Popular Science Monthly/Volume 12/December 1877/Open Air and Health
By Dr. PAUL NIEMEYER.
I SPARE the reader the diffuseness of an introduction, by telling him of a scene in an omnibus, which hinged on the question whether the conductor should open or shut the windows. On the left was
seated a corpulent lady with full face, shrill voice, and labored respiration. The lady on the right was of lean, slender, dried-up figure; on entering the omnibus she had coughed; after taking her seat she held her handkerchief to her mouth and fairly changed color when the one opposite, wheezing, took her place and called out for "Air, air!" exclaiming that she would surely be smothered if the window were to remain closed. "But I," objected the other, "should get my death of cold if the window were opened." The conductor, who for some time stood undecided what to do, received this piece of Solomonic advice from one of the passengers: "Open the window," said he, in a deep voice, "and then one of them will die; then close it, and the other will die, and so at last we shall have peace."
This ending of the scene I state for completeness' sake only, and I add to it, by way of transition to the subject of the present essay, a conversation with a farmer which grew out of the occurrence.
On expressing to this sun-bronzed young man my regret that, in this self-styled "age of intelligence," the fear of colds and of draughts should be steadily increasing, and that it should really be producing the very effects it is meant to guard us against, namely, coughs and colds, he fully agreed with me, but took credit to himself for having risen above such notions. "We farmers," said he, "no longer believe that rust in grain comes from cold; for we know that it results from the development of noxious germs which, emitted by barberry-bushes and decaying stalks, are carried about by the wind."
This idea was of interest to me; for the farmer's account of the origin of "rust" put me in mind of certain throat and lung complaints that, developing unnoticed, gradually lead to positive disease, and the causes of which we physicians are daily more and more clearly tracing to inhalation of impure, vitiated air; hence, instead of speaking of consumptive lungs or tuberculous lungs, we should, rather, speak of "decayed" lungs or "dust" lungs. Stone-cutters are not assured by life insurance companies, because it is known that the stone-dust settles in their lungs, undermining them, producing ulcerations and reducing the average life of the men to thirty-six years. Other "dusty occupations," so to speak, are less dangerous, but of certain callings and of certain classes of working-men we often hear it said that they are seldom free from "dry" cough. The reader, though he or she may have little to do with dust, will perhaps have taken home from the ball a very fair case of "dust-lung" caused by the dust of the dancing-floor. If they will not believe this, let them examine their expectoration the day after the ball. He who has good lungs may without fear inhale dust; he will dance most of it out again; but not so a delicate girl, whose lungs are compressed in a tight corset: when with dust-laden mucus she spits blood, do not say she has "taken cold." No, it is heating that has caused it.
Heating, too, and not cold, far less "trouble with teeth," is to blame when the first-born child of inexperienced young married people becomes feverish, or has a cough, and these symptoms are only aggravated when the innocent victim is treated with "teas" and mixtures, kept in an overheated room, and loaded down with bedclothes.
That our children were intended by Nature to live in fresh, open air, and that the old wives' regimen of keeping warm, living in-doors, and of warm drinks, is the cause of the fearful mortality of young children, is a truth that was not unknown one hundred years ago, but which must still be repeated over and over again.
The reader will allow me to recite the case of a patient of mine. A year ago, during his honey-moon, I congratulated him, and told him that a dry cough with which he was troubled was curable, provided he took care to live in the open air as much as possible, inuring himself to cold, sleeping in well-ventilated chambers, free from dust, etc. But this advice was hardly relished by the young pair. In October they hired rooms in a house that had just been built; its "dampness" they remedied by keeping up fires steadily; the windows were hardly ever opened, as the house stood on a windy corner, and the husband was growing more and more sensitive to cold; for this reason, too, he seldom went out-of-doors. In November he took to the bed, was again about, but he gradually declined, to the last hoping to recover.
Different was the course followed by Mr. H——, who, emaciated and troubled with a cough, had a hæmorrhage after contracting a "severe cold." He went into the country, took as much exercise as he could in the open air, and returned home with only a slight cough. At home he every morning took a warm bath with affusions of cold water, avoided rooms with bad air, etc. In six months he was free from his cough, appeared to be well nourished, and no longer had any fear of taking cold.
If the reader will dispassionately compare these two cases, he will agree with me that the first patient, who had never had hæmorrhage, fell a victim to the action of foul air, while H——used to say, "I must give to my diseased lungs, above all things, fresh air, as the prime necessary of life." Animals never take cold, even in winter; therefore among men it must be a result of wrong habits if air does any harm. We know that gold-fishes quickly perish when fresh water is not provided for them; and when we were boys we used to consider it cruelty to animals if we made no openings for ventilation in the boxes in which we kept cockchafers.
Now, these openings answer to the windows in our houses; doors are meant to be closed, windows to be opened. It has long been held that closed windows are the principal cause of consumption. I would make the proposition more general, by substituting "defective ventilation" for "closed windows." It is very pleasant to be sheltered by four walls against wind, rain, and cold; but, now that we employ window-glass, coal for heating, and iron stoves, and rent is becoming higher, while rooms, especially sleeping-rooms, are growing smaller, we have all the greater reason to keep open ventilating apertures, since our lungs cannot live with less than six hundred cubic feet of fresh, pure air per hour. The man who has but once made trial for one week of sleeping with the window open will never give up the practice.
I once spoke to a lady about this matter, but she replied by telling me the story of a "thoughtless person" who, having left the window open through the night, awoke in the morning blind. She had also read in some newspaper that a man had a stroke of apoplexy produced by the same cause. I was amazed. But, calling to mind that this lady's husband had served in the army, I remarked: "Your husband lay for so long in the open air in the rain-drenched trenches at Strasburg; did he ever write to you that he had taken cold, or that any of the men had ever overnight been struck blind, or had met with any other misfortune? Did he ever contract a catarrh? Did he ever write for licorice, and not rather for tobacco? Your brother-in-law tramped in the deep snow to Besoul, your cousin learned at Le Mans what is the meaning of a fall of freezing rain, and thousands of our countrymen have had like experiences; still, coughs and rheumatism were not frequent, and most of the men came back strong and healthy!"
More rational opinions are gradually making their way, and, in one particular at least, a beginning is being made of a revolution, namely, the system of treatment followed in "climatic" sanitariums, and establishments for the cure of disease by air, difference of elevation, etc. The proprietors of such places, it is true, speak of the "specific" virtues of their climate; but, inasmuch as chemistry shows that atmospheric air all over the earth has the same constitution, the specific virtue must reside in the special purity of the air—a thing wanting in cities, but found in all villages, provided they do not possess large factories. Further, it is an error to suppose that in the south—Florida, Colorado, or in the Tyrol, or by the lake of Geneva—it is as warm as in a hot-house. In those regions, too, it is now and then cold; yet it is easier to be out-of-doors there, for usually the sun shines and the landscape is beautiful. But, since we cannot send all the sick to the south, we must devise some substitute at home, the benefits of which may be enjoyed even by the poorest. Then, too, when we consider that the majority of those who have spent the winter in a southern clime return as—embalmed corpses, because it is only when it is too late that people make up their minds to make the costly voyage, there is reason to expect better results from timely recourse at home to "air-cure." With the means of treatment at hand, disease might be nipped in the bud, and lung-complaints in general would be rarer.
And this result we may hope to attain. That pulmonary consumption is only an acquired disease we know from the fact that it first appears in the apices of the lungs—a portion of the organ which is not affected by hereditary pathological processes. The diathesis only is hereditary, and this diathesis consists simply of a general debility, which, however, can be overcome. But the thing that is transmitted hereditarily is habits of life—the avocation descending from father to son.
MacCormac tells of a family in which father, mother, and six children, died of consumption; the seventh son alone survived, he having quit the paternal house and calling, and gone to sea. Many instances of a like kind might be cited. This case is easily understood when we consider that here the parents and the six children who died had followed a sedentary trade; that they lived in narrow quarters, the air of which was quickly vitiated by the large number of persons breathing it; that they slept in a dusty room, with windows closed, lest they should take cold. They fell sick one after another; but the seventh son, who quit the unhealthy locality, had exercise, inhaled fresh, pure air, became vigorous and healthy, and escaped from consumption.
This simple explanation appears strange to those who believe in "tuberculosis." If this disease has grown to be the curse of modern society, the scholastic interpretation of it has to bear no small part of the blame. The doctrine of the heredity of consumption leads to the belief that the consumptive patient is fated to die of his complaint, and that his death is merely a question of time. He himself often draws the conclusion that the best thing for him to do is to enjoy life as best he may while it lasts. On the other hand, we must condemn the heedlessness of those who, so long as danger is not proximate, fear the expenditure of time and money. These same people, when hæmorrhage suddenly appears, quite lose their heads, adopt the most preposterous methods, whose only result is to cause new hæmorrhages, and to produce a regular case of consumption: whereas many of the old physicians recommend horseback exercise as the best cure for those suffering from hæmorrhage of the lungs, we now often see patients shut up in a hot, dusty room, not allowed to talk, and almost forbidden to breathe.
It is a peculiarity of consumption that it may appear in association with all diseases in which recovery is slow. In the first place, it accompanies inflammation of the lungs, unless the patient, while recovering, is permitted to breathe plenty of pure air. But it also makes its appearance in typhus, diabetes, and meningitis, when the patient is kept for a long time in a close room. So, too, delicate persons—those supposed to tend toward consumption—will all the sooner become indeed "tuberculosed," the more they are coddled, protected against cold, and treated with warm drinks and so-called "invigorants". Pulmonary hæmorrhage is in itself not a symptom of "tuberculosis," but it is made so by wrong treatment.
The foregoing practical considerations will enable the reader better to appreciate the theoretical observations which follow.
The lungs, like all mucous surfaces, secrete mucus even in their healthy state; this collects while we remain quiet, but is thrown out when we move. Every adult person clears his throat in the morning. One who has been sitting for a long time must cough when he goes out-of-doors. Bodily movement is the best "solvent" for a cough. When one's life is sedentary, mucus collects first of all in the apices of the lungs, and it is more difficultly broken up there by bodily movement, because the apices are the uppermost parts of the lung, and the impetus of the cough must drive the expectorated mucus around the corners of the lung. The apices are a veritable receptacle for mucus, which, if not removed, dries up, grows hard, and causes ulceration. In one hundred autopsies we find as many as ninety cases where the apices are more or less shrunken, scarred, and obstructed, and this without reference to the cause of death.
The apices, furthermore, are regular dust and gas traps, especially the right apex, which usually is the first to be affected by consumption, because the air-passage leading to it is wider and less crooked than that leading to the left apex. All impurities inhaled into the lungs, and especially all dust, first make their way to the apices, and there settle, unless they are kept in motion by bodily exercise. Elimination, too, is more difficult in the apices than in the inferior lobes. In coughing, the latter are aided by the abdominal pressure; while the apices, on the contrary, have to depend on their own contractility, which is weaker in proportion as they have been out of exercise, or as their cell-walls have grown together. Heavy clothing, which, like the yoke for carrying water, bears on the collar-bone, diminishes the power of respiration in the apices; a modern winter-overcoat weighs as much as eight or nine pounds. If, in addition to this, we have the usual two turns of a comforter around the neck, then the neck is bound fast, and we have all the conditions necessary for producing a diseased condition of the apices. Under such circumstances it would require considerable exertion in coughing to clear the apices. Hence the troublesome dry cough, which often ends in vomiting, yet does not loosen the mucus in the lungs. No benefit is to be got in such cases from lozenges, drops, extracts; the most that can be expected from such remedies is that they may moisten the throat rendered dry by the effort of coughing. But then they fill the stomach with phlegm. For small children such substances are an actual poison, producing sour stomach, diarrhœa, and fever.
Continued hard coughing in time injures the texture of the lungs, and leads, often with bloody expectoration, to decay of the apices, and, finally, to true pulmonary consumption, concerning the rational treatment of which we add a few words:
As a general rule, where a cough is habitual, whatever the age of the patient, recourse should at once be had to those means of cure which usually are resorted to only at the last moment, and then without any hope of good results. But, unfortunately, most people think only of the present moment. They want a son to complete his schooling as early as possible, and to go to earning money. But what is the gain if the young life, after a few years, ends its earthly career? Better, therefore, that a year or two should pass without remunerative employment, while in the mean time care is taken of the bodily health and strength, the affected lungs are invigorated, and the spirits are renewed. In the first case we have dead capital, in the second capital which bears interest.
The person whose lungs are affected must once for all give up dancing, for dancing as now practised is not "motion," but only destruction of the pulmonary apices by dust and vapor, fatigue of the body through want of sleep and privation of fresh air.
With this one exception, "caution" as usually understood is bad. Let the one who is threatened with consumption look on himself not as one doomed to die, but only as a pulmonary invalid. He should consider that, while it is a misfortune that the pulmonary apices are from their position exposed to disease, we nevertheless have plenty of lung-cells which can be made to do duty in place of them. Still, if these are not daily strengthened by careful treatment, they are in danger of being infected by the others, and of becoming diseased like them. By timely and continuous exercise, it is possible to restore even the diseased cells, and to cure the consumption, or at least to stay its further progress. If one can find the means of visiting Florida, Colorado, or Southern Europe, it is well to do so. But if this is not possible, one must find the means of an air and movement cure at home. That this is possible, the reader will see from the following analysis of the means of cure:
1. Lung-Ventilation.—The patient must with scrupulous conscientiousness insist on breathing fresh, pure air, and must remember that the air of closed rooms is always more or less bad, impure. No man, however uncleanly, would drink muddy, dirty water. Unfortunately, for detecting impurities of air, the only organ we have is the nose, and in most persons the nose is of so obtuse a sensibility that it is of no service. Besides dust, injury to the lungs is caused principally by the products of respiration (carbonic acid and watery vapor), which act as poison on the lungs and the blood. A party which occupies a room for hours, breathing the same air, might be compared to a party of bathers drinking the water in which they bathe. The man who on the street cuts off from his lungs the "cold" air, is like a ruminant. If this literally true comparison were universally accepted and acted on, the number of cough-complaints would be reduced one-half.
The patient must keep the window of his bedroom open. Night-air is fresh air without daylight; he who fears night-air is like a child who dreads darkness; the light in the room after the lamp is extinguished is also night-air. In close, crowded, heated rooms, the patient suffering from lung-complaint respires consumptively. In winter artificial heat may be employed, but the window must be opened above, and thus we have at once both warmth and ventilation. In the city night-air is always wholesomer than day-air, being both purer and stiller.
If it be objected that "what suits the blacksmith does not suit the tailor," I reply that may be true of a plate of sauerkraut. But here the case is just the reverse. The blacksmith who has no trouble with his lungs can stand vapor-dust, heat, fatigue; but the one who has pulmonary disease risks his life if he has not always abundance of fresh, pure air.
So far of the What?—lung ventilation. Next, of the Why?
On rising, let the patient drink fresh milk (not coffee), which will be relished all the more if one wakes with an inclination to cough. Then let him approach the open window, brandish the arms over the head—which enables the lung apices to inhale air more easily—and for a few minutes fetch as deep inspirations of air as possible. He must frequently take such deep inspirations in the open air.
If the lungs do not become free, let him introduce into them—not into the stomach—something to act on the dry mucous membrane—as the vapor of water or of camomile-tea.
If the cough is caused rather by a "scratchy" feeling in the throat, if it is spasmodic, let him swallow or gargle some substance that will quiet the nerves. Cold water is best—in summer ice-water; in some cases cooled fennel-tea is of service, but not sirup or any hot drink.
2. Skin-Ventilation.—This is of no less importance for warding off simple coughs, as well as for preventing the transition to consumption. With its millions of pores, the skin is on the one side the main sewer for carrying away superfluous fluids, and on the other it is the principal factor in cooling the body, in colds, in overheating, and in fevers. We will now consider skin-ventilation from this point of view under the two heads of—a. Elimination of fluids; b. Reduction of temperature:
a. Elimination of Fluids.—Like the external skin, the inner skin, the mucous membrane, exudes moisture, sweats. The mucous membranes, having no covering, are always moist. The mucous membrane of the lungs exhales watery vapor. This vapor comes from the serum of the blood, i. e., from that portion of the blood in which the corpuscles are suspended, and which, after the corpuscles have been filtered out, resembles water. The external skin under ordinary circumstances gives off about twice as much watery vapor. But, in proportion as this elimination is checked by defective skin-ventilation, the water of the blood (serum) has to be eliminated internally through the mucous membranes. Cooling, i. e., the sudden action of comparatively low temperature on the warm surface of the skin—for instance, when one sits in a draught of air—may check transpiration, and so cause the fluids to tend inward in such volume as to overtax the capacity of the mucous membrane of the lungs or the intestines, more rarely of the kidneys, the result being catarrh. But catarrh and coughing are two different things: as for "dry cough," it can never arise from cold. That it results from the inhalation of impure, vitiated air, the reader knows already. It is true that obstruction of the breathing apparatus, as "rattling" in infants, and hawking and hoarseness in grown persons, results from retention of serum; but that this obstruction is not connected with taking cold must be admitted, at least in all cases where the patient has not quit his chamber, or even his bed. As a matter of fact, no one takes a cough from a cold wall or from an open door. The conclusion to be drawn from all this is, that the coughs, hoarseness, and sore-throats, from which those persons suffer in winter who are ever on their guard against colds, are produced, not at all from cold, but from its contrary, overheating of the skin, whose evaporation is feebler the nearer the external temperature approaches that of the body. In this case there is a suppression of the action of the skin, but it is produced not by cold but by improper warming—or, as it is more properly called, by pampering. A hot bath, a cold pack, or a good, lively walk, will work wonders in "loosening" a hard cough. At first, it is true, the patient will cough harder than ever; but this effect is not due to the "cold wind," but to the fact that the accumulated mucus, once started, is expelled en masse. The oftener the patient resorts to the bath, to the pack, and to walking, the less frequent are the fits of coughing, and the freer and easier does he breathe.
b. Reduction of Temperature.—The body's temperature is normal when in the armpit it is about 95° Fahr. Food and drink are stimulants, and the skin is the radiating surface which gives off the surplus heat. If this elimination is not sufficiently active, the body becomes overheated, and this manifests itself by shivering. Overheating is the result when one eats and drinks much, at the same time parting with but little heat. The chill so produced is usually called "inward cold," but this is an error: it is overheating. That this is so is shown from the fact that when on the morning after a "social evening," during which we were overheated, we feel chilly, we have only to take a walk until perspiration is set up; we then feel warm again in spite of a considerable cooling off. And this, by-the-way, is the very best cure for the "Katzenjammer." We live in a climate where it is far easier to heat the body than to cool it. Hence one of my counsels against catching cold is, that the weakly, coughing reader of sedentary habits should not overheat himself with strengthening food, so called (meat, eggs, beer), else he might take an "inward cold," or even a fever.
But a person may contract a genuine (external) cold by unwise precaution against draughts—by neglecting the skin-ventilation. Under this head of unwise precaution we must class the habit of wrapping up the body when it is in a state of perspiration. On the contrary, coat and waistcoat must then be opened so that the shirt may dry quickly, and the underclothing, including the stockings, must be changed. But what does he do who on reaching the top of a mountain, with a wet shirt, buttons up his coat about him, puts on his overcoat, and over all his plaid? He applies a wet poultice at the wrong time.
Prof. Tyndall, in his "Glaciers of the Alps," tells us that, on being overheated during his rambles in the Alps, he at once took a bath, or poured water over his body. "Probatum est" say I, from personal' experience.
"Yes," some one will say, "you are inured to that sort of thing." To be sure I am! But what hinders you from being inured also? Just go out on the ice during this glorious winter weather, put on a pair of skates: you will return bright and fresh; you will throw open the windows, and be indignant at yourself for ever having shut yourself up in such a steaming atmosphere. The next day take a simple bath—not a Russian or a Turkish bath at all—and you will rid yourself of still another part of your phlegm.
3. Muscle-Ventilation.—Muscular fibre respires too, i. e., gives off carbonic acid and takes up oxygen. To this end it must diligently contract and then relax; in short, it must work, or, if the reader prefers the expression, it must practise gymnastics. Whether one takes his exercise at home or abroad, makes no difference. They whose lungs are affected would do well to climb hill-sides, for in such exercise the apices of the lungs are most called into play; in climbing the hands may rest on the hips. Muscle-exercise is not to be separated from lung-exercise. If bodily movement be neglected, deleterious fluids accumulate, which. I call "suffocation-blood" and "fatigue blood." The former contains carbonic acid, which makes one always drowsy, and causes one to go about his day's work with a feeling of lassitude no matter how long he has slept. This feeling of weariness grows steadily worse. "Fatigue-blood" accumulates in the muscles as a result of drinking wine and beer; even simply bending the body causes inconvenience; one feels quite unstrung and wants to recline on a lounge or a bed, whereas what he ought to do is to take a brisk run in the open air, or a little exercise in a gymnasium. In this way the skin is ventilated and the serum worked off.
My essay cannot exhaust all the topics named in its title: the most it can do is to awaken attention, free the reader from certain erroneous ideas, and lead him to believe that the simplest remedy is always the most natural and the best. If any one will put his faith in recipes, I would remind him of the history of the sale of indulgences. We look back with indignation to Tetzel's scandalous work, but how many people still think they can purchase health by gorging themselves with medicines! Consumptives form no small portion of this class. The treatment here recommended costs no money, but demands only will, self-conquest, and perseverance. The treatment is not so complicated as it may appear; it is simply a movement and an air cure, or, more briefly, an "attempering" cure, for effeminacy is the source of all colds, coughs, and consumption, and hardening is the only protection and remedy against them.—Der gemeinnützige Gesiundheits-Almanach.