April i8, 1890.] 



SCIENCE. 



241 



shape of the chest in an opposite direction; and I continued 

 the process till the chest had regained its full development 

 and there was sound health. Each step in the experiments 

 was carefully verified, the same sequence of events was in- 

 variably observed, and I have both traced the presence of 

 these conditions and watched their progress in many cases 

 of consumption. 



We can at any time watch the direct production of con- 

 sumption by the constant inhalation of small particles of 

 various substances in strong healthy men who have been 

 brought up in the country, and we know the disease has 

 been produced in this way for generations. Masons, build- 

 ers, wool and cotton manufacturers, quarrymen, cutlers, 

 file-makers, earthenware manufacturers, etc., supply a large 

 contingent to the mortality from consumption.' Occupa- 

 tions that are carried on in small, crowded, or badly venti- 

 lated rooms, where the respiratory functions are impeded, or 

 those in -which there is a long-continued cramped position of 

 the chest, have long been notorious for the production of 

 consumption. We have examples of this in the case of 

 Manchester warehousemen, drapers, tailors, shoemakers, 

 watchmakers, printers, clerks, and students.^ 



The army supplies us with a practical demonstration of 

 the direct production of consumption by such conditions. 

 Each recruit is specially examined with reference to con- 

 sumption, and three months after he has entered the army 

 he is again examined, when, if any indication of the disease 

 be found, he is at once dismissed the service. These men 

 are placed under the supervision of skilled medical officers; 

 their food, clothing, and home are assured them; they are 

 in the prime of life; and any illness they may have is at once 

 attended to. Yet, notwithstanding this doubly certified free- 

 dom from consumption, and these great advantages, the loss 

 to the army from this disease is much higher than that of 

 the worst district in England. During the six years 1880-85 

 there were^ on an average, 1,330 admissions into hospital, 

 263 deaths, 215 invalids sent home from abroad, and 474 in- 

 valids discharged the service. Army medical authorities ' 

 are agreed in attributing this ''generated" disease to the con- 

 ditions of army life ; and of these they attach most impor- 

 tance to the large amount of time spent in impure barrack 

 air, compression of the chest by clothing, etc., alcoholism, 

 sentry go, and specific disease, or, in other words, to con- 

 ditions that tend to reduce the breathing capacity. 



We have in confinement' another practical demonstration 

 of the direct production of consumption by conditions that 

 tend to reduce the breathing capacity. Prisoners, orphans, 

 and the insane formerly suffered terribly from this disease. 

 At one time the mortality of the white prisoners of New 

 York from consumption was three times that of the popula- 

 tion, and the mortality of the black was double that of the 

 white prisoner. 



In the so-called "inherited" consumption there is yet an- 

 other sad example of the direct production of the disease by 

 such conditions. Look, on the one hand, at the conditions 

 under which these children are brought up from birth, at 



1 Lombard. 



2 Supplement to Registrar-General's Report, 1870-80. 

 ' Parkes, Aitken, Welch. 



* Taennec, Cruveilhier, Peter. 



the early age at which the disease appears, at its greater 

 frequency in the daughters of consumptive mothers, and, 

 on the other, at the plain evidence of the effect of these con- 

 ditions that is seen in the arrested or retarded development 

 of their chests. 



Strong healthy countrywomen, who were accustomed to 

 work in the fields, went to Paris, wore stays for the fijst 

 time, and furnished the majority of Louis' patients. Tall 

 men, who in proportion to their height are small-chested, 

 and narrow-chested men, are notorious for their great lia- 

 bility to the disease. The association between rei^eated in- 

 jury to the lungs by certain diseases and consumption has 

 attracted the attention of most observers. We know that 

 our cities are the chief centresof consumption, that the main 

 tendency of city life is to reduce the breathing capacity, and 

 that men who have been brought up in the country supply 

 the majority of its victims. We also know that in the 

 country such tendencies dominate the sphere occupied by the 

 women who are liable to this disease, and that the female 

 mortality exceeds that of the male. 



Further, we have the same relationship between these 

 conditions and consumption in the animals under our con- 

 trol. Many investigators have produced consumption in 

 animals by strict confinement.* Wild animals kept in tlie 

 great national menageries, cows stabled in cellars under 

 ground in large cities, and our own domestic pets, alike be- 

 come its victims. And where is there a case of consump- 

 tion, experimental or not, in which such conditions were 

 absent? 



1 have carefully sought in vain foi' the record of snch a 

 case. Now, if the interpretation that has been placed upon 

 these facts is true, then we shall find ample evidence of the 

 action of those conditions in the disease itself. They tend 

 to reduce the breathing capacity: consequently their effect 

 must be a progressive reduction of the breathing surface of 

 the lungs, and that is precisely what we have. Long be- 

 fore we get the so-called signs of the disease, we have a pro- 

 gressively lessening chest capacity, that goes^ on to the end. 

 I have shown, I trust not too briefly, that conditions that 

 tend to reduce the breathing capacity can and do produce 

 consumption, and that they are the dominant factors of, and 

 co-extensive with, the field occupied by this disease. Let 

 us now glance at the dominant conditions of the field in 

 which consumption is unknown: for there are still places in 

 Asia, Africa, and America in which there is no consump- 

 tion; and in some of these the inhabitants have no word for ' 

 the disease, and do not know what it means. Travellers in- 

 form us that these people spend the whole of their lives in 

 active exercise in the open air, that they bold themselves 

 erect, bearing the weight of theii- shoulders on the spine, and 

 that their chests are broad, deep, and freely movable. And 

 there is no record of consumption being found in animals in 

 their wild state. 



But this area of freedom from consumption is being steadily 

 diminished by the introduction of civilization, — that is, of 

 conditions that tend to reduce the breathing capacity, — and 

 that is invariably' speedily followed by the first appearance 



' De Miisey, D'Arboval, Bayer, Bricheteau. 



2 Hutchinson, Stokes, Ransome, Graham, Bilfouc 



