¥ A \ y ■A ANALYSIS OF A COEEESPONDENCE ON SOME OF THE CAUSES OE ANTECEDENTS OF CONSUMPTION. By HENRY I. BOWDITCH, M. D., Chairman of the State Board of Health. 308 STATE BOAED OF HEALTH. [Jan. ANALYSIS OF A CORRESPONDENCE ON SOME OF THE CAUSES OR ANTECEDENTS OF CONSUMPTION. Boston, Nov. 10th, 1872. To the Members of the Massachusetts State Board of Health. Gentlemen :—In accordance with a vote passed by the Board, the following circular and list of questions were pre- pared. Some of these questions are evidently connected with what are usually deemed antecedents of consumption in Massachusetts, while others may seem to have little bearing upon them, and may be deemed futile or irrelevant. Following a plan I have pursued in other kindred investiga- tions, I prepared them so that they might be answered even monosyllabically, while they did not prevent, but rather in- vited, more detailed answers. The result has been that I have received responses from over two hundred physicians. The tabular statements that will be given under each question are founded on returns from two hundred and ten. Other letters were received after the calculations were finished, and these are given either in the body of the correspondence or in an appendix. One hundred and forty-two came from Massachusetts, and sixty-eight from other parts,—Maine, Vermont, New Hampshire, Connecticut, Ehode Island, New York, Pennsylvania, Illinois, Michigan, London and Germany. These correspondents are physicians in active practice. Some of them are the most prominent men in the places where they reside,—prominent for their personal qualities, and as physicians. They represent at least toler- ably well the medical profession of the various places from which they write. The " medical opinion," therefore, on the various questions, which comes from them, is worthy of the respect not only of this community, but of any one who feels an interest in the questions themsveles. 1873.] STATE BOARD OF HEALTH. 309 It may seem to many, as I have already stated, that the questions might have been very differently and better pre- pared ; some that evidently might have been asked do not appear on the list. On the questions of intoxicating liquors, and their effects towards the production of consumption, it may seem that I have been too diffuse. The interest in the vast subject of intemperance in this community, and the obvi- ous design of the legislature that, if possible, the various questions connected with the subject shall be discussed by our Board, is my only excuse for any prolixity that may be noticed in this particular. If my life and health are spared, I hope, at a future time, to give more particularly my own views on the possible " Pre- vention of Consumption in Massachusetts." The labor in- volved in such a work will necessarily be long and irksome, inasmuch as I hope to have it based on private records of the cases of consumption I have seen since March, 1839 ; that is, during a period of thirty-three years. It is impossible for me to say how soon I can accomplish this object. Meanwhile I remain, gentlemen, Your friend and colleague, HENEY I. BOWDITCH. 310 STATE BOARD OF HEALTH. [Jan. MEDICAL PUBLIC OPINION ON CERTAIN QUESTIONS PROPOUNDED BY THE STATE BOARD OF HEALTH, ON SOME OF THE CAUSES OE ANTECEDENTS OF CONSUMPTION. The following circular and accompanying questions were sent out to our correspondents. The twenty questions will form so many subdivisions of this paper. After these will be found, in an appendix, certain more elaborately written letters, some of them coming from eminent physicians j— Commonwealth of Massachusetts. [Circular.] State Board of Health, Boston, July 6, 1871. Dear Sir :—The State Board of Health has requested its chairman to re- port upon the means of preventing consumption. The following schedule of questions has been drawn up by Dr. Bowditch for circulation among our regular correspondents, and other physicians, in the various parts of New England and elsewhere. It is hoped that those who may receive it will be ready to assist in the collection of facts, by at least replying with a dot or dash under the words "Yes," or "No," opposite the different questions. But Dr. Bowditch will gratefully receive more detailed statements, and especially cases relating to family or personal history, involving the apparent causes or antecedents, or means of preventing this too frequently fatal disease. As our report must be ready at the close of the present year, and time will be needed to analyze the returns, the undersigned would respectfully request that replies be made at as early a day as our correspondents may find con- venient. In behalf of the State Board of Health, Very respectfully, your obedient servant, George Derby, M. D., Secretary. 1873.] STATE BOAED OF HEALTH. 311 (This half-sheet can be returned, in the accompanying envelope, to the Secretary of the Board, with such additional information as our correspond- ents may be willing to furnish.) Opinions of Dr.______________of______________, State of______________ 1. Is consumption caused or promoted by hereditary influences ? 2. Can consumption be apparently prevented from occurring in children so hereditarily disposed ? 3. What special means can be used for such prevention ? (If so, please name these means on another sheet.) 4. Is consumption caused or promoted by the drunkenness of parents ? 5. " " " « " " of an individual? 6. " " prevented " " " 7. " " " by total abstinence " 8. " " caused or promoted by the " " 9. " •" " " overstudy at school or college ? 10. " " " " overwork in trades ? 11. " " " " special trades ? 12. " " " " overwork of any kind ? 13. " " " " severe bodily injuries ? 14. " " " " " mental trouble ? 15. " " " " marriage? 16. " " checked by marriage (child-bearing, &c.) ? 17. " " caused or promoted by inordinate sexual indulgence ? 18. " " " " contagion or infection ? 19. " " " " exposed location of dwelling ? 20. " " " " wet " " Of course, the above are only a few of the causes that might be suggested. It is hoped that if any correspondent knows of any peculiar circumstances which he may deem important, in reference to the disease, information will be given in detail, as all facts upon the various questions will be gratefully received. First Question. Is Consumption caused or promoted by Hereditary Influences ? We have the following result from our correspondents :— Yes,...........205 No,...........1 No reply,.......... 4 Total,..........---- 210 This table shows at a glance that only one of two hundred and ten physicians denied the great importance of hereditary influence in the production of consumption. Coming, as these returns do, not from theorists, but from physicians who see families grow up and die under their own care, this re- 312 STATE BOAED OF HEALTH. [Jan. suit, though perhaps not unexpected by some readers, cer- tainly not by myself, is very significant. If we can ever have faith in medical testimony, every parent, and, still more, every one preparing, by marriage, to become a parent, should consider himself as forewarned by the above table. Still fur- ther, will not the State feel obliged, at some future time, to restrain the marriage of persons liable to breed consumption, even if it be considered improper and contrary to liberty, at present, to interfere with or prevent any such marriage, how- ever inevitably it may be destined to produce a consumptive, wretched progeny? Massachusetts has yet much to do in " Stirpiculture," ere she can claim to be really a mother to her people. Until that period arrives, each man and each woman is bound to consider this most important question before mar- riage. I am well aware that this caution may seem to ignore all those keener instincts and emotions which usually govern the attractions of young people to each other before marriage. I know, moreover, the beauty of that self-sacrifice which would, at times, unite one healthy young person to another perhaps far advanced in disease. But sentiment must be ig- nored in any suggestions drawn from these tables of God's law, whereby we know that the defects, as well as the high qualities, of the parent descend upon the child "unto the third and fourth generation." Extracts from our Correspondents' letters relative to this question. Brown.—I do not remember to have seen a well-marked case of consump- tion where I could not trace the taint in the ancestry of the patient. Burr.—I can call to mind several families where I have been able to trace consumption through three generations. Gott—Whole families are swept off by the hereditary taint. I saw the other day, a youth of sixteen, just gone with the disease, who is the sixth of eight children that have died of the disease. I have noticed where the disease has been so destructive, that the complexion is blond__light and light eyes. King.—I do not remember any case of consumption which did not to have an hereditary foundation. 1873.] STATE BOAED OF HEALTH. 313 Parks.—The only case to contra-indicate a belief in the hereditary tendency of consumption, and favoring the theory of Niemeyer—which I recollect— was one of fatal pulmonary consumption, in which for a year, or upwards, preceding the pulmonary consumption (as fully declared by rational symp- toms and physical signs), there were several attacks of acute bronchitis, which could not be accounted for by exposure to cold or otherwise. The patient was an only child, whose mother is now living, at an advanced age, and whose own two children (her only ones) are living, and not consump- tive adults. The patient's father I know nothing of. Hurlbert.—I find here, young men (born of consumptive mothers), who fol- low the sea, and have fine, well-developed chests, who are as often the vic- tims as those who stay on shore, and are not nearly as well developed. All our sea-faring men are well formed, but it does not protect against the deadly germ of a consumptive ancestry. Oftentimes I find a whole family tainted with this dreadful plague, when the parents are cousins, and no hereditary influences are traceable. Gammell.—I will cite the case of a family living in Berkshire County, the facts of Avhich are all authentic. The father, to-day, is a hale old man, over ninety years of age; the mother died of phthisis about twenty years ago. Of the thirteen children, four have died of the same disease; of forty-eight grandchildren, eight have died of the same. These all have occupied places of ordinary healthfulness, and all have been engaged in agricultural pursuits. My opinion is that hereditary influences are rapidly developed under the influence of soil-moisture, or any cause that lowers the vitality, and that any employment which deprives such a person of sunlight, pure air, or out-of- door exercise, conduces to the development of the disease. Bonney.—About the year 1831, Rev. Dr. B-----came to this place from Boston, and was settled over the Congregational Church. The last years of his residence here he occupied a house, situated upon an apparently dry and healthy and slightly elevated piece of ground; but the sills were near th« ground, and from the bank (once the margin of the Connecticut River) some three or four rods distant from the house, issue numerous springs.* I am told that the doctor's wife was confined to her house in Boston, at one time, for a year, with some form of skin disease. The following is the mortuary record: Eldest daughter—L- Mother, . Second daughter—L- Father, Third daughter—N— Fourth daughter—E----, Eldest son—J----, Youngest son—E--- Youngest daughter—H----,' One son has died since, at a distance—I don't know the particulars. One son is still living, aged about forty. The son J----is reported to have died of diabetes; all the rest, of consumption. N---- died at Hanover, N. H. g;____lived all but two or three of her earlier days in S. H, and died *'See answers to twentieth question. 40 died Feb. 2, 1837. Age, . 22 " Dec. 16, 1838. u . 43 " July 12, 1839. a . 22 " Mar. 22, 1839. u . 53 " Apr. 30, 1840. u . 23 " Oct. 4, 1840. n . 20 " May 4, 1839. u . 15 " Sep. 22, 1839. a • 2i -," Sep. 22, 1S55. u . 20 314 STATE BOAED OF HEALTH. [Jan. there. I am told that the Rev. Doctor stated that his father's family were consumptive. Mrs. L----D-----had two sisters die of consumption, and .two of can- cer. Three of her own children have died of consumption. One brother of her husband has lost three children by the same disease. Another brother has lost two children by the same. C----W----, an intemperate man, died of consumption. One or more sisters died of the same. He has lost at least four children in the same man- ner, one of whom had lived in Texas, one in Hadley, one in Northampton, and one in Chicago ;*the circumstances all being different as to occupation and mode of life. I am satisfied that the disease is decreasing. The town is much more dry, the food is of a better quality, and the people understand more fully the sanitary conditions essential to health. I cannot but call attention to the excellent suggestions con- tained in the following remarks on the different influences affecting the Irish, in Ireland and in America. Gavin.—Hereditary influence in causing phthisis is very far from being as common as medical writers would lead us to think. The majority of those who have come under my care were free from such cause. To those who are acquainted with the habits of the Irish, in their own country, as well as in America, there is much that deserves thought, and also throws light on one cause for phthisis,'and points to the great importance of climatology. In Ireland, the peasantry live on diet principally made up of saccharine and fatty substances—potatoes and milk—while in this country, meat and bread form their principal diet. Again, in Ireland, the peasantry live in ill-built houses, but if they do, the doors are seldom closed, thereby insuring a good supply of pure air. Quite the contrary here—overcrowded tenement- houses, with small rooms opening into dark passage-ways, doubtful neigh- bors, and other things combined, oblige them to live with closed doors, so that ventilation is next to impossible. I am very much inclined to think that further investigation will show that the two agents above mentioned— radical change in diet and want of pure air—play a great share in producing phthisis amongst the Irish class of the community. In this respect I agree, to a certain extent, with Dr. W. McCormac, of Belfast, Ireland, who con- siders carbonized air the great factor in causing consumption. The apparent good influence of alcoholic stimulants may be noticed in the following instance :— Morse.—J----B----, a man of wealth and healthy family; residence could be called an eminently healthy one. He married Miss S----. The S.'s all had consumption. He had three sons and five daughters. All the sbns and three daughters died of consumption. The eldest son (J. B., JrJ married S----B----, whose mother died of consumption. S----B----died of con- sumption, and all her children, viz.: three daughters and one son. J. B. Jr., marries again, and before he died, begat a son, who, for many years was considered consumptive—had diseases of bones of face, finders and hand called scrofulous, which undoubtedly were tubercular, but by the use of con- centrated nourishing food, pure air, and sunlight, he is now living, and ap- parently well. All medicines were dropped, and milk and brandy were substituted, when he began to gain, and his sores healed. 1873.] STATE BOAED OF HEALTH. 315 Hills.—Consumption seems to be caused, in some cases, by hereditary in- fluences : by which I mean that consumption occurs in the children of par- ents that have died of consumption, or where the uncles or aunts have died of that disease. There are other cases where a parent has died of consump- tion, in which we find the children troubled with a scrofulous condition; such as enlarged glands, a puffy appearance of face, and sometimes of other parts of the body which does not seem to be firm flesh, or adipose tissue. My experience is too limited to be able to tell the result of such cases. The following is analogous to statements already made above, in regard to the Irish in America:— Ruse.—As regards the development of phthisis, not from any hereditary taint, but apparently wholly from local causes I will cite the following:— A family of eight, the parents stout, athletic Irish people, with six children. At the date of my first acquaintance with them, March, 1866, they were all well, with but one exception. This was supposed to have been a cold, the result of suppressed menses from wet feet a month before. It was found to be a tubercular trouble, and proceeded to softening, and excavation in eleven weeks from the time of my first visit, when death ensued from phthisis. About the same time, a brother aged twenty-eight to thirty, con- sulted me, relative to cough: I found roughened respiration at the left top —no particular emaciation. I ordered cod-liver oil and whiskey, and ad- vised him to leave town as soon as possible. One year later (r1867y) I exam- ined the lungs of another daughter of the same family, and found tubercle and condensation of the top of the left lung so marked that there was no doubt in my mind as to the diagnosis and probable result. The brother went to Worcester; returned in 1869; came under my care and died in April, of dropsy, the result of chronic peritonitis with diarrhoea. The only child now at home is to all appearance healthy, but still has a marked resemblance to her deceased sister. Two remaining sons are in different parts of the country, location and health unknown. The parents are healthy Irish, living plainly, but substantially, on a farm. Gould.—Happily consumption has almost deserted this town (Revere); there has not been a fatal case for years,—not since 1 wrote last upon this subject. Upon your first question I answer, Mrs. W----- died quite a number of years ago of consumption, between fifty and sixty years of age ; her sister died at about the same age, and her brother died, aged sixty-three, of consumption. Mrs. W.'s daughter, M., married, died of pure tuberculosis of left lung, between her fortieth and fiftieth years. Mrs. W.'s son, R., had repeated attacks of haemoptysis, and died after his thirtieth year. Another sister has been in a consumption for more than thirty years, and lives on. Her case is somewhat remarkable. For quite a number of years she has had repeated attacks of haemorrhage, but instead of producing a debilitating effect, it relieves the oppression and soreness of the chest. She has been under my care for more than twenty years; uses no medicine, except an occasional dose of Morphia when the cough is too trou^esome, also Tinct. Iodinii, and occasionally blisters, after taking cold. She is married, and over fifty years of a^e. My care has consisted chiefly in attention to the digestive organs. She has lost one son, aged thirty, by this terrible disease, and has other children fairly candidates for the same affection. The cases I report look 316 STATE BOAED OF HEALTH. [Jan. very much like hereditary consumption. The taint may continue to affect the offspring of this family, unless stronger and purer blood be mingled with it. But I have, until recently, firmly believed that, unless there was an hereditary predisposition to the disease, neither exposure, manner of liv- ing, nor the habits of the individual, pneumonia, bronchitis, nor any other inflammatory affection of the respiratory organs, would have the slightest effect in producing it. But, within a few years, I have been somewhat shaken in this belief. I have met with several cases, and have one under my care,— a young man of eighteen, who has a good chest and broad shoulders, and who has all the rational and physical signs of confirmed phthisis, and yet there is no family taint. None of his ancestry on either side, nor any collateral branches of the family, ever died of consumption; but the maternal branch of the family were asthmatic. It was apparently brought on by exposure to cold, producing severe capillary bronchitis and engorgement of the lungs. Bice.—I know that many cases of pulmonary phthisis in this vicinity can be traced to hereditary descent. Often it is traceable to the second and third generation back. Wakefield.—No doubt upon the point, that where the parents (one or both) are affected with tuberculosis, the offsprings are sure to inherit the disease. Hunt.—Hereditary predisposition and the scrofulous diathesis cause it. Call.—Nearly every case I have seen has had a decided hereditary influence, although every child born of consumptive parents does not die of consump- tion. Almost every patient dying of consumption has had some near rela- tive die of the disease. Butler.—Of its always being traceable to hereditary causes I have some doubt, for I have known of cases where no hereditary predisposition could be traced. Howe.—I believe consumption to be hereditary, and, also, the inherited tendency to be the predisposing cause; but I do not believe this cause of itself sufficient to produce a fatal result in nearly all who may have this cause operating in the system from birth. * * * * The tendency may remain dormant during life, unless other conditions favorable to the disease should arise. , Second Question. Can Consumption apparently be prevented from oc- curring IN CHILDREN, HEREDITARILY PREDISPOSED TO THE MALADY? The tabular statement is as follows :— 1873.] STATE BOAED OF HEALTH. 317 On this question of the ability of the medical profession to do anything to prevent consumption from appearing in chil- dren hereditarily liable to it, there is evidently much less cer- tainty on the part of our correspondents than is shown by them on the first question. Fifty-five (26.23 per cent.) are either doubtful, or return no answer. Twenty (9.52 per cent.) return a peremptory " nay," as if they had seen few, if any, cases in which, after all had been done to prevent consump- tion, complete success had been the result. Doubtless, all physicians have seen cases similarly suggest- ive of doubt of their ability to ward off the tremendous in- fluence of blood. Fifteen (7.14 per cent.) think not that it can be absolutely prevented, but that it can be retarded. And finally, one hundred and twenty (57.14 per cent.) declare that they believe that the disease can be, by proper means, pre- vented in those children who are hereditarily predisposed. What these means may be, we shall, perhaps, get a glimpse of under another question. Meanwhile, let us take courage from the fact that more than half of our correspondents do have some hope of being able, at times, to influence the stern rule of one natural law by pitting against it other of nature's equally powerful influences. Extracts from our Correspondents^ letters relative to this question. Packard.—Although not prevented in one or two generations, it may be in a series of begettings. Stone.—Attention, care, and change of residence may do much. Parton.—I do not think plain " yes " or " no " are admissible answers to this question. My opinion is, that a child, hereditarily predisposed to con- sumption, may be so managed as to have the development of the hereditary taint retarded, but to be prevented, I doubt. Contracted and ill-ventilated apartments are often a cause, and should be avoided. Blodgctt.—I am not aware of any such case, but I believe that much may be done by a correct system of prophylaxis to retard its development. Gilbert.—Not generally, but occasionally with those who are intelligent, and have means at their command. 318 STATE BOAED OF HEALTH. [Jan. Third Question. Are there any special means that can be used to pre- vent THE DEVELOPMENT OF CONSUMPTION IN CHILDREN HEREDITARILY DISPOSED? The following is the tabular statement of " opinion " :— By general hygienic measures,.......24 By various specific directions, more or less elaborately described, 96 No means known to prevent it, . .......12 Doubtful,............ 5 No reply,............73 Total,...........210 The large number of physicians who, while answering our other questions, feel compelled to refuse any reply to this one, and those who are doubtful, and finally those who an- swer in the negative, that they know of no special means of warding off consumption in those hereditarily predisposed to it, making in all 90 (42.85 per cent.), presents of itself a decidedly disheartening result in reference to the power of the medical profession to prevent this terrible disease from developing itself, even when forewarned. It proves, how- ever, one thing, viz. : that, in the opinion of a large body of physicians, other and more thoroughly radical measures must be tried than those heretofore employed, before we can hope to cope with the fate impending over the child born of con- sumptive parents. And on looking at the answers of those who give an affirmative reply, we find only one hundred and twenty, out of the two hundred and ten (57.14 per cent.), who think that they can succeed in preventing the disease from coming on. Upon those special means beyond a "general hygienic treatment," which 24 (11.43 per cent.) believe in, we must refer to the more detailed answers under this ques- tion. This is a sad result, but notwithstanding all this want of faith in our power to ward off the disease in an ill-beo-otten child, I cannot but hope that in the far future, when men will think carefully when choosing their residences in which they 1873.] STATE BOAED OF HEALTH. 319 intend to rear their future families ; and when a child is born, all the excellent hygienic laws that may be daily laid down for' childhood and youth shall be fairly acted upon, every hour that the child is growing, and white youth is budding forth to manhood and womanhood ; when professions and all trades shall be chosen with reference to the health of those who are to pursue them; when people learn that sun and air must freely bathe every part of a house; when men* and women shall believe that it is impossible to violate a single law of nature without more or less suffering of body or mind as a conse- quence of that error or deliberate crime against nature's laws ; when these halcyon days shall arrive, then we shall be better able to cope with this hereditary tendency, and, perhaps, shall then be able to crush it out. I think I have seen such cases where a discerning parent has warded off threatened disease, and has so reared a family that it has become even stronger than the average. He has done this, however, by commencing at their birth, and by constant, never-remitting care in reference to every influence which, during their tender years of growth, could have any deleterious effect upon their health. He believed that even one small error might sacrifice a life. His success, as I have stated, has been complete. Extracts from our Correspondents' letters relative to this question. Kingsbury. Change of climate, living and occupation, together with altera- tive medicines. Curtis.—Sunlight, air and muscular development. Bowen.—Out-door life and change of climate. Goodrich.—Plenty of pure air, light and out-door exercise. Stone.—Change to dry and even climate, from Cape Cod to St. Paul, Min- nesota. Blodgett.—By a correct system of hygiene, avoiding all that tends to lower vitality. Brown.—I am not aware of any that have proved successful in finally se- curing the systems of those who are hereditarily disposed. Its development may be, and often is, postponed for a time by careful management. 320 STATE BOAED OF HEALTH. [Jan. J'fye—Regular habits of living; dwelling on high and dry land; temperate habits ; warm clothing; good food, at proper times, and which should be eaten in a proper manner, thereby keeping the digestive and assimilative organs in a healthy condition; and, lastly, by breathing good air by night as well as by day. Chase.—Change of air, climate, diet and general hygiene. Dickson.—Bathing regularly, careful selection of food, regularity of hours for sleep. Hathaway.---Proper diet, clothing, habits, climate, &c. Deane.—Change of residence, habits of life and mode of living. Reynolds.—Not special but general measures, attention to the rules of health, avoiding causes mentioned in Nos. 9, 10, 11, 12, 17, 18, 19, 20 of the circular. Tracy.—I am not quite sure that I understand fully the intent of question 3. I know of no specifics, but, at the same time, my impression is that each case calls for special means, according to the peculiar constitution or con- dition or circumstances of the individual. In some, change of climate; in others, the use of iron ; in another, cod-liver oil; in another, alcoholic stim- ulants ; in another, change of circumstances, &c, &c. In all, the use of those means which will tend to health, in both mind and body. Chapin.—Judicious food, extra clothing, and removal from all local causes. Adams.—In the predisposed, especial attention to all the little precautions; especially in dress. Smith.—Life out-doors; dry place of residence; good food, air and clothing. Nichols.—Active exercise in the open air; and all the means that have a tendency to develop and strengthen the physical powers. Spofford—Anything that preserves the general health. Be careful about colds, fevers, measles, coughs, &c. Soule.—Change of location, in my opinion, has done more to prevent con- sumption 'in children of consumptive parents, than all other means com- bined. In all the cases of consumption occurring in Winthrop * since I have lived here, the disease came with the patient from other places; and in some instances, the patient has been very much benefited by the change, and I am by no means prepared to say that an earlier change of location would not have resulted in a complete recovery. Stone.—Removal to another and healthy location; living, as much as pos- sible, in the open air; sufficient out-door exercise; liberal diet, and general hygienic measures. * It will be remembered that Winthrop enjoys an almost insular climate, being a peninsular promontory projecting far out into Massachusetts Bay.—H. I. B. 1873.] STATE BOAED OF HEALTH. 321 I draw especial attention to the remarks on ill-ventilated apartments in the following letters :— Parker.—The principles of hygiene are especially to be attended to—clean- liness, warm clothing, good, nourishing food, well-ventilated apartments, a plenty of out-door, fair exercise of body and mind, but neither overtasked. A very frequent and powerful cause in developing, if not in actually causing, consumption, is, in my opinion, a contracted, ill-ventilated sleeping-apart- ment. Burr.—By placing children under the most favorable hygienic influences ;* regulating their course of study, hours of play, diet and sleep, their sleeping- apartments. We must see that their rooms are well-ventilated, and that proper attention be given to dress. We should insist upon such children wearing three grades of flannel under-garments during the year,—very thick during the winter months, medium in spring and fall, and a thin grade during the summer, after the middle of June. Calkins.—Dry and pure air, in well-ventilated buildings; nutritious food and ample clothing; out-door life ; attention to the slightest attacks of indiges- tion ; and by the use of those medicines best suited to the promotion of digestion and assimilation. Shaw.—All those agencies which tend to elevate the vitality, as pure air, especially at night; cleanliness; a non-conductor next the skin; sunlight; plenty of nutritious food, especially lean meats and milk; and a chance to get into clean dirt in the country. Heath.—Generous diet, warm clothing, pure air, and continued exercise in the open air, have apparently made a strong and healthy boy of my own child, whose mother had hemorrhage from the lungs during gestation, and died of tubercular consumption two and a half years after confinement. Dicight.—In my judgment the disease may be prevented frequently, al- though perhaps not always, by attention to diet, exercise in open air, sun- light, and judicious clothing. Breed.—Removal from crowded tenements in cities, to open air on Western farms. Ten or twelve examples. Brown.—Principally inunction and attention to diet. Different oils have been used in my practice, generally olive-oil, oil of sweet almonds, or goose- oil. Particular attention has also been directed to the ventilation of sleep- ing-apartments, and warm clothing for the lower extremities. Field.—Exercise out of doors; the breathing of pure air, day and night; wholesome food; and having a good time generally. Re-breathed air, in the young and old, lays the foundation of consumption more than any other cause. Ward.—In answer to No. 3,1 have written " No." In explanation, I wish to say I know of no special means by which to avert such result. Still I have 41 322 STATE BOAED OF HEALTH. [Jan. great faith in general means, i. e., the strict avoidance of all depressing influ- ence, and the use of all available means of improving the general health and strength. This rule, I believe, should be borne in mind in all the stages of the disease, as & preventive, and also as a cure. I believe the disease to be one of debility, and promoted by every means or agency which induces debility. I judge this to be the explanation of the very rapid development of the dis- ease after continued fevers, especially in persons predisposed to tubercular disease. I believe that this one principle, if generally practised, would save many cases (of all ages and conditions) now lost. I am very sure that tonics are the only appropriate treatment (iron especially) for all cases of consumptive disease. I base this opinion upon a pretty extensive use of the * preparations of iron, and the results, as compared with any other plan I have yet heard of. Expectorants, although sometimes necessary, should not be relied upon, as is the case with too many, both in and out of the profession. Scammell.—I know of no method of preventing consumption, except by that kind of diet and mode of life which, in each individual case, is best adapted to promote vigor and increase tone. I have seen cases where consumption was evidently delayed in its progress by such means, and I have no doubt it may be sometimes prevented in those hereditarily disposed. I suppose Dr. Bowditch remembers the case in the Massachusetts General Hospital, exhibited and described to the class by Dr. Jacob Bigelow, when I attended lectures, nearly thirty years since. The man was. sixty years old, and had been in consump- tion forty years. During that long period the disease had been kept at bay by the patient's pursuit of mackerel-fishing, which agreed with him. Of course, the particular mode of life should differ in different cases. Haskell.—I think the proportion of fatal cases much less at the present day than they were forty years ago, when I began practice, owing, I think, in a great measure, to the mode of treatment. Then it was customary, here- abouts, to use a spare diet and depleting medicines; now, nutritious food and stimulants. It does not confine itself to any trade or occupation. Reynolds.—I suppose you wish opinions founded on observation. I have not known consumption apparently prevented in children hereditarily dis- posed to it, because I have never known means used purposely in due season. I think it might be often prevented by life in the open air, or by a change of climate, before the disease was developed. Such means are rarely re- sorted to until after symptoms are manifested. A sea-faring life, a life in the army, an agricultural life, especially in a climate little subject to change, are doubtless among the best means of prevention. Compression of the chest, in females, not only injures them and their female offspring, but their male offspring as well. Females with any tendency to consumption should avoid all compression of the chest from earliest childhood. Downcs.—While some of the medical faculty of our country send their consumptive patients to the West Indies, while other physicians send their patients to Russia, it will be well to suspend judgment until sufficient data are furnished. It would seem, however, that in medias res would bo the most judicious. I have no doubt but that moderate out-of-door exercise- in a dry, exhilarating atmosphere, like Minnesota, is of more advantage than medicine. 1873.] STATE BOAED OF HEALTH. 323 Bice.—I know of no positive means of preventing consumption in children who have inherited a scrofulous taint from their progenitors. Every means to invigorate the general health should be used,—such as a generous diet, pure air, exercise in the open air, warm clothing in winter, dwelling in a high and dry altitude, and, perhaps, the administration of iodine and iron. Also, the patient should not be made to study or occupy the mind in a degree to pro- duce lassitude. I think the constitution can thus be somewhat modified, and perhaps, in some cases, the scrofulous taint completely annihilated. French.—Children should be kept, if possible, from the contagion of the ex- anthemata (measles, scarlet fever, &c), should always be dressed in flannel, take the open air, and as much sunshine as possible; the feet should always be kept dry. If they have eruptions, great care should be used in applying ointments and washes ; it is apt to transfer it to the head or lungs. They should practise temperance in all things. Smith.—I would answer, first, a selection of a mild, dry and healthy climate; second, constant exercise in the open air (I mean a vigorous, free exercise); third, a highly nutritious food, avoiding pork; fourth, daily application of cold water to the skin, with friction; fifth, the cultivation of a cheerful and happy disposition; sixth, avoidance of all excesses. In this section, atmos- pheric vicissitudes are the most exciting causes. I have seen many caused by syphilis. Fiske.—It has been my opinion that a person predisposed to consumption by hereditary taint, &c, might do much to ward off, or entirely to avoid it, by being well clothed, and taking that kind of exercise, out of doors, which would invigorate the system; and, at night, by sleeping in a dry locality, away from water or low, marshy ground. Winsor.—Regular and interesting exercise in the open air, and free admit- tance of fresh air to the dwelling; a regular, easy (but not indolent) life, with cheerful and congenial social relations ; plenty of sleep, and of nour- ishing and palatable food; animal warmth maintained more by clothing, and less by heating apparatus, than is customary. Barker.—By avoiding the common causes, and pursuing a hygienic course; by taking active exercise ; by occupation; by being much in the open air ; and by attending to the first appearance of the disease with approimate medication. Collamore.—I think consumption is prevented in those predisposed to it in some cases, but it is difficult to say how, unless we say, in general terms, by the use of means which conduce to general healthfulness. 'Hon. and Rev. M. A., called by Mr. Webster " the model farmer of Plymouth County," who died a year since at the advanced age of ninety-four years, was troubled with haemoptysis when a young man, and was thought to have had diseased lungs. I do not know that any special deans were employed in his case, but I do know that during his long life he was a model of propriety in eating, drink- ing and exercise; that he avoided excitement and late hours. I have in mind now a young lady whose life is being prolonged by removal to Minne- sota. She is very strongly predisposed, and the disease had commenced before her removal, two years ago, but is now stayed. There seems to be a period, from sixteen to twenty-five, or thereabouts, that seems to be a critical one. 324 STATE BOAED OF HEALTH. [Jan. If by any means the person is wafted over this period his immunity is very much enhanced. About a year since I lost a patient, the last one of seven children, all of which, with one exception, had died with consumption. She was the only one that I had attended. The others had died in different places, but all young. Two of the others, as well as she, had borne children. In her case I think I kept the disease in check for more than a year, by the use of Savory and Moore's Pancreatic Emulsion. The old homestead is in a dry location. Miner.—I have in mind one case where the hereditary predisposition was very great, the subject being Dr. A. M. O., of H------, whose mother, two or three sisters, and a brother, died of it, and who had hemorrhage from his lungs, followed by pneumonia, about twenty years ago. He took cod-liver oil very freely, and some stimulants, after his recovery from the pneumonia for two or three years, and kept at the practice of his profession, over high hills and rough roads, and ahvays at it; I might almost say day and night. He is now strong and well, and nearly fifty years of age. I have thought that his business, keeping him so much in the open air, and the oil and gen- erous diet, with the care he has always taken to keep himself well protected by warm clothing at night and when the weather was severe, have been the means of warding it off. I have other cases of a similar character, and where the same medication and exei'dsein the open air, especially horseback-riding, have done much to prevent what otherwise seemed incurable. I have more faith in horseback-riding than in any other form of out-door exercise. Wilcox.—Such means as are calculated to promote general health, and especially, a good appetite. I have a case under observation for the past year, in which there was positive evidence of tuberculosis developed in the upper portion of the right lung, in which there has been most marked improve- ment, though I will not yet say it imperfectly cured (a boy now sixteen years of age) ; by taking him out of school; by daily out-door exposure (except in the most inclement weather), and by making it a point that this exposure should, whether as an occupation or recreation have an object aside from the fact of its being for health. Added to this, he has taken, during the year, three bottles of Nichols' sirup of the hypophosphites of lime, soda, potash and iron. Metcalf.—I think a permanent residence in a warmer climate, before the de- velopment, to any extent, of tubercle, has apparently prevented the occur- rence of consumption in children hereditarily disposed. In a family in this town, of six children, all but one died of consumption, before arriving at middle life. He removed to New Orleans, and has constantly, except an oc- casional visit to New England, remained in the States of Louisiana and Mississippi. He has always enjoyed good health and never had any pul- monary troubles. I know " one swallow does not make it summer," but you will take my case for what it is worth. • Knight.—Clothing, diet, exercise; also, elevated location, with soft water. Wilmarlh.—The special means for prevention, I should divide under three heads; viz., did, clothing and hygienic influences. We frequently find that children hereditarily disposed to consumption are undeveloped, physically • while the nervous system is unduly active, showing a precocity. This con- 1873.] STATE BOAED OF HEALTH. 325 dition, if encouraged or allowed to continue, undermines the constitution, and impoverishes the health, by using the material through nervous activity, that should go to the growth of the body. A diet for such condition should supply the waste and build up the body. The supply of waste will best be accomplished by the articles containing more or less phosphorus, such as wheat (not flour), beans, fish, &c.; while the growth of the body requires, in ad- dition to these, the albuminous, carbonaceous and fibrinous compounds such as we find in meat, eggs, milk, corn and vegetables. In choosing a diet, reference should be had to the condition of the bowels, which we often find in a constipated state. This should not be allowed, without a persistent, constant and untiring effort to overcome it. Avoid pastry and food that can be swallowed whole. Choose the food that will need chewing, and chew it thoroughly. Take plenty of time to eat, and eat at regular intervals. Fruit and berries may be used with the meals to advantage, the acidity of them moistening the fecal matter; and the small seed and skin promoting the peristaltic action of the bowels. Avoid much drink with meals, as it tends to wash down the food before it is properly masticated. Let supper be the lightest meal of the day, so that the stomach will not be obliged to work during sleep. Encourage the habit of daily evacuation. Perseverance in these matters will usually overcome the constipated habit, if other hygienic measures are brought to bear at the same time. Cathartics should not be depended upon to relieve the condition; they are only temporary in their action. The clothing should be neither burdensome nor scanty, but should be both light and warm. It should not be a ready conductor of heat, thereby caus- ing the wearer to feel changes of temperature unpleasantly. Light woollen garments are more comfortable to the wearer, in this respect, than cotton, and I think, more conducive to health. Protect the extremities. Tight- fitting garments are neither comfortable nor healthful, and tight-lacing ' about the chest is positively injurious and ought to be discarded. Too much dressing about the neck is as injurious as too little. The practice of con- stantly wearing a hairy fur or woollen tippet, keeps the neck in a state of perspiration, and a person is thus always liable to take a cold,—to settle in the throat and produce irritation, with cough. Hygienic influences.—Under this head I would include air, exercise, sleep, restraint of injurious tendencies and the promotion of a healthy physical growth. The air should be pure, free from the influences of low lands or stagnant water, or impurities of de- caying animal or vegetable substances; and it should be what is called a dry atmosphere. Such an air should be breathed freely, out of doors. Exer- cise, such as the system will bear without undue fatigue, should be taken every day. Special attention should be given to the healthy growth and en- largement of the chest and of the muscular system generally. A judicious use of calisthenic exercises would be very beneficial. Sleep should be en- couraged in the early part of the night. If children are kept up late, it is at the expense of the nervous system, and the morning sleep does not fully compensate for the loss. Occupation of such children, until they are seven or eight years old, should be very light, mentally, with just enough physical employment to keep them out of mischief. It is better that they should not go to school before this age, and when they do go, the mental effort should be restricted to the physical capacity. I do not mean by this, to encourage habits of laziness, but to avoid what is too often the case, pushing a forward child. In choosing an occupation for after-life, one should be taken that avoids sedentary habits or close confinement. Trades where fine dust is a 326 STATE BOAED OF HEALTH. [Jan. necessary attendant, should be avoided. Injurious tendencies are those which in any way weaken the constitution; such as overwork, overstudy, too much play, excess of any kind, frequent or continued excitement. Any- thing which calls for an outlay of nervous force more than is conducive to health, should be restrained. Work, study, play and the excitement neces- sarily attending them, are healthful and needed to properly develop the sys- tem, and should be encouraged with alternations of rest, so that a healthy re- action, not an exhaustive fatigue, may follow. Gilbert.—A healthy location; proper food, clothing and exercise; and reg- ular habits. Parsons.—Diet, climate and voluntary expansion of chest. Bice.—I know of no means of preventing it, in children of consumptive progenitors; or, at least, no means other than those used to invigorate the general health. Wakefield.—Children who are clad in flannel; fed upon beef, mutton, etc., instead of pork; well guarded against sudden changes in temperature, may apparently, escape tuberculosis. An exciting cause, e. g. pneumonia, may develop the latent disease. Hammond.—The special means of preventing the disease in children, are those which tend to produce a healthy and vigorous action of all the organs of the body. This can be done by proper exercise, taken when the body is not exposed to any improper state of the atmosphere, either of cold or damp- ness. Exercise in the open air, when the temperature is too low, or when there is much dampness, is not proper. The condition of the system when the person takes the exercise, should be taken into account. If the system is exhausted, in a measure, the exercise should be performed with caution. The clothing should be suited to the season; the diet nutritious. In fact, whatever tends to render the system active and vigorous, also tends to protect the body from all predisposition to disease. Haskell, of S., Me., says (communication received too late to be used in the general analysis),— a. By good nourishing food, largely animal. b. By abstaining from alcohol and tobacco, especially the latter. c. By abstaining from inordinate indulgence of animal appetites. d. By the use of flannels, (if in New England) the year round, to chest legs, and arms. e. By residence in a dry climate, of high latitude. /. By leaving home, and the cares of home, once or twice in a year espe- cially if they go from " the shore," inland. This last clause (/) applies, in my experience, grandly, in the treatment of consumption. By this course, and by the use of clams, oysters, fish etc and cod-liver oil, and porter, whiskey and hot flax-seed tea, etc. with an inhalant mixture, life has been made more comfortable and prolonged. Abell.-To prevent the development of the disease in children there should be extra care in guarding against exposure to wot and chills bv attention to clothing; by using plentiful nutrition; and by keeping the 1873.] STATE BOAED OF HEALTH. 327 digestive system in good order; rather than by any specific drugs ; and by encouraging exercise in the open air, in such systematic ways as would develop muscle, and expand all the air-cells of the lungs, thereby leaving as little soil as possible, for the development of the causes of tubercle; but that any means would entirely prevent the development of those causes, occurring at, or before birth, I am not so positive. I have examined the lungs of infants, dying with other diseases, at the ages of four or six months, whose lungs were studded throughout with minute tubercles. I think change of climate might effect a good deal, in preventing tubercular development, as I have known severe cases to recover, after two years' residence in Min- nesota—both first and second stages—though I think the benefits claimed by residing in Minnesota, overrated—but I know many families who were apparently predisposed to consumption while living in New England, whose children almost never had phthisis developed in Minnesota. There is certainly quite a difference in the atmosphere, in some way, as I found I could myself bear twice the exposure, in Minnesota as in New England, without taking cold. My wife, also, who has been severely attacked with "hay-fever," * for the last fifteen years, (beginning in the latter part of August, and lasting from six weeks to three months,) whenever she visits Minnesota, escapes the attack invariably, and breathes as freely as anybody. On returning to Massachusetts the attack comes on again. She tried this experiment three times, with the same result. Luce.—In a family of seven, four boys and three girls, all the girls and two of the boys died of consumption, under the age of twenty-five. The two re- maining boys were the youngest of the family; the eldest of these began to manifest symptoms of the disease, and embarked for California, where he re- covered, and is now strong and healthy. The youngest is still at home, but in feeble health. The father of this family, is a farmer and fisherman, and is now seventy-two, hale and sound; the mother sprung from a consumptive family, and died in middle life. Butler.—By attention to diet and general habits of life; by change of loca- tion and climate, if one or both should seem to promote the disease; out- door exercise, such as shall tend to expand the chest, and give full, free play to the lungs. Hartwell.—The especial means to be used for the prevention of consumption in children hereditarily disposed, besides a strict observation of all hygienic laws, are, if the mother is affected, the employment of a healthy nurse who shall have the whole care of the child, or, if one cannot be obtained, a healthy woman, who shall feed the child with cow's milk, properly diluted. When milk, drawn from one cow, well-known to the family, is not to be had, Comstock's Food, (Liebig's formula) has been used by me, in two cases, and both thrived remarkably well. If the father is affected, the mother may nurse the child, but ought not to have the father under her charge or care, at the same time. Second, and as important, I think, is the separation of parent * " Catarrhus Autumnalis " would be, I think, the more correct term, according to the recent admirable researches of Dr. Morrill Wyman, on that very distressing malady. Autumnal Catarrh (Hay-Fever), with three maps, by Morrill Wyman, M. D., late Hersey Professor of the Theory and Practice of Medicine in Harvard University. New York : Hurd and Houghton. Riverside Press. Cambridge, 1872. 328 STATE BOAED OF HEALTH. [Jan. and child. (I cannot say that I think we are warranted in making the sep- aration forcible.) If proper ventilation could be enforced, occupying the same house would not be objectionable; but that is almost impossible. This applies to children also, and some of the difficulties are removed. Of course, the various tonic remedies are not to be omitted, of which the best is cod-liver oil, if any tendency to emaciation exists. Holmes.—Warm flannel clothing; fresh meat, butter, milk and eggs, diet; out-of-door exercise in high and dry location; with pure air, erect position, with free and full expansion of the chest, are among the best means of pre- vention. Hills.—A case of mine had Pott's Disease, and while under treatment pul- monary tuberculosis was developed. I do not think an abscess of the verte- bra opened into the pulmonary tissue, although the child previously had an abscess which pointed a little anterior to the large trochanter. The child wasted quite rapidly, had severe cough, and profuse expectoration of thick grayish and yellowish sputa. The child took iodide of lime, and, some of the time, a sirup of the hypophosphites, but most of the time cod-liver oil and some expectorant. In the spring and early summer he began to improve, and by fall was quite fat and hearty; cough continued, but less severe. Im- provement lasted, without relapse, until April, 1871, when the child was taken with diphtheritic croup, and died after two days' illness. In this case I think the tuberculous symptoms were evidently abated, and I was led to hope for complete recovery, had the patient not died of another disease. And here I will state that this child took exercise in the open air whenever the weather permitted it; also ate largely of sugar, and I think, drank milk freely. At the time of death it was four years seven and a half months old. A case came to my knowledge where the mother died of consumption soon after the birth of a daughter. I do not know that that child had any ap- pearance of disease, but the father determined she should have a chance to be robust, so he had the child well and warmly clad, thoroughly protected from the vicissitudes of the weather, and then sent her forth, at all times, and in all kinds of weather. At the present time (unless recently indis- posed), the young lady (of seventeen, I presume) is, to all appearance, in perfect health. I cannot answer whether consumption will assail her in later years, but it is my opinion that without the physical training she went through, she would now be suffering from incipient phthisis. Harlow.—I desire to instance a family consisting of father, mother and four children, two males and two females, in which the parents both died of phthisis fifteen years since. The children were supposed to inherit the ten- dency to tuberculosis, were separated, placed in good families, locality changed, regular systematic hygienic rules were enforced in each case. All have arrived at mature age and are now in robust health, though one of the girls gave signs of incipient pulmonary trouble nearly three years since, which soon disappeared upon making a radical change in her mode of life, viz., removing her from school and keeping her much out of doors. Call.—Change of climate and change of associations are among the best preventives of the disease in question. Aiken.—The best hygienic conditions, such as in infancy, "plenty of milk, plenty of sleep, plenty of flannel!" Later, a country life, especially in the 1873.] STATE BOAED OF HEALTH. 329 summer; plain, but nourishing food, brown bread or its equivalent at least once a day; regular habits generally. Haynes.—Diet; exercise; location; judicious use of such articles of food and drink as will promote the development of bone and muscle. Spalding.—No specifics, but such general treatment as will promote sound physical health. Carbee.—First, attention to diet; second, avoid exposure, either riding or driving, in open air; third, administration of suitable tonics whenever indicated. Bullard.—Removal from consumptive family; out-door employment and nourishing diet; also removal to another State, as going West. Cart:—Temperance, air, exercise in open air, avoiding all manner of debili- tating practices of body or mind, favorable location, etc. McCollom.—Out-door exercise, sleeping-apartments well ventilated, plain, nutritious diet, cleanliness, proper clothing, eight or ten hours' sleep. Fairman.—Large, well-ventilated sleeping-apartments, plenty of exercise in open air, journeying, especially on horseback, good, wholesome diet, freedom from care, attention to the general health, avoidance of cold, wet, damp, and exposed localities. Banney.—I am sorry to say, after a practice of twenty-five years, and observing cases treated and not treated, that answers to your questions must mainly be conjectural, and, consequently, of little value. The conclusion to which I have come is this: tuberculosis results from a peculiarly depraved condition of the system, generally hereditary.. If otherwise, and the predis- position not transmitted, there is not sufficient evidence to establish proof of cause. Until the cause is ascertained, the way of prevention or promotion seems to me very dark and blind. Conclusion,—a glorious uncertainty about the whole matter contained in the questions. Bichmond.—Free, timely, and proper exercise in a pure atmosphere. Special attention should be paid to the digestive organs, or blood-making machinery, that the greatest possible amount of good, wholesome food may be con- verted into blood; and all condiments (stimulating) be avoided. Tobacco, the greatest bane to human kind, from its enervating power, is to be avoided in every form by all means. Porter, more than any article in my practice, pre- pares the digestive organs for nourishment, and guards the system against tuberculosis. Mayo.—Change of climate. Bolan.—I think cod-liver oil, with a constant and small dose of liquor, will retard the disease, and at times, produce a cure. I have seen a few children recover when one lung was entirely diseased. 42 330 STATE BOAED OF HEALTH. [Jan. Lincoln.—Let the child, in infancy, receive its nourishment from a healthy nurse, free from any hereditary taint; a strict attention to cleanliness, keep in a moderate temperature, a sufficient quantity of clothing, pure air and sunlight. Let it sleep with a healthy, but not old, person. In childhood give it healthful, but not too violent exercise, so as not to prostrate those weak powers, but rather to invigorate and strengthen. If the patient is in a state of perspiration do not check it too suddenly. The brain should not be overtasked while the physical powers are weak. There should be an entire abstinence from any of those indulgencies which are so antagonistic to nature. It is our conviction that, by a strict adherence to these prophylac- tics, there is a possible escape from the terrible scourge which cuts down so many of the human race. Sanborn.—Moderate exercise daily, regular habits, such as regularity in eating, drinking, sleeping, and attending to calls of nature, dressing prop- erly, not wearing clothes so close as to punish and disfigure the person, amusements, generous diet, change of location or climate, and keeping in the open air as much as possible when the weather is suitable. A change of climate I consider almost absolutely necessary, and, in the majority of cases, indispensable. Also amusements,—everything which tends to cheerfulness of a moral character. Bobbins.—1st. Residence in the country. 2d. Attention to diet: food to be taken at least four times a day, till ten years old, which is to be largely ani- mal—especially milk; sugar not to be rejected, but largely and judiciously used, as taking the place of fat in adult life. 3d. Bathing, almost daily, with frequent change of clothing. 4th. Constant out-door life. Such children by no means to be sent to public schools. Body before mind. Make romps of them rather than precocious prigs. Bromwell.—Extraordinary attention to general health. Eldredge.—I believe consumption to be decidedly hereditary, and that where there is this tendency life may be prolonged by generous living, re- siding in a favorable locality, having regard to drainage and exposure rather than to temperature; always sleeping in an upper chamber; and by avoiding harassing care and hard labor of every kind. Collins.—Good air, food, residence, surroundings, and everything that goes to make a perfect animal. Peaslee.—Hygienic means, especially out-of-door occupation. Condie.—I have seen cases in which children, male and female, strongly predisposed by hereditary taint to tubercular phthisis, have had the disease arrested, or, more properly speaking, have been saved from a development of the disease, by a proper hygienic course of treatment, including diet and regimen, especially when pursued in conjunction with a complete°chan Wet localities, damp rooms, damp air, and insufficient or imperfect exercise of the muscles of the chest and trunk of the body, are the most prolific causes of consumption. The following letter from Dr. Manson, of Pittsfield, sug- ♦ gests important considerations in regard to the effect of diet, and especially of the free use of pork, even when swine are raised upon the farm where the family resides, and where the animals may be supposed to have been fed in the best man- ner. At any rate we may believe that they are not slaughter- house cattle, nor wholly offal-fed. But still more do I think that the three families tend to suggest the idea of the in- fluence of contagion, or perhaps of improper food; and in support of this view I refer to Dr. Manson's second letter of later date, written in answer to one from myself, asking further information on the subject:— Pittsfield, Maine, August 6th, 1871. Dr. Bowditch: Dear Sir,—I know of no better way to answer your ^ inquiries than by relating, to the best of my recollection, the histories of certain families which have come under my professional observation. First, the family of S. J------, Esq., living in the town of P., came under my care some fifteen years ago. Mr. J. and wife were both from hardy pioneer stock • both living at the present time. Their parents, on both sides, lived to a good old age, according to the best information I can obtain. Said J.'s family consisted of three sons and five daughters. The eldest son died before my acquaintance with the family, I believe of consumption; both the other sons are now living in the State of Minnesota, I think, where they went years since on account of irritable lungs. They visit this State occasionally, but are feeble men, strongly inclined to phthisis, due I believe, to the incipient stage thereof. The daughters were named respectively, Mary, Lucia, Lizzie, and Martha. Lucia, first, after two years' suffering, died of con- sumption aged about twenty-three. Lizzie began to falter somewhat before the death of Lucia, but, in accordance with my advice, spent two winters—one in New Jersey and the other in Tennessee—with apparent benefit; lived some four years, and died aged about twenty. Two or three years subsequent to the death of Lizzie, Martha sickened in the same way, and died in about one year, aged about eighteen. About this time Mary, whose health had been, for some time, poor, began to fail rapidly, and died in about one year, aged 376 STATE BOARD OF HEALTH. [Jan. about thirty-five. Location. The house was on a hill, where all the surround- ing surface was high and dry—much more so than their neighbors'—no unusual dampness in the cellar, drainage good all around; house large, two-storied, high-posted; rooms large and airy. Mr. J. was an independent farmer, worth some eight to ten thousand dollars; seemed anxious to do all he could for his family; had a good orchard, with plenty of fruit,—diet same as farmers in the State usually have. Their animal food consisted princi- pally of pork of his own raising; family always comfortably clothed, the general surroundings were such as to conduce to happiness, nice flower- garden, etc., etc. The north and west sides of the house were protected by tall fir-trees, some thirty or forty fe.et in height, with thick foliage standing quite near the house—an artificial evergreen forest. How much this might serve to keep the back side of the building damp after a storm, might be a question. . The following table shows at a glance the history of the deaths by con- sumption in this family:— 1. Son; think died of consumption. 2. Son; now living in Minnesota, where he went because of an irritable state of the lungs ; he visits here occa- sionally; is a feeble man, strongly inclined to con- sumption. "f b th 3' S°n' Delieved to De ^ tiie incipient stage of consump- hard ^ioneers ti0n' and tlfefr^ar'i 4" Dau&nter Mary; d- of consumption, set. 35, after about n^+n ^__i „„ „ | a year's illness. 5. Daughter Lucy, d. of consumption after two years' ill- ness, set. 23. 6. DaugTiter Elizabeth, d. of consumption, get. 20, after seven years' illness. 7. Daughter Martha, d. of consumption, get. 18, after one year's illness. ,8. Daughter. All the sisters occupied the same well-ventilated room; but they succes- sively took care one of the other. Second Family. Wm. C. P----and wife, both living, aged about 55. The father of Mrs. P. is hvmg-88 years old-smart and active; can split wood, care for cattle &c • says he never was sick. The mother of Mrs. P. died some four or five'years ago of old age, about 82; had suffered but very little from sickness during her life; had borne some twelve children, most all of whom are now living none having died of consumption. B' The father of Mr. P. was a tough, hardy man, never sick; died accident ally, aged about 60. His wife lived until some five or six ye™ and dTed of old age, nearly 90. J 8 ag0' dJld cUed Wm.C.P. had six children, but one of whom is livino- „77aw * tion. The eldest, a daughter, now living • married I 7 f C°"J" • • • • , ,n. r ' . lxvUis> marned has borne one child- is now in incipient phthisis; she is some 30 years of asre All th« J * H \ tween the ages of 16 and 22. g AU the lest dled be" The house is situated upon sandu soil, at about +ila „.. i ents were long- lived. 1873.] STATE BOARD OF HEALTH. 377 i tion quite pleasant; soil so sandy that 'tis never wet, even during a storm; cellar was, as he says, never known to be damp—lo dry, in fact, that the fine sand on its bottom has been so like ashes, and so troublesome, that he has sincerely contemplated cementing it on that account. Has always been in comfortable circumstances, having inherited a farm from his father, a very parsimonious man; family has been comfortably clothed, and fed from the farm. Animal food used has been, like the former, of pork of his own raising ; varieties or extras never found their way to his table. W. C. P. & wife, both living, set. about 55. Both of the parents < of each lived to old age, strong and hale. Tabular Summary. Children. Grandchild. One daughter in consumption now, " All the rest (five in number) died of consumption between the ages of 16 and 22. The family lived on a dry soil; had little variety .of food; meat consisted chiefly of pork, from swine raised on the place. The sisters slept with one another. Third Case.—W. S----, of this town, a hardy, tough man, living, aged 65; wife about the same age, died a year ago of consumption; a very hard-work- ing woman, with no hereditary taint on either side; seven children; all but two have died of consumption; they are the youngest, but are now suffering from the same disease, aged 18 and 24. This family has lived until within a few years in comparative poverty. They may not have really suffered from the quantity of food, but I think they have from the quality; they have been coarsely, sometimes scantily, clad. The meat used by the family has been pork. .The house is situated on the top of a hill, higher than more fortunate neigh- bors ; location quite dry, but perhaps not so marked in this respect as the two previous ones, yet not wet; is dry more weeks of the year than most of their neighbors'. Deaths have occurred between 18 and 30 years of age. Two daughters have married and have children. These three cases occur to me at present as striking examples of phthisis occurring in dry and elevated localities in the absence of hereditary tenden- cies. One fact I should have stated; viz., that Mrs. J. and Mrs. S. were very hard-laboring women, particularly so during maternity, overtasking themselves almost daily, as they acknowledge. Possibly this may account in part for the feeble constitutions of the children. I subsequently wrote to Dr. M. asking more details in regard to the situations of the houses of these families, &c, and received the following reply :— I have gathered some facts concerning your inquiries, believing that theory—hypothetical—had governed full long enough. I have lately visited the family of W. C. P., of whom I wrote you, and found the cellar just as rep- resented, dry like ashes—sandy—never known to be wet soil around the build- ings—sandy—perfectly dry. Mrs. P. gives the following history of her family—prefaced, however, with the assurance that consumption is, and was unknown in her father's family, and also in that of her husband. 1st. Her eldest son died, in the West, from diseased lungs, aged twenty-four; as she could not see him after he sickened, she can tell but little concerning the 48 378 STATE BOARD OF HEALTH. [Jan. case. 2d. S., daughter, who commenced to fail, when sixteen, and died at twenty-two, being sick duViug the whole interval. 3d. F., daughter, died .in nineteenth year, after two years' sickness: P., son, died, aged 18, after one year's sickness: I., daughter, died, aged seventeen, after two years' sickness. The sisters slept with each other to quite an extent, but in an open chamber, , well-ventilated. P., always, or for years, roomed alone, and practised sleeping with windows lowered at the top. The mother feels sure that none of her children suffered from masturbation. When young were strong and healthy. All wore flannel next the skin—home-made—the greater part of the year- had plenty of pork and mutton, with milk, butter and eggs, more or less fruit, etc. Diseases-, in each case, seemed to commence in the throat. Lost much strength and became emaciated, in each case, before commencing to cough or expectorate; a great similarity in all the stages of each case. In case of J. family, the sisters each cared for the other successively, and as near as I .can learn, occupied the same room, well-ventilated and large; further than this I can add nothing concerning them to my former report. The S. family cared for each other, and probably some two occupied the same room most of the time. I long since embraced the opinion decidedly that consumption can be communicated, and in fact, is quite likely to be, where one occupies the same bed with a consumptive. A striking illustration has lately come under my observation : the patient died last week. He was born in Scotland, of hardy parents who moved to this country some eighteen years since. His mother gave me the following history:— " I am sixty-four years of age; my husband is living, aged sixty-six; neither of us has ever been sick ; have seven children, all hardy; never heard of con- sumption amongst the family connection, on either side. Eobert (deceased) was thirty-three years old—boss-weaver in woollen-mill—always hardy and - tough—married a Yankee, about three years ago—wife was sick when he married her—her family was consumptive. She had cough—after a few months, night-sweats, bad. Told Eobert to sleep in another room, but he said he would not leave her. In fifteen months she died. About six months before her death, Robert began to lose his appetite, and falter. I tried again to persuade him to take a separate room, but he would not leave his wife until about three months before her death, when it became necessary to employ watchers. He had then commenced to cough and sweat nights ; and con- stantly failed, till last night, when he died. He was. a strong constitution man until he took sick." One more case on this point: Mr. G., of a family of six children, 'all hardy —no consumption amongst connection—married a wife from a consumptive family; who, after a few years, sickened and died, after about eighteen months' illness. Mr. G. occupied the same room and bed during the first year of her sickness; his health then commenced to fail: got a cough—soon night-sweats—and died, some six months after the death of his wife- his being the only case of the kind iri his father's family. This case occurred early in my professional life, and made a decided impression upon my mind. Other cases I could enumerate, but these may be sufficient cause for my opinion as to the communicative quality of the disease. I will mention that, in conversation with Mrs. P. as above, she remarked that scarlet fever and diphtheria were the causes of the disease in her family As I attended them through these diseases, and knew that the same neigh- borhood was generally afflicted with those diseases at the time her children were—and some were much worse—I asked her why her neighbors' children 1873.] STATE BOARD OF HEALTH. 379 were not affected in the same way, some of whom were more severely at- tacked with those diseases, than her own children. She answered,. " I can- not tell." . Now, my dear sir, I repeat that I am firmly of the opinion, after about twenty years' observation in this consumptive district, that this disease is surely communicable, and it would be almost impossible to convince me to the contrary. Concerning the original exciting causes I am at a loss; am some- times inclined to blame scrofula for the whole thing, and if you, my dear sir, are satisfied that scrofula can be propagated by inoculation, why not by inhalation ? I believe it is so produced by inhalations of exhalations from the lungs and body—but this opinion is somewhat timidly expressed by an obscure country practitioner, striving for reliable information in any matter conducing to the physical betterment of suffering humanity. In connection with the use of pork, I submit the following statements from Rabbi Dr. Guinzburg, a gentleman well acquainted with the various congregations of Hebrews in this city. Under date of October 29, 1872, he writes, in answer to some questions I proposed to him, the following replies :— 1st. The number of Jews living in Boston, is about 5,000. 2d. There certainly have not died of consumption, during the last five years, more than eight or ten Jews in the various congregations. 3d.' It is very seldom that any Jew eats pork. Dr. G. adds, "In order to give you as good information as possible, I did not rely upon my own knowledge, but made particular inquiries of those whom I thought able to give me good information upon this subject." If Dr. Guinzburg's data be correct, they show a very great immunity from consumption on the part of the Jews, com- pared with the citizens generally, as will be seen by the fol- lowing comparison between these numbers and those procured from tHe Registration Reports published by the State. In the Report published 1869, page 64, we find that, for the five years preceding 1869, the annual average of deaths by consumption, was 338 for every 100,000 living. These data from Dr. Guinz- burg and the State Report, give the following table :— Proportions of deaths to 100,000 living. Jews,......... 338 40 380 STATE BOARD OF HEALTH. [Jan. These statements from Dr. Guinzburg are confirmed by the following letter from Dr. A. Haskins, of this city. Dr. Haskins is connected with one of the Jewish benevolent associations for the benefit of the sick. I sent to him similar questions and make the following extracts from his reply :— "I am generally employed in about sixty (60) families (Jewish). I have had these families under my care for two and a half (2£) years. During this time I have seen but one (1) case of consumption. I have averaged among these sixty families, about two visits daily. In my other Jewish practice, which is not inconsiderable, I have in this time (2|- years) seen two (2) cases of consumption. * * * * I am sorry I have no statistics whereby I could compare the two peoples (viz.: Jews and Christians). I can, therefore, give you only my impressions. I should say that I find consumption less frequent among the Jews than among the Christians; this would be my own impression without any data to fortify it." The following, from Dr. Waterman, also sustains the same idea: — Boston, November 2, 1872. Dear Sir,—Excuse my delay in answering your note. I can give you no statistics, and fear that my information will prove to be of a negative char- acter. I cheerfully give the following opinions, however. First, I have at- tended four charitable associations, numbering about 40, 50, 60 and 100 families. At present, I only attend one, containing 100 families, and on which I average a fraction over one visit a day. I have, besides, many private families among the Jews. Second and third questions.—I have at- tended but few cases of consumption, and I think the disease is not so prev- alent as among Christians. I have seen some quick and rapidly fatal cases. Fourth.—The older Jews invariably abstain from pork, and most of the younger ones, especially those from Germany; those born in this coun- try, also the English and Dutch, are not so strict, as a rule, in regard to this matter, nor in their observance of the fast and other holy days. I never knew a Jew to eat pork, as such, but I have seen them eat ham. I have met with two cases of tape-worm, in Jews, but know not whether the parasite came from pork, or beef, or other meat. Truly yours, Thos. Waterman. Certainly, as it seems to me, these replies from Rabbi Guinzburg and Drs. Haskins and Waterman, indicate that consumption is rather rare among the Hebrews of this city. I cannot think that any physician in New England practising among Christian families, can make a report like that of Dr. Haskins, viz..: That in a practice so extensive as that which Dr. II. has had, and extending over two and a half years of 1873.] STATE BOARD OF HEALTH. 381 time, only three cases of consumption should have been pre- scribed for. This apparent infrequency of consumption among the Jews, induced me to examine further, and a friend calls my atten- tion to the fact that this people has not suffered from various diseases as other sects have. For example, they suffered, in the Middle Ages, but little from the plague : the epidemics of typhus in 1505 and 1824 troubled them but little; croup is also said to he rare. Boudin,* (from whom the above facts are obtained) gives the following for the relative liabilities of Schlaves, Germans and Jews, in reference to "plica." 29 ill, in 1,000 of Schlaves. * 18 ill, in 1,000 of Germans. 11 ill, in 1,000 of Jews. On the contrary, they are more afflicted with idiocy and in- sanity, in Denmark, as follows :— 3.34 insane or idiotic among Catholics. 5.85 insane or idiotic among Jews. Unfortunately, Boudin says nothing in regard to their lia- bility to consumption. This subject is altogether too wide for further remarks, at this time, but whilst these pages are in press my attention is called to the following facts mentioned by Dr. Stallard :—f " The mortality of Jewish children under five years in Prussia is much less than of those in Catholic families. * * There is no hereditary syphilis, and scarcely any scrofula to augment the mortality. * * The mother undertakes no work that takes her away from her children. * F The average duration of life at Furth is twenty-six years amongst the Christians and thirty-seven among the Jews. * * At Frankfort, the Christians average thirty-six years and eleven months; the Jews, forty-eight years and nine months. In Prussia, the Christian population requires fifty-one years to double itself, but the Jewish population will double itself in forty-one and a half years. * Traits de G6ographie et de Statistique Medicales, et des Maladies Endemiques. Paris. Bailliere, 1868, vol. 2, p. 141. t London Pauperism amongst Jews and Christians, &c. By J. H. Stallard, M. B., London. Saunders, Otley & Co., 1867. London. 382 STATE BOARD OF HEALTH. [Jan. Wakefield.—Intemperance, according to my observation, causes death by apoplexy, hepatitis, ascites and anasarca, combined with hepatitis or ery- sipelas, &c. Jarvis— Some years ago when I was in, practice, I had complete knowledge of all the ailments of a considerable number of families. I divided them, or rather their members, into two classes—the temperate and the intemperate —and compared their number of days of sickness for two or three years. I added to the intemperate sickness, all others caused by intemperance (as in- juries to passengers, caused by overturning of stage-coach, driven by a drunken stage-driver). The result was 14 per cent, more days, almost, per person, among the intemperate. * Haskell.—There is one cause of consumption, which, I am confident, plays an important, though an insidious part, to which I have never seen any allusion made.* I have in mind at least four families, and more single persons, who were too proud to acknowledge, and too fastidious to endure, the sulphur purga- tory, and who have harbored and nursed the itch until it became chronic, and either the irritation of the skin, or the roundabout methods they adopted. to deaden it, have so broken the general health that they have rapidly gone into consumption. I have a strong impression that this odious evil is a fre- quent precursor of the more fatal malady. In the case of many a college student, whose untimely death has been lain at the door of hard study the itch has been robbed of its share of credit. Collins.—I am a native of America; was graduated in medicine in '43; was connected with the public medical institutions of the city for ten years; served three years in the hospitals. In 1849 my health gave way, and con- sumption was developed. I left the city for the Island of Madeira, where I spent the winters of '49 and '51, four months, on the island. I then went to Spain, France, and England; was abroad one year. On my return I de- sired to find some dry, elevated region, where I could breathe better and cough less than in New York city. Having tried various parts of the United States, I finally selected the south-west corner of Massachusetts, eighty miles from Long Island Sound, 850 feet above tide-water, protected on the north and east by a beautiful mountain range. The Housatonic River flows rapidly through this portion of the valley. No swamps, nor low ground; an abundance of pure, soft water. Now this is the same relative protection that the city of Funchal (Madeira) has, and Malaga, Spain, and Nice, in the north- west part of Italy. The natives here (in Great Barrington) are healthy, and I very seldom meet with a case of consumption which originates in this region. I have been here twenty years, and have long since gotten rid of my pulmonary trouble. The following letter, from Dr. Bartlett, suggests the impor- tance of trying to get a radical change of climate or of telluric influences, by even a small change of location. Many dread the exile from home required by a Southern or Western resi- * Unless the psora of Hahnemann be an exception, which he makes the diseases. ^ 1873.] STATE BOARD OF HEALTH. 383 deuce; many more are too poor to travel; but very many may be able to move the short distance from a wet place to a dry, warm slope. And Dr. Bartlett's letter suggests hope to such:— Chelmsford, February 27, 1872. Dear Sir :—Knowing your interest in the influence of locality upon tuber- cular disease of the lungs, I have thought that it might not be uninteresting to you to receive the history of a case which I have been watching for some years, in reference to this point. A young lady of this town, whose mother died of rapid tubercular disease of the lungs (said to be congenital), and whose father died from pulmonary abscess, resulting from pneumonia, the re- currence of the abscess being frequent for seventeen years, manifested in a marked manner. All those indications which we at times notice in the young female seemed to show that her life would early be brought to a close, as her mother's had been. So strong were these indications that I earnestly advised her step-mother not to sanction an early marriage; but love proved stronger than preaching, and she married and went to live upon the highlands, known here as Robin's Hill. The result has been that all the symptoms of phthisis have entirely disappeared, and it would be difficult to find a healthier woman than she is now, after having borne three robust children. In the course of my inquiries I have learned one fact which it might be desirable to know, viz.: that no case of consumption has ever occurred in any of the families living about this highland. I think that many families, living in dread of the ravages of that terrible destroyer, might here find robust health, instead of being driven away from home to Minnesota and other wild regions of the West. At any rate, I think the experiment might be worth trying, and with every prospect of success. I know that in many cases patients dread the going away from home and its comforts, and if we have at our doors places where health and home may both be secured, at a cheap rate, many a life may be saved with- out the necessity of an expensive and tedious journey. Yours, with respect, John C. Bartlett. I submit, almost entire, the following, from one of the oldest and most respected physicians of Maine :— Topsham, Me., November 19, 1871. Doctor Bowditch : Dear Sir,—Since receiving circular of July I have reflected much upon the queries and suggestions therein proposed, but am fearful of my ability to impart any decided benefit to the cause you are en- gaged in, by any practical responses from my own experience. I.have resided between fifty-one and fifty-two years in this town. In that time I have wit- nessed almost every form of consumption, and almost everything else which usually falls to the lot of a medical man. Beside my home practice I had a tol- erably wide circle of consultations in Lincoln, Cumberland, and several other counties upon the eastern shore, and the regions watered by the Androscoggin and Kennebec Rivers. I feel strongly impressed with the belief that con- sumption, typhus and typhoid fevers are, in proportion to our population, much diminished from what they were half a century ago; so, too, are colic and cholera morbus. So far as my experience and personal obs^rva- 384 STATE BOARD OF HEALTH. [Jan. tion go, consumption is far more frequent among the females than the males. The cause of this, no doubt, is to be looked for in the different habits of the sexes, chiefly in regard to out-of-door life, and also to the stronger sympa- thetic and emotional character of women, especially young women. I have been looking over my notes and diaries for a long time back, and I find the general tenor of my belief to be, in relation to the causes of consumption and its remedies, all in one direction. As Dr. Bowditch suggests a wish to re- ceive " bits of family and personal history," I will, as briefly as possible, give that of the P. family, of this town, a name well known in the Atlantic States, North and South, and in Western and Northern Europe, wherever a cotton- ship was able to discharge her freight. It will epitomize a large class of cases of consumption. About one hundred and twenty years ago a young married man moved into town, and there were born to him, I think, five sons and three daughters; the sons were R., A., T., J. and D. The sons all lived and died in town, and in the immediate vicinity of where they were born : one of the sisters also; the two others lived and died in the adjacent town of Bowdoinham. I am not positively cognizant of the mortuary record of the families of the two sisters who lived out of town, but I am of the opinion that two or three cases of consumption occurred among them. The following table, drawn up from the verbal statements of the writer of the letter, presents a more distinct view of the hereditary character of the process of consumption in this family than can easily be obtained from the letter itself:— •a 2 O Children. Grandchildren, habits, conditions, &c. § O > w eS a c3 o tD e3 Eh fc* =S S i—i t3 c « < °5 2 c O a a H Robert died upwards of 80, of old age. ." Acton, died, not con- ) sumption, . . ) Thomas, no consump-tive signs, died at 80, of cancer; wife died' of consumption, Joseph, drowned, . < David, died, consump-1 tion, ... .1 Daughter, . . ."] Daughter, . . . j> Daughter, . . .J Son, died of consumption. Son. , Son. Daughter (Mrs. Hunter), died of consumption, .< Daughter. Daughter. ^ Several children, none consumptive. Son, cough, haemoptysis, &c, but lived to 82, active; ) his wife grew stronger child-bearing, . . . $ Son, 82, alive and well. Son, asthmatic all his life, alive at 71. Daughter, single, died of consumption. Daughter, married, died of consumption. Daughter, married, died of consumption. Daughter, single, died of consumption. Son, ) twms 5 consumption. Daughter, ) ( consumption. Daughter, typhoid fever. Daughter, puerperal fever. Son, consumption, married cousin. Son, sea-captain, alive, age 65. About the precise history of two, not much known, but thinks one or two cases of consumption among them. No consumption reported in the third. Great Grandchildren. Twelve children, 5 died infants, 7 adults. One daughter far advanced in con- sumption, married cousin, both hus- band and wife died of it, . All his children alive and well. One man child alive and well, age 50. Great Great Grandchildren. Daughter consumption. Daughter consumption. GO 00 H > H o o o f H GO 386 STATE BOARD OF HEALTH. [Jan. " The summing up of the teachings of these three generations of the P. family is as follows : First. The first question that naturally presents itself, is, Does this family history furnish evidence of hereditary predisposition to consumption ? I would answer, Yes. Perhaps some would cavil at this, and ask, Why has not the family of A. P., with a larger family of sons and daughters, contributed to this consumptive catalogue, as well as those of his brothers, Robert Joseph, Joseph Thomas and David ? It is not nec- essary, I take it, that every individual or every family should have such an obituary to establish the generally received truth of what is here affirmed. It has been my lot to have resided more than half a century in a community, where, eighty-five years ago, a family lived, and intermarried with cousins, in which insanity had shown itself. Among their descendants we find many families totally exempt from this terrible inheritance ; while every now and then a case crops out in a branch which for generations, had not produced a person who has had insanity. I do not, of course, deny that other elements enter into the problem, and which have had a vast control- ling power in bringing on or working out consumption,—moral causes, for instance; particularly, depressing influences. In T. P.'s family, the mother lived to see her sons come to manhood's estate: of the four daughters, all of them were in early womanhood at the decease of the mother,—the oldest was about twenty-four, the second, twenty-two, the third, eighteen, and the youngest, fifteen. The mother was a strong-minded woman, and in raising up and training her family, had the larger share of parental influence. Her death was, of course, a heavy blow. The boys, however, were just going out into the world, and mingling energetically in its busy scene; and. by this means were somewhat removed from that extreme poignancy of grief at her death. Far different was the case of the daughters,—trained up as they had been, and learned to look and lean affectionately upon their mother for counsel, for sympathy and support, they felt her death as an irreparable loss, and so it was in truth; and not unlikely from that day they began to droop. The old homestead, to be sure, was still the seat of a generous hos- pitality ; but to these gentle spirits, their world was the old hearthstone and the family circle; but what were these without their mbther ? And their brothers, also, gravitating, from other attractions, into different spheres. These girls, when I first knew them in 1820, were neither sickly nor scrofu- lous,—they were smart, energetic, and, to all appearance, healthy. The eldest possessing the good housekeeping capabilities of the mother, took her place in the family. The second daughter was the most fragile of the sisters ; tall and graceful, her features were somewhat pallid perhaps. The third daughter (she who died first) was accounted the most intellectual. Four months before her death she was, to all appearance, healthy; her facial expression was good. The roses and the lilies showed a fair admixture • and her activity and muscular movements betrayed no ominous indication of disease. The first and second daughters, Dr. N. Smith visited with me sev- eral times ; this third daughter, I believe I mentioned, became brain-affected I presume from tubercular deposit. The youngest girl, had it not been for the sad death of her sisters, would, I think, have been the most brilliant. Second. As to the therapeutical department, if I may say a few words. It would seem as if the most exhaustive efforts have been made to discover the means, as far as the Materia Medica is concerned, to combat consump- tion and to cure it. The four quarters of the globe, and every island ocean and sea (save the yet unrevealed open Polar sea) have been ransacked for material aid. But for long, physicians have been much inclined to abandon 1873.] STATE BOARD OF HEALTH. 387 drugging. The Homoeopaths still professedly have faith in copious dilu- tions ; the Hydiopaths in cold water: then there are the Mesmeric doctors, the vegetable Eclectics and the Electric experts in a medical way; all of these have pushed their claims for success, but the more intelligent the masses of our people become, the less will their faith be in these interested claimants for public notoriety. But aside from such as rest their claims for skill, upon a collegiate diploma, there is a vast horde of disreputable men who have entrenched themselves around the Patent Office, and who are con- stantly sounding their trumpets in the columns of every newspaper. There are very many thoughtful men, outside, and in the profession, who strongly believe that the way out of this labyrinth of professional mysticism aud superstition will yet be pointed out by some philosophical and practical medical man. Perhaps the time is far distant when the correct pathology of what we call consumption, will be determined and accepted. But may: not the laws of the imaginary Hygeia become so truly and faithfully estab- lished as to demonstrate the sources of danger, and thus enable one, who devoutly looks to his pathways in life before he leaps, to escape the danger of destruction? Some, perhaps many, of our recognized diseases may dis- appear; and new ones takes their places, perhaps, so that (if I may use the terse and sententious language of Bunyan) while " one escapes to die, another is taken to live." Very respectfully, Your humble servant, James McKeak. The following facts and opinions are contained in a letter from Dr. C. G. Rothe, of Altenburg, in Saxony, Germany :— Of twenty-seven cases of pulmonary consumption which came under my oare during the la6t two years, there were Caused or promoted by hereditary influences,.....4 cases, u (i " • " trades (1 miller and 4 cigar-makers), . . 5 " u u it " exposure to cold and damp weather, and by damp and cold dwellings in tenement- houses, void of sun and air; and in shops, 18 " The latter 23 cases being of the age from 21 to 46 years, all of healthy origin and of good health up to the time of the onset of the disease. All of them were taken suddenly by a severe, obstinate catarrh, complicated with fever, want of appetite and emaciation, while the physical signs showed chronic inflammation of the surrounding portions of the lungs, mostly in the upper parts, but in some cases in the lower lobes, while the tops remained intact. This inflammation used to spread more or less rapidly over the whole side of the infected lungs, sometimes over both, and ending, in all cases but four, in the " caseous degeneration" of the parenchyma of the lungs and death after three to six months. In four cases the progress of the dis- ease has been checked to the present day, through the inhalation of carbolic acid with tincture of iodine; in three of them all the physical signs have grad- ually disappeared, and their health seems to be totally restored ; the fourth, a married woman, 32 years old, being constantly exposed to damp and cold in a 388 STATE BOARD OF HEALTH. [Jan.'73. hat-maker's shop, had two relapses, and is now, two years after the first severe attack, lying down hopelessly. The inhalations of the carbolic acid had no beneficial effect on the hereditary cases of tuberculous consumption ; and in those cases of inflammatory origin, where miliary tubercles set in, in the course of the disease, and when; the disease spread below the insertion of the bronchial tubes, internal remedies such as cod-liver oil, hypophosphates, all proved of no avail. Drunkenness, sexual indulgence, and overstudy have not been noted amongst the causes of the disease. In children the disease has not been observed, except in one girl three years of age, who, two months after a severe attack of diphtheria, of which she was cured by the carbolic-acid treatment, died after nine days' illness with all the signs of acute tuberculosis. I have excluded this case from the above table because the denial of the post-mortem examination left the diagnosis uncertain. Among the four cases of hereditary tuberculosis there is one of a pregnant woman, in whom, during the stage of pregnancy, the disease developed itself with great rapidity, progressing, at the same time, in the lungs and larynx, so that she was for six weeks totally aphonic. She died three days after her delivery. I am of the opinion that much can be done towards the prevention of this fearful disease by close attention to every " slight catarrh," at its first onset. C. G. Rothe. Altenburg, October 31, 1871. • I