CONSUMPTION: 
HOW TO PREVENT IT AND HOW TO 
LIVE WITH IT. 
ITS NATURE, ITS CAUSES, ITS PREVENTION, AND THE MODE 
OF LIFE, CLIMATE, EXERCISE, FOOD, CLOTHING 
NECESSARY FOR ITS CURE. 
BY 
N. S. DAVIS, Jr., A.M., M.D., 
IfMML— 
PROFESSOR OF PRINCIPLES AND PRACTICE OF MEDICINE, CHICAGO MEDICAL COLLEGE) 
PHYSICIAN TO MERCY HOSPITAL) MEMBER OF THE AMERICAN MEDICAL ASSOCIATION, 
ILLINOIS STATE MEDICAL SOCIETY, CHICAGO MEDICAL SOCIETY, CHICAGO 
ACADEMY OF SCIENCES, ILLINOIS STATE MICROSCOPICAL SOCIETY J 
FELLOW OF THE AMERICAN ACADEMY OF MEDICINE) AUTHOR 
OF A HAND-BOOK ON “ DISEASES OF THE LUNGS, 
HEART, AND KIDNEYS.” 
F. A. DAVIS, PUBLISHER, 
1891. 
Philadelphia and London : Entered according to Act of Congress, in the year 1891, by 
In the Office of the Librarian of Congress, at Washington, D. C., XJ. S. A. 
F. A. DAVIS, 
Philadelphia, Pa., U. S. A.: 
The Medical Bulletin Printing House, 
1231 Filbert Street. PREFACE. 
I have found it difficult in brief conversations 
to impress upon consumptives the necessity of 
rigidly executing certain sanitary rules, whose 
fulfillment is essential to successful treatment of 
their disease. This is especially true of patients 
who live at a distance and are seldom seen. I 
therefore prepared for my patients a series of 
i'y gienic rules, with brief explanations of the 
effect of their execution. From these rules this 
small volume has grown. I find that treatment 
is not persistently pursued unless a patient fully 
appreciates the chronic character of consumption 
and the need of advice and treatment for years, 
and especially when the disease is least active. 
Consumption is the greatest plague of our 
civilization. I have felt that the public should 
he better informed as to its nature and causes, for 
many of the latter can be avoided. Consumption 
can often be prevented when it threatens. Its 
mortality has been lessened in some communities 
by better hygiene, and, unfortunately, increased 
in others by bad hygiene. I believe that it could IV 
PREFACE. 
be reduced everywhere to very moderate limits if 
the bodies of children and growing youths were 
properly developed physically, and if the hygiene 
of our homes, our offices, and our factories was 
more perfect than it is. The hygienic changes 
that are essential can only be effected by a dif- 
fusion of knowledge in regard to the disease. 
Descriptions of the modes of action of climates, 
of forms of exercise, of kinds of labor, etc., are 
so scattered through medical literature that, I 
hope, by bringing together in this volume the 
essentials of them all, it will be useful to prac- 
titioners of medicine as well as to consumptives. 
In that part of this brochure which discusses 
climatology I have not tried to describe individual 
health resorts, but to describe clearly how the 
various climates act upon the human body, and 
especially when the lungs are diseased, so that a 
physician who understood the condition of his 
patient’s lungs and general health could choose 
the climate that would be best adapted to the 
individual’s case, and so that the consumptive 
could better comprehend what was hoped from a 
climatic change. 
In describing the nature of consumption I have 
limited myself to tubercular disease of the lungs. PREFACE. 
V 
The lungs may be destroyed by other diseases, 
but what is commonly known as consumption is 
so uniformly tubercular that in a popular essay 
the other forms may be neglected. 
We hope for much from Koch’s treatment of 
tubercular diseases, which has been announced 
since these pages have been prepared for the 
printer. Eut prevention of consumption must 
be accomplished as before ; sufferers from it must 
obey the same hygienic laws ; contraction of the 
chest must be corrected as before, and climatic 
changes will probably be as much needed to 
promote prompt recovery of strength. 
N. S. Davis, Jr. 
65 Randolph Street, Chicago, 
November 20, 1890. TABLE OF CONTENTS. 
CHAPTER I. 
Nature of Consumption, 1 
Its geographical distribution. Definition. Bacillus tuberculo- 
sis ; proof of its causative action; presence in sputa; in 
various organs ; where it will grow ; exists in the air. Mor- 
tality of individuals closely confined. Access to the body 
by inhalation ; by food; by inheritance. 
CHAPTER 11. 
Nature’s Means of Preventing Infection and 
Predisposition, 15 
Predisposition inherited. Acquired : by imperfect ventila- 
tion ; by insufficient exercise; by nou-nutritious foods; by 
other diseases; by damp ground. 
Prevention of Consumption, .... 29 
Not contagions. Destruction of sputa. Reside on dry soil. 
Pure air. Out-door work. Exercise. Avoid overexertion. 
Clothing. Bathing. Climate. Need of systematic phys- 
ical training for children. 
CHAPTER 111. 
CHAPTER IY. 
Hygiene for the Consumptive, . . . . 43 
Varieties of consumption. Need of pure air. Where found. 
Out-door life. Room ventilation ; temperature. 
vii; viii 
TABLE OF CONTENTS. 
CHAPTER Y. 
Hygiene Continued, 51 
Climate, ideal. High altitudes ; their characteristics ; modes 
of action. Need of sunshine. Indications and contra- 
indications for high-altitude residence; duration of. Col- 
orado and Manitou Springs. Swiss Alps. 
CHAPTER YL 
Hygiene Continued, 71 
Climate. Low altitudes. Cold and dry: Minnsota, etc. Warm 
and dry: Texas, Southern California, Mediterranean coast 
resorts, Arizona. Mode of action of dry climates. Moist 
climates; Georgia, etc. Florida, Teneriffe, Bermuda, Adi- 
rondacks. Ocean climate; characteristics; modes of 
action. Indications and contra-indications. 
Hygiene Continued, 89 
Exercise. General exercise: mode of action; amount; 
kinds; time. Special exercises : for stooped neck; rounded 
shoulders; for small chests,—respiratory gymnastics, lung 
ventilation. Contra-indications and indications. 
CHAPTER YII. 
Hygiene Continued, 109 
Clothing : kind ; weight; chest-protectors ; corsets. Mental 
states. Diet. Administration of food. Milk, vegetable, 
and meat diet; indications for each. Malt extracts. Oils. 
Codliver-oil; when contra-indicated and indicated. Alco- 
holics. 
CHAPTER VIII. 
Treatment for Consumption, . . . .126 
Cough. Pain. Night-sweating. Haemorrhages. Evidences 
of improvement: gain in weight; lung-capacity; slow res- 
piration and pulse; cessation of fever, of cough. Need 
of medical treatment. Duration of consumption. 
CHAPTER IX. ERRATUM. 
Page 80, last line; the words Tampa Springs 
should be Tarpon Springs. 
CONSUMPTION: 
HOW TO PREVENT IT, AND HOW TO 
LIVE WITH IT. 
CHAPTER I. 
Nature of Consumption. 
Consumption is world-wide in its distribution, 
and is always present. It is a veritable scourge, 
and is vastly more destructive of human life than 
the dreaded epidemics of cholera and yellow fever 
that occasionally sweep over our land. On an aver- 
age, one in seven of all persons who die succumb 
to consumption. In certain localities this average 
is much less and in others much greater. Con- 
stant familiarity with the disease has made the 
world tolerant of it, as the world is not of epi- 
demics. 
A simple or untechnical definition of consump- 
tion cannot be given. It is seen by all to be 
usually a slowly wasting and destructive disease. 
Its most characteristic symptoms originate from 2 
CONSUMPTION. 
the lungs. It is a disease that in its more 
advanced and well-marked stages can be readily 
recognized by a physician. Unfortunately, when 
in this stage the physician’s art will enable him 
only to relieve suffering and prolong life, and 
rarely to effect a cure. Its insidious onset is only 
recognized by the most painstaking and careful 
examination, and often only by the prolonged 
study of individual cases. It is, however, all 
important that the onset should be recognized, as 
it is the most hopeful period for the inception of 
curative treatment. 
The possibility of transmitting consumption 
from animal to animal by inoculating a healthy 
one with some of the juices or with some of the 
substance of the affected organs of one diseased 
has been studied for half a century and was long 
since decided affirmatively, but the exact ingre- 
dient which made this transmission possible was 
long unknoAvn. The discovery of this materies 
morhi was announced by Robert Koch in 1882. 
It was proven to be an exceedingly minute fungoid 
substance. It can be grown upon the serum of 
blood after the latter has been carefully purified 
and solidified. For example, if a minute particle 
of tubercular or consumptive tissue is placed on NATURE OF CONSUMPTION. 
3 
the properly prepared blood-serum and kept at a 
temperature of from 98° to 100° F., there will he 
observed, in about ten days, around this particle a 
few minute gray scales. To prevent the con- 
tamination of the blood-serum and the coincident 
growth of other organisms upon it whose germs 
might be floating in the air, it must be kept in 
a tube plugged with cotton, which is found to 
filter the air of all dust and germs. While this 
is the commonest, other contrivances have been 
devised to prevent the contamination of media 
in which germs are to be developed. A fragment 
of one of the gray scales that have grown can be 
placed in a second tube similarly prepared, and in 
another ten days the scale-like particles will have 
become numerous. Thus a long series of trans- 
missions and artificial growths can be obtained, 
and ultimately they will become absolutely uni- 
form in character. By a careful selection of 
the particles to be transferred from one tube to 
another they will be separated gradually from 
any other growths that may have been in the 
first tube-culture. Finally, hr this way a growth 
of one kind of fungus only will be obtained. It 
was by this process that Koch first separated 
the germ causative of consumption from all 4 
CONSUMPTION. 
others. After a pure culture of the consumption 
germ was thus obtained it was found that it' a 
little of it was mixed with water and injected 
under the skin or into the lungs of rabbits, 
guinea-pigs, or mice, or sprayed into the air that 
they breathed, there was uniformly produced in 
them the changes in their organs which phy- 
sicians recognize as tubercular or consumptive. 
If the substance which can thus produce con- 
sumption is examined under the microscope it is 
found to consist of countless minute rods from 
•goVm 12700 inch ill length. These reproduce 
themselves by spores which form within them. 
The rods are known by the technical name of 
bacilli tuberculosis. 
Belief in their power to cause consumption is 
based upon, first, their uniform occurrence in the 
tissues that are tubercular or consumptive and in 
those of no other disease; second, their power of 
producing the disease in other animals inoculated 
with them; and, third, their uniform occurrence 
in the diseased tissues of the animals thus made 
sick. We know that the seed of the poppy pro- 
duces the poppy-plant and flower; for, first, we 
uniformly find the seeds in the flower; second, 
we uniformly find these seeds when planted pro- 5 
NATURE OF CONSUMPTION. 
ducing similar poppy-plants and flowers, which 
in turn also bear seeds. Furthermore, from the 
poppy-plant opium can be obtained, and, when 
administered to man, it produces its somniferous 
effects. The reasoning by which we are con- 
vinced that the poppy-seed produces the poppy- 
plant, and thus opium, which is sleep-producing, 
is the same as that by which we are convinced 
that the bacillus tuberculosis produces a peculiar 
kind of inflammation in the tissues of the body, 
and especially in the lungs, which in time consti- 
tutes consumption. 
The little living rods can be found not only in 
the diseased tissues, but also in the secretions 
from them; as, for instance, in sputa which is 
formed in a consumptive’s lungs.* This fact is 
of the utmost importance, for, by an examination 
of the sputa, it is often possible to say definitely 
whether a given person is consumptive or not 
before other characteristic signs of the disease 
have developed. It is also of the utmost impor- 
tance that a diagnosis be reached as early as 
possible, for it is in the beginning of. the disease 
only that we can hope with much certainty to 
effect a cure. Unfortunately, such an examination 
requires practice and training in the use of the 6 
CONSUMPTION. 
microscope, which as yet only a small proportion 
of physicians have acquired. If at the first ex- 
amination no bacilli can be found we cannot 
affirm that none exist, especially if there are other 
signs which suggest the disease, for they may be 
present in very small numbers, and may only be 
found by repeated search. The importance of 
such an examination is great in cases like the 
following, which are numerous: A young man 
of twenty consulted me because he was losing 
flesh and because of a persistent dry cough. 
Though slender and slightly pale, he was ambi- 
tious and very little debilitated. As far as lie 
knows, consumption has not occurred in his 
family. The question at once arose, Is this a 
mildly persistent bronchitis in a person whose 
sedentary life (a clerkship) has caused a moderate 
general debility and loss of flesh, or is it the 
beginning of consumption of the lungs. A most 
careful examination of the lungs through the 
chest-wall afforded no positive sign of consump- 
tion, but a microscopical examination of the sputa 
demonstrated the presence of the bacilli tubercu- 
losis. A diagnosis of incipient consumption had 
to be made. 
Another patient was a gentleman of twenty- NATURE OF CONSUMPTION. 
7 
eight, in good flesh, of good color, full of vigor, 
and without any feeling of ill health. lie was 
surprised while walking briskly to business by 
having well in his throat a mouthful or two 
of pure blood, and by coughing out a little more 
during the next few minutes. He had had no 
cough, though somewhat subject to colds. The 
haemorrhage caused him alarm, as his mother 
died of consumption. A careful examination of 
the lungs did not demonstrate the disease. In 
the two first examinations of the sputa no bacilli 
could be found, but in the third and rarely in 
subsequent examinations which were made dur- 
ing the following two months they were. Unfor- 
tunately, neither of these persons could take ad- 
vantage of the most favorable conditions for the 
prevention of the extension of the disease. In 
a few months an examination of the lungs 
showed plainly its progress, which was steady, 
but slow. 
Consumptive, or, as they are more technically 
called, tubercular changes, may occur in any of 
the organs of the body. The lungs are many 
times the most frequently affected; the intestines 
and the coverings of the brain are often attacked, 
and the liver and kidneys and bladder may be 8 
CONSUMPTION. 
involved. In children, the glands about the 
neck are especially liable to be affected by 
tubercular inflammation. They swell and often 
matterate. These swellings are usually described 
as scrofulous. The bacilli, the cause of these 
various diseases, arc to be found in all the affected 
tissues, and in the secretions or discharges from 
them. 
Not only may other tissues than the lungs be 
previously and independently affected, but often 
when the disease begins in the lungs it extends 
to other organs; as, for instance, to the throat, 
causing hoarseness and pain on talking, and 
especially on swallowing; or to the intestines, 
producing diarrhoea that is more or less severe 
and often uncontrollable. 
The bacillus tuberculosis cannot grow outside 
of a living, warm-blooded animal, except when 
artificially grown in the laboratory. It requires 
a degree of temperature and a kind of nutriment 
that is not found elsewhere. Therefore, although 
" O 
immense numbers are scattered broadcast by the 
sputa of consumptives, they do not multiply after 
they leave the living body. Unfortunately, 
although under these circumstances they do not 
grow, they retain, for many weeks after they NATURE OF CONSUMPTION. 
9 
have been dried, their vitality and their capa- 
bility of growth and reproduction, if they regain 
a lodgment in a living body. In all thickly- 
settled regions, the dust of the dwelling-rooms 
of consumptives and of crowded places contains 
some of the bacilli, and is, therefore, a possible 
source of infection. Indeed, as consumption 
exists in all lands, in all parts of the world, to a 
greater or less degree, this bacillus is übiquitous, 
and, at times, present in the dust-laden air of 
every inhabited place. 
It is most abundant where people are most 
crowded together, and least abundant where the 
inhabitants are fewest or isolated. We therefore 
find the mortality among those who are crowded 
together and confined, as among prisoners, ex- 
ceedingly high. For example, at Chester, Michi- 
gan, the percentage, as compared with deaths 
from all causes for two years, Avas 31; at Still- 
water, Minnesota, during the same time, the 
average was 24.6; at Jefferson City, New York, 
at the same time, it was 55. In 1877, at Joliet, 
111., it was 77; and during four years in Austrian 
prisons the average was 61. The mortality from 
it in the race at large is only about 14 per cent., 
or 1 death in 7 from all causes. Almost equally 10 
CONSUMPTION. 
high with the percentage in prisons is the per- 
centage in some European convents and closely- 
crowded, badly-managed schools. On the other 
hand, there are many rural districts which are 
comparatively exempt. A still greater freedom 
from the disease is found among the inhabitants 
of mountains and elevated plateaus, and among 
those who live at sea or upon small islands con- 
stantly swept clean by the ever-present and vary- 
ing sea-breezes. These two atmospheres—that 
of high elevations and that at sea—have been 
found, by analysis, to be almost absolutely free 
from all forms of micro-organisms and germs ; in 
other words, to be unusually clean. 
How does the bacillus gain access to the human 
body'? From what has already been said, the 
chief source of infection will be surmised to be 
by inhalation of confined and impure air, which 
has been contaminated by the dried and pulver- 
ized sputa of consumptives. This, to-day, is 
admitted by almost every physician to be the 
chief, and almost the only, source of infection. 
We cannot say that the disease may never 
spread by the direct contact of one individual 
with another; but if it does, such infection is 
exceedingly rare. Rare instances are recorded 11 
NATURE OF CONSUMPTION. 
of husband or wife apparently taking the disease 
one from the other. Somewhat more frequently 
have we evidence of children becoming contami- 
nated from their parents. But in these cases, it 
must be remembered that the vitality of the 
person who possibly acquires consumption in 
this way is lessened, sometimes, by previous sick- 
ness, or by night-watches and broken sleep, little 
exercise out-of-doors, constant mental depression, 
and consequent lack of appetite, imperfect diges- 
tion, and, therefore, lowered nutrition. Besides 
being thus predisposed, the individual is con- 
stantly exposed to the inhalation of air contami- 
nated by the drying sputa of the sick one. It is 
quite as likely, therefore, that in the majority of 
cases which have been reported as caused by 
direct contact with the consumptive person, the 
disease originates otherwise. Indeed, by an 
analysis of air expired by consumptives, the 
bacilli are found to occur in it with great rarity. 
In hospitals where the disease is constantly 
treated it is not found to occur among the nurses 
and resident physicians more frequently than 
among the inhabitants of the vicinage. The 
statistics of the great Brompton Hospital for con- 
sumption is quite conclusive on this point. We 12 
CONSUMPTION. 
may therefore legitimately conclude that there is 
practically no danger of living and being with 
consumptives, so long as we maintain our own 
health by sufficient exercise out-of-doors and by 
sufficient wholesome food. 
It has been demonstrated that what is known 
as pearl-disease among cattle is the same as con- 
sumption in man. Fortunately, only a very 
small percentage of cattle are thus afflicted. By 
feeding the raw, diseased meat to other animals, 
consumption has been transmitted to them. 
Tubercular trouble sometimes affects the udders 
of cows, and the bacilli can then he found in the 
milk. Such milk when fed to other animals will 
often cause infection. It has been asserted that 
in a proportion of trials with milk that was taken 
from tuberculous cows in whom the udders were 
not affected, and that was fed to other animals, 
the disease was transmitted to them. From this 
latter fact we may deduce a lesson which the ex- 
perience of physicians had taught them even before 
such experimental proof existed. A consumptive 
woman should not suckle her children. By doing 
so she may transmit the disease to them. It is 
rare, indeed, that consumption is caused by food, 
and especially in any others than nurslings. For NATURE OF CONSUMPTION. 
13 
the latter there is danger in the milk of con- 
sumptive mothers and of consumptive cows from 
whom it has unwittingly been supplied. Only a 
small proportion, however, of children who are 
fed from such milk are affected, for, if their di- 
gestion is good, the materies morhi will almost 
certainly be destroyed before it can gain lodgment 
in the tissues. Among maturer persons little 
meat is eaten, and none should be, that is not 
well cooked. Cooking destroys the life of germs. 
Stomach digestion, if healthy, also destroys such 
infectious substances; and badly infected meat 
rarely finds its way to the table, as tubercular 
disease in cattle is not very common. The chances 
of infection by the stomach or intestines are, there- 
fore, few. It is, however, right that, as has been 
ordered in some cities, all animals to be slaughtered 
for the table should be subjected to the most 
rigorous scrutiny by experts; and tuberculous 
meat should be destroyed. 
That consumption clings pertinaciously to cer- 
tain families is a well-known fact, and has led 
to the universal belief that it is hereditary. The 
disease, as we find it in man and animals, both as 
it occurs spontaneously and is produced experi- 
mentally, has been studied with the utmost care, 14 
CONSUMPTION. 
in order to learn whether or not this heredity is 
due to the direct transmission of the bacillus from 
parent to child before its birth. From the facts 
gathered from these sources we must conclude 
that the bacilli are not transmitted to offspring 
by tuberculous fathers, and that, while it is pos- 
sible for such transmission to take place from 
tuberculous mothers to their unborn children, it 
occurs with the greatest rarity. The disease is 
hereditary, as will shortly be explained, because 
there is transmitted a predisposition to it, not the 
bacillus tuberculosis. CHAPTER 11. 
Nature’s Means of Preventing Infection and 
Predisposition, 
If the bacillus is so universally present in the 
atmosphere, why do not a greater number of per- 
sons become infected by it % Because the tissues 
in most persons are able to resist and to destroy 
the bacilli. This ability to resist invasion is due 
to several causes. If the bacilli are inhaled with 
dust they are disposed of as is dust. 
Lining the bronchial tubes are minute, short, 
hair-like particles, which possess a constant 
motion, and which can propel upward toward the 
mouth dust that falls upon them. Moreover, 
the interior of the bronchial tubes is covered 
by a small amount of slightly sticky mucus. As 
particles of dust are carried through the bronchial 
tubes and into their various ramifications, the air 
by which they are carried is thrown into eddies, 
and is constantly deflected from one wall to 
another of these tubes. Thus everything the air 
contains is brought in contact with the adhesive 
mucus and held fast, and then borne upward and 16 
CONSUMPTION. 
out of the bronchi by the cilise or hair-like par- 
ticles already mentioned. These are nature’s 
safeguards against the introduction of foreign 
bodies into the lungs. The air that is breathed 
is thus strained and purified. Very few dust- 
particles find their way to the lung-tissues proper. 
There are, however, other means of rendering 
inert the particles of dust that do gain access to 
the lung-tissue, or that cannot be removed from 
the bronchi by the agencies just mentioned. 
Many dust-particles that linger for some time in 
the bronchi are taken into the cells which lie 
upon and in the walls of these tubes, and are held 
by them. The bronchi and lungs thus become 
blackened by soot which is inhaled. In the 
same way bacilli are taken up, and probably often 
destroyed. In these cases there is a struggle be- 
tween the cell and bacillus. Whichever has the 
greatest vitality is victor, and the result is the 
perpetuation of health or the inception of con- 
sumption. These are the means that nature has 
provided to combat the cause of consumption and 
many other diseases. So long as a person’s lungs 
are in good working-order, and so long as the 
cells composing them are vigorous, it is possible 
to resist infection by the tubercle bacillus. PREVENTING INFECTION AND PREDISPOSITION. 
17 
The slow growth of the bacillus is another 
factor that makes it more easily possible for 
nature’s agencies to gain a victory. It is several 
days, under the most favorable conditions of 
growth, before this fungus makes perceptible 
progress. This gives nature’s agents time to 
eliminate or to destroy it. 
There is also a difference of susceptibility to 
the disease, both among families of mankind and 
among animals. In general, wild animals are 
less susceptible than those that are caged. Guinea- 
pigs and rabbits are very susceptible, and dogs 
and cats very much less so. These differences 
are very marked. Among mankind the same 
fact is observable. The susceptibility is inherited, 
and it is because of its inheritability that the dis- 
ease has come to be regarded as an hereditary one. 
The tendency to the disease which some persons 
have is usually described as a predisposition. 
Just what creates this predisposition we do not 
know. We are, therefore, compelled to describe 
it in general terms. One causative factor of it, 
if not the only one, is undoubtedly a lowered 
vitality in the cells of the lungs, or a lessened 
power of resistance. Therefore, when called upon 
to destroy the bacilli which gain access to them, 18 
CONSUMPTION. 
the cells are incapable; the bacilli live, slowly 
grow, and gain a permanent lodgment in the 
tissues. 
The predisposition comes either by inheritance 
or by acquisition. It is inherited from consump- 
tive parents in almost every instance. I have 
already explained how rarely the bacilli are 
directly transmitted from parent to child as an 
inheritance, but predisposition is almost invariably 
transmitted. Much less frequently a predispo- 
sition is inherited from parents suffering from 
other diseases before or at the time of the 
child’s birth. Almost any malignant disease from 
which a father or mother may be suffering at this 
time lessens the vigor and power' of resistance of 
the offspring. It has been shown that children 
born while parents are cancerous are much more 
prone to consumption than others. 
The predisposition is commonly acquired by 
one of four methods ; or, perhaps, most frequently 
by a combination of two or more of them. More- 
over, when, the predisposition is inherited it is 
often increased by the various means by which it 
may be acquired. The commonest causes of its 
acquisition are the breathing of closely-confined 
air, the lack of necessary muscular exercise, the PREVENTING INFECTION AND PREDISPOSITION. 
19 
use of food that is not wholesome, and the pos- 
session of other diseases of the lungs or bronchial 
tubes. 
It is a prolonged stay in rooms imperfectly 
ventilated, crowded, and therefore filled with air 
which is especially liable to contamination, that 
makes the employes of certain factories peculiarly 
susceptible to consumption. The breathing of 
such a close, impure air is often the chief cause 
of susceptibility among the poor of our cities. 
They work in illy ventilated shops that are 
crowded with work-people, and then sleep in 
small rooms in which often the outside air cannot 
enter directly, and in which several may sleep 
simultaneously. Unfortunately, these same per- 
sons are often exposed to some of the other causa- 
tive factors of the predisposition. A legal exami- 
nation into the sanitary conditions of factories, 
tenement houses, and the homes of the poor 
cannot be made too rigid. The construction of 
a sleeping-room of inadequate size or without 
sufficient ventilation should not be permitted. I 
do not urge this only because consumption may 
he caused if due regard is not paid to the hygiene 
of factories and houses, but because the danger 
from any disease is so greatly increased when the 20 
CONSUMPTION. 
sufferers live in poorly ventilated apartments. 
For example, typhoid fever, if treated in the open 
air or in a roomy and well-ventilated apartment 
where the sufferers can be well nursed, produces 
a very small mortality. But when it is treated, 
as physicians are often compelled to treat it, in 
rooms seven by twelve feet in surface area, with 
a window that opens into a court not more than 
a foot wide, between buildings, and with a door 
that opens into a room in which the food for five 
or six persons is cooked and Avhere they eat and 
congregate, the mortality is very great. In such 
rooms, too, consumptives in the early stages of 
the disease sleep and spend much time. Is it 
astonishing that under these conditions the dis- 
ease runs a rapid course and is especially malig- 
nant 1 
A sleeping-room should be capable of most 
thorough ventilation, and should contain at least 
fourteen hundred cubic feet of air. In other 
words, the room should be at least twelve feet 
high and with a floor ten by twelve. For a sick 
person the room should be larger; but the great- 
est care must be taken, and especially in the 
rooms of invalids, that ventilation is maintained. 
Lack of exercise is also an important factor 21 
PREVENTING INFECTION AND PREDISPOSITION. 
producing a predisposition to the disease. Judi- 
cious exercise—l mean by this such exercise as 
does not strain or exhaust muscles—contributes 
largely to maintain vigorous health. By use a 
muscle is made to require nourishment, and 
therefore nutriment is appropriated by it from 
the blood more rapidly and perfectly than under 
conditions of disuse. As a larger supply of 
blood is demanded its circulation is better main- 
tained. There is, however, another kind of cir- 
culation which is not so plainly seen as that 
of the blood, and is consequently often forgotten, 
but one that is quite as essential and should not 
he lost sight of. I refer to the lymph circulation. 
The latter is chiefly maintained by the action 
of the various voluntary muscles of the body. 
Nutriment in the form of blood is pumped from 
the heart into the arteries, and from them is 
carried to the finest vessels, from which it passes 
for the most part into the veins, to return to the 
heart and the lungs; but some of its fluid 
constituents, with dissolved nourishment, ooses 
through the walls of the minutest vessels into the 
surrounding structures, and brings nourishment 
in direct contact with them. This fluid does not 
find its way back into the veins, but into the 22 
CONSUMPTION. 
lymph-channels. While amidst the tissues, it 
loses some of its nutritive substances and becomes 
loaded with the worn-out matter of the system, 
which must be carried olf. The importance of 
this fluid in maintaining a perfect balance between 
a supply of nutriment and an elimination of waste 
matter is evident. The maintenance of a circu- 
lation in the lymph-channels is very largely 
dependent upon the contraction of muscles, for 
each time they contract they squeeze the lymph 
out of themselves much as one would squeeze 
water from a sponge, and on relaxing are ready 
for a fresh supply from the blood. If muscles 
are not used the lymph circulation is sluggish 
and very imperfect; as a result the nutrition of 
the muscles is imperfectly maintained, they be- 
come soft, and are easily wearied, so much so 
that often a perpetual languor is felt, even when 
no exertion is made. Fat may be deposited, hut 
the tissues are not full of vigorous vitality that 
will enable them to accomplish work or combat 
disease successfully. 
In another way sedentary habits and lack of 
exercise lead to bodily deterioration and want of 
vigor. They prevent frequent and deep breathing, 
which is necessary to the maintenance of good PREVENTING INFECTION AND PREDISPOSITION. 
23 
health. Only a part of the air contained by the 
lungs is changed at each respiration. If some 
of it is allowed to remain too long in the lungs 
it becomes overfilled with waste matter and 
ceases to perfectly purify the blood, and then all 
parts of the body begin to feel the lack of the 
invigoration which an abundance of fresh, purify- 
ing air will give to the blood, and through it to 
all the tissues. If you will observe a person 
quietly standing or sitting you will notice that he 
breathes less per minute by several respirations 
than one who is walking or otherwise exercising 
briskly. But in addition to breathing less fre- 
quently he breathes less deeply. In both these 
ways, therefore, the amount of air inhaled and 
exhaled is made to fall below the standard. 
Many persons pursuing sedentary habits still 
further interfere with the maintenance of proper 
respiration by constantly retaining a position 
which cramps the lungs. For instance, we find 
the student and professional man almost con- 
stantly leaning over a desk, and the seamstress, 
the book-binder, and the box-maker leaning over 
their work. The body is bent upon itself and 
the shoulders sag forward. The amount of air 
entering and escaping is plainly greatly lessened, 24 
CONSUMPTION. 
for inflation of the upper part of the lungs is 
almost impossible. Moreover, the air passes 
in and out less forcefully. A considerable part 
contained in the lungs is stagnant. It is evi- 
dent that under these circumstances the blood 
will lack oxidation and vivifying properties; but, 
more than this, any particles of deleterious dust 
that may be inhaled are likely, in the stagnant 
air, to settle upon the lung-tissue and remain 
unmoved long enough to cause serious harm. 
Lack of exercise predisposes to disease of the 
lungs at all ages of life; to the studious and deli- 
cate child who takes little interest in open-air 
sports and almost constantly bends over books; 
to the professional man and book-keeper at their 
desks, or the seamstress at her work. It is also 
a common cause in all ranks of life; to the 
poorest working-girl or wealthiest banker or 
merchant. 
Food which is not sufficiently nutritious is a 
third cause of the acquirement of a predisposition. 
I do not refer to food that contains tubercular 
matter or is infected, for, as already explained, 
this is probably a rare cause of the disease. I 
refer to food that is insufficient in amount and in 
nutritive character. I believe that in our own 25 
PREVENTING INFECTION AND PREDISPOSITION. 
land this is a rare cause, for food is abundant 
here. A lack of Sufficient nourishment aids in 
bringing about a predisposition by lessening the 
vitality of the system and its power of withstand- 
ing disease. 
Some throat and other lung troubles may 
facilitate the acquirement of consumption. We 
often find children, between the ages of six and 
sixteen, who have persistently suffered from en- 
largement of the tonsils. If such enlargement is 
very considerable the sufferer is limited as to the 
amount of air that he can inhale, and therefore 
we almost invariably find that those whose throats 
have been thus persistently narrowed grow up 
tall and slender, with narrow, thin chests, weak 
muscles, and a pale complexion. These are the 
physical conditions oftenest exhibited by those 
predisposed to consumption. And yet this con- 
dition is one that can very easily be prevented by 
the removal of the enlarged glands. It is true, 
however, that only extreme and persistent enlarge- 
ment of the tonsils will produce these results. 
Bronchitis is in itself a predisposing cause of 
consumption, for the inflammation in the bronchial 
tubes causes them in places, and sometimes ex- 
tensively, to be denuded of the hair-like uarticles 26 
CONSUMPTION. 
that I have described as aiding to keep these 
tubes clean. Therefore, if the tubercle bacilli 
fall by accident upon a raw surface they are 
likely to gain sufficient lodgment in the deeper 
tissues and to remain long enough to initiate 
true consumptive changes. Acute bronchitis is 
far less dangerous than the chronic form of the 
disease. Indeed, one might almost say it is with- 
out danger, for it rarely leaves a bronchial tube 
long enough raw to make it possible for the 
bacillus to become fixed and to develop. But in 
chronic bronchitis there is prolonged exposure of 
raw and often ulcerated surfaces. We may make 
the general statement that most chronic diseases 
of the lungs predispose to consumption, and that 
acute ones rarely do. 
There are some other diseases that predispose 
to consumption, most noticeably so diabetes. The 
majority, perhaps, of those who suffer from 
chronic diabetes succumb finally to consumption. 
A residence upon low, damp, and imperfectly 
drained soil is also a predisposing cause of the 
disease. It has been observed that consumption 
is most prevalent among the inhabitants of river- 
bottoms and among those whose homes are upon 
clay and damp or boggy soils. On the other PREVENTING INFECTION AND PREDISPOSITION. 
hand, communities who live upon dry, loose, and 
well-drained soils arc less frequently attacked by 
the disease. The lesson which these observations 
teach is obvious. By preference no one should 
live upon damp or poorly-drained ground, and 
those who are consumptive or predisposed to con- 
sumption should especially avoid such localities. 
These various factors that develop a predispo- 
sition to consumption rarely act alone, or inde- 
pendently. When a predisposition is acquired it 
is almost invariably the result of the simultaneous 
action of several of the causes. For instance, how 
often the factory-girl is compelled for many hours 
daily to breathe an atmosphere that is not purified 
by free and perfect ventilation, and that is loaded 
with the exhalations from many persons, and filled 
with dust that is raised by the constant action of 
machinery; how often the same person must 
maintain a cramped position during the entire 
day; how often is it impossible for her to get 
general exercise during the day, and she is too 
weary to take it after work is done; and how 
often, under these circumstances, are bad colds or 
attacks of bronchitis allowed to become chronic 
for lack of suitable treatment, care, and protection 
from their causes'? 28 
CONSUMPTION-. 
Among the rich we see the young, delicate, 
slender girl or boy, who has been rendered as 
tender as a hot-house plant by care and mistaken 
protection against cold, and even the bracing 
qualities of the out-of-doors air, too languid to 
take the exercise and physical training that will 
give stamina and vigor to the body, and lolling 
upon soft lounges and easy chairs, maintaining 
positions almost continuously that prevent perfect 
and free expansion and ventilation of the lungs. 
I have dwelt thus at length upon the causes of 
consumption, for a comprehension of them gives 
us a key to the prevention and sometimes the 
cure of the disease. CHAPTER 111. 
Prevention of Consumption. 
If the disease is due to a micro-organism which 
consumptives carry with them, and may scatter 
upon the ground and thus permit of its dissemi- 
nation as atmospheric dust, I may be asked, Must 
not its victims he regarded with dread and be 
avoided'? I answer, No! I wish to make em- 
phatic this answer, for nothing would be more 
detrimental than to inculcate the opposite view, 
and nothing would entail more hardship upon the 
consumptive, or his friends and kinsfolk. 
More than a hundred years ago the disease was 
treated as a contagious one, and its victims were 
shunned and rigorously isolated. This treatment 
was adopted in Portugal and Naples. Physicians 
were required to report all cases of consumption, 
and were liable to penalties if they did not. Con- 
sumptives were isolated, and their clothing, the 
furniture of their rooms, and all that they used 
was destroyed after their death; the rooms were 
also thoroughly cleansed and purified. These 
laws were rigorously enforced for more than fifty CONSUMPTION. 
years. With what result \ The frequency of 
the occurrence of the disease and its severity were 
in no way mitigated. Not only does this practical 
experiment demonstrate the futility of such treat- 
ment when applied to consumption, but a com- 
prehension of the ways in which the disease is 
spread, and of the necessity of a predisposition in 
those who are to he afflicted with it, make it 
evident that such treatment is not essential to its 
prevention. 
Since a predisposition is ordinarily quite as 
essential as the exciting cause, or tubercle bacil- 
lus, just as a suitable wort is essential for the 
growth and multiplication of yeast, we can suc- 
cessfully ward off the malady by preventing the 
formation of an acquired predisposition, and by 
strengthening those weak organs whose inherit- 
ance gives to individuals an inherited predispo- 
sition. 
Furthermore, as has been explained, the sputa 
is almost the only means of dissemination for the 
disease. If we can destroy all the sputa of con- 
sumption, and thus prevent its being scattered 
about our rooms, our houses, and our cities, we 
can as effectually limit the dissemination of the 
disease as by maintaining the most rigorous isola- PREVENTION OF CONSUMPTION. 
31 
tion of the sufferers. To accomplish this object, 
all who are consumptive must fully appreciate the 
necessity that they are under of preventing the 
spread of the malady. For the sake of their 
fellow-men, for the sake of their kinsfolk, for the 
sake of their wives or husbands, or their children, 
they must ever be watchful of themselves, and 
guard against a dissemination of the malady by 
acts of theirs. The habit must be acquired of 
never expectorating except into receptacles kept 
for the purpose or upon something that can be 
destroyed before the sputa dries. Cuspidors 
should always contain water, for it is the dried 
sputa which may form a part of the atmospheric 
dust that is dangerous, and not wet sputa. When 
these vessels are emptied they should be thor- 
oughly scalded. They should never be emptied 
upon the ground, or among ashes or other refuse, 
but into the sewers, where the products of de- 
composition aid in destroying the vitality of the 
tubercle bacillus. It is not possible always to 
have access to cuspidors. The handkerchief may 
then be employed, but should be thoroughly 
boiled before it dries. This latter is also a diffi- 
cult direction always to execute. It is better, 
when possible, to make use of something that can CONSUMPTION. 
be destroyed by fire after it lias been used. Fre- 
quently, by consumptives who are confined to bed, 
small pieces of paper are employed for receiving 
the sputa. These are at once folded and placed 
in a small tin box, and before they are dry are 
burnt by the nurse, and the box is scalded. Many 
who are not too weak prefer to use a sputa-cup, 
which should always be made of material that is 
light, that will permit of thorough scalding, and 
that may be kept partly full of water. There is 
little difficulty in gathering and destroying sputa 
when the invalid is confined to the house. Earlier 
in the course of the disease the dissemination of 
its seeds can only be prevented by the constant 
care of the sufferer from it. 
1. The first rule, therefore, for the prevention 
of consumption, is that consumptives should not 
thoughtlessly drop sputa wherever they may be, 
hut into cuspidors containing water, or upon 
something which can he destroyed hy fire or 
cleansed hy prolonged boiling. This rule should 
be most rigorously executed, not only that the 
health of others may be conserved, but that, if 
improvement and a temporary check has been 
placed upon the disease in one of its victims, the 
lungs may not be re-infected or involved at new PREVENTION OF CONSUMPTION. 
33 
points by the inhalation of sputa-dust which, 
through his own carelessness, has gathered about 
his room or clothing. 
2. A consumptive mother should never suckle 
her children, and care should he exercised to 
avoid milk from tuberculous coivs. 
For the prevention of the disease, the acquire- 
ment of a predisposition must be avoided by a 
hygienic mode of life and by the strengthening 
of weak organs by physical training. In most 
instances a similar mode of life and training will 
correct an inherited predisposition. 
3. It is not wise for any one, but those inclined 
to consumption should never live upon low, damp, 
or imperfectly drained soil; their home should he 
upon light soil's. 
4. They should have an abundance of pure, 
clean air to breathe, both by day and night. This 
rule not only necessitates a careful selection of a 
home, but places upon the employers of factory- 
labor the duty of providing shops that are well 
ventilated, and from which the dust is removed 
as perfectly as possible. In England laws have 
been enacted controlling the construction of fac- 
tories, and similar legislation can advantageously 
be made in this country. The fatality and preva- 34 
CONSUMPTION. 
lence of consumption is so great, so much greater 
than any epidemic of yellow fever or cholera, 
that every individual should feel the necessity of 
protecting himself and others by providing and 
using, as far as possible, the best sanitary condi- 
tions of life. Furthermore, in all factories or 
offices where workers of necessity must sit or 
stand continuously in a stooped or cramped posi- 
tion, so that respiration is limited, a change of 
position and the cessation from work for four 
or five minutes in each hour should be required. 
And yet, how often is the physician told by those 
thus employed that such a change, even once in 
two or three hours, is rigorously forbidden by 
employers who exact the most constant and 
unremitting labor during working hours! Is it 
astonishing that the factory-girl is pale, thin- 
chested, weak-bodied, and subject to colds'? or 
that the book-keeper, the shoe-maker, and the 
tailor have a similar aspect and disposition 1 
Frequent illnesses might be prevented, and the 
frequent loss of skilled labor by disease might he 
avoided, by proper care on the part of employers 
of those they hire. Such care would certainly 
be good economy in the long run. 
The choice of a profession or trade should be PREVENTION OF CONSUMPTION. 
35 
made with great care by those predisposed to 
consumption. 
5. An out-door life, and one demanding active, 
muscular exercise should he preferred. When 
such a mode of life is impossible, hours for exer- 
cise in the open air should be arranged for and 
utilized as rigorously as hours for eating and 
sleeping. 
6. Exercise should he taken systematically and 
with reference especially to the development of 
good lung capacity and powers of respiration. 
The best results from physical training are 
obtained in youth and early manhood, while the 
ribs and framework of the chest are still pliable 
and capable of being molded. 
7. Overexertion and consequent depression, 
either of mind or hody, should he avoided. In a 
word, opportunities for rest should be as system- 
atically arranged for as exercise. Both mental 
and physical weariness lessen the power of the 
human organism to withstand disease, and if the 
weariness is prolonged or excessive it lessens its 
ability to regain normal vigor. It is as deleteri- 
ous as is judicious exercise beneficial. Sorrow, 
anxiety, and harassment lead to lack of appetite, 
to imperfect digestion and physical depression; 36 
CONSUMPTION. 
but joy, lightness of heart, and good temper are as 
closely linked with perfect digestion and nutrition. 
8. At all seasons of the year woolenware 
should he worn next the skin. Its thickness may 
be varied. The entire body and extremities 
should be thus clothed, for those predisposed to 
consumption are particularly subject to catarrhal 
affections, such as nasal, throat, and bronchial 
inflammations. In a large percentage of cases, 
they are due to the exposure of the body to 
damp air in which a sudden and violent thermo- 
metric change has occurred. Such inflammation, 
as has been explained, opens the gate to the in- 
vasion of the human system by the exciting cause 
of consumption. Nothing has been found to so 
thoroughly protect the skin against atmos- 
pheric changes as a woolen covering. By 
such garments the surface temperature is kept 
most equitable, and when fluctuations are inevit- 
able its changes are made more gradual. These 
facts have been demonstrated not only by experi- 
ence, but by experiments made with scientific 
precision. 
9. In selected cases tepid and cold baths, 
especially plunge baths and showers, with the 
friction ivhich necessarily must follow, are useful PREVENTION OF CONSUMPTION. 
37 
in toughening the human hochj and in rendering 
it less susceptible to sudden and violent atmospheric 
changes of temperature. All persons predisposed 
to consumption cannot be subjected to such treat- 
ment. It is only adapted to those in whom a 
feeling of well-being is created by the bath. If 
depression and persistent coldness is felt, harm 
rather than good will follow its use. Nor can 
the baths at first be taken in cold water. But 
gradually the body may be habituated to colder 
water. This treatment accustoms the skin to 
sudden chilling, and the hearty rubbing which is 
part of the treatment trains the blood-vessels to 
react promptly after they have been contracted 
by cold, and to restore warmth to the skin. 
10. A change of climate is often necessary. 
In some cases it must be resorted to in order to 
remove the susceptible individual from exposure 
to frequent, violent, and sudden atmospheric 
changes. Changeability is characteristic of the 
climate of many of the most populous regions of 
the earth. As such changeability often causes 
bronchitis and various catarrhal inflammations, 
which in time open the gates for the ready en- 
trance and lodgment of infectious material in the 
lungs, such a climate must be avoided by those 38 
CONSUMPTION. 
disposed to consumption. A mild, dry, and 
equable climate should be sought. For some, 
high altitudes combined with these latter climatic 
qualities are most suitable. 
A predisposition, even when not inherited, is 
in most cases discoverable during the period of 
youth. This, fortunately, is also the time of life 
when the human body is most easily molded by 
physical training, and when habits are to be 
acquired that may throughout life conduce to 
health or to the weakening of various important 
organs, and consequently to disease. I hope 
that I may be able to impress upon parents my 
own conviction of the imperative necessity of a 
supervision of children during all the years of 
youth by physicians who will examine thoroughly 
each child, who will compare their measurements 
and the strength of their various muscles with the 
standards of health, and who will prescribe pre- 
cisely the kind of physical training that each one 
needs to make the body symmetrical and perfect; 
who will overlook and direct the conduct of life 
so as to conduce to the most vigorous health and 
to the prevention of future disease. *A beginning 
has been made in the right direction in a few 
colleges, and professorships of physical culture 39 
PREVENTION OF CONSUMPTION. 
have been established. But physical training of 
children who are unevenly developed, or who 
inherit a predisposition to consumption, should be 
begun earlier in life than their college days, and 
should be equally accessible to the poor and rich. 
Furthermore, more than muscular training should 
be prescribed. Advice in regard to the habita- 
tion, in regard to clothing and foods,—in a word, 
in regard to all that will conduce to health and 
the development of strength and vigor,—should 
be provided. Such physical education is quite as 
essential for the well-being of a community as 
mental education. It can probably be best given 
in schools. This means an addition' to the topics 
at present taught, and provision for an entirely 
different kind of training. That good can be 
thus accomplished has been demonstrated by 
what has been done in some of our colleges. A 
most instructive statistical diagram has been pre- 
pared by Prof. E. Hitchcock, Jr., and embodied 
in the “ Annual Report of the President of Cornell 
University.” In this institution physical training 
is required of all students during the first two 
years of their course. They are examined as to 
their physical development and strength when 
they enter college, and then on leaving. For all 40 
CONSUMPTION. 
who fall much below the average of young men of 
their height special exercises and training are pre- 
scribed. It is among these especially deficient 
students that those particularly predisposed to 
consumption are to be found. The chart to 
which I have just referred shows what can be 
accomplished during a college course. The aver- 
age physically deficient student falls below the 
standard of the average American student in 
almost all measurements and tests of strength, 
and especially in measurements of chest and 
abdominal girth ; but after training for two years 
the same measurements fall little below the nor- 
mal or average ideal, and the lung capacity con- 
siderably exceeds this ideal. This is a practical 
demonstration of what can be accomplished in 
such persons by physical training only. It is 
more impressive, for the lesson is taught by figures 
obtained by measurements and tests made with 
scientific exactness. 
The results of a less systematic development of 
the physique of youths, which is quite as striking, 
can be cited by almost every physician. Fre- 
quently young men and women of consumptive 
families are found by their physicians not only 
predisposed to the disease, but with evidence of PREVENTION OF CONSUMPTION. 
41 
its incipiency. They arc directed to take suitable 
exercise, to pursue on out-door life, to protect 
themselves against colds, and, it may be, to change 
their home to a climate better adapted to their 
disease. These directions are carried out, and 
two or three years later both evidence of the dis- 
ease and that physical conformation of body 
which is characteristic of a predisposition have 
disappeared. Such histories are numerous. 
Physical training, though less efficacious, is 
still very useful in adult life. At this period, 
however, avoidance of too close confinement and 
the breathing of stagnant air, as well as suitable 
protection against atmospheric changes that might 
produce bronchitis and other inflammations of 
the respiratory passages, and thus lessen their 
power of resistance of infectious matter, are of 
pre-eminent importance. This means an educa- 
tion of the people in regard to the dangers of an 
unhygienic life, and in regard -to the means by 
which it can be avoided ; and, as has been stated, 
if necessary a governmental supervision of the 
construction of dwellings and factories so as to 
insure proper ventilation and purity of air. 
If I may formulate a rule which, unfortunately, 
can to-day be put in effect in a very limited 42 
CONSUMPTION. 
number of cases only, but which it is desirable 
should be universally effective, I should say that 
all children from the age of ten to twenty should 
annually be examined by physicians, and all 
found physically deficient should be suitably 
trained and advised of their danger and of the 
means of avoiding it. 
No matter how intellectually brilliant one may 
be, if physical vigor is wanting ability to execute 
and to accomplish work that will insure success 
in life is impossible. The best physical condition 
of a community has an incalculable money value. 
The execution of the rule just formulated would 
surely be of more benefit than can be the most 
thorough quarantine and sanitary cordons against 
epidemic diseases. CHAPTER IV. 
Hygiene for the Consumptive. 
For the cure of consumption when in its 
incipiency, and for its relief when established, 
many of the rules just given for its prevention are 
applicable. It is desirable, therefore, to consider 
some of them more at length, and also with 
reference to individuals in whom the disease is 
established. 
The same hygienic treatment is not applicable 
to every case of consumption. In the most acute 
cases, those commonly called “ quick consump- 
tion,” the disease runs so short and severe a 
course that there is no opportunity for the em- 
ployment of any hygienic treatment other than 
what is applicable to all acute diseases. In 
another group of consumptives the disease is 
properly called chronic. The failure of health, 
though slow, is steady. Fever is almost constantly 
present and lung cavities develop early. The 
most careful treatment, both hygienic and medical, 
enable us to cure a small proportion of these 
cases and to prolong life for many years in most 44 
CONSUMPTION. 
of them. It is unfortunate that more of the suf- 
ferers from this disease do not understand how to 
care for themselves, or for financial reasons are 
unable to do so. A third group of consumptives 
embraces the most chronic cases. They are the 
ones to whom most hope can be offered of a per- 
manent cure. In them there is a first stage, often 
prolonged over many years, in which parts of the 
lungs are solidified, impervious to air, and con- 
tracted. Exacerbations of the disease occur 
occasionally, and with them an extension of the 
area of consolidation takes place. At a later 
period cavities form in the solidified lung-tissue. 
In part, the same hygienic rules apply to the dif- 
ferent varieties of consumption, and in part they 
must be varied to meet the special requirements 
of each. They must also be varied in the differ- 
ent stages of the disease. 
I have already emphasized the necessity for 
pure air to prevent consumption, and I wish that 
I could emphasize the need still more. It is just 
as essential for the cure of the disease. We know 
of no specific remedies for the cure of consump- 
tion. We can successfully combat it only by 
preserving by every possible means the physio- 
logical action of each organ and tissue of the PURE AIR. 
45 
body and by furnishing the blood, for tbe main- 
tenance of its vigorous action, an abundance of 
pure air. Without pure air continuously supplied 
our other efforts are almost surely futile. Pure 
air is therefore, more nearly than anything else, a 
specific for the disease. It is absolutely needful 
for a cure. 
PURE AIR. 
The purest air is found in mid-ocean and upon 
mountain-tops. It is purer on a farm than in 
a city; upon the borders of a city than in its 
centre; out-of-doors than in the house ; therefore, 
a consumptive should live as continuously as 
possible in the open air, and not in large cities or 
densely populated towns. The rooms that must 
at times be occupied should contain air as nearly 
like that out-of-doors as possible. Those who 
are predisposed to the disease and those in whom 
it is in its incipiency should lead an out-door life. 
Those in whom it is more advanced should spend 
every moment that their strength will allow in 
the open air. The need of an out-door life makes 
it necessary for many consumptives to seek a 
mild climate where inclemencies of the weather 
will not drive them in. Unfortunately, all per- 
sons cannot avail themselves of climatic changes. 46 
CONSUMPTION. 
1 would admonish such individuals not to be too 
much afraid of bad weather. Confinement in- 
doors for only a few days will cause a marked 
impairment in many persons, since the mainte- 
nance of appetite, of relief from coughing and 
night-sweating are so much dependent upon an 
out-door life. Therefore, advantage should be 
taken of every ray of sunlight. With feet and 
body well protected by clothing, they should 
leave the house, if for only a few minutes. Dry, 
cold air should never be feared; but moist, cold 
air should be avoided, if possible. A consump- 
tive may sleep safely with open windows in a 
dry mountain-air at a temperature closely border- 
ing upon zero, but in a moist air at a tempera- 
ture of thirty-five a cold will probably be taken, 
coughing will be increased, and pleuritic pains 
or other evidence of injury will be felt. Exercise, 
amusement, or an out-door occupation may there- 
fore be safely pursued in dry, cold, winter weather. 
During the,changeable seasons, fall and especially 
spring, the utmost care must be taken to protect 
the body; but every opportunity must be utilized 
when exercise can be safely taken out-of-doors. 
In genial climates and pleasant seasons those 
who are able should leave the house as soon as PURE AIK. 
47 
dressed ; should pass the entire day out of it; if 
necessary, should rest in hammocks or upon 
lounges in the open air. As few hours as possi- 
ble should be spent in the house. 
But nights arc passed in-doors in all climates 
and seasons, and many consumptives are confined 
to the house, it may be, by fresh or aggravated 
colds or by the severity of the disease. Pure air 
must therefore be provided in our houses. How 
often do we find consumptives, with mistaken 
care, living in rooms the windows of which are 
tightly closed and the cracks around them firmly 
battened and made impervious! The air is 
superheated by a stove. The closeness and de- 
teriorated condition of it is at once noticed by 
strangers who enter the room. Still the consump- 
tive shuns every breath of refreshing, life-giving 
air that may enter from without, as if it were a 
plague. What is the effect of a residence in such 
an atmosphere'? The person is supersensitive 
to every change of temperature. His blood is 
imperfectly oxygenated. The waste of the body 
is imperfectly exhaled and eliminated. Repair 
of injured tissues is impossible. He has no appe- 
tite, and is nerveless, like a wilted plant. The 
air he breathes is loaded with deleterious matt in* 48 
CONSUMPTION. 
of his own production, which may infect portions 
of the lungs as yet healthy. 
I need hardly say that in genial climes and 
seasons the windows of living- and sleeping- rooms 
should be kept widely open. Drafts should he 
avoided. This often can be accomplished by 
movable screens. 
At all seasons and in all climates the outside air 
should be freely admitted to our homes. Where 
artificial heating is necessary it can be accom- 
plished most healthfully by grate-fires, which 
maintain good ventilation as well as furnish heat. 
The consumptive’s room should be kept at a 
temperature not exceeding 70° F. Warm and 
abundant clothing should be worn. If the disease 
is in its incipiency, or if the sufferer from it is 
comparatively robust, a much lower temperature 
at night is permissible. But in advanced cases, 
or whenever acute exacerbations of the disease 
confine one to the house, the atmospheric tem- 
perature should be kept as uniform as possible. 
Furnace and stove heat is not the most desir- 
able, for they tend to greatly dry and often 
burn the air. An atmosphere thus modified is 
particularly deleterious for those who are able to 
leave the house, as they will experience a more PURE AIR. 
49 
violent change in going from the hot, dry air of 
the house to the damp, cold air of the street than 
nature ever produces. The overheating of our 
homes is one of the most prolific causes of catar- 
rhal colds. Fresh air from without should be 
admitted in sufficient quantity to keep the air of 
the house of the same quality as that out-of-doors, 
only it should be warmed. 
The necessity of medium-sized or large rooms 
has already been dwelt upon. Preferably two 
rooms should be at the disposal of those who are 
confined to the house. One should be used only 
as a sleeping-room. During the day its windows 
should be kept open, and it should be warmed 
according to the requirements of the patient an 
hour or so before it is to be occupied. The 
sleeping-room should be simply furnished, and 
only with necessary articles. There should be no 
hangings or draperies about the bed. 
The second room should be used during the 
day. At night it should be as perfectly aired as 
is the sleeping-room by day. The sitting-room 
should be upon the sunny side of the house, and 
nature’s light and heat should be admitted with 
the greatest freedom. This room ought to be 
made as cheerful as possible. 60 
CONSUMPTION. 
Consumptives should sleep alone. Unless the 
disease has caused extreme debility it is not best 
to have attendants continuously in the sleeping- 
room ; nor is it best to keep a light burning. The 
invalid needs all the air the room contains, and 
its oxygen should not be shared with others or 
with burning lights. When necessary, a grate-fire 
may be kept up. Fresh air should be admitted 
through a partly-open window. CHAPTER V. 
Hygiene (continued). 
CLIMATE. 
As exercise out-of-doors in a pure atmosphere 
is the first and most important requisite for the 
successful treatment of consumption, the ideal 
home for the consumptive must be where the air 
is exhilarating, dry, clear, and pure. For those 
who are greatly enfeebled the location must be 
one that is free from frequent high winds or in- 
tense cold. Coldness is rather beneficial than 
otherwise to those predisposed to the disease, or 
who are still fairly vigorous. A rarefied air is 
also a benefit to them. The ideal home must be 
so located as to afford to its inhabitants tempting 
and attractive occupations. Whether this locality 
should be an elevated one with a thin and dry 
air, or at the ocean-beach with a heavier and 
moister air, will depend, as already indicated, 
upon the nature and degree of change in the 
lungs of each individual. Nor is it possible to 
find one locality that possesses ideal character- 52 
CONSUMPTION. 
istics continuously through the year. If the dis- 
ease is changing rapidly the best results will be 
obtained from successive changes to localities 
adapted to the successive stages or conditions 
of the disease. For instance, a physician may 
wisely advise a patient in Chicago, in the month 
of December, suffering from an inflammation in 
the lungs that is increasing the area of disease in 
them and is accompanied by moderate fever and 
considerable prostration, to go at once to south- 
western Texas. The changeable and inclement 
weather of winter and spring may thus be avoided, 
and a warm, genial, dry air and the possibility 
of open-air exercise be insured. But he may 
equally well advise that, if improvement occurs 
and the fever entirely disappears, in late spring 
the patient should go to New Mexico or Colorado, 
to elevations of from 5000 to 10,000 feet. If 
improvement here is continuous a prolonged 
residence may be advisable. Such directions 
may be given to one in the earlier years of man- 
hood, but if the patient is past middle life and 
feeble, or if extensive destruction of lung-tissue 
has occurred, he may he advised to visit Florida 
in mid-winter, and gradually to come northward 
as the heat of spring becomes uncomfortable, CLIMATE. 
53 
and to tarry at various selected points upon the 
way. 
A climate for each consumptive should be 
selected with as much care as a drug, and to be 
beneficial must be as perfectly adapted to bis 
conditions. Consumptives frequently wish to go 
to Florida, or Colorado, or Texas because some 
friend lias recovered at one or the other of these 
places. But it must be remembered that neither 
of these places is adapted to all cases, or even to 
the same case in all stages of its progress. In 
making climatic changes a physician’s advice 
should always be followed. 
The climatic influences which most frequently 
do good, and the greatest amount of good, arc 
found at high altitudes; that is, at elevations of 
5000 feet or more. These good results arc not 
obtained from any one quality of the atmosphere, 
but from many. Perhaps the most striking 
peculiarity of the air of high altitudes is its rare- 
faction. The amount of air-pressure at sea-level 
is fifteen pounds to the square inch. This 
pressure diminishes at the rate of one pound 
for every thousand feet of ascent. The rare- 
faction necessitates a diminished amount of 
oxygen per cubic foot; therefore, in order to 54 
CONSUMPTION. 
maintain life a larger volume of air must be 
breathed per minute than at lower altitudes. A 
person going suddenly to a high altitude experi- 
ences a shortness of breath on even a slight 
exertion, and necessarily breathes rapidly even 
while in repose. If the altitude is not too great 
respiration gradually becomes less frequent, but 
remains permanently unusually deep. This 
habituation to rarefied air is due to the distention 
or unusual inflation of the lungs which it pro- 
vokes. With time the lung-tissue is increased in 
amount as well as stretched. In order that the 
blood may utilize all the oxygen which enters the 
lungs, the heart beats quicker than naturally and 
forces it through the blood-vessels more rapidly. 
This increased work produces a strengthening of 
the heart, just as work causes an increase in the 
size of other muscles. Furthermore, the rapid 
circulation provokes more rapid chemical changes 
in the tissues of the body, and thus leads to a 
general invigoration. Just as by habit respiration 
ceases to be hurried, so, gradually, the heart’s 
action grows slow, but remains more forceful. 
These are the most important physiological 
changes wrought in a healthy man by the con- 
stant breathing of a rarefied atmosphere. And CLIMATE. 
55 
these are just the changes most needed by those 
who are by inheritance predisposed to the disease 
or have acquired a susceptibility in the earliest 
years of life. Their conformation is peculiar 
because of the narrowness, thinness, and length 
of the chest, and comparatively small size of the 
heart and thinness and emaciation of the muscles. 
The constant inhalation of rarefied air will lead 
to enlargement of their lungs and heart, and, by 
stimulating nutrition, to strengthening and growth 
of their muscles. High altitudes are undoubtedly 
best adapted for the removal of a predisposition 
to consumption. 
The production of similar changes in the con- 
sumptive counteracts the tendency of the disease 
to produce contraction of the lungs and a narrow 
and thin chest. If consumption is in a quiescent 
state, the enlargement of the lungs which the 
inhalation of rarefied air produces compensates 
for the permanent consolidation and destruction 
of parts of them. The inflation of the lungs 
causes the walls of the air-spaces to be stretched 
and made thin. This prevents their becoming- 
congested, and thus reduces the danger of exten- 
sion of inflammation along the borders of the 
affected areas. The habitual imperfect expan- CONSUMPTION. 
sion of the chest and diminished vitality of all 
tissues which the disease produces cause a wast- 
ing and weakening of the muscles of respiration. 
Furthermore, it leads to a slow lymph-circulation, 
and one that is especially slow in the lungs. 
But the involuntary deep and full respiration 
which the breathing of thin air enforces neces- 
sarily exercises, and thereby strengthens and 
enlarges, the respiratory muscles. The breathing 
once more of pure air and the invigorated circu- 
lation aid this change by invigorating the tissues 
and stimulating them to a better degree of nutri- 
tion. The involuntary full expansion and con- 
traction of the lungs in respiration cause a more 
rapid lymph-circulation, and, as it is chiefly by 
the lymphatic vessels that inflammatory exudates 
are removed, a diminution of the swelling and 
thickening of the tissues about the areas of con- 
solidation is produced. These changes in the 
size of the lungs and chest and its muscles will 
take place most rapidly and perfectly in tire years 
of youth and early manhood. In those who are 
more than thirty-five or forty the change will be 
very imperfectly wrought. If the disease has 
progressed so far as to destroy the greater part of 
the lung-tissue, a permanent shortness of breath CLIMATE. 
57 
and consequent distress will be experienced at 
high altitudes. Moreover, if the consumptive has 
much fever it will he aggravated by going into a 
a rarefied atmosphere, and harm rather than 
good will ensue. 
The breathing of a rarefied air has a powerful 
effect also upon the nervous system. At first it 
is invigorated and made more active. An eleva- 
tion of more than ten thousand feet will cause, 
in many persons, wakefulness, involuntary mus- 
cular twitching, and aching. Some individuals 
are more susceptible to this nervous excitement 
than others. To most, and to those especially 
who are naturally languid and nerveless, it gives 
a healthy tone and energy; provokes them to 
exercise; promotes a feeling of light-heartedness 
and hopefulness; increases the appetite, and 
stimulates to a better degree of nutrition. These 
are excellent qualities and attributes to have 
developed in most consumptives. But we oc- 
casionally find one who is by nature extremely 
nervous and excitable, and unable to endure, either 
with comfort or safety, even moderate altitudes. 
Thinness and unusual clearness of the air 
are also characteristic of high altitudes. These 
are qualities which make distant objects appear 58 
CONSUMPTION. 
quite near to those unaccustomed to the mount- 
ains. The air is so light that dust and other 
extraneous matter quickly settle or are dissipated. 
The purity of mountain-air is peculiarly useful 
in consumption, as it lessens the danger of ulcera- 
tion of the lungs, if this change has not begun 
before a high altitude is visited. There are few 
or no extraneous ingredients in the air to cause 
new or greater irritation of the respiratory pas- 
sages. 
Dryness is another characteristic of the air of 
high altitudes. In general, we may say that the 
degree of dryness depends upon the degree of 
coldness of the air. To this rule there are ex- 
ceptions, for we find in all deserts extreme dryness, 
but often great heat as well. In mountainous 
regions, however, coldness and dryness usually 
go hand in hand. 
While living in a dry air a person exhales by 
the lungs and skin an increased amount of 
moisture. It is because of this effect that a dry 
air aids in removing the exudates produced by 
inflammation of the lungs. Inflammation is 
always accompanied by swelling of the affected 
tissues, which is chiefly due to the presence in 
them of fluid, of a watery character, that has CLIMATE. 
59 
escaped from the blood-vessels. If by breathing 
and living in a dry air a larger amount of water 
is exhaled than usual, a demand is created for a 
restoration of this surplus to the blood, either by 
the creation of thirst, which is satisfied by drink- 
ing, or by the re-absorption of any fluid that has 
accumulated in the body, as, for instance, in in- 
flamed tissues. It is thus that the breathing of 
dry air promotes the re-absorption of inflamma- 
tory exudates. 
I can, perhaps, best illustrate the influence 
of dry air in removing fluid from the body 
by quoting the computations of Dr. Charles 
Denison. He estimates that at a temperature 
of 71.3° F., in the dry air of Yuma, Arizona, 
3937 cubic inches of water vapor are exhaled. 
On the same day and at the same temperature, in 
the moist climate of Jacksonville, Florida, 3073 
cubic inches are expired. This makes a difference 
in favor of the dry air of 864 cubic inches. But, if 
we contrast the influence of a moist air at the sea- 
level with a dry air at a considerable elevation 
upon the exhalation of moisture, the difference 
is much more in favor of the elevated and dry 
air. For instance, at Denver, because of deeper 
respirations, which increase the volume of air GO 
CONSUMPTION. 
breathed, 1,0G2,800 cubic inches are inhaled and 
exhaled in twenty-four hours, but at Jackson- 
ville only 884,000. At Denver, because of the 
atmospheric dryness, only 1364 grains of vapor 
are inhaled and 10,204 exhaled, or an excess 
of 8910 are exhaled. At Jacksonville, 3172 
grains are inhaled and 8111 exhaled, or an 
excess of 4939 are exhaled. This is less by 
3961 grains than the excess exhaled at Denver. 
Coolness, and in winter even great coldness, is 
the rule in high altitudes. It is a natural con- 
comitant of atmospheric dryness and rarefaction. 
Variability of temperature is another quality that 
accompanies these. But in a dry air coldness 
and variability are not felt by the human organ- 
ism as in a moist one. A moist air causes a 
rapid withdrawal of temperature from the surface 
of the body, therefore a variation of five degrees 
in such an air will produce a severe chilling of 
the surface and shock to the system, which is not 
equalled by a fall of twenty degrees in a dry air. 
Not only are variability of temperature and cold- 
ness very little harmful in dry air, but in some 
instances even beneficial. They provoke or 
stimulate one to exercise. They innervate, and 
thus lead to both greater mental and physical CLIMATE 
61 
vigor. The experience of every one. has con- 
firmed this fact. I scarcely need refer to the 
contrast of feeling which one notices, the in- 
vigoration, on a clear, bright, and cold winter 
morning, and enervation on a warm and sultry 
afternoon. Changeability is, in part, due to 
the diathermancy of the atmosphere which per- 
mits the easy transmission of the sun’s rays. 
Therefore, in the sunshine much warmth may 
be felt, and simultaneously in the shade much 
coldness. For instance, at Davos the solar radia- 
tion thermometer has registered 166° F. by day 
and 16° F. by night. These differences in tem- 
perature between sunlight and shade, day and 
night, make it necessary for persons susceptible 
to rapid changes of the kind to be watchful that 
they do not take cold. 
A cold air benefits those whose lung capacity 
is small and needs increasing otherwise than by 
stimulating to greater physical exertion. Cold 
air, when warmed, expands. Therefore, when 
breathed and warmed in the lungs, it tends to 
dilate them. That this is a fact is demonstrable 
by measuring with a spirometer in winter the 
lung-capacity of a person breathing an artificially- 
warmed air and the capacity of the same lungs G2 
CONSUMPTION. 
a fter the person has inhaled a few breaths of cold 
air at the open door. The variation in capacity 
is considerable. 
Since an out-door life is so essential to the con- 
sumptive, a home should always be chosen, no 
matter whether in the mountains or lowlands, 
where there is the most continuous and unvarying 
sunshine. It tempts to life in the fields and woods. 
Moreover, for the consumptive, it is further use- 
ful, since it causes more frequent and deeper 
respiration than will be practiced in the dark or 
shade. Sunshine always promotes cheerfulness 
and hopefulness,—mental qualities very essential 
to an invalid. 
Mountain-land is, almost without exception, 
well drained. The deleterious influence of a 
residence on damp and imperfectly-drained soil 
has already been pointed out. 
Living in high altitudes usually necessitates 
hill-climbing. I have already shown that no ex- 
ercise is better calculated to enlarge the lungs 
and chest and strengthen the heart and muscles 
of respiration. 
In high altitudes atmospheric oxygen is ab- 
sorbed more rapidly than at low levels, and car- 
bonic-acid gas is also more easily disengaged from CLIMATE. 
63 
the blood and exhaled by the lungs. This is a 
quality of much importance to those in whom the 
lungs are contracted, and in whom, therefore, 
these essential respiratory changes are diminished, 
for it in part compensates for the imperfect res- 
piration which the disease has produced. 
It thus appears that almost every factor of 
mountain climates is adapted to the prevention 
and amelioration of consumption. Unfortunately, 
they are not adapted to every case. 
High altitudes are best adapted (1) to persons 
in whom true consumption has not yet started, 
or has only just begun. 2. To persons whose 
chests have been imperfectly developed and the 
predisposition acquired, providing they are in the 
periods of youth or early adult life. Later than 
this the chest becomes so rigid and its bones so 
hard that it can be molded and enlarged only to 
a very limited extent. 3. To persons in whom 
the disease is well developed, providing they are 
still moderately vigorous and free from fever. Of 
this class the individuals most benefited are those 
in whom the disease is developing very slowly, 
and who are still young. 4. To persons suffering 
from any variety of the disease, providing the 
mountains are visited while the malady is in a 
quiescent state. 64 
CONSUMPTION. 
High altitudes do harm (1) to those consump- 
tives who are past middle life and feeble; (2) to 
those suffering with an active fever; (6) to those 
with large cavities in both lungs; (4) to those 
who are having very profuse haemorrhages, which 
may be due to dilated and weakened arteries 
(aneurism) within lung-cavities; (5) to those 
whose lungs are so far consolidated as to make it 
impossible to perform properly the respiratory 
functions in a rarefied atmosphere. 
No climatic change will do much good if the 
consumptive does not force himself to take all the 
active exercise out-of-doors that is possible. A 
person whose lungs are little affected, if he sits 
constantly about a hotel or boarding-house, and 
broods and mopes, will be little helped; but a 
person whose lungs are badly affected, who has 
the will, the energy, and the perseverance, and 
takes all the exercise possible in the open air, will 
often be restored to vigorous health. 
O 
To produce an arrest of the disease and marked 
improvement, a residence in high altitudes of at 
least six months is essential for most cases of 
consumption; and for all persons in whose lungs 
there are large cavities, or other actively pro- 
gressive or extensive lesions, a residence of two CLIMATE. 
65 
or three years is essential. For the majority it is 
not possible, after checking the disease, to return 
to low altitudes and old habits of life without 
causing a recurrence of the malady. Therefore, 
a permanent residence in a locality that is found 
beneficial is always the best. When this is im- 
possible, periodical returns to high altitudes for 
six months at a time will often hold the disease in 
check, and even sometimes produce permanent 
cure. 
It has been my object to so describe the climatic 
elements of a high-altitude resort that each con- 
sumptive or his physician can make a choice of 
location for themselves. Unfortunately, in the 
eastern part of the United States there are no 
high altitudes that can be utilized. There are 
many most delightful spots of moderate altitude, 
of from 2000 to 3000 feet. Several peaks in the 
Appalachian Range rise above 8000 feet, but their 
summits are so bleak and so frequently cloud- 
capped that they do not afford the necessary 
elements of continuous sunshine, dryness, and 
protection from high winds. 
On the other hand, almost innumerable locali- 
ties can be found among the Rocky Mountains 
which afford, in ideal perfection, all of the ele- 66 
CONSUMPTION. 
ments of high-altitude climate that are essential 
to the consumptive. The best known of these 
are Colorado Springs and Manitou. In many 
respects the Ilocky Mountain resorts surpass 
even those that are most famous in Switzerland. 
They are better adapted than the latter for a resi- 
dence all the year round. At Colorado Springs 
and Manitou so little snow hills, 'and it lies 
on the ground so short a time, that there is no 
period of slush and wet ground and consequent 
damp air, such as is characteristic of spring in 
the Alps. The whole of Colorado, and even of 
several of the neighboring States, is peculiarly 
dry. Bains are rare at all seasons, and cloud- 
less skies are the rule. The altitude of Colorado 
Springs is 6000 feet, and Manitou Springs, live 
miles distant, 6300 feet. These are as delightful 
winter as summer resorts. The air is bracing in 
the extreme. Both have the degree of elevation 
which is essential to insure purity of air, diather- 
mancy, and rarefaction enough to produce physio- 
logical effects. They lie in valleys and are 
surrounded by hills and mountains which pro- 
tect them from high winds, and whose gentle 
slopes admit the sunlight with the greatest free- 
dom. Hotels and boarding-houses at both places CLIMATE. 
67 
are excellent. This is a requisite of every good 
resort, for good and palatable food, clean rooms, 
and necessary service are essential to the invalid. 
It is true that, for those who have regained mus- 
cular vigor, ranch-life, camping, hunting, moun- 
tain-climbing, and exploring are much better than 
hotel life to insure a complete and lasting cure. 
Such life means food that is unvaried in charac- 
ter and often imperfectly prepared, exposure to 
many discomforts and hardships, frequently great 
fatigue, all of which cannot be borne by .most 
consumptives when they first reach the mount- 
ains. Colorado Springs and Manitou, further- 
more, are surrounded by natural objects and 
beauty which attract the visitor to explore them, 
and thus tempt him to the all-essential exercise. 
These localities are delightful summer resorts be- 
cause cool and bracing. They are equally de- 
lightful winter resorts, for the temperature is not 
uncomfortably low and rather invites exercise 
and a life in the open air. Little snow fills, and 
it rarely stays upon the ground more than a few 
days at a time. It creates no appreciable damp- 
ness. Almost uninterrupted sunshine may be 
expected from August to Christmas. March is 
warm, and April and May most delightful spring 68 
CONSUMPTION. 
months. In both places there are mineral springs 
of rare value, but usually not of especial use to 
consumptives. Other favorite resorts in this re- 
gion are Denver, Pueblo, Santa Pc, Albuquerque, 
and Las Vegas. It must be remembered, in 
choosing an occupation, if a permanent residence 
is needed at these mountain altitudes, that city 
life should not be preferred, and that the office, 
the factory, and the sales-room should be avoided. 
A pastoral life is peculiarly adapted to the fairly- 
vigorous consumptive. 
Several locations in the Swiss Alps, at high 
altitudes, have become famous because of the 
numerous cures of consumption effected at them. 
The best known are probably Maloja, Wiesen, 
Davos, and St. Moritz. They are peculiarly 
good winter resorts. Unfortunately, they do not 
afford good, permanent residences; for with rare 
exceptions, in the spring, as the snow melts, 
the ground becomes wet and out-door life is 
prevented by the slush, and even the air is 
made damp. When this change comes, those 
who have spent the winter in the mountains 
must descend to some point already dried. For 
the most part consumptives wintering in the 
Alps gradually descend the mountains in the CLIMATE. 
69 
spring and return to their homes for the summer. 
Repeated winter visits are often necessary. Those 
who require as continuous high-altitude life as 
possible can return when the weather becomes 
settled, and pass the summer as well as the winter 
in the mountains. The Colorado resorts far sur- 
pass those of Switzerland, because they may be- 
come the permanent homes of consumptives, as 
no violent seasonal changes occur in them. The 
Swiss resorts, on the other hand, have the advan- 
tage of excellent hotels and skilled resident phy- 
sicians, who counsel the guests in regard to the 
kinds of exercise adapted to each and in regard 
to the care that each must take in order to insure 
the best results. They watch and encourage 
and guide their patients. Variety in sports, ex- 
ercise, and entertainment is assured the guests 
of these hotels or sanitaria. Out-door amuse- 
ments are an important part of the treatment of 
them. In winter they consist in skating, sleigh- 
ing, tobogganing, snow-shoeing, walking, sitting- 
in the open air in shelters, sketching, etc. 
As soon as the sun is up, out-of-door life begins. 
Immediately after breakfast, by eight or nine in 
the morning, a walk is taken or skates are put on. 
Some seek shelters and sit and watch the skating 70 
CONSUMPTION. 
or games. At noon lunch is taken, and often in 
the open air. Later, tobogganing or sleigh-riding 
to some neighboring village may be enjoyed. 
Snow-shoe parties and excursions in the woods, 
ravines, side-valleys, and to various points of in- 
terest are frequently made. All the sunlight is 
utilized out-of-doors. CHAPTER VI. 
Hygiene (continued). 
climate; low altitudes. 
Before the peculiarly good qualities of high- 
altitude climates were understood, cold and dry 
climates of low altitude were frequently prescribed 
for the same classes of consumptives. Minne- 
sota, Dakota, and parts of British America fur- 
nish such a climate. It is bracing and, for those 
who are energetic, excellent. But, while the 
cold is great in winter, the heat is equally great 
in summer, and between these extremes are 
seasons, fortunately not of great duration, char- 
acterized by much changeability of temperature 
and enough moisture to make the atmospheric 
changes keenly felt by the human body. It is 
not a climate well adapted to the disease at all 
seasons or to a large number of cases. 
Much more generally useful than the dry, cold, 
low-altitude climate is the dry, warm, low-altitude 
climate. Of the latter, we have types in Western 
and Southern Texas, Arizona, and Southern 72 
CONSUMPTION. 
California. At all seasons dryness is peculiarly 
characteristic of these regions. The same kind of 
physiological effects are obtained from this dry air 
as from that in the mountains, but not to the same 
degree, for the effects are intensified by a rarefied 
and cool air. The degree of warmth varies with 
the seasons and the location. Southwestern 
Texas is excellent during the winter season for 
those who need a mild, sunny, and dry air. It is 
a region easy of access to those who wisli to 
escape Northern winters and springs. In summer 
tiie heat, though not uncomfortably great at night, 
is enough by day to be enervating and to lead to 
lassitude and disinclination for exercise. 
As a type of the best localities in Southwestern 
Texas, I can name San Antonio. It is readily 
accessible. It is interesting because of its Span- 
ish features and early history. Its hotels are 
good. During the winter it is dry, and the air 
agreeably warm. In spring, summer, and fall it 
is not as dry as points farther west, such as El 
Paso. The latter is at an elevation of about 
3000 feet. 
Arizona is peculiarly dry, and.its air is almost 
invariably clear at nil seasons. A dry atmos- 
phere, at low as well as high altitudes, can be climate; low altitudes. 
73 
found within its borders. In Arizona and in 
the eastern part of Southern California we find a 
climate fairly comparable to that of Egypt, both 
for atmospheric warmth, dryness, and clearness. 
In Southern California there are many very 
attractive resorts, both for traveling invalids 
and for seekers after a permanent home. The 
climate of the low-altitude resorts, which are 
along the coast, combines the invigorating quali- 
ties of a sea-air with the qualities of a peculiarly 
dry and equable climate. It is true that in the 
Sierras of California excellent high-altitude sta- 
tions can also be found. The temperature is 
uniformly warm throughout them, but it is not 
great or debilitating. The equability at all seasons 
is, perhaps, the most notable climatic peculiarity 
of the coast. It is due to the tempering influ- 
ence of the warm Japan ocean current, which 
bathes it. The water of this ocean stream varies 
throughout the year not more than three degrees 
from fifty-six. It cools the air along the coast in 
summer and warms it in winter. The interior 
desert regions of California and Arizona undoubt- 
edly do much to render the air dry. As in most 
other dry regions, there is very considerable dif- 
ference in temperature in the shade and sun and in 74 
CONSUMPTION. 
the day and night. This must be borne in mind 
by invalids. The air of Southern California is 
bracing and stimulating. The health resorts of 
the region are delightful not for their climatic 
advantages alone, but for beauty of scenery and 
wealth of flowers and fruits. The dryest locali- 
ties are a few miles from the coast. Los Angeles 
is the best known. It is an attractive and thriving 
city, and it is protected from the coast winds. 
Its encircling orange- and lemon- groves and 
vineyards are attractive features in the landscape. 
Near it are delightful suburbs and ocean beaches. 
San Bernardino is much farther from the coast, 
with a drier climate. It is also in the midst of a 
fertile region. Of the strictly coast resorts, San 
Diego is probably the one with the driest and 
warmest climate. The winters are like Northern 
spring. San Buenaventura and Santa Barbara 
are farther North, but most delightful winter and 
also summer resorts. All of these places possess 
excellent hotel accommodations. The long trip 
across the continent diminishes their utility, but 
for many individuals no climate can be found so 
good. 
The Southern California climate resembles that 
of many of the older resorts along the Mediter- 75 
climate; low altitudes. 
ranean coast. Of the latter, those which are 
host known are Mentone, San Remo, and Nice. 
Hyeras and Nice may be looked upon as the 
extremes of the line of resorts which border this 
portion of the Mediterranean coast. Hyeras is 
warmer and its air is less stimulating. It is best 
adapted to the weakest cases, and to those with 
slight fever. Cannes and Nice are less thoroughly 
protected from the Northwest winds, are cooler 
and more stimulating. They are best for those 
who need and can bear stimulation. Those who 
find the climate of the Riviera too bracing may 
resort to some of the Mediterranean islands. 
Palermo can be taken as a type of such places 
with a warmer and moister air. Algiers is 
another favorite resort. 
San Antonio may be looked upon as a conve- 
nient place for temporary residence during winter 
and early spring for such consumptives as are 
still slightly feverish, but able to take some exer- 
cise, and especially for those who are recovering 
from inflammatory attacks. At this place they 
are able to live out-of-doors in the genial sun- 
shine, as they cannot in the North. The dry air 
helps to bring about more rapid re-absorption of 
inflammatory exudates. While many make a 76 
CONSUMPTION’. 
permanent home in this part of the country, it is 
usually better,—at least, for all young patients,— 
when spring is well advanced, to move toward the 
higher land of New Mexico or Colorado. If they 
are free from fever, and, as is usually the case, 
much improved in strength, they may go to the 
high-altitude stations, such as Santa Fe and Colo- 
rado Springs, and here tarry for six months, a 
year, or more, until a cure is established. Many 
of the mild cases and those advanced in life who 
cannot be much helped by a residence at a high 
altitude may he permitted to slowly return to 
their Northern homes, providing they do not reach 
the latitude of Chicago, Buffalo, or New York 
before June. 
The low altitudes of Arizona, its desert regions, 
like Egypt, are most useful to persons in whose 
lungs are large secreting cavities, and to con- 
sumptives with asthmatic complications. The 
secretions are dried and inflammatory exudation is 
lessened. But usually the heat is so great as to 
be enervating and to prevent much active exercise. 
Therefore, when relief is obtained and partial con- 
traction of the cavities has been produced, a greater 
elevation should be sought, where the air is more 
stimulating. It must be remembered, however, 77 
climate; low altitudes. 
that tliis cooler and more invigorating air means 
also a more changeable one, which may rekindle 
catarrhal trouble, unless care is taken to pre- 
vent it. 
The California and Riviera climates are useful 
for all cases of chronic consumption, if they are 
free from fever, and provided they have strength 
for gentle exercise. . Frequently those who have 
been almost bedridden for months will in a few 
days, in this balmy air, so far recover that they 
seek the hammock out-of-doors, and soon, as 
strength returns, begin to take the all-essential 
exercise. 
All cases recovering from and with a tendency 
to recurring attacks of pneumonia or broncho- 
pneumonia are especially benefited by these same 
climates. California is peculiarly adapted for the 
permanent residence of those suffering from con- 
sumption who are in middle life or passed this 
period. The equability, dryness, and stimulating 
quality of the air will greatly lessen the number 
of exacerbations of the disease or hold it in check 
and promote a longer life. For youth and early 
manhood the rarefied air of high altitudes is 
best, providing very large cavities .do not exist, 
or areas of consolidation so extensive that they 78 
CONSUMPTION. 
diminish the capacity of the lungs, and therefore 
do not permit of comfortable respiration. 
In proportion as there is fever or too little lung- 
capacity to permit of active exercise, the stimu- 
lating dry airs prove less efficacious than the 
sedative moist and warm ones. Not unfrequently 
consumption occurs in those who are habitually 
nervous and excitable. Such individuals are 
frequently unable to sleep in high altitudes, and 
are too greatly stimulated even in dry, low alti- 
tudes. For such persons the moderately warm, 
moist climates or moist ones which are sedative 
in action must be chosen. Moist climates are not 
only sedative to the nervous system, but also to 
the bronchial tubes, and allay harsh, harassing, 
and violent coughs. But it is not always so 
desirable to lessen cough as to effect other changes; 
therefore, in choosing a climate we are rarely 
greatly influenced by the character of the cough. 
For those more than thirty-five years of age, in 
whom the lungs are extensively affected, and 
whose cough is severe and wearying, a moist 
climate may be preferred. But after mitigating 
the cough and effecting some improvement, a 
permanent residence should be chosen in a 
moderately moist climate, or one as nearly ap- 79 
climate; low altitudes. 
preaching the dry as can be endured without 
aggravating the cough. A permanent residence 
in a moist and hot climate is so enervating that it 
often leads to increased general debility. 
For the most part the warm-moist and mod- 
erately moist climates are winter and spring re- 
sorts only, and are employed as palliatives to the 
disease while it is active and increasing. They 
insure to many a winter in the open air and 
under sunny skies. By avoiding the rigors of a 
Northern winter and spring, life is often pro- 
longed, the disease is frequently checked, and 
time is gained in which a lasting improvement 
can be effected. 
I have classed San Antonio among the moder- 
ately dry, warm climates, but it might almost 
equally well be grouped with the moderately 
moist, warm resorts. It is geographically on the 
border of both the Avarm-moist and warm-dry 
regions. In winter it is moderately dry, but 
during the remainder of the year it is moderately 
moist. The climate of Northern Georgia and 
South Carolina is, as regards humidity, very 
similar to that of the region about San Antonio, 
and is useful for the same class of cases. Thomas- 
ville, Georgia, and Asheville, South Carolina, arc 80 
CONSUMPTION. 
amid pine-forests. They are especially good in 
the fall, in the winter, and late spring, and the 
neighboring mountain resorts, in the summer, 
for just those cases that are benefited by moist, 
warm climates in winter. The influence of the 
balsamic air is peculiarly good for those who 
suffer from an irritative cough and copious ex- 
pectoration. Most patients, for whom the warm, 
moist climate of Florida or the West Indies is best 
suited in winter, can pass comfortably and salu- 
briously the late spring, summer, and early fall 
in Northern Georgia and South Carolina. Of 
resorts in the United States, those of Florida are 
types of the warm moist. I have already indi- 
cated the class of cases for which they are best 
adapted. Among the favorite resorts of this 
State are St, Augustine, Fernandina, and Cedar 
Keys upon the sea-coast, and Palatka in the in- 
terior, The sky is exceptionally clear and bright 
during the winter. The temperature is delight- 
ful to those who wish to escape the Northern 
cold. Upon the west coast of Florida the air is 
dry and similar to that of the coast of Southern 
California. Resorts along it may most properly 
be classed among those in dry, warm climates. 
Tampa Springs is a comfortable and typical climate; low altitudes. 
81 
resort on this coast. It is attractive because of 
its climate, the luxuriance of vegetation, unsur- 
passed fishing and boating. 
Foreign climates comparable to the Floridian 
are found at Madeira, Teneriffe, Cuba, Jamaica, 
the Bermudas, and the Sandwich Islands. In 
many of these places, and notably at Teneriffe, 
mountain altitudes may be combined with the 
equable, moist, warm climate. Tangiers, some 
of the Mediterranean isles, and points along the 
coast of Italy possess moderately moist, warm 
climates, but are not directly comparable to the 
interior climate of Georgia and South Carolina. 
The balsamic forests at moderate elevations in 
the Adirondack Mountains are favorite summer 
resorts. They do not afford the advantages of a 
high altitude, but make possible mountain-climb- 
ing, hunting, fishing, boating, camping,—forms 
of exercise and modes of life that are most useful 
to those consumptives who possess strength to 
take advantage of them. 
Ocean voyages have long been famous for their 
good influence upon consumption. But what is 
true of land climates is true of the ocean-air: it 
is not equally well adapted to every case. In dis- 
cussing land climates, I have enumerated several 82 
CONSUMPTION. 
sea-shore and island resorts. These combine the 
elements of the land and ocean climate. The in- 
fluence of the ocean climate in its purity is only 
obtainable on a vessel at sea. On so chronic a 
disease as consumption, it exerts little influence 
except when the voyage is a prolonged one. 
The characteristic element of the ocean climate 
is the purity of its air. In mid-ocean the air is 
almost absolutely free from dust; therefore, from 
noxious germs. It is rich in the most energetic 
and useful form of oxygen. It is chiefly this 
quality that makes the ocean climate a tonic one 
to the digestive organs, and causes it to pro- 
mote better general nutrition. The temperature 
is peculiarly equable. There is at sea less differ- 
ence between winter and summer temperature 
and night and day temperature than upon land. 
By day the water absorbs much heat, as the sun’s 
rays penetrate it deeply. It gives off less heat 
than land, for much water is transformed into 
vapor by the heat, which is thus made latent. 
Moreover, the vapor upon the water limits the 
radiation of heat from it by night. In winter 
the cool air is warmed by the slow radiation 
of heat from the deeply-heated ocean. The 
surface water is cooled, at once sinks and is climate; low altitudes. 
83 
replaced by warmer. This process continues 
until the heat absorbed deeply by day and in 
summer has been given off. An ocean climate 
is always a moist one. The variation in its hu- 
midity is very slight. A sea-air also contains 
a minute amount of chlorine, iodine, and bro- 
mine, which may have some effect upon animal 
life. 
A sea-air is usually sedative in its action 
upon the nervous system, and promotes sleep. 
Complete isolation from all affairs of the world 
guarantees to one taking an ocean voyage a 
mental rest and relief from business strain. This 
is important in many cases of incipient con- 
sumption. Overmental exertion is frequently 
a characteristic of the consumptive. The ocean 
air lessens, as a rule, irritative, harsh coughing. 
Its moisture makes expectoration and breathing 
easier. The appetite with as much uniformity is 
improved. Nourishment is better appropriated 
by the tissues, and therefore flesh and strength 
increase. 
Long voyages are particularly beneficial to 
those who are predisposed to the disease, es- 
pecially if the lungs are reasonably well devel- 
oped ; to those who are scrofulous; to those who 84 
CONSUMPTION. 
suffer from frequent haemorrhages, which are 
often checked by the sea-air; to those with a 
moderate degree of consolidation and contraction 
of the lungs and a harsh, irritating, and wearying 
cough. Those who are very weak, and in whom 
much improvement cannot be expected, should 
not make such trips, for they cannot turn back 
if they grow worse. Those who have much 
fever should not venture to sea for the same 
reason. There are those who suffer from sea- 
sickness continuously while on the water, and for 
such a voyage would be harmful, and would of 
necessity lead to greater bodily wasting. Persons 
are rarely met who are so timid while at sea 
that their constant apprehension depresses them 
and prevents their experiencing the benefits which 
otherwise they might. For them, also, sea-voyages 
are useless, if not hurtful. Another drawback to 
the successful treatment of consumptives at sea is 
the limited number of exercises that can be taken. 
This is a drawback which men rarely feel unless 
they are upon a crowded steamer, for, besides 
promenading and the usual deck-games, they can 
help the sailors or take varied gymnastic exercises 
in the rigging. A voyage on a sailing vessel, I 
believe, is much to be preferred to one on a 85 
climate; low altitudes. 
steamer. Prolonged stormy weather is detri- 
mental to the successful treatment of lung dis- 
ease, for it usually compels passengers to remain 
in close and poorly ventilated cabins for hours, 
and sometimes days, continuously. 
Voyages, to accomplish much good, should 
he of several weeks’ and often better of several 
months’ duration. A direction and season should 
he chosen that will be most likely to insure 
pleasant weather. It is usually desirable to get 
those for whom sea-voyages are adapted away 
from winter’s cold and frequent changes of 
temperature. We can insure them two years of 
continuous summer by having them sail from the 
northern temperate zone to the southern, starting 
in October or November and returning in the 
spring. 
The shorter ocean voyages are to the West 
Indies, Azores, or a Spanish or Mediterranean 
port by slow steamer or good ship. The longer 
ones are to South American ports or to Cape 
of Good Hope, or to Australia or India by the 
Pacific. 
Results as beneficial as have been obtained at 
high altitudes have been obtained at sea. Both 
insure pure air and make possible out-door life. 86 
CONSUMPTION. 
They stimulate to exercise and the tissues of the 
body to greater nutritive activity. 
In choosing a climate for individual cases, other 
things than the effect of it upon the lungs must 
be thought of. Especially for those who are weak 
and whose appetites are capricious a place must 
be chosen where good, wholesome, varied, and 
well-cooked food can be had. In choosing be- 
tween similar climates in our own and foreign 
countries the taste of individuals must be con- 
sidered. For those who are moderately strong 
and naturally fond of sports and active exercise, 
there is little trouble in making a selection. But 
for those habituated to a sedentary life, and natu- 
rally disposed to take little exercise, a location 
must be chosen whose natural features are so at- 
tractive and varied that they will awaken interest 
and lead to exercise, or else a resort must be 
selected where a medical man is located who will 
guide and stimulate those who need it to the 
necessary degree of activity. 
The condition of the digestive organs or nerv- 
ous system may make unsuitable to a given indi- 
vidual a climate that would be perfectly adapted 
to the condition of his lungs. There is still a 
larger class of cases who must have an occupation CLIMATE; LOW ALTITUDES. 
87 
by which they can support themselves wherever 
they go. For such, frequent and especially sea- 
sonal changes are impossible, and a permanent 
residence must be chosen where work can be 
found. It is, therefore, evident that often a choice 
of climate is no easy matter. 
The selection of a climate is frequently made 
easier by watching the effect, in a given patient, 
of different kinds of weather, especially of bright, 
warm, moist days, and bright, warm, dry ones. 
There are, unfortunately, many cases for whom 
no climatic changes are desirable. All cases of 
quick consumption should be advised to remain 
at home, for a change is useless. Cases of tuber- 
cular disease of the larynx are little benefited by 
climatic changes. Those who have continuous 
fever are usually best off at home. An exception 
to the last rule I would make for those who are 
fairly strong and not losing ground rapidly, and 
who, by a change, can be sure of enjoying con- 
tinuous out-door life. If cavities are enlarging 
rapidly, or extreme weakness prevents exercise, a 
change is of no use. Discomfort and no benefit 
is produced by changes that are made when life 
is fast ebbing or nearly ended. 
There are many consumptives who, for fin an- 88 
CONSUMPTION. 
cial or other reasons, cannot seek the climates 
best adapted to their conditions. Hope need 
not be lost because of this. We see recoveries 
occurring here in Chicago in those who are pre- 
disposed to the disease, and who suffer in its 
earlier stages. The chances of successful treat- 
ment are, however, much less in any other than 
the climate best adapted to each case. Unfortu- 
nately, our most populous cities and States are 
located in a changeable, cool, damp climate, which 
especially excites or aggravates inflammation in 
the respiratory tracts. 
These are locations illy suited to the treatment 
of consumption. If a change cannot be made, 
care in the execution of the other rules of life 
essential to the treatment of consumption must 
be redoubled. CHAPTER VII. 
Hygiene (continued). 
EXERCISE. 
The importance of exercise and the desirability 
of its being taken out-of-doors have already been 
frequently adverted to. Exercise must be adapted 
to the stage of the disease and to the peculiari- 
ties of muscular development in each individual. 
It must be general; that is, must call into play 
most of the muscles of the body. It must also 
be special, or addressed to the development of 
those muscles that may be peculiarly weak or 
small. 
General exercise, such as is taken in brisk 
walking, running, and horseback-riding, or, better, 
in these combined with others, for the arms and 
chest-muscles promote better nutrition. This is 
accomplished by invigorating the circulation, and 
especially the lymph circulation. It is by the 
latter that nutriment is brought in direct contact 
with the elements of the tissues, and by it waste 
products are removed. The successive contrac- 90 
CONSUMPTION. 
tion and extension of muscles is one of the most 
important factors in the maintenance of vigorous 
circulation of the lymph. It promotes restful 
sleep by causing a healthy weariness. Regular 
exercise out-of-doors will often lessen or check 
night-sweats in those who are a little feverish. 
Such sweats are, without doubt, due to the pres- 
ence of some deleterious substance produced in 
the body by the abnormal action of the diseased 
tissues. In some instances it can apparently be 
destroyed or eliminated. Its elimination is un- 
doubtedly aided by exercise. We often observe 
the rise of fever and return of night-sweats in 
those who, by inclement weather, have been 
housed for a few days, and we observe their dimi- 
nution or disappearance when again the accus- 
tomed open-air exercise is resumed. However, 
the most important and most constant result of 
exercise is the promotion of better nutrition. 
Active—that is, voluntary—exercise is always 
to be preferred. Indeed, it is rare that voluntary 
exercise cannot be taken by the consumptive, 
unless he is too feeble to bear any. Massage, 
which is the form of involuntary or passive exer- 
cise most frequently resorted to, is, therefore, 
rarely useful in consumption. It may be em- EXERCISE. 
91 
ployed for those who are well able, but too lazy 
or sluggish, for active exertion. 
The amount of exercise should be adapted to 
the strength of the individual. It should never 
cause exhaustion, but may be carried to the point 
of producing gentle fatigue, which can be easily 
recovered from by a little rest. It accomplishes 
the most good when it is distributed over the day 
in small amounts. It should he varied; for of 
exercise, as of food or books, one tires, if it is 
unvaried in character. 
Among the best and most easily utilized forms 
of exercise are walking, running, climbing, riding, 
bicycling, tennis, and other sports. Walking to 
be useful must be brisk, and the arms must be 
permitted to swing freely at the side. Nothing 
lessens the good effects of walking so much as 
persistently holding the arms at the sides, with 
the hands in pockets or a muff These positions 
interfere with exercise of the muscles of the shoul- 
ders, and with free, deep breathing. Walking 
chiefly exercises the legs. Those predisposed to 
consumption, or suffering from its more chronic 
forms, with thoracic contraction, should above 
all be urged to exercise the arms and to breath 
deeply. Hill-climbing, especially if the climber 92 
CONSUMPTION. 
carries an Alpine stick or long staff, is pecu- 
liarly good, for it enforces deeper breathing 
than level walking does. The lifting forward 
with each step of a staff that is grasped at a 
point nearly as high as one’s shoulder enforces 
a lifting of the arm and straightening of the 
shoulders which is mild but excellent exercise 
for the arms and chest. Running is a general 
exercise, but also an especially good exercise 
for the muscles of respiration, as it necessitates 
frequent and deep breathing. Rowing is es- 
pecially useful in strengthening the muscles of 
the arms, shoulders, respiration, and less vigor- 
ously those of other parts of the body. Horse- 
back-riding and bicycling produce a gentle gen- 
eral exercise. Rapid bicycling, or wheeling over 
heavy ground, causes the rider to lean forward 
so that respiration is rather impeded than aided. 
It is not, under such conditions, a useful exercise. 
Field sports and gunning are excellent forms of 
exercise, and are exhilarating for those who are 
strong enough to bear them. They are almost 
exclusively adapted to those who are predisposed 
but not yet affected by consumption. The neces- 
sity of never carrying exercise to the point of 
exhaustion must be borne in mind. EXERCISE. 
93 
Those whose chests are abnormally small in 
circumference, or who are round-shouldered or 
otherwise deformed through lack of muscular 
vigor, can accomplish much by exercises es- 
pecially adapted to meet their peculiar needs, 
that can be taken in any well-appointed gym- 
nasium. Gymnasium exercise should never be 
practiced to the exclusion of out-door exercise. 
I have already dwelt on the need of special 
training, which will ultimately lead to a sym- 
metrical development of the body, for those in 
the earlier years of life, predisposed to consump- 
tion. Similar, but, at first, more gentle exercise 
is needed by those in whom the disease has caused 
flattening of the chest. Violent or prolonged ex- 
ercise should be avoided by all who are much 
feverish. This, however, is a general ride, for 
occasionally a consumptive is found who has a 
daily and considerable rise of temperature, who 
is comparatively vigorous and energetic. Those 
who are feverish should be permitted only gently 
fatiguing exercise. We cannot gauge the amount 
of exercise that should be taken, either by the 
degree of bodily heat or lack of energy, but 
only by the strength of the individual. There 
are many who are languid and disinclined to 94 
CONSUMPTION. 
physical exertion, who are both able to take it 
and sure of benefit from it. 
If possible, all exercise should be taken out-of- 
doors. During rainy weather, if the sun appears 
between the clouds, advantage should be taken 
of the few minutes of brightness for a walk and 
a breath of fresh air. 
In our latitude exercise is best taken, during 
the summer mouths, in the first hours of the fore- 
noon or last ones of the afternoon. In late au- 
tumn, winter, and early spring, it should be taken 
near midday. All consumptives should pass as 
much of the day out-of-doors as their strength 
will permit them to do. If the climate they are 
in will allow it, they should rest in the open air 
as well as exercise there so long as it is daylight. 
Of the special exercises the most important are 
those that expand and enlarge the chest and 
insure thorough -ventilation of the lungs with 
clean air. But often other deformities than that 
of a narrow or shrunken chest, such as rounded 
shoulders and stooped neck, must be corrected. 
For the modification of many of these, the instruc- 
tions of a physician and of a gymnasium’s director 
must be relied upon. In order to correct the 
condition of stooped neck and rounded shoulders, 95 
EXERCISE. 
the first requisite is the removal of the causes. 
Leaning over a book or desk or sewing-machine, 
or sitting upon a shoe-maker’s or tailor’s bench, 
or for other reasons maintaining for hours con- 
tinuously a stooping posture, is the commonest 
cause. Such a posture prevents the free and fre- 
quent use of the muscles that maintain a straight, 
erect position, and from disuse they waste and 
are weakened. No occupation necessitating the 
maintenance of such positions should be chosen 
by those who have consumption or are predis- 
posed to it. If they must be followed, the habit 
should be acquired of straightening the back, 
neck, and shoulders, and deeply filling the chest 
as often as every half or three-quarters of an 
hour. If the head droops forward habitually, 
crooking the neck, it is impossible easily to fill 
the lungs, and if the shoulders round forward 
the upper part of the lungs cannot be expanded 
completely. Consumption almost invariably be- 
gins in the top of the lungs, because, as is sup- 
posed, the air is less easily and perfectly changed 
there. The need of perfect expansion of this 
part of the lungs of those predisposed to the dis- 
ease is self-evident. Originating at the top of 
the lungs, it tends to contract and cripple this 96 
CONSUMPTION. 
part of them; therefore, forcible expansion is 
necessary to counteract the tendency. An erect 
carriage should be striven for by all who are 
predisposed to the malady, or have it. 
There are special exercises, and even special 
forms of apparatus in gymnasiums, for the cor- 
rection of these deformities, but to describe them 
is outside the province of this essay. A few gen- 
eral directions may be of value. While sitting 
or standing, an erect position should always be 
maintained. While walking, the head should be 
held up, the neck kept straight, and the shoulders 
thrown back. The top of the lungs will be 
inflated most surely if the muscles down the 
front of the abdomen are slightly contracted while 
an inspiration is taken. Indeed, strong and firm 
abdominal muscles are essential to good breath- 
ing. The habit of standing and walking erect 
is best acquired by permitting the eyes to wander 
among objects about fifteen or twenty feet above 
the ground and fifty of one hundred feet away. 
The reading of signs above store windows and 
doors is often a useful amusement. The muscles 
of the neck are well exercised by balancing a 
book or other light object upon the head while 
sitting or walking. However, if one will remem- EXERCISE. 
97 
her to hold the head erect, there is rarely suf- 
ficient loss of muscular strength to make it 
difficult. The same we may say of straightening 
the shoulders. Indeed, if one will constantly 
endeavor to hold the head up, the shoulders back, 
the back straight, and the abdomen fiat, the mus- 
cles of all these parts will be sufficiently exer- 
cised to keep them strong and vigorous. In those, 
however, who inherit a predisposition to consump- 
tion, or already have the disease, and especially 
if it is in its chronic form, the muscles about the 
shoulders are shrunken and weak. Not only 
must they be strengthened to acquire a symmet- 
rical muscular development over the body, but to 
hold the shoulders back, and, as they are employed 
in deep breathing, to aid it. In general, we may 
say that pulling and pushing from the shoulders 
call these muscles into use and strengthen them. 
Rowing is, therefore, beneficial. To accomplish 
the most good, the pushing and pulling should he 
varied, and from different directions. Dumb-bell 
exercises help to strengthen the muscles of the 
shoulders and arms. Calisthenics, without dumb- 
bells, are often sufficient. An especially good 
exercise consists in swinging the extended arms 
backward as far as possible, keeping them, at the 98 
CONSUMPTION. 
same time, in a horizontal position. One may 
stand in a door-way, and, grasping its sides, per- 
mit the body to lean backward at arms’ length, 
and then pnll it forward into the erect position. 
In this way, the polling muscles of the arms and 
shoulders are used, one’s own body being the 
object pulled. The pushing muscles may be 
exercised by standing back from the door-way 
and, leaning the hands against its sides, permit 
the body to lean forward as far as possible, and 
then push it back into an upright position. To 
develop the muscles best, pushing and pulling 
should not be forward and backward only, but 
sideways and upward and downward also. Each 
exercise should be persevered in until it pro- 
duces gentle fatigue. The exerciser should 
endeavor every day to repeat the motions oftencr, 
and with increased rapidity. If this can be done 
without increasing the degree of weariness, the 
muscles are surely growing stronger. 
In order to expand to normal proportions a 
chest contracted from imperfect development or 
from disease, nothing is so important as respira- 
tory gymnastics proper. By respiratory gymnas- 
tics proper, I mean enforced and frequent deep 
and slow inspiration and expiration. The neces- EXERCISE. 
99 
sity for such exercises cannot be too greatly em- 
phasized. They are needful always when a 
predisposition to consumption exists; also, when 
the disease is causing a slow contraction and 
deformity of the thorax. They often aid in 
loosening and expelling tenacious mucus from 
the bronchial tubes. 
Deep breathing causes better oxygenation of 
the blood, and thus stimulates a better degree of 
nutrition in all the tissues. Not only docs fre- 
quent deep breathing supply more oxygen to the 
blood, but it removes from it more perfectly car- 
bonic acid and water, which is to be exhaled. 
Deep inspiration causes the blood-vessels of the 
lungs to fill, and withdraws as much from the 
veins elsewhere in the body; prolonged expira- 
tion, on the other hand, presses the blood from the 
vessels of the lungs and permits the systemic 
veins to become distended. These circulatory 
changes in the lungs are useful to the consump- 
tive, insuring a better oxygenation of a larger 
volume of blood and giving the vessels greater 
strength Jby training them to readily contract and 
expand. The more palpable effects are enlarge- 
ment of the lungs and strengthening of the respi- 
ratory muscles. 100 
CONSUMPTION. 
Those who are predisposed to consumption or 
suffering from the disease in its earlier stages 
should adhere to the rule of drawing slowly 
as deep an inspiration as possible, as often as 
every three to five minutes while walking out- 
of-doors, and as often as every half-hour while 
sitting in-doors. When an inspiration is taken, 
the head should be erect so that the neck, and 
therefore the wind-pipe, will be straight, and will 
readily transmit air; the shoulders should be 
thrown back so that the upper part of the chest 
can be fully inflated; and the inspiration should 
be made through the nose with the mouth closed. 
By such inspirations, all the respiratory muscles 
are exercised and made to grow strong; the air- 
cavities of the lungs are filled or distended; and 
the whole chest is gradually enlarged, especially 
in its lateral and transverse diameters. Further- 
more, frequent, enforced deep breathing leads 
to its habitual practice. There is not a more 
important habit for the consumptive to acquire. 
Hill-climbing causes involuntary deep breathing. 
Running, for the same reason, is an invaluable 
exercise. It is particularly useful to enlarge the 
lungs. I frequently advise consumptives, in the 
early stages of the disease, to practice running 101 
EXERCISE. 
daily. This cannot be well done by daylight in 
a crowded city, but advantage should be taken of 
eacli clear night. Each day a little greater dis- 
tance should be run, and gradually a little 
quicker gait should be acquired. 
The effect of slow inspiration can be increased 
by breathing through one nostril only. Coinci- 
dent deep inspiration and prolonged expiration 
are desirable. Deep inspiration necessitates a 
somewhat prolonged expiration. The latter can 
sometimes be advantageously further prolonged 
by closing one nostril or by producing certain 
sounds which necessitate various degrees of closure 
of the throat by the vocal chords. Deep inspira- 
tion causes a fall of air-pressure in the lungs, and 
prolonged expiration causes increased air-pressure. 
Practically, therefore, unusually deep breathing 
produces the effect of breathing in a condensed 
air, since, as compared with that in the lungs, the 
atmospheric air is condensed; and prolonged ex- 
piration produces the effect of exhaling into a 
rarefied air, as that within the lungs is compressed. 
This compression can be increased by closing 
both mouth and nostrils at the end of deep in- 
spiration, and making an expulsive effort. Such 
compression of the air in the lungs forces open 102 
CONSUMPTION. 
all the air-spaces within the chest, and decidedly 
promotes the absorption of inflammatory exudates 
and the loosening of secretions within the bron- 
chial tubes. The effects are the same as that 
which, to an increased degree, can be obtained 
from the inhalation of air artificially compressed 
and exhalation into air similarly rarefied. 
Breathing exercises would not be so necessary 
if all the air the lungs contain was changed 
with each respiration, but this is not the case. 
While each lung ordinarily contains about two 
hundred and twenty cubic inches of air, twenty 
only are breathed in and out with each quiet 
respiratory movement. If an unusually long 
inspiration is made, one hundred and ten cubic 
inches can be added to what each lung contains, 
and if an unusually complete expiration is made 
after such an inspiration two hundred and thirty 
cubic inches can be forced out. It is evident, 
therefore, that, ordinarily, one-third the actual 
capacity of the lungs is unused. If irritants gain 
lodgment in these unused portions, they are likely 
to remain long enough to do irreparable harm; 
but it is scarcely possible for foreign substances 
to remain in those portions constantly emptied 
and filled. This is one reason why it is desirable EXERCISE. 
103 
that the entire lung-capacity should be brought 
into use. Moreover, in those parts of the lungs 
where there is air, but where it is rarely or slowly 
changed, waste matter that should be exhaled 
accumulates, and if disease exists in or near 
these areas products of its action may be formed, 
and be re-absorbed, and prove poisonous to the 
body. It has often been experimentally proven 
that the exhalations from healthy lungs are poi- 
sonous. If slowly and continuously absorbed, 
they cause languor, loss of appetite, and loss of 
mental as well as physical vigor. But enforced 
deep breathing insures perfect ventilation of all 
parts of the lungs, and, as is almost self-evident, 
helps to prevent infection when contaminated air 
is breathed, and also to eliminate deleterious 
materials generated by the human system both in 
health and disease. It is evident that the ill 
effects of imperfect ventilation are most apt to be 
developed in those whose lung-capacity has been 
greatly diminished by the acquirement of rounded 
or stooped shoulders or other deforming attitudes, 
or by disease which destroys the air-space. 
I have seen the circumference of the chest in- 
creased two inches in six months by deep breath- 
ing and complete expiration, practiced very 104 
CONSUMPTION. 
frequently for an hour in the morning and again 
for an hour in the evening. At the same time, 
the amount of air exhaled during quiet breathing 
was increased very appreciably, and all respiratory 
movements were made more forceful. This in- 
creased forcefulness is important, since it insures 
the deep stirring of the air in the lungs. The 
invigoration which these exercises wrought, to- 
gether with good food and air, transformed in nine 
months a listless and half-invalid stripling, six 
feet in height, weighing 135 pounds, with narrow 
and long chest, into a vigorous youth, with 
broadened shoulders, whose weight was 180 
pounds. 
What may at first be an enforced or voluntary 
deep and complete respiration becomes by frequent 
and persistent repetition a habit and involuntary. 
It is this habit that should be striven for. One’s 
general physical vigor, as well as the healthful- 
ness of one’s lungs, largely depends upon their 
perfect ventilation, and, therefore, upon the thor- 
ough oxygenation of the blood and its purification. 
But deep and especially very deep breathing pro- 
duces other mechanical effects which have been 
described, and which are useful and absolutely 
necessary to many consumptives, but may be even EXERCISE. 
105 
harmful to others. There can be gotten from 
enforced deep breathing nearly the same results 
as from breathing the air of high altitudes. The 
results are attained more slowly, and require more 
of voluntary effort and constant thoughtfulness 
on the part of the one seeking them. Therefore, 
to those for whom a high-altitude climate is de- 
sirable, but for any reason unattainable, these 
respiratory gymnastics are all important. They 
must be largely relied upon to develop the crip- 
pled lungs, to remove foreign, waste, and deleteri- 
ous matters by ventilation, and to invigorate the 
whole system by the addition of needed oxygen. 
Enforced respiratory exercises should not he 
employed during or immediately after haemor- 
rhages from the lungs, as they may prolong or 
renew the bleeding by preventing the blood-clots 
from plugging the bleeding vessel or by loosening 
them from it. They should not be employed 
when there is much fever, and in a very gentle 
and moderate way when a slight increase of tem- 
perature exists. Very great debility makes their 
employment impossible, and often, if attempted, 
causes such weariness as to he harmful. If large 
cavities exist, they also contra-indicate much 
respiratory exercise. 106 
CONSUMPTION-. 
Respiratory exercises are especially useful when 
the elasticity of the lungs has been lessened by 
disuse or disease, and the amount of air habitu- 
ally exhaled and inhaled is too small; when the 
chest is narrow, thin, or deformed; and when 
catarrhal inflammation exists, and it is desirable 
to loosen and expel secretions from the bronchial 
tubes. The best results are attainable in the 
earlier years of life; that is, during youth and 
early manhood, when the bony frame-work of 
the chest is still pliable, and the upbuilding power 
of the tissues is great. When exercises are pre- 
scribed for consumptives, they must be adapted to 
the stage of advancement of the disease and its 
degree of acuteness. The same exercises are 
adapted to those who are predisposed to it and 
those suffering from its incipient results. Those 
in the earlier years of life, in whom the disease is 
farther advanced, though for the time quiescent, 
must take the same classes of exercise, but with 
much greater moderation; especially must they 
he careful not to produce considerable exhaustion. 
Individuals belonging to these classes must aim 
to correct deformities and imperfect muscular de- 
velopment by special exercise, to enlarge the lungs 
by either voluntary or involuntary pulmonary EXERCISE. 
107 
gymnastics, and to thus effect a general invigor- 
ation. Running, brisk and prolonged walks, 
mountain-climbing, riding, and boating, out-of- 
door sports, as ball and tennis, or hunting and 
fishing, are the most useful and promptly effective 
forms of exercise or combined sports. If business 
is carried on while treatment is being pursued, 
the hours for exercise and the kind taken must 
be fully prescribed and efficiently superintended. 
As these exercises must be persevered in for long- 
periods of time, they must occasionally be varied, 
that they may not become too irksome. Interest 
in them can be maintained by periodically taking 
measurements of the chest when fully expanded 
and completely emptied, and noting the differ- 
ence as increased chest capacity and mobility are 
acquired, and by testing the strength of various 
sets of muscles as they are being developed, and 
by observing the degrees of endurance which are 
attained. With all these exercises, it is best to 
combine systematic and enforced deep breathing. 
To those who have a nightly access of fever, 
but a normal temperature during the greater part 
of the day, and who are able to be dressed, and 
even to do considerable walking, a life out-of- 
doors is still possible. Carriage-riding will afford 108 
CONSUMPTION. 
pleasure and gentle exercise. Short and frequent 
walks can be taken. Deep breathing can also 
be practiced, but less frequently and systemati- 
cally than when no fever exists. Often deep 
inhalation provokes coughing or pain, and can- 
not, for these reasons, be made. 
If fever is continuous throughout the day, 
several hours can be spent in the open air in a 
hammock, or in a seat by the open window, and 
an occasional drive can be taken, or, perhaps, a 
few moments’ walk before the door. More exer- 
cise usually is impossible, or causes harmful ex- 
haustion. Those who are forty years old or more, 
in whom the disease is in its incipiency, or is 
quiescent, can take much more exercise in quan- 
tity than those with slight fever, but it must be 
for the most part the same in character. Its 
object must be to insure complete ventilation of 
the lungs and as complete use of them as pos- 
sible ; but there is little hope of correcting 
deformities and compensating for lung destruc- 
tion. 
Those who are bedridden are unable to take 
exercise, and are usually harmed if they try it. CHAPTER VIII. 
Hygiene (continued). 
CLOTHING. 
I have already explained the need of keeping 
the bodies of those who are predisposed to con- 
sumption completely protected against atmos- 
pheric changes by woolen clothing. Such 
protection is just as needful for those in whom 
the disease is established or advanced. Wool is 
preferable, for it maintains a very equitable tem- 
perature about the body; it is light and porous, 
and is not expensive. It should be worn both by 
night and day. Its weight should be varied with 
the seasons. It is an error to think that to 
increase warmth clothing must be heavy. It 
should be light, in no way cumbersome, and suf- 
ficiently porous to allow of the exit of bodily 
exhalations. Not unfrequently we see persons 
who have disease of the lungs who are over- 
clothed, wearing, it may be, two sets of under- 
wear, a chest-protector, a knitted garment inside 
the dress, a small shawl pinned closely round the 110 
CONSUMPTION. 
bust, and then a large, heavy shawl over the 
shoulders. Such dressing is not conducive to 
cleanliness, for several of the elements of the 
costume are rarely taken off, and are never well 
aired or washed. It is not conducive to health, 
as the weight of the costume is burdensome. So 
many wraps prevent the ready removal of exha- 
lations from the skin and the easy expansion of 
the chest. 
Chest-protectors may be beneficial or harmful. 
If made of woolen cloth, and not too thick, they 
are serviceable, but if they are made of leather 
they cannot he healthful, for they prevent the 
absorption of exhalations and secretions from the 
skin and their removal to the outside air. The 
skin is an important adjunct of the lungs and 
kidneys in removing from the body waste and 
deleterious products of life. If the skin is cov- 
ered by impervious clothing, its eliminative func- 
tions are interfered with. Every tissue»and organ 
in the consumptive must he given the best chance 
to do its work, or must he aided, certainly not 
hindred. For the same reason it is not well, for 
any great length of time, to wear leather or water- 
proof garments. 
Clothing should always he loose, and in no Ill 
CLOTHING. 
way impede respiration. Corsets and tight belts 
should not be worn. Especially are they harm- 
ful during the years of growth, when the chest is 
being molded. They greatly interfere with ab- 
dominal respiration, which is essential to perfect 
tilling of the chest. 
Health should never be endangered for fashion’s 
sake. The exposure of necks and arras to the 
drafts of ball-rooms, and to sudden chilling be- 
cause of imperfect protection by wraps when 
hot and close rooms are left, especially during 
winter and other inclement seasons, is a source 
of great and unnecessary danger. 
Mufflers are wrapped about the face and are 
held over the mouth and nose by many persons in 
cold weather. This is a detrimental habit, unless 
one is walking or riding against a severe wind or 
forced to breath a damp and cold air. Dry, cold 
air should not be feared ; and it must be remem- 
bered that of all things pure air and unhindered 
breathing is what is most essential for those 
whose lungs are crippled. Heavy veils and muf- 
flers are often temporarily useful when a sudden 
transition from a warm air to a cold one provokes 
severe coughing. But even when worn for this 
reason, they should be gradually removed after 112 
CONSUMPTION. 
the transition is made, and should be employed 
in order that the transition can be gradually made. 
DIET. 
A gain in flesh by consumptives is accompanied 
by a gain in strength, a diminution of cough, and 
greater feeling of well-being. It is, therefore, 
necessary at all times to strive not only to stop 
waste, but to promote gain in flesh. The natural 
tendency of consumption is to cause gradual, 
steady bodily waste. Therefore, this tendency 
must be combated by the administration of food, 
and by aiding when necessary its digestion and 
assimilation. Whenever the disease is progressing 
in its destructive course, it is accompanied by 
fever. This fact must be borne in mind, and the 
influence of a fever upon digestion and assimila- 
tion considered. Moreover, the consumptive often 
has no appetite for food, and sometimes even a 
disinclination for it. This, also, is a condition that 
must be combated. In a much smaller number 
of cases there exists inflammation of the stomach, 
which interferes with digestion, and therefore in- 
creases the rapidity of bodily waste. Fortunately, 
these latter cases are comparatively few. Their 
diet and treatment depend upon the character 113 
DIET, 
of the disease of the stomach. It is not perti- 
nent to the subject of this essay to consider 
the diet of those whose stomachs are inflamed. 
The larger number of individuals who lack ap- 
petite have no trouble in digesting what they 
do take. Their disinclination arises from nerv- 
ous influences. Often a change of scene will 
remove this apathy, and they will at once eat 
well, or a succession of bright and cheerful days 
will cause improvement of appetite, and clouds 
and storms will again destroy it. To such indi- 
viduals food in considerable quantities has been 
forcibly administered in spite of their disinclina- 
tion, and it was uniformly digested easily, and 
caused a gain in flesh. The ingenuity and patience 
of the physician is sorely taxed in suggesting 
tempting foods or modes of administering them. 
Change of scene and food is oftenest relied 
upon to improve the appetite, and when this 
mode of treatment cannot be used attempts to 
maintain nutrition are too frequently discontinued. 
Forced feeding and a gain in flesh will often bend 
the inclinations and cause a return of appetite. 
In health we can largely trust our appetite to 
dictate what and how much we shall eat, but in 
ill health this is impossible, and eating must be 114 
CONSUMPTION. 
done not to satisfy desire, but to maintain life or 
strength. Food lias been administered to con- 
sumptives, disinclined to cat, through a stomach- 
tube, in prescribed quantities. Their flesh and 
strength increased. The method of feeding is, 
however, so distasteful to most that, although 
it effects good results, it is rarely employed. 
More frequently food is taken with regularity as 
to time, quantity, and kind, by the physician’s 
prescription, and without reference to the indi- 
vidual’s desire. In this way forced feeding is 
maintained. Food containing nourishment in 
the most concentrated form is to be preferred. 
It must also be easily digestible and assimilable. 
Moreover, it is best given in small amounts, often; 
for instance, one or two wineglassfuls of milk 
every hour or two. Thus, in twenty-four hours 
the needful quantity is administered, hut in 
amounts at a time so small as not to be notice- 
able or to create distress. The best foods at these 
times are milk, eggs, gruels, supplemented by 
cream or butter, or codliver-oil. The latter must 
be administered with especial care, so that its 
taking does not prove disgusting. 
From earliest times milk has been regarded as 
peculiarly serviceable in restoring flesh and 115 
DIET, 
strength to the consumptive. It is easily taken. 
It contains, in almost perfect proportion, all the 
ingredients needed to maintain life. It is readily 
digested and appropriated hy the human system. 
Under all circumstances milk should constitute 
a very prominent element of the consumptive’s 
diet. If the invalid has some appetite, hut one 
that is capricious, it should be pampered at 
meal-times by varied, appetizing dishes; but at 
other times, as a part of routine treatment, a 
glass of milk should be taken. How many of 
these should be drunk will depend on how much 
of other kinds of food is taken. A milk cure or 
an exclusively milk diet has been popular at dif- 
ferent times, and in many countries. These cures 
consist in an exclusive milk-diet for many weeks, 
and often months. Sanitaria for those who wish 
to try it have been established. Good results 
have certainly been obtained, but it is not a mode 
of treatment adapted to all cases. 
Soft-cooked and raw eggs are excellent nutri- 
ment, but, though strength-giving, they are not 
as flesh-producing as are oily and vegetable 
products. In consumption it is especially flesh- 
production that should be stimulated. 
A vegetable diet which supplies an abundance 116 
CONSUMPTION. 
of starch and sugar is more flesh-producing than 
an albuminous one. But neither a purely albu- 
minous or vegetable diet is the best. For those 
who have little or no daily fever, an abundance 
of sugars, starches, and oils are the best; but, if 
fever is quite constant and high, a larger propor- 
tion of albumen usually proves most serviceable. 
Those consumptives whose appetites and diges- 
tion are good should use the same mixed diet that 
one in health would use. 
Malt extracts are often prescribed for con- 
sumptives. In the market are two kinds,—one 
comparatively thin and in reality a very sweet 
beer; the second, a thick syrup without alco- 
hol. The first, as an article of diet, must be 
classed with the alcoholics. The second consists 
of sugar and a digestive agent, which acts as 
docs the saliva and pancreatic juice upon starch, 
converting it into sugar. Therefore, these ex- 
tracts are both food and aids to digestion. They 
are useful, but especially when there is no fever, 
or a very slight or irregular fever. They will not 
replace other foods, but are useful in adding to 
the regimen a needed excess of carbohydrates, 
and in aiding their digestion. 
The circumstances that make starches and DIET 
117 
sugars useful make oils so. All oils are of ad- 
vantage to consumptives, but they are not all 
digested with equal ease. It is well, for those 
who can take them without discomfort, to use, 
freely, butter, cream, and table-oils. The varied 
desserts and fruits upon which cream can be used 
are, therefore, peculiarly good. Oatmeal and 
cracked wheat, rice, and other similar dishes, are 
made more nutritious by the use of cream upon 
them. For the same reason bacon is useful and 
easily digestible, if fried hard. Of all the oils, 
that which is most famous as an aid to the con- 
sumptive is codliver-oil. Unfortunately, this is 
so distasteful to many that it cannot always be 
given in sufficiently large doses to accomplish 
much good. Its field of usefulness is much in- 
creased since various palatable preparations of it 
have been devised. It is peculiarly serviceable 
because it is so readily absorbed from the stomach 
and intestines. The readiness with which it is 
absorbed is probably partly due to an admixture 
with it of some bile from the cod-liver. It is also 
more than a food, as it contains minute quanti- 
ties of iodine, bromine, phosphorus, and other in- 
gredients which act in part medicinally. That 
great benefit can be derived from its use cannot 118 
CONSUMPTION. 
be doubted, but it must be given in suitable cases 
if these results are wished for. If the stomach is 
inflamed, it should not be given. If there is con- 
stant and high fever, it does no good. It must 
not be given in larger amounts than are easily 
digested. If it eructates into the mouth for hours 
after it is taken, it is evident that it is not being 
well digested, or has been taken in too large 
quantities; and usually, under such circumstances, 
it destroys the appetite for other food. Then it 
does harm. Neither should the oils be given in 
amounts larger than are readily borne by the 
stomach, nor simultaneously with large quantities 
of cream and fats, lest the fat-digesting power of 
the intestines be overtaxed, and they cause irrita- 
tion and a detrimental indigestion. It is most 
useful in the most chronic cases, and when the 
disease is least active. It then increases flesh, 
prompts a better appetite, lessens cough, and 
renders the sputa less matter- or pus- like. All 
the bodily functions seem to be invigorated by it. 
Certainly codliver-oil should be tried by all con- 
sumptives in whom a fever or indigestion does not 
contra-indicate it. 
The clear, light-colored oils are the best. The 
brown and strong-smelling oils are not so easily 119 
DIET. 
digested or so wholesome. Codliver-oil should be 
taken during or immediately after meals. The 
amount which can be taken varies greatly with 
individuals. As a rule, its use should be begun 
by the administration of a half-teaspoonful twice 
daily. The dose should be gradually increased 
to as large an amount as is well borne. It is 
rare that more than a tahlespoonful can be taken 
three times daily, and in the larger propor- 
tion of cases not more than a teaspoonful three 
times daily can be used. Children will sooner 
learn to use the oil without distaste and in pro- 
portionately larger doses than adults. It is best 
given as clear oil when it can be thus taken. 
Often a pinch of salt taken before and after the 
oil rapidly removes from the mouth the un- 
pleasant fish-taste. It can also be easily taken 
by many in ice-water. So much ice-cold water 
should be placed in a glass as can be taken in 
one swallow, and to this the oil should be added. 
The oil will gather in a mass in the centre of the 
water, and if the whole is swallowed at once it 
will be scarcely tasted. By others it is more 
easily taken if a little of any bitter tonic, like the 
tincture of gentian or mix vomica, is added to it. 
Many emulsions of the oil arc sold and arc very 120 
CONSUMPTION. 
palatable. They constitute, for many patients, 
the most agreeable mode of administering it. It 
must he remembered that not more than half of 
their bulk consists of oil. The oil is also sold in 
soft, elastic capsules, and when thus taken is 
tasteless. Capsules are made which contain from 
10 drops to a tahlespoonful of oil. The latter 
are so large as to appear formidable, but are 
swallowed with ease by many persons. Capsules 
containing from 20 to 60 drops are readily swal- 
lowed. To take an ordinary dose, from two to 
six of the smaller capsules must be taken at a 
time. 
Alcoholics are regarded by so many as strength- 
giving, and are so often resorted to by consump- 
tives, that it seems best to explain their exact 
mode of action and the results of experience in 
their use. The alcohol in all beverages contain- 
ing it acts the same, but occurs in very different 
amounts in different ones. The other ingredients 
of these beverages have some varying effect. 
If alcohol is added to a dish of food that is 
being artificially digested by a chemist with 
gastric or pancreatic juice, it will retard that 
digestion in proportion to the amount added. 
When, however, alcoholic beverages are taken DIET. 
121 
into the human stomach, they do not always 
act thus. If the stomach is inflamed they will 
irritate it, aggravate the inflammation, and de- 
cidedly retard digestion. If they are taken into 
a healthy stomach in diluted form they mildly 
irritate it, causing it to form a somewhat in- 
creased amount of acid in the gastric juice. This 
may hasten digestion, or, if the stomach is empty, 
cause warmth in it, which amounts in some 
cases to heart-burn. If these dilute doses are 
often repeated, and especially if large amounts, 
or beverages containing large proportions, of alco- 
hol are taken, the stomach becomes constantly 
irritated, then mildly and by degrees chronically 
inflamed. That these beverages should never be 
used in inflamed conditions of the stomach need 
hardly be said. 
Unfortunately, alcoholics do not affect the di- 
gestive organs only. When absorbed and taken 
into the blood, alcohol at once so affects it that 
it cannot take up from the air in the lungs 
as large a proportion of oxygen as is natural. 
This necessarily lessens the rapidity of tissue- 
changes. It diminishes perfect oxidation of 
worn-out tissues which should be oxidized and 
eliminated, and leads to the retention of some 122 
CONSUMPTION. 
product that should be gotten rid of. If by the 
habitual use of these beverages the blood is kept 
constantly from performing its whole work, there 
are gradually produced degenerative changes in 
the tissues. The rapidity with which these are 
produced will vary with the amount of alcohol 
constantly used, and with the susceptibility of 
the individual to its influence. It must be re- 
membered that the destruction of lung-tissue, 
which consumption causes of itself, diminishes 
the amount of oxygen which can be appropriated 
by the blood for its use. Alcoholics continuously 
given, therefore, only heighten the deleterious 
effect of the disease. But not only is tissue- 
change which involves the natural elimination 
of used-up matter interfered with, hut the capa- 
bility of the tissues to take up new matter is also 
lessened. The considerable diminution of tissue- 
change which large doses of alcohol will produce 
causes a lowering of temperature which is quite 
perceptible in fever. Fever of itself is always ac- 
companied by and possibly caused by imperfect 
and abnormal chemical changes in the tissues. 
The products of these imperfect changes are in 
themselves often poisonous, and produce the 
languid feelings and mental dullness which so DIET. 
123 
uniformly accompanies fever. Under these cir- 
cumstances it is certainly not advisable to give 
alcoholics, which add another disturbing and 
deleterious influence. They lower the tempera- 
ture, but do not therefore remove the cause of the 
fever or stop its ravages. They only change its 
aspect. We can say, then, that alcoholics should 
not be given continuously, as they impair the nor- 
mal activity of the blood, and certainly not when 
consumptives are feverish. 
Alcoholics also influence the heart and blood- 
vessels. Small amounts given to those not habitu- 
ated to them cause a quicker heart’s action for a 
few minutes. If given steadily, the blood-vessels 
dilate and the pressure within them is lessened. 
By large doses the heart’s action is weakened. 
Cough is lessened if these beverages are given 
continuously or in moderately large amounts. 
The anaesthetic properties of alcohol accomplish 
this. It dulls the sensibilities and lessens cough, 
just as small doses of opiates do. It lessens the 
power of appreciating discomfort, and thus pro- 
duces a feeling of false well-being. 
I feel convinced, from theoretic considerations, 
as well as from observation of tests, that alcohol 
is not a food. Alcoholic beverages contain no 124 
CONSUMPTION. 
other elements that can act as food than sugar, 
which exists in some of them in small quantities. 
It is hardly necessary, however, to take these 
beverages in order to get the small amount of 
sugar which they contain. 
The views of medical men have changed much 
within a few years in regard to the use of these 
beverages in consumption and other diseases. 
This change lias been wrought by a better knowl- 
edge of their mode of action, and by trials, even 
to the excessive use, of them. Statistics have 
been gathered which show that those consump- 
tives who use liquors live, on an average, some 
months less than those who do not. 
Cleanliness is always a necessity if health is to 
be maintained. It is unnecessary to comment 
upon this requirement. 
Mental excess, anxiety, sorrow, and misfortune 
which depresses often hasten the development of 
the disease or make its progress ungovernable, 
fop they lessen physical vitality. Therefore, these 
conditions should be avoided or counteracted 
when they threaten or exist. Change of scene is 
the most potent means we know of for diverting 
the mind. 
On the other hand, pleasures and recreations DIET. 
125 
which lead to lightness of heart and good temper 
are to be cultivated. A search for such as will 
prove best suited to individuals is frequently a 
trying but important task for the physician. 
Abstinence from excesses and intemperance of 
passions is also essential. CHAPTER IX. 
Medicinal Treatment and Possibilities of Cure. 
As it is not my intention in this essay to con- 
sider the medicinal treatment of consumption, it 
is not necessary to discuss separate symptoms of 
the disease. There are, however, two or three 
that are usually so distressing or alarming to the 
sufferers that it is best to refer to them. Of all 
the symptoms that accompany the disease, cough 
is the most constant. It is one of the first to 
attract attention, and is often so severe as to be 
distressing and wearisome. I refer to this symp- 
tom not to recommend a treatment for it, but to 
call attention to the fact that frequently it should 
not be especially treated. Everything that gives 
the consumptive strength will enable him to bear 
the strain of coughing without weariness. Every- 
thing aimed to heal the lungs tends to remove 
the cousrh. So-called coimh-mcdicines contain 
O o 
anodynes that allay cough by lessening the excita- 
bility of the nerves. The anodyne most used is 
morphine. This, when taken in efficient quan- 
tities, almost uniformly lessens the appetite, and 
126 TREATMENT AND POSSIBILITIES OF CURE. 
127 
often very considerably interferes with digestion. 
It tends to destroy what should especially be con- 
served,—digestion, flesh, and strength. Cough, 
when severe, must be treated; but frequently,even 
then, an anodyne need be administered not more 
than once or twice daily. By preference it should 
be given at bed-time, so as to insure a restful night. 
While anodyne cough-medicine often destroys 
appetite and digestion, it is also true that the 
cough may be so severe as to provoke gagging 
and even vomiting, and may thus interfere greatly 
with the maintenance of nutrition. There are, 
therefore, times when the cough of consumption 
should receive special treatment, and times when 
such treatment is detrimental. The physician is 
often told by his consumptive patient that if only 
his cough was stopped he would feel quite well. 
This is true, providing the cough ceases because 
the disease disappears, but it is not true if the 
cough is only suppressed by an anodyne cough- 
medicine. The severity and frequency of cough- 
ing is not a criterion of the gravity of the disease. 
Coughing often occurs severply in paroxysms 
which recur in individual cases at certain times 
in the day. Most patients cough often in the 
evening, and, if not then, at bed-time. They are 128 
CONSUMPTION. 
frequently awakened at night in order to cough. 
A hard spell of coughing is usual when a con- 
sumptive wakens, and expectoration is more 
abundant than at any other time in the day. 
Severe coughing in the evening is frequently 
due to exhaustion. Those who are troubled by 
it should retire early,—by eight or nine, or even 
earlier. They often sit up purposely as late as 
possible because of the coughing and an inability 
to get to sleep. This is an error in the conduct 
of their life. They should retire earlier instead 
of later, and should be careful during the day 
not to become too fatigued. Evening coughing 
is also aggravated by sitting for several hours 
in family-rooms with many others, where the 
air becomes close, overheated, and often tilled 
with tobacco-smoke, or other irritating fumes, 
and where the invalid, though tired, is tempted 
to talk. The early evening should be passed 
in a quiet room, the air of which is kept clear. 
Much conversation should not be indulged in at 
this hour. 
Coughing when a patient first lies down is 
often severe, and may last for hours. It may be 
due to several causes, or to their simultaneous 
action. The patient is usually wearied, and, 129 
TREATMENT AND POSSIBILITIES OF CURE. 
under such circumstances, coughing is easily ex- 
cited. The exertion of going to one’s bed-room 
and hastily disrobing is considerable. A sudden 
change in the position of the body, from the up- 
right to the reclining, is sometimes a sufficient 
cause of coughing. A bed-room may be cold, 
or cooler than the invalid has been used to dur- 
ing the few preceding hours. The breathing of 
colder air may provoke the cough. Oftenest 
several of these causes act coincidently. I need 
hardly say the air of the bed-room should be 
properly tempered, and, if necessary, the bed 
should be warmed. If a patient must climb 
stairs to reach his bed-room, it should be done so 
slowly that he will not feel at all breathless when 
the top is reached. When necessary, he should 
rest on the way. Clothing should not be re- 
moved at once, but a rest of a quarter- or half- 
hour should be taken in a chair. He should 
then undress leisurely. Individuals who are 
weak often exercise more violently while remov- 
ing and getting into clothing than at any other 
time in the day. They should be assisted. The 
arms ought not to be suddenly raised or jerked. 
Nor ought the body to be violently bent and 
twisted. The motions should be made slowly, 130 
CONSUMPTION. 
and frequent rests of several minutes’ duration 
should be taken. When finally prepared for bed, 
the invalid who is troubled with severe coughing 
at this time ought not suddenly to lie down. 
He should at first sit up in bed for a minute or 
two, and then lie semi-recumbent upon pillows, 
and very slowly and gradually, during a half-hour 
or so, lower his head to a position that is com- 
fortable for sleeping. 
It must not be supposed that these directions 
will enable every consumptive to avoid evening 
or bed-time cough. Often, if faithfully executed, 
they will lessen its severity and its duration, and 
sometimes will prevent it. Severe cases require 
also an anodyne cough-medicine at night. 
Coughing in the night is usually due to the 
accumulation of secretions in the air-passages 
until they must he expelled. If, when a patient 
a wakes, he coughs, expectorates, and falls readily 
asleep again, the cough is rather beneficial than 
harmful. If coughing is hard and prolonged at 
these times, it should be ameliorated. Weakness 
often makes it hard. When this is the case a 
little warm food will frequently lessen its severity 
and duration. A cup of warm cocoa or milk or 
gruel is the best. Less frequently cold drinks TREATMENT AND POSSIBILITIES OF CURE. 
131 
will answer as well as warm. These substances 
help to give needed strength, and the warm liquids 
help to loosen the expectoration and make at 
least the nerves in the throat less irritable. Many 
times coughing occurs more quickly if the in- 
valid lies more upon one side than the other. 
These differences should be noted; and when 
sleep is sought, the position should be assumed in 
which it can he had most restfully. 
A spell of coughing in the morning, either on 
awakening or arising, is the rule with consump- 
tives in whom the disease is active. It is caused 
by an accumulation of secretions in the air- 
passages. These must be gotten rid of, and ano- 
dynes to prevent coughing are, therefore, not 
indicated. The attempt should rather be to give 
the patient strength to bear the coughing spell, 
or to make it effective, and such drugs should be 
used as will make the secretions to be expecto- 
rated thinner and more easily dislodged. 
An early breakfast will help to give or con- 
serve strength. It may be made of a cup of 
cocoa and bread or toast, or a glass of milk with 
bread, or a custard of egg and milk. It should 
be given as soon as the invalid awakes. Warm 
food often makes the coughing easier, but its 132 
CONSUMPTION. 
chief purpose is to give strength both to make 
it bearable and efficient. This little breakfast 
should not displace a later one. The morning 
cough can be helped by appropriate medicine 
when it is severe. 
A much more difficult coughing spell to man- 
age is that which occurs immediately after meals. 
It often provokes vomiting, which causes a loss 
of necessary nourishment. Frequently persistent 
irritation of the pharynx by coughing causes the 
latter to become so sensitive that the swallowing 
of food provokes coughing and even vomiting. 
This form of cough can sometimes be helped by 
remedies applied locally to the throat. If food is 
taken in a liquid form the cough and vomiting 
can occasionally be prevented. In many trouble- 
some cases I have seen the difficulty abated by 
the administration of food in small amounts at 
frequent intervals. More rarely coughing will 
not be provoked if the invalid eats in a recum- 
bent or semi-recumbent posture. 
These forms of paroxysmal coughing are 
most apt to occur in those in whom the disease 
has caused much weakness. They rarely are 
noticeable in its early stages. 
Many consumptives experience no pain, but TREATMENT AND POSSIBILITIES OF CURE. 
133 
this is not the rule. Pain in the chest is of com- 
mon occurrence. It may be due to neuralgia, to 
rheumatism, and to pleurisy. The latter is the 
commonest cause. It is usually aggravated hy 
deep breathing and by coughing. Often it is so 
slight or temporary that it requires no special treat- 
ment. In other cases it is so severe or so frequent 
in occurrence that it demands the physician’s 
attention. Not unfrequently I am asked what 
can be done to relieve these severe but transitory 
pains when medical aid is not at hand. Heat 
usually affords prompt relief, hut if the pain is 
very sharp, counter-irritation, which can be pro- 
duced by a small blister, can be relied upon with 
much confidence. Heat is easiest applied by 
means of a poultice. It should be applied as hot 
as possible, and, unless the pain disappears with 
great promptness, should be renewed often enough 
to keep it hot. A mustard-plaster will accomplish 
the same purpose. If a blister is necessary, a 
small one is usually all that is needed, A piece 
of Spanish-fly plaster an inch square, if applied 
directly over the most painful spot, will usually 
give relief as promptly and perfectly as one three 
times as large. Rest is essential to relieve these 
pains, for it aids one to avoid deep breathing 134 
CONSUMPTION. 
and muscular movements, which aggravate them. 
It is, by all means, best to call upon a physician 
for counsel in all such attacks. 
Another source of much annoyance is found in 
the night-sweating which accompanies consump- 
tion. It causes much discomfort, and is some- 
times so profuse as to cause weakness. The 
sweats are almost uniformly less when moderate 
exercise and an abundance of out-door air can be 
had than when the invalid is confined to the 
house by inclement weather or weakness. When 
not profuse they can often be checked by bathing 
the entire body with tepid or cold water before 
retiring. In some instances salt-water baths, and, 
still more frequently, alcohol and vinegar baths, 
prove efficacious. When night-sweating occurs 
only in the early morning, if a glass of milk is 
taken an hour or two before it is expected, it can 
often be lessened or avoided. If night-sweats 
are not copious or constant in their recurrence, 
they do not require especial treatment. The 
patience and ingenuity of the physician is often 
taxed to devise means for their suppression. 
Haemorrhage from the lungs usually causes 
unnecessary alarm. It is rarely so profuse as to 
endanger life, or even to cause weakness. In TREATMENT AND POSSIBILITIES OF CURE. 
135 
most instances only a few mouthfuls of clear 
blood are expectorated. If such a haemorrhage 
occurs for the first time it may rightly be looked 
upon with dread, for, while not producing fatal 
results, it means, almost without exception, that 
consumption has attacked that person’s lungs. 
These slight haemorrhages may recur often. 
Haemorrhages may occur before any sign of the 
disease can be discovered by the most careful 
examination. They may occur at any stage of 
its progress. The dangerously profuse bleedings 
are usually associated with the occurrence of lung- 
cavities. 
To check haemorrhages, bodily rest is essential, 
and, if the bleeding has been severe, should be 
maintained for some time after it has ceased. 
Cold drinks and pieces of ice, allowed to melt 
in the mouth or to be swallowed slowly, aid 
in checking the flow of blood. Warm drinks 
should be avoided, and, in profuse haemorrhages, 
even warm food. An ice-bag may be applied to 
the chest with advantage. Sev.ere coughing 
should be checked. Salt-water gargles and drinks 
are often resorted to with benefit, but it is doubt- 
ful if with more benefit than can be derived from 
cold drinks and ice. A physician should always 136 
CONSUMPTION. 
be consulted when a haemorrhage occurs. The 
directions that I have given are always appli- 
cable until his advice can be had. 
EVIDENCES OF IMPROVEMENT. 
A gain in flesh is the evidence of improvement 
which is most to be welcomed. A steady gain in 
weight may rightly give one a confident hope of 
renewed health. It is important to note the con- 
sumptive’s weight from week to week in order 
thoroughly to appreciate the tendencies of the 
disease in a given case. It is true that sometimes 
increase of weight will occur while the fever re- 
mains high and while signs of serious trouble 
exist, but usually with such a gain all the symp- 
toms lessen in severity and with a persistent gain 
successively disappear. 
A greater lung-capacity is another evidence of 
marked improvement. This change is especially 
to be looked for and hoped for in those predis- 
posed to the disease or suffering from it in its 
incipiency or from it in its most chronic form. It 
means that the tendency of the disease to contract 
the lungs, and thereby lessen their capacity, is 
counteracted and a normal amount of air-space 
is being gained. EVIDENCES OF IMPROVEMENT. 
137 
The lung-capacity is best tested with the spi- 
rometer, which measures the amount of air that 
can be breathed out after as full an inflation of 
the lungs as is possible. By measuring the girth 
of the chest at the nipple-line when the chest is 
as perfectly emptied as possible, and again when 
filled to its fullest extent, its relative capacity can 
be roughly determined. But small variations in 
respiratory capacity cannot be thus determined. 
An increase in girth is always favorable, especially 
if the increase takes place upon both sides of the 
chest. Those whose chests are being enlarged by 
pulmonary gymnastics will not so soon notice an 
increased difference in girth where exhalation is 
complete and inhalation full as an increase during 
quiet or normal exhalation and inhalation. This 
is because a habit of deeper and more perfect 
breathing is acquired before time enough has 
elapsed to make it possible to materially enlarge 
the chest. 
When deeper breathing becomes a habit, res- 
piration also becomes slower. It is, therefore, a 
sign of improvement. Under these circumstances 
the pulse becomes slower and its retardation is 
also significant of improvement. Fever may 
quicken both the pulse and respiration, in spite 138 
CONSUMPTION. 
of increased lung-capacity, but the latter change 
can rarely be effected while fever is continuous. 
If an abnormally high temperature occurs irregu- 
larly, changes in the average rate of respiration 
and pulse must be sought for evidence of improve- 
ment. The disappearance of fever is a very im- 
portant sign of improvement. An irregular rise 
of temperature, especially one that occurs only 
once in two or three days, is comparatively favor- 
able. The height of temperature is not as indic- 
ative of an unfavorable course as is the persist- 
ence of fever throughout the twenty-four hours 
and day after day. Usually before the fever of 
consumption disappears it becomes more and 
more irregular in its course, and longer periods 
of normal temperature occur. 
One of the last symptoms to disappear is cough. 
Its severity may vary greatly at any time, but it 
will not entirely disappear unless active inflam- 
mation of the lungs has entirely subsided. 
Therefore, in watching for signs of improve- 
ment in a consumptive in the midst of the disease, 
we expect to notice longer periods of low tem- 
perature and increased weight, then slower pulse, 
and, when a period of quiescence is fairly estab- 
lished, habitually deeper breathing and entire ah- EVIDENCES OF IMPROVEMENT. 
139 
sence of fever; finally, a gradual enlargement of 
the chest and disappearance of cough. The fail- 
ure to refer here to the medicinal treatment of 
consumption may create the belief that I think it 
useless. This is not true. It is necessary, but it 
must be adapted to each symptom as it arises. Of 
all diseases, consumption, for its successful treat- 
ment, especially requires close and prolonged 
watching by medical men. It is an exceedingly 
chronic disease, and its victims should be kept 
under treatment, and held rigidly to a proper 
course of life, not for months only, but for years. 
The best treatment and advice will be obtained if 
the consumptive will place himself in the hands of 
a physician upon whom he can rely, who will care- 
fully study his case and guide him. During 
periods of quiescence in the disease, and when it 
causes the least inconvenience, the most can be 
accomplished toward restoring the lungs to a 
healthy condition; but these are times when, 
from a notion of false economy, the physician is 
forsaken, and his advice is neither sought nor re- 
garded. Frequent changes from the care of one 
physician to another is detrimental, as it prevents 
their becoming thoroughly acquainted with the 
individual case and their directing a systematic 140 
CONSUMPTION. 
course of treatment, since it must be planned to 
extend over months or years. 
DURATION OF CONSUMPTION. 
Consumption is pre-eminently a chronic disease. 
Cases are numerous in which it has existed for 
very many years. The average duration, as it is 
generally stated, is not great. Twenty-four to 
thirty-six months are the average limits that are 
usually given. This average is arrived at by a 
study of hospital cases. These are drawn almost 
exclusively from the poorer classes, who are unable 
to seek a physician or care for themselves sys- 
tematically in the early stages of the disease. It 
therefore runs an accelerated course. Almost all 
observers who gather their statistics from private 
practice assign a much greater average duration 
to the disease. Such statistics are, however, not 
numerous. In this latter class of cases the aver- 
age is from six to eight years. They comprise 
persons in whom the existence of the disease is 
recognized in its incipiency, and who are most 
persistent in carrying out both hygienic and 
medicinal treatment. The most extensive and 
carefully-studied statistics of this class that have 
come under my observation were collected by Dr. DURATION OF CONSUMPTION. 
141 
Williams, of London. Of 1000 of his private 
patients whose career was watched for a series of 
years, he found 802 living when the statistics 
were analyzed; of these, 46 per cent, were cured; 
38 per cent, were greatly improved, in 13.4 per 
cent, the disease was stationary, and in 43.5 per 
cent, there was increase of trouble. Of the 1000, 
198 died, but the average duration of their life 
was 7 years 8.7 months; 64 per cent, of these 
lived more than 5 years. Of those alive when 
the statistics were tabulated, 41.4 per cent, lived 
from 1 to 5 years, 58.6 per cent, lived 5 years and 
more, and 30 per cent, lived from 10 to 30 years. 
These facts emphasize the chronic character of 
the disease when it is well cared for. 
Thirty-five per cent, so far recovered that they 
could return to and pursue their regular occupa- 
tions and maintain so good general health that 
they might be considered well. Those who were 
worse, and must be looked upon as genuine inva- 
lids, constituted only 28 per cent. Dr. Williams 
concludes, from his statistics, that “surely the time 
is come when we can hold out a fairly hopeful 
future to the consumptive patient. We can tell 
him that if he is prepared to make certain sacri- 
fices of time, of money, and of liberty for some 142 
CONSUMPTION. 
years, to rigidly carry out certain common-sense 
rules which long experience of the disease incul- 
cates, he may, under favorable circumstances, live 
for a long period, even to the ordinary span of life; 
and, as he lives on, may gain sufficient strength 
to resume his former occupation and duties.” 
Although no observing physician doubts the 
efficacy of good hygiene in prolonging the life of 
consumptives, and in preventing the development 
of the disease in those disposed to it, it is difficult 
to find statistics which will throw light upon the 
matter. A valuable lesson is, however, taught by 
comparing the statistics gathered by a Royal Com- 
mission of 1857 in England to investigate the 
unusual mortality in the army of that country 
with similar statistics collected in recent years. 
In her Majesty’s Foot-Guards there was found to 
he from all causes a mortality of 20 per 1000; 
from consumption alone 11.4, which was more 
than the total mortality of the civil male popula- 
tion of England at the same age. In the army, 
generally, the mortality from consumption was 
7.8 per 1000. Since the great mortality was 
pointed out, great care has been taken to insure 
more space in barrack-rooms and a certain stand- 
ard of air-renewal. The result has been that the DURATION OF CONSUMPTION. 
143 
mortality has been reduced to 2.5 per 1000, which 
is almost as low as the mortality in the healthiest 
districts of England. These figures teach us the 
importance of ventilation. We cannot but wonder 
what might he accomplished if the same reforms 
that were affected in the construction of barracks 
could be effected in house, factory, and counting- 
room construction. We must feel convinced that 
by such changes alone the enormous mortality 
now existing the world over from consumption 
could be greatly lessened. 
It is not possible, by any means with which we 
are now acquainted, to eradicate the disease from 
the world; hut if all who arc predisposed were 
shown their danger, and instructed iu regard to 
the means by which it could be averted, it would 
require not more than one or, at most, two gen- 
erations to reduce its mortality as much as vac- 
cination has reduced the mortality of small-pox. 
I need hardly again in this essay plead for the 
systematic, careful, physical examination, training, 
and instruction of children and youths of ail 
classes. Such oversight and education is as es- 
sentially a part of the duties of the State as it is 
to insure each child a simple education in letters. 
An ability to read is not more essential to good 
citizenship than an ability to maintain health. THE THREE FOLLOWING PAGES ARE REDUCED 
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ORDER FROM NEAREST OFFICE. FACSIMILE PAGE FROM 'STANTON’S PHYSIOGNOMY "—Reduced. 
HOW TO REDUCE SIZE WITHOUT LOSING STRENGTH. 1109 
vpice. A thorough-bred person may belong to the artistic, me- 
chanidal, or scientific classes, either appreciatively or executively; 
he nuist exhibit both gentleness and spirit, as occasion requires; he 
must be governed by the law of justice; he must make the com- 
fort of his associates his concern, and do what is right in order to 
enhance their happiness. 
The facial indications of those who are not thorough-bred, 
speaking physiologically, are as follow: A coarse, thick skin; a 
“muddy” complexion, or one permanently blotched, pimpled, or 
discolored; dull eyes, very small or very large and bulging; 
coarse hair, or that which is very light or colorless,—that is to say, 
of no decided hue. I regard very light colored, pallid people as 
morbid varieties; also those with irregular teeth, a very small or 
ill-shapen nose, small nostrils, perpendicular jaws, exposed gums, 
open mouth, receding chin, or one that projects greatly forward, 
ending in a point; thin, pallid, dry lips; hollow cheeks, flat upper 
cheeks, ugly or ill-shapen ears; a voice weak, thin, hoarse, shrill 
or nasal; a long, cylindrical neck; a high, narrow forehead. 
The undue development of certain organs and systems of the 
body induces abnormal conditions, as, for example, an excessive 
disposition of fatty tissue. When the appetite is voracious, or the 
nutritive system uncommonly active, too much of the carbonaceous 
elements of the food are eliminated, or, as it often occurs, too much 
carbonaceous food, such as white bread, potatoes, etc., is consumed 
for the needs of the body; the consequence is an excess of fat, 
which, in many subjects, impedes respiration, prevents activity, 
and gives a generally uncomfortable feeling. For this condition a 
spare diet is often prescribed, but as this is felt to be a hardship, 
and as few who attempt it succeed in continuing it long enough to 
produce satisfactory results, it is pronounced a failure. 
For this class of people there is a very agreeable and sure 
method of reducing the bulk without reducing strength and with- 
out compelling too great a sacrifice of the appetite. 
HOW TO REDUCE THE SIZE WITHOUT LOSING STRENGTH. 
A diet which will attain this result is easily obtained, and of 
it the subject can use a quantity sufficient to allay the craving 
for food. 
Tliis diet consists of absolutely raw foods, nothing cooked 
being allowed. This diet, of course, must consist mainly of fruits, 
nuts, grains, milk, and, when flesh-meat is desired, a Hamburg 
beefsteak may be partaken of; this steak is raw beef chopped fine 
and seasoned with onion, salt, pepper, or other condiments; to 
this may be added raw oysters and clams. Every kind of fruit FACSIMILE PAGE FROM “STANTONS PHYSIOGNOMY “—Reduced 
SYSTEMS AND FACULTIES REQUIRED FOR A SURGEON. 1143 
is a dangerous being); he should develop his friendliness, love of 
children, and of the opposite sex; in short, he should be a lover 
of humanity. 
THE SYSTEMS AND FACULTIES REQUIRED FOB A SURGEON. 
Ihe best form for a surgeon who attempts the most severe 
Fio. 360.—EDWARD JENNER. M.D. (Celebrated Enoi.ish Physician, 
Author, and Discoverer of Vaccination.) 
No scientific physiognomist could mistake this face for other than that of a physi- 
cian, and an earnest ana attentive one as well, as evidenced by the signs of “natural 
physician” in the cheek-bones, in the attitude of the head and neck, and by the thought- 
ful, observant expression of the eye. The combination of systems in this subject is such 
as is most frequently observed among physicians, viz., the supremacy of the osseous and 
brain systems. The muscular, thoracic, and vegetative powers all assist in this com- 
bination by their development. The signs for Conscience and Firmness are apparent. 
Dove of Home ami Patriotism rank high. Benevolence, Amativeness, Love of Young, 
Mirth, Approbation, Self-esteem, Modesty, Friendship, Alimentiveness, Sanativeness, 
Pneumativeness, and Color combine to form a lovely domestic and social nature. The 
form, size, and peculiarities of the nose claim attention. It is a nose denoting Con- 
structiveness, Originality, and logical power. The signs for Hope. Analysis, Mental 
Imitation. Human Nature, Ideality, Sublimity, Construction, and Acquisition are 
strongly delineated. Self-will is normally developed, while Size. Form, Observation, 
Weight, Locality, Calculation, and Memory of various sorts are manifest. The signs 
of Language in the eye and mouth denote fluency, while the practical faculties, being 
dominant, would give clearness, perspicacity, and directness to his style of expression, 
either oral or written. Time, Order. Reason, and Intuition are well developed. The 
long-continued observation and experiments of this noble physician in his endeavor 
to protect humanity from the ravages of small pox by his discovery of vaccination, 
met at last with a suitable recognition, for he received by a vote of Parliament the 
sum of £30.000, and special honors were awarded him. It is a singular fact that all of 
the bcVtifoctorsof the human race—those who have benefited it by discoveriesof any 
kind "whatever—have met with the most violent opposition, treachery, and often 
disgrace, before they could make the world see the value of their discoveries. Such 
was the case with Dr. Jemier, but his firmness and truth at last gained the victory. 
operations is the round build of body and head, and many of them 
are of this shape. The muscular system should he supreme, with 
the brain system a.close second, the bony and thoracic systems 
about equal and next in development 
The muscular tissue is comparatively unfeeling—insensitive; FACSIMILE PAGE FROM “STANTON'S PHYSIOGNOMY”—Reduced 
OTHER CLASSES OF SURGEONS. 1145 
in the body. Form and Size are also requisite to aid the memory of 
the shape and relative position of each part, and to assist Locality. 
Human Nature is essential in order that he may be en rapport 
with his patients, and also to enable him to divine instinctively all 
bodily and mental states. He should be a good physiognomist, and 
be well versed in the pathology of physiognomy. He must have 
large Observation, in order to take cognizance of the most minute 
changes and appearances. Calculation is a useful trait also, as it 
is required in many ways in the medication and treatment of the 
wounded, as in chemistry and in making surgical implements, etc. 
He should have large Friendship, in order to attach his patients to 
him and to command their esteem; enough Benevolence to sympa- 
thize, but not enough to weaken the feelings when severity is 
required. The faculty of Amativeness is necessary to comprehend 
the nature of the opposite sex; Love of Young also, that he may 
inspire children with love and confidence. 
The sense of Weight should be a strong one, for the muscular 
sense is dependent upon its power in order to gauge the amount 
of force to be used in handling instruments and in bandaging 
wounds, limbs, etc. Executiveness is required to assist authority 
and give resistance. Self-will is another ally most necessary, as 
well as Analysis, Time, Order, and Reason. A fair share of 
musical ability is required to assist the ear in making examinations 
of the heart and lungs, and in auscultation for various other pur- 
poses. If to these faculties one adds large Intuition, he has a fine 
bodily and mental equipment for the practice of surgery. 
Many army surgeons are characterized by a round and broad 
form, with broad, rather low', and round heads; short, round arms, 
and round and tapering fingers' This build is the most suitable 
for those severe operations which require the greatest exhibition of 
force, endurance, and coolness; another class of surgeons—those 
who undertake the more delicate and less forceful operations—are 
characterized by about an equal development of the brain and 
muscular systems. This class of surgeons tend naturally to the 
treatment of those finer, less difficult, and more delicate cases of 
operative surgery, such, for example, as treatment of the ear, the 
eye. etc. This class of surgeons require a fine endowment of the 
brain and nervous system. In short, the muscles as well as nerves 
of this class must be sensitive to a great degree, and this combi- 
nation calls for a fine and high organization. 
The surgeon should be something of an actor in order to 
■know when to be sympathetic and when to be severe. Yet he 
OTHER CLASSES OF SURGEONS. A NEW AND TIMELY KAND-BOOK. 
ABC 
OF THE 
Swedish System of Educational Gymnastics 
HARTVIG NISSEN, 
Instructor of Physical Training in the Public Schools of Boston, Mass. Instructor of Swedish 
and German Gymnastics at Harvard University’s Summer School, 1891. Author 
of “ A Manual on Swedish Movement and Massage Treatment,” etc. 
A Practical Hand-Book for School Teachers and the Home. 
THIS excellent little work is a practical hand-book for teach- 
ing the “ Swedish Educational Gymnastics.” It is true 
there are some treatises on this subject, but they are not 
sufficiently practical to be of use as a hand-book. The author of 
this work has avoided the use of difficult scientific terms and 
made it as popular and plain as possible. 
The first two chapters contain questions and answers such 
as have been most frequently put to the author in his nearly 
fourteen years’ experience as a teacher of Gymnastics, and these 
two chapters will give a very satisfactory idea of the foundation 
of the “ Swedish System of G3’mnastics.” Other chapters con- 
tain what are termed prescriptions for daily lessons arranged 
somewhat as follows: 
Five daily orders of exercises for second and third class 
of Primary Schools. Six daily orders for the first class of the 
Primary Schools. Seven daily orders for the fifth and sixth 
class of the Gramipar Schools. Nine daily orders for the third 
and fourth class and fifteen for the first and second class of the 
Grammar Schools. 
The fullest instructions and commands are given for each 
exercise and seventy-seven excellent engravings illustrate them 
and add greatly to the practical value of the book. It is complete 
in one neat, small 12mo volume of about 125 pages, and may be con- 
veniently carried in the pocket. Bound in extra Flexible Cloth. 
Price, in United States and Canada, post-paid, 75 Cents, net; Great 
Britain, 4s. 6d.; Prance, 4 fr. 
F. A. DAVIS, Publisher, 1231 Filbert St., Philadelphia. Heredity, Health, $ Personal Beauty. 
Including the Selection of the Best Cosmetics for the 
Skin, Hair, Nails, and All Parts Relating 
to the Body. 
JOHN V. SHOEMAKER, A.M., M.D., 
BY 
Professor of Materia Medica, Pharmacology, Therapeutics, and Clinical Medicine, and 
Clinical Professor of Diseases of the Skin in the Medico-Chirurgical College of 
Philadelphia; Physician to the Medico-Chirurgical Hospital,etc.,etc. 
The foundation of man’s being in physical and mental attributes 
is first of all established in this work. * The author then proceeds from 
that firm basis to demonstrate the laws of heredity in human traits, up 
to the point of strength, grace, and beauty of person. Nor does he stop 
there. The health of the skin and hair, and how to promote them, are 
discussed; the treatment of the nails ; the subjects of ventilation, food, 
clothing, warmth, bathing ; the circulation of the blood, digestion, ventila- 
tion ; in fact, all that in daily life conduces to the well-being of the body 
and refinement is duly enlarged upon. To these stores of popular infor- 
mation is added a list of the best medicated soaps and toilet soaps, and a 
whole chapter of the work is devoted to household remedies. It would 
be out of place here to attempt to give a complete notion of the contents 
of the work, the Table of Contents itself occupying twelve pages as a 
mere summary of the numerous interesting topics discussed. The work 
is interspersed with anecdotes that cannot fail to enliven serious dis- 
cussion. In fact, as a hand-book of general instruction, promotive of all 
the physical graces of life, this volume, which we offer to the public, 
beautifully dressed in royal octavo, cannot but prove a most valuable 
addition to any collection of books of instruction and amusement, com- 
bining, as it does, in rare degree, solid information with pleasant reading. 
Complete in one handsome Royal Octavo volume of 425 pages, 
beautifully and clearly printed, and bound in Extra 
Cloth, Bevelled Edges, with side and back gilt 
stamps, and Half-Morocco, Gilt Top. 
EXTRA CIOTH, BEVELLED EDGES 53.50 
HALF-MOROCCO, GILT TOP 3.50 
Prices, IPost-paticS.. 
F. A. DAVIS, Publisher, 123! Filbert Street, Philadelphia. 
For sale by all Boohsellers, or will be forwarded promptly by Publisher, on 
Receipt of Price. Carriage Free. A NEW BOOK. Important in Every School and Household. 
Homely Suggestions to Mothers and Daughters 
concerning Childhood, Maidenhood9 
Wifehood, and Motherhood. 
Til! Oiijllir: "IST 
WILLIAM M. CARP, M.D., Philadelphia. 
Tli is thoughtful and suggestive book is written in a dignified but 
earnest style, and comprises a discussion of some of the most important 
considerations relating to domestic life which affect woman’s highest 
interests. Subjects relating to health, education, sexual development, 
courtship, marriage, and maternity are treated in an instructive manner, 
which charms by its delicacy, frankness, and good sense. It answers 
many questions which every busy practitioner of medicine has put to 
him in the sick-room at a time when it is neither expedient nor wise to 
impart the information sought. 
It will not offend the most proper womanly modesty or refined 
feelings, and may wisely be put into the hands of any woman or girl; 
is a book for the family; will bear repeated readings and will be useful 
to refer to in emergencies. 
It is complete in one beautifully printed (large, clear type) 12mo 
volume of 150 pages and attractively bound in Extra Cloth. 
The following opinions and criticisms are among those which 
occur in a large number of letters and notices concerning it. 
D. HAYES AGNEW, M.D., LL.D., Professor of Surgery, University of Pennsylvania, 
writes: 
“This little brochure will commend itself to the public by the judicious and delicate 
manner in which the subject is treated.” 
OLIVER P. REX, M.D., Clinical T.ecturer on Diseases of Children, Jefferson Medical 
College, of Philadelphia, writes : 
“Itis a success and more; it is a truthful and practical treatise of the subject. I shall 
always recommend it to patients in search of such knowledge.” 
PHILADELPHIA PUBLIC LEDGER: 
“ In the 144 pages allotted to him he has compressed an amount of homely wisdom on the 
physical, mental, and moral development of the female child from birth to maturity which is 
to be lound elsewhere in only the great book of experience. It is, of course, a book for mothers, 
but is one so void of offense in expression or ideas that it can safely be recommended for all 
whose minds are sufficiently developed to appreciate its teachings. 
PRICE, $l.OO, ItTet. 
F. A. DAVIS, Publisher, 1231 Filbert Street, Philadelphia. Will be Published December I, 1891. 
THE CHINESE: 
Tlteir Present and Future; 
Medical, Political, and Social. 
ROBERT COLTMAN, Jr., M.D., 
Surgeon in Charge of the Presbyterian Hospital and Dispensary at Teng Chow Fu; Consulting 
Physician of the American Southern Baptist Mission Society ; Examiner in Surgery 
and Diseases of the Eye for the Shantung Medical Class; Consulting 
Physician to the English Baptist Missions, etc. 
The author has spent many years among the Chinese ; lived 
with them in their dwellings ; thoroughly learned the language ; 
has become conversant with all their strange and odd character- 
istics to a greater extent than almost any other American. lie 
has been a physician to all classes of this wonderful people, 
and the opportunities thus afforded for a clear insight into 
the inner life of the Chinese, their virtues and vices, 
social, and sanitary condition, probable destiny, and their impor- 
tant position in the world to-day, have been ably and wisely 
used by Dr. Coltman. The simple, direct, straightforward 
style in which Dr. Coltman has written this book makes 
it entertaining and fascinating as well as profitable reading 
throughout. 
Illustrated with Fifteen Fine Engravings from Photographs 
of Persons, Places, and Objects Characteristic of China. 
In one Handsome Royal Octavo Volume of about 
250 pages. Appropriately bound in Extra 
Cloth, price, $1.75, net. 
IT. jPI. TDjPIAT'IS, 
1231 FILBERT STREET, 
PHILADELPHIA, LLzPI.