FOUL AIR AND DISEASE OF THE HEART. 187 



I hold that the breathing of impure air is a fruitful source of disease 

 of the right heart occurring after middle age. How many people igno- 

 rantly favor its occurrence by confining themselves to closely-shut, 

 non-ventilated, hot, stifling rooms, in which the carbonic acid has ac- 

 cumulated to 2 or 3 per cent, of the air they respire 1 How many are 

 thus destroyed by being compelled, through the exigencies of life, to 

 pass the greater part of their time in pits and manufactories where 

 ventilation is defective, ok in which the air respired is poisoned by nox- 

 ious fumes and offensive emanations from the materials undergoing the 

 process of manufacture ! How many are falling victims to the poison- 

 ous influence upon the heart of the atmosphere of an underground rail- 

 way ! What do these facts suggest ? How are these evil results to 

 be prevented ? The simple answer is Let the rooms in which you 

 live be effectually ventilated by an incoming current of air filtered 

 from all adventitious impurities, and so divided that no draught shall 

 be felt ; and by an outgoing current which shall remove from the 

 apartments the carbonic acid, carbonic oxide, sulphurous-acid gas, sul- 

 phuretted hydrogen, and other noxious compounds, as rapidly as they 

 are generated. Apply the same principle to public buildings, theatres, 

 schools, manufactories, pits, and to all places in which people are ac- 

 customed to congregate. 



As to underground railways, the best plan is to avoid them. 

 True, the time passed in their polluted atmosphere is usually very 

 short ; but it is, nevertheless, sufficiently long to paralyze occasionally 

 the heart's action, and always, by its pollution of the blood and by its 

 direct effect upon the nervous system, to favor degeneration of the 

 structures of the heart. 



It often occurs to a medical man to visit a patient for the first time, 

 and to find him suffering from a dilated right heart. He may for some 

 short time have been sensible of a change in his breathing on walking 

 rather quickly, or in mounting the stairs, or he may never have felt, or 

 at least recognized, any such sensations. His attention was first ar- 

 rested by observing that his feet and ankles were swollen, especially 

 at night on going to bed. This sign it is which gives him the first 

 alarm, and which causes him to seek the aid of his physician. An ex- 

 amination of his case detects a dilated right heart, with incompetency 

 of the tricuspid valve. How has this condition of the heart been 

 brought about ? There is no history of previous cardiac disease ; 

 there has been no illness ushering in the present condition of things ; 

 there has never been, nor is there now, any affection of the lungs, and 

 yet the right heart has suffered a lesion fatal to life ! The answer is, 

 that every such case has passed the age of forty, that the tissues of the 

 right heart have entered upon the period of degeneration, and that 

 this degeneration has, with very few exceptions, been hastened by the 

 breathing of an impure air, either during the pursuit of the ordinary 

 occupations of life, or in the patient's own dwelling. 



