Consumption in America (Part I)

This is part one of a three-part series.
Read part two here and part three here.

I.

Consumption in America, — its causes, — its eradication such are the questions we propose for investigation. Who will deny their importance? What family in the land that has not suffered from the ravages of this terrible disease? As far back as our records go we find evidences of its existence. It was never more rife than it is now in New England, where, according to Keith Johnston, is its most favored seat: How shall we cope with and perchance strangle it?

We believe that eventually the world will successfully meet these questions. We cannot hope in this article to do more than glance at our reasons for this belief; but, while giving them, we shall allude to some of the chief causes connected with the origin, and suggest some means for the probable mitigation, and, possibly, for the future extermination of the disease.

The various data afforded by modern investigations lead us more and more to the hope that consumption is at last on the point of unravelling to us its mysteries, as, of late, other diseases have revealed to us theirs. Some of these causes will hereafter be avoided by our descendants, although it may be too late to prevent the present generation from suffering for the many sins of commission and of omission perpetrated by itself and its ancestry. If our fathers and we had only known and acted upon some of the principles and rules we shall try to lay down in these pages, we should at the present day be saving at least one third, and perhaps more than one half, of all the young and the beautiful who now annually die in New England from this scourge of our race.¹

As we proceed, we may at times seem dogmatical. If so, it will be because of the narrow limits of this paper. But we shall always try to keep within the lines of strict truth, and shall make no assertion which we do not believe fully sustained by facts.

Its Nature.

As a cause of death, it corrupts and destroys portions of the lungs and at times other organs of the body, by a development of bodies called tubercles, and by the inflammatory processes connected therewith. It is preceded by various influences tending to the fatal end.

By some persons it is considered n real disease by itself, but simply the culmination, it may be, of all other complaints, — an agency in nature prepared from the beginning of the world to sweep out of existence the thousands who, from their long and tedious ailments, or for their vicious hereditary tendencies, are no longer fit to live. We are no believers in this doctrine, and only allude to it now in order to draw attention to the point, and to express the hope that the perusal of the following arguments will lead all to believe that consumption is not necessarily fatal, even if it attacks a person, and that, like many other diseases, it is capable of being prevented if we act wisely.

Its Relative Prevalence formerly and at the Present Time. To whom must we appeal for Relief?

From the records of deaths in towns in former days and at the present time, and from the estimates of the ablest physicians of the last century and our own, it is apparent that consumption is more prevalent now in New England than it was less than a century ago. It will, we fear, daily increase the number of its victims, unless the community learn wisdom.

It is unequally distributed in New England, being very rife in some parts, and rare, or scarcely known, in others. From an examination of the United States census, Dr. Gould thinks—and we are inclined to agree with him—that, generally speaking, under similar hygienic influences, the disease lessens from North to South in the United States. It at present kills about one quarter of all who die annually in Massachusetts, and one sixteenth part of those dying in Louisiana. But if we can show that causes have been at work since the settlement of the country, over the whole extent of our land, insidiously tending to the development of consumption, which causes can be voluntarily overcome by individual exertion, or checked by philanthropic effort, or summarily abated, if need be, by legislative enactment, then what we advocate deserves the undivided attention of every human being in his capacity of parent, philanthropist, legislator, and capitalist. Before each and all of these we claim an impartial judgment and corresponding subsequent action; for no half-way measures are fitted for the occasion.

Residence on a Damp Soil as a Cause of Consumption.

We presume that the community at large are unaware of the vast influence of the location of a house or of a village on the existence of consumption. Many of the medical profession, if cognizant of the fact, still practically ignore it, and twenty years ago it was totally unknown. At that time all physicians believed that, as a whole, the world was everywhere decimated by the disease; that it made but little difference whether a man were born and had lived under the sunny skies of the Antilles, or had shivered amid the snows of Iceland, — everywhere this destroyer of his progeny would be present. And certainly no one dreamed, even ten years ago, that, in our bleak and misnamed temperate(!) climate of New England, places could be found almost free from consumption; while in other spots—particular homesteads even—it was frightfully rife.

All this is now changed. European observers, looking at the subject of climatic influences in their broadest sense, and, convinced by data drawn from the entire globe, have decided that certain places—such as Iceland in the North of Europe, the cool, clear, dry, and rarefied atmosphere of the Swiss mountains, the high plains of Mexico, some of the lofty valleys on the western slopes of the Andes in South America, raised high above the waters of the Pacific, and similar places elsewhere—enjoy a blessed immunity from consumption; while other places, quite differently situated, are very subject to it. Dr. R. H. Coolidge had foreshadowed this same fact in regard to this country, and hinted at its cause.

In 1854 a committee was appointed by the Massachusetts Medical Society to investigate the origin of consumption in Massachusetts. Among questions sent out to physicians in every town in the Commonwealth, and upon which either positive statistics or medical opinion was obtained from all the towns, were two upon the influence of locality. Contrary to all preconceived notions, the committee was compelled to draw the following inferences from the facts presented by correspondents: —

1st. Phthisis (consumption) is very unequally distributed in New England.

2d. There are some places which enjoy a very great exemption from its ravages, if not quite as much exemption, as any portion of the globe can claim.

3d. There are some spots, nay, even particular houses, which are frightfully subject to it.

4th. There is a cause governing this unequal distribution of the disease, — a law not recognized before these investigations, and still practically ignored by the majority of human beings, which, however, is one of the main causes, if not the sole cause, of this unequal distribution in New England, and possibly elsewhere.

5th. This cause is intimately connected with, and apparently dependent on, moisture of the soil on or near which stand the villages or houses in which consumption prevails.

These results are based upon too large an array of facts to admit now of any doubt of their substantial correctness. They have been supported by similarly observed facts in Rhode Island, Vermont, Maine, and New York, and by the registration returns of Massachusetts. They have very recently been confirmed by English investigations, carried on under the direction of the Privy Council, which investigations have such an important bearing upon our subject that we feel that we ought pointedly to allude to them. The Council, being desirous of learning whether any effect had been produced upon the health of the inhabitants of towns where sanitary improvements had been fully carried out for a number of years, caused investigations to be made upon the relative prevalence of various diseases before and subsequent to the period at which said improvements were made.

Various important results were obtained, tending to show that the public health had been very much benefited thereby. But that which was deemed worthy of the name of “discovery by Dr. Buchanan,” was the striking one, that in towns that had been thoroughly sub-drained, and thus had been made comparatively dry, instead of having a soil permeated with moisture as previously, there was a marked diminution in the number of deaths by consumption, sometimes even to the extent of more than one half.

This discovery in Old England was simply a practical illustration of the truth of a law previously proved to exist in New England, where actual statistics in not a few instances had proved, —

1st. That there are from twice to three times as many deaths from consumption in the wet places of New England as in those that are dry; and

2d. That generally in proportion to the amount of dampness of the soil is the tendency to death by consumption.

This fact, that a law of soil-moisture, as a chief cause of consumption in Massachusetts, really existed, and the correlative fact that dryness of the soil is characteristic of those places in other parts of the globe where consumptives resort with advantage, had naturally suggested the inference that probably the same law is widespread over the globe, and is one of the real laws of the increase of consumption everywhere.

The results obtained by Dr. Buchanan were deemed so important, that the Privy Council directed him to continue his investigations during the past year, and he has arrived at results entirely analogous to, and fully sustaining, the views previously advanced by him, and by the committee of the Massachusetts Medical Society, years ago.

We have just received, from Dr. Simon, the chief medical officer of the Privy Council, their Tenth Report. It contains the results of these further investigations in England and Scotland. The summary of the whole is in these words, and, in order to make them more emphatic, they are printed in the original partly in capitals, as given below: —

“The whole of the foregoing conclusions combine into one, — which may now be affirmed generally, and not only of particular districts, — THAT WETNESS OF THE SOIL IS A CAUSE OF PHTHISIS TO THE POPULATION LIVING UPON IT.”

The reporter terminates with these remarks: “Until the end of my own inquiry I was in complete ignorance of Dr. Bowditch’s researches. I should not insist on this point, except for the purpose of giving to the conclusions which Dr. Bowditch and myself have obtained the additional weight that they deserve from having been arrived at by a second inquirer wholly ignorant of and therefore unbiassed by the work of the first.”

It seems to us that no unprejudiced mind, when remembering that this law has been thus proved to exist in this country and in Great Britain, and recalling this second fact that most of the places where consumptives resort are dry, and those they avoid are rather moist than dry, can hereafter doubt that sufficient proof is thereby given of the existence of a general law acting over large extents of country, and probably over the entire world.

This law certainly acts over wide extents of country, or within the narrowest districts of New England. There are even single homesteads in Massachusetts which for more than half a century, as actual statistics prove, have felt its influence, and others within a radius of a fraction of a mile upon which, owing to location merely, it scarcely ever has appeared to have any effect. Two or three generations have been cut down in the former houses, and more will continue to be cut down, unless the inmates become convinced that no parent ought to attempt to bring up children in defiance of this natural law any more than he would attempt to do so in defiance of the laws of gravity or of combustion.

Children will leave such homesteads hereafter, as they quitted them heretofore, and recover health only to fall back again if they return under the blighting influences of the consumption-breeding soil on which is placed the home of their childhood. We have known nearly one whole family thus cut down one after the other, and all ignorant of the essential cause of their disease. Finally, the youngest, as he grew up towards manhood, began to fail as his brothers and sisters had failed before. He wisely inferred that death to him was in the house; that something, he knew not what, prejudicial to his race existed there, and that he was doomed unless he forsook the spot. Acting on this just assumption, he left, and wholly recovered, and lived in other parts to a green old age.

We know of two families in Massachusetts of whom the following story may he told. Two healthy brothers married two healthy sisters. Both had large families of children. One lived on the old homestead, on the southern slope of one of the numerous beautiful and well-drained hills in that vicinity. The whole house was bathed all day long in sunlight, and consumption did not touch any of the young lives under its roof. The other brother placed his house at a very short distance off, but upon a grassy plain, covered all summer with the rankest verdure. In its front was a large open common. In the centre of this, water oozed up from between the split hoofs of the cows, as they came lowing homeward at evening, and the barefooted boy who was driving them used to shrink from the place, and preferred to make the circuit of its edge rather than to follow the lead of his more quiet comrades. Back of the house was a large level meadow, reaching to the very foundations of the building. Through this meadow sluggishly crept the mill-stream of the adjacent village. Still further, all these surroundings were enclosed by lofty hills. The life-giving sun rose later and set earlier upon this than upon the other fair homestead. Till late in the forenoon, and long before sunset left the hillside home, damp and chilling emanations arose from the meadow, and day after day enveloped the tender forms of the children that were trying in vain to grow up healthily within them. But all effort was useless. Large families were born under both roofs. Not one of the children born in the latter homestead escaped, whereas the other family remained healthy; and when, at the suggestion of a medical friend who knew all the facts we have told, we visited the place for the purpose of thoroughly investigating them, we thought that these two houses were a terribly significant illustration of the existence of this all-powerful law. Yet these two homes had nothing peculiarly noticeable by the passing stranger. They were situated in the same township and within a very short distance one from the other, and scarcely any one in the village with whom we spoke on the subject agreed with us in our opinion that it was location alone, or chiefly that, which gave life or death to the inmates of the two.

We might speak of other homesteads which seem to us now to be the very nests of consumption in consequence of this law, and yet not one parent in a hundred acknowledges even theoretically his belief in the truth of our assertion. Parents themselves, during a long residence, may escape from the dire influences of location; and therefore they imagine, if their children are falling, that some other evil agency is at work, rather than this law.

Illustrative of this error on the part of parents, we cannot forbear relating the following fact. We know of a house situated about a foot above and just on the edge of a small lake. The cellar, if there be one, must be below the level of the water. The house, built with taste, nestles amid over-hanging thickly leaved trees, through which the sun’s rays can scarcely penetrate even at midday. The homestead is overrun with the springing woodbine, clematis, and honeysuckle. Coolness, dampness, and little sunlight are the characteristics of the spot. In the midst of summer it is the beau ideal of a quiet, refined country house, which any one, even the most fastidious, would desire to occupy. Yet as we have looked at it, and have remembered how one by one the children born in it have been cut off by consumption either at puberty or at early manhood or womanhood, we have turned with loathing from all its external beauties, and have regarded them all as so many false and fatal allurements, bringing inevitable ruin to those who should fall within the sphere of their influence.

These tales are no creations of our imagination, but positive and undeniable facts.

We have thus very briefly spoken of one of the primal causes of consumption in New England and Great Britain, and probably throughout the world. Let us now turn to several other apparent or real causes of the same. At the termination of the statements of all, we will give with equal conciseness our views as to what is required on the part of individuals and of the community in order to meet, and if possible subdue, those causes.

In Consumption Hereditary?

In one of the rural cemeteries of this Commonwealth there is the following inscription in Latin on the tombstone marking the joint graves of a man and his wife, both of whom had died of consumption. It seems like the dying wail and prayer of the parents for the future welfare of their children: “Insatiable disease! thou hast destroyed both parents: spare, O spare our children!” That prayer was unanswered, possibly from a total neglect of the very means whereby alone such a prayer could be answered.

Undoubtedly it is true that public opinion considers consumption as hereditary, and medical experience seems to support this view. We presume that there is scarcely a physician anywhere who would not admit the truth of this belief. Yet no physician would dare to say that, in any given case, consumption would necessarily be transmitted from parent to child. Granted that, as a general rule, the child of a tuberculous or consumptive parent either dies early, or at the age of puberty or young manhood or womanhood, it by no means follows that such is always the fact, or that we have no means wherewith we can contend against and fully subdue that downward tendency.

If we give to such children proper food, and fitly clothe them; if we exercise them freely in the open air from earliest babyhood; if at a later period we prevent too much study, and will not allow them to be closed up in abominable, furnace-heated school-rooms, now so common throughout the land, but, on the contrary, urge them to engage in all athletic sports; if, when arriving at adult age, we caution those of tender frames against choosing sedentary employments, — such as clerkships, the ministry, and the thousand other semi-literary kinds of employment, which of themselves tend to deteriorate the bodily powers, — but rather lead them to the more active mechanic trades, or farm or sea or business life, — if with a steady, untiring purpose we do all these things, then we may hope to crush out the evil tendencies, all the rash humors that the parents give the child; we may smother the seeds of consumption planted before birth in the Constitution, and instead of weakness give strength; and thus out of a weak, puny childhood we may form stalwart men and graceful and healthy women, fit to be the future parents of the race.

Both opinions are to a certain degree true. We cannot doubt that weakness of physical organization and actual tendencies to consumption are transmitted by some consumptive parents to their children; nevertheless, in many cases, if these proper precautions be followed from the cradle up to at least thirty or forty years of age, weakness and that tendency may be wholly overcome, and the individuals may be not only really healthy during that period, but for the usual age of man. The great difficulty is, that, where one family thinks of these precautions and is convinced of their necessity, there are a thousand who wholly neglect them from an ignorance of the common laws of hygiene. Some wilfully neglect them, owing to a want of real faith in their immense powers. Others again, though fully persuaded of their general value, lack that enduring, almost divine grace given very rarely to women and still more rarely to men, which, when possessed, leads one to recognize the fact that years of untiring watchfulness and of painful self-sacrifice perhaps will be needed, on the part of the parents, in order to prevent the seeds of disease, sown at the very moment of conception, from becoming so rapid and luxuriant of growth as to obstruct all the springs of healthful life in the dear young body committed to their charge.

But we must confess the sad and unwelcome truth, that, in many instances, with all our present knowledge, no amount of human and hence necessarily imperfect care can save some children. At their birth they are doomed to an early death. By the diseased condition of the parents, sometimes, alas due to their own or to their ancestors’ previous excesses, the tender bodies of the children are so tainted that life becomes a burden. We have often seen in such cases the terrible vindication of the power of the old Mosaic law, “For the sins of the fathers are visited upon the children unto the third and fourth generation.” Such children die early; and this is exactly right. The race would constantly deteriorate were it otherwise. For there is no greater proof of Divine foresight than the law which certainly prevails, that only to strength and perfect health belongs the highest life, which alone has as its birthright the will and the power to contribute to the continuance of the human race.

Is Consumption ever contagious?

In looking back upon the history of this question as held by previous centuries, one is struck with the curious degree of uncertainty that has prevailed in the medical profession in reference to it. Previously to 1775 or thereabouts, most authors and some entire communities believed in contagion. In Italy it was the common custom to disinfect the houses where consumptive patients died, and to burn the clothing that was believed to be contaminated by their touch. Morgani, undoubtedly one of the ablest and wisest of his day, and one whose works prove that he was constantly examining bodies of persons dead from all diseases, was said to have been actually afraid to dissect the body of a consumptive patient.

During the last quarter of the last century there was great indecision on the part of the faculty, and many protested against this strong position. From the writings of that period it is evident that the idea of contagion had met a strong opposition, and finally, early in this century, an opinion the exact reverse of contagion was arrived at. Forty years ago scarcely any one believed in it, and even Italy relaxed its strict rules. But within a few past years the belief in the contagiousness of tubercle, which is usually synonymous with consumption, has suddenly again sprung up in Germany, under the influence of experiments made by modern physiologists. Inoculations of tuberculous matter from men to animals have been made, and the disease has been reproduced in the animal. It is true that doubt has been thrown upon the real value of these experiments; and we think that doubt is a just one, because it has been found that any long-continued local irritation of an animal—as, for instance, the keeping up of a violently irritating sore on the body—may eventually excite tubercular disease. Moreover, the fact that tubercle when inoculated, that is, put under the skin by means of an operation, produces consumption in an animal, is no valid reason for thinking that the emanations from the breath or skin of a tuberculous patient would certainly convey the disease from man to man. Still further, if the disease were really so contagious as some believe, why have not physicians and nurses and attendants at special hospitals for the lungs, — as at Brompton, for example, — been taken down by the disease?

Nevertheless, we think we are correct in saying that some of the ablest physiologists of Germany and of France believe in the inoculability, and consequently, as they contend they have a right to do, they adhere to the doctrine of the contagiousness of the disease. In England, too, the same thought is beginning to germinate. Dr. Budd, of Bristol, last summer addressed a letter to the eminent surgeon, Mr. Paget, avowing that belief, deduced from his own experience during a medical practice of over thirty years’ duration. Dr. Budd, however, gives us no facts, but simply the statement of his belief, drawn from what he deems sufficient data. Considering the distinguished merit and high character of Dr. Budd, his simple statement deserves great consideration, although we may not be able fully to adopt his views.

Briefly, we may say that medical opinion is, at present, much divided upon the topic of the contagiousness or otherwise of consumption. Few, if any, believe it to be equally contagious with small-pox and other kindred contagious diseases. Still, medical opinion rather verges now towards the belief that the disease is at times capable of producing a like disease in others, unless precautions are taken by those who have the care of ministering to the consumptive. With these precautions we believe there is no danger; without them there is peril. And to this let us now address ourselves. In doing so, we must be allowed to refer to some investigations made some years since. At that time we prepared a brief article on the question, “Is consumption ever contagious?” We were able to remember but six cases, occurrlng in an experience of many years, of which we had full record, and in which when we commenced the investigation we supposed there was undoubted evidence of the transmission of consumption from one person to another. All of these cases were of individuals wholly disconnected by blood with the originally consumptive patients who were thought to have given the disease to them. They were of the persons who had had consumptive husband, wife, or female friend, and had been in very close and devoted attendance upon the consumptives. We have no doubt now upon the relation of cause and effect in all the cases. But it happened, unfortunately for rigid proof, that in all the cases some one ancestor, though frequently distant and collateral, had had consumption. Hence, although apparently this fact must have had a very trivial effect in any of the cases, it becomes impossible wholly to separate the element of hereditary influence from that produced by the supposed contagiousness of the disease. It may be remarked, however, that there is scarcely an individual in the community upon whom the same argument might not be used; for, in the wide prevalence of consumption, there is scarcely a man or woman who cannot find that some relative, near or remote, has died of it. The one case of our six cases in which this element was wholly absent, and in which all the relatives feel sure that the patient actually got the disease from attendance on the consumptive, is as follows: A young girl, a farmer’s daughter, the very picture of robust health of body and mind, and of a quiet and calm disposition, had become devotedly attached to another young woman rather older than herself, of commanding intellect and of most charming character. The consequence was a real enthusiasm of friendship between the two. The elder was not in strong health when the union began, and erelong consumption became manifest in her. The young friend gave herself up wholly as special nurse, and stayed with the invalid daily and at night slept near her for some time. Her own strength finally broke down with a series of ill-defined symptoms, and great prostration of all the powers of life. The parents, who had long perceived an apparent decline of her health, and had vainly tried to persuade her of the dangers of the situation, immediately took her home. We then saw her as we had previously seen her companion, but irretrievable injury had already been done to the lungs. She was unwilling to part with her friend, except on the express condition of being informed when the symptoms should become so much more serious as to threaten an early death. The two friends determined to be together during the last few days of life. This was granted, and some months afterwards the younger girl again spent a week with the dying invalid, and, so far as her own health would allow, ministered to her. After the death of her friend our patient never rallied, but slowly sunk, and died of consumption; the whole process, from the moment of first attendance till her own death, being about two years. We have no doubt that, if she had not thus sacrificed herself to close devotion on the sick girl, she would not herself have been subsequently diseased.

A priori, we might infer that such cases would be more likely to occur among women than men. The earnest ways of women, their willingness to stay in constant attendance, and their unwillingness or inability to go out except very rarely, would make them more susceptible to any emanations front the sick than men would be. The active duties of life call men from home. The sympathies of men are less keen than those of women, so that their very natures are less fitted for personal attendance on the sick. On the contrary, the keener instincts of woman lead her at times to a truer self-devotion and even to death in such a cause.

In illustration of this, and to show by what means we believe that consumption is sometimes given by a husband to his wife, we will relate the following. It was our fortune to attend a man slowly dying of consumption, who, while hopelessly and helplessly ill, was devotedly cared for by his wife, who at the time felt herself, and seemed to be, in perfect health.

Years after her husband’s death, and when she was bravely battling against the disease, which commenced its insidious attacks immediately subsequent to his death, she related to me the following fact, but only on my definite inquiries as to how intimate her relations had been with him during his illness. It seems that often, in wintry nights, that faithful woman would arise from the side of her husband, who was lying with his dress drenched with the chilling sweat of increasing disease, and would persuade him to take her warm clothing and to lie down in the dry warm place she had just left, while, simply throwing a blanket over it, she would take the spot that had been previously occupied by him! Upon our expressing a horror at the thought of the danger she had run, and which apparently had told with so much power upon her, she quietly remarked that she knew at the time the danger that she was incurring. She had no thought of danger to herself, and only of her husband’s comfort! “But,” added she, “I then got what I have never recovered from.” A certain vitality seemed to go out of her; and though her nature contended for many years against the encroachments of the disease, she finally died, always believing that she had taken consumption from her husband, but with a certain martyr-like joy that such had really been the fact.

We have now in our mind other and analogous cases, as, for example, of husbands having their first cough when “inhaling the breath of their sick wives,” while ministering to their necessities. We have known daughters and sisters who, full of apparent health and strength, when consumption has seized a mother or sister, have continued to sleep with the invalid, and to breathe the same closed-up atmosphere at night, and to watch all day without perhaps a moment of healthful out-of-door exercise. And we have been distressed to find not a few of such healthy young persons gradually beginning to suffer with indigestion, debility, and finally cough, and all the symptoms of consumption. In some instances, in fact, the attendant has died before the life of the original patient has ended. These facts are very significant; and although we are well aware that, in some of them, other elements of disease may have had their fatal influences, still the cases have been full of suggestions as to the necessities of greater precautions than we, in this country, have usually taken in this matter. These precautions we shall speak of hereafter.

Influence of the different Trades and Professions as Causes of Consumption

This question is of vital importance to every young person about to choose a profession or trade as the business of life. It is worthy of the maturest thought of every parent and every philanthropic employer; for upon the proper choice of a trade or profession will depend much of the future weal or woe of the youth just commencing life. At present there seems often to be, while making the choice, a woful amount of ignorance of the common rules of health.

We may consider the question in two lights; namely, first, as it regards a perfectly healthy youth; and, second, as it has reference to one that is either actually in ill health or who from physical organization or hereditary tendencies is liable to suffer from consumption.

And, first, it is undoubtedly true that a man may take any of the various trades or professions, and if he only do not neglect the rules of health, he may practise without injury any of these arts even to advanced life. Nevertheless, there are some which, from their very nature, or their necessarily accompanying circumstances, are less healthful than others. Among these may be named all those practised in places in which fine dust is floating in the air, whatever that dust may be. Especially deleterious is the trade of machinist, in working at which quantities of fine steel-dust are set flying; or the knife and scissors grinder’s trade, in which, in addition to the steel, a cloud of emery-dust is drawn in with almost every breath. It is true that some of these various dusts do not produce real tuberculous disease, but they all tend to clog up the finer air-cells of the lungs, and are liable to cause cough, emaciation, and death, at times with tubercular complications.

Next, perhaps, in order come all those trades that cramp the chest, and prevent free expansion of the lungs, and incline the patient to bend forward, thus permanently diminishing the calibre of the chest, compressing the delicate structure of the lungs, causing obstruction therein, with subsequent disease and death. Prominent among these trades stand such as that of shoemaker for men and that of seamstress for women. These are essentially sedentary in their nature, and have most strongly marked tendencies of the nature alluded to. But they likewise lead to the various forms of dyspepsia, to irregularities of the digestive and of other of the more delicate functions of the body. These latter complaints are too often found, when we unravel the history of cases of consumption, to be the precursors for months previously of the dreaded affection of the lungs. The whole internal arrangements of many large establishments for “slop” work, where perhaps from fifty to a hundred young women or men are collected in large unventilated rooms, are simply an outrage upon common decency, and infamous with regard to arrangement for the health of the employees. How general it is we know not, but not infrequently we have been informed by patients that at times, for example, no water-closets can be found on the premises, or, if found, they are in a deplorable state. Hence constipation and indigestion come to add their weight to the deleterious influences of the trade itself.

Less constantly confining to the chest, but as employments analogous to the last-mentioned trades in effect, we may name those of clerk and student. Both tend to induce inaction of the entire body and a curving forward of the chest; and although neither of these professions necessarily produces disease, and although it is possible for the student and clerk to avoid the evils that are impending, they very frequently do not avoid them, either from their own gross ignorance of hygienic laws, or from the cupidity of the employer, which prevents them from properly attending to the same. Those employed are at times compelled to work in houses totally unfit for human beings to inhabit, while at other times love of gain deprives them of the requisite time for exercise and for the taking of food.

Such cruelty on the part of employers, we admit, is rare. Moreover, we are inclined to think that there are but few who wilfully sin in this manner. They have ample means; and money with them is resolvable into human labor. In modern scientific language, of “the correlation of forces,” they virtually say, “With the force of so much money we ought to get a corresponding degree of human force applied to the purposes required.” Under this idea, the health of those employed is considered of but secondary importance. We confess that we think there are few even of our worthiest employers who have the perfect health of those employed seriously at heart; and this is not derogatory to them, for it is simply human nature, and will continue as long as our present mode of conducting business is continued. When a true Christian co-operation is introduced into all the channels of business, then, and not till then, will those employed see to it that everything is done to prevent detriment to their lives during their hours of toil.

Another evil tendency of certain trades is to require sudden transitions from heat to cold and wet to dry, the long continuance in cold, damp cellars or warerooms half underground, which, even in the heat of midsummer, though deliciously cool to the transient customer, are most deadly in their influences upon those permanently employed therein. Of such employments is that of the moulder, with his constant wet about him, and the beer-bottlers, who lives most of the time in damp, dark cellars; and analogous to these cellars in their influence on human health are the cool, damp underground rooms of dry-goods dealers, in all our streets of business. These each and all tend to produce consumption, and are therefore nuisances as at present managed; for anything is a nuisance that tends to destroy human life. We have had to warn not a few clerks of the risk they were running in staying in such places. If they fly from them early, they may be saved. If they continue after health is once seriously impaired, they are doomed. Such places ought to be forbidden by law, and, when a proper public sentiment arises, this will be done.

We have thus far considered the influence of these various kinds of business upon persons in perfect health; and we may merely add, that, if there be danger to those in health, it will be madness on the part of those having hereditary tendencies to tubercular disease, or who are actually diseased, to enter into them, or into any of an analogous kind. Strange as it may seem, we find often an utter neglect of these rules, and pursuits in life are commenced without a thought of the effect on future health.

If a boy is puny, he is made more puny by being allowed to study, instead of being urged into the open air and to athletic sports, or into the farmer’s field; and when he is of age to choose a profession, he becomes a dyspeptic clergyman, prepared to preach his own unwholesome vagaries, instead of healthful strong Christian doctrines, or we find him a nervous, irritable, one-sided professor, who, in his frantic efforts to govern the healthful impulses of students, forgets, if he ever had them, the dreams of his own youth; or perchance such a one will delve behind the accountant’s desk in comparative misery through life. There seems to be little judgment, no forewarning of the young. By accident the choice is made, and, according to the doctrine of chances, life becomes either healthful or a tissue of weak and morbid hours, too often cut short by consumption.

This is part one of a three-part series.
Read part two here and part three here.