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Consumption.Tuberculosis is not always nor necessarily a disease of the lungs; since it may invade many other organs of the body and cause fatal results. The intestines and the brain are especially liable to be attacked by it; in fact, most of its victims under the age of puberty die of " consumption of the bowels," or of the brain. The term consumption, however, is usually limited to the disease as it occurs in the lungs, the word tuberculosis being employed to designate it when it attacks other organs of the body. The disease is, however, one and the same process, wherever it may occur, though the details vary, of course, according as one organ of the body or another is affected. Without entering into particulars, we may say in general, that pulmonary consumption consists in the deposit of scrofulous matter in the substance of the lungs. This scrofulous matter - technically called tubercle - is the result of a long continued inflammation ; it follows that consumption is essentially a slow or chronic inflammation of the lungs. This explains to us the familiar fact that consumptive patients have usually suffered for a considerable time from a chronic bronchitis or from repeated attacks of pneumonia before the symptoms of consumption became apparent.- In fact, even the physician often finds difficulty in deciding whether a patient who has long suffered from chronic bronchitis has already begun to have consumption. So, too, individuals who have repeatedly suffered from pneumonia are apt to become finally consumptive, because the inflammation of the lungs becomes permanently established - the repeated pneumonias, in other words, develop into consumption. The deposit of scrofulous matter, or tubercle, varies considerably as to its rapidity and location in the lungs. There are, accordingly, different types of consumption, some of which run a rapid course to a fatal termination, while others drag along slowly, and may even terminate in recovery, if the individual be given a good opportunity to throw off this scrofulous deposit. Then, again, the formation of the tuberculous deposit does not proceed uniformly ; a considerable amount will be formed in a short time, after which the patient, in consequence of a change of residence or other cause, improves in health. For a considerable time the disease may make no progress, and may occasion the patient far less annoyance than formerly ; in consequence of which the individual and his friends may be sanguine of ultimate recovery. But, sooner or later, there comes a relapse ; the patient takes cold, or sojourns in a damp climate, as a result of which the tuberculous deposit is increased and the old symptoms return with renewed vigor. This matter is usually deposited at the upper part of the lungs, just under or near the collar-bone; and the observation of a large number of cases seems to indicate that the left lung is somewhat more frequently affected than the right. After the amount of matter deposited has attained a certain size, it undergoes a process of softening, becomes liquid, and is expelled in part, at least, from the lungs by the act of coughing. If the tuberculous deposit only were thus affected, the disease would doubtless end in recovery, since the lung would heal up after this matter had been expectorated. Such is, indeed, the actual history of some cases of pulmonary consumption. Individuals who have given all the evidence of consumption, and in whose chests the deposit has been recognized upon medical examination, ultimately recover entirely, and an examination of the lungs shows that the deposit has been entirely removed. These are the favorable cases, and, unfortunately, the rare ones ; for, in the large majority of instances, the softening of the deposit is accompanied by a destruction, a " breaking down," of the lung tissue itself surrounding the deposit. This broken-down lung tissue is cast out by expectoration with the softening tubercular deposit, giving to the expectorated matter and to the breath of the patient that peculiarly offensive putrid odor so often observed in consumptive patients. In course of time, a considerable portion of the lung substance may be thus expectorated, so that there remain large cavities in the lung. It is, in part at least, from the walls of such cavities, where the lung tissue is constantly breaking down, that the hemorrhages occur which constitute one of the formidable symptoms of this disease. Symptoms*- Pulmonary consumption is usually very slow and gradual in its development; indeed, it is often impossible, as already remarked, to fix definitely the exact date of its commencement. In many cases, the symptoms indicating lung difficulty are preceded for weeks or months by general ill health, loss of strength and of weight; yet, since these symptoms may be caused by other affections, it is impossible to ascribe them definitely to incipient consumption. In a larger number of cases, the symptoms of lung trouble, particularly the cough and expectoration, are present for a considerable time before any evidences of general debility are observed ; yet these early symptoms may be indistinguishable from those of chronic bronchitis. Usually, one of the earliest symptoms noticed is cough ; and, after the patient's attention is called to it, he will often remember that at first he used to cough chiefly in the morning, upon rising, being comparatively free from this troublesome symptom during the day. The cough is usually slight, dry and hacking at first , the matter expectorated is slight in quantity, white and glairy. The patient's attention is rarely directed to this symptom, unless one of two things should happen - either spitting of blood, or marked loss of flesh and strength. The expectoration of blood, while a more usual symptom at an advanced stage, may nevertheless occur at an early period of the affection ; the blood raised is usually small in quantity, of a bright red color, and occurs as streaks in the mucus. This is sure to attract notice, and to alarm the patient. It is usually only after the appearance of this blood that he seeks medical advice, having treated his previous cough as insignificant. Pain in the chest is not a necessary symptom of pulmonary consumption, since it is not caused by the disease itself, for the lung tissue-the part affected in consumption-seems to have but little susceptibility to pain. The individual suffers from pain in his chest only when the membrane covering the lungs-the pleura is involved in the inflammation, for this pleura is exquisitely sensitive to pain. Sometimes, however, the pleura becomes involved early in the disease, in which case pain is an early and prominent symptom of the disease. This pain is sharp, and is described by the patient as stitches in the chest, commonly referred to the upper part of the lung, just under the collar bone, often shooting through to the back. This pain is by no means constant, even in the same case, being sometimes so severe as to keep the patient within the house, at other times so slight as to pass unnoticed. These pains have considerable significance for the physician, though they are usually considered by the patient to be rheumatic or neuralgic. The breathing is usually somewhat increased in frequency, though this increase rarely attracts the patient's attention, unless he be engaged in some occupation requiring considerable physical activity; in this case he is apt to observe that his breath is shorter than formerly, and may be indeed compelled to give up the most severe part of his labor because of this shortness of breath. Another early symptom, often noticed by the patient himself, or by his friends, is increased heat and dryness of the skin. As the disease advances, this heat amounts to positive fever, which usually increases toward evening, when there is apt to be a decided flush on the cheeks. At this time, too, the patient often has ill-defined, chilly sensations, or shiverings ; or well marked chills, followed by fever and perspiration, may occur with such regularity that the difficulty is supposed to be ague. Another symptom often present with these is the occurrence of " night sweats. " As the strength and weight of the patient decrease, there is usually some impairment of the appetite and digestion, amounting at times to a decided aversion for food ; the patient usually has a special dislike for fatty articles. Emaciation is the rule in consumption, but at times there is but little apparent loss of flesh, though the patient becomes very pale. The strength is usually impaired, even though the bulk of the body be not materially diminished. During the early part of the disease diarrhea is an occasional but by no means constant symptom ; in the more advanced stages it is usually pronounced and troublesome, and then often indicates that the disease is affecting the bowels as well as the lungs. In some instances obstinate and frequent recurring diarrhea, and a persistent cough are the first indications of pulmonary consumption. In females there is always, usually at an early period of the disease, an interference with the menstrual function; as a rule, the discharge becomes gradually less in quantity, the periods irregular and finally suppressed. A popular idea is inclined to ascribe the disease in some way to a suppression of the menses, but the fact is that this suppression is not the cause but the result of the disease, or rather of the impairment of health and loss of flesh incident to the consumption. The mind usually remains perfectly clear and unaffected until within a few days of the fatal termination ; and what is far more remarkable, the patient is usually cheerful and confident of ultimate recovery. This delusion amounts sometimes to actual infatuation, causing the individual to disregard the grave symptoms of his case and to conceal them from the physician; and if informed of the actual state of the case, he is apt to take offense or to undervalue the professional ability of the medical adviser. The disease advances to what is termed the second stage, by which is meant the period during which the tuberculous deposit is becoming softened and expectorated. During this stage the previous symptoms continue in somewhat exaggerated form ; the cough becomes a prominent and troublesome symptom, for though less irritating to the patient, it is more frequent, and usually followed by expectoration. During the transition from the first to the second stage, expectoration is apt to be difficult, the patient being compelled to cough long and painfully before he succeeds in raising any material from the lung. But as the breaking down of the lung tissue proceeds, the cough becomes easier, since the matter is more readily loosened and brought up. This expectorated matter now consists, in addition to the white and frothy material of the first stage, of thick yellow masses, sometimes streaked with blood. The amount of material expectorated varies considerably, depending largely upon the rapidity with which the softening process proceeds in the lung ; it may amount even to a half pint or a pint daily. Sometimes the patient will suddenly expectorate a considerable amount of matter during a few acts of coughing, owing to the sudden loosening and discharge of larger masses of softened tuberculous matter. As the patient becomes weaker, the act of coughing becomes a severe task upon his strength, and in the later stages expectoration is often but imperfectly performed. Hemorrhage occurs less frequently perhaps after the formation of cavities than in the earlier stages of the disease; yet when they do occur, such hemorrhages are far more alarming. For not only is the amount of blood lost greater than formerly, but the effect upon the patient is more decided, since the loss of a given amount of blood now affects his diminished strength more than was previously the case. It occasionally happens that a blood vessel of considerable size gives way in the lung, and the patient dies in a few minutes, either from loss of blood or from suffocation in consequence of the presence of the blood in the air passages. During this stage another symptom, which is often present in the first stage of the disease, or may even be one of the earliest signs, becomes prominent. This symptom is huskiness of the voice, which often increases to hoarseness, or may proceed to complete loss of voice, so that the patient is unable to speak above a whisper. This results from the spread of the disease to the larynx, usually involving the vocal cords, and often causing ulceration upon them and in their vicinity. The pains in the chest are apt to be continued from time to time in the second stage, and occasionally become constant symptoms. The appetite is now decidedly impaired, diarrhea is frequent and persistent. At times, indeed, this looseness of the bowels becomes a serious matter, exhausting the strength of the patient in spite of all efforts to control it. A symptom upon which considerable stress is laid by medical men is the appearance of the finger ends, which become quite club shaped, the nails being curved downward toward the end and toward the root, while the middle makes the summit of the curve. This appearance is by no means constant, though quite characteristic when present. During this stage, too, the feet and ankles are usually swollen, especially if the patient walk or sit erect. This symptom merely indicates the general failure of the patients strength, and possesses no other significance. The course of pulmonary consumption is apt to be hastened by complications which arise in other organs ; among these the most frequent, perhaps, is consumption of the bowels, indicated by profuse and obstinate diarrhea - the spread of the disease to the abdominal cavity, and to the organs contained in it. In some cases the disease occurs also !.n the membranes covering the brain, causing interference in the mental functions-a complication more frequent in young persons than in adults. The disease may also affect the urinary and the genital organs, causing difficulty in urination ; not infrequently there occurs an entire loss of the power to propagate in the male, as a result of this disease, and this loss may occur before the symptoms of lung difficulty arouse suspicion as to the nature of the disease. Cause.-Consumption, or, speaking more generally, tuberculosis, whether it occurs in the lungs or brain, or other organ of the body, is due to a specific and particular cause. The researches of the last two years, conducted in all parts of the civilized world, have demonstrated what is now universally admitted - that the body of every consumptive individual, as well as of every tuberculous animal, harbors immense numbers of minute vegetable parasites. These organisms, belonging to the general class of plants known as fungi, of which the mould on jelly is a familiar example, invade the body of the individual, and seem to act as a source of irritation which results in the tuberculous inflammation. These parasites ordinarily gain access to the body in the air which is inspired ; and hence the disease is usually first manifested in the lungs. Yet they may secure access to the blood, and thence be carried all over the body, affecting any or all of the organs. So far as we know, consumption never occurs without the presence of these parasites; yet it is equally evident that certain other circumstances must contribute in order that this disease may be estab lished, for these parasites do not gain a foothold so long as the individual enjoys perfect health. It is only when the system has been prepared in advance for the reception of these organisms - when, in other words, there occurs some departure from the usual state of health - that the individual becomes liable to consumption. This departure from the natural standard of health - or predisposition to consumption, as it is technically termed - may be either inherited or acquired. Long observation has rendered the fact familiar to all, that the children of consumptive parents are especially liable to the disease in question. There appears to be a peculiarity of constitution which renders the individual especially favorable, or predisposed, to the development of consumption ; and this peculiarity of constitution is transmitted from parent to child, just as peculiarities of feature or of mind are likewise transmitted. While this hereditary tendency is perhaps often overestimated, yet that there is such a tendency cannot be, and is not, denied. It by no means follows that the children of consumptive parents must necessarily become tuberculous; nor that those of non-consumptive parents are safe from the disease. Indeed, the vast majority of cases occur in individuals whose family history contains no record of consumption. Most cases of consumption, in other words, are acquired - that is, the individual, though not burdened with any known hereditary taint, lapses into such a condition of health as to make him liable to the invasion of the disease. Among the causes which predispose to the development of consumption, is a cold, moist, variable climate; and it seems to be the variability, rather than the coldness of the climate, which is to be held responsible for the influences favoring the disease, for certain parts of the world, even of our own country, are cold and moist, and yet afford such protection against consumption as to have become a refuge for consumptive patients ; while, on the other hand, certain localities located so near the tropics as to be quite warm the year round, are also unfavorable to the development of the disease. Consumption seems to prevail more upon the seacoast than in the interior at the same latitude, perhaps because of the sudden and rapid changes to which the former localities are especially susceptible. It has also been shown that in the State of Massachusetts, cases of consumption occur more frequently along the borders of streams and marshes than in other localities. The most favorable climate seems to be warm and dry, and free from the rapid changes which characterize a considerable part of our own land. Another influence which predisposes to the development of tuberculosis is the frequent or repeated occurrence of other inflammations in the air passages, such as bronchitis and pneumonia. Possibly these repeated inflammations are to be regarded as an evidence of the inherent weakness of this part of the individual; at any rate, it is an unquestioned fact of observation, that con sumption is often preceded by a long and obstinate bronchitis, or by repeated attacks of pneumonia. Still another influence, or rather set of influences, are the conditions inseparable from sedentary pursuits. It is well established that consumption is especially prevalent among those whose occupations confine them to close, ill-ventilated rooms, where they are not only deprived of exercise, but are compelled also to breathe impure, vitiated air for many hours a day. These influences explain, too, to a certain extent, the extreme prevalence of the disease among the poorer classes of society living in crowded and not over-clean quarters, and subsisting upon inadequate or improper food. An interesting observation in this connection is the universally recognized fact that wild animals in confinement are apt to suffer and die from this disease; for consumption is not a monopoly of the human family, but attacks a large number of the lower animals, wild as well as domestic, and it is well ascertained that domestic animals kept in close confinement are far more liable to the disease than animals of the same species permitted to enjoy abundant air and exercise. " The stabled cow, the penned sheep, the tame rabbit, the monkey, the caged lion, tiger or elephant, are almost invariably cut off by tuberculous affections. "-Aitken. There is reason for believing also that an improper diet, one which does not furnish the different substances required for the system, is often an important factor in inducing the disease. Such diet may be improper, not because it is deficient in quantity, but because it is not judiciously selected and regulated. The liability to consumption varies also with age, the most susceptible period of life being from tw'enty to thirty years, the next most susceptible time between ten and twenty years of age ; yet no period of life affords exemption from consumption, since the disease may affect even the child in the womb. Observation indicates that certain other diseases exert an influence in favoring or opposing tuberculosis. The disease seems to occur somewhat frequently after typhoid fever, measles, and scarlet fever. On the other hand, consumption is rarely found in individuals suffering from organic heart disease, or from emphysema of the lungs. It has been asserted, too, that during pregnancy a woman is but slightly susceptible to consumption, even though she may become so after delivery; yet, more careful observation indicates that this idea is not founded on fact. Indeed, certain observations would indicate that pregnancy and lactation rather favor the development of consumption ; for Pollock found that of one hundred and fifty-five cases of consumption occurring in women recently confined, the disease began in forty-eight of them during pregnancy, and in fifty-one about the time of confinement. Intimately associated with the subject of consumption are the other manifestations of tuberculosis in the various organs of the body; but the only one that will be mentioned here is the enlargement of the glands in the neck. It is a common observation that children exhibiting the so-called " scrofulous habit," that is, those with thin, white skins, watery eyes, and inclination to a sandy complexion, are subject to enlargement of glands in the neck, even from early childhood. These enlarged glands may remain for a long time in the same condition, without giving rise to much pain or annoyance ; but, sooner or later, they are apt to become larger and somewhat tender, the skin over them is reddened, and finally is perforated, giving exit to a quantity of matter. The openings made in this way are apt to be very slow and obstinate in healing, and may resist all ordinary efforts and treatment for months; and, when finally healed, there remain ragged, irregular, and unsightly scars. Such children seem especially prone to the development of tuberculosis in various internal organs, though it has not been observed that when they reach adult age they are especially liable to consumption. It seems unquestionable that this enlargement of the glands, accompanying the general debility and feebleness of health, is one of the many manifestations of tuberculosis. The duration of pulmonary consumption varies extremely, according to the original condition and subsequent surroundings of the patient; yet, it cannot be too emphatically stated that consumption is not always fatal. It is a prevalent belief that the individual who has become tuberculous, has practically received his death warrant. Now, while it must be admitted that a large majority of cases terminate fatally, yet, it is equally true that a small minority recover entirely from the disease. In many cases the progress of pulmonary consumption is extremely slow, because it seems to be for a long time a doubtful battle between the disease and the individual ; and it is just these cases in which the scale can be turned in favor of the patient by judicious treatment in the way of sanitary surroundings as well as medicines. In all cases it is, of course, of supreme importance that the actual facts in the case should be ascertained as early as possible ; for, if anything is to be done in the way of cure, it must be done early. Every individual, then, who has any well-grounded suspicions that he is already attacked, or is especially liable to be attacked by consumption, should at once ascertain the truth by consulting a competent physician. If he be the child of consumptive parents, and have an obstinate, even though slight, cough; if he lose flesh rapidly, even without sufficient cough to attract attention ; if he be troubled with pains in the chest, with an obstinate and long continued diarrhea, or with other symptoms which do not yield readily to the treatment employed, it is the wisest policy to submit himself to a thorough examination, in order that the existence or non-existence of tubercular disease should be ascertained. And, even if there be no record of consumption in the family, it should be borne in mind that this fact does not give positive assurance of safety from the disease ; since, as has been stated, the majority of cases occur in individuals who have no suspicion of the true nature of the disease, feeling assured of their immunity from consumption by the fact that it has not afflicted other members of their family. These are the persons who neglect, year after year, a persistent, hacking cough, which troubles them, at first, only in winter, and leaves them comparatively free in the summer; and, even if their atten tion is directed to the possibility of consumption by their friends, they are inclined to ignore the warning, or, at least, postpone it. Many such are first seriously awakened to the danger by a hemorrhage more or less severe. In those cases in which recovery occurs the tuberculous matter is either softened and expelled from the lungs by expectoration, or they become hardened by the deposit in them of lime and similar salts, after which the tuberculous masses cease to cause breaking down of the lung tissues, and the disease is arrested. Sometimes these little balls of lime which have been formed in and around the tuberculous masses are finally loosened and expectorated, when they are called lung stones. These favorable terminations usually occur as the result of careful managing and treatment, yet instances are recorded in which the patient recovered from undoubted pulmonary consumption without any other treatment than simple cough medicines, yet such cases of spontaneous recovery from consumption are so rare as to be curiosities, and can not unfortunately be expected in any but the rarest instances. There are many cases in which it seeems for a time that such spontaneous recovery is going to occur; the patient and his friends observe that all the symptoms decrease as spring and summer approach, and are deceived by this lull in the disease into a belief that recovery will occur. Such belief has doubtless prevented many a patient from resorting to the measures necessary to save his life. For it should be known that consumptive patients are always better in warm weather, whether the disease affects the lungs, the bowels, or the bladder; but they are just as certainly worse again during the following winter, and although another improvement may occur during the second summer, yet the patient has lost ground very decidedly. There is one symptom, however, which is rarely neglected, the hemorrhage from the lungs; this warning truly alarms the patient, and if repeated will surely lead him to do his uttermost to check the disease. It is very satisfactory to know that these cases in which repeated hemorrhages occur to terrify the patient and his friends, are usually the most favorable. Treatment.-The first item in considering the treatment of consumption is naturally the possibility of preventing or escaping it. Unquestionably the best protection against consumption, as against so many other diseases, consists in maintaining the highest possible standard of health; diet, air, exercise and clothing should all be carefully attended to, not only in a general way, but also in detail. The food of patients inclined to consumption should be nutritious, easily digestible, and generous in quantity and quality. It is a mistake to prescribe definite rules for the guidance of the appetite in such cases. Many people make a hobby of insisting upon just so many ounces of bread and meat per day. The only valuable rule consists in permitting and encouraging the patient to eat such food and in such quantity as he desires ; his own experience will teach him to avoid such articles as he cannot readily digest. In some cases, it is true, it will be especially desirable that the diet should include meats and milk ; in nearly all, care should be taken that butter, cream and other fatty matters should be included in the diet. The object is always to secure the best possi'ble nutrition ; it will rarely, if ever, happen that the patient incurs harm by overeating. Another most important item is fresh air, especially if taken out doors. It is perhaps impossible to overestimate the benefit to be derived from outdoor exercise. Dr. Flint, of New York, some years ago, reported the history of sixty-two cases which had fallen under his own observation, in which the disease was arrested. After discussing these cases in detail, he remarks : " In twenty of these cases the arrest took place under hygienic measures, without medicinal treatment. In these cases the most important point related to change of habit as regards exercise and outdoor life. In many cases the change consisted in relinquishing sedentary callings for other pursuits, in order to carry out more effectually the desired reformation. I am well satisfied that here is the foundation for the successful management of pulmonary tuberculosis. I would rank exercise and outdoor life far above any known remedies for the cure of the disease. There are grounds for believing that the advantage of a change of climate mainly consists in its being a change of habits as regards exercise and outdoor life." It is scarcely necessary to remark that exercise is rarely beneficial if taken merely as exercise, and without the charm of amusement or interest to engage the attention. The same remark applies to the different plans recommended for inflating the chest. Thus we are told that much benefit is to be derived from the habit of slowly expanding the chest, and as slowly permitting the air to escape, this exercise being repeated morning and evening. Doubtless much might be done by such measures, were they persevered in; yet, because performed merely as a hygienic measure, they will be rarely followed out faithfully. In most instances the best plan is to give up the usual employment entirely, and to devote the time to the restoration of health by engaging solely in such outdoor occupations as secure amusement and entertainment as well as physical exercise. A most important point for such patients as seem predisposed to the disease is the care to avoid taking cold; that is, to avoid wetting the feet, draughts of air, and sudden changes of temperature. This does not, of course, mean that the patient should be confined to the house; for, when properly protected by warm clothing, he is much better in the open air than in the house. Indeed, many patients have gone to California and the Sierras, into localities where the temperature was uniform, though not too warm, and have here spent months in the open air, sleeping at night with no other protection than that of a tent. In many parts of our country, however, where the climate is subject to sudden changes, it is advisable for the patient to be within the reach of shelter at all times. In such places especially it is desirable that warm clothing should be worn throughout the year ; either woolen or silk goods may be worn next the skin, reinforced in colder weather by a garment of buckskin or chamois leather. Such clothing should be worn not simply around the chest, but over the entire body, from neck to ankles. Another measure, which is often useful in hardening the individual, is cold bathing, a sponge bath being taken night and morning. This should not, however, be insisted upon if it be manifestly a severe test of the patient's endurance. So soon as it becomes apparent that the individual is acquiring consumption, no means should be neglected which can possibly contribute to the arrest of the disease. One of the most important of these means is unquestionably residence in a climate which is not subject to sudden changes of temperature. It is doubtless true that a change of residence contributes in many ways to the improvement of the individual's health, since, under the circumstances, he is very apt to devote himself to the care of his physical condition, and to employ his time in outdoor amusements and exercise. Yet, making due allowance for the value of these measures, there remains considerable importance to be attached to the climate itself. Much attention has been devoted to this subject, and the relative worth of numerous localities and of various climates has been the subject of close observation and study. Several popular errors in regard to this subject have been corrected; among these was the idea, which is even today quite prevalent, that a warm climate was absolutely essential for improving the consumptive's condition. Upon this subject Aitken says: " It was long a preva lent belief that consumption was limited by latitude, and that it never appeared in warm countries-for instance, south of the Mediterranean. But this is proved not to be the case, for the returns of the army, prepared by the above writer, have shown that consumption is more frequent in the West Indies than even in England - a statement first made by Sir James Clark in his work on climate, in illustration of the injurious effects of that climate on consumptive patients sent there from this country. " According, also, to the opinion of this author, great heat appears to have a powerful effect in predisposing to tuberculous diseases, probably by diminishing the exercise in the open air. That it is not the climate of the place which alone produces this result in the West Indies, is shown by the fact that officers were attacked in infinitely smaller proportions than private soldiers ; and it is more than probable that crowded barrack rooms, a restriction to salt diet and drinking spirits may have produced the result. " It would appear that England and Wales, the Cape of Good Hope, Canada and Malta are more exempt from consumption than many countries which, from their higher temperature, have hitherto been supposed to enjoy a remarkable exemption from this complaint. " The feature which has been supposed to exercise much influence upon the progress of consumption is the moisture of the climate ; it has been found that not only particular localities, but even particular districts, and even individual houses in the same district, vary much as to the prevalence of consumption, according to the moisture of the soil. It seems, indeed, well established that those localities particularly favorable to the development of the disease are usually marked by an unusual degree of moisture. Yet it is equally true that moisture alone does not constitute a necessary barrier to the improvement of a consumptive's health, since some of our noted resorts have a more or less moist climate. When it becomes evident that the patient is suffering, or is about to suffer, from consumption, the question arises, where shall he go ? The answer must depend largely upon the condition and history of the patient ; for let it be understood that there is no charm, no specific curative influence in any climate ; the object is merely to place the patient under the best possible conditions for preserving his strength and for removing him from those influences which seem most injurious. There is, therefore, no one rule which applies to all cases, and no one climate which is suitable for all consumptives. One. feature is absolutely necessary, namely, a reasonable uniformity of temperature through the season ; that is, the absence of those sudden and excessive changes which are so characteristic of our Atlantic seacoast, for example. Dryness is best adapted to a considerable number of cases, though not to all ; warmth is favorable for most consumptives, though some cases improve more rapidly in colder localities. This last fact has been well brought out by observation on the effects of residence in the northern part of the United States. Instances are known in which consumptive patients who had scarcely been able to hold their own in Florida or other warmer places, have rapidly improved in Minnesota, Dakota and other localities in the same latitude ; and this improvement has continued even during the winter, which is in these regions extremely severe. Such cases are doubtless in the minority, since the greater number seem benefited by the warmer climate of Southern California, Colorado and even Florida ; but the fact indicates that there is a diversity in the requirements of different cases. Probably the best way for conjecturing the most suitable climate is to be derived from the feelings of the patient at different seasons. If his condition be better during the hot summer months at home than during the cooler spring and fall, he will probably be better suited by sojourn in a warm climate ; while if he feel oppressed and en feebled by the summer heat when at home, he might try to advan tage the more Northern resorts already named. "With reference to the particular situation to be selected," says Dr. Flint, " it should contain resources for occupation and mental interest. There must be inducements for outdoor life. I have known patients who had been accustomed to active habits, suffer intolerably from ennui, in going to places where the supposed excellence of climate was the only attraction. It is frequently better to move about from one place to another, than to remain stationary. As soon as the place becomes tiresome, it is best to leave it. Traveling in foreign countries, without any special regard for climate, is often the best plan, the advantage consisting in the interest and inducements to exercise derived from a succession of new scenes. A sea voyage is generally useful, and if patients are fond of the sea, a long voyage, if practicable, may be advised. Places which are especially the resort of patients are to be avoided ; the moral effect of seeing daily examples of the different stages of the disease is unfavorable. A change is often useful when there is no superiority on the score of climate, because it is in this way only in certain cases that relief from the cares and anxieties of business can be secured. The habits and taste of the patient are to be considered. Persons who are dependent on the associations and comforts of home and friends for their happiness will not be likely to be benefited by being sent away, especially if alone and among strangers. The stage of the disease and the rapidity of its progress are points of great importance. It is truly a cruel act to send to a distance patients who are in a condition admitting of but little prospect of improvement, and who would probably not live to return. The amount of damage which the lungs have sustained, as determined by physical signs as well as the symptoms, are to be taken into account, before entertaining the question relative to change of climate. And finally, if a change be made and prove effectual, it becomes an important question whether, if practical, the change should not be permanent. An arrest of the disease does not extinguish the predisposition to it, and the safest course, undoubtedly, is to take up a residence in the climate in which the disposition to consumption is less liable to be reproduced than in the climate in which it has been already once developed. " The following extracts, from a table prepared by Dr. Mattocks, indicate the relative frequency of consumption in different parts of the Union. As is shown in this table, the disease is far more frequent in the older, more thickly settled portions of the country, being most prevalent in New England, and least frequent in the Western and Southern States. In 1860, there was in Massachusetts one death from consumption for every 250 inhabitants:
Cod liver oil, too, is to be regarded as a food, and not as a specific cure for the disease. It is found beneficial not only in the advanced, but also in the early stages of consumption. An adult may take with advantage one or two tablespoonfuls three times a day, preferably after meals. The nauseous taste of the oil is in many cases a serious impediment to its use, some individuals being utterly unable to take it. For such cases, some one of the many compounds prepared expressly to disguise the taste of the oil - emulsions, combinations with malt, etc., can be used; if these also be objectionable to any fastidious palate, the oil can be taken inclosed in capsules. It sometimes happens that even when thus taken, so that the taste is disguised, the oil materially impairs the appetite or digestion, or both ; in such cases the unpleasant effects may often be avoided by diminishing the quantity of the oil ; in any case it is advisable to begin the use of this agent by giving small quantities, say a teaspoonful or less, and gradually increasing to one or two tablespoonfuls. Certain symptoms of the disease may also require treatment, among them the cough, diarrhea, and night sweats. The cough is inevitable, so soon at least as the softening and breaking down of the lung tissue begins; hence the only object in treating the cough is to diminish the irritation and consequent exhaustion of the patient. Hence such remedies as squills and ipecac are out of place, and may even do harm ; but some sedative mixture may be of service, such as the following : Dilute hydrocyanic acid, - - Half a drachm. Sulphate of morphia, f Half a grain. Syrup of tolu, water, - Each one ounce. Mix, and take half a teaspoonful every hour. Or, instead of this, the following mixture may be given : Paregoric, ----- Syrup of wild cherry, - Each one ounce. Mix, and take half a teaspoonful every hour or two. The night sweats of consumption may be quite profuse and exhausting, even before the later stages of the disease are reached. They are best and soonest relieved by improving the patient's strength and vigor, since the night sweats are merely indications of the general debility and exhaustion induced by the disease. It may be possible, also, to materially reduce this per spiration and its ill effects, either by using some astringent wash externally, or a preparation of belladonna as a medicine. For the former purpose, alum may be dissolved in alcohol, and the patient lightly sponged with this, before retiring ; at the same time minute quantities of atropia - one. one-hundredth of a grain - may be given as a pill, at night. Or the following mixture may be given: Aromatic sulphuric acid, - Three drachms. Sulphate of quinine, - - Fifteen grains. Water to make two ounces. Mix, and give a teaspoonful in water at night. The pains in the chest are often so troublesome as to disturb the patient's rest extremely. These can usually be relieved by che use of belladonna plaster applied to the painful spot, or friction with chloroform liniment or a light mustard plaster may also prove beneficial. But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy! Also, please consider sharing our helpful website with your online friends.
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