CONSUMPTION 285 periments that tuberculous disease may be communicated by inoculation from man to cer- tain animals, namely, rabbits and guinea pigs. These experiments have been repeated with the same result by others. It appears, how- ever, that inoculation .with morbid matter other than that from the tuberculous products is also followed by the development of tubercle. Were it true, as asserted by Villemin, that tu- berculous products only are capable of produ- cing the disease by inoculation, and that there- fore these products must contain a specific morbid material of the nature of a virus, the fact would lend strong support to the opinion that consumption is to be reckoned among the contagious diseases. This opinion has been heretofore held by some, being based on in- stances of persons who live in close compan- ionship, especially as husband and wife, be- coming successively affected. The study of a large number of cases with reference to this point, however, affords but little evidence of the disease being communicable. Consump- tion ends fatally in the great majority of cases. This well known fact leads to an underesti- mate of the number of cases in which recovery takeSv place. Cases are not extremely infre- quent in which the progress of tuberculous disease ceases before the lungs have become greatly damaged. The traces of an old tuber- culous affection are not very uncommon in bodies examined after death from, other and various diseases. This arrest of the progress of the disease sometimes takes place spontane- ously, that is, under circumstances which seem to denote an inherent tendency to recovery. Small tubercles in the lungs may undergo the calcareous degeneration; the organic matter which they contain is absorbed, leaving the mineral portion, and in this form they may be expectorated. These so-called " obsolete tu- bercles," or pulmonary calculi, sometimes ex- pectorated in great numbers, are thus evidence that there has existed a tuberculous affection which, instead of progressing, has undergone retrogression. There is reason to believe that a small amount of tuberculous products may be entirely absorbed. But even when the tuber- culous affection is considerable, and has ad- vanced to the formation of cavities, recovery is by no means impossible. If fresh tuberculous products do not take place, in other words, if the tuberculous cachexy no longer continue, the cavities may cicatrize; and patients re- cover with a certain amount of permanent in- jury which, as the quantity of lung in health is greater than is required in ordinary breathing, is only felt when there is an unusual demand for the respiratory function, as in taking active exercise. Even if recovery do not take place, tuberculous cavities sometimes remain almost or quite innocuous, and under these circum- stances the affection is so far mitigated that life and comfortable health may be maintained for an indefinite period. There are no known specific remedies for the cure of consumption. This is not saying that medicines are not often useful. At the present time the remedies which are in vogue, and which in certain cases are more or less serviceable, although having no specific virtue, are the various vegetable and mineral tonics, the hypophosphites, arsenic, and cod-liver oil. The latter is perhaps a food rather than a medicine. But measures rela- ting to diet, regimen, and climate, and other sources of hygienic influence, are vastly more important than any medicaments. The great object of treatment is the removal of the con- stitutional condition of which the pulmonary affection is the local expression; that is, the tuberculous cachexy. With reference to this object, all available means of strengthening and invigorating the system are to be em- ployed. The diet should be as abundant and as nutritious as possible, embracing fatty ar- ticles of food in as large a proportion as the appetite and digestion will allow. Living out of doors as much as possible is an impor- tant part of the hygienic treatment. The writer is cognizant of several cases in which persons in advanced consumption recovered after adopting a savage life, that is, roughing it and living in the open air. Long voyages are often useful, and sometimes seem to ef- fect a cure, instances of which have repeat- edly come under the writer's observation. On the other hand, the disease sometimes pur- sues a favorable course under hygienic circum- stances which would not be considered as con- ducive to this end. This statement will apply to some hospital cases. Unquestionably cli- matic influences are often useful, and a change from an unfavorable to a favorable climate is sometimes apparently instrumental in effecting a cure. That such a change is not curative in the majority of cases does not militate against this statement, for consumption will end fatal- ly in a very large proportion of cases in spite of all the measures which, with our present knowledge, can be brought to bear upon the patient. If a change of climate be made, the desirable qualities of that to be selected are dryness, uniformity, elevation, and the absence of malaria. A dry, uniform, cold climate is suitable for some cases, and for others one which is dry and warm is more favorable. It is not always easy in particular cases to de- cide whether it is best to choose a warm or a cold climate. Perhaps the best criterion is the previous experience of the patient as to the in- fluence upon health and vigor of the summer or the winter season. In making a change of climate, various circumstances are to be consid- ered, such as the resources for occupation and recreation which different places offer, the feelings of the patient with respect to absence from home and separation from friends, the supply of the proper articles of diet, and the influence of associations. With reference to the latter, the moral effect of going to a place in which consumptive patients congregate is often unfavorable. As a rule, consumptive
