Health, or, How to Live

CAUSES OF CONSUMPTION

SIR JAMES CLARK says, “It may be fairly questioned, whether the proportion of cures of confirmed consumption is greater at the present day than in the time of Hippocrates; and although the public may continue to be the dupes of boasting charlatans, I am persuaded that no essential progress has been made or can be made in the cure of consumption, until the disease has been treated upon different principles from what it hitherto has been. If the labor and ingenuity which have been misapplied in fruitless efforts to cure an irremediable condition of the lungs, had been rightly directed to the investigation of the causes and nature of tuberculous disease, the subject of our inquiry would have been regarded in a very different light, from that in which it is at the present period.” HHTL 213.1

While I shall not attempt a discussion of all the causes of phthisis pulmonalis, I shall, in a brief and familiar way, consider the more obvious sources of this terrible malady, and particularly those which all classes — even the poorest — may remove or avoid. HHTL 213.2

IMPURE AIR A CAUSE OF CONSUMPTION. — In discussing the causes of disease, whose principal expression is in the lungs, nothing can be more legitimate than a consideration of the air we breathe. In full respiration, it penetrates every one of the many millions of air-cells. HHTL 213.3

DUST. — Every species of dust must prove injurious. Workers in those factories where tools are ground and polished, soon die of pulmonary disease. The dust of cotton and woolen factories, that of the street and that which is constantly rising from our carpets, are all mischievous. M. Benoiston found among cotton spinners the mortality from consumption, 18 per thousand per annum; coal men, 41; those breathing an atmosphere charged with mineral dust, 30; dust from animal matter, as hair, wool, bristles, feathers, 54 per thousand; of these last the greatest mortality was among workers in feathers; least among workers in wool. The average liability to consumption among persons breathing the kinds of dust named, was 24 per thousand, or 2-40 per cent. In a community where many flints were made, there was great mortality from consumption, the average length of life being only 19 years. HHTL 213.4

GASES. — Among the poisonous gases which infect our atmosphere, carbonic acid deserves special consideration. The principal result of all respiration and combustion, it exists in minute quantities everywhere, but when it accumulates to the extent of two or three per cent., it seriously compromises health. I have seen the last half of an eloquent sermon entirely lost on the congregation. Carbonic acid had so accumulated, that it operated like a moderate dose of opium. No peroration would arouse them. Nothing but open windows could start life’s currents. In lectures before Lyceums, I often have a quarrel with the managers about ventilation. There is, even among the more intelligent, a strange indifference to the subject. HHTL 214.1

As this work is not designed to guide architects in the construction of buildings, I will not indicate, as I have done in another work, the best known means for ventilation. HHTL 214.2

The following fact graphically illustrates the influence of carbonic acid on human life. HHTL 214.3

THE SUICIDE. — A young Frenchman, M. Deal, finding his hopes of cutting a figure in the world rather dubious, resolved to commit suicide, but, that he might not leave the world without producing a sensation, and flourishing in the newspapers, he resolved to kill himself with carbonic acid. So, shutting himself in a close room, he succeeded in his purpose, leaving to the world the following account, which was found near his dead body the next morning: HHTL 214.4

“I have thought it useful in the interest of science to make known the effects of charcoal upon man. I place a lamp, a candle, and a watch on my table, and commence the ceremony. HHTL 214.5

“It is a quarter past ten; I have just lighted the stove; the charcoal burns feebly. HHTL 214.6

“Twenty minutes past ten; the pulse is calm, and beats at its usual rate. HHTL 215.1

“Thirty minutes past ten; a thick vapor gradually fills the room: the candle is nearly extinguished; I begin to feel a violent headache; my eyes fill with tears; I feel a general sense of discomfort; the pulse is agitated. HHTL 215.2

“Forty minutes past ten; my candle has gone out; the lamp still burns; the veins at my temple throb as if they would burst; I feel very sleepy; I suffer horribly in the stomach; my pulse is at eighty. HHTL 215.3

“Fifty minutes past ten; I am almost stifled; strange ideas assail me.... I can scarcely breathe.... I shall not go far.... There are symptoms of madness.... HHTL 215.4

“Sixty minutes past ten; I can scarcely write ... my sight is troubled.... My lamp is going out.... I did not think it would be such agony to die.... Ten ... Here followed some quite illegible characters. Life had ebbed. On the following morning he was found on the floor.” HHTL 215.5

THE BLACK HOLE OF CALCUTTA. — The famous case of the “Black Hole of Calcutta” has been so universally read that the facts are new to none; but the version of that terrible affair, by Mr. HOLWELL, may be new to some of my readers. I believe no similar fact serves so well to impress the subject upon the public mind, and therefore reproduce his account, which appeared in the Annual Register for 1758. HHTL 215.6

“Figure to yourself the situation of a hundred and forty-six wretches, exhausted by continual fatigue and action, crammed together in a cube of eighteen feet, in a close sultry night in Bengal, shut up to the eastward and southward (the only quarters whence air could reach us) by dead walls, and by a wall and door to the north, open only to the westward by two windows strongly barred with iron, from which we could receive scarce any circulation of fresh air. We had been but a few minutes confined before every one fell into a perspiration so profuse, you can form no idea of it. This brought on a raging thirst, which increased in proportion as the body was drained of its moisture. Various expedients were thought of to give more room and air. To gain the former it was moved to put off their clothes; this was approved as a happy motion, and in a few moments every one was stripped — myself, Mr. Court, and the two young gentlemen by me, excepted. For a little while they flattered themselves with having gained a mighty advantage; every hat was put in motion to gain a circulation of air, and Mr. Baillie proposed that every man should sit down on his hams. This expedient was several times put in practice, and at each time many of the poor creatures whose natural strength was less than that of others, or who had been more exhausted, could not immediately recover their legs when the word was given to rise — fell to rise no more, for they were instantly trod to death or suffocated. When the whole body sat down, they were so closely wedged together, that they were obliged to use many efforts before they could get up again. Before nine o’clock every man’s thirst grew intolerable, and respiration difficult. Efforts were made to force the door, but in vain. Many insults were used to the guard to provoke them to fire on us. For my own part, I hitherto felt little pain or uneasiness, but what resulted from my anxiety for the sufferings of those within. By keeping my face close between two of the bars, I obtained air enough to give my lungs easy play, though my perspiration was excessive, and thirst commencing. At this period, so strong a urinous volatile effluvia came from the prison, that I was not able to turn my head that way for more than a few seconds at a time. HHTL 215.7

“Now everybody, except those situated in and near the windows, began to grow outrageous, and many delirious. Water! water! became the general cry. An old Jemmantdaar, taking pity on us, ordered the people to bring us some skins of water. This was what I dreaded. I foresaw it would prove the ruin of the small chance left us, and essayed many times to speak to him privately to forbid it being brought; but the clamor was so loud it became impossible. The water appeared. Words cannot paint the universal agitation and raving, the sight of it threw us into. I flattered myself that some, by preserving an equal temper of mind, might outlive the night; but now the reflection that gave me the greatest pain was, that I saw no possibility of one escaping to tell the dismal tale. Until the water came, I had not myself suffered much from thirst, which instantly grew excessive. We had no means of conveying it into the prison but by hats forced through the bars; and thus myself, and Coles, and Scott, supplied them as fast as possible. But those who have experienced intense thirst, or are acquainted with the cause of nature of this appetite, will be sufficiently sensible it could receive no more than a momentary alleviation; the cause still subsisted. Though we brought full hats through the bars, there ensued such violent struggles and frequent contests to get it, that before it reached the lips of any one, there would be scarcely a small teacupful left in them. These supplies, like sprinkling water on fire, only seemed to feed the flame. Oh! my dear sir, how shall I give you a just conception of what I felt at the cries and cravings of those in the remoter parts of the prison, who could not entertain a probable hope of obtaining a drop, yet could not divest themselves of expectation, however unavailing, calling on me by the tender considerations of affection and friendship. The confusion now became general and horrid. Several quitted the other window (the only chance they had for life) to force their way to the water, and the throng and press upon the window was beyond bearing; many, forcing their way from the further part of the room, pressed down those in the passage who had less strength, and trampled them to death. HHTL 216.1

“From about nine to eleven I sustained this cruel scene, still supplying them with water, though my legs were almost broke with the weight against them. By this time I myself was nearly pressed to death, and my two companions, with Mr. Parker, who had forced himself to the window, were really so. At last I became so pressed and wedged up, I was deprived of all motion. Determined now to give everything up, I called to them, as a last instance of their regard, that they would relieve the pressure upon me, and permit me to retire out of the window to die in quiet. They gave way, and with much difficulty I forced a passage into the center of the prison, where the throng was less by the many dead, amounting to one-third, and the numbers who flocked to the windows; for by this time they had water also at the other window. I laid myself down on some of the dead, and recommending myself to Heaven, had the comfort of thinking my sufferings could have no long duration. My thirst now grew insupportable, and the difficulty of breathing much increased; and I had not remained in this situation ten minutes before I was seized with a pain in my breast, and palpitation of heart, both to the most exquisite degree. These obliged me to get up again, but still the pain, palpitation, and difficulty of breathing increased. I retained my senses notwithstanding, and had the grief to see death not so near me as I had hoped, but could no longer bear the pains I suffered, without attempting relief, which I knew fresh air would and could only give me. I instantly determined to push for the window opposite me, and by an effort of double the strength I ever before possessed, gained the third rank at it — with one hand seized a bar, and by that means gained a second, though I think there were at least six or seven ranks between me and the window. In a few moments the pain, palpitation, and difficulty of breathing ceased, but the thirst continued intolerable. I called aloud, ‘Water, for God’s sake!’ I had been concluded dead; but as soon as the men found me amongst them, they still had the respect and tenderness for me to cry out ‘Give him water’! nor would one of them at the window attempt to touch it till I had drunk. But from the water I had no relief; my thirst rather increased by it; so I determined to drink no more, but patiently wait the event. I kept my mouth moist from time to time by sucking the perspiration out of my shirt sleeves, and catching the drops as they fell like heavy rain from my head and face; you can hardly imagine how unhappy I was if any of them escaped my mouth.... I was observed by one of my companions on the right, in the expedient of allaying my thirst by sucking my shirt sleeve. He took the hint, and robbed me from time to time of a considerable part of my store, though after I detected him, I had the address to begin on that sleeve first when I thought my reservoirs were sufficiently replenished, and our mouths and noses often met in contact. This man was one of the few who escaped death, and he has since paid me the compliment of assuring me, he believed he owed his life to the many comfortable draughts he had from my sleeves. No Bristol water could be more soft or pleasant than what arose from perspiration. HHTL 217.1

“By half-past eleven, the much greater number of those living were in an outrageous delirium, and others quite ungovernable; few retaining any calmness but the ranks near the windows. They now all found that water, instead of relieving their uneasiness, rather heightened it, and Air! air! was the general cry. Every insult that could be devised against the guard was repeated to provoke them to fire on us, every man that could, rushing tumultuously towards the windows with eager hopes of meeting the first shot. But these falling, they, whose strength and spirits were quite exhausted, laid themselves down, and quietly expired upon their fellows; others, who had yet some strength and vigor left, made a last effort for the windows, and several succeeded by leaping and scrambling over the backs and heads of those in the first ranks, and got hold of the bars, from which there was no removing them. Many to the right and left sunk with the violent pressure, and were soon suffocated; for now a steam arose from the living and the dead, which effected us in all its circumstances, as if we were forcibly held by our heads over a bowl of strong volatile spirit of hartshorn until suffocated; nor could the effluvia of the one be distinguished from the other. I need not ask your commiseration when I tell you in this plight, from half an hour after eleven till two in the morning, I sustained the weight of a heavy man with his knees on my back, and the pressure of his whole body on my head; a Dutch sergeant, who had taken his seat on my left shoulder, and a black soldier bearing on my right: all which nothing would have enabled me to support, but the props and pressure equally sustaining me all round. The two latter I frequently dislodged by shifting my hold on the bars, and driving my knuckles into their ribs; but my friend above stuck fast, and, as he held by two bars, was immovable. The repeated trials I made to dislodge this insufferable incumbrance upon me, at last quite exhausted me, and toward two o’clock, finding I must quit the window or sink where I was, I resolved on the former, having borne truly, for the sake of others, infinitely more for life than the best of it is worth. HHTL 219.1

“I was at this time sensible of no pain, and little uneasiness. I found a stupor coming on apace, and laid myself down by that gallant old man, the Rev. Jervas Bellamy, who lay dead with his son, the lieutenant, hand in hand, near the southernmost wall of the prison. Of what passed in the interval, to the time of resurrection from this hole of horrors, I can give no account.” HHTL 220.1

At six in the morning the door was opened, when only twenty-three out of the hundred and forty-six still breathed. These were subsequently revived. HHTL 220.2

As the subject of ventilation stands first in importance among those bearing on the prevention of consumption, I give one additional fact. HHTL 220.3

STEAMER “LONDONDERRY.” This steamer left Liverpool for Sligo, on Friday, Dec. 2nd, 1848, with two-hundred passengers, mostly emigrants. A storm soon came on. The Captain ordered the passengers into the steerage cabin, which was eighteen feet long, eleven wide, and seven high. The hatches were closed, and a tarpaulin fastened over this only entrance to the cabin. HHTL 220.4

The poor creatures were now condemned to breathe the same air over and over again. Then followed a dreadful scene. The groans of the dying, the curses and shrieks of those not yet in the agonies of death, must have been inconceivably horrible. The struggling mass at length burst open the hatches, and the mate was called to gaze at the fearful spectacle. Seventy-two were already dead, many were dying, their bodies convulsed, the blood starting from their nostrils, eyes and ears. HHTL 220.5

It does not appear that the Captain designed to suffocate his passengers, but that he was simply ignorant of the fact that air which has passed to and fro in the lungs, becomes a deadly poison. HHTL 221.1

The “Black Hole of Calcutta,” the “Steamer Londonderry,” and a thousand other instances where immediate death has resulted from carbonic acid, constitute a terrible chapter in human suffering and death; but they are all as nothing compared with the millions who nightly sleep in unventilated rooms, from which they escape with life, but not without serious injury. As a medical man, I have visited thousands of sick rooms, and have not found in one hundred of them a pure atmosphere. I have often returned from church, seriously doubting whether I had not committed a sin, in exposing myself to its poisonous air. There are in our great cities, churches costing $50,000, in the construction of which not fifty cents were expended in providing means for ventilation. Ten thousand dollars for ornament, but not ten cents for pure air. Parlors with furnace heat and many gas-burners (each of which consumes as much oxygen as several men) are made as close as possible, and a party of ladies and gentlemen spend half the night in them. In 1861 I visited a Legislative Hall. The Legislature was in session. I remained half an hour in the most impure air I ever attempted to breathe. If the laws, which emanated from such an atmosphere, were good, it is a remarkable instance of the mental and moral rising above a depraved physical. HHTL 221.2

Our school-houses are, some of them, so vile in this respect, that I would prefer to have my son remain in utter ignorance of books, rather than to breathe during six hours of every day, such a poisonous atmosphere. Theatres and Concert rooms are so foul, that only reckless people continue to visit them. Twelve hours in a railway car exhaust one, not because of the sitting, but because of the devitalized air. While crossing the ocean in the Cunard “Africa” and again in the Collins “Baltic,” I was constantly amazed that men who knew enough to construct such noble ships, did not know enough to furnish air to the passengers. The distresses of sea-sickness are greatly intensified by the sickening atmosphere which pervades the ship. Were carbonic acid black, what a contrast would be presented between the air of our hotels and their elaborate ornamentation. HHTL 221.3

It is hardly necessary to say, that every place I have mentioned, might be cheaply and completely ventilated. HHTL 222.1

A writer in Chambers’ Journal, in reviewing the first volume of the Health of Town’s Commission, says: HHTL 222.2

“The startling facts brought forward as to the creation, we may call it, of scrofulous affections by impure air, are new, and present some of the gloomiest features of the volume, inasmuch as they prove the fatal effects of the pernicious influences complained of, in the existence of a deteriorating population, diseased in themselves, and bequeathing disease to a still more wretched posterity. Joseph Toynbee, Esq., one of the witnesses examined, appears to have devoted special attention to this part of the subject. On being asked as to his observation of ‘the effect of defective ventilation,’ he replies — ‘The defective ventilation appears to me to be the principal cause of the scrofulous affections, which abound to an enormous extent amongst our patients. When I have had a scrofulous patient come before me, I have always been able to trace this as one of the agents.’ He cites the work of a French physician, M. Boudeloque, in which it is stated ‘that the repeated respiration of the same atmosphere is the cause of scrofula; that, if there be entirely pure air, there may be bad food, bad clothing, and want of personal cleanliness, but that scrofulous disease cannot exist.’ The following facts are further quoted:— ‘The development of scrofula is constantly preceded by the sojourn, more or less prolonged, in air which is not sufficiently freshened. It is impossible to deny that hereditary disposition, the lymphatic temperament, uncleanliness, want of clothing, bad food, cold and humid air, are of themselves circumstances non-effective for the production of scrofula.” HHTL 222.3

” ‘When it is seen, on the other hand, that this disease never attacks persons who pass their lives in the open air, and manifests itself always when they abide in an air which is unrenewed, and this, whatever may be the extent of other causes, it appears evident that the non-renewel of the air is a necessary condition in the production of scrofula. Invariably, it will be found on examination, that a truly scrofulous disease is caused by a vitiated air, and it is not always necessary that there should have been a prolonged stay in such an atmosphere. Often a few hours each day is sufficient; and it is thus that persons may live in the most healthy country, pass the greater part of the day in the open air, and yet become scrofulous, because of sleeping in a confined place, where the air has not been renewed. This is the case with many shepherds. It is usual to attribute scrofula, in their case, to exposure to storms, and atmospheric changes, and to humidity. But attention has not been paid to the circumstance that they pass the night in a confined hut, which they transport from place to place, and which protects them from wet; this hut has only a small door, which is closed when they enter, and remains closed also during the day; six or eight hours passed daily in a vitiated air, and which no draught ever renews, is the true cause of their disease. I have spoken of the bad habit of sleeping with the head under the clothes, and the insalubrity of the classes where a number of children are assembled together.’ “ HHTL 223.1

“An instance is adduced in corroboration: ‘At three leagues from Amiens, lies the village of Oresmeaux; it is situated in a vast plain, open on every side, and elevated more than 100 feet above the neighboring valleys. About sixty years ago, most of the houses were built of clay, and had no windows; they were lighted by one or two panes of glass fixed in the wall; none of the floors, sometimes many feet below the level of the street, were paved. The ceilings were low; the greater part of the inhabitants were engaged in weaving. A few holes in the wall, which were closed at will by means of a plank, scarcely permitted the air and light to penetrate into the workshop. Humidity was thought necessary to keep the threads fresh. Nearly all the inhabitants were seized with scrofula, and many families, continually ravaged by that malady, became extinct; their last members, as they write me, died, rotten with scrofula.’ “ HHTL 223.2

” ‘A fire destroyed nearly a third of the village; the houses were re-built in a more salubrious manner, and by degrees scrofula became less common, and disappeared from that part.’ Other facts are brought forward, all tending to prove the fatal effects of vitiated air, and the beneficial results of constantly pure atmosphere, not only on the health, but on the morals of the people. Other authorities — Dr. Blacke, Dr. Blakely Brown, Dr. Duncan, and Professor Alison — fully confirm these statements; in addition to which we are informed that ‘defective ventilation may be considered one great cause of all the diseases of the joints which we so frequently meet with, as well as of the diseases of the eye and skin — shingles, lepra, and porrigo, or ringworm. Besides the eye, the ear is injuriously affected by vitiated air, which thus becomes the cause of many cases of deafness. It is a fact, that at least two times more of the children of the laboring classes are affected by the earache and deafness, than of children of the rich and better conditioned classes, less exposed to like influences.” HHTL 224.1

“Every population throws off insensibly an atmosphere of organic matter excessively rare in country and towns, but less rare in dense than in open districts; and this atmosphere hangs over cities like a light cloud, slowly spreading, driven about, falling, dispersed by winds, washed down by showers. It is not vitalis halitus, except by origin, but matter which has lived, is dead, has left the body, and is undergoing, by oxydation, decomposition into simpler than organic elements. The exaltations from sewers, church-yards, vaults, slaughter-houses, cess-pools, commingle in the atmosphere, as polluted waters enter the Thames; and not withstanding the wonderful provision of nature for the speedy oxydation of organic matter in water and air, accumulate, and the density of the poison (for in the transition of decay, it is a poison) is sufficient to impress its destructive action on the living, to receive and impart the processes of zymotic principles, to convert, by a subtile, sickly, deadly medium, the people agglomerated in narrow streets and courts, down which no wind blows, and upon which the sun seldom shines.” HHTL 224.2

“A small quantity of organic matter can only escape with the carbon and aqueous vapor (37 1/2 ounces daily, according to Dalton) from the skin and lungs. The presence of a putrid atmosphere is perceived by the senses in parts of all towns; and Liebig, by operating on large masses of the atmosphere, has obtained ammonia, which is a product of the putrifaction of animal matter. The existence, therefore, in the atmosphere of animal matter, is incontestible; and, as it must be most dense in the densest districts, where it is produced in the greatest quantities, and the facilities for decomposing it in the sunshine, and sweeping it away by currents of wind, are the least, its effects — diseases and death — will be most evident in towns, and in the most crowded districts of towns. It is to this cause that the high mortality of towns is to be ascribed.” HHTL 225.1

Consumption originates in the tubercular diathesis. This diathesis is produced by those agencies which deprave the blood and waste vitality. Of these agencies none is so universal and potent as impure air. When we consider that besides mingling momentarily with the blood of the entire system, it is in direct and constant contact with every part of the lungs, we cannot fail to deduce, that foul air must play a most important part in that local expression of the tubercular taint known as pulmonary consumption. HHTL 225.2

Dr. Guy, in his examination, affirms: “This (deficient ventilation) I believe to be more fatal than all other causes put together.” Dr. Guy showed that consumption was nearly twice as common among tradesmen as among the gentry, which he attributes to the bad ventilation of their stores. HHTL 225.3

Some of my lady friends in Boston, who are accustomed to pure air at home, greatly dread to “shop,” because of the bad atmosphere found in the stores. I am not acquainted with three stores in Boston that are well ventilated. It is really touching to see the poor clerks, of either sex, with their pale, wan faces, languidly moving about in an atmosphere which is slowly poisoning them. HHTL 225.4

The distinguished Dr. Carpenter says: “Again the due elaboration of the fibrin of the blood is undoubtedly prevented by an habitually deficient respiration, and various diseases which result from the imperfect performance of this elaboration, consequently manifest themselves. The scrofulous (consumptive) diathesis is thus frequently connected with an unusually small capacity of the chest, (or lack of oxygen in the air.)” HHTL 226.1

Dr. Griscom says: “Now it is not disputed, that matter, carried from the digestive organs, and thrown into the circulation, cannot be perfectly nutritive unless it be perfectly aerated or oxygenated. This fact is fully established. A very small quantity of food, even when it is to a certain extent unwholesome, may possibly be assimilated, and with a due supply of air to ventilate it when it arrives in the lungs, may become highly nutritive; but the largest conceivable quantity of what is called nutritious food, taken into the stomach and there digested, can never be elaborated into nutrative blood without a due supply of air to arterialize it.” HHTL 226.2

Prof. Alison, one of the highest authorities on this subject, remarks: “It is hardly possible to observe separately the effects on the animal economy of deficiency of exercise and of fresh air, these two causes being applied together, and often in connection with imperfect nourishment. But it is perfectly ascertained, on an extensive scale, in regard to the inhabitants of large and crowded cities as compared with the rural population of the same climate; first, that their mortality is very much greater, especially in early life and the probability of life very much less; and secondly, that of this great early mortality in large towns, a very large proportion is caused by scrofulous disease. And from these two facts, it evidently follows that deficiency of fresh air and of exercise, are among the most important, because the most remediable of the causes from which the scrofulous diathesis arises.” HHTL 226.3

Dr. Griscom concludes his excellent work on the “Uses and Abuses” of air, with the following remarks: “To those who have the care and instruction of the rising generation — the future fathers and mothers of men — this subject (ventilation) commends itself with an interest surpassing that of any other. Nothing can more convincingly establish the belief of the existence of something essentially and vitally wrong in the habits and circumstances of civilized life, than the appalling fact, that one-fourth of all who are born, die before reaching the fifth year, and that one-half the deaths of mankind occur under the twentieth year. HHTL 227.1

Let those who have these things in charge, answer to their own consciences how they have discharged their duty, in supplying to the young, the responsibility of whose lives they have assumed — A PURE ATMOSPHERE — THE FIRST REQUISITE FOR HEALTHY BODIES AND SOUND MINDS.” HHTL 227.2

CLAUDE BERNARD’S EXPERIMENTS. This eminent man made some interesting experiments upon animals, which illustrate an apparent paradox often observed in human life. HHTL 227.3

A sparrow placed in a bell-glass of given size, lived three hours; but at the end of the second hour, when there was still oxygen enough to sustain the bird another hour, if a fresh sparrow were introduced it expired immediately. Or if at the end of the second hour the sparrow was taken out of the bell-glass and allowed to fly about in pure air a few moments, and was then placed in the bell-glass again, where, but for this removal it would have lived an hour, it was instantly killed. HHTL 227.4

Some time since I had occasion to visit an establishment where one hundred and fifty girls, in a single room, were engaged in needle-work. Pale faced, with low vitality and feeble circulation, they seemed unconscious that they were breathing an atmosphere which at once produced in myself dizziness and a sense of suffocation. If I had remained a week, like them, I should have become unconscious of the vileness of the atmosphere. HHTL 227.5

Lewes mentions that two French women, one sick with typhoid fever, were in a room heated by a coke stove. The gas escaped from the stove. The well woman was suffocated and fell senseless on the floor, but the sick one retained her consciousness, and by loud cries brought assistance. HHTL 228.1

Lewes, in explaining this paradox says, “vitiated air will suffice for the respiration of a depressed organism as it would for that of a cold-blooded animal. In this depressed condition, less oxygen is absorbed, and therefore less is required in the air. When we enter a vitiated air, the breathing becomes laborious; the consequence is a depression of all the organic functions, and the breathing becomes easy again, because we no longer require so much oxygen, and we no longer produce so much carbonic acid. Were it not for this adjustment of the organism to the surrounding medium, by a gradual depression of the functions, continued existence in a vitiated air would be impossible. We see the vigorous bird perish instantly in air which would sustain an enfeebled bird for more than an hour.” HHTL 228.2

Put a bird and a snake into an air-tight bell-glass. After a little time the bird will fall from its perch, dead. The air has been so exhausted that it no longer contains sufficient oxygen to maintain life in the warm-blooded animal, but the cold-blooded snake still lives and continues to live, until the oxygen is reduced to less than three per cent. HHTL 228.3

A young woman, exuberant with life, comes from the country to visit her city cousins. She finds them with pale faces, cold extremities, and general debility, but, apparently comfortable in a furnace-heated, unventilated house, in which she must almost gasp for breath. HHTL 228.4

I frequently observe in the street-cars, ladies, with contracted waists and feeble vitality, breathing with indifference an atmosphere from which I am compelled to escape to the platform, even though I must stand in the rain. HHTL 228.5

In each and all of these cases, the unconsciousness does not save from mischievous consequences. The poison operates, not only in lowering the vital tone, but in shortening the life, and in the production of numerous maladies. HHTL 229.1

FOUL AND DAMP CELLARS. The atmosphere of nearly every house is contaminated by emanations from a foul and damp cellar. If you breathe the air of an ordinary cellar, with senses fully awake, you are conscious it is far from pure. This air is constantly making its way into the rooms above. Without doubt, disease of the lungs, the organs most exposed to atmospheric poisons, may often depend, to some extent, upon this cellar atmosphere. The emanations from decaying potatoes, cabbages, turnips and other vegetable substances in a cellar, have often produced grave fevers. That these poisonous gases may affect the lungs I cannot doubt. HHTL 229.2

The thoughtful and earnest, will ask at once, “What can be done to remove this source of disease?” I reply: Line your cellars with cement, ventilate and drain them carefully, and keep them scrupulously clean. The frequent use of whitewash upon the walls, and over head, will prove an efficient antiseptic. The occasional use of a solution of chloride of lime in the corners and out-of-the-way places would prove an important addition. HHTL 229.3

But the true policy for those who reside in the country, is, to construct out-door cellars, in which the vegetables may be preserved. Once a week, what are needed for the house, may be brought in and deposited in a large box, so constructed as to preserve its contents from freezing. As the articles of food usually kept in a cellar are, in town and cities, purchased in small quantities, the out-of-doors cellar is there unnecessary. HHTL 229.4

The ground, about nearly every house, should be thoroughly underdrained, to the depth of three feet, with round two-inch tile, such as are used for agricultural purposes. The drains should be connected, and terminate in a common outlet a few rods from the house. This should be carefully guarded by grating, to prevent its being obstructed. The drains can be connected with the eave-gutters, so as to receive all the water that falls on the roof, not needed for the cistern. By such means, the ground near the house is kept dry; and, besides the greater healthfulness secured, is much improved for garden, lawn, fruit-yard and grapery. The soil under the house, preparatory to building, should be excavated as for a cellar, to the depth of one foot, and the open space filled with sand and charcoal. The part corresponding to the center of the house, should be elevated one or two feet above the line corresponding to the walls, and when the house is erected, the space under the walls should be left open, that the air may circulate freely under the building. It is very easy with ornamental wood or iron work to conceal the open space without lessening the circulation of the air. To keep the lower floor warm, it should be double, with an intervening space of a foot in which to pack some nonconductor. HHTL 229.5

If a cellar be suspected and is not susceptible of purification, it might be filled with sand, gravel and charcoal. HHTL 230.1

Dr. Bowditch, in his able address before the Mass. Medical Society, declared it as his conviction that a moist soil is a most fruitful source of consumption. In the light of such authority, the importance I have given to the subject of cellars — which are almost invariably damp — will not be deemed an exaggeration. HHTL 230.2

Dr. Bowditch arrives at the following conclusions: HHTL 230.3

First, consumption is not equally distributed over New England. HHTL 230.4

Second, Its greater or less prevalence depends very much upon the characteristics of the soil on, or near which the patients, affected with it, have resided. HHTL 230.5

Third, Moisture of the soil is the only known characteristic that, so far as our present investigations have gone, is connected with the consumption-breeding districts. HHTL 230.6

Dr. B. earnestly deprecates the indifference of the State, and the profession, to the question of location for towns. In another place he says: HHTL 230.7

“The public should correct its own views upon the whole subject of the planting of cities and villages. It should not allow speculators to run the risk of contaminating every family that may subsequently colonize a spot best fitted, perhaps, for the promotion of consumption. Now, the track of a railway, or the wit or reckless energy of the owner of some swamp, may be the sole reason for erecting a station house, and thereby promoting the early erection of dwelling houses near by, on localities totally unfit for human habitation.” HHTL 230.8

In arousing the profession to its obligations, he uses the following language: HHTL 231.1

“We may meet with a patient, suffering under what is sometimes inaptly called the “pretubercular condition,” where there is in the system — a good-for-nothingness — a languor, in fact, of body and soul, perhaps a slight dyspepsia, some emaciation and debility — a little cough, but without physical signs of pulmonary disease. If a patient has been residing under the circumstances named in this address, as promotive of consumption, it will be our first duty to urge him to leave the spot.” HHTL 231.2

“Still more should a removal be urged, if any, even the most trivial, of physical signs of pulmonary disease be found. A short distance, even half or quarter of a mile, may do much good; but I should prefer to have such a patient remove at once to one of the places already known, or which may hereafter be found to be drier and more favorable for him.” HHTL 231.3

I take the liberty to express the hope that Dr. Bowditch will bring to the investigation of other causes of consumption his discrimination and patience. HHTL 231.4

MOISTURE IN THE ATMOSPHERE. It is the common belief that a dry atmosphere is most favorable to the consumptive. Many medical authors have advanced this assumption. It is, nevertheless, an error. In the British Isles, and in France, outside the cities and manufactories, the mortality from pulmonary diseases is much less than among the agricultural classes of this country. And, on the western shores of this continent, consumption is comparatively unknown. HHTL 231.5

Our disadvantage in this comparison is attributable, in considerable part, to the lack of humidity in our atmosphere. Without the evidence of facts, we might, a priori, argue, that excessive dryness of the air would produce dryness and irritability of the air-passages. From time immemorial, watery vapor has been used as a remedy in irritation and inflammation of the respiratory organs. HHTL 232.1

A hundred times have my consumptive patients expressed surprise that the wet weather, in which I have insisted they should go out, as usual, has not injured them, — that they even breathe more freely than on pleasant days. Of course, I tell them, if the body is well protected, the more moist the air, the more grateful to the lungs. HHTL 232.2

There is no possible weather which can excuse the consumptive for keeping in-doors. Give him sufficient clothing, protect his feet carefully, and he may go out freely in rain, sleet, snow and wind. Ignorance of this fact has killed thousands. HHTL 232.3

That point of temperature at which the moisture of the air first becomes visible, is known as the dew-point. According to one authority, the mean dew-point of England, from the first of November to the last of March, is about 35 degrees; that of our Northern States about 16. Now suppose a house in England is kept at a temperature of 70 degrees, the drying power would there be represented by 35. A house with the same temperature in Albany, for example, would possess a drying power of 54. This great contrast in the atmosphere of the two countries is strikingly illustrated by the difference between the plump body and smooth skin of the Englishman, and the lean, juiceless body, and dry, cracked skin of the Yankee. It is also shown by the well-known difference in the influence of house-heat upon furniture. Our chairs, and sofas, and wood-work, warp and shrink, while nothing of the sort occurs in England. HHTL 232.4

As we cannot increase the amount of moisture in the atmosphere of our continent, we must limit our practical efforts to the air of our houses. If we use a stove, its entire upper surface should be made a reservoir for water; ornamental work, of but little cost, may be used to conceal it. The furnace may be made to send up, with its heat, many gallons of water daily, in the form of vapor. In justice to stoves and furnaces, I must say here, that, in the facility to do this, they possess one advantage over open fire-places. HHTL 232.5

By adding artificial moisture in this way, to the air of our houses, we not only save our furniture from drying and shrinking, but protect our skin, eyes, nose, throat and lungs from undue dryness, and from the affections to which it would give rise. It is found necessary, in our cloth manufactories, to maintain a moist atmosphere in order to successful spinning. Intelligent managers have assured me that coughs and throat difficulties are comparatively rare in the spinning department. HHTL 233.1

We must all have observed, that, while the air of a hot kitchen is comfortable, that of a parlor at the same heat, from an air-tight stove, is almost suffocating. The kitchen has a hot stove, but the steam of its boiling kettles moistens the air. HHTL 233.2

Your country aunt, who has lived over her cooking-stove for years without serious inconvenience, after spending an afternoon in your parlor, heated by a stove or furnace, returns home “glad to get out of that hot, stifling air.” And yet the thermometer may have indicated that the kitchen was ten degrees warmer than the parlor. The dry heat of the parlor produces headache, irratability, and perhaps a sense of stricture in the chest. If we would avoid these, a dry chapped skin, an irritable nervous system, and a dry hacking cough, we must add the needed humidity by artificial means. Almost every writer on consumption regards humidity in the atmosphere as one of the principal causes of this disease. If the moisture is in such excess that it becomes visible in the form of fog, it may act prejudicially upon the respiratory apparatus; but, so long as its relations with the temperature are such that it remains in an invisible form, it must ever tend to preserve in the lungs a condition farthest from irritability. HHTL 233.3

Again, humidity in its influence upon the respiratory apparatus, is determined in considerable part by the clothing of the body. If insufficiently clad, and exposed to an excessive humidity, the general vitality may be so depressed, and the blood so driven from the surface, that disease of the lungs will result. But if the body be well guarded, moisture in the air, except when in great excess, and in very low temperatures, will ever serve to preserve in the respiratory apparatus, freedom from the dryness and irritability which constitute a prominent feature in most diseases of these organs. A striking illustration of its benefits is found in the comfort which phthisical persons derive from that condition of the atmosphere which accompanies a rain-storm in the summer, and again, by the relief which such patients experience in visiting the western shores of our continent, or an island in the ocean where the air is loaded with humidity. HHTL 233.4

FURNACES AND STOVES. Since the introduction of furnaces and stoves, diseases of the respiratory apparatus have greatly multiplied. The heat from these, dries the life juices out of the throat and lungs. When I am asked to see a consumptive, and find my patient in such an atmosphere, I begin by saying. “no treatment will save you if you continue to poison your lungs in this air.” HHTL 234.1

If in the shutter of a dark room, you make a small aperture, you will observe in the jet of light, that the air of the best ventilated room is full of floating particles. In their ordinary condition they do not seriously injure the respiratory apparatus; but it has been shown by reliable observers, that when these motes are exposed to contact with a heated stove or furnace, they are carbonized and become poisonous to throat, lungs and blood. If this be true, it is a new and good objection to stoves and furnaces. The common idea that the air itself may be burned by a hot stove, is not well founded. HHTL 234.2

I do not say it is impossible to ventilate a room warmed by furnaces or stoves; but, with the present ignorance on the subject of ventilation, and insensibility to atmospheric influences, not one house in a hundred thus heated, will be well ventilated. If the machinery by which the needed change of air may be secured, is left to the control of the occupants of the house, bad ventilation will be the rule. HHTL 234.3

OPEN FIRES VS. STOVES AND FURNACES. An open fire is number one among house blessings. If possible, it should be a wood fire with a large fire-place. Such a fire is a great luxury. It fills the family circle with satisfaction and sociability. To keep up the draught, the entire air of the room is constantly changed. Even if the room be small, and the company large, the excretions of the lungs and skin cannot so accumulate as to make the room smell close. Strange that people will not have this delightful blessing in their houses at any cost. Let them, if need be, go without silks, broadcloths, a piano, and finery of every kind, and have this excellent purifier and comfort in their homes. Who would not go miles to visit an old-fashioned log house with its great roaring fire? In whose childish reminiscences is not that crackling, rushing fire the most beautiful of memories? Why not have it all back again? If a small part of the money which we spend in foolish, mischievous fashions, were given to the re-introduction of this good old-fashioned blessing, we should all be healthier and happier. HHTL 235.1

Next to the wood fire, the open grate, with coal, is best; and, if the draught be good, it is a good ventilator. HHTL 235.2

In an institution for the treatment of weak chests which we shall soon open in Boston, we shall make open wood fires play an important part. HHTL 235.3

FIRES IN BEDROOMS. Most people think that sleeping in cold rooms is essential to health. This is a mistake. An open fire greatly improves the atmosphere of a bedroom. By it, the air of the room is constantly changed. With it, the window will be kept open. With a fire, less bed clothing is needed — an important advantage, — for a large number of blankets not only interferes with circulation and respiration but prevents the escape of the gases which the skin is constantly emitting. Except there be wind, ventilation of any room depends upon a difference in temperature between the air inside and that outside. If the thermometer inside indicate a temperature 10 degrees below the freezing point, and outside the same, there will be no ventilation. All motion in the air originates in a difference of temperature between different points. If we would secure the constant introduction of air from the great ocean outside, into our bedrooms, we must raise the temperature within, considerably above that without. HHTL 235.4

NIGHT AIR. Consumptives, and all invalids, and indeed persons in health, are cautioned to avoid the night air. Do those who offer this advice forget that there is no other air at night, but “night air?” Certainly we cannot breathe day air during the night. Do they mean that we should shut ourselves up in airtight rooms, and breathe over and over again, through half the twenty-four hours, the atmosphere we have already poisoned? We have only the choice between night air pure, and night air poisoned with the exhalations from our skins and lungs, perhaps from lungs already diseased. HHTL 236.1

Many persons indulge a very silly dread of a draught. It is only by motion in the atmosphere that our lungs obtain the purest air. If at night the air move briskly directly over your bed, your lungs will receive precious supplies. If you cannot endure this direct draught, you must deny yourself a great luxury. I once thought that a draught at night directly over my head was a thing to be avoided. Now I seek it as one of the real blessings of life. My wife, who inherited a consumptive taint, was ever guarding against night air. Now she sleeps with two open windows at one end of the bed, and an open door at the other. Neither of us have had a cold for several years. Every one must exercise his own judgment and prudence. I should be sorry were my words to lead any one into an injurious exposure. But among the many hundreds — I might say thousands, — whom I have advised to sleep with open windows, I have never known a single person to be seriously injured, even temporarily; and I may add, that almost without exception, so far as I have known, they would not return to their former habit of sleeping in unventilated rooms. At first you may contract a cold, but if you bathe freely in cold water, and employ vigorous friction upon the parts exposed while in bed, even this may be avoided. But after a few weeks’ experience it will be quite unnecessary for the physiologist to lecture you on the subject. You will yourself take to exhorting your friends upon the importance of well ventilated bedrooms. One of the compensations of our great war, will be found in the conviction among a million returned soldiers that night air is not a poison, and that draughts are less dangerous than Minie balls. HHTL 236.2

Of course I am not unaware that what I have said on sleeping in a draught will meet with very general reprobation, but it is not the only case in which false education and prejudice have undertaken to ignore a great natural. I can adduce the experience of thousands in favor of a free exposure to night air and winds, and after a wide observation, I have never met one person who has tried such exposure for one month and spoken against it. A writer pertinently speaks on this point after the following fashion: HHTL 237.1

“Man acts strangely. Although a current of fresh air is the very life of his lungs, he seems indefatigable in the exercise of his inventive powers to deprive himself of the heavenly blessing. Thus, he carefully closes his bed-chamber against its entrance, and prefers that his lungs should receive the mixed effluvia from his cellar and larder, and from a patent little modern aquarius, in lieu of it. Why should man be so terrified at the admission of night air into any of his apartments? It is Nature’s ever-flowing current and never carries the destroying angel with it. See how soundly the delicate little wren and tender robin, sleep under its full and immediate influence; and how fresh, and vigorous, and joyous, they rise amid the surrounding dewdrops of the morning. Although exposed all night long to the heavens, their lungs are never out of order; and this we know by the daily repetition of their song. Look at the new-born hare, without any nest to go to. It lives and thrives and becomes strong and playful under the unmitigated inclemency of the falling dews of night. HHTL 237.2

I have a turkey full eight years old that has not passed a single night in shelter. He roosts in a cherry tree, and is in primest health the year through. Three fowls, preferring his to the warm perches in the hen-house took up their quarters with him early in October, and have never gone to any other roosting-place. The cow and the horse sleep safely on the ground, and the roe lies down to rest on the dewy mountain-top. I myself can sleep all night long, bareheaded, under the full moon’s watery beams, without any fear of danger, and pass the day in wet shoes, without catching cold. — Coughs and colds are generally caught in the transition from an over-heated room to a cold apartment; but there would be no danger in this movement, if ventilation were properly attended to, — a precaution little thought of now-a-days.” HHTL 238.1

Dr. James Blake advises the consumptive to join with several friends, procure horses and wagons, and set off upon a long journey, sleeping in the open air, no matter what the weather. He seems to think this the only way in which it is possible to induce the consumptive sleep in the fresh air. Doctor Jackson gives the case of a consumptive young man (he does not state the condition of his lungs) who was cured by sleeping in the open air on a hay-sack. This advice and experience do not quite harmonize with the common terror of night air. HHTL 238.2

But while I believe that breathing the pure out-door air all night is an important curative means in this disease, I do not believe that sleeping in the open fields in a stormy night is the best means for securing pure night air, in the case of a feeble woman; on the contrary, I think it might be more pleasantly, and quite as effectually secured in a comfortable house with open windows and an open fire. HHTL 238.3

No doubt the lives of thousands would be saved by destroying their houses, and compelling them to sleep in the open air; not because houses are inevitable evils, but because they are so badly used. Windows are barred and closed, as if they keep out assassins; draughts defended against, as if they were bomb-shells; and the furnace-heat still more corrupts the air, which has done duty already — to how many lungs, for how many hours? HHTL 238.4

Let the consumptive thank God for the blessing of a house, but let him use it wisely. How my heart has ached, to see the consumptive patient put away in a bed, behind curtains, in an unventilated room, the doors and windows carefully closed, to shut out the very food for which the lungs and system were famishing! HHTL 239.1

I do not wonder that Blake, Jackson, and many others, have an out-door life of the wildest and most exposed sort to invalids of this class; but I do wonder that they have not equally insisted upon abundance of air for them, as pure as that of the fields and mountains, in their own homes, and in the midst of friends and comforts. — Weak Lungs by Dio Lewis. HHTL 239.2