Consumption in America (Part II)

The second installment in a three-part series about the wasting disease now known as tuberculosis

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


Want of Sunlight as a Promoter of Consumption.

It is hard to prove the direct agency of a want of sunlight in the production of consumption. Reasoning from analogy, however, we might infer that, as plants grow up thin and white and unhealthy when deprived of light, so, under similar circumstances, the human being would suffer. But we see the evil influence on man caused by absence of the sun’s rays, in the pallid and emaciated forms of many of the children of the poor, particularly of those living where the direct sunlight cannot enter. It is true that want of proper food, & c. must usually have their own specific effects conjoined with this. Nevertheless; to any one who has experienced the genial glow coming from the sun on an early spring day, little will be needed to prove its strengthening power. All modern science tends to make the sun the centre of force and of life to vegetables and to man. The ancients knew better than we, for they had their solaria on the house-roofs, where they could enjoy in quiet their sun-baths. We, on the contrary, often place our sick on the north side of the house, where the sun never enters; or, perchance, if we have them in a southern room, we close all the blinds and curtains of its windows for the sake of our Brussels carpets, thereby unconsciously demonstrating that we think more of our finery than of the health of our households. We believe firmly that to the influence of pure air and direct sunlight we owe a vast deal of our common every-day health. Hence, in the treatment of our patients, we always seek to unite these advantages. We have been told by some consumptives that one of the best prescriptions we have made has been their removal from a north room to the sunny south chamber. As we write, two cases come to mind, strikingly illustrative of the sun’s benign influence. We had been attending, at an orphan asylum, a girl about twelve years old, who had been long ill of severe typhoid fever. She was wholly prostrated in mind and body, and emaciated to the last degree. It was plain that she was falling into that depressed condition of all the powers of life that so often precedes consumption: Day after day we visited her, but all recuperative power seemed lost. Half dead and alive, the little creature neither spoke nor moved, and ate only on compulsion. One day, on our way to visit her, we felt that elastic thrill which the warm rays of the sun impart in the early cool weather of spring. We involuntarily leaped along, and were instantly struck with the fact that “virtue had gone out of us” when we left behind us the sunlight and warmth of the street and entered that northern chamber, the dormitory of the poor orphan. That inspiriting influence the invalid had never experienced in the slightest degree during the whole of her sickness, as, owing to its peculiar situation, not a ray of direct sunlight had ever entered the chamber. We were shocked, and for the first time considered the depth of her loss, and our own remissness in regard to her. The air of the room had been pure, the ceilings of the infirmary were lofty, the attendants had been faithful and sagacious. Nothing seemed lacking, in fact, to restore health. Yet it did not come. On the contrary, there seemed a constant downward tendency. “A sun-bath in the warm rays of this delicious spring day is what this girl needs,” we instantly said to the sister superior. This lady gladly consented to the change, and placed the little patient in another room having a southern aspect, and consequently filled with sunlight. The invalid immediately recognized the change, and asked, in her weak way, to have the curtains raised, so as to let in the full blaze of the light. So on she wanted to sit up, and directed that the easy-chair, in which she was propped, should be so placed as to allow her whole body below her face to be exposed to the direct rays of the sun. It was the natural tendency of disease, seeking for all life-renovating influences. And we have never met with so marked or so rapid improvement as immediately began in the body and mind of the girl. Appetite and strength increased daily, and with them burst forth again all the joyousness of the child’s heart.

Another analogous case, which, although we do not demonstrate by it the influence of the sun alone, we cannot forbear to name, because by such examples we impress perhaps on the minds of our readers the real principles underlying the whole question. A lady aged about thirty, resident in the northern part, of New England, consulted us for undoubted tubercular disease of the lungs. Her house was well situated, and on the side towards the south was a small piazza resting on stone steps, which was raised two or three feet above the ground. The winter was approaching and rules were to be given. Having full faith in these divine influences of pure air and sunlight, we directed that she should sit out on this piazza every day during the winter, unless it were too stormy. It was so arranged as to shut out the cool air on three sides, and to admit the full blaze of sunlight in front. Here, according to our directions, she used to sit wrapped in furs, reading or writing for several hours each day during the following winter, and with most excellent results. She was directed frequently to make deep inspirations, in order to fill the lungs with pure air. She was never chilled, because the sun’s rays and her warm clothing prevented it. She never “took cold” there. On the contrary, the balmy influences exerted upon her by her daily sun and air bath were so grateful; her breathing became so much easier after each of them, that, whenever a storm came, and prevented the resort to the piazza, the invalid suffered in consequence thereof. Whether these remarks will prove to our readers that want of sunlight may be reckoned among the causes of consumption may well be doubted, but we trust that, at least, they will convince some sceptics that sunlight has a potent influence in raising the human body from various weaknesses that sometimes are the precursors of fatal phthisis.

Want of Pure Air a Promoter of Consumption.

We mean by this, not only air uncontaminated by distinctly unpleasant and noxious odors, but all air which, whether perceptibly bad or not, has lost the necessary elements for perfect health. Understood in this way, how few houses in modern times, especially in winter, nay, at all seasons, save in the warmest weather of summer, present the requisite amount of pure air for those who live in them! In this respect we are infinitely poorer than our ancestors. We contend that, if it be possible, no person ought to breathe a second time the air that has been once expired. Look at what occurs at each act of inspiration. The oxygen of the inspired air is partly absorbed into the system of him who breathes it, and carbonic-acid gas, useful to plants but deleterious to man, is returned in expiration. If, therefore, we should definitely close up a room, and put a certain number of persons in it, without allowing sufficient of the outward air to enter, all of them would soon die of actual suffocation, or be at least made seriously ill, simply from the breathing of such air. If more time were used, and a little pure air only occasionally were admitted to the apartment, a prostrating fever would arise in any animals or men thus closed up. Continue a similar but less confined treatment, and you would bring about more slowly emaciation, debility, prostration of all the bodily powers, and, after a time, true consumption might and would be very liable to occur.

In the light of these statements let us see how our predecessors of older and of later times lived, and whether we have improved upon their methods. One has only to glance at the noble opening in the dome of the Pantheon at Rome, or, still better (because built in times nearer to the present), at the smoky aperture in Cardinal Wolsey’s lofty kitchen at Oxford, and he will be sure of one fact at least, namely, that those who lived in former days were not afraid of feeling or of breathing the open air. Our American ancestors also built houses in which the chimneys were fitted for something more than mere throats through which the smoke could escape, though each of them, doubtless, “builded better than he knew.”

Some of us, even at the present day, remember the massive and widely opened chimney-pieces and the broad hearth-stones, capable of receiving logs of immense size. In those days the hearth-stone was really the gathering-place for the family. Around that roaring “ventilating shaft,” as it would be called now, the children conned their lessons or told their fairy-tales, while their elders, perhaps, smoked their pipes; and yet, from the very nature of the arrangements, the air must have been purer than can by any means be found around our detestable air-tight stoves, or those equally wretched apologies for comfort and health, the flues of the modern hot-air furnace, or coils for hot water and steam. Formerly there was less fear of drafts; no double windows were needed, but the father and his children drank in from their own hearth, warm, pure, but not over-heated air; while at the same time they were all fancy fed by the beautiful flame as it flickered and sang its quiet song all day, and each heart was brightened at evening, when the family gathered around it from their various labors. Now all is altered. The idea of a family hearth is lost, save as sung in old-fashioned poetry. The children of the present day know of it only by hearsay. Instead of all this they collect at a table at which burns the badly trimmed, perhaps ill-smelling, kerosene lamp, or under the bright blaze and heat of gaslight, while the room is warmed by the furnace or air-tight stove.

What is an air-tight stove? Let us try to answer. If we were to build an open fire in a closed room, there is no one who would not anticipate evil. Bad air, as people commonly say, — carbonic acid and oxide gases, according to chemistry, — would soon arise, and death of the inmates would result if no help in the form of the external air should come to their relief. What real difference is there between thus building a fire in the middle of a closed room and the starting of one in an air-tight stove, and then shutting the damper to prevent too rapid combustion? With the damper closed, we have a state of things almost entirely analogous to an open grate of coals in the middle of a closed room. For the carbonic oxide, that deadly gas, begins to be given off almost immediately after the fire is lighted. It penetrates into the room, through not only the crevices of the stove, but also through the very pores of the iron itself. This has been proved completely by European science, for attention has been recently very strongly brought to the subject by reports to the Imperial Academy of Sciences, at which this fact was stated.

Meanwhile we have, in our medical experience, been often convinced that all human beings suffer somewhat when exposed to these stoves, and especially do those afflicted with lung disease have a difficulty of breathing when in a room thus warmed. By ordering their removal, and by opening the chimneys, relief more or less marked has always been immediately obtained by our patients. A certain freedom of breath has been restored to them, which they did not have while the stove contaminated the air with its noxious vapors. Hence we have arrived at the conclusion that this must be our first object in the treatment of any pulmonary difficulty. It is next in importance to exercise in the open air.

Want of Good Food and of Proper Digestion bring Consumption.

Consumption literally means a want of proper nutrition. Hence it is evident that, if good food be not given, evil will be the result. Usually this influence is seen in connection with other deleterious agencies already spoken of, such as location, contagion, the hereditary nature of the disease, and bad air and confined employments, so that it is hard to eliminate this cause from many others. But by the following statements our readers will, we hope, be convinced that want of good food is not to be neglected as one cause of consumption.

We do not remember a single case in which food alone caused the trouble, when all other influences were good. But it is undeniable that, given an undoubted case of threatened or of actual consumption, then such a case with poor nutrition, owing to imperfect or improper food, will run rapidly towards death if the same course be continued, — whereas it will, perhaps, be wholly turned towards health, if only this element of cure be fully and fitly introduced. The unfortunate prisoners at Andersonville had too little food, and became terribly emaciated; but the whole nervous system rather than the lungs was affected. In these sad cases so many other horrible circumstances were occurring, in addition to the starvation, that it would be impossible to say which was most important.

But no one can deny, as already stated, that, if you place a patient suffering from consumption in the best circumstances, and neglect to provide him with proper food, he will die. Give him proper food and drink, and he will live. But how rare it is in this country to find upon the tables of either rich or poor or middle classes plenty of wholesome, simple, and nutritious food! It will be the greatest blessing to the subsequent generations when all the girls in our public schools are taught by some Professor Blot to make good bread and simple puddings, and how to cook simply the various meats and vegetables. At the same time it will be important to impress upon the community at large that it should have nothing but such food on its tables. Let any one pass a night in any of our country towns, and, unless he happen to be at the house of the physician, he will probably be asked, at breakfast, to partake of various articles wholly incongruous, and forming a frightful compound for any stomach, — not tending, as all food should tend, to perfect digestion. Instead of pure, light bread and sweet butter, and perhaps a small slice of fresh meat, with coffee or tea, the traveller is compelled—often under the penalty of giving offence if he refuse—to partake of heavy, and perchance sour or cream-of-tartar bread, with perhaps rancid or heavily salted butter, two or three different kinds of pies, pickles, cheese, and doughnuts, followed by two or three different kinds of cake. We do not present this as uniformly the character of New England farm-house fare, but the fact that such fare is ever proffered in any community seems to indicate a want of proper public opinion upon the subject of diet, that is very much to be regretted. In cities bow common is it to see young and old collected for dinner at restaurants and railroad stations, eating wretched preparations called food, and even bolting that without proper mastication. The inevitable result is indigestion, with its train of miseries, among which comes rapidly along, in not a few cases, consumption. Sap a man’s digestion, and you make him a fit subject for this disease. For it is a fact well known to physicians, that, if a man have dyspepsia for several months, and then cough begin, he rarely escapes with his life. Hence, though bad or imperfect food may not be proved to be positively the cause of consumption, we see the importance of good food and drink as a preventive of it. What that food should be we defer speaking of until later in this paper.

Insufficient or Imperfect Clothing as a Cause of Consumption.

This is not so evidently a cause of consumption as some other influences of which we have spoken; yet we think there can be but little doubt that, indirectly at least, any carelessness in this respect, as is often caused by fashion, is fraught. with danger. Only a few years since our ladies were unwilling to wear shoes appropriate to our winter climate. Hence arose many “a cold.” And the time has passed by when we may neglect a cold as among the remote but undoubted causes of consumption.

Our young ladies, and not a few gentlemen, formerly used stays so tightly laced as to press deeply into all the internal organs near the waist, and thus prevented free expansion of the lungs; whereas the surest way to prevent consumption is to daily and hourly fill these same lungs with pure air. How can that be done with a tight band around the waist? These articles are less used than formerly, and, if used, are applied less tightly, and so far our clothing has improved of late years. At the present time the extraordinary exposure of the person, when driving in party dresses to the ball in winter nights, is fearful, and the return home, after the whirl of the waltz, and when every fibre of the young frame is palpitating, is eminently hazardous.

We might name other similar imprudences. In general it may be said, that any neglect of the use of a sufficient amount and proper kind of clothing is perilous. On the other hand, there are cases when from over-caution injury is done, and the person is weighed down and exhausted by too much clothing. We have seen children perspiring and losing flesh and strength under the flannels prepared for them in the depth of summer by over-anxious mothers. Adults, too, at times sweat like training prize-fighters under thick flannel shirts during the day and woollen blankets at night, for “fear of taking cold!”

One day in summer, when the thermometer was above 90° in the shade, we were called upon by a patient who had a shawl wrapped over his ears so that we could hardly see his face, and on disrobing him for examination we found he had two overcoats and three flannel shirts, besides the usual dress worn by a man! On our protesting that such an amount of clothing was injurious and depressing, actually tending to increase his disease, he, innocently assured me that he clothed himself so warmly to “prevent taking cold.” Nothing could be more absurd. We have only to keep an animal too warm and too quiet, and we can produce tubercular disease. A páté de foie gras proves this.

In conclusion we may say, that, although we have had no case of consumption that we deem fairly attributable by itself alone to a want of; or an abuse of clothing, we have no doubt of its important influence on the cause of consumption, and that often an attention to, or a neglect of common hygienic rules, in this respect, tends to check or aggravate the disease, or even, in some cases perhaps, to be the first excitant of it.

Is our System of Education a Promoter of Consumption?

We believe the affirmative of this question to be true, at least as applied to the Northern and Western States. We have had too many bitter experiences of its influence to have a shadow of a doubt on this point in reference to New England. We appeal to every physician of ten or twenty years’ practice, and feel sure that, in reviewing his cases of consumption, he will find not a few of them in which he will trace to overwork in our grammar or Normal Schools the first springs of the malady.

We pride ourselves, and justly so, on our system of public-school education. Without an intelligent reading people, a democratic commonwealth is the veriest farce possible. Education is the life-blood of our Republic. Without it our nation would fall. It saved us in our late Rebellion. Here in New England it provides our chief annual crop for exportation to other parts of the country. Having thus, as our readers will see, the strongest love and respect for our system of education, we nevertheless assert that it is grossly imperfect in one great particular, while actually injurious to the health of the community in others. It wholly neglects the body in the desire to cram the memory and stimulate the intellect. This is evident at a glance. Instead of looking to the full development of a youth, both body and mind, where does our school system make any provision for the proper manly and womanly physical development of the children? A vacation is occasionally given; but where is the proper physical training of the pupils? Nowhere. Surely nothing can be more absurd than this; but it is not the less true. What school-committee-man thinks of a rounded, full-developed muscle and vigorous frame of body as the precursor of; support, and actual aid to a noble, well-balanced intellect? Who thinks of turning out of our schools’ muscular young scholars? During the Rebellion, and in some instances since the war ended, some school, here or there, has introduced a military drill as a part of its regular curriculum. To us this was one of the most hopeful of signs. But neither parents, teachers, nor pupils ever entered, save spasmodically, into the plan; and now we fear that what was spasmodically commenced will be given up, just as it was beginning to unfold some narrow chests, and thus to prove of inestimable value to the whole community. By its erect positions and various exercises the air is introduced into the minutest cells of the lungs, and all the limbs of the boys are beautifully rounded out. But, as we have said, we fear from present appearances that even these few exercises will ere-long be discontinued. It is true that the Latin and High School of Boston, and a few more in the country, still continue the drills introduced into them under the stimulus of the Rebellion. But as one swallow does not make a spring, so the drilling of one or two schools does not constitute a system of physical education for our whole community. It is ludicrously absurd to even think of it in that light. Besides, any school education that systematically neglects one half of our young people, namely, the girls, the future wives and mothers of the state, is a lamentable failure in one of its most important duties. No one can deny this proposition. Common experience teaches all of us that we cannot have a healthfully acting mind in an unhealthy body. The old Latin axiom, “Mens sana in corpore sano,” is practically ignored by our school committees. They vainly hope to do what nature will not allow them to do, namely, to stimulate the intellect at the expense of the body, or at least without reference to the wants of the body. The attempt cannot be made without peril to both. Man is of a compound nature, which needs harmonious development. An undue attention to one part generally brings neglect of another, and as a consequence arise either gross monstrosities, disease, or death. If there he one truth that modern physiology teaches, it is that every intellectual effort, every noble aspiration, every emotion of the heart, depends for its perfect healthfulness upon the equally perfect play of some of the minutest parts of our physical frames. Especially is this true of that delicate structure, the so-called nervous system. Put that out of order, as we are very apt to do by over-stimulation of it at school, and soon all the frame of the child goes wrong. If continued too far, nothing but unmitigated evil results.

It is singular to what extent errors on this subject exist. A few years ago the subject of “Education in our public schools, and its effect on public health,” was proposed as a proper subject for discussion in the Suffolk District Medical Society. The society contains all the educated physicians of Suffolk County, and therefore might naturally be deemed a proper arena for the debate. But the proposer soon found to his sorrow that the discussion would be a very heated one, and productive of great personal ill-feeling. Many of the society, being members of the school board, considered themselves personally “insulted” at the bare thought that the school system could be productive of aught but good. The result was that no action was ever definitely taken on the subject.

Of late years the love of athletic sports is increasing among young men, and good will doubtless result; but it may be questioned whether the extravagance of youth and the general tendency of our country to overdo everything may not eventually bring much harm even in these beneficial amusements, whereas a regular system of physical education established by the school committee would not be so liable to abuse.

But not only does our school system, in its practical operation, entirely ignore the necessity for physical culture, but it at times goes further, and actually, as we believe, becomes the slayer of our people.

And this brings us to the especial object of these remarks, namely, our system of education as a cause of consumption.

During the past twenty-five years we have met with not a few cases like the following: A child of not unhealthy parents, resident in the city, is sent in early life to one of our common schools. Eager to learn, quiet and retiring in disposition, loving books rather than society, the pupil soon becomes the favorite of the teacher, and prominent in the class. In addition to the love and commendation of the teacher, such a child has usually placed before him the stimulus of prizes to be won, and of unexampled honors to be carried off at the exhibition of the school. As he is willing and apparently intellectually able to work, extra duties are probably put upon him. The parents, ignorant of physiological laws, are proud of the success, and stimulate the poor child still further by urging it to try to gain the prize already too much coveted. The evenings at home, instead of being devoted to a gentle home education, which parents should always be able to give to their children, and which should be considered by them a sacred duty, are occupied by school studies often till late at night. At break of day, the child’s first thought is of grammar, instead of the quiet loveliness of the morning. A lesson in philosophy, perhaps, takes the place of a prayer, or of a run out into the purest of God’s blessings, the clean and clear morning air. Breakfast is swallowed, and off to school races the half-tired young victim, nervously anxious for fear of having ill prepared the lesson, and weak from want of sleep, or, at least, from sleep disturbed by dreams of lessons lost and gained. The forenoon is passed, certainly in winter, in an atmosphere totally unfit for human beings to live in, — furnace-heated, insufficiently ventilated, usually of a temperature above 70°, and alternately heated to a close stifling degree, or chilled by the open windows, raised from time to time in order that teacher and pupil may momentarily breathe1 with comfort.

The interval between school-hours not infrequently is more or less occupied with lessons or reading, because the child “loves reading and hates to walk.” Meanwhile parents and teachers and committee-men stand by and see this process of gradual deterioration of physical health which must inevitably follow such a course of folly.

The result of all this school training is as certain as the day. Every child who goes through the above process must inevitably suffer, but not all alike. Some have one complaint, some another, and some, doubtless, finally escape unharmed. At times, they only grow pale and thin under the process. But not a few go through to the exhibition, and, after working harder than ever for the two or three last weeks of the term they gain the much-coveted prize only to break wholly down when it is taken. The stimulus of desire for success is gone. That has sustained them up to the last moment. Success having been accomplished, the victim finds, too late, that what it has been striving for is nothing now that it is won. But all vitality seems gone out. The previous weak health, which mental stimulus had sustained without open complaint, gives way when its support is removed, and then come loss of appetite and loss of strength. The slight cough, scarcely noticed before, becomes more marked, and the physician is summoned. Almost uniformly in the cases of this kind does he find fatal, perhaps far-advanced disease of the lungs.

This result has happened in all our institutions for instruction, whether grammar, high, Latin, or Normal schools, or colleges. The using-up process in the colleges is not unfrequently somewhat in this wise: A young farmer or mechanic or laborer, apparently in good health, but somewhat advanced in life, determines to be educated, and to go through college. He wants his teacher to “put him through” in the shortest possible space of time. He prepares himself to enter college in two years, whereas usually five or six years are needed. After entering, he has to study hard to keep up even with his juniors. Imperfectly educated, he feels himself no match with the trained athletes of the academic course. Hence arises in his mind the necessity for spending all his time in study. Day after day no physical exercise is taken. Perhaps, poor in purse, he attempts to board himself on small and imperfect fare; thus in another and equally fatal way undermining his already overstrained and weakened constitution. He has also the stimulus of ambition as well as poverty to urge him to grasp, if possible, a scholarship, in order to eke out his scanty means of support, or perhaps release himself from the burden of dependence on another’s most willing charity. Some men will be able to stand all this, and come out apparently without injury. Very few, however, will dare to advise any one else to undergo the same trials; for they feel that physiological laws cannot be set at naught with impunity, and most of such persons bear to their graves a consciousness of evil done, even though in the eyes of the community eminently successful men. Such men are often in the ranks of the melancholy sermonizers, or dyspeptic lawyers, irritable, Abernethian physicians, whom we meet with in this world, and to whom we have already alluded. A certain unhealthy tinge, so to speak, covers their whole subsequent life, — delicate, most transitory, and fickle of appearance though it may be, it is nevertheless there, and quite perceptible to themselves, if not to others. In some the sting goes deeper, and the currents of life are so vitiated that but a little more work is needed, after leaving college, in order to make them fit subjects for consumption. A trivial exposure of these unfortunate victims of their own or of society’s reckless folly develops a slight, at first scarcely noticeable cough. “It means nothing,” the sufferer says, and really believes. But it lasts one, two, or three months. After all this ambitious toil for an intellectual education at the expense of his physical frame, he awakens from his delicious dream of ultimate success in his undertaking to the sad reality of impending death by consumption. This, again, is no fancy sketch. We have seen this result too many times to allow of a doubt upon the subject. We now hear with a certain horror the fact stated, that a youth, who from childhood to early manhood has been engaged in active pursuits, has suddenly become smitten with a love of learning, or intends to prepare for the ministry; for we are sure that he will suddenly leave all the labors requiring active bodily exercise, and will devote himself to purely intellectual work, with very few or no tasks for the body. A premature grave, or long, inefficient death in life, is almost always the final result. And we are equally confident that such is not the necessary effect of study, and that it will not happen when wisdom shall prevail. The only way, however, to prevent it, is to have our school and college systems so managed that the body, as well as the mind, shall be so educated as to produce perfect men and women. And if; perchance, a youth commence late in life to study, let him not be allowed to force himself to superhuman efforts to overcome difficulties in one year that usually require four. Let him, above all things, never forget that, as he leaves an active, hard-working life, he, above all others, is bound to the daily practice of open-air exercise, and such a course of gymnastic work as will tend to perfect physical health.

Mental Emotions and Depressing Passions as Causes of Consumption.

Most writers speak of these influences as being quite powerful causes of consumption. We have never seen a proof of the truth of this assertion. We fear that death even from a “broken heart” belongs rather to the ideal world of poetry than to that of fact. The lyre of Moore and the exquisite poetic prose of Irving would almost persuade us that such deaths are perhaps common. We will not deny their existence, but we have never seen them. Nature usually does not act in that way. On the contrary, we have seen cases where mental suffering, falling upon broad religious natures, has really ennobled the whole physical and mental life afterwards. Such natures do not usually succumb physically; they lose themselves in sympathy with others. Others, however, of less elevated characters are doubtless injured by suffering. Absorbed in themselves, becoming careless of their physical well-being, they allow themselves to neglect all these rules of health often alluded to in this paper. Consequently they may readily become victims of any disease to which, by hereditary influences or any of the causes heretofore named they may be in danger, and from which, without this superadded sorrow, they would have escaped. Among these diseases stands consumption.

How we shall deal with such cases, and others similar in character we shall speak of later.

Excesses of Various Kinds as Causes of Consumjtion.

All excess is unnatural and morbid. Of itself it brings disease and death inevitably in its train. Even a good, used extravagantly, tends to evil. All evil has, as its real seminal principle, a certain trace of good. It is good run mad. The abuse of liquor, repeated and long, continued drunkenness, may be a cause of consumption, whereas a moderate use of stimulants is in some constitutions, and under conditions of weakness of body, not radically evil. We are inclined also to believe that, with other constitutions, and especially after a certain age, they tend to prolong life, and to make that life better able to perform its various duties. We know this opinion runs counter to the views of many; nevertheless, it is really “Gospel truth,” and as such we avow it. At the same time we would denounce as earnestly as we can all intemperate use of liquor; and for this purpose we have no hesitation in presenting to the drunkard, as among the many loathsome diseases to which his beastly habits may lead him, this most terrible of all diseases, consumption.

Habitual intoxication, strikes at the healthy action of all the great functions of the body. It stimulates and goads the nervous system to insanity, though it may be temporary. It drives the blood in rapid currents through the heart and bloodvessels, putting them upon extra duty, which sometimes they are unable to perform. Hence arise obstructions of various internal organs of the liver, kidneys, heart, & c., with dropsies and organic diseases as a consequence. Moreover, the appetite for common food palls under the constant recourse to the dram-bottle, and “good digestion” never waits on appetite, even if; in spite of the constant use of alcohol, appetite, that saviour of the natural being, does still exist. Attacking thus all the main foundations of human health, it is not surprising if; at times, the drunkard is fairly worn down, and consumption at last sets in. Hence the common suggestion that the drunkard of the tubercular family is apt to escape consumption is by no means strictly true. The man who indulges too freely runs a great risk of dying of consumption, while at the same time he is much more liable than others to die of any of the more common long-continued diseases to which man is subject. He is also much more frequently than others struck suddenly dead by acute disease. If, therefore, the habitual drinker merely for pleasure finds comfort and a relief to his conscience from what we have admitted above in regard to the certain amount of value to be attached to the moderate and appropriate use of stimulants, he must be very easily satisfied, and for such a man warning is useless.

One other species of excess we deem it our duty to allude to in this connection, although to some prudish souls we may seem to trench on forbidden ground while treating of it at any time, and especially in a journal like this.

The relations of man to woman and of woman to man may contain all that is healthful. Much of whatever is noble and beautiful in human existence depends upon and flows from them. Legitimately and temperately sustained, they tend to longer life and to better health in both sexes than celibacy can give.

This assertion rests on scientific data, and no doubt ought to be entertained thereupon. But let any parties misuse these relations in unhallowed pleasure-seeking, or even in lawful wedlock, and diseases of various kinds will surely follow. Among them stalks boldly forth, at times, consumption. In the veritable confessional so often met with in the career of a physician, we have gained proof perfectly satisfactory to us, that carelessness of hygienic laws in this respect, as in all others, tends inevitably to disease, and even death by consumption.

We might speak of excesses in various other ways, such as overwork or its exact contrast over-quietness, over-anxiety in business, & c., as some of the more remote causes of consumption. But we forbear, and all that it is needful for us to say in conclusion is this, namely, any excess of whatever nature brings more or less disease as its necessary consequence, and with it may come consumption at last to close the scene.

We have thus run over, in a general way, the main causes of consumption as we believe them to exist in this country. Strictly speaking, however, any statement will be but an approximation towards the truth, and undoubtedly it is rare that any one of these above-named “causes” constantly and alone is the producer of the disease. They run over long spaces of time, insidiously working upon and vitiating the springs of health. Now one of them may be prominent, and again another; and on still other occasions many of them may be combined. Imperfect as human beings are and always will be, no one, even with the best intentions, ever has been, or ever will be, immaculate or perfectly accurate in carrying out the best devised plan for procuring sturdy health. No one can feel more keenly than we do the imperfect nature of the sketches we have given. Nevertheless we give them, at the request of others, as the pith of our third of a century’s experience in professional life; and, in what is called now the quaint style of the fathers of medicine, who wrote centuries ago, we humbly hope that God’s perennial blessing may go with them, as far as in them we have spoken the exact truth.

This is part two of a three-part series.
Read part one here and part three here.
  1. This is no fancy sketch. We visited one of our school-houses last year, in which we could not have stayed half an hour without great distress of body. The temperature was far above 70°, and the air had apparently been breathed over and over again. The whole body became bathed in copious perspiration during the few moments that we remained in the room, and we did not wonder that the scholars had headaches and appeared a puny set.