FOUL AIR AND DISEASE OF THE HEART. 193 



subjects of such disease might, despite the cardiac mischief, have con- 

 tinued to live for an indefinite time. 



It has frequently been my duty, during a practice of nearly thirty 

 years in the midst of a large community prone by the habits and par- 

 ticular avocations of the people to heart-disease, to investigate cases 

 of " found dead " in bed, and I have often been compelled to refer the 

 immediate cause of death to the effect of carbonic acid liberated by 

 respiration and confined to the apartment, in destroying the sensibil- 

 ity and contractility of the heart, rather than to the direct influence 

 of the diseased heart itself. 



I remember that on one occasion I was summoned to a case which 

 had occurred in a bedroom fifteen feet long, twelve feet wide, and eight 

 feet high. In this room, with the door and window closed, no fewer 

 than twenty persons slept night after night ! Can any one doubt that 

 the air of such a room would be charged to excess with carbonic acid 

 exhaled by respiration? Those who perished in this manner were be- 

 yond the age of forty ; and, in every instance examined, the right side 

 of the heart was either primarily affected by tissue-degeneration, or 

 by disease consecutive to mischief in the left side of the heart and 

 lungs. 



Often indeed in the dwellings of the middle and higher classes of 

 society the provisions for ventilating both their bedrooms and their 

 day-rooms are miserably inadequate to preserve health. The conse- 

 quence is, that cai'diac disease is promoted to an inconceivable extent. 

 There is no other disease in ichich the demand for cold, fresh air is so 

 urgently pressed by the patient as in cardiac disease. There is none in 

 which a constant supply of pure air is more needed none in which it 

 is more grateful to the patient, or in which it has a more immediately 

 beneficial effect. At all times and seasons in the depth of winter by 

 day and by night a patient suffering from a paroxysm of cardiac 

 asthma will hurry to the open door or window, and there, with his 

 body hanging half out, will remain, with scarcely any vestments upon 

 him, breathing the cold air until the paroxysm has ceased. Ought not 

 this urgent, this powerful supplication of Nature to teach us the impor- 

 tance of ventilation, and of a full supply of fresh air in the treatment 

 of heart-disease? 



I hesitate not to say that free ventilation the free admission of 

 pure air into the apartment by day and by night is one of the most 

 important remedial measures which can be adopted in the treatment of 

 this disease. 



Where this means is defective, but where, nevertheless, the vitia- 

 tion of the air of the bedroom does not exceed 1 per cent, of carbonic 

 acid, a sensible effect is produced upon those who have slept within its 

 influence. They complain, on leaving their bed, of weakness ; their 

 limbs tremble ; they feel somewhat giddy, and their head feels heavy, 

 or it aches. The least effort disturbs the heart's action, which is some- 



TOL. II. 13 



