Consumption in America (Part III)

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

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


Can Consumption be crushed out of the World?

We now pass to the more difficult part of our subject, namely, to the attempt to answer the question, How shall we destroy the disease? how, if possible, expunge it from the earth? At present this question can be answered but very imperfectly.

We are met at the outset by some most excellent men, the ultra sceptics and quietists, so to speak, of the day, with the curt reply, “You will never drive consumption from mankind.” All disease is “according to God’s providence.” “It is in the order of nature, and as such it cannot be abolished.” Man lives and breathes a certain length of time on this earth, and it is sure that in good time he will meet death, probably by disease. “As for consumption, it has many causes, and exists equally in every part of the globe where man lives.” “In fact, one can hardly call it a disease, but it is often only the culmination and conclusion of all other diseases.” “It is the agency by which God gives the final coup de grâce to all the various diseases to which we poor mortals are subject.”

In all these assertions, not always supported by the strongest proofs, we admit a certain amount of truth. We grant that, before man existed, his precursors, the fossil monsters, probably had diseases, and doubtless in their various Titanic fights, and by accidents in flood and field, limbs were broken or internal organs became diseased, while nature either cured or killed the patient. Perhaps, too, some of the antediluvian mammoths died of consumption. Who knows or ever can know the exact truth, one way or another? And shall we take a suspicion drawn from prehistoric ages, or even actual present facts, as our rule of judgment in reference to the future?

Granted, if you please, that consumption is universally spread now; although this assertion is by no means true, if any reliance can be put in human testimony. Granted that for centuries back it has annually cut down its myriads of victims in certain wide districts of the earth’s surface. Granted all this, is that any reason for saying that we shall never see change in these respects? Certainly, at this era of the world, during which has been given the greatest boon ever vouchsafed to suffering man, namely, the complete knowledge of the fact that by ether we can virtually annihilate pain, shall we doubt of the possibility of still further relieving human woe in the future time? Who among us, whether in or out of the medical profession, twenty-five years since would not have ridiculed the idea that a man, by any means then known, could, with ease to himself allow the surgeon’s knife to play for hours among the most delicate of his nerves, or that he would willingly submit to have an inflamed tooth wrenched from its socket, and all the while not only to be totally incapable of suffering, but, perhaps, be lapped in Elysian dreams? As the world has been forced to believe this, and now gladly accepts what it formerly would have deemed an absurd proposition, so do we now have high hopes that we are on the point of being able to cope with and to crush out this destroyer of our race, consumption. By looking at and studying minutely, as pathologists all over the world are now doing, the various hidden causes of consumption, and by thus adding all of us to the common stock of knowledge upon the subject, some future experimenter on nature’s laws, some coming Morton, born at a fortunate epoch for discovery in his special line of work, will, like him, tell to his successors the method of annihilating consumption, as that great benefactor of the human race has revealed the remarkable powers of ether; or if, perchance, we may not wholly eradicate consumption, we may at least render it comparatively harmless, as he has enabled us virtually to annihilate suffering.

But what can we do now towards checking consumption? Let us look at the question under the following heads: —

What shall man do, first, as a lawmaker; second, as a philanthropist; third, as a capitalist; fourth, as a parent?

First. It is a well-settled axiom that it is the duty of our law-makers to take some action in regard to the health of the people of the Commonwealth. This is granted by every one. The laws, wise or unwise, already existing on our statute-books on the subject of public health fully prove this. We contend that this power should be applied to the prevention of consumption, and that the question of deciding where villages and towns should be built, or, if built, what should be done to make them healthy, comes legitimately before the legislature. It is better, and, moreover, in the end it is much cheaper, to prepare for and prevent evils, than to wait till they have grown to huge dimensions, which by their very bulk may present almost inseparable obstacles to a radical cure of them. It would have been far better, years ago, to provide for the thorough drainage of London, than to wait till now to remove its sweltering mass of filth. Hecatombs of human victims have fallen upon the altar of folly in this respect, but only recently has Parliament taken proper note of the difficulty, and under the guidance of more enlightened views of the demands of public hygiene is London now endeavoring, at a vast expense, to purify itself.

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New York and Boston and other cities in this country are suffering this year, as they have been in the past, for want of a proper regulation in reference to the increase of consumption.

As it is surely the duty of every Commonwealth to provide that nothing be done detrimental to the well-being of her citizens, so it is a self-evident proposition that she has a right to interfere and prevent villages and towns from being founded by ignorance or purely selfish interest, on spots tending to cause consumption; and it is equally the duty of town authorities to attend to unwholesome localities within their respective limits. The same principle of law which gives to towns in England and to the Metropolitan Board of Health of New York the right to shut up cellars and other residences which lack the proper hygienic influences, ought to demand of the State some legislation on this matter of soil moisture. We know a village situated on a wide, level plain, through which a sluggish river barely creeps along its winding course towards the sea. The whole earth on which the houses are built is literally reeking with water. This village has sprung up, mushroom-like, on each side of a railroad that runs directly through it. Already its situation is affecting the health of the inhabitants, yet no active general measures, we believe, have ever been taken to drain the town. The State should have had the power to declare that the site was an improper one for human habitation, or it should have been thoroughly sub-drained before a single house was built upon it.

Not a few towns in the country are thus fosterers of consumption, owing to the fact that they have within their borders some of the causes of the disease which have been alluded to in the preceding papers, but which are removable if we only persistently and firmly carry out plans for such removal. There are also houses now standing and still occupied that are destined to become the early graves of families springing up in them. They are, and will continue to be, as they have been in the past, pestilential foci whence will radiate this dire disease throughout the Commonwealth. Yet some men still doubt whether the public has a right by legislative act to interfere with the private rights of their owners. Upon all these points the legislature, we contend, has not only a right to exercise, but a correspondingly high duty to perform. It should take some action, and prevent, as far as practicable, by wise and impartial laws, the continuance of such really public nuisances. A State Board of Health should be established, which should investigate and have some voice in determining the proper sites of new towns, and of their appropriate drainage, even when apparently the sites are well chosen. Into older and badly drained towns, and in particular localities in otherwise healthy towns, the legislature should, by its proper agents, enter and abate any nuisances, especially those tending to spread such a disease as consumption.

For the sake of the poor man, who is now often obliged to hire a miserably placed house or get no roof to cover him, such a board should have the right to say to the capitalist, “We will shut up your house, if you do not make it healthy. You have no more right to build upon a swamp or over a pond and offer it as a dwelling-place for citizens, than you have to put any other well-known nuisance at the doorstep of your tenant.”

Second. We would urge upon every lover of his race to examine with candor the various causes of consumption enumerated above, and perchance others not enumerated, and, having done so, endeavor by action and counsel to induce his neighbors and the community to act in accordance with the truth in this matter, so far, at least, as it is now or may be hereafter imperfectly enunciated. Surely there can be no nobler object to occupy the minds of the philanthropists than that of procuring healthy homes for the masses of our people. And if ulterior fame be sought for, one may be well satisfied with memories similar to those that cluster around the names of George Peabody, Lord Herbert, Southwood Smith, and Florence Nightingale of England, and Parent Duchatelet of France, for their unselfish devotion to the great cause of public health.

Third. The capitalist in the erection of tenant buildings is morally bound to recognize any well-established hygienic laws. If he do neglect them, he deserves the stern rebuke of the whole community in which he lives. If need be, the terrors of the law should be visited upon him, provided, after due warning from constituted authorities, those who are obliged to hire of him are compelled by his criminal neglect to live in unhealthy situations. We believe that eventually self-interest on the part of the capitalist will induce him to select proper sites for his future village or house-lots. For if hereafter a village or a house should gain an evil reputation, owing to its improper situation, the property will of course depreciate in value or become wholly worthless, as it surely should, provided it is placed so badly that there is no remedy possible.

Such will and ought to be the result in regard to not a few houses in New England at the present time.

Fourth. It is the duty, as of course it should be the pleasure, of every parent to look sharply to the situation of the homestead in which he hopes to educate the powers of body and mind of the children that are beginning to spring up around him. Let him understand, that, as he would avoid giving poison to his children in their daily food, so he should see to it that the air they breathe into their lungs, and which bathes night and day the delicate texture of their skins, is dry and pure, and uncontaminated by deadly emanations from surrounding soil. Let him avoid a wet soil as a spot for building, whether that place he on the hillside or in the valley. Or if it be already chosen and the homestead built, let a thorough under-drainage be made all around the house and to a considerable distance from it. Many may think that a hillside residence alone is sufficient. Far from it. One of our correspondents told us that, till he knew of our investigations, he could not understand why consumption entered almost every dwelling scattered over one of the hills in his own town, while it rarely was found in those upon a bill similarly situated with respect to sunlight, points of the compass, & c., and similarly wooded. There was, however, one very striking difference which he had always noticed between them, namely, that one had a dry, porous soil, upon which it was necessary to dig deep for wells, while on the other water was reached a foot or two below the surface. The earth was, in fact, so full of water that whenever, in accordance with ancient superstition, the graves of those who had died were opened in order to procure certain relics for the benefit of some living but invalided relative, the coffins were always found full of water, although buried in very shallow graves. My correspondent had never associated the idea of moist soil with the unusual prevalence of phthisis in the place. It might be asked, What was to be done in such a condition of things? A village is built; houses and families have been for years gathered there. Are the inhabitants to forsake their homes? By no means. Doubtless it is a misfortune that the spot should have been so occupied; but the English investigations already alluded to point to the remedy. The whole soil on which the town has been built must be thoroughly sub-drained by the joint co-operation of all the dwellers upon it; otherwise it will continue to be, in future as in the past, the destroyer of the children that are born upon it. Supposing that a proper homestead has been procured, the parents must still further be careful that in every respect, from birth to adult life, no deleterious influences should be allowed to exert themselves upon the young family. On the contrary, their efforts should be constantly directed towards obtaining all means possible for keeping up the standard of perfect health in each and all of its inmates. Especially is this care needed in those families in which hereditary consumption exists, and in which young children are peculiarly apt to become martyrs to the disease.

In conclusion, let us briefly review what has been previously given in detail, and indicate the methods which, if carefully followed, would, in our opinion, tend eventually to check certainly the ravages of consumption, and possibly, after a number of generations, to extirpate it wholly.

Build your houses in the country, in preference to any place near the sea-coast. In the country choose a slope rather than a plain to build upon, and where the sun can have full access to it, if possible, all the day. Be sure (if need be, by effectual sub-drainage) that the soil is thoroughly permeable to water. Let no moisture from the soil, from any source, be permitted to distil its pernicious influences upon the future dwelling or its inmates. Let the rooms be large, of substantial breadth rather than height, and so pierced by windows that the air may have a bounteous and free entrance and exit. Let fireplaces be built in every room and chamber, — fireplaces made for real use, not kept for show, and not closed with iron plates which are to be pierced for air-tight stoves. Eschew all furnace heat, except for warming the entries and corridors.

Outside of the house let there be ample space for air and sunlight One or two trees may be permitted to grow near the house, but not to overshadow it, for nothing but evil comes from too much shade, either of trees or climbing vines. Both of these may very materially prevent the warm rays of the sun from reaching and bathing the exterior, or from penetrating the interior of the house, which they should be allowed to do freely, even in the depths of summer. Nothing so deadens the atmosphere as the too constant closure of the windows, blinds, and curtains, whereby light and heat as well as fresh air are excluded. Every morning let the windows be opened widely, so as to drive off the remains of foul air that has necessarily accumulated from the sleepers during the previous night. Every night let a part of the windows be left open, and if possible at the top and bottom, so that during sleep there may be still a plenty of fresh, unbreathed air for the children and adults to use. Of course the amount of space thus opened will vary with the season; but often, even during our Northern winters, especially in a furnace-heated house, a small aperture, at least, may thus be left. Two or three extra blankets only will be needed for any coldness thus caused.

As to the value of fresh air, alike for the healthy and the invalid, there seems to exist great doubt in this community. Even, the healthy have no real faith in its efficacy as a means of giving health. Invalids, almost without exception, we have to educate to that faith. They have so many doubts about the weather. It is too cold, too hot, too windy, or too blustering. It is cloudy, or an east wind prevails. These and a hundred other trivial deviations from perfect weather are noted, and the unfortunate invalid quietly stays within doors day after day to avoid them. Nothing is more pernicious, no behavior more unwise. Both invalids and healthy persons ought to eschew all such views as arrant folly. “Whenever in doubt,” we say to our patients, “about going out, always go out. If a violent storm is raging, to which no one would willingly expose himself, then keep to the house, but the moment it ceases, seize the occasion for exercise out of doors.” “It would be better,” said the late John Ware, “for everybody, sick and well, to face every storm, than to be fearful, as we now usually are, of even a trace of foul weather.”

Having thus provided a dry, well-aired homestead, which during day and night shall give a healthy atmosphere to the family, let the parent be careful that simple but nutritious food be given. The food in most of our country towns, as we regret to have been obliged to say, is commonly most inappropriate, and far from simple in its cookery and its extraordinary compounds. For the very youngest child Nature provides its sweetest and best nourishment from the mother’s breast. For several months, if that mother be healthy, and really enjoy as some mothers do the almost divine mission thus given to them, nothing more is needed or wished for by the child. If a mother’s milk cannot be procured, then the diluted milk of the cow or goat may be used, into which may be grated, after a few months, a little biscuit or stale bread, or something similar. When about eight months or a year old, a child, especially one in feeble health, or one born of parents either feeble or having tubercular tendencies, may suck a little meat, beef or mutton, Iamb or fowl, and even small quantities very finely chopped up may be swallowed. As it grows older a few vegetables may be added. But in all this let there still be simplicity and not too great variety of food. We believe that in England a better course is pursued in this respect than is followed generally in this country. There, children even beyond the age of puberty are confined to the simpler diet here recommended. All unnecessary stimulants and condiments are avoided, and it would be fortunate for us all if American parents would copy these wiser rules of our “mother country.”

On approaching adult life, if simple habits have been inculcated, they will naturally be followed even in the additions to the amount and variety of food which come with advancing years and self-guidance. Wine or similar stimulants are never needed in this country save as medicine, and usually for this purpose only after adult life. Before that period, however, they may be necessary for use among the dyspeptic and debilitated, who, either from originally bad constitutions or previous self-indulgence, or inattention to hygienic laws, may have so impoverished their powers of life that they need the extra stimulus in order to preserve life or to make it comparatively comfortable. The current of such lives runs sluggishly, instead of flowing luxuriant and free as it does in perfect health.

But parents have not done their whole duty in thus providing a healthy home and proper food for their children. They must prevent, before it be too late, the waste of their lives in extravagance of over-action or of inaction. Neither too much nor too little of physical or intellectual work must be permitted. The tendency is in this country to over-action in everything. We have few lazzaroni here. The climate, the genius of our republican institutions, the all-powerful stimulus of necessity in the grand struggle for existence, — ambition, competition, and emulation, — all tend to force us to over-action. It begins with the sports and studies of childhood; it drives us of adult life with railroad speed on our daily routine of business; and it hurries many to a premature decay of mental or bodily power, and often to an early death by consumption or other diseases. Too deep and continuous study, or too long and constant physical labor, cramps and injures the body, while not giving true wisdom to the soul. No child should be allowed to be at school more than four or five hours a day, and even during these he should have several recesses and intermissions. The remainder of the twenty-four hours should be given partly to sleep and partly to healthful out-of-door work or sport, or to home education, the last of which is much neglected in this country, owing to our overweening confidence in the common schools of the land.

This tendency to over-action, even in an excellent direction, is seen, at the present time, in the extravagances to which athletic sports, such as rowing and base-ball, are now carried. To a certain degree they have become pernicious both morally and physically. Betting and gambling are their too frequent accompaniments. And certainly, when a Milesian “trainer” is employed to train a party of young and refined college youths for a race with brother college-mates, almost exactly as would be done in case of a “mill” between two bulldog-like prize-fighters, the height of absurdity is reached in this direction. There is, however, not only absurdity, but radical evil, resulting often from such extravagance. Not a few of our youths will bear to their graves the effects of over-exertion in these games. Writers on surgery and diseases of the heart sustain this statement. We regret to feel compelled to make this protest against these admirable sports, for, notwithstanding these imperfections in their actual management, they have, as a whole, done infinite service to this community. The present number of athletic young men, compared with the many puny ones of the last generation, is, we think, very striking.

All we demand of the parent is that he should, as the vicegerent of the Almighty, guide and guard the child from youthful extravagance on his own part; and save him from the forcing propensities of teachers, or from the training of others of his own age from undertaking any amount of intellectual or physical labor that is unsuited to his powers of endurance. Such over-labor in any direction will inevitably tend to disease, and often to death by consumption.

All this will require, on the part of the parent, not only the highest ideas of the real nobleness of his own position as the guide and guardian of the future man or woman, but likewise a reverent regard for, and estimate of, the young being given to his charge. This regard will lead him, if need be, to a lifelong devotion on his own part for the attainment of the object in view, namely, the perfect physical, intellectual, and moral health of his child. Some may say that in these remarks we have supposed the circumstances of every parent is such that he can command all the necessary resources involved in the above statements. Such critics will reply: “Your rules are all very well for the rich, but how can the poor man act upon them?” We grant that while legislators and philanthropists and capitalists neglect their duties, and either pass by, or perhaps actually encroach upon, the rights of the poor man, the latter must necessarily suffer. But, even now, few parents are actually obliged to live and to bring up children in unhealthy situations, or to allow them to be ruined by over-work. If a proper abode cannot be found in a city, one can generally be found somewhere on the line of railroads, in which the family can live. Ere many years have passed, we hope and believe that every workingman will have his dwelling in the country. When the interests of capitalists and of the working classes effectually combine, the majority of our laborers will live at night out of the city proper, and thus avoid all the misery involved in the rookeries of large towns, where now the poor “most do congregate.”

In truth, no nobler undertaking could be desired by any capitalist, who is sighing under the very abundance of his wealth, than the following: Let him purchase large tracts of unoccupied land, which now are to be found in every direction around our cities, and which could be easily made accessible by rail, and build on these territories numberless small but well-arranged cottages for an honest, hard-working tenantry to occupy. Let each house have its quota of land, and each homestead be open for sale to the occupant, who shall be allowed to pay for it in small instalments. Where is the rich man or body of men who will be ready thus to combine a real blessing to the poor with ample returns to themselves? Is it not a fact that, notwithstanding all the miseries, and at time squalid poverty, of the laboring classes, from among them have sprung most of the noblest and best of our race? Long before the Blessed Babe lay in the manger at Bethlehem, and ever since that period, even in these latter days such men as Abraham Lincoln and Michael Faraday, have seemed to be illustrations of the existence of this almighty law. Is not this fact sufficient to stimulate the capitalist to look into the question of providing proper dwellings for the poor, not merely in order that all extra suffering from disease may be prevented, but also with the hope of thereby raising into a perfect manhood some who without this aid would die in early years?

Still more would we urge the plan traced above, because by it doubtless many might be brought out to the light and warmth of a better social existence, and thus become, in their turns, benefactors of the race.

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What influence should the still mooted question of the contagiousness and non-contagiousness of the disease have upon us? We may safely feel that there is no degree of contagiousness in consumption like that which holds good of some other diseases, — like measles, small-pox, & c. But while granting this, we have no doubt that there is a certain number of cases in which consumption seems to have been communicated from one individual to another. Hence our duty is as follows: —

1st. Never allow any one to sleep in the same bed with a consumptive.

2d. If possible, let the attendant or friend sleep in an adjacent room, within easy call, rather than in the same room.

3d. Never let one sister (i. e. one with the same hereditary tendencies) sleep with another who is tuberculous.

4th. If possible, always have a paid nurse to attend to the mere drudgery of the sick-room.

5th. As this will be often impossible, let the attendant be sure to go out not less than twice daily, and fill her lungs with pure air, or at least with air different from that of the sick-room.

On the subject of clothing no specific rules can be laid down that will meet all cases; but the following is what we deem simply prudent: —

Always strive to dress in such a manner as to feel perfectly comfortable, — neither too cold in winter nor too hot in summer. Of course this necessitates very different dresses in these two periods of the year. A question often arises, Ought flannel to be used all the year round? That question is categorically and very decidedly answered in the affirmative by some. But even this article should be left to the decision of each individual. Some are made almost frantic by it in summer, while others seem to need it.

The spring in our New England climate is particularly trying in its changes from heat to cold; and if the above rule be followed, namely, of keeping one’s self comfortable, it entails a frequent change of dress during even the short space of twenty-four hours.

In connection with clothing, and as, in fact, preceding it, we ought to allude to cleanliness of the skin. If possible, the skin ought to be daily washed all over either with warm or cool water.

What shall be done in case any great depressing passion seems threatening to bring on consumption?

The true way to meet such a case is as follows: While requiring absolute attention to self-evident hygienic rules, we should endeavor to induce the sufferer to seek relief from his or her own agony by becoming a ministering servant to the suffering of others. If the whole nature rebel against such a course, or if the man or woman lack those elements of character which fit one for such a mission, then oftentimes travel is the panacea under which life and health seem again to become new. hove all things, prevent by every means in your power all brooding over past misfortune or sorrow. “Let the dead past bury its dead,” and stimulate the unhappy invalid for the joys and the duties of the morrow; and, if this can be done, oftentimes consumption and all its kindred terrors will flee away.

Thrice blessed is the person who is obliged in mental affliction to work for the bare subsistence of himself or others.

How shall we meet the fact of the hereditary character of the disease?

Very delicate questions often will be suggested to the physician in reference to this part of our subject.

As illustration often convinces more than all else, we give the following as actual fact. More than thirty years ago, we were consulted by a young man, who frankly confessed that he believed he had disease of the lungs, and he asked us to say whether or not he could rightly be married to an excellent young person to whom he had been for years engaged. We found that his opinion was correct, that decided disease of one lung existed, but it was not at the time in an active state. We found, however, at the same time, that an adverse opinion on our part would forever shatter the hopes of two lovers who had been for years devoted to one another. There was not an argument save this local disease which we could bring against the idea of marriage. We will not attempt to indicate the reasoning whereby we came to the decision that we ought not, by any motion of our own, to prevent the union. Ten or twelve years of sweetest married life were the result, and then the husband died of lung disease. But exactly what the youth feared came to pass, namely, one of his children died in very earliest infancy, and the other at the age of twenty, — both of consumption. The latter was particularly interesting to us. He seemed to be in perfect health. On arrival at an age to commence business, all his antecedents and his hereditary tendencies were forgotten. Instead of avoiding all excitants to consumption, he was allowed to settle on the borders of a lake in a large Western city, and there to become a clerk to a corporation doing an extensive business, by which he was very much confined to his desk and over-worked. As we have seen in the previous paper, he should of all things have avoided just such a location and that employment, — he should have sought for an active out-of-door life, if possible, in some dry inland town. After he had been laboring at his desk, however, a comparatively short, time, we were summoned only to find him past all relief. In a few months he died with rapid consumption.

In the above case we deemed ourselves justified in allowing the marriage to be consummated, because, as may be stated generally, we were not sure that the disease would progress, and there was a chance of the husband’s getting well, and there was no certainty that children would be born. But there are cases every day arising in which it seems almost madness for either party to think of marriage, — cases in which death seems foreshadowed with the certainty of almost absolute fate. In many of such, parents and physicians alike should protest.

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Our articles have become so much longer than we intended when we commenced, that we forbear further allusion to other causes of consumption already mentioned. They have, perhaps, been sufficiently touched upon.

We conclude, as we began, in hope; and for a final statement lay down the following as our medical faith on this important question: When all men and women live in properly placed and rightly constructed houses, and at all times attend carefully to the hygienic laws of mind and body in themselves and their offspring, then will consumption, like many kindred evils, be wholly eradicated, or made comparatively harmless in its influence on the human race.

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