254 



SCIENCE. 



[Vol. XV. No. 377 



mand that a practical effort should now be made to reduce 

 the compression of the chest, the inhalations of small par- 

 ticles, and confinement, especially in rooms under ground, 

 to a minimum in those trades. 



At birth the child has a proportion of chest girth to height 

 that slightly exceeds that of the maximum standard. I 

 have suggested the birth standard as the true standard of 

 health; but under the present system of bringing up chil- 

 dren, they are, from the moment of birth right through the 

 whole course of modern education, submitted to conditions 

 that tend to reduce the breathing capacity; so that for a 

 height of 51.84 inches there is a chest-girth of 26.10 inches, 

 instead of one of 35.18 inches, or a loss, in about ten years, 

 of nearly nine inches. And when there is consumption in 

 the family, extra care is taken of the children; that is, these 

 .^conditions are pushed to an extreme limit, and the so-called 

 inherited consumption is the direct result. Here you have 

 .the best standard of chest-girth. Is it too much to ask that 

 .the conditions of the child's surroundings as a whole shall 

 be so arranged that it may be retained? Look at the poor, 

 puny chests we meet with, and at the reports of the regis- 

 trar-general, and then we shall see the grave responsibility 

 that lies upon us for producing such a change, and permit- 

 J;ing it to continue. 



J have pointed out the means by which we can develop 

 rthe lungs to the required standard, and in so doing have 

 .shown how that development is to be retained, and con- 

 ■sumption be effectually prevented. These measures are 

 very simple; and in one form or other, and at some period 

 or other within the twenty-four hours, they are within the 

 reach of all. But they effect a complete change in our 

 habits, mode of life, and surroundings; and a change of this 

 nature must be slowly, gradually, and cautiously effected. 

 I warn you against stretching the lungs (that is not develop- 

 ment), against violent or sudden exertion and exhaustion. 

 Uninterruptedly, step by step, acclimatize the bodies to the 

 new conditions, and then they will lead us safely and surely 

 to complete protection from consumption. 



How can we reduce the mortality from consumption to 

 insignificant proportions, and so complete the measures that 

 are necessary to secure the practical suppression of the dis- 

 ease ? This is the state with which we have to deal. The 

 lungs are being progressively destroyed by a process of 

 irritation' caused by more work being thrown on 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 in- 

 volved by attempting to perform compensatory work, with 

 the result that the general health is more or less seriously 

 tcompromised. Consequently, in order to adequately deal 

 ■with this state of things, we must treat consumption upon 

 ithe following principles : to establish an equilibrium between 

 the amount of interchange required to be effected and that 



» Tanner, Aitken, Wilson-Fox, Wftldenburg, Schottelius, Roberts, Lombard, 

 Marcet, Sanderson, Simoo, Cohnheim, Frankel, Rindfieisch, Niemeyer, Pow- 

 ell, Ewart. 



2 Gautler, Peter, and the French Sohool. 



3 Graham Balfour, Gintrac, Hanot (Jaccoud), Hutchinson, Fabino,Wintrich, 

 gecht, Schnievosft, Waldenburg, Ransome, Stokes, Frieund, Aitkeu. 



effected ; to enable the other organs of the body to perform 

 their ordinary functions; 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 secure complete recovery from consump- 

 tion. A little consideration will make it evident, that, to 

 carry out the first principle of treatment, we shall have to 

 take measures from two distinct points of view. On the 

 one hand, the conditions that impede the effecting of these 

 interchanges must bo, as far as that is possible, removed, 

 and those that have an opposite tendency substituted ; and, 

 on the other, any deficiency that may remain must be made 

 good by the compensatory action of one or more of the 

 other organs. For this purpose we shall, in the first place, 

 put the patient under conditions of habitation, habits, and 

 surroundings that tend individually and collectively to 

 promote these interchanges. The consumptive patient must 

 be sent as soon as possible to live in a house the sanitary 

 condition of which has been ascertained to be good, situated 

 on an elevation, either in the country or at the seaside, 

 where the air is pure and free from dust. Each room must 

 communicate continuously and directly with the external 

 air. Sunlight should be freely admitted; the windows con- 

 stantly kept open, night and. day; and the temperature, as 

 recorded by a maximum and minimum thermometer, grad- 

 ually lowered till there is not so great a difference between 

 it and the external air as that we still find in the rooms 

 of consumptive patients. The patient's clothes must be 

 warm, not too heavy, and made so loose that they can offer 

 no restraint to the free movement of the chest. Wool manu- 

 factured in such a way that it is elastic, permits free venti- 

 lation of the skin, and is not too heavy, should be worn 

 next the body ; that used during the day must not be worn 

 at night, and the under-linen should be frequently changed. 

 As much time as possible must be spent in the open air. If 

 the patient is unable to walk, he should ride or drive in an 

 open carriage till he has gained sufficient strength to enable 

 him to do this. Sitting in a position that tends to impede 

 the movement of the thorax must be carefully and constantly 

 avoided, and the patient should be gradually induced to 

 throw the weight of the shoulders on the spine till he both 

 sits and walks with the body erect. If any deficiency re- 

 main, — and that, as well as its amount, will depend upon 

 the extent of the disease, — we shall have to obtain compen- 

 sation for it by measures that increase the activity of the 

 functions of the skin, or the kidneys, or the alimentary 

 canal. To increase the functional activity of the skin, we 

 shall direct the patient to be bathed or sponged with warm 

 water, medicated or not, as frequently as may be found de- 

 sirable, once daily in any case; and, if necessary, we shall 

 increase that activity by prescribing diaphoretics. If the 

 action of the skin obtained by the above measures be not 

 sufficient for the purpose, or if it be already performing its 

 share of this compensatory work, then we shall increase the 

 activity of the kidneys by suitable diuretics, and attend to 

 the functions of the alimentary canal. Now, the above 

 measures, thoroughly and carefully carried out, will, if the 



