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NATIONAL LIBRARY OF MEDICINE

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Surgeon  General's Office
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NLM051092397 
 
 
 
 
 
BY THE SAME AUTHOR.
CATARRH,   SORE-THROAT,  AND   HOARSE-

                           NESS.

A Book for the Laity, Descriptive of Certain Diseases of  the

   Nose and Throat, and the Best Methods for their Cure.

   Illustrated, i6mo, cloth, $i oo.

                      PRESS NOTICES.

  "This is an excellent manual."—Hartford Post.
  " The information can be made a blessing to thousands."—Common-
wealth.
  " Addressed to the common-sense and impartial judgment alike of
physicians and laymen."—Troy Times.
  1  Such a valuable little book deserves to be put in the hands of every
reader."—Boston Advertiser.
  *' The subject is treated with gratifying intelligence and thorough-
ness.— N. Y. School Journal.
  " Dr.  Kitchen has  condensed large knowledge   in  little space.
*  *  * There is nothing of the quack in it from beginning to end."—
The Christian Intelligencer.


STUDENTS'  MANUAL OF DISEASES  OF THE

                 NOSE AND  THROAT.

A Digest, Descriptive of the  More Commonly Seen  Diseases

  of  the  Upp'er  Air-Tract, with the  Methods of Treatment.

  Illustrated.   Price, $i  00.

  " In matters relating to Diseases of the Nose and Throat, this work
is a veritable  multum inparvo.  All  unnecessary discussion is elimi-
nated.  The facts stated are those which are generally accepted by the
majority of authorities in this branch of  medical  science.  It will be
found of great value to the hard-worked medical undergraduate, to all
beginners in throat work, and as a quick  and  reliable handy book of
reference for  the general practitioner.   No other work known to us
contains so much plainly stated knowledge on this  subject  in such
small  space."—Dr. A. P. Zemansky.

        G. P.  PUTNAM'S SONS,  PUBLISHERS,

                NEW YORK  AND  LONDON 
CONSUMPTION
ITS
NATURE, CAUSES, PREVENTION
                AND CURE
J.  M. W. KITCHEN, M.D.
Assistant Physician to the Bellevue Chest Class (O. D. Dept.); Assist-
   ant Surgeon to the Metropolitan Throat Hospital; Jate In-
     structor in Diseases of the Nose and Throat at the New    +■■-ri"i-'•■
        York Post-Graduate Medical School; Author   .--.Ttf  >.' " IV ^
           of "Students' Manual of Diseases of   ''»'
the Nose and Throat "; " Catarrh,  ySC*\
  Snrp-TVirnat and Hoarse-    Jr&-
             etc.        A$3s
          G. P. PUTNAM'S SONS

     NEW YORK : 27 & 29 WEST 23D STREET

LONDON : 25 HENRIETTA STREET, COVENT GARDEN

                   I88S 
     VIFA
       K578c

fdz^ aJCi SblCj  70 .&
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   COPYRIGHT
By J. M. W. KITCHEN, M.D.
   Press of
G. P. Putnam's Sons
  New York 
CONTENTS.
                                              PAGE
Introductory........  .............................   i
The  Anatomy,  Physiology and Hygiene of the
   Pulmonary  Structures........................   6
The Definition, Names and Different Forms  of
   Phthisis.......................................  20
What we know of the Nature of Phthisis......  24
The Symptoms which  accompany, and are charac-
   teristic of  the diseased Processes............  32
The Physical Signs Indicative of Phthisis.......  44
The Possibilities of Curing the Disorder........  49
Other Diseases which may be taken for Phthisis 52
The Causes of  Phthisis...........................  54
The  General  Principles  which should  Govern
   the  Treatment of the Disease................  68
Relation  of  Man's Surrounding Conditions  to
   Phthisis.—Climate.—The Atmosphere.—Heat and
   Cold.—Moisture.—Light.—Locality and Soils.—Food.
   —Physical  Culture.—Hereditary Transmission.—Oc-
   cupation.—Dress.—Social Habits and Surroundings.
   —Individual Habits.—Ventilation and Heating......  77
The  Office  of  Medicines  in the  Treatment  of
   Phthisis.......................................  208
The Political Duty of  the People in Relation
   to Phthisis....................................  218
Conclusion......................................• •  222 
 
         INTRODUCTORY.

  Consumption—portentous word ;  word
of sad reminder to thousands of families
whose diminished membership is the re-
sult of the disease it designates.  Word
indicative of apprehension to thousands
of other families, who  dread its  occur-
rence in some of the brightest and  most
loved of the family circle.   Probably over
three million members of the human race
are  swept from life each year by pulmon-
ary consumption, or phthisis, as we shall
designate the disease in  the  following
pages, that being  the  name most fre-
quently given to it by the medical profes-
sion.  Ghastly monumental  epitaph  in
record of the ignorance, slothfulness, and
unfortunate surroundings  and conditions
incident to the lives of the great majority
of the human  race.   If  during  some un-
usual epidemic,—as of yellow fever  or
cholera, for example,—a few thousand in-
                   i 
2
Introductory.
dividuals  die, the whole  social fabric is
stirred to its depths.  Governments and
individuals pour  out their resources lav-
ishly  to  promote investigation, to  insti-
tute preventive measures, and to offer im-
mediate succor to the afflicted ;  but hun-
dreds of thousands  die of phthisis each
year in the more  civilized countries, and
yet the general community is not stirred
in the least.  Man has the facility of soon
becoming "used" to the conditions which
surround him, even  if they are  evil ones
that imperatively need correction ;  and
his apathy in regard  to  the scourge  of
phthisis is a forcible and deplorable  ex-
ample of this adaptability.
  The laity, in ignorance  of the subject,
look upon phthisis as one of  those myste-
rious  providences which must be accepted
and borne, along with many  other incom-
prehensible experiences and disciplines ;
and we are not sure but that the profession
of a generation or so ago took somewhat
the same view  of the malady.  Even  in
this day, it would seem that the  physician
is too liable to look upon phthisis as a 
Introductory.
3
very uninteresting and  hopeless  disease,
merely calling for  the usual  prescription
of  cod-liver oil  and a  trip  to   Florida.
The profession continually sees through-
out whole  communities in-and-in breed-
ing of consumptives, and methods of liv-
ing from day  to  day which must surely
keep up  the consumptive death-rate;  yet
how often does it lift up its voice in  pro-
test ?  It  is  a serious  question as  to
whether  a physician's whole duty  extends
only to the  acre of disease.   Some fatal-
ist might say, "Why agitate the  matter?
If it were not for disease, war, and famine
the earth would soon be over-populated."
We should say  that if the  world is in
danger of being over-populated, the  rem-
edy should consist in shutting off the sup-
ply, and  not in killing off  the surplus of
its  inhabitants.  It is our opinion,  that
the life which  is worthy of generation, is
worthy of being lived out to the fulness
of its cycle.   If man is a progressive cre-
ation, this bearing and rearing of  individ-
uals to a period when they are just about
ready to  live and give the world the  ben- 
4
Introductory.
efit of their experience and work, and
then to have them  cut  down by disease,
would seem a great waste of force.  We
decidedly believe that the world would be
more of  a beneficiary,  if with criminals,
paupers,  the insane and scrofulous, con-
sumptives were not allowed to breed and
perpetuate through  their  progeny  their
miserable,  inefficient, and  trouble-giving
existence.   We believe that the time will
come when the law, supported by the sen-
timent of society, will  demand a health
fitness as one of the requisites  of a legal
marriage.  It is  probably  true, that  so
long as man's social condition is anything
like what it is at present, and he is at  all
subject to disease, phthisis will exist; but
this malady is largely preventable, and if
the conditions are  favorable, it is a cura-
ble disease.  It is anything but an honor
to the profession that  such a frightfully
large number of the human  race become
its victims.   Why should not some of the
energy that is yearly expended  in writing
book upon book on the nature of tuber-
cle, be spent in  devising  and  spreading 
Introductory.
5
abroad knowledge of the  measures which
would be  preventive  of  the  disease ?
But tubercle  has been worshipped,  and
very little has been  done  to prevent the
race from becoming tuberculous, the pa-
tients having been  rather left to shift for
themselves in the way of  treatment.   It
is  encouraging to know that during the
last twenty-five years the general advance
of knowledge, and its diffusion, has  had
an  appreciable  effect  in  reducing  the
phthisical death-rate.
  Before  discussing the treatment of this
disease,  it  will  be  proper to  describe
briefly its nature, symptoms, causes, etc.
It will also  be desirable to give a short
description  of the anatomy,  physiology,
and  hygiene, of  the structures in  which
the disease usually occurs—that is to say,
the  pulmonary organs—so that the ra-
tionale of the treatment may be more ob-
vious. 
THE ANATOMY, PHYSIOLOGY AND HYGIENE
   OF THE PULMONARY STRUCTURES.
   One of the prime requirements  for the
nutrition  of the  human body,  is  that
every minute element in it should be con-
stantly in a state of chemical activity, ox-
ygen being the  prominent agent in pro-
ducing this action.  The oxygen produc-
ing this action is derived from the atmos-
phere.   It is absorbed into the blood, and
that nutritive current carries it  to every
part of  the body.  The oxygenation  of
the blood  current has to be continuous.
If it is remitted for even a very few mo-
ments in man, the  result is death.  The
method  by which oxygen is  continuously
transferred  from the atmosphere  to the
blood is called the  function of respira-
tion, or breathing.   The special structures
which carry out  this  function  are the
lungs, and the adjunct mechanism neces-
sary for  producing motion in them.   The
lungs are designed for the purpose of ex-
                   6 
Consumption.
7
 posing a  very extended surface of blood
 to intimate atmospheric contact, and inci-
 dentally,  for fulfilling the  purposes of an
 air reservoir.  To carry out these func-
 tions, we  find the construction of the two
 pulmonary  organs, known  as the  right
 lung and  the left lung, to consist of an im-
 mense number of very  small  air  cavities,
 or air cells, as they are more frequently
 called, which communicate  by  air  pas-
 sages,  known as bronchial  tubes, with the
 windpipe, or trachea, which leads into the
 throat.   Let us  follow the air on  its way
 to the  pulmonary air cells.  It enters the
 nasal passages, passes through them into
 the pharynx, or throat, where air can also
 arrive by  way of the mouth if necessary.
 At the base of the tongue is  the  larynx,
 the mechanism  which  produces  the un-
 modified sounds of the voice.  It is a con-
 tinuation  of the upper extremity of the
 trachea   or  windpipe.   The   opening
through  the larynx is  a fissure  that  di-
lates when  air is drawn into the  lungs.
 The air current passing it and traversing
the trachea for  about four inches, is  di- 
8
Consumption.
vided at the upper part of the breast-bone
into two  streams, one of which passes to
each lung  by way of a  large bronchial
tube.   These large bronchial tubes divide
into others, and these in turn continue to
divide and  subdivide, until there are thou-
sands of fine tubes, known  as  capillary
bronchial tubes, leading from the larger
ones.   Finally, these capillary or hair-like
tubes terminate in an air sack called a ves-
tibule.  Clustered  around this vestibule,
and leading into it, are a number of the
pulmonary  air  cells  before  mentioned.
The arrangement  of the air cells, vesti-
bules, and terminal bronchial tubes is such
as to  remind one of a bunch of grapes.
It will be  seen that in  its  configuration
this whole  system of tubes and cells is
the analogue  of a tree, the trachea rep-
resenting the trunk, the  bronchial tubes
the branches,  and the  innumerable  air
sacks and cells the leaves.   Each of the
pulmonary air cells is  closely surrounded
by a net-work of blood-vessels of hair-like
minuteness.   These are the  small ter-
minal branches of  the  pulmonary artery. 
Consumption.
9
This large vessel  conveys to them  from
the right side  of  the  heart  the  dark ve-
nous blood, which  has been deprived of its
oxygen in its course  through the circle
of blood-vessels extended throughout the
body, and which has become loaded with
carbonic acid gas.   This gas  is a  result of
the  chemical action  continually taking
place in  the various parts of the human
structure.  In  passing through  the pul-
monary  net-work   of  blood-vessels,  this
dark venous blood loses its excessive car-
bonic acid gas  and is aerified, free oxy-
gen  being absorbed into it.   Thus oxy-
genated, and with its color changed to a
light rich red, it becomes arterial blood,
and  is returned by the pulmonary  veins
to the left side of  the  heart,  from whence
it is distributed  to the  whole  organism by
way  of   the  large arteries  and  their
branches.  The lungs are also  supplied
and  nourished by the bronchial arteries
and  their branches.   In proportion to
weight, there are no other structures that
are so freely supplied  with  blood-vessels
as the lungs.   The combined extent of 
IO
consumption.
the surface of the air cells  is many times
greater than that of  the  external surface
of the body.  The air cells being lined by
an  exceedingly  thin  and  delicate  mem-
brane,  and the small blood-vessels having
coats also very thin  and soft in texture,
it will be seen that the structural require-
ment of exposing a large surface of blood
to atmospheric contact is furnished.  The
thinness  and delicacy of the  membranes
interposed between  the  blood  and  air
gives very slight interference to the com-
plete mingling  of the two.   It must be
known that gases will readily pass through
almost any material, by means of a force
peculiar  to  them,  known as  diffusion.
This is a  sort  of repulsion  of the gas
atoms  for each other.   The pulmonary
structure  is strong  enough in  health to
retain the blood in its vessels, but it does
not prevent oxygen  or  other gases from
passing freely through any  of  the -walls
of those vessels.  The  distance  of the
pulmonary air cells from the outer world
prevents,  in  a great measure, their deli-
cate texture from being injured by those 
Consumption.
n
injurious matters found  in the air, such
as dust,  etc., which are deposited on  the
surface of the air tract higher up.   Very
hot  or very cold air  is  tempered in its
passage through the  air tubes before it
reaches  the delicate  surfaces of the air
cells.  These air tubes,  air cells,  blood-
vessels, and some nerves and lymph chan-
nels, are held  in their relative positions
by a  frame-work composed  of a  small
amount  of elastic fibrous  material, known
as connective tissue.   This frame-work is
very much  like an elastic sponge, which
quality gives the lungs their power of ex-
panding  during the  act of  inspiration,
when air is drawn into them, and of spon-
taneous partial  retraction during expira-
tion, when  air is driven  out  of the pul-
•monary  organs.   It must be  noted here
that all the membranes lining the air cells,
the  coats of  the arteries, etc., are com-
posed, as are other animal tissues, of an
aggregation of an  immense  number  of
microscopic  cells of  somewhat varying
shape and appearance.   When speaking
of these  cells,  they  must  not be  con- 
12
Consumption.
founded with the  pulmonary  air cells,
which are cavities.  The term  cell is ap-
plied to both  the cavity and the small
bit of  protoplasm, of which united myri-
ads constitute the whole human structure.
   One  of  the terminal bronchial  tubes
and its attached air cells form one of the
many lobules of which the lungs are com-
posed.   A number of these lobules form
the larger lobes  of the lungs.  The right
lung has three  lobes, separated by deep
fissures, while the left  lung has only two
lobes.   The general shape  of  the  lungs
is that  of the interior of the whole chest,
which they fill, except such of the middle
part as is occupied by a partition which
runs from the breast  bone to the spinal
column, and  which  contains  the heart,
great blood-vessels, etc.  The shape of
each lung is that of an irregular pyramid,
having  a concave base, corresponding
with the upper surface of the diaphragm
upon which it rests, and somewhat  cut
off on  the inside to correspond with the
surface  of the  aforesaid  partition,  with
which it is in  contact,   The  left  lung is 
Consumption.
n
considerably excavated  at the inner base
in front, to make  space for the heart,
which  is there located.   The  lungs  are
suspended  in the cavities of the chest by
means of their roots, which are composed
of the  main bronchial tubes, blood-vessels,
etc.   Except at the points where  these
lung-roots  enter, the lungs are free to
move,  expanding  or contracting within
the cavities in  which they  hang.   They
are covered with  a  smooth,  glistening
membrane  called the pleura, whose office
is to lubricate the pulmonary surface, thus
preventing friction between  it and a simi-
lar membrane which covers the inner  sur-
face  of the chest walls.   This membrane
is peculiarly subject to inflammations,  and
in phthisis  is generally more  or less af-
fected during  the  course of the disease.
The  bronchial  tubes are lined with  mu-
cous  membrane,  and  those tubes of  a
medium  and  larger  size are  furnished
with  numerous mucous glands,  whose
office is to  properly moisten and protect
the  surface  of  the  membrane.  This
membrane  is much  subject  to diseased 
14
Consumption.
eased action,  especially of the catarrhal
inflammation  known as bronchitis.  It is
universally affected  in phthisis, and  fur-
nishes most of  the  expectorated matter
produced in  that affection.   All of the
bronchial tubes are surrounded by,  and
have in  the structure of their walls, more
or less of the  elastic fibrous connective
tissue before  mentioned.   This  usually
undergoes considerable  increase in  its
bulk during  the course of phthisis, and
this  increase  is sometimes the principal
change  to be noticed when the  diseased
lungs are examined.
  As the combined space  contained  in
the various pulmonary air tubes and cells,
is sufficient in their utmost state of com-
pression, to hold a hundred and twenty
cubic inches of air, and  with a very deep
inspiratory effort will  hold  about  two
hundred inches additional, it will be seen
that in  the  lungs is provided a storage
reservoir for air, of very  respectable capac-
ity.  This provision is  necessary to  the
carrying out of  the  functions of voice
production,  coughing,  etc., and the con- 
Consumption.
15
tinuous action of the  great  function  of
the pulmonary organs, respiration.
   The respiratory method is  as follows  :
Air is drawn into and expelled from the
lungs by alternate  changes in the shape
of the  chest  walls;  these changes first
enlarging and then reducing  the cubical
capacity of the chest cavities.   The move-
ments which  effect these  changes  are
caused by the contraction  and descent of
the diaphragm, a muscular partition which
closes in  the  base  of  the  chest, and  by
the elevation  and outward movement of
the ribs.   This occurs during  inspiration,
and enlarges  the  chest cavities,  produc-
ing in them outside of the  lungs a partial
vacuum.   The external air, acting under
general  atmospheric   pressure,  rushes
through the air tubes into the lungs, ex-
panding them so far as the recession of
the internal surfaces of the chest  cavities
will allow.   Following the movement of
inspiration comes an elastic recoil of the
chest  walls,  diaphragm, and of the  lungs
themselves.   This is expiration, and  its
movements  drive out some of the air from 
i6
Consumption.
the lungs.  When inspiration occurs, fresh
air  is driven through the  nose,  mouth,
trachea, and bronchial tubes  of  the first,
second,  and  third  magnitude,  where  it
meets the  residual air  contained in the
air cells and smaller bronchial tubes.  At
about this  point  the  air  current  ceases,
and the fresh air  mingles with the gase-
ous contents further along,  through the
force  which produces diffusion  of gases.
At  the  surface of  the air cells,  through
the action  of this same  law, and  also by
so-called osmotic action,  the oxygen of
the air enters into loose combination with
the red corpuscles of the blood, and is car-
ried on  to  ultimate chemical union with
the various tissues  of which the body  is
composed.   The  excess  of carbonic acid
gas in the venous blood passes out through
the surfaces of the air cells, where, with
some organic impurities and watery vapor,
it mingles  with the air  in the  cells  and
bronchial tubes,  and then, during expi-
ration, is forced  into the  outer world.
Here  it  may be taken up by vegetation
as nutritive matter, and after awhile may 
Consumption.
17
be once more  returned to the same pair
of lungs, by way of the alimentary canal
and blood-vessels of the individual.
  The Hygiene of the lungs may be brief-
ly stated as follows :  The parts  must re-
ceive  constant nutrition  and   support
from a blood current free from all vicious
qualities, and  one  which contains in due
proportion the elements which are requi-
site for their nutrition.  The parts must
be used to such a  degree, and with such
regularity, that their  functions  may be
fully developed and maintained,  but they
must not be overused to such  a degree
that the continual  waste will be  greater
than the building up, or the parts become
too large and  powerful  for  the require-
ments of the body  when engaged in the
usual avocations of life, a condition often
occurring in athletes.   Furthermore, the
parts must not be abused by inhalation
of irritating or otherwise injurious mat-
ters.  The  atmosphere  taken  into  the
lungs should be pure, free from  excessive
gaseous adulteration, and moderately dry,
so that  the great functional  exchange of
    2 
i8
Consumption.
gases, moisture, and thrown  off organic
impurities,  may  take   place  freely  and
easily.   The chest walls and the adjunct
structures  which  are  concerned in the
process  of  respiration   should   have
their integrity preserved by proper exer-
cise, by  correct  habits  of posture,  and
by avoidance of deforming external press-
ure caused by improper methods of dress,
or  by excessive  atmospheric  pressure.
This latter occurs when diseased  proc-
esses partially close the air passages which
lead to the lungs.  If  air  cannot have a
sufficiently free passage in reaching these
organs, there is produced too  much  of an
air vacuum inside the chest, and the  chest
walls  are liable to give way  before the
increased external air pressure, thus lead-
ing to deformities of the chest.
  From  the  above, it follows  that  in the
lungs we have organs which are by reason
of their anatomical complexity and deli-
cacy of construction, by their physiological
necessity of continual  motion and  func-
tional activity, and by  their hygienic re-
quirements, peculiarly  subject to  disor- 
Consumption.             19
ders which might arise  from  conditions
of malnutrition, or from direct or indirect
irritation, both from external and internal
sources, and which if  once started would
be particularly difficult of correction.
 
THE DEFINITION, NAMES AND DIFFERENT
           FORMS OF PHTHISIS.
  The word phthisis in this day is gener-
ally considered to  mean  certain diseased
processes in the lungs, which result in de-
struction to  as  much  of the pulmonary
structure  as may be  invaded by  them,
and which are  accompanied by a marked
wasting of the whole body.  It is perhaps
impossible to give a brief comprehensive
definition  of the  term.   A  very short
study of the subject only, is necessary to
convince  one that the word phthisis is
not satisfactory as a  name  for  the  dis-
eased processes which  at the present day
are indicated by it, for it only describes
one symptom, namely,  that of wasting, or
consumption.  The term ptilmonary con-
sumption  is  sufficient as an  unscientific
name,  but  a fully satisfactory  scientific
term is yet to  be suggested, and in  lieu
of a better name,  pulmonary phthisis is
generally accepted by medical authorities.
                   20 
Consu?nption.
21
When we come to name the varieties and
sub-varieties of this  disease we are not at
such  a loss.    Thus,  tuberculosis  is  a
good  term to  designate  one of  them;
fibroid phthisis another;   and   so on.
Galloping  consumption and seventeen-
year  consumption  are very  good lay
terms  to "indicate  certain very acute and
very chronic  varieties  of the affection.
From  this  it should  be known that phthi-
sis, as  is so generally understood, is not
one simple uncomplicated disorder of the
lungs.   It   may be  several  distinct dis-
eased processes, or one only.  Although
phthisis has been certainly known to ex-
ist  as  far  back as historical records ex-
tend, and  was  described by the fathers
in medicine, it is  only within a very few
years,  comparatively speaking, that any
doubt  has  been  entertained as  to the
simple nature of the disease.  Until quite
recently, the existence of but one form of
phthisis was admitted.   All  the diseased
appearances  observed  in  the  disorder
were supposed to be solely due to the
growth or  deposit in the lungs of  small 
22
Consumption.
bodies  known as  tubercles.   It is  true
that this  peculiarity is  present  in  most
cases of the  disease,  and may  in  some
acute cases  be the  only change to be
noticed  in  the   pulmonary  structures.
However,  as scientific study of the dis-
order progressed,  especially as the struct-
ures were  examined under  the micro-
scope,  it was found that there were dif-
ferent  forms of  phthisis.  Among  oth-
ers,  were those which have been called
catarrhal  phthisis  and  fibroid   phthisis,
though these are poor names, and do not
describe  correctly the  disease  changes
which  have taken  place and may be fre-
quently observed.   Nevertheless, in place
of better  names,   tuberculosis, catarrhal
phthisis,  and  fibroid  phthisis  may be
used to indicate the three most charac-
teristic  appearances which are  most fre-
quently presented  in this disease.  Other
variations  are less  frequently observed.
They are  brought  about by  various in-
frequenf causes, and have been named as
follows:  scrofulous  phthisis,  which  oc-
curs in scrofulous individuals;  pneumo- 
Consumption.
23
nic phthisis, which follows  inflammation
of the lungs ; syphilitic phthisis,  due to
the working  of  syphilis locally  in  the
lungs;  hsemorrhagic  phthisis,  which  is
caused  by  haemorrhages in  the  lungs;
embolic  phthisis,  which is  the  result of
shutting off the blood from a part of the
lung by some plug getting  into and clos-
ing the  blood-vessel which supplies the
particular  part; etc.   It must  be  men-
tioned that different authorities give dif-
ferent names to these various processes,
on account of their individual hypothetic
opinions as to the nature of the  processes
and their causations.   Furthermore, some
authorities call by the name phthisis, cer-
tain   inflammatory  pneumonias,  which,
though having  practically  the  same de-
structive effects  in  the  lungs, are not so
liable to be dangerous to life.  As all of
these latter types of the disease are rare
in their occurrence,  and as  the  subject
would be  otherwise  complicated  to the
lay reader, only the three first named will
be considered in the discussion of the sub-
ject in the following pages. 
WHAT WE KNOW OF THE NATURE OF THE
               DISEASE.
  It must be stated at the beginning, that
there are  certain points  relating  to  the
nature and  causation  of phthisis which
are  not yet generally accepted by  the
medical profession, as having been  defi-
nitely settled.  However, we are  gradu-
ally  gaining  more light  on the subject,
and  the disclosures of the past two years
have been particularly valuable in throw-
ing  light  on subjects which  up to that
time were imperfectly understood.
  In the lung which is affected by phthi-
sis we generally  see three distinct pro-
nounced disease  changes at one time,
any  one  of  which  may  predominate.
Exceptionally,  one or  two  only  of  the
changes may be present. The first, which
is the  most frequently seen, and usually
the  most  prominent  appearance, is the
presence in the pulmonary structures of
numerous  small  tubercles.  These  may
                   24 
Consumption.
25
be thinly scattered, or thickly massed to-
gether.   They are apparently joined by
a web of tissue similar in appearance to
connective tissue.  They may be present
in small, or in large  numbers.  They ap-
pear,  if fully  formed, like  gray,  semi-
transparent, shining bodies of  about the
size of  millet seeds.   They may become
somewhat  larger  and turn  to  a yellow
color  as they become older.  They are
found in almost  any part of the pulmo-
nary structure.  Sometimes  the material
of which these tubercles is composed, in-
stead  of  forming  these  round minute
bodies,  infiltrates  the pulmonary struct-
ure in  a diffused  manner.   In certain
cases  of acute  phthisis  (the galloping
consumption of the  laity) these tubercles
are usually present in  large   numbers,
widely   disseminated  throughout   the
lungs.   When a thin slice of  one of these
tubercles is examined microscopically,  it
is found to be composed of  a vast num-
ber of small cells,  not to  be distinguished
from  many  of the  cells found in  the
healthy tissues of  the body.  At the mar- 
26
Consumption.
gin of  the  tubercle are to be  seen large
so-called mother cells and spindle-shaped
cells, and the whole seems to  be  held
together by some  transparent  adhesive
substance.   Sometimes the  tubercle ap-
pears  to have   an  interlacing fibrous
frame-work.  By  means  of  a certain
method of examination, in which an ani-
line staining fluid is used,  there has lately
been discovered in the tubercle certain
minute rod-shaped organisms belonging
to the  family Bacilli.   This organism has
been  called  the Bacillus Tuberculosis.
As the tubercle ages, it becomes opaque,
yellow, and friable.  It softens,  and then
acts  somewhat like an abscess.   One or
several, by uniting, go through  a process
of inflammatory ulceration,  and are dis-
charged into some air passage or cavity.
The result  of the formation and degener-
ation of  these tubercles is, that the pul-
monary structure in which they occur is
literally compressed out of existence, and
in their place cavities are  formed.  They
also  induce irritation in the surrounding
parts, and when  breaking down, contam- 
               Consumption.             27

 inate  the  general  system.   Occasionally
 the tubercles  may  dry up into  hard,
 chalky masses. The time occupied during
 the production and  continuation of  the
 tubercle probably  extends  over a some-
 what uniform  period.   New crops of tu-
 bercles are continually being formed, but
 if a large  number are  produced at one
 time the  disorder takes on an  appear-
 ance of acuteness  not observable where
 there is  a  less extensive tubercular pro-
 duction.
   The  second distinctive diseased condi-
 tion seen  in the phthisical lung, is the
 formation   of  yellow  cheesy  masses,
 known  as  yellow or  infiltrated  tubercles
 or  nodules.   These  are larger than the
 minute gray tuhercles, and may attain a
 size as large or  larger  than  a  chestnut.
 These are  probably formed  in the vesti-
 bule and its surrounding air cells.  It has
 been claimed that they are the result of a
 chronic diseased  process of  the walls of
 the air cells.   They are mostly composed
 of cast-off matter which  has formed these
walls, but they also have in  their compo- 
28            Consumption.
 sition mucus,  blood cells,  and granular
 matter.   They may  undergo  softening
 and be absorbed, or may go  through a
 process of  cheesy degeneration,  and be
 expectorated after a certain  amount of
 softening.   The  nodules may become of
 a chalk-like nature, and either have a cap-
 sule of connective  tissue formed  around
 them, or else ulcerate their way into an
 air passage and be expectorated.   Their
 formation is usuaily an extendedly chron-
 ic process, and results, like the  tubercular
 formation, in destruction of  the lungs
 from pressure  and inflammation, leaving
cavities, blotting out or ulcerating blood-
 vessels, and contaminating  the general
 system with   inflammatory and  other
 products.
  The third distinctive diseased appear-
 ance  characteristic  of  this  malady is an
 increase in the amount of the connective
tissue  composing the elastic frame-work
of the lungs.  Some authors assert that
part of this  new connective tissue  is of a
different character from that found in the
healthy lung.   This formation  occurs in 
Consumption.
29
greater or  lesser  amount  around  the
bronchial tubes  and blood-vessels, be-
tween the lobules  and air cells,  and  in
and around the tubercular matter.  Like
all new connective tissue formations,  it
eventually contracts and becomes perma-
nent.  It is then essentially the  same  as
the hard, tough, white material which  is
formed in the scars or cicatrices of lacer-
ated  wounds, deep burns, etc.  This for-
mation destroys the  healthy lung  sub-
stance by  displacement as  it increases,
and by compression during its subsequent
contraction.   This contraction is apt  to
be followed  by  a sinking inward of the
chest walls.   This can be seen externally
by examining the patient's chest.  In the
beginning, all these processes are charac-
terized by a  consolidation of the pulmo-
nary substance.   Instead of being light,
elastic, and compressible as in the healthy
state,  the lungs  become heavy, inelastic,
and  non-compressible, the parts  invaded
containing little  or no air.   In  connec-
tion with these changes, there are usually
found diseased  conditions  in  the bron- 
30
Consumption.
chial tubes, and  the  pleura or the mem-
brane covering the lungs.  The  tubercu-
lar formation may occur at the same time
in the larynx,  in the covering membrane
of the brain, in  the  intestines and other
parts  of the body.   During  the disease,
the blood of  the individual  is thin and
watery, and otherwise changed.   Phthisis
usually commences  in the upper part of
the lungs, and progresses  downwards.
This  peculiarity is  probably due to  the
fact that the upper parts  of the lungs are
less freely supplied with blood than  the
lower lobes, and  hence are liable to suffer
sooner in poor states of general nutrition.
Such in brief is what we  know of the na-
ture of these diseased processes.   There
are many questions relating  to this  sub-
ject which are not  settled in the minds
of all the members  of the medical  pro-
fession,  although  almost  every  writer
holds a decided  and individual belief on
these points.   Among these questionable
points are the following  : What is tuber-
cle ?   How  is it formed ?  Is  it depos-
ited ?  Is  it  an  inflammation ?  Does it 
Consumption.             31
grow ?   Is it implanted from  without the
body ?   Is it  the  result of irritation of
the pulmonary  structures alone ?   Does
phthisis  follow bronchitis ?   Is phthisis
a  hereditary taint?  etc., etc.   The dif-
ferences of opinion on  these and many
other points are various  and  radical, and
on them professional men have disagreed.
Merely to  mention the points discussed,
the works  that have been written  upon
the subject, and the-names of the learned
writers,  would be  an  almost endless, as
well as an unprofitable,  task.  So far as
the purposes of this book are concerned,
all this difference  of opinion is of  com-
paratively   little  practical  importance.
On the more important  matters relating
to the causation of the  malady and  its
best  methods   of  treatment, the  most
eminent members  of  the profession are
agreed, and it is the purpose of the writer
to bring forward  and  emphasize  these
practical points,  rather  than to discuss
matters which are only of  scientific inter-
est. 
THE SYMPTOMS WHICH ACCOMPANY AND
   ARE CHARACTERISTIC OF THE DISEASED
   PROCESSES.

  The  three  chief  varieties of phthisis
have  each such distinctive symptoms  as
to make their differentiation in diagnosis
a matter of no great difficulty, and these
characteristic  symptoms will  be  stated
further on.  There  are certain symptoms
common  to  every  variety  of  phthisis.
These  are  dyspnoea,  or  shortness  of
breath;  cough ;  hsemoptisis, or spitting
of  blood ;  expectoration ;  pain ;  fever ;
accelerated pulse ; disordered digestion ;
emaciation ; diarrhoea;  arrest  of  men-
struation ;  change of  voice ; oedema,  or
swelling of the extremities ; enlargement
of  the  ends of  the fingers ; brain  symp-
toms, etc.
   Dyspnoea, with an increased rate rof res-
piration,  is always  more  or less present
during the phthisical course, and espe-
cially  after muscular exertion.   It may
                   32 
Consumption.
33
 be one of the first  things noticed.   For
 example, after walking up stairs  the  pa-
 tient becomes short of breath.   During
 rest, this symptom may not be prominent.
 It may be due to  the loss of the  pulmo-
 nary substance,  or to the  fever which
 causes an  extra consumption of oxygen,
 or to obstruction of the bronchial tubes,
 or to a coincident pleurisy, which would
 make the extensive motion of deep breath-
 ing  painful to the patient.
   Cough.—This is an early and constant
 symptom.   At first  it may  be dry  and
 hacking.   It is apt to occur in paroxysms,
 and may cause nausea or vomiting.  It
 may have  a  brassy, laryngeal  quality, if
 the  larynx is complicated in  the disease.
 As the expectoration comes on, the cough
 becomes bronchial  in quality,  and with
 the  formation of cavities it becomes deep
 and cavernous.   The cough may be  ab-
 sent in the insane, and also when  the  pa-
 tient has  any other prominent disease.
 Nervous coughs, the result of reflex irri-
 tations,  may  be  confounded  with   a
phthisical cough.   The  original  seat of
     3 
34
Consumption.
 irritation in these cases may be in  the
 uterus, the abdomen, the eyes, or in other
 localities.   Hypochondriacal and hysteri-
 cal  cases may  also  have coughs which
 simulate that of phthisis.
   Hcemoptisis.—The spitting of blood, in
 amounts varying from  a slight streak in
 the  expectorated matter, to  a pint or
 more at one time, is generally a promi-
 nent and important symptom  of  phthi-
 sis.   It may be  the first indication of
 approaching trouble.   In the early stages
 it  is usually a bronchial haemorrhage, and
 though not serious  in  its immediate re-
 sults, is prognostic of coming trouble, due
 to pulmonary weakness and  laxity of  tis-
 sue.  In the later stages of the disease,
 it  is a serious symptom, showing pulmo-
 nary destruction  and ulcerative action in
 the walls of the blood-vessels.  The rupt-
 ure of a vessel of large  size in the pulmo-
 nary  tissues may cause  speedy  death
 from suffocation.   The  blood in these
haemorrhages is  bright  red  and  frothy
showing its pulmonary and arterial origin.
and when they occur the patient  usually 
               Consumption.            3 5

 experiences a sense  of trickling behind
 the breast-bone.  Spitting of blood may
 result from many causes besides phthisis.
 For instance, the blood may come from
 the gums,  from any  part of  the mouth,
 from the back of the  nose, from the stom-
 ach, from the larynx,  or it may be caused
 by what is known as atheromatous degen-
 eration  of  the  arteries.   Some  women
 habitually spit  blood during  their men-
 strual periods who have perfectly healthy
 lungs, and these cases must  not be con-
 founded  with   premonitory  phthisical
 haemorrhages.
   Expectoration.—The matter expector-
 ated during phthisis is  quite characteris-
 tic.   Most of it  is produced by a coinci-
 dent inflammation of the bronchial tubes in
 the  immediate vicinity  of  the phthisical
 process.   At first it is a scanty,  transpar-
 ent, viscid mucus.   There are apt  to be
 yellow spots and streaks  in  it when the
 smaller bronchial tubes  become  affected.
 When the air cells  are implicated, parts
of their  lining  membrane in a state  of
disintegration,  and perhaps some  blood 
36
Consumption.
streaks will be found in  it.   WTith  the
process of softening, the phthisical prod-
ucts are expectorated in round, grayish
masses.   In  fresh cavities they are thin-
ner, with  a rosy tinge.   They sink in
water,  and  may contain  elastic  tissue
fibres,  young cells,  and lumps of cheesy
and chalky matter,  bacilli,  and blood and
pus globules.   If dilatations in the bron-
chial tubes are  present, the expectorated
matter collected and detained in the cavi-
ties is  apt to undergo fermentation, and
becomes exceedingly  offensive in odor,
and  may  be   expectorated  in  large
amounts at one time.
  Pains in the  chest may  be present at
varying  intervals  during  the affection.
They are usually caused by inflammation
in the  pleura and in other parts surround-
ing the affected lung.
  Fever.—This is  probably the most im-
portant  symptom  in  connection  with
phthisis.   If this action is long continued,
it hastens  an  unfavorable result.  The
temperature ranges from ioo° to  1070 F.,
being in  proportion to the  nature and ex- 
Consumption.
37
tent of  the affection.  The  patient  is
usually freer from fever in the morning.
In  the afternoon, after a state  of  chilli-
ness, it increases, and then declining, is
followed  by a night  sweat, usually very
profuse.  The sweat may  be limited to a
particular part of the body only, as  for
example, one half of the  body.   In such
cases the other half of the body is  liable
to some other affection, such as neuralgia
or nasal catarrh.  The fever of  phthisis
is designated  "hectic."   It  is probably
the  result of  the irritation  produced  in
the  general tissues  of the  body by  the
degenerated  phthisical  products  which
have been  absorbed by  the system,  the
debilitated condition of the patient pro-
moting  the action.  It   occurs  also  in
other conditions of debility,  as in nursing
women, and in cases  where  chronic  ab-
scesses produce a large amount  of pus,
etc.  There  are  intermittent, remittent,
and  irregular types of the fever.   When
the sweats are very  profuse  they are  ex-
haustive to  the patient.   They are proba-
bly due  to  relaxation of the muscles  of 
38
Consumption.
the vessels which supply the perspiratory
glands.   It is thought that they are some-
what beneficial in relieving  the body of
the impurities absorbed from  the phthisi-
cal process, and in reducing the great and
damaging heat of the  febrile action.  It
is  certain that after them the patient feels
better for some hours.   A  regular  ther-
mometric observation  of  the  phthisical
patient is of great assistance  in judging
of the nature and rate of progress  of the
disease.
   Accelerated pulse.—An increase in the
pulse rate is an invariable accompaniment
of the disease.   The heart acts  in  an ex-
citable and feeble manner, the pulse indi-
cating from  ioo to 140 beats per minute.
As the fever  increases the  rapidity of the
pulse is also increased.
   Disordered  digestion.—Unfortunately,
in  phthisis this is a more or less marked
symptom.  Exceptionally, the patient re-
tains a   good  appetite throughout  the
course  of the  disease.  In  some  cases,
disorders of the digestion, due to various
causes, bring  about the affection.   The 
Consumption.
39
usual lack of appetite may even amount
to repugnance  for food, and the inability
to digest not only leads to  impaired  nu-
trition  of the  various  tissues, but  the
undigested  food gives rise to irritative
diarrhoea.   Later in  the  disease,  a  ca-
tarrhal  condition of the stomach is likely
to be present, and is caused by the conges-
tive tendencies  of  the poor circulation.
Vomiting is often observed, and is  mostly
produced by paroxysms of coughing.
   Emaciation.—Though not particularly
diagnostic of  phthisis, this symptom is
always  present to a greater or less  degree
at some time during the course of  the af-
fection, unless  the  course  is very  acute.
The emaciation may precede the phthisis,
being due to disorders  of nutrition,  but
fever is the prominent cause of the  notice-
ably rapid and extensive bodily waste.
   Diarrhoea.—This is apt to occur in the
later stages.   It may be due to the pres-
ence of undigested food in the intestine,
or to the irritation  of the tubercular proc-
ess  in  that   organ.   It   is  sometimes
called "colliquative."  When it is  exces- 
40
Consumption.
sive, the "hectic" is apt to be less.   Tow-
ards  the last, the  feces  may  become
dark  brown  and  very   offensive,  and
streaked with blood, the latter being pro-
duced from ulcerated surfaces.
  Arrest of  menstruation.—Among fe-
males this is  an early symptom.   It  is
due  to a lack of nerve force, and to the
derivative effect of  the pulmonary irrita-
tion.
  Change of voice.—If the larynx be im-
plicated  in the  process, as is  frequently
the case, the  voice takes  on  a  peculiar
husky tone.  The inflammation and ulcera-
tion  of the organ gives the patient great
distress,  the act of swallowing being so
painful  that it interferes  with the taking
of sufficient nourishment.
  (Edema, or swelling of  the feet  and
lower extremities, is a usual  condition of
the later stages of  the  malady.   It  is
caused by the sluggish state of the  circu-
lation.
  Enlargement of the ends of the fingers,
as well as incurvation of the finger nails,
is  usually  seen.   The   enlargement  is 
Consumption.
4i
caused by  an increase of the connective
tissue of the ends of the  fingers, brought
about by impediment to the pulmonary
circulation  causing  congestion  in  the
parts.   It is not peculiar to phthisis, being
seen in heart troubles, etc.  The incur-
vation of  the nails  is caused by the loss
of the cushion of fat which normally pads
the ends of the fingers.
  Brain  and  abdominal  symptoms  oc-
cur when the tubercular process extends
to those parts of the body, and are unfa-
vorable signs.
  The characteristic diagnostic symptoms
of Tubercular Phthisis are usually such
as precede the physical signs in the lungs.
They are  as  follows.: The change in  the
voice, and other laryngeal symptoms ; loss
of flesh, strength, and appetite, with dys-
peptic symptoms and fever; night sweats
and hacking,  dry cough.   After these, ex-
pectoration and shortness of breath com-
mence,  and  then shortly signs of solidi-
fication  are to be observed in the lungs.
  Catarrhal Phthisis  is characterized
by first  having local symptoms of bron- 
42
Consumption.
chitis or pneumonia, while the general sys-
temic symptoms only occur secondarily in
gradually increasing progression.
  Fibroid Phthisis is particularly marked
by its very slow rate  of progression.  It
has great chronicity, and the temperature
is never very high, nor the  pulse  rapid.
There  are periods  when the  symptoms
abate, and there are symptoms of chronic
bronchitis present.   In a very acute form
of  tuberculosis  the  general  symptoms,
previously stated, may be so pronounced
as  quite  to  mislead  the physician,  and
may be so like the symptoms  of typhoid
fever as to be undistinguishable from it,
especially as in this form  the morning
temperature  may be  higher   than  the
afternoon.
  Pregnancy  interrupts the progress of
the disease for the time being.   The prop-
agation of the species  being  the  second
great function of the individual (the first
being  that of  self-preservation),  when
engaged  in  the work of gestation the
first energies of the body are directed to
this functional action.  It is a well recog- 
Consumption.
43
nized clinical  observation that phthisical
patients, when pregnant, cough less, spit
less blood, and the general diseased proc-
ess is  retarded.   But  after the confine-
ment, the disease makes up for the  delay
by an increased rate of  progress.  It is to
be supposed that few medical men  would
advise the  bearing of  a  phthisical child
for the sake  of retarding the phthisical
process in the mother.   However, there
might be instances where great hereditary
or property interests required and  made
allowable the extension of life in this way. 
THE PHYSICAL  SIGNS INDICATIVE OF
              PHTHISIS.
   In medical parlance,  a physical sign
means a symptom which is perceptible to
the  senses of sight, touch, and hearing,
and  is to be  distinguished from a  symp-
tom, which  we  recognize,  through  the
reasoning powers, from the patient's rela-
tion  of  the  unusual  sensations experi-
enced by them as the  effects  of  the  dis-
ease.   As   instances  of  the  physical
method  of  examination  we may  cite
the  following  facts.  We can  see  the
movements of the chest,  etc.  We  can
feel the movements of the heart ; the vi-
brations produced in  the lungs by  the
voice, etc.   We  can  hear variations in
the sounds of  the heart, the breathing,
etc.   This being so, it must be conceded
that the method of observing disease by
physical exploration is extremely  valua-
ble.   The  physical signs of  phthisis, in
conjunction with the symptoms described
                   44 
Consumption.
45
 in the previous chapter, are of great  im-
 portance in  diagnosticating the disease.
 In many cases either method alone would
 not  give sufficient evidence  to warrant
 the making of a diagnosis.   It is usual to
 speak of phthisis  as having three  stages
 —a first stage of  consolidation, a second
 of softening, and a  third of excavation.
 Each  of these stages  furnish peculiar
 signs which are characteristic of it.   How-
 ever, there may be some cases where  the
 first stage gives no  physical sign  of  its
 occurrence.  In inspecting or looking at
 a phthisical chest, there  is  usually found
 a restriction in  its  respiratory expansion,
 which is proportionate to the  amount of
 pulmonary consolidation and the duration
 of the disease.   Falling in of the  chest
 walls occurs  to a greater or lesser extent
 after the disease has made some progress,
 it either being due to the contraction of
 the fibrous connective tissue of the  lungs
 or to  loss  of the lung  substance itself.
 When the hand is held over the diseased
lungs (for the malady usually occurs  on
one side only) and the patient  counts or 
46
Consumption.
coughs, there is more of a jar  communi-
cated to the hand over the affected part.
However,  even  in health  there would
naturally be more of this vibration on the
right side than on the left.  A deficient
expansion of the chest walls may often be
more easily perceived by the hand, than
by the sight.  If there  is  a large cavity
near the surface  of the lung, the vibration
of the voice, or of  the gurgling  of  liquid
in the cavity, may  be  detected by  the
sense of  touch.  If we  tap with the end
of the finger, or with  an appropriately
constructed small  hammer, we may hear
a comparative difference in the resonance
between  the  healthy and  the  affected
sides.  A dull quality in  the sound pro-
duced, proportionate to  the amount  of
consolidation present, is  usual, but this
sign is often obscured by the presence of
neighboring distended  air  cells, and by
the intervention of healthy lung substance
between the consolidated part and  the
chest wall.  In  the  second  and  third
stages  the dulness  becomes widespread
and tubular in quality.   If we strike or 
Consumption.
47
percuss the  chest forcibly, deep-seated
dulness may be elicited.   If there are cav-
ities near  the surface, a sort of " chink,"
known as the " cracked pot" sound, may
be produced.  If we listen with the ear
at the chest walls, we may find in the first
stage a weakness in, or even suppression
of, the  ordinary sounds  of respiration at
the affected point, and  exaggerated res-
piratory sounds elsewhere.  A prolonged,
high-pitched respiratory  sound may also
be  noticed.  As  the  lung consolidates,
the respiratory sound  acquires  a  quality
known as bronchial, and the heart-sounds
become more intense  over the  affected
part.   During the course  of the disease,
the local bronchitis, which is usually pres-
ent,  produces  an  abnormal  amount  of
mucus  in  the bronchial  tubes, and the
passage of the  respired air through and
over  this  fluid gives  rise to  crackling
sounds of  various 'dnd, known as mucus
rales.  Over cavities may be heard gur-
gling and  tinkling sounds, produced  by
air  bubbling through, and of  fluid drop-
ping into the liquid contents of the cavi- 
48
Consumption.
ty.   The respiration may also sound like
air being blown over the mouth of a bot-
tle or through a cavern.  Friction sounds
are frequently heard, caused by the rub-
bing together of the inflamed pleural sur-
faces contiguous to the affected parts  of
the lung.'
  It is of the greatest  importance in the
treatment  of phthisis that an early recog-
nition of the diseased condition be made.
The invasion of the malady is quiet and
insidious, and early symptoms and signs
are unfortunately likely to be overlooked
or made light of, though nothing can  be
more fatal to the success of the treatment
than such  neglect.  Among the impor-
tant early signs to be recognized,  are pro-
longed, high-pitched, jerky, or interrupted
respiratory sounds, and high-pitched mu-
cus rales,  restricted to  the upper part  of
one  side of the chest.  These signs,  in
combination with some of the symptoms
described  in  the  previous chapter,  may
give early warning of the phthisical proc-
ess. 
THE POSSIBILITIES OF  CURING THE DIS-
                ORDER.
  Phthisis is without doubt a serious dis-
ease, and multitudes become  its victims.
Must therefore a person die whose lungs
are affected  by this  disorder?  Such  a
conclusion does  not necessarily  follow.
Phthisis is a  curable malady, if the condi-
tions   which  surround  the  patient are
fairly favorable, and the treatment be un-
dertaken in time.   Unfortunately for the
majority of individuals  who  are afflicted
with the  affection, their lot  in  life is so
hard that they cannot even command the
conditions which  are necessary  to pre-
vent the acquisition  of the disorder, to
say nothing of those  necessary for curing
it.  When we speak of curing  the dis-
ease, we mean the stoppage of its further
progress; for, of course, the  part  of the
lung which has been  affected, is to all  in-
tents and purposes destroyed, and the in-
dividual is crippled to just the  extent of
     4            49 
50
Consumption.
this destruction.   The lungs are such im-
portant organs, that, if too much  of  the
structure is destroyed, the  life of  the in-
dividual  must  cease ;  but if the part de-
stroyed is only slight,  its destruction may
not interfere with the resumption of an
actively useful  life.  Usually  the lung is
so much crippled that the individual  has
to somewhat restrict his life as to its ac-
tivity, and  be careful in  his avoidance of
various wearing, depressing and irritating
influences,  which would not interfere ma-
terially with the life of the possessor of a
complete pair  of  healthy lungs.  Many
an individual lives a long life,  during the
greater part of which he has had  only
the use of one lung.   Autopsies  on the
bodies of those who die of other diseases
very frequently show that there has been
old, but cured  trouble, in the lungs ex-
amined.  Catarrhal phthisis is less fatal
than the tubercular variety, and patients
with  fibroid  phthisis   may  live  many
years, and  finally die from some other dis-
ease.   A necessity to  the cure of  a case
of phthisis is  a  strong  will  power, and 
Consumption.
5i
determination on the part of the patient
to battle with the disease.  It always is a
hard battle,  and sometimes  a long one,
before success can be claimed, and it re-
quires patience and nerve to sustain the
fight.  But let it never be forgotten that
prevention in these  cases is better than
any amount of cure. 
OTHER DISEASES WHICH MAY BE  TAKEN
             FOR PHTHISIS.
  There  are a  number  of diseases  and
diseased conditions which  present  symp-
toms  and  signs  so like those of phthisis,
that they  may be  taken  for it.   For ex-
ample :  the  spitting of blood is likely to
cause great alarm to those  in whom it oc-
curs ;  but  this  expectorated  blood may
come  from the back of the  nose, from the
gums, or mouth, or the  larynx, or other
parts  of the air passages,  or even from
the stomach.  Sometimes the function of
menstruation takes on a  vicarious action,
and blood is expectorated for that reason.
Chronic bronchitis may simulate phthisis
so closely  as to be hardly distinguishable.
Indeed, a  certain  condition  of chronic
bronchitis may be, so far as its effects are
concerned, just about the  same thing as
a  fibroid  phthisis.  Typhoid  fever,  in-
termittent   fever,   pleurisy,  pneumonia,
and cancerous growths  in the chest may
                   52 
Consumption.
53
seem very much  like  some  of  the first
stages of some of the  varieties of phthi-
sis, but generally a short course of obser-
vation, and the  application of  the tests
which  the knowledge  of every  trained
physician enables him to apply, will make
the distinction between  the diseases  ob-
vious. 
THE CAUSES OF PHTHISIS.
  Of vastly  greater  importance  to the
patient than a knowledge of  the  nature
of phthisis, is information as to the  caus-
ative influences which are active  in pro-
ducing this serious disease; for it  is only
when a proper comprehension is attained
of the numerous  causes at  work  in  its
production,   that  an  effectual  rational
treatment of the  affection  can be  insti-
tuted.   It is well at the start to put aside
the idea of only one specific origin for the
disease.  It  is  certainly  probable, that
the introduction  into the system  of spe-
cific tubercular matter, such  as the  bacil-
lus  tuberculosis,  may be a cause of the
disease, but  it  is  not by any means the
sole  cause.   A phthisical  action  is  no
longer an entire  mystery.   It is  due to
general  predisposing  causes which are
well understood, and to immediate irrita-
tions of which we know much.  The proc-
                   54 
Consumption.
55
esses  of the disease are  governed  by
general  physical laws, and take on their
peculiar character under  the  influences
of the anatomical construction and physio-
logical functions of the  parts  in  which
they occur.   The causes, both direct and
indirect, which  act to  bring  about the
peculiar diseased conditions of phthisis,
are numerous.  The  great predisposing
cause  of phthisis  is  malnutrition,  by
which is meant,  that a deficient supply of
proper  nutrient matter  being furnished
to the  pulmonary and  other  structures,
there is a  deficient  vital action  on the
part of the anatomical elements composing
those structures,  the  result of which  is
that they lack  firmness, density,  tough-
ness, and vital activity.  Being in  such a
weak and delicate state, they are more
sensitive to many  irritating  influences,
and are not  able to resist causes  of dis-
ease  which  would produce no  malign
effects  upon  them if they  were  in  a
healthy  condition.  The  causes  which
bring about states of  malnutrition are
almost too numerous to  mention. 
56
Consumption.
   Congenital malformation of the bodily
structure  is a  prominent  one.   In this
condition, the digestive  organs  may not
be sufficiently  well constructed anatom-
ically to carry on the  processes  of  diges-
tion  and  assimilation;   or the nervous
system may not have  sufficient structural
or functional  development to  generate
and  distribute  the nervous energy nec-
essary to  carry on the  functions  of the
various organs of the  body with that
rapidity and force  essential to  vigorous
nutrition;  or  the heart  may be  too
small and  weak to propel the  nutritive
fluids properly; or the lungs may not be
large  enough   for   respiratory  needs.
With the latter  class  may be rated  badly
formed chests;  as, for instance, those that
are  flat  and   contracted.   Such   badly
formed  chests  prevent  sufficient  respir-
atory motion  and functional  activity of
the  pulmonary  organs.   In these  cases
the lungs are likely to be over used, and
do not have sufficient rest to allow full
repair to take place in them.
  Another great  predisposing  cause of 
Consumption.
57
phthisis is hereditary acquired habit.  In
a certain number of cases the hereditary
tendency of the pulmonary structures to
take on  the phthisical action  is  so  in-
tense and  fixed,  by  in-and-in breeding
and by the habit of generations of phthis-
ical ancestry, that, in a certain sense, it
becomes a physiological act, and it is just
as natural  for  some  persons  to become
consumptive at some period of their lives,
as it is for their noses to bud  out on their
faces, or for all animals to undergo senile
degeneration  towards  the  end of their
lives.  But  more   often  the   hereditary
tendency requires  some immediate excit-
ing cause to start the disease  into action.
The general debility  of  parents, due to
vicious  habits  of  life, or to  inheritance,
may be  handed down from  one  gener-
ation to  another, and thus predispose to
phthisis.  A diseased  habit  may  be  ac-
quired.   Thus,  a  tendency of blood to
accumulate in the  lungs becomes a habit
after  a certain amount  of exposure to
such  exciting  causes  as  the  frequent
"taking of colds,"  inhalation of irritating 
58
Consumption.
matters,  etc.  This habit may only  re-
quire the  conjunction  of  pulmonary mal-
nutrition  to start a phthisical action  in
the lungs.  A habit that may be heredi-
tary or acquired is slothfulness, which, if
indulged in, must  bring about a diseased
condition  in its possessor  sooner or later.
It will also be obvious that a vast variety
of acquired habits would have a tendency
to bring about a generally unhealthy and
debilitated state   of the  body, in which
state the-lungs would  offer a ready field
of action for any  special irritation causa-
tive of phthisis.   Therefore,  the follow-
ing may be cited as among the predispos-
ing  causes  of phthisis:  in general,  all
depressing  and debilitating  influences ;
eating  insufficient  and  badly  selected
food ;  intemperance in the use  of alco-
holics, and  of the sexual function; lack
of proper exercise and use of the mus-
cular, nervous, and other  systems ;  ex-
haustion  from  over-work, both  of  the
brain  and  muscles ;   anxiety, unhappi-
ness, and other mental disquietude ;  ex-
citability  of temperament, a  peculiarity 
              Consumption.             59

resulting  in a greater waste of the bodily
structures than can be replaced during
the periods of rest and by the nutrition
supplied  by the  digestive system ;   de-
ficient ventilation, and all contamination
of the atmosphere with deleterious,  irri-
tating,  or useless gases, which  may be
either absorbed into  the  blood,  or  irri-
tate the pulmonary mucous  membrane,
or prevent a sufficient  amount of oxygen
being supplied to the blood, or prevent the
proper excretion of the products  of  res-
piration ;  impropriety  of, and inefficient
dress ; sedentary habits, especially when
such  habits follow over-development of
the  lungs.  This  latter is  a  frequent
cause of  phthisis  in   those who  having
been  professional athletes,   afterwards
adopt sedentary lives.   Defective drain-
age and lack of personal cleanliness may
be  predisposing causes of the disease;
the excitements of fast living which are
so frequently seen in the lives  of fashion-
able people, especially in young women ;
previous debilitating  disease ;  unhealthy
occupations ;  depressing or too exciting 
6o
Consumption.
climates.  These,  with  others,  are  all
predisposing causes of phthisis.
  It is probable that the  beginning of
catarrhal  and  fibroid  cases  of  phthi-
sis, if  not of the  tubercular type  also,
are marked  by some congestive condi-
tion of the  blood in the lungs, a condi-
tion in which there is an abnormal deter-
mination of the  blood  to  the lungs.
Possibly there is  also  a disturbance of
the nervous supply  distributed to  the
pulmonary   organs.   If  this  state  of
things  occurs at some unfavorable time,
when the pulmonary structures lack tone
on  account  of being  poorly nourished,
they are not able to resist  the influences
that are brought  to  bear  on them,  and
the diseased processes  are  then  inaugu-
rated.
  There are a great number of condi-
tions and influences which  are certainly
known to have so direct  a relation to
phthisis that they can be correctly called
immediate exciting causes of the disease,
most of them  producing this abnormal
congestive  condition of the  blood in the 
Consumption.
61
lungs.   The most generally prominent
are  climatic.   These  act  deleteriously
through  unfavorable  conditions of quick
change and great range of temperature,
or through the presence  in  the  atmos-
phere  of  excessive moisture  and irritat-
ing impurities.   These  conditions either
produce direct  bronchial and pulmonary
irritation, or else  act indirectly, by  their
effect on the surface of the body.
  The causes just cited explain the pro-
duction of some  of the diseased condi-
tions which are found  in  the phthisical
lung, but they do not satisfactorily ex-
plain  the causation of the tubercular
formation.  About  four  years  ago  a
young German physician, by the name
of Robert Koch,  electrified  the  medical
world  by quietly announcing that he had
found  in  the  expectorated  matter  of
phthisical patients, and  in the  tubercles
themselves, a  microscopically small or-
ganism, which  has been called the Bacil-
lus  Tuberculosis.   It was  discovered by
means of a peculiar  method  of  coloring
of, and microscopic examination of, the 
62
Consumption.
tubercular matter.   It has been inferred
that this  minute parasite is the  specific
cause of tubercular  phthisis.   This view
is accepted by many prominent medical
authorities, but  has  as  yet not been ab-
solutely proved  to be correct.  There is
great probability, though, that it  may be
a  correct  theory,   and  it  is  the best
hypothesis as to the cause of this affec-
tion ever brought  forward.   The bacil-
lus is a very small oblong or staff-shaped
body, equal in length to half the width
of a red-blood corpuscle,  and when the
tubercle  is  examined under the micro-
scope it is found scattered throughout
its substance.   It is  almost always found
in the phthisical tubercules, and has not
been found in the  product of any other
disease.   It may be  placed in an artificial
fluid or solid nutrient preparation,  and
there propagated and  reproduced  from
generation to  generation.  These  repro-
ductions, if inoculated into the  bodies of
certain animals  of  tender structure—as,
for example, the rabbit—will produce in
them a disease  which resembles  that of 
Consumption.
63
 pulmonary phthisis in man.   This matter,
 however,  will not  infect  certain  other
 animals;   and a  process  which  seems
 identical  with the tubercular one can be
 produced in  rabbits by inserting mechan-
 ical irritants, like bits  of glass, etc., into
 their bodies.  There are many facts, also,
 the results of ages  of observation of the
 disease, Which do not  accord  with this
 theory of the production  of tubercular
 phthisis.   However, it  may be entirely
 possible that the entrance of this parasite
 into the human body, by way of  the ali-
 mentary  canal,  or  by  the  air  passages,
 may be one,  and a very frequent cause of
 the disease,   the  organisms  being con-
 veyed into the body by the food,  or in
 the form  of dust   in  the  atmosphere
 breathed.
   If this minute organism is the cause of
 the tubercular formation, the great major-
 ity of humanity  is  furnished with  some
 protective influence against this  insid-
 ious foe.  If it were not so, as the bacillus,
 under this hypothesis,  must  be present
almost everywhere, the human race would 
64
Consumption.
soon become extinct.  But it is contended
that only a small part of the race is  sus-
ceptible to its  noxious  action, that only
which is reduced to this susceptible  state
through   the  malnutritive   and  other
causes before cited.  It is  a well-known
fact that some persons who are intimately
brought into contact with phthisical  pa-
tients acquire the disease.   Notably is this
the case with husband and wife.  It must
be noted, however,  that medical men who
attend clinics where the rooms are packed
with phthisical  patients, and who breathe
air which must be laden with bacilli, and
nurses who attend these patients in  insti-
tutions, do not seem to be especially sub-
ject to the disease.   For these, and other
reasons, we are inclined to think that  the
cases which  seem as though  they were
produced  through  contagion, by  contact
with  a phthisical patient, are in reality
caused by the direct influence of the mind
on the local parts which become diseased.
A continuous  attention concentrated on
the parts, and  a belief  by the individual
that he is, or will become, phthisical,  will 
Consumption.
65
probably,  under  some  circumstances,
eventuate in the  diseased  process.  This
result is seen frequently in hypochondri-
acal patients, and is quite  likely the incit-
ing cause of most of those cases of so-
called contagion, resulting from close con-
tinual  contact with  phthisical  patients.
We have no doubt that  intense sympathy
with a  phthisical  patient, coupled  with
a  subsequent   active   imagination,  has
brought the disease  to  many  an individ-
ual.  However,  it would  be  a wise pro-
vision in all cases, to see  that the apart-
ments of the patient  are particularly well
ventilated,  that  he occupies a bed sepa-
rate from others, and that those who  at-
tend him should be careful to  maintain
their own health status  at the very high-
est possible  standard.
   The  following  may also be noticed as
exciting causes of one  or  another of the
varieties of  phthisis : the continuous  in-
halation of  irritating gases and mechani-
cal impurities, particularly of metallic and
other dusts; the irritation of  the pulmo-
nary structures  from  impurities  in  the
   5 
66
Consumption.
blood; the   blood   congestive  and  ob-
structive tendencies of malarial fever  and
heart disease ;  imprudences during men-
struation ; the  plugging up  of  a pulmo-
nary blood-vessel of considerable size; a
retained  pulmonary  or bronchial haemor-
rhage.  The disease very often  follows
measles,  small-pox,  and typhoid  fever,
bronchitis, pleurisy, and acute and chronic
pneumonias or  inflammations of the lungs.
The age of the individual has not so much
to do with  the causation of  the disease,
as have the outside  conditions which are
liable  to be coincident  with the  various
stages of life.  The  greatest number die
of  phthisis  between the ages of twenty
and thirty years,  an  age when the duties,
anxieties, and cares of life begin to press
heavily upon the individual.    Although
the largest number of persons who die  of
the disease are about this age, it has been
found that the proportionate death-rate
among those  who  acquire  it, increases
progressively  with  advancing  age.    In
other words, a person attacked by phthi-
sis at twenty has a much better chance of 
              Consumption.             6j

recovery than  if he were sixty years of
age.  The causes producing phthisis will
be further referred to in subsequent chap-
ters,  under  various  subjects  there  dis-
cussed. 
THE GENERAL PRINCIPLES WHICH SHOULD
   GOVERN  THE TREATMENT  OF  THE
   DISEASE.
  Food.  Air.   Exercise.—These  three
words  may be  considered as representa-
tive of the most important principles con-
cerned in the treatment of phthisis.   It
does not seem  probable  that any specific
medicinal remedy for the cure of phthisis
will ever be found, even if it be proved
that  the bacillus lately found in the  dis-
eased formations is the specific cause of
the malady.   The invasion of the disease
is so insidious, that no warning of its com-
ing is  given.   The enemy usually has a
strong foothold  before  his  presence  is
noticed.  Even if such  a remedy were
found, it could  hardly be expected that it
would  be continually taken by the large
number of persons needing it, merely as
a preventive measure.  Furthermore, it is
not probable that any medicament which
would  have a  specific effect in  destroy-
                  63 
Consumption.
69
ing the parasite would be of much avail,
for the reasons that  anything taken in-
ternally which would destroy the  bacil-
lus, would probably also injure the normal
structures of the body, and  the  diseased
structures are so difficult of access, that
local  applications to  effect  such  a pur-
pose are almost entirely  out of question.
At any rate,  all such procedures  in the
way of treatment have been of no avail,
and we are  compelled to  combat the dis-
ease upon principles which  relate  to the
building up and sustenance  of the body
on a high physical plane.   If the various
structures of the body, including the lungs,
are in a sufficiently healthy state, this dis-
ease cannot find a properly prepared soil
in which to commenee its ravages, or, if al-
ready commenced,  it can make no head-
way.
   Under these principles, and from what
has been stated concerning the  nature
and causation  of phthisis, it of course fol-
lows, that, if a person's ancestry and the
individual  himself  live  correctly,  and
avoid undue  irritative exposure  to the 
7o
Consumption.
productive  causes,  he will never  have
phthisis.  It is  very easy and simple to
write this preventive formula,  but it  is
one very difficult of execution in any case,
and an impracticable proceeding to carry
out, so far as it  relates  to the great  ma-
jority of mankind, to whom, most unfort-
unately, the boons  of  proper  food  and
pure air are denied by reason of the hard
conditions which hedge in their existence.
Fortunately for  this large class of human-
ity, they are forced, by a seemingly hard
but really kind necessity,  to undertake as
a preventive measure, that which is the
greatest remedy against phthisis—work ;
or, in other words, exercise for the vari-
ous  structures  of the body—muscular,
nervous,  and  all   the   other  systems.
Among the comparatively  few well-to-do
individuals who  can  command, not only
the luxuries and  elegances  of  living, but
also  those  hygienic necessities,  proper
food and pure air, it is usually the lack of
being obliged to work with  the muscular
system for the means of subsistence, and
ignorance of the physiological  necessities 
Consumption.
71
and benefits of work, which renders them
an easy prey to disease, including .phthi-
sis.
   The  preventive treatment of phthisis
should begin even at a pre-natal period.
Phthisical  individuals should  not repro-
duce their kind, or if they do marry they
should be particular to select very healthy
mates.  The foetal existence should  re-
ceive the best hygienic influences which
the mother can give to her progeny dur-
ing gestation.  From birth to the end of
life  the  individual  must  have  food of
proper quality, and  in proper  quantities,
to  thoroughly nourish  all parts of  his
body, and to generate the amount of heat
and energy necessary to the carrying out
of a healthy existence.   He must live in
an  atmosphere  which  is  not  only free
from irritating and depressing  influences,
but it must  also be one which  is of such
a tonic and sustaining nature that he will
be able to live on a  high  physical plane
under its  influence.   By means  of  exer-
cise he must keep the various parts of his
body up  to  their  normally physiological 
72
Consumption.
 state, and must develop those parts which
 may be congenitally deficient.   He must
 avoid  all the varying, depressing,  predis-
 posing causes, as well  as the  particular
 exciting causes of the  disease.  Still, he
 must  accustom  himself to  as great an
 amount  of  shock  and  irritation  as  his
 strength will  withstand, and yet retain  a
 good health status.  The amount of wear
 and tear, general irritation  and attrition,
 which will be for his good, must "be a mat-
 ter of individual experience ; but it must
 be distinctly understood that the individ-
 ual of phthisical tendency is  not  like  a
 strong, healthy man,  and that he  cannot
 live the life  of such a man  if he expects
 to live a long  one.   His existence must
 be a somewhat restricted one.   He is to
 be considered as the analogue of the tea-
 rose, the half-hardy plant,  which  attains
 its best conditions of growth and  flower-
 ing capacity as a green-house  plant.  It
will not do to treat it as a hot-house plant,
nor, on the other hand,  as the hardy wild
rose.   It is true that hardiness of  consti-
tution  can be built up to a certain  extent 
Consumption.
73
in the phthisical person  by years of care-
ful living, but there will probably remain
in him  for life some delicacy of constitu-
tion.   He must always  be on  his guard
against excessive irritating  and depress-
ing causes.   It must be remembered that
there is no individual so congenitally phys-
ically perfect, but that some predisposing
and  directly irritative causes may  be
strong enough to bring  about the phthis-
ical process  in  him.  It is  a theoretical
supposition, that a few generations of reg-
ulated breeding  and living, would entirely
banish phthisis from the race as a result
of any of the ordinary irritative  causes
liable to be  met with, in living out  the
cycle  of human life ; but until the millen-
nium, it may be presumed  that medical
practitioners will  see  enough  phthisical
cases  to make understanding the disease
and its treatment a matter of great  impor-
tance.   Various  minor  but  important
matters  relating  to the  prevention  of
phthisis will  be considered further  along,
in connection with  the  subjects of dress,
hygienic individual habits,  healthfullness 
74
Cotisumption.
of occupation, the construction and loca-
tion of habitations, etc.
  In the czire of phthisis, it may as  well
be recognized that in the majority of cases
a  number  of favorable conditions  sur-
rounding the patient, as well as  an early
recognition and  active  treatment of the
disease,  are absolutely  necessary  if suc-
cess is to be expected.   Among these con-
ditions,  and a particularly necessary one,
is that of a strong determination on  the
part of the patient to combat the disease.
A few cases tend to self-cure, but only a
few.  The treatment is one of attention
to a multitude of small  matters.   For in-
stance, the wearing of slippers instead of
warm shoes, may make  all the difference
between a  cure and a fatal result.
  In treating the trouble, the causes which
have been at work in producing it, should
be sought for  and removed, as far as pos-
sible.  Then the patient should be act-
ively nourished by introducing  into  the
system the necessary amount and quality
of food required to build  up and sustain
healthy tissues, as quickly, continuously, 
Consumption.
75
and extensively, as the combined capacity
of the  patient's digestive  ability, the in-
genuity, knowledge, and resources of the
physician,  cook,  and larder  will allow.
The  normal  functional  activity of  the
patient's  tissues  should  be  called forth
through the tonic influences of breathing
pure  and invigorating air of the correct
degree  of moisture, gravity, and tempera-
ture,  by proper exercise, change of scene,
congenial  occupation and cheerful sur-
roundings.   By so doing, it  is expected
that we can surround the  morbid process
with  a  pulmonary structure  so firm, re-
sisting,  and well nourished, that  the  dis-
eased action can  make  no headway into
its substance by continuity or contiguity.
This  point gained, it is  only a matter of
time for the phthisical process already in
action to run  through its  course of for-
mation,  softening, and  excavation, and
to terminate by self-limitation, leaving the
seat of its  action either  fortunately in-
tact  or,  as  more  frequently happens,  a
region  whose   functional  uses  are  de-
stroyed, the locality  being fenced about 
76
Consumption.
by more or less newly formed connective
tissue, which eventually contracts.
  The patient should  avoid  all sources
of depression and irritation.   Particularly
should he dress properly.  Furthermore,
the aid of the pharmacopoeia's tonic, sed-
ative, and other remedies may be invoked,
for  the general help  that they may fre-
quently afford in  correcting errors of nu-
trition, etc.   Above all, it should be  re-
membered  that  the  stomach must  be
treated with  gentleness  and reverence.
With a sound stomach there may be great
hope for the patient, but with a disordered
one, the  chances  are not  nearly so good.
  The more  minute particulars  of  the
curative treatment will be  discussed in the
following chapters. 
RELATION  OF MAN'S SURROUNDING CON-
         DITIONS TO PHTHISIS.
       Climate in its Relations to Phthisis.

   Any one skilled in pathological statis-
tics, with isothermal chart  and local me-
teorological  tables before  him, can  map
out with great accuracy and facility those
localities which  are the favorite abodes of
phthisis, and indicate the  proportionate
death-rate from  that disease, among the
population  of various  localities.   The
state of the atmosphere has  a most  im-
portant bearing on the health of animals.
Its  barometric,  thermometric, and  hy-
grometric conditions,  producing  varying
degrees  of  pressure,  temperature,  and
amount of moisture, have a direct bearing
on  the  most common  functions of the
animal   economy.  Race   characteristics
are largely formed through the influence
of climate.   The rigorous climate  pro-
                   77 
7^
Consumption.
duces  men  of  vigorous,  quick  action,
while the mild and equable climate orig-
inates  individuals  whose  characteristics
are,  like itself, lacking in energy.  The
ease of existence, which is a concomitant
of the moderate climate, induces a certain
slowness and slothfulness of life.   People
habituated to a certain climate find it a
difficult matter to become  accustomed to
a new order of things in a different local-
ity  and  latitude.   Changeability  of cli-
mate is  one of the causative influences
producing phthisis.
  Variation in climate depends upon so-
lar  declension or  season,  altitude, lati-
tude, local character of soils and surround-
ings, amount of rain-fall, and the physical
character of the country, such as the pres-
ence or absence of bodies or streams of
water  and mountains and plains.  Fur-
thermore,, the existence of forests, which
tend to equalize  temperature and moist-
ure,  the  cultivation of the soil, the pres-
ence of  towns and manufacturing  estab-
lishments, and the density of  population
are all factors which qualify the nature of 
Consumption.
79
 a climate, and are to be taken into consid-
 eration in estimating its value in relation
 to phthisis, either as a causative influence,
 or  in  the preventive and curative treat-
 ment of the disease.   Phthisis is found in
 all  climates,  but its home  and  favorite
 locality  is  in  the  temperate zone, that
 inappropriately named region, where ex-
 tremes of temperature—great  cold and
 excessive heat, free atmospheric moisture
 and considerable atmospheric impurity—
 are  found.  It is  infrequently found  in
 latitudes  where  the  temperature  does
 not  fall  much below that of the  human
 body, and also in  climates  so  cold that
 atmospheric moisture is only present  in
 very  small amount.   The  climate most
 favorable  to  its production,  is  that  in
 which  quick and extensive  temperature
 changes  occur, in which there  is a max-
 imum  amount of  moisture, and  where
great atmospheric  impurities and mias-
matic influences abound.
  The most important  consideration in
the estimation of a climate  in connection
with its relation to phthisis,  is its fitness, 
8o
Consumption.
as a means in the treatment of  phthisical
invalids.  Next  to  the investigation  of
the  alimentary  conditions and  habits
of the  patient, inquiry as to his climatic
surroundings is in order.  Is the climate
exerting an  irritating  or  depressing  or
too exciting an influence on the patient?
or is there too great  or too little  atmos-
pheric pressure ? or is its heat or moist-
ure unfavorable  to him ?   A correct de-
cision  as to  these  points  is of great  im-
portance in the  treatment.  The  desira-
ble conditions which should be sought for
in a change of climate  for  the  phthisical
invalid  are  as follows : First, purity  of
atmosphere.   Second, a barometric press-
ure which best conduces to the functional
activity  of  the  patient's respiration and
heart  action.  Third, a ratio of moisture
present which will be most desirable for the
peculiarities  of  the  individual.  Fourth,
equality of temperature.  Fifth, absence
of high winds.    It will be observed  that
all of  these  qualities are negative  influ-
ences.   A "bracing" climate  is merely
one in which depressing influences are ab- 
Consumption.
81
 sent.  The  stimulus  which comes from
 a change of scene is not to be confounded
 with climatic effect.  We are  inclined to
 think that when  the patient makes a cli-
 matic  change,  he usually  imagines  that
 he is to receive some mysterious panacea
 from the  atmosphere.   With this idea he
 goes to some comfortless spot, away from
 friends and home comforts, where he can
 get very little  to  eat suitable  to  his con-
 dition, and relying upon the  climate to
 effect  his physical regeneration; he  is
 likely to  neglect many of those hygienic
 habits which he should adopt and practice.
 Naturally, such  a patient does not im-
 prove  much when  he  goes away from
 home for the benefit of his health.   By
 removal from an impure, contaminated, or
 depressing atmosphere, or  an irregular
 climate, to a suitable locality, chances of
 irritation  or depression from those causes
 are removed, and the transpiratory proc-
 esses occurring in the lungs are more com-
pletely and effectively brought about.
  Selection of climate with  regard to at-
mospheric pressure and moisture  must
    6 
82
Consumption.
be made to suit the individual needs and
peculiarities  of the patient; no definite
rule  can be  laid  down.  The  patient
must search  for, and personally test, the
various climates for himself.   The atmos-
pheric  pressure, etc., which allows of easy
respiration and proper determination  of
blood  to the pulmonary structures, is not
the same for  different  individuals.  A
great deal depends upon the  nature  of
the patient's  disorder  and temperament.
For  example,  a phlegmatic person  may
need a more stimulating climate,  while
an excitable one may  require a soothing
one.   We are  inclined to think, that  if
there be equality  of temperature, a cor-
rect  amount  of moisture present in the
atmosphere,  and freedom from impurities,
the lower the  altitude, with  its  greater
atmospheric  pressure, the more beneficial
it will  usually be found for the  phthisical
patient.  However,  good authority  as-
serts that from one to two thousand feet
of elevation above tide water is beneficial
for the average case.   It is certain that the
higher  the  elevation of  the  place  of 
Consumption.
83
abode, the greater the tendency is to pul-
monary congestion and consequent  haem-
orrhage.   We also find that in  the  more
rarefied  atmosphere  greater pulmonary
motion is required in the oxygenation  of
a certain amount of blood; and in phthi-
sis the less  pulmonary  movement  made
by the patient in  the  aeration of  his
blood, the better.   As a practical thing,
we seldom find purity and dryness of at-
mosphere  and equality  of temperature
except at high elevations.   The  amount
of atmospheric moisture most  beneficial
to the phthisical  patient also  varies  in
individual cases.   If there is a coincident
bronchitis  present, with  a free  secretion
of  mucus, then a dry climate is usually
best; but  in  some  cases moist climates
are serviceable.  An important point  to
take into consideration in selecting a cli-
mate for the phthisical is that of equality
in  temperature.   Sudden great thermo-
metric  change is, as every one knows,
deleterious  even  to strong individuals;
and it is even more so to  the delicate in-
valid, who is more sensitive to  these  ex- 
84
Consumption.
ternal influences.  The undesirable  effect
may be due to the reflex irritating action
on the pulmonary and  other organs, fol-
lowing the effect on the skin of the sud-
den  change  of  temperature.   Further-
more, chilling the surfaces of  the  body
drives  the blood away  from the exterior,
and  congests the  internal organs, espe-
cially the  weak, diseased  ones.    How-
ever, in prevention of phthisis, too equable
a climate  is  not the  ideal.   A certain
amount of shock resulting from change
of temperature is necessary to the  build-
ing up and continuation of a healthy con-
stitution.   Perhaps  the most important
characteristic of a climate,  from a phthisi-
cal point of view, is its   adaptability to  a
continuous out-of-door  life.  This brings
us to the  subject  of winter climates for
the  phthisical.  We have  to admit here,
that we  have  no  entirely  satisfactory
winter climate for such  cases on the  At-
lantic side of the North American  conti-
nent.  The writer's opinion  is the  result
of a rather extended personal observation
of our  country east of the Mississippi 
Consumption.
85
River.  For those to  whom  dry  air is
beneficial, and who have sufficient vital
force and activity to keep up vigorous,
continuous exercise, there are many dry,
cold regions in  our  northern  country
which  would  prove desirable; but  the
greater number  of  phthisical  patients
have not this power, and for them, if they
are to live the out-of-door life which  will
give them the greatest amount of atmos-
pheric purity, with the beneficial stimulat-
ing effects of direct sunlight and  active
exercise, they must have a higher tem-
perature to  effect the  conservation of
their vital forces.  Outside  of this, other
things being equal, the breathing of very
cold air has an injurious  effect upon very
delicate pulmonary organs by  reducing
their vitality  The great trouble  with the
best of our climates is, that they  are to
be enjoyed  only with  the disadvantages
of a deficient supply of proper  food, of
deprivation  of friends and home comforts,
and  of the  lack of surroundings  which
might  interest and occupy  the attention
of the invalid.  These drawbacks espe- 
86            Consumption.
 cially apply to females.  Dr. Alonzo Clark
 is the originator of the following  aphor-
 ism, " Men and  dogs  may live in the
 fields,  but women  and  cats  require  a
 home."   The  truth  therein  expressed
 will  be  generally  conceded.   This being
 the  case, it chances  that  when a change
 of climate is desirable, the  physician  is
 forced to  send the patient to some local-
 ity which   perhaps is not otherwise the
 best for him.  Unless the  patient  will
 live  out of doors, or if he  is unhappy be-
 cause of the lack of interesting and com-
 fortable  surroundings, or  because  of
 homesickness, it is undoubtedly better for
 him  to  stay  at home.  The winter at-
 mosphere  in  the  rooms  of a well built,
well  lighted,  well  ventilated  and well
heated Northern home, contains  nothing
positively bad, and only lacks the incen-
tive  to active exercise, and the  mental
stimulation which  comes with the  freedom
and  sights of out-of-door life.   In view
of this deficiency  of available winter cli-
mates, it is yearly becoming more obvi-
ous  that the  sum?ner climatic treatment 
Consumption.
87
of phthisis is not only the most feasible
method, but should never  be  neglected.
As winter is  a disagreeable season  all
the  world over, so  is  summer equally
characterized  by its  desirable  qualities,
and  our   Northern  and Middle States
abound in numberless localities where the
summer  climate offers  all  the practical
advantages for the  treatment of phthisis
that could be  expected.   Physically con-
sidered, he must be a very worthless  in-
dividual who,  if he be given  the opportu-
nity, cannot attain  during our  Northern
summer, sufficient  physical   stamina  to
tide  through the inclement colder season,
with its various irritating and depressing
influences.  Of course  it must  be dis-
tinctly understood, that the very finest of
climates will not support and maintain in
health any one, unless he calls to his  aid
the necessary  adjuncts of correct nourish-
ment,  the  vigorous  functional  action of
the various organs of his  body, and the
application of  ordinary hygienic prudence
and  caution   as to  the minutiae of  his
daily life.   (For the location of favorable 
88
Consumption.
climates, see " Locality in  its  Relations
to Phthisis.")

    The Atmosphere in its Relation to Phthisis.
  Man lives at the bottom of a vast ocean
of diluted  nutritive matter, which  sur-
rounds the earth  to the depth of some
twenty miles, and  which is  known as  the
atmosphere.   This gaseous  ocean  has
weight, and owing to  the attraction  of
gravitation, and the molecular mobility
of the elements of which air is composed,
it exerts in every  direction a continuous
pressure.   This pressure varies at differ-
ent altitudes, and owing to various atmos-
pheric and solar  influences, varies from
time  to  time in  the  same place.  Ow-
ing to this fact,  considerable  difference
in respiratory  effort is necessarily made
in different locations,  and at  times  of
varying pressure.   Furthermore, ease of
circulatory action  in the various parts of
the body, especially in the lungs, is some-
what  regulated by this  physical  cause.
The less the  pressure, the more  readily
does  the   heart  fill the  minute  blood- 
Consumption.
89
vessels of the lungs.   If  a  change of at-
mospheric pressure in an individual case,
is a requirement, as it  often  is,  it may
be advantageously gained by the patient's
locating  at  some altitude that will fulfil
the  requirement.  The  nutritive  matter
in the atmosphere available to man is
oxygen,  a most  active gas, which  com-
poses one fifth part  of  the atmosphere,
most of  the remainder being  formed of
nitrogen, a passive, inert gas, and thus an
excellent diluent.   The oxygen has  a
chemical affinity for a vast number of ele-
mentary  and compound  substances, and,
among others, the principal organic ele-
ments which enter into  the composition
of those elementary  substances  used as
food, and with the  tissues of the  body
themselves.   Being absorbed by the vari-
ous parts of the  body from  the blood, or
directly from the  atmosphere through the
skin, it enters into active  chemical  union
with the  various  matters found  in the
parts, and in so  doing gives rise to the
heat and force  necessary to  vital  action.
The atmosphere further  contains watery 
90
Consumption.
vapor in varying  amounts, a small per-
centage of  carbonic acid gas, of nitrogen
compounds, of various impurities in the
shape of floating dust disintegrated from
organic  and mineral matters, and of innu-
merable  microscopic,  animal, vegetable,
and disease germs.  So far as man is con-
cerned, probably his best condition would
be conserved if the atmospheric contents
were composed of but the two elements,
oxygen  and nitrogen,  with  the  presence
of a moderate amount of moisture.   If
the proportion of oxygen be even slightly
reduced, his health suffers.  If it be  re-
duced ten per cent, he dies  almost imme-
diately,  on  account of the deficiency.  If
the percentage of carbonic acid gas and
other impurities be increased, he also suf-
fers.  He cannot live if carbonic acid gas
is present  in the atmosphere in amount
equal to one quarter of the atmospheric
bulk, as  the accumulation of  the gas in
the system prevents the absorption of the
necessary  amount  of  oxygen, and  first
producing  insensibility,  finally depresses
the nerve centres, and thus causes death. 
               Consumption.            91

 Atmospheric  impurities have a very  im-
 portant effect in  the production and con-
 tinuation of phthisis.    This result may
 come from the absorption into the sys-
 tem of  depressing or  irritating gaseous
 impurities,  of  disease principles, particu-
 larly of  the  bacillus tuberculosis, which
 is now claimed to be  the specific cause of
 phthisis  ; from the inhalation of matters
 which lodge in the pulmonary  air tubes
 and vesicles, and by their mere presence
 on the lining membrane of those organs,
 or  by absolutely  working into  the text-
 ure of the  pulmonary tissues, set  up  an
 irritative diseased process.    These  irri-
 tants may be fine  particles of metal, such
 as  are  produced  by  steel grinders,  and
 also of   coal and  other dust.   So much
 being accepted, it must obviously be con-
 ceded that  the breathing of  fresh, clean
 air is a prime necessity for the phthisical
 patient  in the treatment of the disease.
 The following are among the more com-
mon causes producing  atmospheric con-
tamination.   Bad ventilation; overcrowd-
ing  in   habitations  and   assemblages; 
92
Consumption.
 the  gaseous and other emanations from
 water-closets,  sinks, drains,  sewers, sta-
 bles, and street and  road dust;  the prod-
 ucts of combustion  given off by  manu-
 factories,  and  by heating  and cooking
 apparatuses; the defective cleanliness of
 roads, streets, and private premises ; and
 all fermentative and manufacturing proc-
 esses.    Indoors,  the  impurities  may
 come from decaying matter in the cellar ;
 from  overheated and badly constructed
 stoves ; from  artificial  lights;  from the
 emanations of the cooking process ; from
 unclean utensils, and the emanations from
 sick and uncleanly persons ; and from nor-
 mal respiratory excretion.   The dwelling-
place  of the phthisical patient  should be
selected with  a view  to  avoiding  these
sources of  atmospheric impurity.   If the
patient should be confined  to  his  room
there   should  be only enough artificial
light present to make it cheerful ; and too
many persons should not be in the  room,
on account of the resulting contamination
of the air.   The presence of carpets, cur-
tains,  and other fabrics, especially of wool, 
Consumption.
93
should be dispensed with to as great an
extent as possible, because  they absorb
and retain organic impurities.  Excessive
growth of hair and beard should also not
be allowed  for  the same reason.  The
presence of  salt in the atmosphere may
be  regarded  as  an impurity, except in
those  localities  where it  is  constantly
present.   Even in such instances  it may
act as a pulmonary irritant ;  and along
the sea-coast and shores of extensive salt-
water  inlets,  where alternate land  and
water breezes prevail, the remittent pres-
ence of salt in the  air,  acts seriously as a
direct irritant to the lining membrane of
the pulmonary air spaces, and  is thus one
of the  causes at work in producing phthi-
sis, and in preventing its cure.

      Heat and Cold in Relation to Phthisis.

  The human body is composed of a vast
aggregation of cell elements.  These are
minute microscopic masses of protoplasm,
a substance  always  present  where the
vital phenomenon  known as  life, is ob-
served.  Protoplasm, as seen in different 
94
Consumption.
organisms, always requires a certain de-
gree  of  heat at which  it  manifests  its
highest functional activity.  This temper-
ature varies  in different  organisms,  but
in man it is about 980 F.   As this degree
of heat is  lessened, the  functional activ-
ity of the anatomical cell elements of the
body declines, and at about 900 F. ceases.
If the degree of heat  be increased to
about  no° F., the protoplasmic function
also  comes to an end.  It is due  to  this
fact, that the application and abstraction
of heat  diminishes,  and in excess, abro-
gates nervous sensation  in the  human
body ; and on this account both extreme
heat and cold have a prejudicial effect on
man.  The average  atmospheric temper-
ature being  considerably below that of
the human body, to keep up the  degree
of heat necessary to carry on life, there is
provided in the body a continuous chem-
ical action  in the various tissues, and the
frictional action  of  the blood  coursing
through  the  blood-vessels  and  of  the
movements of the anatomical elements in
the  body.   This latter  cellular friction 
Consumption.
95
may be  excessive in the absence  of  dif-
fused  fatty matter  in  the tissues.   Fat
acts, in a manner, as a  lubricator  in  the*
various  tissue movements.   It  is  quite
probable that the lack of fat in the pul-
monary structures may result in an exces-
sive amount of friction in the anatomical
elements, and thus tend to excite phthis-
ical action.   Heat and  cold  have direct
relations  to  phthisis  in  various ways.
For example, excess or lack of  heat reg-
ulates  in a measure soil  decomposition
and  the production  of  alimentary  prod-
ucts,  thus determining  the  nature and
quantity of the food supply of the  inhab-
itants  of particular localities.  Heat in-
duces  various  decomposition  processes,
both  of  vegetable and  animal  matters,
which  result in  atmospheric  contamina-
tion.   Furthermore,  a  high degree of
heat renders the atmosphere dry, and thus
increases  its capability of absorbing and
diffusing watery  vapor.  A great degree
of cold also renders the  atmosphere dry,
by condensing and congealing its  moist-
ure.   A  certain  amount  of temperature 
96
Consumption.
change from heat to cold, and vice versa,
conduces to vigorous vital  action  in man
by its tonic effect.  This effect is a reflex
action on the internal organs of the body,
originating from the  sensation  of heat
and cold on the external surfaces.   Cold
of a certain degree  has a beneficial effect,
by contracting the minute blood-vessels on
the surface of the body, pressing the blood
out of them, ana  increasing the blood
supply to the important internal  organs,
thus bringing  about better and quicker
general nutrition.   This beneficial action
may be easily  overdone, thus producing
the diseased action commonly known as
"taking  cold."   The  exposure  of the
large  expanse  of pulmonary  membrane
lining the air cavities to the  cold air in-
haled,  tends to reduce  the bodily heat,
but this effect is counteracted by the in-
creased vital action of the oxidation proc-
esses  at that point, and the reflex quick-
ening of the action of the internal  organs.
This reaction is the tonic  effect of cold,
and unless  it occurs  in  response  to ex-
posure to cold, the result  is deleterious; 
Consumption.
97
hence, for those  delicate phthisical inva-
lids who have a deficient responsive vital
power, very cold climates are depressing
and  injurious.   On the  other hand, heat
represses the oxidation  processes,  is con-
servative of bodily heat, and sustains the
respiratory function.   Therefore  those
delicate invalids are more comfortable in,
and  are  most benefited by, the warmer
climates.   There is a considerable amount
of idiosyncrasy observed among patients
as to the degree of heat which is best  for
them.   Perhaps the average atmospheric
temperature  in which the best muscular
efforts can be  made, is at  about 6o°  F.,
and the most generally agreeable temper-
ature to  rest in, is at  about  yo°  F.   Dur-
ing sleep, a somewhat lower temperature
is desirable, as  conducing to a quieting
effect in  producing restful sleep.   While
a certain  diversity of temperature  is  de-
sirable  in the daily life of those who
would avoid phthisis; in those in  whom
the diseased action is commenced,  equal-
ity of temperature is greatly to be  de-
sired, for  then it becomes  important to
    7 
98
Consumption.
avoid  every excitation  of the  diseased
parts,  either by  direct or  reflex action.
Rather, on  the other hand, should such
measures be instituted as will have a de-
rivative effect, in  directing away from the
affected parts any excessive circulatory or
nervous action, and in soothing the over-
excited parts.  Perhaps  the atmospheric
temperature which is  most destructive to
the phthisical patient, and most provoca-
tive in causing  the disease, is at about the
freezing point; for at this temperature,
the atmosphere is most capable of being
loaded with perceptible moisture, and on
this account, and on that of the  depress-
ing influence of this degree of cold, there
is the most  marked injurious effect  upon
the pulmonary organs.  W^hen the tem-
perature ranges much below this  point,
the watery  vapor of the  atmosphere is
congealed, and  the air being thus  dried,
gains  non-conductive  properties which re-
duces  its  effect on  either the external
surfaces of  the body, or  on the  lining
membrane of the pulmonary air cavities.
Of course reference is made to ordinary 
Consumption.
99
 temperatures.   When an intense degree
 of atmospheric cold prevails, its effect on
 the  pulmonary tissues, results in a condi-
 tion of depression, pain, shock and subse-
 quent irritation.

      Moisture in its Relations to Phthisis.
   Water in some form is universally dif-
 fused over  our globe.  It is in  the rocks
 and soil.  All organized bodies are largely
 composed of it, and, as  a matter  of im-
 portance to our subject,  it is  always in
 the  atmosphere,  in varying proportions.
 Water is a  universal solvent, and largely
 determines   in  matter the properties of
 hardness, density and mobility.   Without
 it there would be scarcely any motion on
 our planet.   Water is the largest  single
 element entering into the composition of
 the human  body.  If it  is not  taken in
 proper  quantity,  the  nutritive  processes
 may be decidedly interfered with, produc-
 ing diseased conditions.  The regulation
of the  quantity of  water used,  may  be
an important point in the correction of
errors  of nutrition  in  the phthisical pa- 
i oo            Consumption.
tient.  We are inclined to think  that the
drinking of such excessive  quantities of
milk, or other fluids, as is frequently rec-
ommended, must have a prejudicial effect
in those phthisical cases  in which there
is already  an unnatural thinness of the
blood.   It  is questionable  whether  any
advantage  can be gained in over-disten-
sion of the blood-vessels with poor blood,
especially in those cases where haemor-
rhages are a  frequent symptom of the
disease.  But  it is true that the  arterial
pressure should be kept up  by drinking a
sufficient supply of water to thoroughly
fill the blood-vessels.   Perhaps  the  most
important  characteristic  of  an  atmos-
phere to the consumptive, is the amount
of moisture which it contains.  A certain
amount of moisture in the  atmosphere is
absolutely indispensable to  health and to
life itself.   The amount best adapted to
individual needs varies, which  we  have
already seen is the case with atmospheric
pressure and temperature.  Atmospheric
moisture acts  in preventing an  excessive
drying effect of  the surfaces of the body. 
Consumption.
101
 It also gives the air, conducting proper-
 ties, and thus  tends to carry off the sur-
 plus heat generated in the body.  Other
 conditions being equal, phthisis is always
 found to preponderate in proportion to
 the presence of an excess of atmospheric
 moisture.   When  it is present in excess,
 it is undoubtedly a prominent cause in the
 production of the disease.  An excessive
 amount  of  atmospheric moisture has its
 prejudicial effect in this way.   In propor-
 tion to the amount present, it renders the
 air a quick conductor of  heat, and thus,
 through close contact with moist air, the
 individual is subject to a quick deprivation
 of his bodily heat.   Such deprivation is
 liable to cause chill, reflex action, depres-
 sion of the vital activities, and disturbances
 of the vascular  system, that  is, of  the
 blood supply.   These disturbances, acting
 through  the agency of  the nervous sys-
 tem, deprive some  of  the  tissues of suffi-
 cient blood, and give an excessive supply
to others, both of which results are unde-
sirable.   Excessive atmospheric moisture
acts also  in  preventing active  excretion 
102
Consumption.
 through the avenues of  the skin and pul-
 monary organs, and in cases of high tem-
•perature and high degrees of atmospheric
 watery saturation, the evaporation of per-
 spiration  is  retarded, and thus a proper
 escape of bodily heat is prevented.  This
 last condition is  particularly  depressing
 to  the general  system.   The  capacity of
 the atmosphere for absorbing watery va-
 por increases with the elevation  of tem-
 perature,  and from this cause and others,
 the amount  of vapor in  the  atmosphere
 is constantly varying.   With  air  rated at
 1000, and water at i, as a means  of com-
 parison, air at 320 F. will take up moist-
 ure at  the  rate of 5.69 per cent, and at
 6o° F.  14.108 per cent.   The  amount of
 moisture present in the  atmosphere of  a
 certain locality, depends upon the texture
 of  the  soil, the surface  drainage, the vi-
 cinity  of bodies of water or streams, and
 the direction of  the winds, some  being
 dry while  others  are  universally  wet.
 Solar  declension is the  most  important
 factor  at  work  in deciding the presence
 of  free moisture.  The more directly the 
Consu mption.            103
sun's  rays  strike  the  atmosphere, the
more is heat absorbed, in consequence  of
which  the  atmosphere  becomes  dried
through its  increased capability of taking
up  the free moisture present.   Atmos-
pheric  moisture tends  to  equalize the
temperatures of a locality.   In dry  coun-
tries, the daily variation of temperatures
is extreme.   Water is the greatest known
absorber of heat, and the watery vapor  of
the  air absorbs it from  the sun's  rays  in
large amounts, holding it, and  only  grad-
ually giving it off.   In  dry countries, the
direct rays of the sun during the  day are
very hot, little moisture being interposed
to absorb the heat rays, while as  soon  as
the  sun's rays  are  hidden at sundown,
the  atmospheric temperature  falls  very
quickly, and the night temperature will
be found to vary greatly from that of the
day.   This  fact may be sufficient to  inter-
dict the phthisical  invalid  from  residing
in a locality where otherwise the  dryness
and other  characteristics  of the atmos-
phere would be beneficial.  In this  mat-
ter, as in many others, moderation should 
104            Consumption.
be the rule.   The  amount  of  moisture
present in the atmosphere should neither
be too great nor too little.
       Light in its Relations to Phthisis.
  Science has very  little to offer in ex-
planation  of  the  undoubtedly correct
clinical observation,  that light has an im-
portant bearing on  our subject.   Light
is a complex manifestation of heat, chem-
ical action, and  illumination.  The rela-
tion of the heat property of light to our
subject,  is not  difficult to understand,
and has  been already commented upon;
but the  process by which  the  chemical
and illuminating properties of  light sub-
serve  the  purposes  of animal  nutrition
and growth,  is left for future  scientific
revelation.  Perhaps, in man, the illumi-
nating  properties   affect   his  general
health through the  functions of the eye.
If that organ is not used it becomes  dis-
eased ; as the visual nerve centres have
very intimate and direct connection with
the various bodily organs, which are only
accustomed to respond functionally to 
Consumption.
105
primary visual action, it is not difficult to
appreciate that lack  of  light,  depriving
the  optical  apparatus  of its function,
would also indirectly have a  depressing
and deteriorating effect  upon the whole
body.   However this may be, we know
as the result of practical  extended obser-
vation, that  neither plants  nor animals
retain their  health  if deprived  of light.
Certain animals, such as  rabbits, become
phthisical  if  confined  in a  dark,  damp,
cold place for a few  weeks.  The old  ex-
periment  of utilizing the  Mammoth Cave
as a  residence for  consumptives  was a
failure, principally on account  of  the  de-
privation  of light.    Not only is it desira-
ble for the phthisical person  to expose
himself as much as possible to  direct sun-
light, both as a preventive and curative
influence,  but  his dwelling should be so
arranged  that  the sun's  direct rays  can
penetrate  as much  as  possible  into  his
living  rooms, and the fading of carpets,
curtains   and furniture,  should  not  be
allowed to interfere with this hygienic
provision.  Very  often  a  dwelling   is 
106            Consumption.
 made  unhealthy by  being shaded with
 trees, which  not only deprive it of light,
 but also keep it damp and cold.   It is a
 matter of great moment to build a dwell-
 ing in such  shape and position, that the
 direct sunlight may have full  opportunity
 to shine  into every room.   We have yet
 to see a winter hotel for invalids so con-
 structed  as  to  possess  this  advantage.
 In  such  a structure, its greatest length
 should be from east to west, so that it
 should face  the south, and consequently
 receive  the  sunlight  all   day.   All  the
 apartments for invalids should be on the
 southern face of the  building, and there
 should be no obstacles, such as porches
 or wings, to intercept the direct sunlight.
 The halls  may be at the back of  the
 building, but no sleeping or other rooms
 intended for the invalid guests, should be
 constructed on the sunless side.  In our
 northern climate, a hygienic dwelling in-
 tended  for  an  all-the-year-round resi-
 dence, should be built so  as  to approxi-
 mate  in  form  to an  oblong rectangle,
with its  greatest  length  from  north  to 
Consumption.           107
 south.   There  may  be deciduous shade
 trees planted at the narrow  southern end
 of  the  house,  to  protect  it  from  the
 scorching rays of the summer sun at mid-
 day, and evergreens on its northern side
 to protect  it from  severe, cold, harsh
 winds; but the eastern and western sides
 should be left open to the direct morning
 and afternoon sunlight.   With  windows
 properly located, all  the  rooms of such a
 house would  receive more or  less direct
 sunlight during some portion of the day.
   The  stimulating  and beneficial effect
 of the sun-bath is now well recognized.
 It would be  hardly practicable for the
 delicate  consumptive  to  indulge in  this
 luxury,  but as a  preventive measure it
 might be of considerable value.   In child-
 hood a race on a sandy beach  in a bare
 skin bathing suit,  followed by a short dip
 in the water,  has  a splendid stimulating
 tonic effect.   The blue glass  craze  has
 gone out of  fashion;  it was  a good
 mania in its way;  not that the refractive
 and reflective qualities of  the blue glass
gave the transmitted light,  any peculiar 
io8
Consumption.
virtues, but  because  exposure  to  sun-
light of any degree,  for certain patients,
is a good influence, and by transmitting
pure  sunlight  through a  blue medium,
some  of the  heat and  illuminating rays
are  absorbed, and thus a  patient might
advantageously expose  himself  to  the
chemical rays, when otherwise the undi-
vided ray might be disagreeable, on ac-
count  of  undue heat  and glare.  The
phthisical patient should be in the bright
sunlight as much as possible, and one of
the objects in sending such a  person to a
mild climate, is that he may  receive the
benefit  of this beneficent influence  by
living most of his time out of  doors.

   Locality and Soils in their Relation  to Phthisis.
  As we have  stated that certain  condi-
tions  of atmospheric temperature, press-
ure, moisture,  and  purity, together with
the influence of light, are essentials in
the treatment of phthisis, it is in order to
show  where  these  conditions  may  be
found, or in other words, to  indicate the
locations where the phthisical individual 
Consumption.           109
should  reside.   Individual  need  must
again be the test in the selection of such
localities.  A close inspection of the pro-
posed  dwelling  and its immediate sur-
roundings should never be neglected.  A
certain  region may,  in general,  furnish
all the requirements sought  for, but the
particular position of the proposed dwell-
ing may annul all the general virtues of
the region, on account of some local de-
fect.  For example :  the habitation may
be  in some  small valley where dampness
and cold  air  settles, while on  a hill  or
plain at a little  distance,  equality, mild-
ness, and dryness of  atmosphere may
exist.   The  near presence  of  a small
brook,  pond, marsh,  or  sewage-soaked
soil, and  consequently  polluted water-
supply,  might make that particular local-
ity undesirable.  ' A very common  objec-
tion to some locations is the impossibility
of procuring proper food for the patient.
Phthisical persons should,  if possible,  al-
ways locate in  the  neighborhood  of  a
good milk  supply.   A  most  important
point is, that the surroundings  should  be 
no
Consumption.
of  such a  character  that  the  patient
should find occupation of some  kind, or
amusement of an interesting and agreea-
ble nature.   If a  locality  has a mentally
depressing influence on the patient, it  is
no  place  for  him, no matter  what  its
other virtues may be.
  The main points to avoid in  selecting
a locality are uninteresting surroundings,
lack of  proper food, excess of moisture,
impurity of  air  and  malarial influence,
extremes and changeability of  tempera-
ture,  and  high winds.   The local  soil
should always be observed.  It should be
naturally  well drained,  and if  not suffi-
ciently porous, should have enough incli-
nation of  surface  to allow water to flow
off  readily.   All localities have a sub-soil
water  level, and the ideal locality should
have  this water  level at a  considerable
depth.  A glance  at the wells of a neigh-
borhood will  throw light  on this point.
It is obvious that a tenacious soil, which
either  holds  water  in  depressions,  or
which is level and has no under-drainage,
is not the location for the phthisical pa- 
Consumption.           111
tient.   But where are the  best locations
to be  found ?  There are some  regions
so  benign  in  their  climatic  influences
that  " colds"  are   not   even  known.
Egypt, India, Lower California,  etc.  are
examples;  but such favored localities are
few  and far  away.  However, there  are
many  places  here and  there, where  a
reasonable number of the necessary re-
quirements and conditions  can be found.
The location nearest to New York City
fulfilling such requirements, is the neigh-
borhood of  Morristown,  N.  J.    This
place is situated  on an extensive gravel
formation, has an elevation of three hun-
dred feet above tide water, and we doubt
if there is a much better  locality for an
all-the-year residence for an individual of
phthisical tendency.   All Northern New
Jersey twenty-five miles west of  the sea-
coast, has a generally good climate, and
many favorable localities, as  have some
parts of Southern New Jersey,  as,  for
example, Lakewood;  also  Western and
Central New York west of the Hudson
River,  whose valley is as  damp, depress- 
112
Consumption.
ing, and  malarious  as it is beautiful.
The Adirondack region is  a fine one.  It
has considerable elevation, and presents
unusual attractions for those who love na-
ture, and  affords excellent opportunities
for the sportsman to indulge his longings.
The  hill  countries of  Vermont,  New
Hampshire, and Western  Massachusetts
have good summer climates.   The  little
town  of Gilmanton, Belknap Co.,  N. H.,
situated at  an elevation of  eleven hun-
dred feet above the sea, enjoys a  climate
during the  months of July and August,
as nearly perfect as  can be expected  on
this earth.   It is exceptionally favored as
to  drainage, location, and surroundings,
and the purity of air found  there is  re-
markable.   Eastern  Massachusetts, and
the country bordering the easterly sea-
coast  and  Long Island Sound, do  not
afford a favorable climate for the average
consumptive.   Most  of  the prevailing
winds are moist, and there  is much atmos-
pheric  harshness, even  during the most
favorable months of  the year.   Western
North  Carolina, Northern Georgia and 
Consumption.           113
 Eastern Tennessee afford very desirable
 climatic conditions  during  the  spring
 and fall.  The high elevation of the land,
 together with the fine  scenery and purity
 of  air, are the prominent advantages of
 those  localities.   Most  of our  Southern
 towns of large  size are unfortunate in
 their locations and surroundings, and we
 know  of none  which present advanta-
 geous climatic conditions.  The locality
 which has  the  finest  winter  climate to
 be found in  our Southern States, is along
 the  swell of pine woodland which com-
 mences about fifty miles south of Macon,
 Ga., and runs into North-Western Flor-
 ida, the tract having an elevation of from
 three hundred to five hundred feet above
 the  sea.    Some small   towns, such  as
 Eastman and Thomasville, are springing
 up  in that region, and are gaining fame
 as health resorts.  Aiken, near  Augusta,
 is located on a sandy tract of pine land,
 and has a somewhat similar climate, but
 is  more subject  to cold storms.   The
other locality is  milder, and has a singu-
larly  balmy  atmosphere.   The  region
    8 
H4
Consumption.
 though, has its  rivers and  swampy spots
 which should be  avoided,  and the  ther-
 mometer occasionally runs down  below
 the freezing point.  The great drawback
 of the region is its lack of local attrac-
 tions in the way of scenery, etc.  There
 are  pine forests, turpentine  stills, saw-
 mills, and also an occasional agricultural
 attempt ; but the above mentioned attrac-
 tions are not likely to be of great interest
 to the  average individual.  On  this  ac-
 count we are frequently  obliged to select
 Florida as  the  most available winter  re-
 sort for the phthisical invalid,  within a
 reasonable  distance  from  New  York
 City; it is also comparatively easy of  ac-
 cess.  All  Eastern  Florida is damp and
 has a changeable climate, but it presents
 points of interest  so greatly superior to
 those of  other localities,  and its  latitude
gives it such climatic  mildness, that it is
 to be preferred  to many other localities
 as a  winter resort.   Its  water attrac-
 tions, both of river and ocean,  its orange
groves and  semi-tropical  vegetation, and
 the large  number of its visitors, a  small 
Consumption.           115
part only of whom are  invalids, give the
locality interest and liveliness.
  If an immediate change of climate and
scene is regarded as imperative,  and in
phthisis delay in  treatment  is  to  be
avoided, it would be well to spend the
fall or spring in the  uplands  of the inte-
rior of  the South, the winter in Florida,
and the  summer  at  some  appropriate
place in the Northern States.   If pecun-
iary,  or  other  circumstances,  preclude
other  than a  short trip southward, it
should  be taken  in the  spring, and so
late that the  return  home  will not be
made until the weather has  become set-
tled and warm.  Southern California and
New Mexico are spoken of most  favor-
ably as beneficial resorts for consump-
tives.   Minnesota and  Colorado are the
Meccas  to  which  many phthisical pil-
grims wend their way, the elevated coun-
try  affording the dry, pure  and bracing
air which  is  the panacea,  giving at least,
palliation in  a  certain  number  of  cases.
As  to  Colorado,  patients who  go there
usually die  of  the disease if they  stay 
116             Consumption.
long enough.  Estimated as to its climate,
it is probably desirable  for a short visit,
especially in the beautiful summer season
which invites such active out-of-door ex-
ercise as must be taken in hunting, moun-
tain exploration, etc.   Owing to the thin-
ness and dryness of the air, there are very
trying extremes between the day and the
night temperatures.   It  is said that  the
purity of the air is somewhat tainted in
this day, by the many coal fires of Den-
ver, and that the bad sewerage and dust
of that  town, give it a very undesirable
atmosphere.  Of all the  localities known
to  us,  where  we would send  a patient
with incipient phthisis for the six winter
months, we should prefer the  Bermuda
Islands.  The  temperature  of  these is-
lands is remarkably equable, being only
surpassed by that  of the Madeiras ;  the
whole yearly range never being beyond
400 F. and the daily variation does  not
exceed  50  F.   Besides  this wonderful
equality of temperature,  there is more to
see of natural beauty, and of man's work,
that would be of interest to  the average 
Consumption.           117
 individual, than can well be found in  the
 same extent of territory anywhere within
 the same distance from New York.   The
 winter climate is  a cool one, and too bois-
 terous for a delicate invalid.  The average
 winter   temperature   is  6o°   F., which
 makes possible a  continuous  out-of-door
 life, in which  abundant sources of occu-
 pation  and  amusement  can  be  found.
 The atmosphere though always moist, is
 pure and equable in temperature, and the
 wind though blowing continually, will im-
 part health to almost any one  not too far
 advanced in phthisis.   If the disease  has
 made much progress, the  climate is  too
 exciting, and  the  disease makes rapid,
 unfavorable progress.   The greatest  ob-
 jection  to  the  Bermudas  as  a place  of
 winter resort,  is the lively shaking which
 the passenger  has to experience on  the
 small steamer in its trip across the Gulf
 Stream.
  The Bahamas and other islands to the
southward, afford  a warmer,  but  less
equable climate, and  may be utilized by
more delicate  patients  who  desire  a 
n8
Consumption.
change   from  other  visited  localities.
Parts of Australia, and the Sandwich  Is-
lands, are  frequently lauded as  sanitari-
ums of great  virtue  for  phthisical pa-
tients.
  In  Europe  Heiden,  Gais, Weissbad,
Kreuth, etc., are recommended as summer
resorts ; Soden, Badenweiler, Wiesbaden,
and Lake  Geneva  as  fall resorts; and
Mizza,  Mentone,  Pau,  Nice,  Algiers,
Cairo, and the  Madeiras,  etc., as winter
resorts for  the phthisical  patient.  Too
long a residence in one  locality is gener-
ally not desirable.  Change of scene and
company, and  the  stimulus of moderate
climatic change are all beneficial.

       Food in its Relations to Phthisis.
  In considering the treatment of phthi-
sis, the most important  part of  the sub-
ject, by far, is  that  which relates to the
food  supply of the patient.  Starvation
has probably more to do in the produc-
tion of phthisis than any other individual
cause.  The proper regulation of the pa-
tient's food supply, is  the fundamental 
Consumption.
119
means of effecting the cure ot the dis-
ease.   By starvation, we mean the depri-
vation of proper  food,  both as to the
quantity and quality, required for healthy
nutrition.  We  should  call  the diet  of
fried food, pie and unlimited tea, indulg-
ed in by so many of  the  inhabitants  of
our Northern States, starvation.
  By food, is generally meant  all  those
matters  which  serve  in  the  building up
and  sustentation  of  the  tissues  of the
body.  In its broadest sense,  this includes
oxygen,  but as  this element  does not en-
ter  the  system by the alimentary canal
to any great extent, it need not be con-
sidered in this part of the subject.   With
the exception of  oxygen, man's food is
composed of a variety  of complex sub-
stances,  mostly of animal or  vegetable
origin.   Besides  water, considerable in-
organic mineral matter is used as food in
the form of common  salt, and in other
forms that may be in solution in drinking
water.   By proper selection, it is probable
that man could receive all the necessary
nutritive matters, excluding oxygen, from 
120
Consumption.
the products of the animal and vegetable
kingdoms.   Physiologically  considered,
the elements which are found to be nec-
essary to the  maintenance of the nutri-
tion of the  body are oxygen ; water ; the
mineral  salts,  which  include   sodium
chloride, potassium chloride, potassium
phosphate,  sodium sulphate ; the  carbo-
hydrates, which  include  the   starches,
sugars  and fats;   and the  nitrogenous
principles of albumen, fibrin,  etc.  Some
of these principles are only formed in the
body  from crude  matters furnished by
the food, while others are absorbed and
utilized in  their own  form.  Some of
them  are of vastly more  importance to
the general economy than others, but all
should be  supplied in  the food, and in
about the correct proportionate  amounts
necessary to  fulfil  the requirements of
healthy and economical nutrition.  It is
a  great waste of  food and force, and
a  prejudicial tax  upon a weakly diges-
tive apparatus, to have a large amount
of food supplied to it, which may either
be  slightly nutritious, or  which may be 
Consumption.           121
largely in excess of the needs of the sys-
tem for those particular food  principles
required.  The  food,  after introduction
into the alimentary canal, undergoes by
means of the digestive processes, soften-
ing, liquefaction, and to a certain degree,
chemical change, before being absorbed
into the general system ; and it is often
the  case that inability of the digestive
organs to  properly fulfil  their office, is
the  inciting  cause of phthisis,  the body
not  receiving a sufficient  nutritive sup-
ply.  The principal articles of  food used
by man are, water, salt, milk, bread, meat,
eggs, oils, vegetables and frtiits.
  Alilk  contains  water,  caseine  and al-
bumen, fat and mineral salts.
  Bread, contains water, starch, nitrog-
enous  matters such as gluten, dextrine
or sugar, fat and mineral salts.
  Meat  contains water, albuminous mat-
ter, fat and mineral salts.
  Eggs contain the same ingredients as
meat, though in different proportions.
  Vegetables contain water, starch, sugar, 
122
Consumption.
gum, fat, cellulose, albuminous matter and
mineral and vegetable salts.
  Fruit  contains  water,  starch, sugar,
gum, cellulose, the salts of the vegetable
acids, and sometimes fats.
  Thus it will be seen that nearly  all
food contains about  the  same  food ele-
ments, but the proportionate amounts of
these principles vary greatly  in  the dif-
ferent  foods.   In  some, water  is about
the only component element present; in
others,  starch  predominates ; in others,
sugar ; in others, fats ; in others, albumen,
and so on.  The  conditions of  mechani-
cal texture vary.   Some may be  eaten in
the crude state, while others absolutely
require the effect  of  heat  and moisture,.
as applied in the  process  of cooking, to
make them at all digestible.  Thus it will
be seen, that in order to supply the  food
elements to the system in correct propor-
tions, qualitative selection, together with
variety in the food eaten,  is of  the first
importance.  Furthermore, the digestive
ability, as influenced  by age,  health sta-
tus, and congenital anatomical conforma- 
Consumption.
123
tion, is another prime factor, in deciding
upon the nature of the food which should
be eaten in individual cases.   In furnish-
ing a proper food supply to an individual,
the following points must be taken into
consideration, namely :  age, health sta-
tus,  digestive ability and  conformation
of the digestive organs,  idiosyncrasy, the
requirements of  occupation  and activity
of growth, and climatic  influences.   The
offices which the different  food principles
fulfil in the human economy, are in brief
about as follows ;  IVater is a solvent, and
gives mobility and inter-changeability to
the different tissues.  Salt  (chloride of
sodium) regulates the process of osmosis,
and is an element  in the composition of
all the tissues.   The other mineral salts
are useful  in building up the  bony sys-
tem ;  are found  in the  composition of
the other  tissues;  and give  the  blood
alkaline  properties very necessary to its
functions.   Albumen and Fibrin are used
extensively in the muscular system, and
in lesser amounts in the construction of
other tissues.  The Fats  are  generally 
124
Consumption.
found in all the tissues, are useful in lu-
bricating and preventing cellular friction,
in giving beauty to form, and in protect-
ing the  more  delicate  tissues : also by
chemical unipn  with large amounts of ox-
ygen, they generate great quantities  of
heat and energy,  throughout  the body.
The Starches and  Sugars also produce
heat and energy, though in lesser degree,
by their  chemical  metamorphoses in  the
body.  It having been before mentioned
that age and condition have an important
influence in determining what should be
a proper  food supply for the individual, it
follows, that in the case of infants, chil-
dren, the  aged, and  in  certain persons
whose digestive apparatuses are delicate,
ease of absorption and suitability for the
purposes of building up  and sustaining
the tissues, are necessary qualities  that
should receive  consideration  in selecting
their food  supply.  Not  only must  the
young have a sufficient  amount of sugar
and starch  in their food, to produce  the
heat and energy required, but they must
have a proportionately large supply of the 
Consumption.
125
mineral and nitrogenous elements to build
up the bony and muscular systems.
  In cases of digestive malformation and
inability, the digestive apparatus should
not be over burdened  with innutritious
matters, or those  hard  to digest.   In
these   cases a  large  proportion of  the
food supply should  be of easily digested
and assimilable matters.
  The fully grown adult, engaged in ac-
tive  muscular  exercise,  needs  such  an
amount  of  albuminoids as  will replace
the continuous waste of muscular tissue,
and large quantities of  heat and energy
producing foods, to conserve their pur-
poses.
  In warm climates the starches are to
be preferred to the fatty foods, because
in their chemical metamorphoses   they
produce less heat.  Notice must be taken
of the fact that in some  cases  particular
foods   disagree with some  individuals;
and in extreme  cases, they even act as
poisons.  When we inquire as to  the
definite proportions of each of  the  food
principles which should  be supplied in 
126           Consumption-
the food of the phthisical individual, we
have  to deplore the fact  that more ex-
tended  attention has not  been  given to
this part of  the subject by those  authori-
ties who  should have  made  it  a special
study.   In  the  more  socially advanced
countries, the authorities supply the ag-
ricultural   inhabitants  with  food-tables
and  formulas,  indicating  the   relative
amounts  of  the  various  foods  which
should be fed  to domestic animals to gain
certain results ; but  the subject as it re-
lates to the human being has not received
such refined attention.   Until something
of the same nature is done for the human
race, it can hardly be expected of the av-
erage layman  that he should  be able to
regulate his diet, as to quantity and qual-
ity, from some  scientific generalities in
text-books, on the nature of albuminoids,
fats, and starchy matters.
   In the present unavailable state of scien-
tific knowledge on the  subject, we know
of no definite set of  rules which  could
be made  generally available for individ-
ual guidance in  this matter.  The medi- 
Consumption.
127
cal adviser must apply his general knowl-
edge and judgment to the case in hand.
However, some generalities may be given
as guides.  For instance,  we know that
milk contains all the food elements found
in  the  human  body, and all  that  are
necessary in  the nutrition  of a young in-
fant.  From  birth until the child  begins
to get its teeth, no food but  the milk of
a  healthy woman  should be taken by  a
phthisical infant.   If  possible it  should
not  be  allowed  to  nurse  a  phthisical
mother,  and if  one woman's milk does
not  nourish  it, it should  be changed to
another  nurse.  Prepared infants' foods
should  be  regarded  with marked  dis-
trust.  Perhaps  in  some few cases their
use  may be  allowable, but as  a general
rule they are not proper food for infants.
Cow's milk was intended for the  coarse
stomachs of calves, and human  beings of
an older  growth.   Although  it is not  en-
tirely adapted for infants' food, it may be
given  in  cases  of extreme need, after
properly  diluting it with water, and add-
ing enough cream  and sugar to make it 
128
Consumption.
more like the mother's milk.   In the use
of milk as an article of food, man has one
of the best safeguards against Phthisis,
and  remedies in the cure of the disease.
In  fresh, rich  milk is found,  in  readily
absorbable and assimilable form, all the
elements of  nutrition, in very  favorable
proportions.   It  is  necessary  for  the
maintenance of the alimentary functions,
that more or less bulky  and indigestible
matter should  be eaten to serve the pur-
pose of exciting  the muscular motion of
the intestines,  and to give  the circular
muscles  of  the stomach  and intestines
something  to  act  upon ;  or,  in  other
words, to give those organs ability to
carry out the function of  passing along
alimentary matters from one end of the
canal to the other.  Therefore, a contin-
uous milk, or other fluid diet, would  not
be conducive  to  man's best health; but
by making a practice  of using a certain
proportion  of  milk,  with  his  food, the
phthisical individual,  possessing  an ali-
mentary  tract  in  fairly  good  health,
would  always be sure that  enough nutri- 
Consumption.
129
tive matter would be absorbed, to furnish
sufficient nourishment to his pulmonary
and  other tissues.    One meets with  a
great many people who say that milk dis-
agrees with them.  We imagine that the
reason of this is that those persons eat
too much rich food in addition to drink-
ing the milk, in consequence  of which
the alimentary tract  has more nutritive
matter furnished it  than it can digest,
and  the  surplus  acts  as a foreign body,
exciting gastric and intestinal irritation.
In other cases, the individual may  have
too good absorbing powers, and the easily
absorbed milk flushes the liver too  pow-
erfully, producing functional disorders of
that organ.   In some few cases milk un-
deniably acts  as  a poisonous irritant to
the individual.  In most of these  cases
much can be  done in the way of creating
a tolerance  for milk, by commencing its
use in  small amounts, or by mixing  it
with barley  gruel, lime  water,  alcoholic
stimulants, etc.  In  those cases where
milk cannot be taken, cream, butter, and
easily digested meat broths will have to
    9 
130           Consumption.
be  substituted for  it.   In selecting a lo-
cation for the consumptive, ease of access
to a good milk supply should be consid-
ered of great  importance.   Canned con-
densed  milk  makes  a good substitute,
and may be  taken  on hunting  or other
expeditions in wild parts of the  country.
Drinking the  milk of goats, asses, pre-
pared kumyss, etc.,  has, as a general thing,
only the advantage of an appeal to the
invalid's  imagination, giving him the com-
fort of expecting relief from  their use.
Kumyss  however, is often of great value
in cases of  delicate stomachs.   Let us
then, lay down, as a rule, that the phthis-
ical   individual should  drink a certain
moderate amount  of milk at each meal,
avoiding the  excessive quantities which
are frequently recommended.   In regard
to other foods, we  will  only  formulate
dietetic generalities.  As a general thing,
the habit of eating fatty foods should  be
cultivated  on account of their very high
nutritive values;   and furthermore, be-
cause in consumptive individuals, the abil-
ity to digest  them is usually limited—this 
Consumption.
I3i
lack of ability being either natural or ac-
quired.
  The  great majority  of  persons  who
have the disease, or a  tendency to it,
accumulate  very  little fatty tissue  and
object  to  fatty  foods.  This  may  be
caused  by  some  deficiency in  the  con-
struction, or  functional  abilities  of the
pancreatic  gland,  whose secretion has
emulsive  power over the fats, enabling
them to pass into the system in the form
of an emulsion.  The most effective fatty
food  for phthisical  individuals  is  cod-
liver  oil,  it being more  easily digested
than  other fats, and  ranking highest for
its power of producing heat and  energy.
It should be taken at, or just after, meals,
in quantities as  great as can be digested
—a  point which  can be ascertained by
examining the  feces for signs of  undi-
gested oil.   It  may  be  given  gradually,
in order  to  accustom the  patient to it,
a teaspoonful  three  times  a day after
meals, being  enough to start with.  It
should not be given in those cases where
there is  much fever  present.  It  may be 
132
Consumption.
taken  in  the froth of  porter,  or  the
mouth may be rinsed out with a strong
alcoholic beverage before taking it,  or it
may be advantageously used  in the form
of an  alkaline  emulsion flavored  with
bitter  almond, wintergreen, etc.   If  the
disgust for it is  unconquerable, butter,
cream, olive oil, glycerine or other easily
assimilable  oils,  will  make  a tolerable
substitute for it.   Beef fat, which  stands
next to cod-liver oil in nutritive  value, is
unfortunately difficult of digestion, and is
therefore  not of much utility to the in-
valid.  So far as  other  foods are  con-
cerned they may be eaten in variety and
in proportions to  suit individual cases,
though the starches and  sugars are  hard
of digestion,  and  should be  used spar-
ingly.   It must be borne in mind that a
great  help  to digestive activity,  is  the
reflex  action  on   the  digestive  organs,
following titillation of the  terminal  gus-
tatory  nerves, by  savory food.   If  food
is not  pleasing to the  taste, it does  not
digest  as well as it otherwise would ; and
the proper culinary preparation of  the 
Consumption.            133
consumptive's food should be considered
as a highly important item in the treat-
ment of  this disease.   Great attention
should be given  to furnishing a pleasing
variety, and  to exciting the appetite by
savory preparation of the food.   It must
be  understood, that  the idea to be car-
ried out, is  to induce the  patient to eat
all the properly selected food that he can
digest, and  to waste no  force  by eat-
ing food  that contains disproportionate
amounts of the various principles needed
in the  active nourishment  of the various
tissues of  the  body.  To furnish some
criterion of the  amounts of the various
kinds of food which  the phthisical  indi-
vidual  needs, we may  mention  that an
active  man  in full health requires about
the following-  amounts of  the  various
food principles during one day, namely:
water,  2000  grams; mineral  salts, 20
grams;   fat,  100  grams;   starch  and
sugar,  300  grams;  albuminous  matter,
130 grams.  These are represented  in
the following amounts of food :  water,
1530 grams; butter or fat,  100  grams; 
134
Consumption.
bread, 540 grams; meat,  433 grams.   A
gram  is  the  32d  part  of  an  ounce.
Besides this food supply, a man needs a
certain variety of fresh vegetables, fruit,
sugar, milk, etc., to maintain  him at the
best health  status.
  When the phthisical process is active,
it  must  be  remembered that  nutritive
matter  has to  be introduced  into the
individual, not  only  in sufficient supply
to meet a  normal demand, but also  to
meet the drain  caused by the expectora-
tion, and by the  over-active tissue meta-
morphosis  which is coincident  with the
fever.   Of course in treating the disease,
the activity of the intestinal  canal  must
be regulated by giving proper  attention
to the coarseness and irritating qualities
of the food  used.  In phthisis, the skin
may be utilized in aiding the alimentary
tract to absorb nourishing matters, as for
example, by the  inunction of  fats.   Cod-
liver oil is  the  best  fat for  this purpose,
but  it stains the skin and its  odor  is
offensive.   Perfumed  suet   is  a   more
elegant  material, and  may be  used  if 
Consumption.
135
desired.   After a warm bath at night, a
couple of ounces may be rubbed into the
skin,  and a thick night-gown  worn  to
prevent   soiling  the bed-linen.   Blood
from  the  butcher's shambles may be thus
introduced  through the skin.  The cus-
tom  of   drinking fresh blood  is  often
recommended,  and  if  the patient  can
stand such  a disgusting draught, it is a
beneficial practice, but  good milk  ordi-
narily answers  the  purpose just as  well.
Shall alcohol  be  used  in  phthisis  as a
food?  Some years ago, alcohol was ex-
alted as  a  remedy of  great virtue  in
phthisis, but in this day the  tendency is
toward  great  moderation in  its  use.
However, great and radical differences of
opinion exist on this point.   The use of
alcohol  as  a beverage  by the  normally
healthy individual, can  only  be more or
less harmful, though a certain  amount
introduced  into the system will fulfil the
purposes  of food in the  production  of
force  and energy.  This amount is  from
one to  two ounces  taken  in  the course
of twenty-four hours ; and it  seems that 
136
Consumption.
in persons with  poor digestive  and de-
ficient assimilative abilities, the use of a
moderate amount of alcoholic beverage
may be beneficial, producing some force,
stimulating  the  circulatory  system  to
greater activity,  and improving  the  di-
gestive processes by gentle  irritation of
the gastric  mucous membrane.   If it is
taken, it should  always be  moderate in
quantity and much diluted as to quality.
The  malted  liquors  and  sweet  wines
should always  be selected in preference
to the stronger  beverages;  the former,
because  they contain a slight amount of
nutritive  matter  in  addition  to  the
alcohol, and  the  latter, because  of  the
absence of acidity, and  the  presence of
those flavoring and odoriferous oils and
ethers which  have  a  stimulative  effect
on the digestive function.  There should
not be  enough  taken to quicken  the
pulse, to flush  the  face, or to  affect  the
head.  When   such symptoms are  ob-
served,  the  alcohol  is doing harm as a
food.   The alcoholics may be  given  ad- 
Consumption.            137
 vantageously and  pleasantly, beaten up
 with egg and milk.
   An important point in  the prevention
 of phthisis, is that the food of the young
 should  be of a simple character, though
 nutritious.   They  should  be made  to
 avoid tea, coffee and  other nerve stimu-
 lants,  pastries,   confections  and  condi-
 ments that will give  them a  distaste for
 simple  food.  While  it should  be seen
 that a full nutritive supply is taken,  the
 stomach should be trained to  digest sim-
 pie and rather bulky foods.

    Physical Culture in its Relation to Phthisis.
   " In the sweat of thy face shalt thou  eat
 bread till thou return  unto the ground."
 Thus wrote  the law-giver, and whatever
 one's  opinion may  be as to  the  divine
 origin of the above sentence, it must be
 conceded that it contains the essence of
 a physiological  law of great importance.
 If a man does not work, and incidentally
sweat for  the means  of his subsistence,
he  must do  so  if he  wishes  the  best of
health.   It is a physiological fact of prime 
138
Consumption.
interest to this subject, that the  various
organs of the body must all carry on their
functional  actions, between sufficient pe-
riods of rest, with  continuity,  regular-
ity  and vigor,  to maintain  an elevated
general physical status, and  this is partic-
ularly true of the largest system in the
body—the muscular system.   Motion of
all parts of the body is essential to health.
Even the brain  has need  of the  motion
it receives from the throbbing of the  arte-
ries.  Along with purity of  air  and  the
proper nourishment  of the tissues by se-
lected  food,  the relation  of exercise to
phthisis is  of the greatest importance in
considering its treatment.  If the various
parts of the  body are not exercised, de-
generation and loss of  function in those
parts follow.  This  is  readily noticed in
the nerve degenerations which follow dis-
use of  the conductor  nerves, examples of
which are seen in paralysis.  The degen-
erative change can also be noticed in the
eye, in cases  of disuse of that organ.
  Exercise conduces to the nutrition of
the  body  in various  ways.   First,  the 
               Consumption.            139

functional motion  of  an  organ, by com-
pressing the venous blood from the tis-
sues, accelerates the circulation, and rap-
idly makes room for the reception of fresh
blood, with consequent increased nourish-
ment of the anatomical elements compos-
ing those tissues.  Secondly, the lymphatic
flow is  also accelerated in  the same way.
 Thirdly, exercise stimulates an increased
action of the  heart and chest, and so,  by
a quickened circulation and increased  ar-
terial pressure, the general  nutritive proc-
esses are  improved.   Hygienically con-
sidered, the prime  motive  for taking ex-
ercise should  be to strengthen the action
of the heart and lungs, and  to bring about
a healthy  development of those organs.
Fourthly, exercise acts beneficially by giv-
ing motion  to  the  various  abdominal or-
gans.   This generates  friction and  press-
ure  in  those  parts, causing blood  to  be
directed to  them, the result  of which is
their increased nutrition and functional
activity.  Fifthly,  exercise acts benefi-
cially in  diseased  conditions,  especially
in  phthisis, through the derivative  effect 
140
Consumption.
which exercise of other organs of the body
has, in drawing away from the lungs or
other diseased parts, the excessive blood
supply usually attendant upon the disease
process.   Sixthly, exercise acts beneficial-
ly when it brings the  individual into con-
tact with a continually changing and hence
purer atmosphere, and  presents  to his
notice new sights, sounds,  and smells, all
of which have a stimulating influence on
the general  system through the medium
of the special organs  of reception, that is,
the eye, ear and nose.   Seventhly, exercise
acts beneficially by increasing the activity
of the  excretory processes, thus  ridding
the system of not only useless,  but it may
be, of injurious excrementitious products.
Eighthly,  exercise is beneficial  because  it
gives opportunity for the development of
parts of the body which may be  congeni-
tally deficient.   Ninthly, active  exercise
improves  the  general system,  by giving
the individual a good  appetite, and by
causing rapid tissue changes.  Tenthly, ex-
ercise accustoms the anatomical elements
of the various tissues  of the body to the 
Consumption.
141
 performance of their functions with quick-
 ness and ease.  The dexterity that comes
 with practice, so readily observable in the
 complete complex organism, is the result
 of repeated action in the minute cell.  It
 is not alone sufficient that nutritive mat-
 ter be closely and continuously presented
 to the cell element for its nutrition, but
 the  cell must also receive  the nervous in-
 fluence which calls  it into functional ac-
 tivity, before it can attain  that  healthy
 tone which is necessary to  the make-up
 of the firm,  dense, tough  and resisting
 tissue that will be able to  withstand  hard
 usage.
  The exercise  of the tissues of the body
 should be  a  harmonious and regular de-
 velopment and use of each and all of the
 various organs of  the body up to the full
 exercise  of their functional  activity.  In
 theory, an individual can only be said to
 be in perfect health when all of the  vari-
 ous  tissues of the body are thus called
 into  use, whether that use be a function
of motion,  of resistance,  of support, of
secretion, of  excretion, or of origination 
142            Consumption.
or  transportation  of the   nervous  in-
fluence.   Practically considered, such re-
finement of cultivation cannot be carried
out in any single  case, and much less so
would it be possible in  the  lives of the
vast majority of human beings.  In most
cases, the exercise of the muscular system
as the largest, of  the  nervous system as
the motor incitor, and of the  digestive
organs  because of their prominently im-
portant functions,  must  suffice.  These
systems  being kept in good order, their
influence will usually be sufficient to main-
tain the rest of the  body in the  right
channels of healthy nutrition.  It is not
only necessary that the muscles be used,
but the vigorous culture  of  willed effort
is so important that it must not be  neg-
lected in any case  of phthisis.
  It must be borne in  mind that abuse of
any part by excessive exercise, is not a
virtue.   The over-developed muscle is in
an  abnormal state, and  invites disease.
The  over-used  nervous  system  results
in general prostration.
  Professional athletes usually live  short 
Consumption.
143
 lives,  being liable  to  die  of disease  of
 local parts,  as  of the  heart  or lungs, or
 from over-nervous strain.   In some cases
 of phthisis, the application of correct prin-
 ciples of physical culture, would at  once
 call for less active  use of the whole, or
 of  a part of the body.  There are many
 restless,  nervous individuals  whose  di-
 gestive  organs do  not supply sufficient
 nutritive matter to  nourish  their bodies,
 or  else, whose  periods of  rest  are too
 short  to  allow  of reconstruction  of the
 over-used tissues.   Rest is the sole rem-
 edy, which,  if  taken in time, would  save
 many  an individual from  an  attack  of
 phthisis.
  While thorough exercise of the pulmo-
 nary organs is a requisite in the preven-
 tion of phthisis, just as soon as  the dis-
 ease  process  commences,  a  change  of
 treatment is required.   Then, as much
 local rest as possible  must be given  to
 the  parts implicated ; and to  effect  this,
 violent functional use of the lungs must
 not  be  called   for  during  the  active
stage of the  disease.  Systematic gentle 
144
Consumption.
 exercise  may be  taken  by filling  the
 lungs moderately, and then holding  the
 breath,  allowing  the  inspired air to ex-
 pand, and thus dilate the air cells.  This
 is all the special  exercise  that  can be
 given with benefit to the lungs.   Violent
 muscular  exertion,  excessive  emotion,
 great respiratory effort, such as is needed
 in shouting, etc., or doing anything that
 will bring about excessive respiratory ac-
 tion, should be avoided.   Rather, on  the
 other hand, should use be made of  the
 derivative  benefits of  exercise  by using
 the  neighboring and  distant organs of
 the  body,  and thus calling blood  away
 from  the  excited diseased  parts.   In
 cases of congenital malformation much
 can  be done by physical culture to  rem-
 edy  the defects of  conformation.  Badly
 formed chests, such as the flat, contract-
 ed and pigeon chests, may be much im-
proved in  form and  functional capacity
by the proper  exercise of the  upper part
of the body, and by cultivating the habit
of holding  the trunk and limbs in good
form, training the  various muscles  to 
              Consumption.            145

hold the chest in correct position.   The
fact that persons  who have the  most
symmetrical   chests   are   usually  left-
handed, is a good  illustration of the de-
velopment that  exercise will give to  the
chest.   It is only  carrying out  the  well
recognized physiological fact, that the use
of an  organ increases its size and func-
tional capacity   A deficient digestive ap-
paratus may be  vastly improved  by some
jarring exercise,  such as  is  gained in
horse-back  riding,  and by systematically
eating such  bulky foods as  will give it
considerable work to digest and  to move
along the digestive tract.   In the preven-
tion of phthisis, it  is  very important  that
such exercise as will develop the  chest
and its contained  organs should be at-
tended to  with   regularity.   Children
should be required to maintain habitually
an erect position in standing  and sitting,
which habit will tend to give the chest a
good external shape  and  internal capac-
ity.  If the child is allowed to stoop and
lounge, the muscles which hold the chest
in shape lose their tone and waste  away
    10 
146
Consumption.
through disuse ; the bodies of the verte-
bral column, through unequal  pressure,
become uneven, and  after that  malfor-
mation  occurs,  the regaining of  a  correct
position is difficult,  and  complete chest
expansion is interfered with.   The inter-
ference  with  the motions of  the chest
by constricting  dress, is a great and po-
tent evil.   The use  of  proper furniture,
such as  square-backed chairs, of a  correct
height to allow of the resting of the  feet
on the floor, is  an item  of importance to
be considered in the cultivation of  a good
form in  the young.
  A correct position  in sleep should be
demanded, with a view of preventing de-
formity.   Of all the forms of exercise
beneficial  to  the phthisical  individual,
walking stands pre-eminent.   In  walk-
ing over  a diversified  surface, the  mo-
tion  exercises  nearly all  the  organs of
the body.
  The  muscles of the  upper  part  are
actively engaged,  being called  into  use
in the  process of  balancing the body.
Walking has the advantage  of  being so 
Consumption.
H7
easily regulated as to the amount of force
expended, that  respiratory  effort need
not be  carried on too energetically.   It
is conducive  to  an erect  posture of  the
body ; it brings  the individual into  con-
tact with  fresh  air, and  with change of
scene;  and  it  acts  derivatively, by at-
tracting to  the  great muscles used  in
walking, the  excessive  supply of blood
that is  drawn  to the lungs  during  the
phthisical action.
  Running is beneficial  in  the  preven-
tion of the disease, by encouraging vig-
orous respiratory action,  thus  enlarging
and giving increased nutrition to  the pul-
monary tissues.   It is not to be  recom-
mended in cases of mal-nutrition, or great
delicacy of the pulmonary tissues ; and it
should not be practised when it produces
pain in  the pulmonary region.
  Horseback-riding is the lazy man's ex-
ercise.  It is particularly beneficial in giv-
ing the internal  organs, especially those
of  the   abdomen,  stimulative  exercise
through the  jar  and shaking received.
Its  practice is highly  beneficial in cases 
148
Consumption.
where  the digestive  apparatus  is slug-
gish.   The stimulus  which comes with
the novelty of position  and motion also
has a good effect.  It may be taken ad-
vantageously as  an occasional  change in
the regular routine of exercise.  It does
not give  a harmonious  development to
all the muscles  of the  body, and unless
great care be taken, encourages a stoop-
ing habit, induces round shoulders, and
gives a waddling gait to  the walk  of
males.   It may  be taken where walking
for some cause is impossible.
  While walking is the best exercise to
develop and  retain in health,  the  lower
extremities,  the  upper  portion  of  the
body  needs  some accessory exercise to
fully develop it,  and to  call out its func-
tions.  The best special exercise known
to us for this purpose, is the use of Indian
clubs.   In performing the various exer-
cises with these implements,  the whole
upper  part of the body can be fully and
harmoniously exercised  and developed to
any degree  without  strain, and at any
rate of speed that may  be practicable. 
Consumption.            149
As accessory to this method of  physical
culture, and  beneficial, if practised  occa-
sionally, may be mentioned sparring with
the  sand-bag,  and fencing.   Skating,  if
practised in moderation, is a fine exercise
for  both  males  and  females,  but care
should be taken not to carry it to excess,
and to prevent sudden cooling and chill.
Bicycling is  a  fashionable amusement of
the  day, and if moderately  indulged  in,
is a tolerably good means  of exercise,
though a great many serious  accidents
result from it, through the falls received.
Rowing is a good occasional exercise.  If
excessively practised, it tends to pull the
shoulders forward and the ribs together.
Wood-chopping and sawing are useful, but
little known, accomplishments, in this day
of steam machinery.  Whipping the trout
streams is a  splendid exercise for the
phthisical individual, and in many  cases
hunting is also beneficial.   The  greater
part of ordinary farm work, especially
pitching hay outside  of the dusty hay-
loft, is  decidedly beneficial,  if not  over-
done.  Exercise that  requires  excessive 
150           Consumption.

strain  should  not  be  encouraged,  al-
though a certain  amount of strain results
in  functional benefit  to  the  muscles,
ligaments,  bones, etc.   Dumb-bells are a
monotonous source of exercise, and are
liable to  produce strains.   For those who
are too stout; for those who  suffer from
inactivity of the abdominal organs ; for
those  who  may be  crippled;  etc.,  the
jolting chair, a  mechanism actuated  by
handles,  moved  by the  individual him-
self, is a good and convenient substitute,
for  horseback-riding,  and even  posses-
ses some advantages  peculiarly its own.
The joggling board, a long, elastic board,
with its  ends resting upon supports, of-
fers a means  for very  moderate  exer-
cise, for  very stout or very delicate per-
sons.  It is very much  to be deplored
that so few occupations  are calculated  to
give a harmonious development and ex-
ercise  to all parts of the body.
   The very delicate  phthisical  invalid
cannot of  course take very active exer-
cise, and for him driving, perambulation
or sailing  will   have  to  be substituted; 
Consumption.
151
the latter, though  the  mildest  of all, is
very beneficial.  Something can be done
for the great invalid or for the  incorrigi-
bly lazy individual, by  the passive  ex-
ercise known as massage, in which  the
whole  body  is beaten,  punched,  rubbed
and pommelled by another person, either
with the  hand,  or  with machinery used
for that purpose.   We regard  a  regular
daily rubbing of the whole surface of  the
chest with towel, flesh-brush or hand, as
one of  the important items in the suc-
cessful  treatment of phthisis.  It  should
be  done, preferably  by  the  patient,  at
least twice each day, and with  sufficient
vigor to  keep  the  chest  muscles and
other tissues in a  high state of  health.
The practice toughens the  skin, and pre-
vents it from easily receiving impressions
from cold, and it also  acts  derivatively,
drawing away blood  and  nervous influ-
ence from  the  lungs.   The intercostal
muscles  should  be kept  well developed
by  a regular habit  of  taking deep but
gentle   inspirations.   As  before pointed
out, it is very important to surround the 
152
Consumption.
pathological process with tissues that will
not only resist, but which will also  influ-
ence in a beneficial manner, the  diseased
tissues by their own healthfulness.   Con-
genial and  hygienic work, is one of the
best  remedies   in  the   prevention   of
phthisis ; and regulated exercise, and oc-
cupation for the  mind, is  a sine qua non
in its  curative treatment.   It is impor-
tant that the phthisical individual should
manage, if  possible, to  get his  exercise
in the course of his daily occupation  or
amusement.   Exercise  taken by  itself
only for its effects  is  rather dull work,
and is very  liable to be neglected; never-
theless, it should not be  neglected, and
should be a religious daily duty,  as much
so as  making the toilet, or eating a meal.
The  temperature  in  which exercise  is
taken is a point that should be consid-
ered.   Active exercise should, if possible,
be taken  in a temperature lower  than
that in which the  patient sits while  at
rest.  This is  easy to accomplish in cold
weather, but it is a difficult  matter to ar-
range in warm weather.  At such times, 
Consumption.
153
the patient should be careful not to incur
too great and sudden changes of bodily
heat, and he can do this by careful regu-
lation of his clothing, and by not over-
exerting.  He should  dress lightly while
exercising, and then should put  on addi-
tional covering  when  resting.   Even in
winter, when over-clothing is worn out of
doors, it  is always prudent to retain the
additional clothing for a few minutes aft-
er returning indoors, so as to prevent the
body from  being  too  suddenly  cooled.
A vast number  of colds are  due to this
sudden indoor cooling after  active exer-
cise.   The winter visitor to the Bermuda
Islands, where the interior atmosphere of
the houses is usually cooler than  the out-
door  atmosphere, is quite astonished to
have  to  put on his overcoat when he
goes  indoors, and to discard  it when he
goes out.
  To get the utmost  benefit from exer-
cise, it must be  taken  vigorously, and to
a sufficient degree  to fully test the func-
tions  of  the  various  organs exercised.
The thin-blooded student, who  takes  a 
154           Consumption.
slight  stroll  as his daily exercise,  can
hardly comprehend the  delicious glow
of vigorous health which he would  feel
through his whole organism after several
months of active  work  on a well regu-
lated farm.

       Heredity in its Relations to Phthisis.
  The marriage relation is an outgrowth
of the influence of the  second great in-
stinct  of human nature,  namely, that  of
reproduction.
  As people rise in the social and intellect-
ual scale, various other  influences of an
ethical and practical nature regulate the
coming together of the  sexes  in this re-
lation.  How often, even in  this day of
supposed enlightenment, do  any of the
contracting parties ever consider the re-
sult of the contract from the physiologi-
cal point  of view?  It must be conceded
that scarcely  a recognizable  percentage
of  the whole  of  mankind do  so.   The
pecuniary side of the  question is always
looked at from every point of view, and
even the  social standing of the two  con- 
Consumption.           155
tractors  is  criticised and comparatively
balanced in the scale of social equalities ;
but the effect the marriage may have on
the health  of  the  man  and the woman,
and the quality of  the  progeny they will
be able to  give to  the world, is scarcely
ever  thought  of for a  moment.   It is
true that the  law  forbids the marriage
of very near relatives, and  parents  are
liable  to  look askance  at  present  ill-
health, as being likely to interfere with
the material success of  the  young cou-
ple.   But how often  do parents  call in a
medical expert to  sanction the legality
and  morality  of the  marriage,  judged
from  the physiological  point  of  view ?
And how often is a physical  examination
made before marriage by an  expert with
a view of ascertaining their physical adapt-
ability  to   enter  into  the  estate,  and
to carry out the high duties  of procrea-
tion ?   It   may  be  said,  ATever.    It
should be done, Always.
  As the   result  of this  reprehensible
neglect on  the parts of  individuals  and
governments, we find a system of  breed- 
156
Consumption.
ing among human beings, which would, if
imitated in the breeding of domestic farm
animals, be considered a disgrace to the
agricultural economy of any civilized peo-
ple on  the face of the globe.  Contem-
poraneous man is an artificial animal, and
is naturally inclined to return to  the  or-
iginal type;  hence  it  is  a  necessity, if
the best artificial status be retained, and
improvement in the race  expected, that
he should exercise great  care  in breed-
ing, as  well as in living.   It is to be  re-
gretted  that among the great majority of
the race,  individual preference  and  de-
sire, coupled with  opportunity, are about
the only influences  which take part in
the production  of a, too  generally, mal-
formed  and  degenerate  progeny.   Un-
der this state of affairs, we see the man
permeated with  syphilis, unrestrictedly
marrying  the  pure young girl, thus  en-
tailing misery upon her, and  her descend-
ants.  The scrofulous,  the insane,  crim-
inals,  paupers, and  many others whose
children are entirely unfitted to do any-
thing for society but harm, all marry and 
Consumption.           157
 reproduce ;  and  yet society makes  no
 great protest against the evil.  Perhaps
 this evil of unregulated human  breeding
 is as fully seen in the production of con-
 sumptives, as in  any other undesirable
 class  produced.   There  is  either  the
 mating of two  individuals whose ances-
 try have a distinct phthisical history, and
 whose progeny will  almost  certainly fall
 before the disease ;  or else the anatom-
 ical formation  of  the parties is  so  pe-
 culiarly  faulty, that  their children will
 probably  exhibit   great   deficiencies  in
 some part of their pulmonary or alimen-
 tary structures ; or, if the parents are de-
 bilitated  by  debauchery, intemperance,
 or  syphilitic and other diseases, then  the
 children also become  fit candidates,  to
 swell the death-rate from phthisis.
  There   are,  we   suppose,  very  few
 thoughtful  persons  who  would not  ad-
 mit that this state of affairs is all wrong.
In the proper regulation of reproduction,
is found  the  most  radical and effectual
measure that can be adopted in  the preven-
tion of phthisis.   We contend that viewed 
158
Consumption.
by the highest standard of morality and
enlightenment, no  individual  decidedly
tainted  with  the  phthisical  tendency,
should do  the world the wrong of bring-
ing forth a progeny, cursed with inefficien-
cy and inability to carry out the functions
of an ordinary life.  Some  may say that
this is too high an ideal;  but it is an ideal
that is adopted and practised by at least
a few individuals  who have  right ways of
thinking.  The writer had a friend, a young
lawyer, brilliant and courted,  who  could
have  chosen a wife wherever he would;
but he was cursed with an hereditary taint
of phthisis, and determined  that he would
never be guilty of extending the curse,
and so went on in life alone.  When the
age at  which  phthisis  usually  showed
itself  in  his  family came,  consumption
developed in him, and he died, happy, at
least, in having performed a heroic task
in life, even if it were a negative  one.
All honor to such  a brave  being.   It  is
hardly to be expected that such sacrifice
of desire can  be  looked for, in this day
at least; but certainly, phthisical individ- 
Consu mption.           159
uals can  make a selection of a  partner
in marriage, who  shall have the physical
qualities  necessary to annul,  in  some
measure,  the  bad traits which  otherwise
must appear, more or less, in the first,
or a later generation of their descendants,
for it  frequently occurs that the disease
tendency skips one generation, and  ap-
pears in the second or third.
   It is particularly desirable that the wife
be  robust and healthy, as she has dur-
ing  the first  months   of  existence,  the
sole ability  to furnish the nourishment
necessary for the healthy development of
the growing  child.  The  mother should
make,  during  gestation,  a special effort
to keep her health up to a high status,
by  eating proper food,   and   by freely
taking gentle  exercise in  the  open  air.
The condition of the health, both of  the
father  and the mother, at  the  procrea-
tive period, has a  most important effect
on  the health  of  the future  offspring.
There   are  numerous  instances  on rec-
ord, where a  phthisical father  produced
phthisical children while his disease was 
i6o
Consumption.
in progress;  but with his recovery and
the regaining of vigorous  health  and
strength, the  children then  born to him
were healthy.
  Weakly  and delicate children  are  like-
ly to be the reproductive  result of debil-
itated  parents,  and  of  course  all such
are exposed to, and  are particularly lia-
ble to  be affected by, the  special irritat-
ing and  mal-nutritive  causes  producing
phthisis ;  and so, in  this  way, does  he-
reditary influence help in  the production
of phthisis, and increase the improbabil-
ity that it is likely soon to become a rare
disease.

     Occupation  in its Relations to Phthisis.
  The  old Mosaic record declares  that
work is a punishment visited upon man-
kind, because  of the  pomological curios-
ity and gustatory tastes of our ancestors,
Adam  and Eve ; but  modern physiology
shows  that the regular functional exercise
of all the various organs  of the body, is
essential to the health, not  only of man,
but of  the lower animals, as  well.  With- 
Consumptioji.
161
 out deciding upon the merits of these two
 explanations of the universal industry ex-
 hibited by animals, it is enough for our
 purpose to recognize the universality and
 the necessity  of  work.   Occupation of
 one form or another,  whether engaged in
 for mere  amusement, or for the impera-
 tive necessity for gaining a subsistence, is
 an absolute essential  to man's perpetuity.
 The occupation in which  he  is engaged
 largely determines his happiness and pros-
 perity,  or brings  to  him poverty, misery
 and  disease.    The conditions  that  sur-
 round the vast majority  of men,  deter-
 mine  what their occupation shall be, and
 the individual seldom  has much of a choice
 in the matter.  Unfortunately for many,
 their occupation is such that it is not com-
 patible  with good health.   The depriva-
 tion of  light, the forced  requirements for
 breathing  foul  air and mechanical  irri-
 tants,  and the slight  remuneration  re-
 ceived preventing  the procuring of prop-
 er food, are all concomitants of many oc-
 cupations,  and are prominent factors at
work  in the  production of phthisis,  and
    ii 
162           Consumption.
in the  prevention  of its cure.  Among
the occupations  having a peculiarly dele-
terious  effect, are those  which  produce
much dust, such as  steel-grinding  and
polishing,  stone-cutting  and  polishing,
milling,  mining,  tobacco-working,  etc.
A prominent  axe company says, that it
cannot get its grinders to live over four
years;  they acquire phthisis.   Another
class  of  occupations  unfavorable to the
phthisical, is such as give rise to irritating
and depressing  vapors; as, for example,
japanning, fertilizer  manufacturing,  etc.
Another class, is where the work is sed-
entary, and the individual works in badly-
ventilated rooms.  Tailors and shoemak-
ers are very liable to have phthisis.  The
reason why shoemakers should so univer-
sally work in poorly ventilated and over-
heated rooms, is one of the unexplained
facts observed in the experience  of a life-
time.   Furthermore,  the evils  of damp
air, of wet clothing, of over-work, etc., are
incident  to  many occupations causative
of phthisis.
   In  every case of  phthisis  the nature 
Consumption.
163
of the patient's occupation should receive
close attention.   In  many  instances,  a
change  of  occupation, or a correction of
the evils coincident to it, will be all that
is  necessary to bring about  a curative in-
fluence.  The question of occupation for
wealthy patients is not a very perplexing
one  to  the  physician.   The resources of
travel, of the hunt, of athletic sports  and
amusements, of sailing, of pleasure farm-
ing and gardening, etc., are available;
but what  shall become of poor  individu-
als, especially women, who must  die  un-
less  change  of occupation  be afforded ?
There are at least some occupations open
to these poorer people, in the pursuit of
which, health may be  gained, and some
pecuniary return as well.   For men, agri-
cultural industry  in all  its branches, is
open.   There are  hundreds of thousands
of farmers located throughout the  health-
ful parts of the country, who  would be
glad of  additional help during the busy
season,  even if it  were accepted with re-
strictions as  to over-work,  avoidance of
the dust of the hay loft, and requirements 
164            Consumption.

of a plentiful supply  of  fresh milk  and
eggs to  the phthisical worker.  Turpen-
tine farming in the elevated pine forests
of the South, is a particularly advantage-
ous winter pursuit for  the individual with
a phthisical tendency, either if he engages
in it as  director of the business, or if he
merely  hires himself  as  a laborer,  and
swings the long-handled axe in boxing the
trees, or later in  the season collects the
crude turpentine from them.   For those
who  have sufficient vigor, the life of the
lumberman, either in  the Southern or in
the Northern forests, during  the winter,
is advantageous; and  in some localities,
lumber  sawing  is a  healthful  pursuit
Vegetable, fruit and flower gardening, is
a field open to many, except in the neigh-
borhood of the  larger  cities, where there
is too much competition from a very hardy
and  hard-working class  of people, who
are able to withstand great exposures to
severe   climatic  influences.   Gardening
in the  milder climate  of the South, is  a
continually growing   industry.   Orange
and other fruit  culture, in Florida and in 
Consumption.           165
 Southern California, is a fascinating and
 desirable pursuit, for those who have the
 means and patience to wait for returns.
 The  cattle and  sheep  business  on the
 plains offer attractions for many, and cer-
 tainly abound in opportunities for health-
 ful out-of-door exercise.   Stage, car and
 truck driving,  is generally conducive  to
 a state of health  that would  prevent  an
 attack of phthisis.
   When we consider the  healthful  occu-
 pations open to women, there is less diver-
 sity of choice.  Domestic service in the
 houses of the  closely-built city, is not a
 healthy  pursuit, but  the demand for will-
 ing domestic service in all the suburban
 villages, and on all the farms of the whole
 country,  is unlimited.   Cooking,  and
 sweeping, unless  a  respirator is worn,
 should be avoided as much as possible ;
,but almost all the other work of a  well-
 lighted,  ventilated and heated suburban
 residence, is particularly well adapted  to
 the  phthisical  woman.   Of   course  no
 confirmed phthisical person should  have
 the care of children.   As an independent 
166
Consumption.
industry, well adapted to woman's phys-
ical abilities, and which offers a fair chance
for a moderate success, may be mentioned
the raising of poultry, both for their eggs
and flesh.  The demand for good poultry
and eggs is unlimited, and the only reason
why their production should not be made
a special  industry, is the item of labor;
the main requisite  to success being the
careful attention which should be given
to the minutiae of cleanliness, protection,
etc.  One of the most successful bee rais-
ers in America is a woman, and  there is
no reason why the keeping of bees should
not be  largely extended  as  a  lucrative
pursuit for women, as well as silk culture,
which is now beginning to receive con-
siderable  attention.    The points  that
should be considered in the selection of
an occupation  suitable to  the phthisical
individual, are taste for the pursuit, oppor-
tunity to  breathe pure, unirritating, non-
depressing air, chances for taking a great
amount of exercise in the outer  air, and
requirements  which  do not  necessitate
exhaustive efforts.  It should be borne in 
Consumption.           167
mind that in some cases over-worked indi-
viduals will find rest, by change of occu-
pation.
   As most  of the evils which accompany
the various  industrial pursuits may be cor-
rected, or at least reduced very largely,
why should not employees have the ad-
vantage which such corrections will give ?
This  is a question of right, that employ-
ers of labor should consider, and  which
governments should legislate  on, for the
good of the people.

        Dress in its Relations to Phthisis.
   It would be impossible to express the
exact ratio of causative influence that im-
proper and  insufficient dress has,  in the
production  and perpetuation of phthisis;
but if the indirect influence that impro-
priety of dress has on the general health,
and the diseased results which are due to
inadequate use of the protective proper-
ties of dress, be taken into account, then
the ratio is a considerable proportion of
all cases of  phthisis.   The principal and
most important use of dress, is to regulate 
168
Consumption.
the rate of loss of heat from  the  surface
of the body.   Its lesser use, is to  protect
parts of the body from mechanical injury,
from moisture and from excessive heat.
  Owing  to the love of adornment, and
the caprices of  fashion,  these uses are
very frequently  perverted.    If the  uses
of dress are fulfilled,  there is no legiti-
mate  reason why dress  should  not be
made a matter of artistic  study, of pleas-
ing variety and of  personal  adornment.
These  aesthetic  uses of  dress, however,
should not be primarily  considered, nor
allowed to interfere with the health of
the individual.
  That such misuse is practised  so fre-
quently, requiring unhygienic exposures
of the bodily surface, or excessive cover-
ing for it, or causing mal-forming pressure
intended to alter the  shape  that nature
has decided to be  best  adapted  to the
carrying out  of  the active functions of
human  life, is only very strong evidence
of the  lack of intellectual development,
distinguishing the men and women of the
present day. 
               Consumption.            169

   The temperature of the atmosphere in
which the majority  of  the  human race
lives, being  usually  below  that  of the
body, clothing is either conservative in
preventing a wasteful loss of heat from
it, or else it  is an absolute necessity in
preventing more  heat  from  being radi-
ated  and conveyed from  the  surface of
the body, than can be manufactured and
maintained by the chemical and mechani-
cal processes at work in the various tis-
sues.   Dress  accomplishes this purpose,
by the  interposition  of  a  good non-con-
ducting material between  the surface of
the body and the atmosphere, thus  re-
tarding the  radiation of  heat from the
body.   It also prevents  heat from being
conveyed away from  the body, by means
of fresh,  cool,  air  being  brought  too
quickly in contact with its surface.  It
must be  understood  that this  process of
intervention  is only  a comparative one.
There is hygienic  necessity  for  some
direct contact of the air with  the body,
and such  air  should  be  continuously  re-
newed,  though  with comparative slow 
170
Consumption.
ness.   Hence,  articles  of dress  should
always be more or less porous  in  their
nature, and  for  convenience,  it  is also
necessary that  dress should be  light in
weight, flexible, soft, and not  too bulky
in texture.   The  material,  the qualities
of which most universally  fulfil  these
conditions, is wool.  In itself it is a very
good  non-conductor of  heat,  and when
made up into fabrics, it entangles among
its meshes, by  reason of a  peculiar me-
chanical  or chemical  attraction  that  it
seems to possess  for gases  and vapors,
a large amount of air, which is also a
good  non-conductor of heat.    Wool pos-
sesses good wearing qualities,  and about
the only objection  to it is that it is irri-
tating to  some  delicate  skins.  As a
means of  preventing  shock,  resulting
from  sudden  changes  of  temperature,
and for the  purpose of  absorbing perspi-
ration, the  phthisical  individual  should
wear  at all  seasons of the year  woollen
under-garments, which should be made
to entirely enclose the  chest.  Such a
garment  should be worn high in the neck 
               Consumption.          171

 at  all seasons, and  should  have  long
 sleeves during cold  weather.   In warm
 weather short  sleeves may be worn with
 a considerable  amount of comfort  to the
 patient.   Part  woollen  fabrics may  be
 worn in cases where  the skin is irritable
 Cotton, next to wool, is  the best material
 for general  use  in the manufacture of
 dress.   It  is  not  so  good  a non-con-
 ductor as  wool, does  not  make up into
 such light and air entangling fabrics, and
 does not wear so well.   However,  it is of
 great  use  in the  manufacture of gar-
 ments for warm weather.  Silk and linen,
 being  better  conductors of  heat, than
 cotton,  though wearing  well,  are  not of
 much practical use to the phthisical pa-
 tient in fulfilling the office of  protection.
 Silk is less objectionable than  the latter,
 but linen under-garments and  bed-cloth-
 ing should be  carefully avoided by  the
 consumptive, as  they convey  away  the
bodily heat too rapidly, and by conducing
to chill and shock, cause too great a con-
tinuous draught  upon  the vital  forces.
The character of dress used by the phthis- 
172
Consumption.
 ical individual requires careful consider-
 ation.   It should protect the whole sur-
 face of the body sufficiently, and must not
 over-heat any particular part.  If any fav-
 oritism is shown in protecting any parts
 of  the body of the phthisical person, it
 should be the chest, because of the suscep-
 tibility of the pulmonary tissues through
 reflex  action, to temperature  changes af-
 fecting the exterior of the chest; and the
 feet, because when  they  become  cold
 through  being inadequately  clothed, or
 getting wet, rapid loss of heat follows,
 circulation in them  becomes  retarded,
 and determination of blood to  the pulmo-
 nary structures is then induced.  The av-
 erage dress of the male  of the day, has
 attained a considerable  height of hygienic
practical and aesthetic excellence.  One of
its defects is  in leaving an exposed place
over the front of the upper  part of the
chest for the  purpose  of displaying a
shirt-front that may be  more  or less im-
maculately white;  but  this  defect  can
readily be rectified, and usually is  reme-
died, among  men  of intelligence, by the 
Consumption.
*73
 wearing of a chest protector underneath,
 or a thick scarf over the shirt-front.
   More frequently the man makes a mis-
 take in wearing fashionably-shaped shoes
 of too small a size, making his feet fit
 the shoes, thus deforming the feet, giving
 himself much discomfort, and throwing a
 prominent obstacle in the way of his tak-
 ing sufficient walking exercise.  The fool-
 ishness of the  last generation in wearing
 excessively thin foot covering, is not seen
 so much in this day.  With his thick arctic
 shoe for  winter, and a thin rubber over-
 shoe for  wet summer weather,   the man
 of to-day  is usually comfortably and  hy-
 gienically  shod.  There is  still an  ad-
 vanced step for him to take  in this matter,
 and  that  is, in having the shoe  made  to
 fit the foot.  There  should be  plenty of
 room in the  shoe for the foot to  swell,  as
 it does when a  sufficiency  of pedestrian
 exercise is taken.   A little experience
will show the amount  of  room necessary
for comfort.  The foot should be meas-
ured after a brisk walk, while the blood
is attracted to it, and  the sole of  the shoe 
174           Consumption.
should be of a shape and size of the sur-
face of the foot which touches the ground,
with additional room in front of the toes,
to prevent the stubbing of those members.
   The man of phthisical tendencies should
carefully avoid  one popular custom in
dress, and that is of discarding his usual
clothing for the evening, so-called,  full-
dress suit.   There  are  few easier  ways
of  bringing on  an attack  of  pleurisy,
bronchitis or pneumonia, than to don a
thin evening suit, and to go out on a  cold
damp night,  for  an evening's amusement.
    If it must be  worn,  the  individual
should always wear a compensatory  addi-
tion of  extra under-clothing.  There are
few more  significant  evidences  of  the
advance in  general intelligence, during
the past few years, than are shown by the
sensible changes instituted in  the dress
of  children,  during that  period.    The
bare-necked,  bare-armed,   bare-legged,
thin-slippered children  of twenty years
ago, are now very rarely to be  seen.   In
fact, the clothing of young children in
the present  day, leaves  very little to be 
Consumption.            175
 desired, either  in a hygienic or aesthetic
 point of view.   The principal deficiencies
 are, in  not adding extra clothing for out-
 of-door use,  to the  rather  thinly  clad
 lower  extremities,  during cold weather;
 in not having them wear sufficiently heavy
 under-clothing  over the whole  neck and
 extremities ; and in wrapping the neck in
 furs, a  practice which  is liable to  cause
 delicacy of tissue in the neighboring parts,
 by over-heating.
   When we leave the dress of man and
 child,  and come to that of woman, what
 is there to say?  It seems all wrong, from
 the top of  the much-puffed and  tortured
 head, to the toe of the thin,  no-top  and
 almost  paper-soled slipper.  Why in the
 name  of all that is  mysterious, does a
 mother, who has  exercised  a very con-
 siderable amount  of common  sense  and
 enlightenment in clothing her young chil-
 dren, seize upon  her  daughters as they
 approach the  age of puberty, habituate
 them to customs  of dress which are in
 every way  calculated to repress healthy
life,  and to plunge  the poor  girls  into 
176
Consumption.
ill health before they  are  fully grown ?
Among our higher classes,  who have the
best opportunities  to  live healthy lives,
it  is a very  rare thing to  meet a fairly
healthy woman  of  twenty-five  years of
age ; and a still rarer sight  to see a mar-
ried woman of thirty years, who has borne
children, in possession of  fine health.
   Our American young women  are not a
class of whom,  physically speaking, our
nation  may be proud.   We do  not hesi-
tate to state our belief,  that the  follies
and misuses  of  dress,  customary  among
our women,  have  more to do  with the
production of this  state of  affairs, than
any other single cause.   Their clothing
not only deforms  them,  but  it   inade-
quately  clothes them on some parts of
the body, and over-clothes them on other
parts ;  and above all, it is an obstacle to
almost all active exercise  so necessary to
their health.   Why should  a woman pin
on the  top of her head a mass of defunct
hair, arranged with an  expense of inge-
nuity and time that would suffice to give
her a thorough training in the laws  of hy- 
Consumption.
177
giene ?  Why should she perch  upon it
some airily-constructed  arrangement  of
straw, feathers and flowers, that does not
in the least subserve the purposes of pro-
tection, but which results in entirely un-
fitting the wearer for meeting the ordinary
atmospheric  emergencies of breeze and
shower?  Why does  a  mother strap her
daughter's waist  in  a  "corded" girdle
while still a young child, and  into a corset
at fourteen years of age, and keep strap-
ping  it until  the abdominal and dorsal
muscles and  fasciae are  all  atrophied, or
wasted, and  have  lost  their functional
ability of  support; until the  intestines
are forced down into the pelvis, or  over
the brim of that bony basin, which proced-
ure gives the young  woman a pendulous
abdomen, or,  maybe, dislocation of  the
uterus,  with  consequent misery for  life ;
until the lower ribs are crushed downward
and  inward,  and the liver  and stomach
are pushed  upward and atrophied,  and
that   great blood-vessel,  the abdominal
aorta, cannot  pass half  its blood supply,
and the returning veins are  obstructedly
    12 
178
Co7isumption.
congested, and the absence of abdominal
breathing would  indicate that  the  dia-
phragm was not the chief muscle of respi-
ration ;  while  upper  thoracic  breathing
has to do the whole work of aerification
of the  blood ?   Why  do women wear
such long and such tight skirts that they
could not take a brisk walk, even if their
pulmonary organs could aerify their blood
fast enough to carry on the needed mus-
cular  exertion ?  Why  do women wear
foot apparel so constructed  that it keeps
them  standing upon  their toes ; that is
so small for them that  their toes are all
compressed   into  an   undistinguishable
heap, and that is  neither thick enough to
resist the ordinary moisture of the public
road,  nor to keep the feet warm  enough
to maintain  a  proper circulation in them ?
Why do they  wear open-work silk stock-
ings with slippers entirely  open on  the
upper surfaces of the foot,  thus  practi-
cally giving their feet no clothing at  all,
and following an almost  sure method of
inducing a determination of blood to the
pulmonary structures?  Why do phthisi- 
Consumption.            179
 cal women, when  they  are  told to wear
 woollen under-clothing, get  short-sleeved
 undershirts cut low in the neck ; and why,
 when  they want to be fully dressed, do
 they bare  so  large a part of their bodies
 to  the public  gaze?  These, and  many
 other  pertinent  questions that might be
 asked, may have reasonable answers, but
 they are beyond the ken of the  writer.
 We merely  wish to record here as our
 decided opinion, that these peculiarities
 in  women's  dress,  largely influence, di-
 rectly   or  indirectly,  the production  of
 phthisis, and that, in the successful treat-
 ment of the disease, they are  evils that
 must  be corrected.   We  do  not hesi-
 tate to  say that the putting of a corset
 on  a  young  girl of phthisical tendency
 is an action  that almost certainly  dooms
 her  to  death  from phthisis.   A very re-
 markable  thing  in  connection with the
 subject, is  that there is scarcely a woman
who ever believes  that  she  is guilty  of
tight lacing, or who can  understand that
even slight pressure upon the waist, can
bring about  malformation  in that part 
i8o
Consumption.
of the body,  or  seriously interfere with
its  functions.  There  can be no  better
visible evidence  upon this point, than  to
observe the wasting and change of con-
formation  which takes place, even in  an
adult, as the  result of an application  of
a plaster jacket.   It is true that woman
naturally  breathes more with the top  of
the chest than man, but it is not nature's
plan that breathing with the lower part of
the chest  should  be abrogated in any de-
gree, as it always is in the case of any one
who wears a corset or  a tight waist.
  Of course the tighter the constriction
around the waist, the  greater will be the
interference with the functions of breath-
ing,  etc.   No one should be willing  to
allow such an interference with the health-
ful functions of the body,  and much  less
so, any one with a phthisical tendency.
  Very often the pointing out of some
apparently  unimportant  impropriety   of
dress, as for instance, wearing insufficient
clothing around  the upper part of  the
chest, or wearing no-top slippers instead
of warm shoes, will be  the deciding influ- 
Consumption.
181
 ence that will direct the phthisical invalid
 out of the  road of  no hope,  into  the
 road leading to cure.  As in cases of pul-
 monary trouble, an additional amount of
 clothing is needed around the weak and
 sensitive  chest, it is better  to have  some
 special article  of clothing made that will
 be adapted to  the top of the chest, rather
 than to put on a large garment that will
 overheat  the  body generally.   A perfor-
 ated buckskin under-jacket  is a  conven-
 ient garment to wear ; if unperforated it
 retains too much perspiration and  viti-
 ated air.  A flannel  jacket which can be
 frequently washed, is better.   The bed-
 clothing of the phthisical should receive
 special attention.  It is better to sleep in
 a warmer atmosphere than to use a large
 amount  of  bed-clothing,  so that there
 may be a free  escape  of  the  vitiated  air
 from the surface of the body, but proper
 ventilation of  the sleeping-room should
 never be  neglected  to  gain the  point.
 Delicate children  are very liable to get
chilled by the displacement of their bed-
clothing.   This can usually be  remedied 
182
Consumption.
by tying the covers down all around the
bed, or by having  the child's night cloth-
ing made in the form of a bag; if night
drawers are used,  the legs may be made
long enough to sew up at the ends.   A
very important practice  for  the delicate
person to attend  to, is  regulating  the
amount  of  clothing, according to  the
daily temperature, as well as to the season.
Such  persons  should always carry about
with  them  sufficient clothing  to meet
sudden emergencies, and  should  never
allow themselves to become over-heated
from excessive clothing.   In taking exer-
cise, particular care should  be used  to
exercise in comparatively light  clothing,
and when resting,  to put  on additional
covering, so as to prevent the too sudden
conveying away of  the heat of  the body,
or the too sudden  evaporation of  perspi-
ration.  It must be borne in mind that
the weaker the patient, and the less active
his  circulation and heat-producing proc-
esses, the more clothing he will need to
conserve the little  heat  he may be able
to generate. 
Consumption.
183
Social Habits and Surroundings in their Relation to
                Phthisis.
  Man  is  a  social and imitative  animal.
Outside of the natural pleasure taken by
him  in  congenial  society, it  is an  abso-
lute necessity, to a certain degree, that he
should  live  in close masses,  owing to
the  extremity to  which  the principles
of the laws  relating to  the  subdivision
of labor are carried  out, in our modern
state of  civilization.   This  massing  to-
gether of human beings brings about the
evils of over-crowding in  dwellings ;  the
accumulation of  filth ;  atmospheric  con-
tamination ;  lack  of  proper food, and of
personal cleanliness ;  promiscuous sexual
intercourse,  and  a generally depressed
state of morals,  which  always becomes
prevalent  under   these   circumstances;
from  all of which  naturally follow crime
and intemperance, and venereal and other
diseases.   As the individual imitates  the
habits and customs of those who surround
him, it will be seen, that  one who is ex-
posed to  such irritating and depressing
influences as are the inevitable results of 
184
Consumption.
such a social  state,  must suffer.   Other
things being  equal, the production  of
phthisis,  and the  obstacles to its success-
ful  treatment,  are  in direct  proportion
to the social depression of a people.  If
there were no other  causative  influence
at work than that of a low  and ignorant
social state of a part of the  population,
phthisis would remain a prevalent disease.
If phthisis is to be prevented, it follows
that rigorous  regulations as to  the over-
crowding of habitations, their proper con-
struction, especially  in  regard to afford-
ing good light, ventilation, and  drainage,
and  regulations  as  to cleanliness, both
in private and  public  places, would  be
imperative necessities among the  lower
grades of society.
  Furthermore,  the  diffusion  of knowl-
edge  as  to the  hygienic conditions nec-
essary to good health, would also be im-
perative.   Examples of  such knowledge
would relate  to the art  of eating, the
laws which should  govern  the   procrea-
tive  function,  etc.   If a  cure  is  to  be
brought about in a  phthisical individual 
Consu mption.           18 5
 of low social status, his removal to favor-
 able social surroundings is an absolute ne-
 cessity.

   Individual Habits in their Relation to Phthisis.
   Man is a creature  of habit, and this  is
 not only so of a man as a complex whole,
 but it is true of each organ, or anatomical
 element entering  into his  composition.
 When a tissue becomes habituated to act-
 ing in a certain way,  it has a tendency to
 continue this manner of action, whether
 that action be  normal  or  pathological.
 This  phenomenon of habit  is  so strong,
 that it may be sent down through genera-
 tion after generation, to a far distant pos-
 terity.
   It has been before remarked that man
 is an  artificial animal, and his artificial na-
 ture has been  brought about  by the ac-
 cidentally acquired habits of individuals,
 perpetuated in their posterity.   While
 habit is largely a  matter of inheritance,
 it  can  also be  acquired,  and is  regu-
lated  in a measure  by the control of the
mind.   This being so,  the  importance 
186
Consumption.
to the phthisical  individual of correcting
habits prejudicial to himself, and of adopt-
ing others that will have a favorable in-
fluence upon  him,  becomes  manifest.
There are  a number  of  habits  which
have a direct relation to phthisis,  either
through   their  good  or evil influences.
The  individual of  phthisical  tendency
should form the habit  of taking as much
sleep  and rest during  the  twenty-four
hours, as will suffice for  the building up
and complete regeneration  of all his tis-
sues that may have been used during  the
hours  of  functional activity.   The time
which should be given to sleep and rest,
depends  entirely upon the particular ac-
tivity of the nourishing and  tissue build-
ing  processes  of the  individual.    The
slow tissue-builder needs the  most sleep,
and  as a  rule,  nervous people,  whose
tissue waste is great, also require a great
deal  of sleep.   About the only general
law that  can be  formulated on  the  sub-
ject, is that enough sleep should be taken
to refresh the  individual.   The  position
taken in sleep is  a matter of  importance. 
               Consumption.           \ 87

 The habit that some people  indulge  in,
 of sleeping in a curled up position, is not
 desirable.  The  most  healthy  position
 for the development and  maintenance of
 a good pulmonary  apparatus,  is to  lie
 flat  on the back, with the head only mod-
 erately raised.   A  correct  habit  in this
 respect should be cultivated.  Every one
 should adopt the habit of sleeping in  a
 well  ventilated room, and of airing  the
 bed-clothing thoroughly to rid it of the ex-
 cretory emanations from the body, which
 may have been absorbed during the night.
 It is well  to make a note of the beneficial
 effect and practice of sleeping in differ-
 ent under-clothing from that worn during
 the  day.   Personal cleanliness is a most
 important habit  to  be cultivated  in the
 prevention of phthisis.
   If  the  greatest purity of air  is to be
 enjoyed by the  individual,  he certainly
 has to exercise scrupulous cleanliness, not
 only as to the surface of the skin,  but as
 to the interior of his nose and mouth as
well.   Any one with a number of decayed
teeth, holding masses of putrefying food 
i88
Consumption.
between them, or with an offensive nasal
catarrh, inhales into his lungs  at every
breath, an  atmosphere that must exert a
depressing and deleterious effect upon his
general health, as  well  as  upon  the  pul-
monary organs.  Regular visits to the den-
tist,  the  use of the tooth-brush  at least
twice each  day, after each meal would be
better, and appropriate treatment of the
catarrhal trouble  will correct these  de-
fects.  Washing the body not only serves
the purpose of cleanliness, but it encour-
ages a healthy  action in the skin, which,
in phthisis, has  an  important derivative
effect.   In the prevention  of phthisis,
the regular use of the cold bath is  one
of the most  effective  means that can be
adopted.   It may be taken in any form,
but,  usually, cold  sponging  is  prefera-
ble.  This  can  be so regulated that  the
cold water  can be applied to a greater or
lesser surface of the body at one  time, at
any degree of temperature suited to the
case in hand.   A brisk rubbing with the
sponge is a most important factor in the
process.  The cold bath acts beneficially, 
Consumption.
189
 through the tonic influence of cold.   A
 certain amount of  shock is a necessity to
 the carrying out of the vital functions of
 the body.   The various organs of all ani-
 mals act responsively to the stimulus  of
 shock of one kind or another.  This is  so
 of man, from the first shock that the cold
 air of the outer world has upon the newly-
 born infant, which  causes him to give the
 first respiratory gasp, until the individual
 lies  down to die, having become so used
 to every kind of shock, that his organs,
 worn and deteriorated in shape and qual-
 ity by long use, will not take cognizance
 of anything further in the way of stimulus.
 The regularly used cold bath, not only af-
 fords a shock that has a stimulating effect
 upon the general nutritive processes, but
 it also so accustoms the individual to the
 effect of exposure to sudden cold, that he
 is very much less liable  to feel the  effect
 of undue exposures which result in the
 deleterious  " colds " so often experienced
by the phthisical individual.  It should be
noted that if the cold bath is not followed
by a reactionary glow,  it should be  dis- 
190
Consumption.
continued, or moderated in severity, as it
will then do harm by its depressing influ-
ence upon the  system.  Sea bathing is
usually more vigorous than  fresh-water
bathing.  The action of the salt water is
rather  more  irritating to  the skin than
fresh, and the buffeting  of the surf af-
fords an increased  general stimulus.   A
very beneficial bath for very  delicate in-
valids,  is  one where the  bathing fluid is
diluted alcohol.   Some of the alcohol is
absorbed through the skin, and  the after-
glow is more sure to be produced.   Long,
hot baths cannot be recommended to the
phthisical  person,  on  account  of their
depressing effect; and the hot bath,  fol-
lowed by the cold  douche, is rather  too
severe  for any  but a vigorous  person.
Hot sponging is very  useful in  checking
the sweats of phthisis.   The habit of eat-
ing proper articles of  food  must, of all
things, be  cultivated by the phthisical in-
dividual.   It is  quite  customary for thin
people to desire  those varieties  of food
that mostly go to build up the  muscular
system, while the corpulent will almost in- 
               Consumption.            191

variably evince a fondness  for  those  ali-
mentary substances  which will produce
fatty tissue.  A correct habit  in  this re-
spect can be cultivated, to a great extent,
and should never be neglected.  Further-
more, personal acquisition  of a taste for
deleterious  articles should be carefully
avoided.  Tea, coffee, and other nerve
stimulants, should be denied to the young,
and the alcohol, opium and tobacco hab-
its, avoided  at all ages.  There are some
cases in which smoking may not produce
a very perceptible injury, but the delicate
mucous membrane  lining the air passages
of the phthisical lung, is usually irritated
by the inhalation of tobacco smoke, even
if the  habit does not have a deleterious
effect upon  the nervous system, as is al-
most universally the case.   A prominent
Austrian sporting baron induced phthisis,
and died from it, through excessive smok-
ing, in order to give his family the ben-
efit of a large insurance upon his life.
  The sexual relation  may be said to be
almost always habitually abused.   Nature
has given man  ability to receive pleasure 
192
Consumption.
through the functions of the reproductive
organs, and it seems reasonable that these
functions  should  be  rightly used;  but
there is no excuse for the abuse of these
functions.   Co-habitation, under the  re-
striction of lawful wedlock, is sanctioned
by the social consent  of  all peoples, but
multitudes are continually kept in  a state
of depression and unfitness for active use-
fulness in the world, by excessive indul-
gence  in, or  abuse of  the  sexual  act.
Here again is one of the depressing influ-
ences which have an indirect, but import-
ant bearing to our subject.   Regularity
in the practice of good habits may be al-
luded to as being very desirable for the
maintenance of health on a high plane.
  It cannot  be too  strongly impressed
upon the mind of the individual of  phthis-
ical tendency, that he, of all men, must live
on such a high physical plane, if he would
avoid the disease, which is always liable
to fasten  upon  him while he is living a
life  of low physical  status.   Such a per-
son should have his meals regularly, and
should see that a daily fecal  evacuation 
Consumption.
193
takes place at a regular hour; this caution
is especially applicable to women, and to
persons of sedentary habits.   The  place
for defecation  should be so arranged in
regard to convenience and comfort, that
it should be a solicitation to the act, rath-
er than a cause for dread, as  it  so com-
monly is, in so many household establish-
ments.  He  should go to bed in season,
and  should  have  a methodical life  well
mapped out  before  him, so that he may
foresee, if possible, the  injurious  influ-
ences that he will  have to meet and pro-
vide against.   He should avoid  evening
dissipations  and  large assemblies  of all
kinds.  He should  avoid long rides in
badly  ventilated  railroad  cars;  as for
open stages and street cars, they are death-
traps for the consumptive.   In general, he
should cultivate the art of taking care of
himself.   It is astonishing to see how long
a phthisical individual will sometimes live,
if he only knows how to, and will  take
care of himself.   Patients should  form
the habit of restraining the  act of cough-
ing as much as possible, rather than to
    13 
194
Consumption.
depend upon sedative  medicines to pro-
duce a quieting effect.   It is desirable that
there should be no more coughing than is
absolutely necessary to free the air pas-
sages from accumulated mucus, etc.; and,
of course, the fewer  medicines  a patient
takes, the better it is for his stomach, and
for him.

   Ventilation and Heating in their Relations to
                Phthisis.
   It may at first seem strange that the
farming   population  of  our  Northern
States, which has within its grasp the ad-
vantages of pure air, exercise and proper
food,  should  furnish  so great  a  num-
ber who become  the victims of phthisis.
There are numerous causes which conspire
to bring  about  this  undesirable  result;
among others,  unfavorable climate, star-
vation and over-work.   Furthermore, and
notwithstanding the many advantages for
hygienic living which  they may enjoy,
the farmer and  his  family are  usually
great trespassers against  the  laws of hy-
giene.  Perhaps in  nothing else  is  this 
Consumption.
195
more forcibly illustrated, than in the poor
ventilation and over-heating of the living
rooms  ©f the family dwelling.   The usual
near vicinity of barn-yard, pig-pen, chick-
en-house,  etc., do  not conduce to great
purity  of  air in the warmer season, when
doors  and windows are  freely left open ;
but in  the cold weather, it is unusual to
see the slightest  provision  for  the en-
trance  of  pure air into,  or the egress of
foul air, from  the dwelling.   The sleep-
ing  apartments are  usually  nearly air-
tight, and so the atmosphere breathed by
the inmates is usually more or less foul,
depressing, and irritating.  Furthermore,
the apartment in  which  the family  gath-
ers,  is commonly  over-heated, while the
other parts of  the  house are  usually very
cold and damp.  Thus we have  another
cause for irritation and shock in  the ex-
tremes of  temperature to which  the  in-
mates  are subjected, in passing from the
over-heated room,  which has  had a weak-
ening tendency, to the outer  air or to the
colder  parts of the house.  The evils of
bad  ventilation  are  even worse  in the 
196
Consumption.
habitations of  the  working classes in the
cities.   The travelling public is, as a rule,
generally subjected to the evils which re-
sult from bad ventilation and heating.
   Hotels are notoriously bad in  these re-
spects, and railway stations  and cars, are
contrivances which furnish travellers with
a  supply of air, almost  entirely lacking
in good qualities, both  as to purity and
temperature.  Corporations are supposed
to be devoid of soul, and it is only here
and there  that one is far-sighted enough
to appreciate that  the good health of its
passengers  is a matter  of  sufficient im-
portance to require their attention.
   It may be stated that  there can be no
such thing as  perfect ventilation in any
closed apartment.   Nothing but exposure
to a breeze in  a pure out-of-door atmos-
phere, will  give an approach to perfec-
tion, in  this  respect.  The  quantity  of
fresh air  that should be  introduced into
an  apartment can only be generally des-
ignated.    An  individual might be  kept
alive, if  only  fifty cubic feet  an  hour
were given to him to breathe, but nothing 
Consumption.            197
short of two  thousand feet per hour, for
each  individual,  could  be considered as
giving purity of atmosphere in an occu-
pied apartment.   The  phthisical  person
should beware of becoming habituated to
the use of a deficient supply of fresh air,
and less sensitive to the ill effects which
are produced by the deprivation.
  The great  agency at work in ventilating
the habitations  of man, is the diffusive
force of gases.   Fortunately, this is so
powerful a force, that the  ordinary mate-
rials of which habitations are constructed,
offer no irresistible obstacle to  its being
carried into effect.   The process is facili-
tated by the  means of  transit offered to
the diffusing gases, by  cracks and holes,
windows,  doorways, chimney  flues,  and
special avenues  constructed for  ventilat-
ing  purposes.   If  the  dispersion  of the
effete gases and the ingress of  fresh air,
were  all that was  to be  gained by  ven-
tilation, the  process would not be diffi-
cult ; but  in  addition, organic impurities
and  watery vapor have to  be disposed of,
and  this necessity requires that a certain 
198
Consumption.
amount of motion should  be given  to
the air  in a room, or in  other words,  a
draught  has  to  be  produced.   This is
done  by means of heating  the  air  to  a
certain  degree  above that  of the  outer
atmosphere;  by the  displacing  force  of
winds; or by the mechanical processes of
forcing  or drawing out the vitiated air.
In domestic  practice, the most  conven-
ient  method  of effecting  the removal of
vitiated  air  from  apartments,   in  mild
weather, is by the free opening of doors
and  windows ;  and in cold  weather, by
the use of ventilating flues alone, or of
flues  assisted by the  apparatus  used for
heating or cooking purposes.  The flue
acts in the removal of vitiated air, either
by the suction  force  induced at  the top
of the flue by  winds, or  by the  heating
of the gaseous  contents  of the flue, in
which case the contents become lighter,
and  expanding, rise;  the  colder external
air under atmospheric pressure, forcing
the vitiated  air up the flue.   Thus it will
be seen that the air  flue  is  the analogue
of a  continuously acting air-pump.  In 
Consumption.           199
 the modern system of heating with the
 cellar furnace, provision  is usually made
 for a fresh  supply of air, by means of an
 air-duct, leading from outside the build-
 ing to the furnace chamber, where  it is
 heated, and then conducted to the differ-
 ent apartments of the house.  This air
 supply should never be  taken  from  the
 cellar, and  care should be exercised  lest
 any source  of impurity near the entrance
 to  the  air-duct should contaminate  the
 entering air current.   The cellar  should
 be  kept scrupulously neat and clean,  and
 free from  decomposable or odoriferous
 matters, as  it is almost impossible  to  pre-
 vent some of the air from the cellar from
 gaining entrance to the heating chamber
 of the heater and air conductors.
  In cases where a stove is used for heat-
 ing an apartment,  some  means for  the
 admission of fresh air must be provided.
 Either a tube  may be led  from the outer
 air and open under the stove, or a venti-
 lating  aperture  may  be  made  near  the
top  of  the  room, or a window may be
slightly lowered from the top.   This  lat- 
200
Consumption.
ter method is one of the  most  feasible
ways  of  securing  ventilation, for either
sleeping  or living rooms.   It should  al-
ways be practised  in sleeping rooms, un-
less special means for ventilation  exist.
A direct  draught from the opening upon
the sleeper should be avoided.   This can
be done by opening a window on the op-
posite side from which the wind blows, or a
board may be fitted into the upper part of
the window casing, at an angle of  forty-
five degrees, so that it will receive the
first force  of the  wind, which, being  di-
rected upward, becomes diffused and loses
its power.   The window blinds  may  be
used  for  this purpose,  the slats  being
placed at the proper angle.  If the ne-
cessities of ventilation make the room too
cold for the delicate  invalid, a fire must
furnish the necessary heat; but an  abun-
dant introduction  of fresh air  into  the
sleeping apartment must neverhe neglect-
ed  in  the  treatment  of phthisis.   The
ordinary  chimney  flue offers an excellent
means of ventilating the rooms which are
connected  with it, and  of  course acts  all 
Consumption.
201
the better,  if there is an open fire in it.
If there are plenty of loose windows  and
doors in an apartment, an active open
fire will create  such a draught, that us-
ually, sufficient  fresh  air  will be intro-
duced into the room through  the various
cracks without providing  special  means
for  its admission.  These cracks  should
not be  closed by weather strips ;  these
latter, so-called  comforts,  do  an incredi-
ble amount of mischief to the health of
the community.   It is desirable to have
at least a small avenue for the escape of
vitiated air at the top of a room, so  that
a movement of the watery vapor and or-
ganic impurities  collected  there,  may be
facilitated ; for, with only the ordinary low
openings of the chimney flue,  there is lia-
ble to be some stagnation in the air at the
top of the room.  The  household heat-
ing apparatus may be briefly considered
in this part of the subject, as its proper
use is of importance in effecting the  ven-
tilation  of habitations, as  well as  in fur-
nishing the amount of heat desirable for
the  inmates.   The method  of heating 
202
Consumption.
which will keep one in vigorous health, is
undoubtedly the open fire.   This method
of heating warms  the  body by direct ra-
diation, without injuriously heating and
drying  the  atmosphere  breathed.   It
serves  the  purpose  of keeping the air
warm enough  to prevent  a too  rapid
loss of bodily heat; its cheerfulness pro-
duces a beneficial effect through the men-
tal  faculties, and it has  the tonic  effect
produced  by a certain amount  of  irreg-
ularity in  the  supply  of heat, the  body
being alternately exposed to varying de-
grees of heat  and cold.   A baby with
an  ordinary amount  of  inherited  vigor
will  be much  more   healthy, and will
not  " take  cold " so readily,  if  it  is
reared by  the  open fire, alternately  expe-
riencing the range of  temperature which
is  found  between the hearth,  and the
colder parts of  the room near the win-
dows, than it will  if it is brought  up in
the equable temperature  of the  furnace-
heated apartment.  The  open  fire has
some disadvantages ; requiring much care
and consuming much  fuel.   It is difficult 
Consumption.
203
to  regulate  according  to  the weather,
and housekeepers object to its uncleanli-
ness,  but this  objection can  be met by
proper care and the selection  of  the  best
fuels.  Though it is the method  of heat-
ing to maintain a vigorous health status,
by itself alone it is not the best method of
heating for the delicate  phthisical invalid
in very cold weather.  For such persons, it
is too unequal in its heating qualities ; the
extremes of cold on one side,  and of  heat
on  the other, result in  too tonic and ir-
ritating an influence on  the  invalid  who
may be in the  active stage  of phthisis.
Supplemented by a supply of moderately
heated air from a properly  constructed
furnace, it  becomes the  ne plus ultra of
heating appliances for the phthisical indi-
vidual.
  The open  grate soap-stone stove  is a
compromise between a stove and a hearth
fire.  It is more easily regulated than the
latter,  less expensive  in regard  to fuel,
more  cleanly, very cheerful, and  fulfils a
very good  office  in the invalid's  room.
We are inclined to think that the stove 
204
Consumption.
 is an  apparatus that is too  often  un-
 justly abused.  No doubt there are many
 stoves that are very bad indeed, but there
 are some good ones.   It  is the only con-
 venient, and in fact  the  only feasible ap-
 paratus, for furnishing heat in cold weath-
 er,  to  people of moderate  means, in re-
 gions where fuel is expensive.  Properly
 constructed,  it  offers great advantages
 for economy in the use of fuel; is easily
 managed, so that the amount of heat pro-
 duced  can be regulated,  and withal, is  a
 very good ventilator.
  It must be understood that a stove to
 be efficiently hygienic, must  be so large
 that it  will not require overheating, and
 must have a large smoke flue provided
 for the direct escape of  the products of
 combustion.
  The damper of the smoke flue  should
be  so constructed that it can  never  en-
tirely close the flue.  If a stove  is used,
the directness of the draught is  impera-
tive, and it  is absolutely necessary,  for
the complete escape  of all  the products
of combustion and the proper ventilation 
Consumption.
205
of the apartment, that there  should  be
a considerable loss of  heat  up the chim-
ney  flue.   All those returnable  flue,  all
the  heat-saving,  patented  complex ma-
chines, so  often  called  "parlor  stoves,"
should be  avoided by the  phthisical  in-
valid, and a simple, direct draught stove,
preferably   constructed  of   soap-stone,
should  be  adopted.  In this luxurious
day, men of independent means do  not
live  on a very high physical plane.   In
fact, most  persons prefer  to live  on  a
low plane, and run the risks  consequent
upon such living, rather than to forego
the comforts and luxuries of the  present
day.  For  all such,  the household  fur-
nace is a necessity.  When  properly con-
structed, it is easy of management, cleanly
economical, and gives  the whole  interior
of the house  the balmy atmosphere of
summer.
  The best, but most expensive appliance
of this  kind,  is  the  hot water  furnace.
This  consists  of a heater and radiators
containing  water, which  may be  heated
to any degree under 2120 F.   Usually 
206
Consumption.
a separate set of radiators is placed in an
air-heating chamber under  the flue that
leads to each  apartment.   This apparatus
furnishes a mildly heated, moist and very
pure air.  It  is very  expensive to intro-
duce, but it is the most economical in use,
and  gives a  more continuously equable,
easily regulated heat than any other heat-
ing contrivance.  The first cost of the
steam  furnace is less, but  it is  inferior,
being difficult to regulate in the produc-
tion  of mild degrees of heat, and is liable
to accident from explosion.  The steam
heater, with radiators introduced into the
sleeping and living apartments,  without
any provision being made for ventilation,
is  about the  most  unhygienic  heating
apparatus known.   If open  fires are used
with it, it  answers  well  in those cases
where  it is difficult to convey heated  air
through flues.   The  most  universally
adaptable furnace, because  of  its  reason-
able first cost and its ease of management,
is the iron furnace.  If properly construct-
ed, it supplies heated air of  a fair quality.
It should always be so  large that  it will 
Consumption.
207
not require over-heating, and it should be
frequently examined to discover any de-
fects.  It should have a large  escape flue
with a  powerful  draught,  so  that  there
may be a complete and  speedy escape  of
the products of combustion, and it should
always be so arranged as to supply moist-
ure to the heated air, which would other-
wise be too  dry, and exert a  deleterious
effect upon the surfaces of the body, both
external and respiratory.  These precau-
tions being taken, the iron furnace  is, by
no  means, the demon  of  general patho-
logical production, that some would have
us  believe.    Phthisical  individuals,  in
changing to winter climates,  should re-
member  that at even the mildest of our
Atlantic  coast resorts, they  may  expe-
rience  periods  of severely cold  weather,
and meet such contingency by providing
themselves with a proper  heating  appa-
ratus and a supply of fuel. 
    THE OFFICE OF MEDICINES IN THE
        TREATMENT OF PHTHISIS.

   It has  been the earnest  hope of the
medical profession, as well as of others, in
times  past  and present, that  some  spe-
cific remedial cure for phthisis might be
found.  The  finding of such a  boon is
something to be devoutly desired.  Many
remedies  have been brought forward as
supposable specific cures for the  malady,
but  all have  proved disappointing.  At
the  present time  there  seems but little
prospect of the discovery of such a reme-
dial treasure-trove.  In the treatment of
phthisis the use of medicines subserves a
subordinate part in comparison with hy-
gienic therapeutics; but such use is so
important, that it must  not  be disregard-
ed.  Although medicine is not given with
the direct view of a specific influence on
the  disease,  it  may be  most advanta-
geously administered with a view of pro-
moting the building up and  the  mainte-
                  208 
Consumption.            209
 nance of the bodily tissues in that elevated
 health status which is our  only hope for
 staying the progress of the phthisical proc-
 ess.   In  multitudes  of  cases, successful
 treatment depends upon the co-operative
 aid of medicaments,  in  conjunction with
 the general hygienic treatment.  Millions
 of human beings could be saved from  the
 ravages of this disease, if a simple tonic
 could be administered to them, at just  the
 right period.  The temporary help which
 they  would receive at  this critical  time,
 would give the  pulmonary tissues suffi-
 cient ability to resist  the commencing ac-
 tion of the disorder.  The giving of medi-
 cines in these  cases, is mostly for  the
 purpose of improving the general nutri-
 tion of  the  patient.   In  administering
 drugs to the phthisical person, the use of
 opium, or of any substance that will have
 a deleterious effect upon the general sys-
 tem  must  be  avoided as far as possible,
 and  only  adopted as  a last  resource.
 Above all, care should be taken not to use
any drug  which will  injure the stomach.
Among the undesirable conditions which
    14 
210
Consumption.
can be advantageously combated through
the agency  of  the  Materia  Medica, are
the following:—Individually peculiar, bad
nutritive conditions.  Poor, low states of
nutrition, with weak  heart   action, etc.
Acute  bronchial  and  pleuritic  attacks.
Painful conditions of the chest walls. Ex-
cessive cough and expectoration  of offen-
sive decomposing matter. High tempera-
ture and sweating.  Accompanying laryn-
gitis.   Sleeplessness.  Loss  of  strength
and vital action.
  Prominent  among  the  medicaments
used in this disease, are alcohol,  quinine,
cod-liver oil, opium, etc.  Though  opin-
ions may differ as to  the expediency of
giving alcohol to the phthisical patient as
a beverage,  there can  be no  doubt as to
its value when  administered  medicinally.
It is given to support the patient during
very low conditions ; for  its  anodyne ef-
fect ;  to reduce heat and to  repress too
active tissue  changes;  to  support  and
stimulate the  heart's action ;   to aid de-
ficient digestive ability ; to afford a little
additional force and energy,  and  to in- 
Consumption.
211
crease the circulation at the surface of the
body.
   Quinine, or  the similar cinchona alka-
loids,  may be used in small doses,  for
their tonic effects.  In large doses, they
are highly prized  for their efficacy in con-
trolling the temperature, sweats, and local
diseased process in the lungs.   In acute
cases  they do not seem to possess  so
much  power in controlling the tempera-
ture.
   The Iron preparations are useful  for
their general  nutritive effect,  being es-
pecially indicated for  patients who have
poor, thin  blood.
   Cod-Liver Oil is valuable  not  only as
a food, but also because of its medicinally
tonic and other influences. It thus fulfils a
two-fold  purpose;  for while its fatty ele-
ments are  utilized as a food, the peculiar
principles  which  it  contains, exert their
tonic and  otherwise generally  beneficial
nutritive effects.   It sometimes improves
digestion and controls the diarrhoea, while
at other times it has a contrary  effect.
   Opium will allay excessive cough, give 
212
Consumption.
sleep, and may be used for its stimulating
effect in case of need.  With chalk and
other ingredients, it is used for the diar-
rhoea.   It is valuable  in mixtures, and is
used in the  form of sprays for local appli-
cations  to  the  larynx and  trachea.   It
should never be given until the failure of
milder remedies necessitates its use, and
it should be administered at the  start in
the smallest doses that  will produce the
desired  effect.
  Oxygen Gas is variously rated as a bene-
ficial agent  in  the treatment of phthisis.
In some cases, the effect of its inhalation
is very good.   It appears to succeed fet-
ter with the phlegmatic, than it does with
nervous individuals.   It gives the  patient
some  increased force,  and stimulates the
general  system.   Three or four  gallons
are breathed each day.   It is administered
from an elastic bag, which has a  breath-
ing  tube to  be applied to one nostril,  air
being breathed at the same time through
the other.
  The Hypophosphitcs of lime  and soda
have had  an  extensive  reputation  as a 
Consumption.
213
 specific remedy for phthisis.   This reme-
 dy seems to have succeeded better in the
 hands  of  its  introducer, Dr.  Churchill,
 than in the  practice  of the  profession
 generally.  However,  this medicine, be-
 sides furnishing phosphates to the body,
 is a good general tonic;  it sometimes im-
 proves intestinal digestion,  and  not  in-
 frequently  acts  beneficially  through  its
 psychical influence.
   In correcting individttally peculiar mal-
 nutritive conditions, each  case must  in-
 stigate the selection of  remedies appro-
 priate to its needs.
   In poor,  low states  of nutrition, with
poor heart action, etc., we can bring a long
 list of remedial agents to bear, including
 cod-liver oil, iron, quinine, digitalis, arse-
 nic, the simple bitters and aromatics, pep-
 sine, and pancreatine,  alcohol, the phos-
 phates, hydrochloric and lactic acid, etc.,
 etc.   When there  is deficient digestion
 of the starches, diastase  is indicated.  It
 may be given  in the form of malted bar-
 ley,  or of the  fluid malt extracts.
   In correcting  disordered conditions of 
214
Consumption.
 the digestive organs, good effects are often
 produced  by bismuth, hydrocyanic acid,
 nux  vomica,  the  mineral  acids,  silver
 oxide,  astringents,  laxatives,  etc.  Raw
 scraped beef  is  frequently of service  in
 controlling vomiting ;  part of a teaspoon-
 ful being given  at  one time in sandwich
 form.
   Acute Bronchitis and Pleurisy can be
 decidedly ameliorated, and even cured by
 our  pharmacopoeia.  We  are inclined to
 think that physicians as a rule  are liable
 to give too little consideration  to  ordi-
 nary  colds or bronchial attacks, regard-
 ing them  as  of  no great consequence.
 In  cases  of  phthisis,  their  prompt and
 thorough treatment is  of great impor-
 tance.   Usually,  if  a person  appreciates
 the approach of the period of chill which
 indicates the taking of a cold, the result
 can be  aborted  by immediately taking a
 large  dose of some alcoholic beverage.
 Even if a  cold  be under headway,  it
can be limited to a small  portion of its
natural course by energetic internal treat-
ment  and  local  application of appropri- 
Consumption.
215
ate remedies.  Chronic  bronchitis is al-
ways  an accompaniment of the  chronic
phthisical  process, and  its proper treat-
ment  by the inhalation of appropriate
astringents and other sprays, should al-
ways  be practised.  This  diseased  proc-
ess can  be effectually  held  in  control
and will assist most materially in bringing
about a cure of the more serious condi-
tion.
   The coincident pleurisy and pains in the
chest may be relieved by  belladonna, mus-
tard or pepper-plasters,  dry cups, flying
blisters,  iodine,  or by  hot  applications,
either wet  or dry.  The former may be an
application of turpentine and hot water,
and the latter may be in  the  form of a
rubber  bag  of  hot water, or  a  bag of
hot salt.   Ironing the painful spot with
a hot  smoothing-iron, is also  a conven-
ient method of relieving this troublesome
symptom.
  Excessive  cough and  expectoration of
offensive decomposing matter.—A  certain
amount of cough is  absolutely necessary
to relieve the air passages  of superfluous 
2l6
Consumption.
matters which may be the result of either
healthy, or diseased action ; but when the
cough is harassing, prevents rest, and is
painful, it should  be controlled;  and for
this  purpose,  there  may  be used locally
or internally,  chloroform, conium, aether,
hyoscyamus,  hydrocyanic  acid,  chloral
and  the  bromides, and in extreme need,
opium.   In regard to  the expectoration,
internal  medication may be used in con-
junction  with the inhalation of atomized
sprays, using  for the latter, solutions  of
the alkalies, arsenic, carbolic  acid,  per-
manganate  of potash,  benzoin, creosote,
ipecacuhana, iodine, turpentine, the astrin-
gents, etc.
   The high  temperature and excessive
sweating may be mitigated by giving large
doses of  quinine,  or  the salicylic com-
pounds, for the former; and for the lat-
ter, by bathing  the surface  of  the body
with alcohol,  astringents, weak acids,  or
by hot sponging in conjunction with the
internal  administration  of belladonna,
chloral, quinine  and digitalis.
  In treating the Chronic Laryngitis that 
                Consu mpt ion.             217

 may accompany phthisis, the local appli-
 cations  should  be  made by a physician
 who is  familiar with such work.   The
 amount of relief which  can be offered to
 the  patient having this particular  compli-
 cation, is of inestimable value. The train-
 ed physician  can make  direct  cleansing,
 astringent, sedative and  soothing applica-
 tions to the diseased spots ;  or inhalations
 may be taken  by the  patient  himself,
 which afford great relief.*
   Refreshing  sleep is absolutely necessary
 to the patient, and to secure it, resource
 to all the hypnotics,  even  including  the
 opium compounds,  is justifiable.
   Failure of strength and vital action.—
 Although we  depend mostly  upon  gen-
 eral  hygienic  principles  to combat  this
 tendency, the various  medicinal  heart
 stimulants, such as ammonia, alcohol,  etc.,
 are of great assistance.
  * The newly discovered local  anaesthetic Cocaine will prob-
 ably prove to be of great value in these cases.  The condition
 may be so painful as to prevent swallowing, yet a slight spray
 of Cocaine on the diseased parts will absolutely relieve the
pain and thus allow of a sufficient nutritive supply being swal-
lowed. 
THE POLITICAL DUTY OF THE PEOPLE IN
        RELATION  TO PHTHISIS.

  The lay portion of the community has
a duty to  perform in regard  to the enor-
mous production  of phthisis, and its  ter-
rible  results  in  civilized  communities.
Every individual  should be  ready  to do
his part in connection with this duty.  It
is unfortunate that so important a duty
should only receive general attention and
interest.   The medical  profession may
raise its voice, but the decisive action that
will control this malady, must come from an
instructed, enlightened populace.    Pop-
ular governments are merely instituted to
carry out  such measures  as  will be con-
ducive to the welfare  of  the people.
They are  the  people's executive commit-
tees, so to speak.
  Among the other duties of such a gov-
ernment,  is  that  of providing for  the
sanitary welfare of the people who have
created it.  The  best governments have
                  218 
Consumption.
219
recognized this duty in the appointment ot
medical departments  that shall have this
matter in charge.   Of course it is a debat-
able question as to how far such a depart-
ment should extend its influence  for the
sanitary elevation of a people.   Our own
national health department, so far, seems
mostly  to have restricted its office to
merely protecting the people from outside
malign  influence.  The writer is of the
decided opinion that a government falls
short of its duty, if it  does not carry its
influence by instruction, and if necessary
by  enforced  regulations, into the  daily
habits of life among the people.  When
it is  considered that  about  a hundred
thousand  of the citizens of the  United
States die yearly from phthisis alone,  is
it not reprehensible that our government
should not be actively at work, in spread-
ing abroad the  information,  and in en-
forcing  those  sanitary regulations, which
would lead not  only  to a great decrease
in  this death rate, from phthisis, as well
as from other diseases, but which would
also afford incalculable alleviation to all 
220
Consumption.
 the attendant misery that  such a state of
 ignorance, or wilful wrong-living spreads
 abroad through the land?
   The great majority of our people, be-
 ing by reason of the  social conditions
 which  surround them, unable  to  attain
 the knowledge which would relieve them
 from  this particular scourge of  phthisis,
 and enable them to escape  from the in-
 fluences producing it, have a right to ex-
 pect from government such action as will
 correct so great an evil.  An enlightened
 government owes to its people, such reg-
 ulation of the marriage relation, that the
 production of worthless progeny would be
 brought down  to the smallest  possible
 per centum.   It should provide for its
 people practical methods, through which
 sanitary knowledge might be brought with-
 in the reach, and if need be, even enforced
 upon  each and  every individual of its
 population.   It should see  that its  peo-
 ple are not allowed  to  dwell in badly
drained,  or over-crowded localities, that
the poorer  classes  should have decent
habitations ;  enough  food  to eat ;  that 
Consumption.           221
industry should be enforced, if necessary ;
and that the managers of deleterious in-
dustries should be caused to take all prac-
ticable  precautions  against  those influ-
ences causative of disease.
  Until such a state of affairs is brought
about, no great decrease in the phthisical
death-rate is to be expected. 
CONCLUSION.
  As a general deduction from what has
been written, it will be just to add that
the  treatment  of  phthisis is not  one
of simple routine ; but that it is one  of
close attention  to  many small  matters.
We  have merely touched on many  of
these points in  the previous  pages, but
the reader  must  not  conclude that any
one  of them is  unimportant.  Further-
more, the treatment of phthisis requires
the application  of a large amount of gen-
eral  knowledge  and  experience, seldom
possessed by any one but the trained phy-
sician.  The success  of such a physician
in his treatment, depends largely upon
the ingenuity and skill with which he  ap-
plies  his general knowledge  and  experi-
ence, in the treatment of the case  in hand.
As no two  individuals are just  alike in
their structure,  or in the  method  of their
lives, or  their diseased processes entirely
                  222 
Consumption.
223
similar, or the  causes  which have  pro-
duced  their malady the same, all do  not
require the same treatment.   Also, if a
cure is to  be  effected, the  patient must
be surrounded with conditions which  are
at least fairly favorable for the attainment
of such a result.  Above  all, in  the gen-
eral treatment of phthisis, the main ideas
to be kept  prominently in view  are,  that
mal-nutrition, atmospheric contamination,
and unhygienic habit, must  be combated
and corrected.
 
 
 
 
 
NLM051092397