HOW TO KEEP THE LUNG-BELLOWS IN GOOD CONDITION
THE NEED OF PURE AIR
Free Air is Pure. As air, in the form of wind, actually sweeps all
outdoors, day and night, it clearly is likely to pick up a good many
different kinds of dust and dirt, which may not be wholesome when
breathed into our lungs. Fortunately, nature's great outdoor system of
purifying the air is almost perfect, so that it is only when we build
houses and shut in air from the great outdoor circulation, that "dirt"
that is really dangerous begins to get into it. Caged air is the only
air that is dangerous. Free-moving air is always perfectly safe to
breathe any hour of the day or night, or any season of the year.
Shut-in and Stagnant Air is Foul. This restless air-gas cannot be
stored outside of the body, any better than it can be inside. For one
thing, it is too bulky; and for another, it begins to become impure in
various ways, as soon as it is shut up. It is the most unmanageable food
that we "eat," for we can neither cook it nor wash it like solid food,
nor filter it nor boil it like water, except on a very limited scale. We
can do nothing to it except to foul it, which we do with every breath
that we breathe, every fire that we make, every factory that we build.
Our only chance of safety, our only hope of life, is to connect every
room and every corner of those little brick and mortar boxes, those
caged sections of out-of-doors, that we call houses, with nature's great
system of air supply, "All Outdoors." Fortunately, the only thing
needed to make the connection is to open a window--no need to send for a
plumber or put in a meter, and there is no charge for the supply after
connections have been made.
The Enormous Amount of Air. Air outdoors is everywhere, for practical
purposes, absolutely pure, just as water is when it comes down from the
clouds. And like water, its only dangerous impurities are what we put
there ourselves. The purity of outdoor air is due mainly to the fact
that there is such an enormous amount of it, not only the miles and
miles of it that stretch away on every side of us, but nearly thirty
miles of it straight up above our heads; its purity is also due to the
fact that, like water, it is always in motion. When heated by the sun,
it expands; and, in doing so, it rises because it is less dense and
therefore lighter. As soon as the pressure of the air above is lessened,
air rushes in below from all the cooler regions around. This rushing of
air we call a _wind_. If the low pressure lies to the north of us, the
air rushes northward over us to fill it, and we say the wind is from the
south; if the air is flowing to the south of us, we say the wind is from
the north.
How Air is Purified. In these winds certain small amounts of dust, or
dirt, or leaf mould are whirled up into the air, but these are promptly
washed down again whenever it rains; and the same is true of the smoke
impurities in the air of our great cities. Air is also constantly being
purified by the heat and light of the sunbeams, burned clean in streaks
by the jagged bolt of the lightning in summer, and frozen sweet and pure
by the frosts every winter. So that air in the open, or connected with
the open, and free to move as it will, is always pure and wholesome. But
to be sure of this, it must be "eaten alive"--that is, in motion.
Stagnant air is always dead and, like all dead things, has begun to
decay.
The Carbon Dioxid in the Air. Air, as you will remember (p. 132), is a
mixture of oxygen and nitrogen, and its value in the body is that it
gives off part of its oxygen to combine with the body wastes and burn
them to carbon dioxid. Oddly enough, even pure outdoor air contains tiny
traces of carbon dioxid; but the amount is so very small as to be of no
practical importance, in spite of the fact that every kind of animal
that lives and moves upon the earth is pouring it out from his lungs
every second. The rapidity with which it disappears is due in part to
the rapidity with which it rises and spreads, or is blown, in every
direction; and in part to the wonderful arrangement by which, while
animals throw off this poisonous gas as waste, plants eagerly suck it in
through the pores in their leaves and eat it, turning it into the
carbohydrates, starch and sugar, which, in turn, become valuable foods
for the animals. So perfect is this system of escape, or blowing away,
of carbon dioxid, combined with its being eaten up by plants, that even
the air over our great cities and manufacturing towns contains only the
merest trifle more of carbon dioxid than that over the open country. Its
other smoke-impurities, dirts and dusts, escape, or are blown away so
rapidly that they are seldom thick enough to be injurious to health,
except in the narrowest and darkest streets; so that it is always safe
to open your windows wide for air, wherever you may live. The principal
danger from smoke is that it cuts off the sunlight.
The Necessity for Ventilation--Impurities of Indoor Air. The worst
impurities in air are those that come from our own breaths and our own
bodies; and, unexpectedly enough, carbon dioxid is not one of them. In
spite of hundreds of experiments, we do not yet know exactly what these
impurities are, though they are doubtless given off from our lungs, our
skins, our mouths, and teeth, especially if the latter are not kept
clean and sweet, but left dirty and decaying.
We do know, however, to a certainty that air shut up in a room, or
house, with people, rapidly becomes poisonous and unwholesome. As we
breathe on an average about eighteen or twenty times to the minute when
we are grown up, and twenty-five to thirty times a minute when we are
children, you can readily see how quickly the air in an ordinary-sized
room will be used up, and how foul and unfit for further breathing it
will become from being loaded with these bad-smelling lighter gases,
with the carbon "smoke," with heat, and with moisture. The only way in
which a room can be kept fit for human beings to breathe in is to have a
draught, or current of air, pouring into it through open windows, or
open doors, or ventilating shafts, at least as rapidly as it is being
breathed by the persons who occupy that room. By hundreds of tests this
has now been found to be on an average about four bushels a minute for
each person, and any system of proper ventilation must supply this
amount of air in order to make a room fit to sit in.
If a man, for instance, accidentally gets shut into a bank-vault, or
other air-tight box or chamber, it will be only a few minutes before he
begins to feel suffocated; and in a few hours he will be dead, unless
some one opens the door. A century ago, when the voyage from Europe to
America was made in sailing vessels, whenever a violent storm came up,
in the smaller and poorer ships the hatches were closed and nailed down
to keep the great waves which swept over the decks from pouring down the
cabin-stairs and swamping the ship. If they were kept closed for more
than two days, it was no uncommon thing to find two or three children or
invalids among the unfortunate emigrants dead of slow suffocation; and
many of those who were alive would later have pneumonia and other
inflammations of the lungs. On one or two horrible occasions, when the
crew had had a hard fight to save the ship and were afraid to open the
hatches even for a moment, nearly one-third of the passengers were found
dead when the storm subsided. So it is well to remember that we are
fearfully poisonous to ourselves, unless we give nature full chance to
ventilate us.
There are also other ways in which the air in houses may be made impure
besides by our own bodies, but none of them is half so serious or
important. All the lights that we burn in a house, except electric ones,
are eating up oxygen and giving off carbon dioxid. In fact, a burning
gas jet will do almost as much toward fouling the air of a room as a
grown man or woman, and should be counted as a person when arranging for
ventilation.
If gas pipes should leak, so that the gas escapes into a room, it is
very injurious and unwholesome--indeed, in sufficient amounts, it will
suffocate. Or, if the sewer pipes in the walls of the house, or in the
ground under the cellar, are not properly trapped and guarded, _sewer
gas_ may escape into the house from them, and this also is most
unwholesome, and even dangerous.
Cellar and Kitchen Air. Houses in which fruit and vegetables are
stored in the cellar become filled with very unpleasant odors from the
decay of these. Others again, where the kitchen is not properly
ventilated, get the smoke of frying and the smell of cooking all through
them. But such sources of impurity, while injurious and always to be
strictly avoided, are neither half so dangerous when they occur, nor
one-tenth so common as the great chief cause of impure air--our breaths
and the other gases from our bodies, with the germs they contain.
Drafts not Dangerous. Now comes the practical question, How are we to
get rid of these breath-poisons? From the carelessness of builders, and
the porous materials of which buildings are made, most houses are very
far from air-tight, and a considerable amount of pure air will leak in
around window-casings, door-frames, knot-holes, and other cracks, and a
corresponding amount of foul air leak out. But this is not more than
one-fifth enough to keep the air fresh when the rooms are even partially
occupied, still less when they are crowded full of people. As each
individual, breathing quietly, requires about four bushels of air (one
and a half cubic yards) a minute, it is easy to see that, when there are
ten or more people in a room, there ought to be a steady current of air
pouring into that room; and when there are twenty or even forty people,
as in an average schoolroom, the current of air (provided there _is_
one) must move so fast to keep up the supply that the people in the room
begin to notice it and call it "a draft." It would be difficult to
ventilate a room for even four or five persons without producing, in
parts of it, a noticeable draft of air. In fact, it is pretty safe to
say that, if somebody doesn't feel a draft the room is not being
properly ventilated. At one time this was considered a very serious
drawback--drafts were supposed to be so dangerous. But now we know that
a draft is only air in motion, and that air in motion is the _only air
that is sure to be pure_. There is nothing to be afraid of in a draft
which is not too strong, if you are clean outside and in, and reasonably
vigorous. If the draft is too strong, move away from the window or the
door. Colds are very seldom caught from the cold, pure air of a draft,
but nearly always from the germs, or dirt, in the still, foul air of a
tightly closed room. This fact has swept away the chief objection to the
_direct_, or natural, method of ventilating through open windows.
Methods of Ventilation. Fortunately, as often happens, the simplest
and most natural method of ventilation is the best one. Open the
windows, and let the fresh air pour in. If there be any room which
hasn't windows enough in it to ventilate it properly, it is unfit for
human occupation, and is seldom properly lighted. Most elaborate and
ingenious systems of ventilation have been devised and put into our
larger houses, and public buildings like libraries, court-houses,
capitols, and schools. Some of them drive the air into each room by
means of a powerful steam, or electric, fan in the basement; others suck
the used-up air out of the upper part of each room, thus creating an
area of low pressure, to fill which the fresh air rushes in through
air-tubes or around doors and windows. They have elaborate methods of
warming, filtering, and washing the air they distribute. Some work
fairly well, some don't; but they all have one common defect--that what
they pump into the rooms is not _fresh_ air, though it may conform to
all the chemical tests for that article. "The proof of the pudding is in
the eating," and fresh air is air that will make those who breathe it
_feel_ fresh, which the cooked and strained product of these artificial
ventilating systems seldom does.
[Illustration: THE "DARK ROOM" DANGER OF THE TENEMENTS
The rooms "ventilate" from one to another; bedroom, dining-room, and
kitchen being practically one room, with only one window opening to the
_outer air_. Most of the old small tenements were built on this plan and
are accountable for much of the lung disease in cities to-day.]
If they could be combined with the natural, window system of
ventilation, they would be less objectionable; but the first demand of
nearly all of them is that the windows must be kept shut for fear of
breaking the circuit of their circulation. Any system of ventilation, or
anything else, that insists on all windows being kept shut is radically
wrong. It is only fair to say, however, that most of these systems of
ventilation attempt the impossible, as well as the undesirable thing of
keeping people shut up too long. No room can be, or ought to be,
ventilated so that its occupants can stay in it all day long without
discomfort. In ventilating, we ought to _ventilate the people in the
room_, as well as the room itself. This can only be done successfully by
turning the people out of doors, at least every two or three hours if
grown-ups, and every hour or so if children. That is what school
recesses are for, and they might well be longer and more frequent.
[Illustration: VENTILATING THE PUPILS, AS WELL AS THE CLASSROOM]
The first and chief thing necessary for the good ventilation of houses
and schools is plenty of windows, which are also needed to give proper
light for working purposes, and to let in the only ever-victorious enemy
of germs and disease--sunlight.
Secondly, and not less important, the windows should fit properly, and
be perfectly hung and balanced, so that the sash will come down at a
finger's touch, stay exactly where it is put, and go up again like a
feather, instead of having to be pried loose, wrested open, held in
place with a stick, and shoved up, or down again, only with a struggle.
[Illustration: A WELL-AIRED CLASSROOM
The windows to the left of the pupils cannot, of course, be shown in the
picture, but it can be seen that the lighting of the room is chiefly
from that side. Notice that the windows are both down from the top and
up from the bottom.]
There should be, if possible, windows on two sides of every room, or, if
not, a large transom opening into a hall which has plenty of windows in
it. With this equipment and a good supply of heat, any room can be
properly ventilated and kept so. But it _will not ventilate itself_.
Ventilation, like the colors of the great painter Turner, must be "mixed
with brains"; and those brains must be in the room itself, not down in
the basement. In the schoolroom, each teacher and pupil should regard
the ventilation of the room as the most important single factor in the
success of their work. The teacher has a sensitive thermometer and guide
in, first, her own feelings and, second, the looks and attention of her
pupils. There should be vacant seats or chairs in every room so that
those too near the window in winter can move out of the strong current
of cold air.
[Illustration: A HEALTHFUL ARRANGEMENT OF WINDOWS AND SHADES
The windows face in more than one direction. The shades are hung in the
middle, not only regulating the light in the room, but allowing free
passage of air at the top.]
Windows should reach well up toward the ceiling and be opened _at the
top_, because the foul air given off from the lungs at the temperature
of the body is warmer than the air of the room and consequently rises
toward the ceiling. It is just as important in ventilation to _let the
foul air out_ as to let the fresh air in. In fact, one is impossible
without the other. Air, though you can neither see it, nor grasp it, nor
weigh it, is just as solid as granite when it comes to filling or
emptying a room. Not a foot, not an inch of it can be forced into a room
anywhere, until a corresponding foot or inch is let out of it somewhere.
Therefore, never open a window at the bottom until you have opened it
at the top. If you do, the cold fresh air will pour in onto the floor,
while the hot foul air will rise and bank up against the ceiling in a
layer that gets thicker and thicker, and comes further and further down,
until you may be actually sitting with your head and shoulders in a
layer of warm foul air, and your body and feet in a pool of cool pure
air. Then you will wonder why your head is so hot, and your feet so
cold!
Currents and Circulation of Air. In fact, this tendency of hot air to
rise, and of cold air to sink, or rush in and take its place, which is
the mainspring of nature's outdoor system of ventilation, is one of our
greatest difficulties when we wall in a tiny section of the universe and
call it a room. The difficulty is, of course, greatest in winter time,
when the only pure air there is--that out of doors--is usually cold.
This is one of the few points at which our instincts seem to fail us.
For when it comes to a choice between being warm or well ventilated, we
are sadly prone to choose the former every time. Still we would much
rather be warm _and_ well ventilated than hot and stuffy, and this is
what we should aim for.
The main problem is the cost of the necessary fuel, as it naturally
takes more to heat a current of air which is kept moving through the
room, no matter how slowly, than it does a room full of air which is
boxed in, as it were, and kept from moving on after it has been warmed.
The extra fuel, however, means the difference between comfort and
stuffiness, between health and disease. Fortunately, the very same cold
which makes a room harder to heat makes it easier to ventilate. When air
is warmed, it expands and makes a "low pressure," which sucks the
surrounding cooler air into it, as in the making of winds; so that the
warmer the air inside the room, or the colder the air outside of it,
which is practically the same thing, the more eagerly and swiftly will
the outdoor air rush into it. So keen is this draft, so high this
pressure, that some loosely-built houses and rooms, with only a few
people in them, will in very cold weather be almost sufficiently
ventilated through the natural cracks and leaks without opening a window
or a door at all. And what is of great practical importance, an opening
of an inch or two at the top of a window will admit as much fresh air on
a cold day as an opening of a foot and a half in spring or summer, so
swiftly does cold air pour in.
Bearing this in mind, and also that it is always best to ventilate
through as many openings as possible, both to keep drafts of cold air
from becoming too intense, and to give as many openings for the escape
of the foul air as possible, there will be little difficulty in keeping
any room which has proper window arrangements well ventilated in winter.
An opening of an inch at the top of each of three windows is better than
a three-inch opening at the top of one. But you must use your brains
about it, watching the direction of the wind, and frequently changing
the position of the window sashes to match the changes of heat in the
room, or of cold outside.
No arrangement of windows, however perfect, is likely to remain
satisfactory for more than an hour at a time, except in warm weather.
This watchfulness and attention takes time, but it is time well spent.
"Eternal vigilance" is the price of good ventilation, as well as of
liberty; and you will get far more work done in the course of a morning
by interrupting it occasionally to go and raise or lower a window, than
you will by sitting still and slaving in a stuffy, ill-smelling room.
Plenty of Heat Needed. Any method of heating--open fireplace, stove,
hot air, furnace, hot water, or steam--which will keep a room _with the
windows open_ comfortably warm in cold weather is satisfactory and
healthful. The worst fault, from a sanitary point of view, that a
heating system can have is that it does not give enough warmth, so that
you are compelled to keep the windows shut. Too little heat is often as
dangerous as too much; for you will insist on keeping warm, no matter
what it may cost you in the future, and a cold room usually means
hermetically sealed windows. Remember that coal is cheaper than colds,
to say nothing of consumption and pneumonia.
[Illustration: A HEALTHFUL BEDROOM
Windows on two sides; shades rolling from the middle; draperies few and
washable; no carpet, but rugs by the bedside.]
Ventilating the Bedroom. The same principles that apply to ventilating
a living-room or day-room apply to ventilating a bedroom. Here you can
almost disregard drafts, except in the very coldest weather, and, by
putting on plenty of covering, sleep three hundred days out of the year
with your windows wide open and your room within ten degrees of the
temperature outdoors. You need not be afraid of catching cold. On the
contrary, by sleeping in a room like this you will escape three out of
four colds that you usually catch. Sleeping with the windows wide open
is the method we now use to cure consumption, and it is equally good to
prevent it.
No bedroom window ought to be closed at the top, except when necessary
to keep rain or snow from driving in. Close the windows for a short time
before going to bed, and again before rising in the morning, to warm up
the room to undress and dress in; or have a small inside dressing-room,
with your bed out on a screened balcony or porch. But sleep at least
three hundred nights of the year with the free air of heaven blowing
across your face. You will soon feel that you cannot sleep without it.
In winter, have a light-weight warm comforter and enough warm, but
light, blankets on your bed, and leave the heat on in the room, if
necessary--but _open the windows_.
COLDS, CONSUMPTION, AND PNEUMONIA
Disease Germs. In all foul air there are scores of different kinds of
germs--many of them comparatively harmless, like the yeasts, the moulds,
the germs that sour milk, and the bacteria that cause dead plants and
animals to decay. But among them there are a dozen or more kinds which
have gained the power of living in, and attacking, the human body. In so
doing, they usually produce disease, and hence are known as _disease
germs_.
[Illustration: DISEASE GERMS
(Greatly magnified)
(1) Bacilli of tuberculosis; (2) Bacilli of typhoid fever.]
These germs--most of which are known, according to their shape, as
_bacilli_ ("rod-shaped" organisms), or as _cocci_ (round, or
"berry-shaped" organisms)--are so tiny that a thousand of them would
have to be rolled together in a ball to make a speck visible to the
naked eye. But they have some little weight, after all, and seldom float
around in the air, so to speak, of their own accord, but only where
currents of air are kept stirred up and moving, without much opportunity
to escape, and especially where there is a good deal of dust floating,
to the tiny particles of which they seem to cling and be borne about
like thistle-down. This is one reason why dusty air has always been
regarded as so unwholesome, and why a very high death rate from
consumption, and other diseases of the lungs, is found among those who
work at trades and occupations in which a great deal of dust is
constantly driven into the air, such as knife-grinders, stone-masons,
and printers, and workers in cotton and woolen mills, shoddy mills,
carpet factories, etc.
[Illustration: A VACUUM CLEANER
Most of the dust being emptied from the bag, would, in ordinary
sweeping, have been merely blown around the room. By the vacuum process
the dust is sucked up through the tube into the storing receptacle.]
In cleaning a room and its furniture, it is always best to use a carpet
sweeper, a vacuum cleaner, or a damp cloth, as much as possible, the
broom as little as may be, and the feather duster never. The two latter
stir up disease germs resting peacefully on the floor or furniture, and
set them floating in the air, where you can suck them into your lungs.
There are three great groups of disease germs which may be found
floating in the air wherever people are crowded together without proper
ventilation--for most of these disease germs cannot live long outside of
the body, and hence come more or less directly from somebody else's
lungs, throat, or nose. The most numerous, but fortunately the mildest
group, of these are the germs of various sorts which give rise to
_colds_, _coughs_, and _sore throats_. Then there are two other
exceedingly deadly germs, which kill more people than any other disease
known to humanity--the bacillus of consumption, and the coccus of
pneumonia.
Our best protection against all these is, first, to have our rooms well
ventilated, well lighted, and well sunned; for most of these germs die
quickly when exposed to direct sunlight, and even to bright, clear
daylight. The next most important thing is to avoid, so far as we can,
coming in contact with people who have any of these diseases, whether
mild or severe; and the third is to build up our vigor and resisting
power by good food, bathing, and exercise in the open air, so that these
germs cannot get a foothold in our throats and lungs.
Colds. Two-thirds of all colds are infectious, and due, not to cold
pure air, but to foul, stuffy air, with the crop of germs that such air
is almost certain to contain. They should be called "fouls," not
"colds." They spread from one person to another; they run through
families, schools, and shops. They are accompanied by fever, with
headache, backache, and often chills; they "run their course" until the
body has manufactured enough antitoxins to stop them, and then they get
well of their own accord. This is why so many different remedies have a
great reputation for curing colds.
If you "catch cold," stay in your own room or in the open air for a few
days, if possible, and keep away from everybody else. You only waste
your time trying to work in that condition, and will get better much
more quickly by keeping quiet, and will at the same time avoid infecting
anybody else. Get your doctor to tell you what mild antiseptic to use in
your nose and throat; and then keep it in stock against future attacks.
Often it is advisable to rest quietly in bed a few days, so as not to
overtax the body in its weakened condition.
[Illustration: EXERCISE IN THE COLD IS A GOOD PREVENTIVE OF COLDS]
Keep away from foul, stuffy air as much as possible, especially in
crowded rooms; bathe or splash in cool water every morning; sleep with
your windows open; and take plenty of exercise in the open air; and you
will catch few colds and have little difficulty in throwing off those
that you do catch. Colds are comparatively trifling things in
themselves; but, like all infections however mild, they may set up
serious inflammations in some one of the deeper organs--lungs, kidneys,
heart, or nervous system, and frequently make an opening for the
entrance of the germs of tuberculosis or pneumonia. Don't neglect them;
and if you find that you take cold easily, find out what is wrong with
yourself, and reform your unhealthful habits.
[Illustration: A YEAR OF CONSUMPTION ON MANHATTAN ISLAND
Every black dot represents one case reported. The groupings show how
rapidly the disease spreads from one household to another in the same
locality.]
HOW TO CONQUER CONSUMPTION
Different Forms of Tuberculosis. The terrible disease tuberculosis is
the most serious and deadly enemy which the human body has to face. It
kills every year, in the United States, over a hundred and fifty
thousand men, women, and children--_more lives than were lost in battle
in the four years of our Civil War_. It is caused by a tiny germ--the
_tubercle bacillus_--so called because it forms little mustard-seed-like
lumps, or masses, in the lungs, called _tubercles_, or "little tubers."
For some reason it attacks most frequently and does its greatest damage
in the lungs, where it is called _consumption_; but it may penetrate and
attack any tissue or part of the body. Tuberculosis of the glands, or
"kernels," of the neck and skin, is called _scrofula_; tuberculosis of
the hip is _hip-joint disease_; and tuberculosis of the knee, _white
swelling_. "Spinal disease" and "hunch-back" are, nine times out of ten,
tuberculosis of the backbone. Tuberculosis of the bowels often causes
fatal wasting away, with diarrhea, in babies and young children; and
tuberculosis of the brain (called _tubercular meningitis_) causes fatal
convulsions in infancy.
[Illustration: CONSUMPTION IN CHICAGO
Four hundred and seventy-seven cases in one month--February, 1909.]
Tuberculosis of the Lungs--How to Keep it from Spreading. Tuberculosis
of the lungs is the most dangerous of all forms, both because the lungs
appear to have less power of resistance against the tubercle bacillus,
and also because from the lung, the bacilli can readily be coughed up
and blown into the air again, or spit onto the floor, to be breathed
into the lungs of other people, and thus give them the disease.
Two-thirds of all who die of tuberculosis die of the pulmonary, or lung,
form of the disease, popularly called consumption.
The first thing then to be done to put a stop to this frightful waste of
human life every year is to _stop the circulation of the bacillus from
one person to another_. This can be done partially and gradually by
seeing that every consumptive holds a handkerchief, or cloth, before his
mouth whenever he coughs; that he uses a paper napkin, pasteboard box,
flask, or other receptacle whenever he spits; and that these things in
which the sputum is caught are promptly burned, boiled, or otherwise
sterilized by heat. The only sure and certain way, however, of stopping
its spread is by placing the consumptive where he is in no danger of
infecting any one else. And as it fortunately so happens that such a
place--that is to say, a properly regulated sanatorium, or camp--is the
place which will give him his best chance of recovery, at least five
times as good as if he were left in his own home, this is the plan which
is almost certain to be adopted in the future. Its only real drawback is
the expense.
But when you remember that consumption destroys a hundred and fifty
thousand lives every year in this country alone, and that it is
estimated that every human life is worth at least three thousand dollars
to the community, you will see at once that consumption costs us in
deaths alone, four hundred and fifty million dollars a year! And when
you further remember that each person who dies has usually been sick
from two to three years, and that two-thirds of such persons are
workers, or heads of families, and that tens of thousands of other
persons who do not die of it, have been disabled for months and damaged
or crippled for life by it, you can readily see what an enormous sum we
could well afford to pay in order to stamp it out entirely.
One of the most important safeguards against the disease is the law
that prevents spitting in public places. Not only the germs of
consumption, but those of pneumonia, colds, catarrhs, diphtheria, and
other diseases, can be spread by spitting. The habit is not only
dangerous, but disgusting, unnecessary, and vulgar, so that most cities
and many states have now passed laws prohibiting spitting in public
places, under penalty of fine and imprisonment.
[Illustration: A REPORT-FORM FROM A HEALTH DEPARTMENT LABORATORY
In a suspected case, the physician sends a specimen of the sputum to the
Laboratory to be tested, and receives a reply according to the result of
the test. The form is filled in with the name of the patient and signed
by the Director of the Laboratory.]
The next best safeguard is plenty of fresh air and sunlight in every
room of the house. These things are doubly helpful, both because they
increase the vigor and resisting power of those who occupy the rooms and
might catch the disease, and because direct sunlight, and even bright
daylight, will rapidly kill the bacilli when it can get directly at
them.
How great is the actual risk of infection in crowded, ill-ventilated
houses is well shown by the reports of the tuberculosis dispensaries of
New York and other large cities. Whenever a patient comes in with
tuberculosis, they send a visiting nurse to his home, to show him how
best to ventilate his rooms, and to bring in all the other members of
the family to the dispensary for examination. No less than from
_one-fourth to one-half_ of the children in these families are found to
be already infected with tuberculosis. The places where we look for our
new cases of tuberculosis now are in the same rooms or houses with old
ones. A careful consumptive is no source of danger; but alas, not more
than one in three are of that character.
[Illustration: A SIGN THAT OUGHT NOT TO BE NECESSARY
But, being necessary, it should be strictly respected and obeyed.]
It has been estimated that any city or county could provide proper
camps, or sanatoria, to accommodate all its consumptives and cure
two-thirds of them in the process, support their families meanwhile, and
stop the spread of the disease, at an expense not to exceed five dollars
each per annum for five years, rapidly diminishing after that. If this
were done, within thirty years consumption would probably become as rare
as smallpox is now. Some day, when the community is ready to spend the
money, this will be done, but in the mean time, we must attack the
disease by slower and less certain methods.
[Illustration: A COMPARATIVE DEATH-RATE OF CONTAGIOUS DISEASES
Note the number of deaths from tuberculosis to one from smallpox; yet
smallpox before the days of vaccination and quarantine, was the
universal scourge. Similarly, by preventive measures, we are controlling
the other diseases. Why not also tuberculosis? (Statistics for greater
New York, 1908; total number of deaths from all causes, 73,072.)]
Why the Fear and Danger of Consumption have been Lessened. Terrible
and deadly as consumption is, we no longer go about in dread of it, as
people did twenty-five years ago, before we knew what caused it; for we
know now that it is preventable and that two-thirds of the cases can be
cured after they develop. The word consumption is no longer equivalent
to a sentence of death. The deaths from tuberculosis each year have
diminished almost one-half in the last forty years, in nearly every
civilized country in the world; and this decrease is still going on.
The methods which have brought about this splendid progress, and which
will continue it, if we have the intelligence and the determination to
stick to them, are:--First, the great improvements in food supply,
housing, ventilation, drainage, and conditions of life in general, due
to the progress of modern civilization and science, combined with a
marked increase in wages in the great working two-thirds of the
community. Second, the discovery that consumption is caused by a
bacillus, and by that alone, and is spread by the scattering of that
bacillus into the air, or upon food, drink, or clothing, to be breathed
in or eaten by other victims. Third, increase of medical skill and
improved methods of recognizing the disease at a very early stage. A
case of consumption discovered early means a case cured, eight times out
of ten.
Its Cure and Prevention. Fortunately, the same methods which will cure
the disease will also prevent it. The best preventatives are food, fresh
air, and sunshine. Eat plenty of nourishing food three times a day,
especially of milk, eggs, and meat. Sit or work in a gentle current of
air, keep away from those who have the disease, sleep with your windows
open, take plenty of exercise in the open air, and you need have little
fear of consumption.
In the camps, or sanatoria, for the cure of consumption, these methods
are simply carried a little further, to make up for previous neglect.
The patients sit or lie out of doors all day long, usually in reclining
chairs, in summer under the trees, and in winter on porches, with just
enough roof to protect them from rain or snow. They sleep in tents, or
in shacks, which are closed in only on three sides, leaving the front
open to the south. They dress and undress in a warm room, or the
curtains of the tent are dropped, or the shutters of the shack closed
night and morning until the room is warmed up. In cold climates they
dress day and night almost as if they were going on an arctic relief
expedition, and spend twenty-four hours out of the twenty-four in the
open air.
[Illustration: A TUBERCULOSIS TENT COLONY IN WINTER]
They eat three square meals a day, consisting of everything that is
appetizing, nutritious, and wholesome, with plenty of butter, or other
fats; and in addition, drink from one to three pints of new milk and
swallow from six to twelve raw eggs a day. You would think they would
burst on such a diet, but they don't; they simply gain from two to four
pounds a week, lose their fever and their cough, get rid of their night
sweats, and usually in from two to five weeks are able to be up and
about the camp, taking light exercise. When they have reached their
full, normal, or healthy weight for their height and age, their amount
of food is reduced, but still kept at what would be considered full
diet for a healthy man at hard work. If sick people can be made well by
this open air treatment, those of us that are well ought not be afraid
to have a window open all night.
Two-thirds of the treatment that would cure you of consumption will
prevent your ever having it. While tuberculosis chiefly attacks the
lungs, it is really a disease of the entire body, or system, and cannot
attack you if you will keep yourself strong, vigorous, and clean in
every sense of the word.
How to Recognize the Disease in its Early Stages. To recognize the
disease early is, of course, work for the doctor; but he must be helped
by the intelligence of the patient, or the patient's family, or he may
not see the case until it is so far advanced as to have lost its best
chance of cure. We can now recognize consumption before the lungs are
seriously diseased. Among the most useful methods with children is the
rubbing or scratching of a few drops of the toxin of the tubercle
bacillus, tailed _tuberculin_, into the skin. If the children are
healthy, this will leave no mark, or reddening, at all; but if they have
tuberculosis, in two-thirds of the cases it will make a little reddening
and swelling like a very mild vaccination. But in order to get any good
from this, cases must be brought to a doctor, early, without waiting for
a bad cough, or for night sweats.
Signs of Consumption. The signs that ought to make us suspicious of a
possible beginning of tuberculosis are first, loss of weight without
apparent cause; fever, or flushing of the cheeks, with or without
headache, every afternoon or evening; and a tendency to become easily
tired and exhausted without unusual exertion. Whenever these three signs
are present, without some clear cause, such as a cold, or unusual
overwork or strain, especially if they be accompanied by a rapid pulse
and a tendency to get out of breath readily in running upstairs, they
should make us suspect tuberculosis; and if they keep up, it is
advisable to go at once and have the lungs thoroughly examined. Nine
cases out of ten, seen at this stage, are curable--many of them in a few
months.
Even if we should not have the disease, if we have these symptoms we
need to have our health improved; and a course of life in the open air,
good feeding, and rest, which would cure us if we had tuberculosis, will
build us up and prevent us from developing it.
[Illustration: AN OUTDOOR CLASSROOM FOR TUBERCULOUS CHILDREN
The roof and the side awnings are the only obstructions to the outer
air.]
PNEUMONIA
Its Cause and Prevention. The other great disease of the lungs is
_pneumonia_, formerly known as inflammation of the lungs. This is rapid
and sudden, instead of slow and chronic like tuberculosis, but kills
almost as many people; and unfortunately, unlike tuberculosis, is not
decreasing. In fact in some of our large cities, it is rapidly
increasing. Although we know it is due to a germ, we don't yet know
exactly how that germ is conveyed from one victim to another. One thing,
however, of great practical importance we do know, and that is that
pneumonia is a disease of overcrowding and foul air, like tuberculosis;
that it occurs most frequently at that time of the year--late winter and
early spring--when people have been longest crowded together in houses
and tenements; and that it falls most severely upon those who are
weakened by overcrowding, under-feeding, or the excessive use of
alcohol. How strikingly this is true may be seen from the fact that,
while the death-rate of the disease among the rich and those in
comfortable circumstances, who are well-fed and live in good houses, is
only about five per cent,--that is, one in twenty,--among the poor,
especially in the crowded districts of our large cities, the death-rate
rises to twenty per cent, or one in five; while among the tramp and
roustabout classes, who have used alcohol freely, and among chronic
alcoholics, it reaches forty per cent. The same steps should be taken to
prevent its spread as in tuberculosis--destroying the sputum, keeping
the patient by himself, and thoroughly ventilating and airing all rooms.
As the disease runs a very rapid course, usually lasting only from one
to three weeks, this is a comparatively easy thing to do.
Though pneumonia is commonly believed to be due to exposure to cold or
wet, like colds, it has very little to do with these. You will not catch
pneumonia after breaking through the ice or getting lost in the snow,
unless you already have the germs of the disease in your mouth and
throat, and your constitution has already been run down by bad air,
under-feeding, overwork, or dissipation. Arctic explorers, for instance,
never catch pneumonia in the Frozen North.