142 



SCIENCE. 



[Vol. XV I II. No. 449 



moval of those who have a body incapable of that work, and 

 that it is directly produced by the habits and surroundings 

 that tend to reduce the breathing capacity below a certain 

 point in proportion to the remainder of the body. Obviously, 

 the first thing that has to be done is to prevent the production 

 of this disease, and for that purpose we must see that the 

 body is used to the extent its size demands, and that the work 

 it has to perform is carried on under conditions that are 

 favorable to the body, — that is to say, we must so arrange 

 our habits and surroundings that their tendency as a whole 

 is to develop the lungs. Each act of man, each factor in 

 his environment, tends either in his favor or against him. 

 We must avoid as far as possible — and where that is not 

 practicable we must counteract their action — those that tend 

 to reduce the breathing capacity. Close, badly- ventilated, 

 or hot rooms, the inhalation of any kind of dust, the habit 

 of taking small quantities of alcohol (termed "nipping"), 

 stooping, positions that cramp or impede the full and free 

 movement of the chest, the corset or tight-Btting clothes, 

 overloading the body with clothes, etc., are examples of such 

 -conditions. And we must place ourselves as far as i^ossible 

 under the conditions that tend to develop the lungs. We 

 should spend as much time as possible in some form of active 

 exercise in the open air, live in rooms that are in direct free 

 communication with the external air night and day, summer 

 and winter, and keep their temperature down. We ought 

 to have the clothing quite easy over the chest at full inspira- 

 tion, wear wool next the skin, take a tub daily, hold the body 

 -erect with the chest thrown well forward and the shoulders 

 held well back, get into the habit of taking deep inspirations 

 followed by full expirations, and breathe through the nose. 

 And we should go in for singing, swimming, gymnastics, — 

 Ling's system by preference, — and for one or, better still, sev- 

 eral forms of athletic sports, rise early, and maintain the tem- 

 perature of the body by muscular exercise. I have briefly 

 indicated the conditions that are favorable or unfavorable to 

 lung development, and to that I will only add that measure- 

 ments by the tape, the spirometer, and the manometer should 

 be regularly taken, recorded, and compared with the standards 

 that indicate a fully developed chest, and that it is the plain 

 duty of each one of us to see that he stands well in that re- 

 spect, for we can protect ourselves from the possibility of an 

 attack of consumption by securing and maintaining a lung 

 capacity far above the point at which the disease origi- 

 nates. 



The second direction in which we must take action, if we 

 mean to remove this curse of civilization from our midst, is 

 to recognize early, and that promptly and adequately, those 

 •who have the great misfortune to be its victims. This is the 

 state with which we have to deal here. The lungs are being 

 progressively destroyed by a process of irritation caused by 

 more work being thrown upon them than they are able to 

 effect, and this inability has been produced by their having 

 been and still being subject to conditions that tend to reduce 

 their capacity ; and, further, during the progress of these 

 events, the other organs have become involved by attempting 

 to perform compensatory work, with the result that the gen- 

 eral health is more or less seriously compromised. Conse- 

 quently, in order to adequately deal with this state of things, 

 we must treat consumption upon the following principles: 

 To establish an equilibrium between the amount of inter- 

 change required to be effected and that effected, to enable 

 the other organs of the body to perform their ordinary func- 

 tions, to restore to the lungs their power of adjustment to 

 their external conditions, and to obtain the above without 



producing indications of friction. That is, in other words, 

 we must arrest this process of irritation, restore the general 

 health, and develop the lungs to the required amount, in 

 order to effect the cure of consumption. I will now briefly 

 indicate the method of applying the principles above laid 

 down. We must, to arrest this process of irritation, remove 

 the conditions that impede the effecting of those interchanges 

 by placing the patient under conditions that tend to develop 

 the lungs, and make good any deficiency that may remain 

 by causing compensatory action by one or more of the other 

 organs. We shall proceed with measures for the restoration 

 of the functions of any organ that may have been deranged, 

 and when we have obtained the arrest of the disease and 

 effected an improvement of the general health we shall begin 

 to develop the lungs. We must carefully select appropriate 

 medicines and measures for each purpose we have in view, 

 use them at the right time and to the right extent, and 

 watch their effects, so that if there be any indication of fric- 

 tion we may at once effect the necessary modification or use 

 some other medicines or measures for that purpose. 



It is easy to cure consumption at the commencement, even 

 when both lungs are affected. It can be cured when there 

 is a large amount of disease, and it may at least be amelio- 

 rated when both lungs are extensively diseased. I speak from 

 practical experience, and I for one will not attempt to place 

 a limit upon the great power of Nature when all her forces 

 are called forth and aided. 



The links of evidence slowly forged by men who have gone 

 and by others still with us I have put together. Test the 

 chain thus formed where and how you please, and you will 

 find that it is complete and unbreakable. We have per- 

 formed our part of this work, and in the name of those who 

 have taken part therein I now call upon you to give effect 

 to it by uniting together in the great work of suppressing 

 consumption. 



PROGRESS OF PREVENTIVE MEDICINE.' 

 Unprecedented progress in human knowledge characterizes the 

 present centiiry, and has not been wanting in preventive medi- 

 cine. It is, however, during the last half of it that advance has 

 been most remarkable, whilst it is in a later part of that period 

 that it has so established itself in the popular mind as to have 

 passed from the region of doubt and speculation into that of cer- 

 tainty. It is now pretty generally understood that about one- 

 fourth of all the mortality in England is caused by preventable 

 disease, that the death-rate of large communities may be reduced 

 much below that at which it has been wont to stand, that the 

 average duration of life may be made to approximate nearer to 

 the allotted fourscore, and that the conditions of living may be 

 greatly ameliorated. The chief obstacles to improvement have 

 been ignorance and want of belief. A better knowledge of the 

 laws of life and health, a more rational comprehension of the na- 

 ture and causes of disease, are gradually but surely entailing im- 

 provement in the conditions of living and in the value of life, and 

 the diminution and mitigation, if not extinction, of morbid condi- 

 tions which have in past times proved so injurious or destructive 

 to life. Such are the subjects contemplated in the work of this 

 section, and as far as time permits the most interesting of them 

 will be discussed, Those selected are of great importance in 

 their relations to public health; let us hope that observers who 

 have formed their opinions from experience in other countries 

 and under different circumstances may throw new light on them. 

 In the brief space of time at my disposal it would be impossible 

 to-give a continuous outline ot the progress of preventive medi- 

 cine during the past, or to trace its growth and development out 



1 Abstract of tlie inaugiiral address before the Section of Preventive Medi- 

 cine of the Congress of Hygiene, in London, England. Aug. 11, 1891, by Sir 

 Joseph Fayrer, K.C.Sl., F.R.S., president of the section (from Nature of 

 Aug. 20). 



