Sir James Clarke 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."
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 may remove or avoid.
_Impure Air a Cause of Consumption._--In discussing the causes of a
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.
_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 woollen factories, that of the street,
and that which is constantly rising from our carpets, are all
mischievous. M. Benoiston found among cotton-spinners the annual
mortality from consumption to be 18 in a thousand; among coal-men, 41;
among those breathing an atmosphere charged with mineral dust, 30, and
with 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.
_Gases._--Among the poisonous gases which infest 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 one or two per
cent, it seriously compromises health. I have seen the last half of an
eloquent sermon entirely lost upon 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.
The following fact graphically illustrates the influence of carbonic
acid on human life.
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 up 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.
"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.
"It is a quarter past ten. I have just lighted the stove; the charcoal
burns feebly.
"Twenty minutes past ten. The pulse is calm, and beats at its usual
rate.
"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.
"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.
"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....
"Eleven o'clock. 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. The
following morning he was found on the floor.
The steamer Londonderry left Liverpool for Sligo, on Friday, December
2d, 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.
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.
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.
The victims of the Black Hole in Calcutta and of the Steamer
Londonderry, with the thousand other instances in which immediate death
has resulted from carbonic acid, are terrible examples in the history of
human suffering; but these cases are all as nothing, compared with those
of 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 persons, and have not found one hundred
of them in 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
fifty thousand dollars, in the construction of which not fifty dollars
were expended in providing means for ventilation. Ten thousand dollars
for ornament, but not ten dollars for pure air! Parlors with
furnace-heat and a number of 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. 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
breathe, during six hours of every day, so poisonous an atmosphere.
Theatres and concert-rooms are so foul that only reckless people can
continue to visit them. Twelve hours in a railway-car exhausts one, not
because of the sitting, but because of the devitalized air. While
crossing the ocean in the Cunard steamer Africa, and again in the
Collins steamer 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!
It is hardly necessary to say that every place I have mentioned might be
cheaply and completely ventilated.
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 infer that foul air must play a most
important part in that local expression of the tubercular taint known as
pulmonary consumption.