing  into
the  lungs, do  not  produce immediate  pain,
being lodged  in the fluid  and  mucus con-
tained  in the  lungs, yet  when continually
inhaled,  they  excite inflammation, which,
spreading through the texture of the lungs,
produces a train of symptoms which will be
productive of the most serious effects.
         4 
38    CAUSES OF PULMONARY DISEASES.

  Workmen are  often exposed to the  inju-
rious  effects of mechanical irritation of the
lungs from  breathing  air  loaded with  fine
dust.   The  measurers  of grain,  sculptors,
stone-cutters, grinders of  cutlery, such as
work in cotton  factories, workmen in  coal
yards, all experience more  or less the effects
of the mechanical irritation of the lungs from
this cause.  The  direct action of them  is
purely mechanical, and  they produce  their
effects upon the air passages, and their indi-
rect effects  are the controlling and limiting
of the power of the lungs in their exercise.
  The softer dust, that arises during the fab-
rication of  various  substances into cloths,
carpets, etc., is equally capable of bringing
on serious irritation in the membrane  lining
the air tubes.  Most of those who toil  daily
in an  atmosphere of a close factory charged
with the floating particles from weaving and
other similar operations,  almost always have
greater or less chronic diseases of the organs
of respiration.  Dry cough soon seizes them,
by which  they  are  continually harassed;
this  is  soon followed  by pain in the  chest
spitting of blood, and fever.  Carpet weavers,
 aee makers, some workmen in cotton facto- 
     CAUSES  OF PULMONARY DISEASES.    39

ries all draw into their lungs the fine parti-
cles of woollen or cotton, which occasionally
produce upon the delicate mucous membrane,
effects similar to those of harder and rougher
substances.
  Besides  mere  mechanical  causes, there
are others  to which workmen are exposed,
such as breathing chemical vapors, sulphurous
fumes, smoke, and other irritating substances.
The effects of breathing air loaded with dele-
terious vapors, are  exhibited in the produc-
tion  of  permanently  difficult  breathing,  an
affection very  common to  those  criminals
who are condemned by the  laws of their
country to  work in metallic mines.   These
vapors are  so irritating as to excite an imme-
diate and perpetual cough.   The vapors are
loaded according to the nature of the mines,
with particles of lead, copper, antimony,  sil-
ver, arsenic, etc., and  the air cells of persons
breathing this atmosphere  have been found
contracted  to half their capacity.
  Other vapors appear to make an  impres-
sion through the lungs upon the nervous sys-
tem.  Thus certain odors, as musk, the odor
of  the  rose,  and  other flowers, however
agreeable to  the senses, are sometimes pro- 
40    CAUSES OF PULMONARY DISEASES.

ductive of great distress;  hence the danger
of sleeping  in  apartments in  which  plants
are kept, for a person may " die of a rose in
aromatic pain."
  In  summer, during hay making, the ago-
nizing effects of the effluvia from the odor of
hay, are known to many a  sufferer under  the
name of " hay asthma," while  similar effects
often arise from an exposure to the  fumes of
sealing wax and other effluvia or subtle  va-
pors.  Among them nothing surpasses ipe-
cacuanha in the violence of its effects upon
some persons.   The effects of these sub-
stances are, in others, directly upon the air
passages, as in the  production of  rose  ca-
tarrh, etc.
  The principal cause of  the  prevalence of
disease  of the throat among those who  are
in the habit of public speaking, is the inordi-
nate and unnatural use of the delicate organs
of the voice, in requiring them  to perform an
office  for which they are not  constituted.
The lungs as the reservoir ought always to
supply the necessary quantity of air, while
the vocal  organs give it articulate  sound.
The larynx is the most essential of all  the
vocal organs,  and  the parts  composing  it 
CAUSES OF PULMONARY DISEASES.   41
are so exceedingly  delicate in their struc-
ture that any exertion to cause them to per-
form a part for which they are not designed
deranges them  and destroys their healthy
action, and congestion or inflammation is the
result.  This is  brought about by the habit
that many speakers have of neglecting to
respire at proper intervals, and thereby fail to
have the quantity of air needed to complete
a long sentence; and to supply this deficien-
cy a violent effort must be made by the small
muscles that move the organs of voice. This
unnatural use of them cannot fail to produce
very serious effects.
   These remarks apply more particularly to
clergymen,  among whom  there exists,  in
general, a more quiet  manner of  speaking
than is found among other  classes of public
speakers.  The sustained tone of voice in
which a considerable part of their public ex-
ercises are  performed, leads directly  to the
neglect of the necessary efforts to supply the
requisite quantity of air.  This supply must,
on the part of those who use but little muscular
effort while speaking, be effected voluntarily.
Public speakers of  other professions, where
there  is much  declamation or considerable
          4* 
42    CAUSES OF PULMONARY WSEAsES.

muscular effort, replenish the chest  by in-
stinctive and involuntary movements, as the
respiration is always increased by exercise.
The proper method of preventing the evils
now referred to, will be considered  in the
chapter devoted to the subject of the preven-
tion of pulmonary diseases.
  The indirect  effects  of respiration upon
the lungs in the  production of disease, arise
from  the influence of  respiration upon the
process of  nutrition carried on  by the blood
throughout  the  system.   There  is but one
disease  of the  lungs  depending  upon this
cause.  Pulmonary consumption arises from
the imperfection of the nutritive process.  It
is identical in its nature with scrofula, differ-
ing in no respects from it except in its  seat.
From  the  certain and slow decay  of the
whole system when  the  scrofulous affection
is situated  in the lungs, it has  received the
remarkably expressive name of consumption,
when situated in other less vital organs it re-
tains its proper name, but notwithstanding
the name does  not lose its identity in what-
ever part of the body  it  may manifest itself.
   Nothing is more  common  than  scrofula
showing itself in childhood, and consumption 
     CAUSES  OF PULMONARY DISEASES.   43

in the same individual at adult  age.   This
arises from the peculiarities of the lymphatic
system at the period of growth, but which it
is unnecessary to consider in this work.  So
common indeed is the existence of these two
affections at the same  time, but  in different
stages  of development, that tubercles  have
always been found in the lungs on dissection
where scrofula has shown itself externally.
  The deposit of this albuminous matter is
made frbm the blood, and is the result of an
imperfect nutrition, acquired from some cir-
cumstances under which  the individual has
been placed, or inherited  from the  parents,
and maintained  by the  imperfection of the
vital powers of the individual.
  The  matter  contained in  all scrofulous
tumors, whether they  are external, or situ-
ated in the lungs, is precisely the same.  It
consists of pale, opake albumen, more or less
coagulated, resembling sometimes the whey,
at other times, the curds of milk.  Analysis
shows that the animalized part of the matter
contained in these tumors consists exclusive-
ly of albumen ; being 98.15 parts of 100, the
remainder, 1.85, is  nothing but salts of lime
and soda. 
44    CAUSES OF PULMONARY DISEASES.

  The deposit  of albumen constituting the
disease in question, is sometimes connected
with a slight inflammation or congestion  of
the part; this, however, is by no means essen-
tial.   It is often a  mere accidental circum-
stance, and  appears to act by arresting the
free  circulation  of  the  part,  and thus pre-
paring it for the deposition of the albumen.
At other times  an inflammation accompa-
nies  the swellings  of the disease;  this also
is  a  mere  accident, and  arises  from the
distension,  irritation, and  pressure of the
surrounding parts,—the inflammation  being
the consequence and not the cause  of the
disease.
  It  is a disease of pure debility with a large
amount of  imperfect  materials circulating
with  the  blood, and a great deficiency  of
proper  healthy and organized substance.
From this cause an imperfect  composition of
the  body  must  ensue,  which is  thus pre-
disposed to derangement and disease upon
the occurrence of some  exciting cause.
   That it is a disease  of debility is evident
 from the languor and  paleness  of persons
 affected with either in its incipiency or in 
      CAUSES OF PULMONARY DISEASES.    45

its matured  state.   Heaviness  on slight ex-
ertion, and  a frequent  pulse, are the  usual
attendants upon the disease in all its forms ;
and when constant, are a sure  sign of some
organic difficulty, and, in the  greatest num-
ber of instances, of the incipient formation of
tubercles in  the lungs.  These signs always
accompany debility.
  When considering the  uses of the lungs,
the important influence of respiration  upon
the nutrition of the body was brought promi-
nently to notice.  It was then shown that
where respiration was imperfectly performed,
the nutritive process was also imperfect, and
that  albumen, the simplest  form of animal
matter, existed in abundance.  To this rule
there does not in any class of animals exist a
single exception.
  What is true with reference  to animals  as
a class is also true in individuals.  Those of
feeble respiratory power abound in badly
formed  blood,  are pale, and  afflicted with
deposits of albumen, constituting scrofula  or
consumption, according to the seat of the de-
posit.  Scrofulous people have always nar-
row chests, and feeble powers of respiration;
hence the want of suitable nutrition, and the 
46    CAUSES OF PULMONARY DISEASES.

existence  of the primitive and unorganized
animal matter which abounds in animals of a
lower class.
  The existence of albumen in reptiles, and
other animals of feeble respiratory powers,
is as natural to  them as the absence of  heat
in the blood ; but when this occurs in those
animals which  possess  naturally  a much
higher organization, it  cannot be regarded
in any other light  than as a  disease.   The
usual accompaniments of disease attend this
state of the body, for persons thus affected,
are  not  only feeble and pale, but  an inde-
scribable  sensation of want of health, accom-
panied  by chilliness either  locally or gene-
rally, is always present.  The latter symptom
is precisely what might have been expected
 if the views taken of the uses of  the lungs
 in preserving the heat of the body be cor-
 rect.  In the lower animals this want of heat
 is  natural—in the more  perfectly organized
 animals it is an evidence of imperfection, and
 is disease.
    As was before remarked  it is not intended
  to enter  into the consideration of the chemi-
  cal  experiments or the various theories which
  have been advanced in relation to the influ- 
     CAUSES OF PULMONARY DISEASES.   47

ence of respiration upon nutrition, but merely
to state the facts  that  appear to us in the
broad field of animal life.  The condition of
the blood  in phthisis, therefore, which  has
been a fruitful source of unsatisfactory theo-
ries, must be passed  over, and the  general
effects of respiration in their ultimate results
alone stated.
   Persons  predisposed  to consumption have
usually the chest contracted in some part, or
there is a general diminution of its capacity,
indicated  by  its  narrow form,  prominent
shoulders,  and  a disposition to yield to the
contraction by  stooping forward.  This state
arises from  the natural conformation of the
parts, or it may occur from an inflammation
in  some parts of the lungs, followed  by a
contraction of the affected part.  In either
case an imperfect respiration  is performed,
the nutrition of the body is imperfect, and
the albuminous deposits are formed.
   Another and a very fruitful  source of con-
 sumption is the imperfect respiration arising
 from  sedentary  habits, confinement within
 doors, or constant exposure to impure air in
 badly ventilated and crowded places,  small
 and badly constructed bed-rooms. 
48    CAUSES OF PULMONARY DISEASES.

  These latter causes being capable of many
and  convincing proofs, and bearing at once
upon the great principles urged in this work,
it will be interesting to investigate it in  the
same manner as has already been done when
considering  the uses of the lungs, by exa-
mining their effects upon different animals.
  Among the lower animals we may discover
the effects of domestication and confinement,
in their usual attendant, an imperfect respi-
ration.  Scrofula  exists in  the  horse under
the name of farcy; in  the domestic  fowl it
exhibits itself as the pip ; swine, shut up as
they almost  always are, without the oppor-
tunity of  free  exercise, are  subject to  the
same  disease ; indeed,  its  name is derived
from this  animal.  Pulmonary consumption
is very common among cows that are kept
constantly in stables. Mr. Youatt in his work
on cattle gives  the following account of the
cause of this disease:—" There  is one strik-
ing fact, showing the injurious effect of heat-
ed  and empoisoned  air on the pulmonary
system. There are cow-houses in which the
heat is intense, and the inmates are often in
a state of profuse perspiration.   The doors
and windows  must  sometimes  be opened, 
      CAUSES OF PULMONARY  DISEASES.   49

and the wind  blows  in cold enough upon
those that are close to them, and, one would
naturally think, could not fail to be injurious.
No such thing.  These are the animals that
escape ; but the others at the further end, on
whom no wind blows, and where no perspira-
tion is checked, are the first to have inflam-
mation and consumption."
   Here are plainly exhibited the effects both
of bad  ventilation and a rarified air ; neither
condition containing  a  sufficient  amount of
oxygen for the purposes required by the ani-
mal, and in place of its natural  vigor and
high nutrition, a state of disease indicating
the want of natural vigor appears.
   Among domestic animals, the dog and the
cat, although they are attacked with inflam-
mation of the lungs, rarely if ever have con-
sumption.  It is well  known  that neither of
these animals are ever placed in  a state of
confinement; they are allowed to rove about
almost at will, and their domestic habits are
more a  matter of choice than of necessity.
On the  contrary,  monkeys frequently have
consumption; a disease of which the orang
outang  also died  a  few years since in the
city  of  New York.   These animals are of
           5 
50   CAUSES OF  PULMONARY  DISEASES.

necessity greatly abridged of their natural
freedom; and, from what we have seen, a
great diminution  of the powers of respira-
tion must ensue from the absence of natural
exercise.
  The deterioration of the atmosphere from
crowding  together a number of inhabitants
in large towns and manufactories, is a very
common cause of scrofula and consumption.
These   conditions are  more  common  in
Europe than in our country.   A number of
years since, Dr. Percival, of Manchester, in
England, gave an account of the distressing
effects  produced by  crowding  together a
number of people.  The whole  number of
deaths from  scrofula, as mentioned by him,
was about one-third of  the entire number of
deaths among children of that place.  In the
hospital for sick children, at Paris, one half of
the bodies  that have  been opened exhibited
 marks of scrofula in some parts of the body,
 either in the lungs or in other parts.
   The bad effects of impure air on the ten-
 der and susceptible frame of children, I have
 often had occasion to observe, and have often
 noticed that  it is far more injurious of itself
 than improper diet in older children ; the lat- 
     CAUSES  OF PULMONARY DISEASES.    51

ter, although  unquestionably a great cause of
disease, may  yet  be  rendered  digestible  by
habit;  and an entire change of food, at first
difficult of digestion, may become suitable
for the child, and be  easily digested ; but  the
air must always be pure, the child never can
thrive in impure air.
   In accordance with this view, are the facts
mentioned by Mr. Carmichael of Dublin, in his
acount of the  scrofulous disease which prevail-
ed in the House of Industry in that city, where
one hundred and  fourteen children  were
lodged in one ward, the air of which became
insupportable in the morning, while hundreds
were confined  in  the  school-room  during
the  day.   The disease prevailed under these
circumstances in all its fatal violence, and in
every form  of ordinary  phthisis and scro-
fula.
   It is  scarcely possible  for us to conceive
of the effects of confined atmosphere such as
the inhabitants of some parts of the Alpine
valleys experience.   The effects of confined
air during the summer are  here rapidly dis-
sipated by the friendly breeze or the sudden
tempest, which have full sweep over the  face
of the entire country.  There can be no 
52    CAUSES OF PULMONARY DISEASES.

doubt, from the account of recent travellers
there,that the physical deterioration of man in
these regions exhibited by  the  goitre and
the diminished stature, arises from the stag-
nant air which the inhabitants are compelled
to  breathe, from  the  impossibility  of  the
usual motions  in  the  air affecting the  re-
gions—added to the continued rarifications of
the air by the  heat which is  reflected from
one mountain side to the other.
  The skin of these people becomes  disco-
lored, and  covered with  scrofulous  sores,
an enlargement of the thyroid gland takes
place, and forms the goitre ; while, from the
general want of  proper  assimilation,  the
limbs become  distorted.   The  grades  of
scrofulous disease, from the simple goitre to
the  more  complete cretinism, are innumera-
ble.  All this arises from the causes already
mentioned, for, according to Dr. James John-
son's observations made  upon the spot, both
goitre  and  cretinism  prevail  in the most
intense degree in the  gorges and ravines,
while both  disappear  in  proportion as  we
ascend the mountain, and when a certain al-
titude is reached, both maladies disappear.
  In  our  public hospitals  the effect of a 
         CAUSES OF PULMONARY DISEASES.    53

   change in the mode of ventilation frequently
   demonstrates the  truth on this subject.  In
   one of the New York public charity Institu-
   tions the number of deaths was lessened  by
   one third, by the adoption of some important
   improvements in the mode of ventilating the
   rooms.
     A charity school in London, where scrofu-
   lous  disease  existed to a great  degree, be-
   came healthy when another house was  built,
   and fewer occupied a given  space, and im-
   portant improvements  in ventilation  were
   introduced.
     Our workshops are built often with  little
   regard  to the health of the  artisan.   The
   ceiling is often too low, too many are crowd-
   ed into  a  small space, and the apartment is
   frequently improperly heated and imperfect-
   ly ventilated.
     One who has carefully observed in relation
i   to this subject  says, " I observed carefully,
   the  state of health of a shop of letter-press
   printers in London.  They worked in rooms
   similarly lighted and heated, and in which
   ventilation was equally neglected, the  only
   difference being in the quantity of impure ♦
   air which the several men had  to  breathe,
i
              5* 
54    CAUSES OF PULMONARY DISEASES.

this  quantity being  ascertained  by  actual
measurement  of  the  rooms  themselves.
Among 104 men having less than 500 cubic
feet  of air to breathe, there were 13 who
had  spit blood, 13 were subject to habitual
catarrh, and 18 to other diseases, making a
total of 44 invalids.   Of 105  men who had
from 500 to 600 cubic feet of air to breathe,
5 had spit blood, 4 were subject to colds, and
23 to other  diseases, making in all  32 inva-
lids ;  while out of 100 men who had  more
than 600 cubic feet of  air to breathe, 4 only
suffered from spitting of blood, 2 from catarrh,
and 18 from other diseases, making a total of
24 invalids."
  Whatever produces weakness in the pow-
ers of respiration, or whenever there exists
an insufficiency of oxygen, either by the ad-
mixture of the air with other gases, thereby
lessening its relative  proportion,  or by  its
extreme rarification by  heat  or otherwise,
strongly predisposes the system to consump-
tion.
   It is not  generally known that excessive
heat as well as excessive cold  and dampness,
when applied habitually, will produce a lan-
guid action, and the  disease in question, as it 
      CAUSES OF PULMONARY DISEASES.    55

is, under such  circumstances, a powerfully
debilitating agent.
  Dr.  Alison, in the Trans. Med. Chirurg.
Soc.,vol. i.,p. 397, remarks that "the pulmonic
disease among the black troops (natives) of
the Leeward Islands and Windward  Islands
was almost exclusively phthisis;" and " pul-
monary consumption caused twice as great a
mortality among the blacks  as among the
whites."  Scrofula is a very common disease
among the Hindoos, Hottentots, and negroes;
the only difference  appears to be, that the
influence  of  cold is far more rapid in its
effects than heat.
  Sedentary occupations of all kinds, as they
limit the action of the chest, lessen the pow-
ers of  respiration and  produce disease.  If
the sedentary habit is combined with a stoop-
ing posture, the capacity of the chest and the
abilities of respiration  have a double obsta-
cle with which to contend.  The lungs, from
want of use, become small in size, while the
contracted form of the  chest which arises
from  habitually stooping, compresses them
into still greater limit.   The blood  passing
through  them is but partially changed, and
imperfect nourishment is the result.  Pale-
ness, lassitude, and  often absence of mental 
56    CAUSES  OF PULMONARY DISEASES.

energy mark  the condition of those who from
necessity are obliged to  subject themselves
to the evils of confined air, absence of natu-
ral exercise, and unnatural  postures.  Pains
in the sides, and lungs, and inability freely to
respire,  are  what  they  daily  experience.
Spitting of blood, weakness of the digestive
powers, an obstinate and too often an almost
irremediable  constipation of the bowels, are
their habitual ailments.
  In an account published a few years ago
in a public journal of the comparative diseases
of journeymen tailors, cabinet  makers, and
bakers, numbering thirteen hundred and sixty
individuals, the influence of sedentary habits
and constrained position in  developing  pul-
monary diseases  is  remarkably exhibited.
The  diseases  most  destructive were those of
debility, and occurred among the first men-
tioned.  Of catarrhal fevers one in six of the
Tailors  was affected, of  the Cabinet makers
one in nine, Bakers  one in six.  Spitting of
blood, Tailors one in four! Cabinet makers
one in one hundred and seventy! the propor-
tion not mentioned among Bakers.  Of other
diseases there  did  not  appear to be much
difference.
   Who is there that cannot add to this list 
      CAUSES OF PULMONARY DISEASES.    57

of pulmonary affections from his own know-
ledge ?   The feeble  form and pallid hue of
the toiling  sewing girl  meet  us  at  every
turn, and these  are among the greatest num-
ber of victims  of pulmonary consumption.
The sedentary sempstress suffers  the most
from this cause, and  a premature grave is in
most instances her end—her only relief.
   But it is among the flowerets of the land who
neither toil nor  spin that the fatal disease also
prevails, and too often  from their own obsti-
nate folly.   The practice of tight lacing has
for years been  the object at which the sati-
rist has aimed his shafts of wit, and against
which the philanthropist has labored with his
words of wisdom  and  caution, but we fear
with but little  effect.  Although the use of
corsets appears to have to some extent been
abandoned, it appears  also that  it  is but for
the purpose of  using the  dress for  the same
object for which stays and corsets have been
employed.   A score or two of hooks and eyes
now attach  the dress with a power nearly
equal  to the multiplied  power of the corset-
lace and eyelet-holes.  The writer  one even-
ing had  an audible  demonstration of this
upon the sudden  yielding of one or two of 
58   CAUSES  OF PULMONARY DISEASES.

these fastenings to the elastic force within.
It is probably the  fear of this accident that
has induced the adaptation of the usual  mode
of tightening corsets  to  the  ordinary  dress
worn at an evening party : and no internal
elastic energy can overcome the power thus
applied.  The individual can affirm with truth
that she wears  no corsets, but a brief  state-
ment of the  inability to  respire under such
pressure, will it is hoped  bring such a reader
as thinks she  has complied with a plain rule
of hygiene, to reflect upon the  necessity of
still greater advances towards a compliance
with its  requisitions, and to obedience  in
spirit as well as in letter.
  When we  breathe we take into the chest
and expel a certain quantity of air which can
be  measured by a certain instrument con-
structed  for  that purpose.  A middle sized
man inspires  about 80  cubic  inches  when
dressed, and  106 when his dress is loosened.
After a full  dilatation of the chest he can
inhale 126 cubic  inches when dressed, and
 186 when undressed.   Now these experi-
ments we  must admit have  never, it  is be-
lieved, been  performed with  the ladies, and
therefore  we  can only  guess at  the re- 
      CAUSES OF PULMONARY  DISEASES.   59

suits in some of them.  These surmises we
must  therefore leave for  those most  inter-
ested.
  What can be the object for distorting the
figure, and  compressing it out of all natural
symmetry?   It arises decidedly from a false
taste: it  is a remnant of barbarism—to be
regarded in a light similar to that in which
the Chinese who compress  the feet, or  the
Indians  that flatten the  head by  artificial
means, ought to be viewed.
  This tight lacing prevents respiration,—
the freedom of the circulation is impeded, the
blood is forced to the face, at first of a deep
red, then pale, and from imperfection of the
nutritive  process,  dingy and cadaverous.
From difficulty of respiration the nostrils are
widened, and the lips are parted for the same
purpose, or  tightly compressed to assist the
passage of  air through the  nasal  passages.
All this is extremely unsightly.  In addition
to these, there is an expression of greater or
less suffering in the whole face, which ceases
to be the seat of ingenuous  expression—no
emotion being exhibited with its appropriate
expression,  except it be that of pain, badly
concealed by a forced smile. 
60    CAUSES OF PULMONARY DISEASES.

  There is no beauty, no grace in the con-
straint attendant upon this artificial state of
distortion.   Without  freedom of movement
there can  be no  grace.  No  harmonious
union of features and symmetry of  form can
exist  without an  unrestrained  and  uncon-
trolled power of motion, whereby the  most
transient emotion  of  the mind may  impart
its delicate traces upon the face and form.
  The inimitable  chef-d'oeuvre of Medicis
exhibits the human form  in all its perfections
of beauty, symmetry, and grace ; and it is but
the counterpart of nature unchanged and un-
adorned.
  From all the facts stated when considering
the uses of the lungs, and the  causes operat-
ing indirectly in the production of  pulmona-
ry consumption, it is evident  that the imper-
fect state of the respiratory function,  arising
from a limited capacity of the lungs, an im-
perfection in the air  respired, or the  combi-
nation of both, so far interferes with the pro-
cess of nutrition as to prevent  the  proper
elaboration of the simplest form of  animal
substance which results  from the  process of
digestion.   That  the  presence  of albumen
is  the result of this imperfection in  the re- 
      CAUSES OF PULMONARY DISEASES.   61

spiratory  process.  A condition  marking a
state  of  disease arising  from deficiency  in
the vital  powers, and consequently a state
of debility, and the deposit  of albumen  in
the lungs furnishing the  usual  symptoms
which characterize  pulmonary consumption.
£ 
V.
CHARACTERISTICS  OF THE DISEASES  OF THE
           RESPIRATORY  ORGANS.

  Catarrh.—This most  common  inflamma-
tion of the air  passages, is  attended with a
secretion  of mucus from all  these parts;
it is from this that  the name is derived.  In
ordinary language it is called a cold.  When
the disease  exists in the nose and parts ad-
jacent it is called cold  in the head ;  when in
the throat, it is  known  as catarrhal  sore
throat ; when in the trachea and throughout
its branches in  the lungs, it is familiarly
known as cold  in the chest.
  Besides the seat of the affection constitut-
ing the varieties above mentioned, it may be
considered  as existing   in  three  different
forms.  1st, that  of common  cold ;  2d, epi-
demic of influenza ; and 3d, as  it occurs in
old people.   In all these conditions there are
 some peculiarities common to each, but most
 of them belong to all.
   The voice is  a  little changed  in  this
 disease; the  alteration  consists  of  a  pe- 
 DISEASES OF THE RESPIRATORY ORGANS.  63

culiar  sound, which  is not easily described.
It is more vibrating  and hollow in its inci-
pient state ; after the continuance  of the dis-
ease,  where  the  secretions in the nose or
throat  are thickened, the stoppage of air in
these parts produces that sound of the voice
most   strangely   denominated   " speaking
through  the  nose,"  although the sound is
the reverse.   Hoarseness  is  the  usual  at-
tendant when the seat  of the affection is the
upper  part of the throat at the commence-
ment, but disappears as soon as the mucus is
freely  formed in  the part, and the cold be-
comes " loose."
  Respiration is  not much affected in ordi-
nary catarrh.  The  greatest  inconvenience
arises  when  the  mucus formed  in the  air
passages becomes thickened, as is very com-
mon in infants, when it is called the " snuf-
fles."   It becomes in them sometimes a very
serious affection,  from the impossibility to
breathe  while sucking.   The efforts at re-
spiration and the  disorder of the circulation,
arising from these  efforts, will  sometimes
cause convulsions.
  From this thickening of  the mucus  a par-
tial stoppage will  occur in the branches of
the air tubes within the lungs, in every form 
64
DISEASES  OF THE
of the disease  and at any age, making  the
respiration difficult for the time; this stop-
page, however, is but temporary ; a full re-
spiration, followed by an  irresistible cough,
will usually remove all the causes of obstruc-
tion.
  Cough is an invariable  attendant  of a
" cold," whenever its seat is in any other part
than in the " head."  Too often much mis-
chief is done by domestic prescriptions for
cough alone, administering such remedies as
will stop the  cough  without relieving  the
disease producing it.  Anodynes for the re-
lief of  cough  are the usual active  ingre-
dient in quack medicines, the arrest of this
being  so easily  effected that the poor patient
is deceived into the notion that he is speedily
to be cured, without knowing that the cough
is absolutely necessary to  relieve the  lungs
from the accumulation which takes place in
them.  Cough is a natural action, an instinc-
tive movement  whereby the lungs are to be
unloaded of the effects  of the disease ; and
is precisely analogous, except that  it is in-
voluntary, to the blowing of the nose to re-
move  the  accumulation  of mucus which
takes  place within that member. 
           RESPIRATORY ORGANS.         65

   In  many persons, however, the cough is
excessively annoying and prostrating?  the
aged  suffer much from protracted cough, and
measures should be adopted for the relief of
such  symptoms. A judicious physician alone
is capable of judging of the propriety of such
interference, and the extent to which it ought
to be carried.   The remarks adverse to  the
use of means for the arrest of the cough,
apply only to  the ignorant, indiscriminate,
and  injudicious  use of the means for effect-
ing that  object; for nothing is more appro-
priate than a timely use of the requisite re-
medies for the  relief  of so annoying and
sometimes dangerous a symptom.
   Expectoration is  closely connected with
cough, for this cannot take place without  the
action of coughing.
   At  first, expectoration  is  scanty as  the
disease progresses, the unpleasant feeling of
oppression and pain is relieved  by the for-
mation of mucus, and the passage of it from
the lungs ; analogous to this, is  the flux of
fluid from time to time in the eyes and nose,
when the  disease is situated in these parts,
which usually  relieves the pain and fulness
over the  eyes and about the head.
           6* 
66           DISEASES OF  THE

  There is but little pain or  fever in simple
catarrh; neither  of these is of  sufficient
importance to demand much attention.
  The physical signs of catarrh in the early
stage are dry, sonorous, and  sibilant  ronchi,
and, in  some rare instances,  a total  absence
of respiratory murmur.  But the clear sound
upon  percussion  indicates  a good condition
of the vascular structure, the  obstructions
arising from a thickening of the mucous coats
of the bronchi.   When  secretion  is  esta-
blished, the mucous ronchus is heard, and ac-
cording to the acute or deeper  tones, is the
situation of the disease in the smaller or larger
bronchial tubes.
  The catarrh of old persons is by no means
an uncommon disease ; it prevails in the fall
and spring, and  usually attacks such as are
of a full but feeble habit.
  The  respiration  is panting, noisy,  and
wheezing, and is  at times so difficult as to
oblige the patient  to take an erect or sitting
posture.   The cough, frequent, short, and
obstinate, sometimes  producing  vomiting.
The expectoration is free,  consisting of thin
mucus.
  Pain in the  chest is rarely felt, but the 
RESPIRATORY ORGANS.
67
patient has wandering pains  in the limbs,
like those of rheumatism.  The fever is often
high, the skin dry, and the thirst great.
  The countenance is generally pale, some-
times a little  bloated, and  occasionally the
lips  and tip  of the  nose are livid, and the
cheeks assume the same shade of color.
  The debility is very great, and, as the dis-
ease advances,  the  debility increases  with
an  aggravation of all the symptoms.  Al-
though the mucus is abundant, the coughing
becomes impracticable from debility, when
the danger is very great.
  Influenza.—This differs from other affec-
tions of the same parts, by its being caused
by  epidemic  influence,  and  the   debility
which  accompanies it on its invasion, which
is common with all epidemic diseases.   The
peculiar characters of  the disease exhibit, in
different epidemics, every variety, from the
slightest  catarrh to  the most obstinate and
complicated disease.
  In proportion to the violence of the inva-
sion are the cough and violence of the respi-
ration. But the characteristics of the disease
are pain in the head, back, and loins, accom-
panied with  great prostration of strength. 
68
DISEASES OF THE
The eyes are suffused, with a tingling sen-
sation in the nose, followed  by sneezing and
the  discharge  of a  thin  acrid  fluid,  while
there is a redness and a stiffness in the throat,
with a  discharge of thick  mucus.  In pro-
portion  to the extent  of the affection over
the lungs, there  exists more or  less sense
of stricture around that part.   The accom-
panying fever increases every evening, and
in severe  cases  has a distinct chill.  The
complications are varied  and numerous, de-
pending on constitutional  peculiarities, and
the peculiar condition of the atmosphere from
local  causes ; in  every form debility exists,
which in some severe and complicated cases
resembles the collapse of cholera.  The ex-
pectoration, which at first was difficult, con-
sisting of thick viscid mucus, becomes thick,
copious, and  purulent.
   Bronchitis.—Closely allied  to  the fore-
mentioned diseases is  bronchitis ; ah  exten-
sion of either of them may form an inflam-
mation  of bronchial tubes.  Bronchitis may
make its invasion either as simple catarrh or
suddenly assume  its peculiarity, of inflamma-
tion of the bronchial air tubes.
   Acute Bronchitis.—There is little change 
RESPIRATORY ORGANS.
69
in the voice  in this  affection beyond an oc-
casional thickening; it  presents  much the
same condition as is  found  in catarrh.   The
respiration is a little quickened, depending
upon the violence of the catarrh or the con-
tinuance of the fever.
   Cough is always present, at first dry, hard,
and  more  or less painful.   As the affection
becomes relieved by  the secretion of mucus,
the cough, instead of being an annoyance, is
for the most part a source of relief. In some
instances, however, it  continues  to  be  a
means of constant annoyance, and demands
measures for its temporary mitigation.  Ex-
pectoration at first is  usually scanty ; it after-
wards becomes more copious and frothy,
and  sometimes streaked with blood; when
it  presents the appearance of the white of
an egg, it makes  a very severe form of dis-
ease, and its expulsion gives but little if any
relief; when, on the contrary, it appears more
like  ordinary mucus, the expectoration af-
fords, in most instances, decided relief.
  The  pain  attending  acute  bronchitis  is
usually in  the  middle of the chest immedi-
ately beneath the sternum, and it varies in
degree  from  a feeling of simple rawness to 
70           DISEASES OF THE

an obtuse pain, and  denotes  the extent and
degree of inflammation.
  Fever is  usually  high, with thirst, head-
ache, white  tongue, and hurried respiration.
If the inflammation be not relieved, the fever
and  accompanying symptoms  increase, but
when the difficulty of respiration increases,
feelings of great depression appear ; severe
sweats occur, and  congestion  of the  lungs
takes place.  In favorable  cases,  the dis-
ease declines between the fourth and eighth
days, but if  the symptoms increase after the
latter period, the most unfavorable  anticipa-
tions will likely be realized.
  Chronic  Bronchitis.—This  form of dis-
ease is that  which is found to prevail among
those who are exposed to the inhalation  of
air  loaded with  dust, such as  stone cutters,
workmen in coal yards, grinders of cutlery,
etc.
  It also prevails  as a result of the acute
 diseases already mentioned, and of whoop-
 ing-cough,  measles,  small-pox,  and  some
 chronic diseases of the skin.
   The lighter forms of chronic bronchitis are
 marked by habitual  cough  and  expectora-
 tion of a slight degree, which are increased 
           RESPIRATORY ORGANS.         71

upon  sudden changes of weather or sudden
exposure to  change  of temperature,  from
other causes.  It often  continues for many
years without producing anything more than
an inconvenience.
  When, however, it arises among those ex-
posed to the mechanical irritations  above
mentioned, or where  it already  exists, and
the inflamed  membrane is kept in a state of
constant irritation by the mechanical parti-
cles in the air, such  as those already men-
tioned, and the dust from a fire of anthracite
coal,  it is sometimes a very serious affection,
demanding all the  resources  of art for its
relief.
  The respiration under these circumstances
is very difficult, and  the cough severe and
harassing.   The expectoration is often co-
pious, and mixed with pus and blood.  A fit
of coughing  will also end in severe haemor-
rhage.
  It  is a disease which, if not speedily re-
lieved by  remedies,  or an  abandonment of
the occupation and an entire removal of the
causes producing and maintaining its exist-
ence, will certainly prove fatal. 
72           DISEASES  OF THE
   The physical signs in acute bronchitis are
sonorous and sibilous ronchi.
   When  secretion is  established,  a moist
mucus ronchus is heard throughout the chest,
corresponding with the process of expecto-
ration.
   Inflammation of the  Larynx.—The voice
in this disease becomes hoarse and  loses its
quality, and is  either  shrill  or  rough, or  is
altogether  lost, at least that part  which is
formed  by the larynx, the patient speaking
in a whisper, with the lips and teeth only.
   The  dry,  contracted,  squeaking  kind of
hoarseness implies a worse disease than if it
is moist.   If the cough continues harsh and
cracked until it is entirely lost, it indicates
more  destruction  of the  parts  than if  it  is
suddenly lost.  Whatever defect there is in
the voice, it is often only apparent when tjie
patient  attempts to  speak loud, for the pa-
tient  instantly  acquires the  habit of speak-
ing in that tone, which is easily done.
   Respiration is somewhat  affected, and  if
the disease be violent, is performed with dif-
ficulty, and in the acute  form the  patient
will  be suddenly awakened by a  feeling of
suffocation. 
RESPIRATORY ORGANS.
73
  The cough is dry, suffocating, and severe,
as is the case with all inflammation about
the throat unaccompanied by any secretion
of  mucus.  In this  disease, in its  chronic
form, the  cough is more teazing and annoy-
ing than severe.
  The expectoration at first is quite scanty, but
as the disease advances there is often an abun-
dant mucus and pus, which is sometimes streak-
ed with blood.  The recurrence of this kind
of expectoration is sometimes attended with
relief to the breathing, although  the  voice
may become more affected, and there may
be  more  pain and soreness in coughing;
this marks the formation of ulcers.   In very
formidable instances,  some  portions of the
bones and cartilages, which form the organs
of voice, have been expectorated.  They at
times have fallen back into the trachea, and
caused  inflammation of that part, which has
extended to  the lnngs.
  Pain.—There arise  soreness and pain in
the part affected, which latter is often only
felt  during  the  act  of swallowing; this
last is a peculiar symptom of the seat of the
inflammation.   Pain is so rarely felt that in
more than half the  cases that  occur none
                 7 
74
DISEASES OF THE
whatever is felt.  Except in the acute form,
but little fever attends the disease, even then
it does not form a prominent symptom of the
affection.
   AsTHMA.-r-Pure asthma is a spasmodic dis-
ease.    It  is not  unfrequently  confounded
with  a  congestion  of the  bronchial tubes,
which,  from some similarity of the symp-
toms with the present disease, has been called
congestive asthma.
   The  voice in asthma offers no peculiarity
of any  importance ;  it is  low, obscure, and
husky, apparently from the  great  difficulty
of furnishing a  sufficiency of air  from  the
lungs to perfect its  sound.   The patient is
•very  unwilling to speak.
   Respiration.—The   distinctive  mark  of
asthma  is the difficulty  of respiration; in-
deed, those  who suffer attacks of asthma,
are seldom free from shortness of  breathing
at intervals.
   The  efforts at breathing are exceedingly
distressing ;  the  body is bent forward, with
 the arms resting upon the knees ;  the chest
 is contracted with a feeling of tightness as if
 something were drawn around it.
    The attack usually occurs about midnight 
RESPIRATORY  ORGANS.         75
after  a slight uneasiness in the respiration,
with  pain  in  the  head during  the evening.
At an uncertain time after falling asleep, the
patient  is  suddenly awakened  by the in-
creased  violence of the respiratory  efforts.
He feels as if his  lungs were enclosed in  a
ligature, which makes him feel the necessity
of an erect posture, and a free exposure to
the cool air.
  Although there are great efforts at respi-
ration, the chest is never fully dilated; the
violent efforts of the  muscles appear to re-
tard,  rather than assist respiration, and both
inspiration  and expiration  are  performed
slowly and with a wheezing  sound.
  These symptoms continue for many hours,
usually lasting until towards morning.  The
breathing  then  becomes less laborious and
more slow; the inspirations are longer and
more full.   On awakening the next morning,
the patient finds his breath freer and easier
than  during the night, but not quite natural.
He still  feels a tightness across the breast,
cannot breathe easily  in the horizontal  pos-
ture,  and cannot attend to any business with-
out feeling a return of his breathlessness and
uneasy sensations.  If these, however, are 
76
DISEASES OF THE
avoided, the breathlessness continues to be-
come easier.
  These fits of difficult breathing may return
for several nights in succession, but with di-
minished force, until after a few  nights the
remissions  become complete, and after four
or five attacks, the disease may be considered
as terminated.
  Cough.—Although there is a wish to cough
it is very difficult if not impossible, as cough-
ing requires a full  supply of air to be passed
into the lungs.  Coughing is always a favora-
ble sign, and invariably brings up some mu-
cus ;  when relief  is experienced in propor-
tion to the amount of expectoration. . When
this is free and abundant, relief will speedily
follow.
  The  mucus  expectorated  is   sometimes
dark  colored, and  sometimes mixed with re-
cent  blood.  Neither  of these conditions is
of any  importance.
   Fever is rarely present; the patient on the
 contrary   complains  of  chilliness, and the
 whole  surface of the body has  a pale and
 shrunken  aspect.   When  fever  does  exist,
 the disease is then dependent upon indiges-
 tion, or upon inordinate eating. 
RESPIRATORY ORGANS.
77
   When asthma has once attacked an indi-
 vidual, it is liable to return frequently during
 the  whole life.   These attacks may some-
 times  be  avoided  by avoiding the causes
 which excite them into action, and which
 nothing but the watchful experience of the
 patient can detect.
   Physical Signs.—In cases of pure spasmo-
 dic asthma the sound on percussion is gene-
 rally good, but  in  very severe cases, dull.
 There are sonorous and sibilous ronchi, at
 the beginning, followed by sub-mucous  and
 sub-crepitant ronchi.  Some degree of wheez-
 ing and sibilus remains after the attack.
   Inflammation of the Lungs.—Among the
 diseases of the respiratory  organs  there are
 none more formidable and obstinate than the
 inflammation  which affects the substance of
 the lungs, if we except pulmonary  consump-
 tion.   It sometimes appears suddenly, with-
 out  being  preceded by  any  other, and at
 other times is a consequence or a complica-
tion of other diseases.  In whatever manner
it makes its invasion it presents the following
characteristics.  The voice is  low and re-
strained, from  the  difficulty  of filling  the
chest to supply the  necessary quantity of air.
                 7# 
78           diseases  of the
Efforts to speak greatly increase the oppres-
sion with which the  patient is  distressed.
Respiration is frequent, short, and painful,
increasing  from  fourteen  in  a  minute, the
usual number in health, to thirty and upwards
during the same period.   The  difficulty of
respiration compels the patient to assume an
upright position, or to  be  supported in bed
on  the  back, with  the  shoulders  raised.
Cough is short and dry at first, and when the
inflammation is  severe it often  ceases alto-
gether from the  pain that, it causes.  It is in a
little  while attended  with a scanty expecto-
ration, but this affords but little knowledge of
the extent of the disease ; it is from the ra-
pid and  forced  character  of the respiration
principally that the required information is to
be gained.
  Pain always attends this disease, in  every
degree—at times sharp, and  again dull and
diffused.  The pain  is always deep seated,
and in different  parts of the chest in different
 individuals.
   When the pain is in the side and of an acute
 nature, inflammation of the lungs is then com-
 plicated with pleurisy.
    The expectoration is at first composed of 
RESPIRATORY ORGANS.
79
a scanty mucus;  it afterwards  becomes of
a dark sooty color, and viscid in its consist-
ence.
  Fever is always high, with hot skin, espe-
cially on the chest; flushed face:  frequent
and quick pulse, and all the usual attendants
of fever are present in this affection.
  The physical signs at the commencement
are puerile respiration, and afterwards when
the disease is  fully formed, crepitant ron-
chus; when the lungs become hepatized, there
is an absence  of the respiratory  murmur,
with bronchial respiration.  When  suppura-
tion occurs there  is mucous ronchus.  There
is in all stages of the disease dullness on per-
cussion.  The  parts most  usually  affected
are the lower lobes of one or both lungs.
  Pulmonary Consumption.—This is a dis-
ease characterized by a gradual  wasting, ac-
companied with more or less cough and ex-
pectoration depending upon a destruction of
the lungs,  arising from  the ulceration pro-
duced by the presence of tubercular masses
in them.  The following are the symptoms
peculiar to this disease in the different modes
of its progress.
   1. It may make its invasion insidiously and 
80
DISEASES  OF THE
slowly.   Often the first symptoms, most gene-
rally in the young,—between the  sixteenth
and twenty-fifth years—are, the patient be-
comes a little emaciated, has a constant cough,
at first dry, or with only a small quantity of
mucus.  The pulse is always  quickened; in-
deed, in many an instance this is the only sign
in the incipient stage,  scarcely ever  beat-
ing less than 90  pulsations in a minute, and
often  as many as 120.   The respiration al-
so is more frequent than  in health, amount-
ing to about twenty-five  in a minute, and is
easily excited upon any exertion.  The skin
is dry, while there is a hot uneasy feeling in
the cheeks.
  The expectoration gradually becomes more
copious, and from floating on the surface be-
comes heavier than the water, and sinks.
   At this period of the disease the face alto-
gether loses its color and  becomes pale,  sal-
low, and cadaverous ; but in many instances,
especially in young females, it is of a peculiar
delicate and transparent appearance, with a
slight pink color in the cheeks.
   2.  The next form of attack is after catarrh
or bronchitis.  The patient  has often  had a
" cold," finds that it is more protracted in its 
RESPIRATORY ORGANS.
81
duration than usual;  or  if he has been re-
lieved from the most common symptoms, will
suffer a recurrence upon  a slight exposure to
the cold air or dampness.  At each attack,
the urgency of the symptoms increases, and
more particularly the shortness and frequen-
cy  of respiration ; the expectoration, which
at first consisted of thin  mucus, or a jelly-
like substance,  becomes  thick, opaque, and
has the  appearance of pus.  The  pulse in-
creases  in rapidity, varying from 100 to 120
beats in a minute.  The  skin is hot and dry
at night, when the patient is in bed; when he
sits up he complains of cold.   After a while,
a slight moisture is perceived about the head
and chest in  the morning,  after a night of
fever; the first indication of hectic fever.
   3. The third mode of  attack is so obscure
and insidious that for a long  time  no affec-
tion of the lungs can be suspected, from the
absence of the usual signs  accompanying
the disease.  The cough is very slight, and is
on this  account rarely noticed.  Consump-
tion may be  suspected when there has ex-
isted for some time an indescribable feeling
of weariness and indisposition, and when the
patient's respiration is carefully watched, and 
82          DISEASES OF THE
found to be rather more frequent and more
limited than is natural.  In addition to  this
he cannot take a full breath without a feeling
of oppression.  The pulse also is more quick
than in a state of  health, beating from 90 to
100 strokes in a minute, and easily excited to
a greater  frequency.
  The use of the stethoscope should by no
means be  neglected when the case is obscure
in its ordinary symptoms.
  4.  In another  mode  of attack  bleeding
from the lungs is  the first  symptom that at-
tracts attention ; this, however, is rather an
indication of previous obscure disease, than
a cause of consumption.   A succession of
such attacks must arise from some  previous
diseased condition of the  lungs,  which has
escaped notice from the entire absence of the
usual signs exhibited in pulmonary diseases.
It appears to correspond with the state of the
lungs connected with the want  of the usual
manifestations of consumptive  symptoms,
mentioned in the  preceding class.
   The condition of the lungs in which there
exists an absence of the usual symptoms is
various—sometimes slight  chronic  pneumo-
nia, at other times congestion, again, the  sim- 
           RESPIRATORY ORGANS.         83

pie accumulation of tubercular matter.   The
symptoms attending these conditions of the
lungs, causing haemorrhage, are a dry, harsh
skin during the day and  part of the night,
but easily  made to  sweat  about  morning.
When cough  is present, it is short, tickling,
and sometimes occurs in violent paroxysms.
Respiration is  much quicker than natural,
easily  accelerated, and rendered laborious
by exertion.
   The physical signs in this class of patients
will apply to the one immediately preceding.
They consist of bronchial respiration, some-
times sonorous and sibilous ronchi.   In the
sub-clavicular, scapular, or sub-scapular re-
gions fine  mucous ronchi is  heard; while
more natural  sounds exist in the inferior re-
gions.
   These are the different  modes of the inva-
sion of this most formidable  disease ;  and
however much it varies in the manner of its
attack,  the  distinctive signs of the  disease
may be comprised in the following summary.
Cough,  with expectoration;  quick breathing,
often  with a feeling of oppression or tight-
ness of some part of the  thorax,  and easily
increased upon exertion; hectic fever; di- 
84
DISEASES  OF THE
arrhoea ; and a gradual wasting throughout
the whole disease.
   Cough is the most constant symptom in
pulmonary consumption.   In the  early part
of the disease it is tickling, frequent, and al-
most always without expectoration.   When
the latter takes place it  is  usually frothy.
The cough, at the commencement, depends
for its character upon the nature of the at-
tack.   If this is accompanied with much in-
flammation,  the cough is  the  most urgent
symptom, as it causes a great deal of distress
and pain, and interrupts the sleep.  In the in-
stances in which the disease begins more in-
sidiously and with less fever, it is often very
slight  for weeks, and even for months, with-
out attracting  much  attention.   But  it  be-
comes more annoying and troublesome  as the
disease advances.  When it is attended with
much expectoration it becomes very trouble-
some.
   Cough is violent in the active period of the
disease, but as it approaches its termination,
the strength of the patient  is  so  much re-
duced that it is with great difficulty that he
can cough.   One  character of the cough in
consumption demands attention.   It is, that 
RESPIRATORY ORGANS.
85
the sense of irritation is experienced in the
throat, so that the patient will be led to think
that the  disease is  seated in  the  wind-pipe
and not in the  lungs.
   Expectoration.—In  the beginning of con-
sumption the  expectoration consists of thin,
frothy mucus,  sometimes a part of it quite
opaque and of a greenish hue.  It always as-
sumes an  orbicular  shape when  received
into any vessel;  when  into water, part of it
sinks in a little while, and part remains par-
tially floating, resembling clouds in the wa-
ter.  The  part that sinks resembles small
balls of cotton.
   As the disease advances after the softening
of the tubercles in the lungs, the expectorated
matter becomes less abundant, and appears
again like mucus expectorated at the begin-
ning, or it may be altogether absent, when the
cough partially ceases.   The cough increasing
without any expectoration, and being very ir-
ritating, and more or less painful, the patient
imagines that he has " taken  a fresh cold."
Expectoration of thick matter comes on again
as  other tubercles  soften;  he then remarks
that he is getting better, as his cough is be-
coming " more loose."   It then  gradually
                    8 
86           DISEASES OF  THE
loses its peculiar character and becomes as
it was before.  A continual recurrence  of
these symptoms almost invariably marks the
course of pulmonary consumption.
  Respiration.—The breathing  is  always
quickened; the respiratory  actions varying
from 26 to 32 in a  minute.   This is always
to be remarked whenever  the  patient is in
motion.
  The manner in which respiration is per-
formed, seems to indicate  an intolerance of
the air on the part  of the  lungs, for it is no
sooner inhaled than it is expelled, and the ex-
piration is longer than the inspirations.
  Percussion over the upper part of the chest,
immediately under the collar bone, causes a
duller sound than  is  natural, one side being
usually more dull than the other.  Over the
mammary and sub-mammary regions  the
sound is sometimes preternaturally  clear.  In
the  axilla it  is   usually dull in the early
stage, but as the disease advances it becomes
clear.
   The signs on auscultation also differ  in dif-
ferent stages of the disease.  Bronchial  re-
spiration in the commencement of the disease,
is its characteristic sign. 
RESPIRATORY ORGANS.
87
  In the next stage, before cavities have been
formed, sonorous  ronchi and sibilous wheez-
ing are heard, with moist, mucous ronchus.
The sound of respiration is more or less dull,
usually completely so ; and either during in-
spiration or at its close, there are heard the
moist crepitating ronchus or  fine  mucous
ronchus,  or both combined, in the subclavi-
cular or mammary regions before, the axilla-
ry region at the side, and the scapular region
behind.   A cooing sound will also be heard
in the same regions.
   All these sounds increase in intensity and
coalesce  as it were, and a gurgling sound is
heard; this occurs at the end of a week or
ten  days.   Air is afterwards heard to enter
into the space where the gurgling sound was
heard; this is the cavernous respiration, and
when  the  patient coughs or speaks, a pecu-
liar re-echo is heard.
   The sound of the voice in this part is pecu-
liar, vibrating  strongly through  the stetho-
scope, and seems to come directly from the
chest to the ear.  Spitting of blood may oc-
cur in consumption in three different forms :
merely streaking the matter expectorated, or
in the quantity  of a teaspoonful or two, and 
88
DISEASES  OF  THE
in a large, profuse  bleeding.  In some form
or other, it occurs in almost two thirds of all
the cases of consumption.
   Hoarseness  is another symptom that  oc-
curs in many cases ; almost one third are af-
fected with this symptom.    The hoarseness
varies in degree, and sometimes amounts to
an entire loss of voice. Pulmonary consump-
tion has in some instances been mistaken for
inflammation of the larynx, from the remarka-
ble prominence  and  continuance  of  this
symptom.
  Pain.—This is not a very common attend-
ant of this disease.  In the early stages, how-
ever, when there exists  some inflammation,
pain is felt in particular  parts, and a feeling
of weight  and  oppression throughout  the
chest, usually increased upon a full inspira-
tion.   The most usual place for pain to be
felt in consumptives, is between the shoulders,
and at the close of the disease at the lower
extremity of the sternum.
   Fever attends most cases of consumption.
At the commencement it is usually inflamma-
tory ; the pulse varying from 90 to 120 beats
in a minute.
   In the second stage of the disease, hectic 
RESPIRATORY ORGANS.
89
fever makes  its  appearance in the greater
number of cases.  It resembles, in some re-
spects, an attack of intermittent, commencing
with  chills towards  evening,  with pains,
and  a  contracted skin.  Heat, and  dryness
of the skin succeed, marked by a bright pink
spot on the cheeks.  A severe sweat follows,
known by the name of night-sweat.   One set
of paroxysms usually occurs orice in twenty-
four hours,  and sometimes  there are two in
the  same period.
  Wasting is  a constant symptom  of con-
sumption; about one half of all the cases com-
mence with this, as the most prominent cha-
racteristic.    In  the others it is connected
with diarrhoea, sweating, and fever. The most
common  cause is, however, the want of  nu-
trition in the  system, from the diminution of
the  function of respiration. 
                  VI.

PREVENTION  OF THE DISEASES OF  THE RESPI-
             RATORY  ORGANS.

  Local Diseases.—Many of the local diseases
of the respiratory organs may,  in a great
measure, be prevented by a careful watching
and avoidance of their causes. These  causes,
in some instances, require the personal expe-
rience of the individual alone, apart from any
general rules upon the subject.
  Nothing so clearly  shows  the  remarkable
influence which individual peculiarities exer-
cise  in the  production of disease, than the
successful resistance  made by the lungs of
one person to the action of a cause which in
another almost invariably  results in departure
from a sound and healthy condition of these
organs.   Causes of  disease, and the reme-
 dies  for its  removal,  are,  for the  most  part,
 relative agents ; they are especially  so  with
 reference to the lungs—none acting uniform-
 ly in every instance, but receiving their power
 from the condition of the part upon which
 they  act, and the general predisposition  of 
     PREVENTION  OF THE DISEASES,  &C.  91

the system.   From this difference in the sus-
ceptibility of different individuals, it is obvi-
ous that no rules  can be laid  down  that can
be  regarded as unerring guides.   Experi-
ence, in many instances, offers the only safe
rule for our conduct with  reference  to  the
avoidance  of those atmospheric causes  of
diseases of the air passages, which arise from
some physical modification in the  air.   An
illustration may be given in  the instance of
asthma.  This disease is excited in different
individuals by directly opposite  states of at-
mosphere, and that condition which produces
it in one, will actually relieve it in another.
Many asthmatics are relieved in damp wea-
ther, and experience the  most of their afflic-
tion during the prevalence of dry and cold
weather, or in situations  that are constantly
dry  and  cold.   Some persons thus affected
have actually removed to situations for relief,
which others, similarly affected, have  left for
the same object.   So again, habitual bronchi-
tis is relieved in some, by the influence of a
cold air, which by abstracting the heat of the
inflamed  part,  causes a feeling of refresh-
ment and  an arrest of the cough; while
others experience, under similar circumstan- 
92     PREVENTION OF THE  DISEASES
ces, positive injury, in the  production of  all
the train of evils attendant upon this malady.
These are extreme cases, but serve to illus-
trate the principle that all remedies, both pre-
ventive  and curative, are  not absolute, but
relative powers.
  Their influence can sometimes be ascer-
tained by  the  experience alone of the pa-
tient; at other times they will require the
careful  investigation of the actual state of
the lungs,  to discover  their natural or ac-
quired tendency, that the exciting cause may
be avoided or  the suitable remedy applied.
With these preliminary remarks the follow-
ing suggestion  on the mode of  avoiding  the
usual effects of different  conditions of  the
atmosphere are made.
   While extreme heat or extreme cold  is a
 cause of disease in the pulmonary organs, it
 rarely happens that  they exist to such an ex-
 tent  as to render particular  directions  for
 their avoidance necessary.   Man  will  in-
 stinctively leave any situation, if  it be possi-
 ble,  where  they   exert  their  influence
 to the  injury  of   health or  the  destruc-
 tion  of life;  for their baleful effects  are
 immediately felt.   It is when sudden changes 
        OF THE  RESPIRATORY ORGANS.     93

 of temperature in the air  occur that great
 derangements arise,  but  without any  very
 profound sense of evil at the time,  for the
 extremes need not be great to produce these
 effects ;  it is sufficient that the vicissitudes be
 sudden.
   As  preventives  of diseases of the lungs
 from these causes,  there are  two  general
 rules to be observed : 1, To render the  con-
 dition of the air as uniform  as possible, and
 2, to accustom the system to the variations
 of the atmosphere where  uniformity  cannot
 be established.
   The best  method  of artificially  heating
 our habitations is the only subject that can
 come  under consideration  under  the  first
 rule, in connexion with a reference to suita-
 ble clothing.
   The best mode of warming a house either
 throughout or in the different apartments, is
 that which will combine a uniformity of tem-
 perature  with a suitable ventilation, whereby
 a continued supply of external air is  admit-
ted with its appropriate moisture.  In addition
to the admission of the  air from  without en-
suring thereby a suitable amount of pure air,
the humidity of the air must also be main- 
94    PREVENTION OF THE DISEASES

tained, a condition which no artificial means
has as yet been able to accomplish.
   The open fireplace for an  apartment is
decidedly preferable to a stove or a ^furnace
placed in the lower  part of the house  with
flues to convey the  heated rarified air into
the room.   The  inconvenience of an open
fireplace   is that it  produces  a current of
air along the floor or upon the back, where-
by a cold feeling  is produced, and those ex-
posed to  it are  in truth exposed to all the
evils which result from a current of cold air.
This evil scarcely exists unless the weather
be extremely cold, and then it  becomes ne-
cessary to adopt some other or additional me-
thod of warming a house.   This is best done
by a  stove  placed in the  entry, which ac-
complishes in a great measure the objects
above  stated—those of supplying  heat and
introducing at the same time a quantity of
external air.  A stove in a room rarifies the
air where there is but little opportunity of its
escape, and  consequently but little is intro-
duced into the  apartment.   A stove on  the
contrary placed in the main entrance  to the
house, receives  fresh air continually, not only
from the outer  door  being  frequently open- 
       OF THE  RESPIRATORY ORGANS.     95

ed, but by means of cracks and other open-
ings ;  the air being rarified ascends through-
out the whole house, and escapes  in various
small  openings  in the  upper part.  To en-
sure this passage of air one  flue of a chim-
ney in the upper part of a house is sufficient.
A free ventilation is thus established ; indeed
more  fresh  air is inspired  than  if no such
arrangement was  made ; for  in  the  latter
case for want of something to set it in  mo-
tion the air of the whole house remains stag-
nant,  and although it is cold it is not pure.
   An objection  has been made to  the use of
entry stoves on  account of the heat they oc-
casion throughout the house, whereby the in-
mates are  so accustomed  to warmth  that
they are the more liable to be affected by the
external  air and the  usual vicissitudes of
temperature.  This objection  to  the use of
stoves can only arise where the  air of the
house is maintained at  a  high  temperature ;
this should not be the object.  To preserve
a uniformity of temperature approximating to
that which experience has found to be the  best
for maintaining the vigor of the system, should
be the aim in artificially warming a house.
The heat ought to be greater than the tem- 
96     PREVENTION OF  THE DISEASES
perature of winter weather  without, as we
have to provide for the diminished power ol
evolving animal heat while in a quiet  state
in-doors, but not so great as  to amount to the
warmth of summer.  The summer heat of
75°, especially when the air is just saturated
with water, as at sea, is the  most agreeable
and  salutary temperature, when the  body
remains at rest.  There is a great difference,
however, between the temperature artificial-
ly produced in  a  limited  space, and in the
same statje of atmosphere produced by  natu-
ral causes.   A want of the invigorating elas-
ticity of the external  air is uniformly felt,
which no evaporation of water in the  house
can remove.   It depends on some other con-
dition of the air, perhaps upon  its electric
state.  The house  should therefore not be
heated, but its temperature raised some de-
grees  above the  average  temperature of
winter, and kept  uniformly at that  point.
If a temperature from  50Q to 55° could be
steadily maintained it would be found  to be
the  most conducive to health, and  obviate
much  of the danger  that not unfrequently
arises  during  the  coldest  of weather, on
leaving a warm parlor for other parts of the 
       OF THE RESPIRATORY ORGANS.      97

house, whereby a difference of temperature
sometimes varying from  20° to 40°  is ex-
perienced in a few minutes.  Whenever a
change in the atmosphere  occurs to such an
extent from natural causes, it is universally
regarded as productive of very serious con-
sequences,—the danger cannot be less when
similar vicissitudes of temperature are en-
countered  several times a day in passing
through a house, where one room is warmed
to the  temperature of summer,  and the ad-
joining one is at, or even below, the freezing
point.  The danger is greater than going out
into the external air, for this is never done in
cold weather without additional clothing.
   To  prevent experiencing these sudden
changes, the air of the whole house ought to
be kept at a temperature of 50°, and  if any
chilliness  is  experienced  in  the  necessary
occupations in the apartments where there is
no fire—for it is  not intended to make  this
supersede  the use of an  open  fire   in or-
dinary sitting rooms—it ought to be removed
by  adding something  more to  the clothes
worn.
  The objection to the  heat of a  house  ef-
fected  by artificial means may be made with
                   9 
98     PREVENTION OF THE  DISEASES

more reason when rarified air is diffused by
means of flues connected with a furnace in
the lower  part of the building, which sup-
plies heat only by rarifying the air, a mode
of warming quite different  from  radiation.
It is not intended  to examine the subject of
the difference between  rarified heated air
and radiant heat,  beyond simply stating that
radiant heat is the natural and most salutary.
It is the form in which all living bodies are
supplied by the sun  and  by reflection  from
surrounding objects; while it is rarified air,
often loaded with various emanations, that is
productive of many diseases arising from at-
mospheric  causes.  Next to  an open fire,
therefore, the heat from  which is always ra-
diant, a stove is  best, if it  is  placed in an
open part of the  house,  where the air can
have access, and not in a close apartment.
  The objection  to  the  use of rarified air
conveyed from a  furnace in the lower part
of the building is  principally on account of
the great heat and want of humidity of the
air, which is evident from the cracking of the
furniture, shrinking  and warping of doors,
etc.  Such  a  condition of the  air produces
great inconvenience, and sometimes serious 
       OF THE RESPIRATORY ORGANS.     99

evils in many that are affected with a delicate
state  of  the  lungs  and air-passages;  the
heated dry air, absorbing moisture  from
every  source, including the skin and bron-
chial tubes of the inmates of the house.   The
face becomes hot and dry, and coughing and
irritation are  quickly induced on entering a
house heated in this manner, while immedi-
ate relief and a feeling of refreshment are
experienced on emerging  into the cold air
without.    It  sometimes happens  that too
great a quantity of water is evaporated from
the furnace, loading the air  with an excess of
moisture, exhibited particularly in the upper
part of the house,  which in many parts  is
covered with  a dripping moisture, and the
window-glass  so obscured with dew as to
lose its transparency.  The principal evil of
this state is, that the clothes absorb the ex-
cess of vapor, and the wearer experiences a
chill upon going into the  cold air—a  state
well known to be productive of very serious
consequences.  Another evil from the use of
rarified air is,  that  in moderate weather the
fires are often extinguished on account of the
extremely uncomfortable heat; immediately
the moisture contained in the hot air becomes 
 100    PREVENTION OF THE DISEASES

 sensible and is deposited on anything around,
 causing a feeling of chilliness and dampness,
 not unlike that experienced upon entering a
 vault or cellar.  The whole subject of warm-
 ing a dwelling with rarified air, and supply-
 ing this air artificially with  moisture, being
 founded solely  upon theory,  when put in
 practice, like most other theories that are not
 founded upon practical  facts, only partially
 succeeds in accomplishing the object.  Rari-
 fied  air ought only to  be used for conve-
nience and economy, in churches and other
places used for  large  public assemblages,
where people  are exposed but a short time to
its influence.
  To a certain extent the objections against
the use of an air heating apparatus apply to
 a stove ; but the supply of heat from a  pro-
 perly constructed stove can be more easily
 regulated and  kept at a low degree, while its
 situation causes not only a large quantity of
 heat to be radiated, which a  furnace never
 can do, but there is a  constant  supply of
 fresh air from without,  all of which is  dif-
 fused throughout the house.   Besides, there
 does not exist any mode of producing  artifi-
 cial warmth, against the use of which some 
OF THE  RESPIRATORY ORGANS.    101
objection cannot be  urged; and while it is
desirable to modify  the  temperature of a
whole house, the choice ought to be made of
the mode which is the least objectionable.
  The next method of  guarding against the
influence of a  change of temperature is by
accustoming the system to these changes, as
far as this can  be  done among persons sur-
rounded by all the comforts and refinements
of civilized life.
   There is a constant disposition to seek for
enjoyment  and comfort by depending upon
artificial  heat during the winter season ; such
a dependence, although in a rigorous  climate
to some  extent necessary, yet it constantly
tends to lessen the powers of life below the
standard of good health.  It has been proved
by a great  number of  experiments, amount-
ing to  many thousands, upon  domestic  ani-
mals, and from experience of universal ex-
tent in the  human  race, that heat  continued
for a length of time renders the system fee-
ble and incapable of resisting the effects of
cold.   Indeed, all healthy and agreeable sen-
sations are destroyed  by this cause,  and the
helpless individual that has lived in a heated
atmosphere suffers  from every change of
                    9* 
102    PREVENTION  OF THE DISEASES

temperature, however trifling it may be, and
a breath of air but little cooler than that to
which he is accustomed becomes a cause of
disease.
  The best, and  indeed only method of re-
moving this excess of susceptibility is by ex-
ercise in the open air.  An individual  who
has been long habituated  to the  enervating
heat of a warm apartment, must seek for re-
lief from the effects that it produces, in an at-
mosphere the temperature of which is below
that to which he  has been accustomed. It
may at first be  difficult to withstand  the
shock of the cold ; the attempt  must there-
fore  be  cautiously  made  for a short time,
and must be extended at each attempt by
remaining longer  in the cold.  A steady and
determined perseverance  in this course will
ultimately be attended with success, and re-
lieve  many  a delicate  individual  from the
strong propensity to colds, coughs, catarrhs,
etc;, which  so constantly occur  during the
winter season.
  In order to withstand the cold and to pre-
vent its injurious effects upon the lungs, the
dress ought to be abundant and composed of
warm materials.  This is the most natural 
       OF THE RESPIRATORY ORGANS.    103

means of preserving animal heat, and much
of the evils produced by cold to the pulmona-
ry system might be prevented by guarding the
skin  against  it.   The  body  ought  to be
always preserved comfortably warm by this
means, for the effects of cold are often com-
municated to  the lungs by the skin.   Those
who wear plenty of clothes in a cold room
or in the open air in winter will escape many
attacks of disease, for it  will  be found  that
the mucous membrane lining the nose, throat,
and lungs, will thus be enabled to resist the
changes of temperature.
   In all attempts to harden the body and enable
it to resist cold, the use  of plenty of warm
clothing should never  be omitted, upon going
out into the external air, for it is through the
skin principally, as was just remarked, that
the cold acts  upon the  lungs.   There are
many instances when  the action is direct, oc-
curring in such as are extremely  delicate,
but there are many others in whom the action
of cold is indirect, affecting the skin in the
first instance ; this is  the case of those whose
health is better established, and doubtless is
the only mode by which  persons  in  good
health are  affected with catarrhs,  etc., on
being exposed to the cold. 
104    PREVENTION  OF THE DISEASES
  When a  person passes  rapidly  from a
heated place, to weather  much colder, and
he is in ordinary health and well clothed, the
skin remaining warm, the lungs rarely ex-
perience any inconvenience from  the cold
air.  A disagreeable sensation from cold is
always to   be  regarded as   indicating a
tendency, however slight, to disease;  this is
usually felt in the skin, rarely in the  lungs,
and if the former is well protected the latter
rarely  suffer.
  These remarks upon the comparative sen-
sibility of the lungs and skin and  the  mode
whereby animal heat  is best maintained, are
applicable to a cool temperature within doors
as well as to vicissitudes without.  It was
recommended, when it is  advisable to main-
tain a uniform  temperature in the house, to
keep it between 50° and 55° ; this, however,
will generally be found too  cool for comfort
when there  is no exercise taken, and the ad-
ditional warmth of a parlor fire will be sought.
But if rooms are occupied when there is no
fire, additional  clothing  will be needed, and
will be  found  abundantly sufficient to pro-
tect the system  from the  effects  of cold
while  sitting quietly writing or reading; as 
        OF THE RESPIRATORY ORGANS.    105

 the lungs will never suffer directly from such
 a temperature.  This  fact  may be proved
 while   sleeping,  for  a  temperature  much
 colder  than  this may be breathed  without
 once producing  cough, while the  body is
 covered with abundance of  bed-clothes; but
 let these be removed, and a chilliness will be
 felt, and cough is very likely to follow.
   Among the causes  of local diseases  of
 the  lungs is mechanical  irritation arising
 from dust, etc.,  principally  from certain ne-
 cessary occupations.   It is  obvious  that the
 only effectual mode of preventing the sad and
 fatal effects of this cause is the change of the
 business,  and an  entire removal from  the
 place where  the dust or particles load the
 air.  When this cannot  be  done, the mouth
 and nose should  be covered  with a cloth that  ,
 will  allow of breathing, but which  is  thick
 enough to prevent the  passage of the fine
 particles  which affect the  bronchial tubes.
 A wetted sponge may be also used  for the
 same purpose, placed  before the  mouth.
 Some advantage may be obtained by work-
 men,  by  the  direction  of the wind, or by
 allowing a current of air to pass freely by
them. 
106    PREVENTION OF THE DISEASES

  With respect  to  the fine  dust from the
combustion  of anthracite,  nothing can  be
used to prevent  its injurious  effect so often
experienced by  those who  have  delicate
lungs.   A fire of wood or of bituminous coal
must be substituted,  while there is a large
opening to the chimney, to allow the smoke
freely to escape.
  When considering the causes of the vari-
ous diseases of the respiratory organs, that of
an improper use of the voice by many public
speakers, was mentioned as a very common
source of affections of the  throat.   The me-
thod  of preventing the diseases from this
cause, is very simple.   It  consists in filling
the lungs at proper intervals while speaking,
with a sufficient quantity of air to supply the
lungs, that the organs of  voice may not be
taxed  with  a double amount of duty when
this supply is  exhausted.   Teachers of vocal
 music always direct their pupils  to "take
 breath" at certain parts of the exercise, that
 there may always be  a sufficient amount of
 air in the  only  reservoir—the  lungs—and
 thereby prevent the  throat from being exces-
 sively and unnaturally exerted : for such  ex-
 ertion will always be made when there  is a 
       OF THE RESPIRATORY ORGANS.    107

deficiency.  Clergymen who  use but little
exertion  in  speaking, should never neglect
this rule, to  make up for the absence of the
instinctive  respiration  which  takes place
where much muscular exertion accompanies
extraordinary vocal  efforts,  whereby the
lungs are kept  constantly  filled.   Actors,
auctioneers, etc., are rarely, if ever, troubled
with affections of the throat, instinctive and
involuntary  movements of  the chest, from
constant exertion,  furnishing  the  required
amount of air for all demands of the vocal
organs.  No such instructions are needed for
such  persons, for no  voluntary interference
for proper respiration, is necessary for them.
   Constitutional Disease.—The prevention
of the disease of the lungs arising from con-
stitutional causes,  or Pulmonary  consump-
tion, next demands our attention.
   Pulmonary consumption being  sometimes
excited into action, after remaining for a long
time latent,  by those agents which produce a
local  affection, the  remarks already made in
relation  to  such diseases, are, in every re-
spect, applicable to those  depending on con-
stitutional predisposition.
   It has been seen, when treating of the uses 
 108    PREVENTION  OF THE DISEASES

 of the lungs, and the causes of pulmonary
 diseases, what an important influence a free,
 full, and profound respiration exerts upon the
 whole system ; and that the lungs can never
 be disproportionately less than the other parts
 of the body, and perform their part imper-
 fectly, without the  individual  experiencing
 general debility, and sooner or later the in-
 vasion of a disease, which, for want of timely
 knowledge and proper interference, becomes
 usually fatal in its termination.  A contracted
 form of the chest gives evidence of an imper-
 fect development of the lurus, or of their par-
tial contraction from previous disease, and is
always attended with  imperfectly formed
blood, and its attendants, a  badly nourished
body, debility, constant chilliness, etc.   It is
 obvious that the only mode of remedying this
 evil is by employing such measures as would
 tend to develope  and expand  the chest and
 lungs, and to bring them to their full  power
 of action.
   It is well known that the more an organ is
 exercised within the bounds of  its legitimate
 use, the more will it  be  developed, and  the
 better will it be  prepared to discharge its
 proper functions.  The  perfections of  the 
       OF THE RESPIRATORY ORGANS.    109

limbs of a professional dancer, and the won-
derful movements and delicate  accuracy of
the fingers of the artisan or musician,  are fa-
miliar examples of a state of perfection from
habitual use.   In these and similar instances,
a  full development  of the  function  of the
member  accompanies the physical  develop-
ment of  all its parts.  It may  also be con-
sidered as an axiom, that the more perfect an
organ is in its  development, the  less is it lia-
ble to disease.  These  principles are fully
applicable to the lungs, and a disposition  to
disease may often be averted by their judi-
cious use in assisting them in the development
of their parts.
   There  are two methods  of accomplishing
this object:  that of voluntary inspiration,  or
efforts systematically and periodically made ;
and involuntary or instinctive, such as  occurs
during active muscular exercise.
   Voluntary Respiration.—A  very  simple,
and at the same time a  very effectual mode
of developing the parts concerned in the im-
portant function of respiration, is the practice
of inflating the lungs daily,  by a full inspira-
tion, and  then  allowing the air inspired to re-
turn slowly by compressing the lips.  The 
110    PREVENTION  OF  THE DISEASES

air cells will thereby be completely filled, and
slowly emptied, and thus their gradual enlarge-
ment will be effected.   This should be done
at stated periods, morning and evening, while
the clothes are loose.   Six inspirations each
time, if  persevered in for a few weeks, will
render the effort an  agreeable  one, from the
sensation which the exercise of the full power
to respire always produces.    The patient
should first assume an erect posture by placing
the back, shoulders, and head, firmly against
the wall of  the  apartment.   I have known
the chest of one who had every appearance
of incipient  consumption, expand under this
process  so as to be decidedly appreciable by
a tailor's measure in  a month, and a year's
perseverance in this course has  produced a
visible alteration in  the form and  size  of the
chest, giving the individual that sturdy ap-
pearance which is the usual attendant upon
a complete development of the lungs.
  The  lungs  thus  expanded,  will,  as has
already been stated, be  enabled to expose
to the  renovating  influence  of the oxygen
of the air a larger quantity of blood, and the
blood be thereby prepared to carry on  the
process of nutrition throughout  the  system, 
       OF THE RESPIRATORY ORGANS.    Ill

in the place  of an  imperfect elaboration
arising from its being  imperfectly formed.
Instead of albumen  abounding in the system,
the effect of a full respiration is established,
exhibited  in the formation of a more  elabo-
rate animal  substance, and the body thereby
maintained  in its healthy condition, and no
deposits of the material which characterizes
scrofula  or  pulmonary  consumption  can
exist.
  Besides the  effect upon the system gene-
rally, that of the removal also of an extreme
susceptibility and delicacy of the  lungs, and
thereby preventing  their becoming easily in-
fluenced by  the usual  temporary causes that
produce inflammation in them, is one of the
most striking results of  a  systematic  perse-
verance in exercising the respiratory organs.
I have known  those who have uniformly been
attacked with  cough in  the fall of the year
for several years in succession, entirely re-
lieved  from this effect  of a change of tem-
perature,  and to remain totally free during
all seasons and on every change of weather,
although  constantly exposed  to all the vicis-
situdes which  occur in  active  life.  In  one
individual the  lungs were  so quickly affected 
112    PREVENTION  OF THE  DISEASES

by the cold air of a winter's night upon issu-
ing from a warm room, and so  contracted,
that it was almost as difficult to breathe as in
an attack of spasmodic asthma.   After prac-
tising carefully and upon  correct principles
the inflation of the  lungs  for a few  months,
every vestige of this susceptibility to cold
disappeared, and at the present time the most
violent and cold north-west wind causes not
the slightest feeling of his former complaint.
  The inability to exercise a free inspiration
when tightly clothed  has been already men-
tioned, and it is only necessary to refer to it in
this place, to show the importance of selecting
the morning  and evening when the body is
loosely  covered with clothes,  as the most
suitable time for  exercising the lungs  in the
process of voluntary inflation.   It is needless
again to refer to the absolute necessity at all
times of having the dress sufficiently  loose
to allow of the free movement of the  chest,
as  a preventive of pulmonary consumption
—tight lacing above  all must be totally pro-
hibited.
   A word of caution is  perhaps necessary
to prevent an excessive and improper filling
of the lungs beyond the ability of the patient 
       OF THE  RESPIRATORY ORGANS.    113

to practise inflation.   Under  ordinary cir-
cumstances, five or six inspirations made  as
above directed  daily, morning and evening,
cautiously and  properly used, will  be suffi-
cient to effect the object designed, and even
this it may be  necessary to limit, that  the
results may be  safely and surely obtained.
  Involuntary  or  Instinctive Respiration.—
This is to be accomplished by suitable exer-
cise taken always  if possible in the free air.
The exercise  usually prescribed  is  occa-
sional—perhaps a short walk or a ride in
pleasant weather, and strict  confinement
during the interval.  Unremitting exercise,
even  to  toil, and  rough riding  is  the  only
kind from which benefit in the way of pre-
vention can  be expected.  If  the body is
well covered with clothes, the  state of the
weather ought not to be an object of con-
stant dread ; although  very severe or wet
weather it is but prudent to avoid, but gradu-
ally endeavoring by an accumulation of vital
energy to overcome its effects.   None need
apprehend  suffering from  exercise  and ex-
posure  taken  judiciously  and  within  his
power;  it is only the extremely feeble in the
last stage of consumption that are unable to
                   10* 
114    PKr,. r. a iiun OF  THE DISEASES

bear  exertion;  and   it  not   unfrequentlv
happens that  such as are much  debilitated
find their  strength improve in proportion  to
the efforts used.
   The best method of  ascertaining the abili-
ties of the body to bear exercise is by taking
it  systematically and   at regular periods.
No occasional efforts will answer, it must  be
done  statedly and always, if possible,  with
an object  in view  that the mind may be at
the  same time properly occupied,  which
itself will  prevent the  sensation of fatigue
and debility.   This must have  been noticed
by most  persons when engaged in  athletic
games; an  amount of exercise is endured,
which if taken without the  interest and ex-
citement  attendant  on such  amusements,
would  be absolutely  impossible  to endure
from the excessive fatigue.
   Of all  kinds of exercise  walking is the
most natural  and  most easily  regulated,
besides being that which every individual can
use.  In order to  use  it beneficially for the
proper exercise of all the muscles, and the
expansion of the chest, it ought to be  taken
with the  shoulders braced backward so as to
enable the chest to be fully expanded, and 
          OF  THE RESPIRATORY ORGANS.    115

   this posture, with a long step, will bring into
   action nearly all the muscles of the  body.
   That this is the proper  attitude for  walking
   appears from the  natural  desire  that  stu-
   dents and such mechanics as are occupied in
   a stooping  posture, have for relieving them-
   selves by a walk after confinement; all the or-
   gans of the body being thereby placed in their
   most natural  positions, and relieved  from all
   constraints.  The  student  especially ought
   to seek

                         " The rural walk,
      O'er hills, through valleys, and by rivers' brink "

   as a relief  for constant  mental exercise,  and
   constrained and  bent  position of the body,
   so apt to produce injurious effects  upon  the
   vital organs.
     Habitually walking  in  the open  air  pre-
   serves a free and healthy circulation of the
   blood,  and maintains a proper heat in  the
   body;  thereby enabling  to withstand  the
   chilliness so apt to occur  in delicate persons
   in winter, and  which   prevents them  from
t   engaging  in  any occupation except in  the
i   house.
i     As a means of cure  for  incipient pulmo- 
116    PREVENTION OF THE DISEASES
nary disease a remarkable instance came
under  the notice of the writer  a few years
since.   When on an  excursion  in  the
country, a  party was made  up to  ascend a
mountain, which became  to all except  one
individual,  a toilsome and fatiguing  under-
taking.  While every other one was obliged
to stop frequently to rest, this individual ex-
hibited scarcely any more fatigue than would
have been  experienced upon level  ground.
Upon  remarking  his exemption from the
general panting and fatigue presented by the
rest of the wearied  travellers, he  imparted
a very interesting and important fact when
 detailing   the  reasons for  his  exemption.
 It  was, briefly, that  a few years  previous
 he had experienced most of the symptoms
 of forming consumption, attended  with fre-
 quent, but slight  spitting of blood.  Finding
 but little relief from various means  used  in
  his treatment, he adopted that of violent and
  fatiguing  walks, and especially that of as-
  cending hills.  All his untoward symptoms
  disappeared, he increased in strength, and at
  the time when these facts were  communi-
  cated was a hearty, ruddy, and  robust man.
  Although in this instance excessive exertion 
       OF THE  RESPIRATORY ORGANS.    117

was attended with the best success, it is  by
no means intended  to recommend  to the
invalid a similar  excess of exercise at first.
The  risk encountered was great, a rupture
of a blood-vessel  might have ensued in his
weak  state;  the principle, however, was
correct, and escaping the danger which  at-
tended the  experiment, of which he was  ig-
norant,  he  obtained  all  the benefits  he
expected.   Exercise should  not  be  used
beyond its proper  amount—it has its dose
like any other remedial agent,  suited to the
constitution and present condition of the pa-
tient,  and   cannot   be  exceeded  without
danger.
   Running,  leaping,  or any other exercise
that is attended with a sudden  movement of
the body, ought  not to be used by  the  in-
valid.   All professed  runners have been
short-lived, as the running footmen of former
days, few  ever  arriving at the  thirty-fifth
year.   Habitual  walkers, on the contrary,
are remarkable  for  their longevity.   Mr.
Josiah Walter, late of Connecticut, in his 99th
year, attributed  the health and  vigor  he
enjoyed to  his " having always  preferred
walking  to  riding on  horseback or in  a
carriage." 
118    PREVENTION OF THE DISEASES

  It is almost unnecessary to  urge exercise
as a means of health to young children ; but
it may not be so obvious that the well-being
of the individual, both physically and  men-
tally, in after life, depends upon the amount
of vigorous exercise taken during the period
of growth.   Most of the men who have been
distinguished for their manly  size and intel-
lectual vigor, appear to have been accustomed
to very violent exercise and feats of strength,
even  in  early youth.  The  most gigantic
mind  has been connected with a fully de-
veloped body, brought about  by early exer-
cise  and great strength, for  which the indi-
vidual has been at the early period of life
alone  remarkable.  And  if   the  history of
such persons  could be traced to their occu-
pations in youth, more than one Adam Clark,
priding himself upon nothing more than his
ability " to  roll a great  stone up a  hill,"
would be found.   If such were the  occupa-
tions in early youth there would not be found
among studious persons
          " The languid eye; the cheek
    Deserted of its bloom; the flaccid, shrunk,
    And withered muscle ; and the vapid soul."
  Of various gymnastic exercises, there is a
choice suited to the physical capacity of dif- 
        OF THE RESPIRATORY ORGANS.    119

 ferent individuals.  Tennis, bowls, or quoits,
 require much muscular power, and too much
 exertion  for the invalid ;  they may be used
 upon an  entire recovery, when it  is neces-
 sary to preserve the health  already gained.
 The same remark will apply to all gymnastic
 exercises, and none ought to be used that is
 attended  with  positive debility and fatigue.
   In winter during bad weather, it may per-
 haps be difficult if not impossible to use ex-
 ercise in  the open air, and it becomes neces-
 sary to resort to some mode whereby it can
 be taken  within doors.   It should, however,
 be borne  in mind that there can  be  no sub-
 stitute for that taken in the open air, and all
 such means as  dumb-bells,  pulley-swings,
 etc., are but  to be used  when nothing else
 can be resorted to.  The best exercises in-
 doors, are battledore, parlor ball, graces for
 the more  delicate, and the turning lathe and
 ordinary carpenter's work  for those that are
 more robust.   Whatever of this  kind is un-
 dertaken  it ought never to  be  as  a  task,
 but always blended with  amusement or some
 positive object.
  As a close  and ill-ventilated habitation, or
apartment, is productive of the most serious 
120    PREVENTION OF THE DISEASES

consequences  through the medium  of  the
lungs, it is imperiously necessary that proper
measures should be adopted to effect a suita-
ble ventilation.  This is more  needed, per-
haps, in our sleeping apartments,  in which
we pass so much of our time, and which are
most usually less adapted for  the  purpose of
free respiration than any others in the house.
Often many  persons are  crowded  in one
room, and what is  worse, a small apartment
or closet is the only place used  in which to
put the bed.
  A bedroom  should be large and lofty, and
so constructed with windows and doors op-
posite as to allow of being freely ventilated
during the day.  This is of so great import-
ance to health generally that  it should  never
be neglected,  except  when the weather is
wet.
   A very pernicious practice in arranging
sleeping apartments is, to have a bedstead for
small children with its  bed and  bedclothes
placed beneath another during the day ; the
accumulations of bad air from perspiration
while sleeping, and the complete want of all
ventilation, are productive of the most seri-
ous consequences to children, who need, du- 
       OF THE  RESPIRATORY ORGANS.    121

ring that most important period of life—the
period of growth—all the requisites for pro-
per nutrition  of the body.   For the same
reason, a room occupied during the  day
ought not to be used as a sleeping apartment,
as perfect  cleanliness and  free ventilation
cannot be preserved, while the air becomes
constantly more vitiated.
  By referring to the chapter on the causes
of pulmonary  diseases,  the  remarks there
found upon the deleterious influences of bad
and confined air will render it unnecessary
to say more in this place upon  the import-
ance of breathing a pure and cool air.
  The temperature of a bedroom is of con-
siderable importance ; it should never be in-
creased  by a  fire in it, except in  cases  of
sickness.  The temperature ought never  to
exceed 50°, and ought to be maintained by
means already mentioned, but never, if pos-
sible, by a fire  in the room itself.
  While the  weather is not unusually severe,
the habit of dressing and undressing without
a fire will be found to be salutary,  as  there
will be less  susceptibility to atmospherical
changes, than when the opposite custom  of
                  11 
122    PREVENTION  OF THE DISEASES

burning a bright and warm fire in the bed-
room is adopted.
  In the coldest of weather there is no oc-
casion for a fire in the bedroom  where the
individual is in bed ;  for suitable warmth can
always be obtained by a sufficient quantity of
bed clothes, and no inconvenience will ever
be  felt by  breathing cold air  if  this  be
properly attended to, as  almost  every one
must have experienced when the  breath has
frozen  on the  clothes  around  him, while
sleeping quietly and  without any irritation of
the lungs.
  Among the evils of a fire in the bedroom
is the consumption of oxygen to very great
extent, and if the doors are kept closed, and
there is  also an imperfect  draught in the
chimney,  a  great deterioration  in  the  air
takes place.  Even  burning a candle or a
lamp for several hours in a close room where
there are several persons sleeping, assists
greatly in the consumption of oxygen ; when
used, it should always be placed  in the fire-
place.
   Plants ought never to be kept in  a sleep-
ing  apartment, for in addition  to the  odor
from many of them,  which on some  persons 
       OF THE  RESPIRATORY ORGANS.    123

produces  a  powerful impression upon  the
nervous system, the proportion of oxygen is
changed by them.
  Where persons have a decidedly consump-
tive tendency a generous nourishing diet and
sometimes even a stimulating  diet are re-
quired.  There are, however, so many com-
plications of different degrees attending the
disease both in its incipiency and when it is
completely established, that no positive rule
applicable to all cases can be laid down ; the
judicious physician alone  can make the ne-
cessary discriminations. 
VII.
TREATMENT OF  PULMONARY DISEASES BY  IN-
                HALATIONS.

  The use of remedies in aerial form is sin-
gularly adapted to affections of those organs
which are anatomically and  physiologically
adapted to the contact of air.  The delicate
structure of the lungs and air  passages causes
them to respond instantly to  any impression
made upon them by  substances introduced
through the medium of the air. The compara-
tive purity of the air is, for the most part, in-
stantly detected by some  portion of the re-
spiratory organs in ordinary  respiration, and
the presence of deleterious  particles, or  of
such a state of  atmosphere as imparts a feel-
ing of refreshment and vigor  to them, are
evidences of the  instantaneous effects pro-
duced for evil or for good.
   Persons exposed to chemical fumes ex-
perience more or less irritation in the throat
and lungs, and  such as are for the first time
brought into an atmosphere loaded with such
emanations have instantly an  excitement and 
      TREATMENT OF PULMONARY, &C   125

cough produced, of a very distressing charac-
ter.  That of chlorine in bleaching establish-
ments, nitrous  and sulphurous  acid  vapors
in chemical factories,  produce an immediate
impression on  the bronchial tubes, and  a
tickling and harassing cough, according to
the greater or less amount of vapor diffused
through the air.
   Workmen also in cutlery establishments,
or where there  is much dust floating, always
show the effects of such an atmosphere on
the lungs, and have usually coughs of a very
serious character.
   The effects of effluvia from various vege-
table substances, and the aroma of flowers in
causing an attack of asthma, or the fumes and
fine  powder of ipecacuanha when breathed,
have already been referred to, and are only
mentioned in  this  place  as  affording evi-
dences of the instantaneous impressions re-
ceived by the delicate membrane lining every
part of the air  passages.
   Some of these impressions are of an agree-
able and salutary nature, such as the vapor of
turpentine; and workmen in  India  rubber
factories, the emanations of which are analo-
gous to  the  particles of turpentine vapor,
                  11* 
126     TREATMENT OF PULMONARY

are,  as  I  am  informed  by a  well known
manufacturer*  of  this article,  remarkably
free from  pulmonary diseases.
  A sojourn in the pine forests, in some forms
of chronic bronchitis, is  described  by those
who have used this mode of treatment, as af-
fording  a  decidedly agreeable and refreshing
feeling in  the warmth and  vigor that  it im-
parts ; while the air of a green-house and that
loaded with moisture,  as is experienced at
sea, is so grateful in some  forms of the  dis-
ease,  while equal  relief is afforded  in an-
other form by the dry  air  of a mountainous
region.
  From the extreme  delicacy,  therefore, of
the lungs,  and their susceptibility to sudden
impressions when  active  substances  are
breathed,  it is obvious  that remedies applied
to them through  the medium of the  air, by
inhalation, would  be more likely  to be speed-
ily followed by their appropriate results, than
if applied  in the usual method, which requires
them to travel through the  entire circulation
before  reaching the part to be influenced.
Not only  the surface of the air tubes, but the
* Mr. Charles Goodyear. 
          DISEASES  BY INHALATIONS.     127

 extreme minute sacs  of the air cells and the
 cavities of abscesses and ulcers, may thus in a
 moment be reached, and the remedies applied
 directly to the diseased surfaces.  When the
 mucous membrane of  the  bronchial  tubes
 needs stimulating, the remedies for effecting
 this object can be applied directly to the part,
 and the desired result  obtained  in far less
 time  than by any other means.  In cases of
 cough proceeding solely from irritation in a
 deep-seated part of the lungs, when it is de-
 sirable to relieve it by the use of an anodyne,
 it will be found that  inspiration, by convey-
 ing the remedy to the seat  of the disease,
 will most  effectually afford  relief, and that
 more permanently than if the anodyne were
 administered in the usual mode.
   The long-continued use of expectorants by
 the stomach in certain chronic affections, es-
 pecially of such as cause  more or less nau-
 sea, do often produce,  in  addition to their
 specific effect, some  unnecessary  derange-
 ment  in another organ, and much prostration
 of vital energy, which  the patient  may be
 but little able to sustain.  A persevering use
of nauseating remedies will cause great  de-
rangement in the digestive  organs, and  thus 
128     TREATMENT OF  PULMONARY

complicate,  to  a great  extent, the original
malady.   All  these  effects may- often be
avoided by a proper use of inhaling reme-
dies.
  Fumigation.—Fumigation, or inhaling the
smoke and vapor of certain substances, has,
from time to time, been commended ; but the
careless and rough manner in which it has
been performed, and the want of discrimina-
tion in the diseases for which it has been re-
commended, has  caused it  to be, at present,
almost entirely neglected.  Indeed, fumiga-
tion can scarcely be applicable to diseases of
the lungs; the structure of which is so deli-
cate  that the  minute  particles,  of  which
smoke is composed, finding  their way into
the air cells, become a source  of irritation to
the lungs.  In smoking  tobacco or stramoni-
um for asthma, the unburnt particles accompa-
ny the essential oil of the plant, in the form
of smoke, and  not  unfrequently defeat the
object desired.   So, also,  the fumigation of
tar—the mode of preparation recommended
by Sir Alexander Crichton, by the direct ap-
plication of heat—extricates also the products
of imperfect combustion.  In some affections
of the lungs, great relief  has been experi- 
         DISEASES BY INHALATIONS.     129

 enced ; but in some forms  of the same dis-
 ease,  complete disappointment  has ensued,
 resulting from the cause already mentioned,
 connected  with a want  of sufficient care  in
 examining  the precise condition of the lungs.
   The neglect of a proper discrimination in
 the disease has led to repeated failures in the
 use of the means referred to.  Thus fumiga-
 tion with tar  has been used in " consump-
 tion."  There can scarcely be anything more
 indefinite than this term  to convey an idea
 of the state of the lungs.   Some persons
 with " consumption" may have  so active an
 inflammation of a portion of the lungs or air
 passages as to render the remedy altogether
 inapplicable.   So with asthma; if a suitable
 and  careful investigation be not made, the
 fumes of tobacco may be ignorantly applied
 in the congestive form, and not in the spas-
 modic.  The smoke of rosin has been ad-
 vised for chronic cough; but if the actual
 condition of the mucous membrane of the air
 tubes is that of inflammation in any degree,
 it will greatly aggravate all the symptoms.
Indeed, fumigations are applicable to but few
conditions of these parts, but all the appro-
priate  remedies can be breathed  into  the 
130     TREATMENT OF PULMONARY
lungs through the medium of watery vapor
without producing any of the evils of an ex-
traneous substance.
  Vapor of water.—As water is freely formed
in the lungs, and as they are always bedewed
with its vapor, it is  obvious that  this is the
most natural substance that can be placed in
contact with them.  It is, therefore, but fol-
lowing the indications of Nature  to use it as
a medium for applying the requisite reme-
dies, and thus escape the hazard of employ-
ing irritating and  uncongenial  substances
which must  enter the  lungs by smoking or
fumigation.
  Whatever remedies are to be used  by
breathing, ought to be  evaporated in con-
nexion with water, and if the remedy select-
ed be the appropriate one, no unpleasant ef-
fects can ever occur from the presence in the
lungs of fine mechanical particles, existing in
the  form of the  dust or smoke  of burning
 substances.   The chemical  irritation,  also,
 of empyreumatic oil,  will also be  avoided,
 the heat being fully controlled and limited by
 the impossibility of heating the water beyond
 a certain degree of temperature, which is not
 sufficient to effect the formation  of this oil. 
DISEASES BY INHALATIONS."     131
 It is not intended to record the detail of cases,
 but simply to give the results of many years'
 experience in the use  of such remedies as
 have been found of decided efficiency, and
 always administered in connexion with  the
 vapor of water.
   The vapor of water can be used with  ad-
 vantage  in  cases of simple catarrh  in  its
 first stage,  indicated by pain over the eye-
 brows, soreness  and dryness of the  throat,
 attended with a slight  fever.  There  are
 many persons who  are  subject to attacks of
 this kind ; they are  usually delicate, and  are
 extremely  liable to "take  cold" upon  the
 slightest  change of  temperature.   They
 always  experience   more  or less debility,
 such as is universally felt during the preva-
 lence of  influenza.   There is nothing in the
 whole collection of  Materia Medica, in such
 cases, so efficacious  as the inhalation of  the
 vapor of water.  It should be inhaled from a
 large basin, so as to pass through the nose
■ and mouth at the same time.
   In the forming stage of influenza, the same
 course will often arrest the symptoms  and
 give immediate  relief.   But  the  disease is
 sometimes  so  violent  in its invasion   Uut 
132     TREATMENT OF  PULMONARY
other active measures will often be required.
In common catarrh, however, not depending
on epidemic influence, and mild  cases of in-'
fluenza, immediate relief is for the most part *
experienced.  In acute bronchitis, also, where
the violence of the inflammation has been, in a
measure, subdued, and the skin  has  become
relaxed, the efficacy of inhaling  the vapor of
water is exhibited  in a  surprisingly  short
time, as  I have  repeatedly  witnessed.  In
this affection, and in all, when it is  intended
chiefly to reach the more remote parts of the
air passages, it  ought to be breathed from a
proper  inhaler, made of glass or porcelain:
either of these is better than metal.   It is
especially useful when the inflamed mem-
brane  is still  dry, and  the expectoration
scanty.   A large quantity of vapor is given
off from the lungs  in health, amounting to
more than one pound in twenty-four hours.
When this process  is to any extent arrested,
as is the case in inflammation of these parts,
much  distress and pain  necessarily ensue;
and for its restoration, I know of nothing so
speedy as that of the application of warm
vapor to the inflamed  surface,  which  acts
much in the manner of a tepid or warm bath 
          DISEASES BY INHALATIONS.     133

 to the skin.   It is necessary to  remark  that,
 as in the former instance, it is  not so bene-
 ficial in robust  persons as  in those who are
 more delicate, and on this account ought not
 to be used to the exclusion of other measures.
   Stimulating inhalations are  highly useful
 to excite the debilitated part, in chronic bron-
 chitis.   These may consist of the vapor  of
 balsam  of copaiba, Canada balsam,  Venice
 turpentine,  and that of  the fir.  In all debi-
 litated states of the air passages, especially  in
 old persons, this course is attended with most
 admirable  results.   Although all these  sub-
 stances have properties in common, there is
 something peculiar in  each, which renders a
 selection necessary—only to be determined
 by a  cautious use and watching of their ef-
 fects.  A small quantity of either  of these
 articles may be  placed in a vessel of boiling
 water ; the vapor of which, when sufficiently
 cooled, may be  inhaled in the usual manner.
 To avoid the fatigue of repeated inhalations,
 the water  may  be evaporated from a large
 vessel, so as to fill the room.  Tar, which is
 the product of burning the cones of the pine,
 comes under this head.  It is more particu-
larly applicable  to phthisis, of which I shall 
134     TREATMENT OF PULMONARY

presently  speak.   Benzoin  is an  important
remedy  for  chronic  bronchitis.   Unless
great caution  is  used,  it  is apt  to create
coughing.   It had better  be inhaled from a
large vessel, and  not from  an inhaler, for by
diluting it, it will cause much less irritation.
Balsam of Tolu is  another article which is
very efficacious in those cases which require
an active stimulant; the vapor of this sub-
stance may  be drawn into  the lungs through
an inhaler, as it is not as likely to irritate  the
lungs as Benzoin.  The excessive discharge
of a thin fluid in debilitated or  aged persons
will  often be ^arrested by the use  of this
species of vapor in the proportion of half an
ounce to half  a pint of water, slowly evapo-
rated by a spirit lamp.
  This relaxed state of the membrane lining
the lungs  sometimes requires the use of as-
tringent and tonic vapors.   For this purpose^
tannin, oak  bark,  pure green  tea, cinchona
bark, each has been in its  turn  successful in
affording  relief.  A few drops  of sulphuric
acid, added  to a decoction  of cinchona bark,
have appeared  to add greatly to its  tonic
powers.
   Vinegar is an excellent stimulant where it 
         DISEASES BY INHALATIONS.     135

is required to excite expectoration, and  to
soften the tough mucus that may have  col-
lected in the air  passages.  It is necessary
that pure distilled vinegar should be used,  as
common vinegar is apt to contain sulphuric
acid.
   Inhaling the vapor of stramonium is highly
useful in allaying the paroxysms of spasmodic
asthma; so, also,  that of tobacco.   Both
these substances  should be  used with great
care.  The advantage of combining medi-
cinal vapors with water is in no case more
apparent than in the  use of tobacco ;  for,
besides the smoke which  passes into the
lungs, in ordinary smoking, an empyreumatic
oil, which  is  an  active poison,  also  passes
with it;  whereas the proper active part of
the plant, the nicotia and a volatile oil, alone
enter the lungs with the aqueous vapor.   The
employment of tobacco requires  a great  deal
of caution, especially in those who have not
been accustomed  to its use.
  There is  not  an  uncommon  affection  in
young females ; it exists without evidence of
any disease, and appears to be purely a  ner-
vous cough without any distinct disease.  In-
halations of the vapor of hops, or the extract 
136     TREATMENT OF PULMONARY

of hops, will often afford relief; and occasion-
ally, it will be  necessary to use the coniuni,
or stramonium; but under whatever treat-
ment, it is too frequently a very obstinate, but
not a dangerous affection.
   In  sore throat  great relief is obtained by
inhaling the vapor of water, hops, vinegar,
and  camomile.   Whatever other measures
are adopted, these should not be neglected.
   Pulmonary Consumption.—The  detail of
the nature  and  progress  of this formidable
disease  has  already been given.  In accor-
dance with the design of this treatise, I will
confine  myself to the statement of such sub-
stances  as have been found useful in the form
of vapor, in curing the disease and in allevi-
ating the distress which accompanies it in its
various  stages.  Balsam of Peru, Balsam of
Tolu, storax, benzoin,  and myrrh,  stimulate
the parts of the lungs which are the seat of
the ulcers ; and they are, therefore, only use-
ful in cases of great prostration, and where
there is little inflammation  in  the  affected
part.  For the same condition of the affect-
ed part, tar is useful.   For a less amount of
stimulation, the vapor from squills, or elecam-
pagne, will be found useful.  In violent  and 
         DISEASES BY  INHALATIONS.     137

distressing coughs, sedative inhalations will
be required, as the conium, or  stramonium,
the latter infused in ether, fifteen drops  to
half a drachm  of which may  be inhaled
twice or thrice  a day.  Iodine is, also,  in
some cases, beneficial; but from the extreme
irritating nature  of its  vapor, it  requires  to
be combined with an anodyne, as the conium,
and then to be used with great caution.   The
tincture  of the  iodide of  potass, and the
tincture of conium,  may  be combined, and
about two drachms of the former, and twen-
ty drops of the latter,  used for inhalation.   I
have used the vapor  of  alcohol  with most
beneficial effects in  confirmed phthisis.  In-
deed, it has been followed by more decidedly
good results than any  other remedy that I
have employed in the  treatment of this for-
midable  disease.  The  patient  should  be
made to breathe  alcoholic vapor from an  in-
haler,  or the atmosphere that  immediately
surrounds him may be impregnated with the
vapor, by swathing  the  upper  part of the
chest with a soft towel, kept moist by any
alcoholic fluid, found to be the  most agreea-
ble.   The warmth of the body  is sufficient
to  evaporate the  necessary  quantity  of 
138     TRE-ATMENT  OF PULMONARY

alcohol.  The latter is the mode  which  I
have adopted, when  the patient is quite  de-
bilitated and requires to be surrounded with
vapor.  A most  hopeless  case  of consump-
tion occurred a few  years since, in a man
who had previously lost two brothers with the
same  disease, and was treated as  the last re-
source by alcoholic vapor.  Perfect recovery
followed, and he is now in the enjoyment of
vigorous health.
  In the application  of remedies,  it is almost
unnecessary to state that  the precise condi-
tion of the lungs ought to be ascertained as
accurately as possible,  by  all  the means
which modern science  has placed in our
hands; for it is  upon a  knowledge  of  the
facts thus ascertained that the proper appli-
cation and ultimate success depend.
  Whenever the  symptoms are aggravated
and the disease  increased by  the employ-
ment of inhaling remedies, an error has been
made in the diagnosis, or it is so complicated
as to make an application that is suited to the
affection in its simple state inapplicable to its
complicated  condition;   indeed  the  most
watchful care is necessary in all affections of
the lungs, for there is no organ equally liable 
        DISEASES BY  INHALATIONS.      139

to so great a variety of derangements, often
existing also at the  same  time.   A careful
testing of their susceptibility must always be
used,  by commencing with remedies of the
mildest and least irritating  character. 
w.

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