SOME PRACTICAL HINTS DRAWN FROM AN OBSERVATION OF FIFTY YEARS CONCERNING THE MANAGEMENT AND

TREATMENT OF PULMONARY PHTHISIS.

BY A. B. PIERCE, M.D., Weldon, N. C.

For all practical purposes I divide pulmonary phthisis into tubercular and catarrhal consumption. And I remark that both may, under certain circumstances, be tubercular and catarrhal, and catarrhal may exist alone without the tubercular, but both more or less partake of the same symptoms before a fatal termination is reached.

As to whether the tubercular diathesis is dependent upon a specific germ, I shall not discuss, but give it as my opinion, from all the lights before me, that it is. It does not follow, however, that the other form, catarrhal, is dependent upon the same cause. That the catarrhal may exist without being dependent upon a specific germ, is equally clear to my mind for the following reasons: Previous to the changed condition of the colored race there was not one case in several thousand where consumption was ever developed in that race of people. So prevalent was this sentiment among the profession, that an eminent physician of Halifax county, in the forties, gave it as his opinion in court that he never knew a negro to die with consumption. Though this may have been an extreme opinion, yet, by almost universal consent, the profession was a unit on that subject, that it was the rarest occurrence for a negro to die with consumption of the lungs. But this, you may say, proves nothing, as the germs may have been there, but the circumstances were not favorable for their development. This would be begging the question, and as such the position would not be tenable.

With regard to the contagiousness of the disease, the evidence seems to favor the opinion, to a limited extent, especially the tubercular form. I am disposed to think, however, that too much stress is laid on the germ theory of the disease, and consequently inconvenience and erroneous views very often arise from the enforcing of such ideas.

The germ theory of disease is very often a cloak for ignorance and a want of observation and clinical experience.

If the germ theory be correct in all cases of consumption, it would seem natural to find out the germicide and apply the remedy, and thereby you have accomplished a great deal towards solving the problem of curing consumption. Common observation and common-sense teaches us that something else is to be done in order to ward off the a tacks of this dire disease. As I have already hinted, the negro race are peculiarly liable, since their changed condition, to what we term catarrhal consumption. I can accourt

*Read before the North Carolina Medical Society, May 15, 1895.

for it in no other way than their changed condition. Whereas they were well fed, well clothed and slept mostly with plenty of air to aërate the lungs, and took plenty of exercise, sleeping a good deal in the open air. They are now ill-fed, badly clothed and crowded in ill-ventilated houses to sleep, thus creating bad and insufficient nutrition and reducing the vital forces below the normal standard of health. In this way the system falls an easy prey to mal-nutrition and irregular habits.

Since this change in their condition I have seen whole families die out with this condition of system, when I could account for it in no other way. Malnutrition, produced from cold and hunger, I consider the cause of the whole trouble. I notice that females are more liable to this condition than males, due partly, I suppose, to that condition of system peculiar to the post-partum puerperal state.

Another reason why more females are attacked with this disease than males, is that the most of them have become perfectly thriftless and lazy, thus fostering a condition of system favorable to the development of such diseases. It is truly alarming to witness the number who are annually dying from what we term catarrhal consumption. I can see no remedy for this state of things but a return to industrious habits and a change of diet.

The remedy for these evils next demands our attention. As to the negro population, I see no remedy so long as their condition is unchanged. better portion of them, who are thrifty and industrious, may improve, but they are very few.

As to the treatment of pulmonary phthisis, I regard it as more preventive and palliative than anything else. At no time is the aphorism, "Throw physic to the dogs" more true and appropriate than when applied to the treatment of pulmonary phthisis. In the first place, I lay down some general rules: Studiously avoid everything that would disorder the digestion, such as cough mixtures and the like, and take nothing that would lower the vitality of the system or prevent the highest type and best grade of nutrition. Climate, it is true, has something to do with the treatment of the ailment, but in order to be effective it must be utilized in time, before the vital forces are lowered too far.

A high, dry atmosphere, combined with the inhalation of pine fumes, is doubtless conducive to the healthful state of the pulmonary vesicles. A seafaring life and horse-back exercise I regard as the most favorable conditions to promote the due performance of the functions of the lungs. But few, however, can avail themselves of these remedies, and we have to resort to other treatment in the majority of cases.

The use of the cold bath, with proper restrictions, I regard as one of the greatest preventives to the progress of the disease. I do not go as far as some in recommending ice-cloths to the chest. The shock to the heart in delicate persons is too great, and I regard it as a hazardous remedy; but

there is a way gradually to apply the cold bath to the chest and lungs which is not at all hazardous.

My plan is to wash the head and neck and whole chest daily with cold water, with the naked hand, which will enable you to apply the remedy without the shock to the system which results when it is applied in other ways. That system of exercise that expands the chest most and exposes the most breathing surface to the oxygen of the atmosphere, I regard as the most salutary and effective treatment for consumption of the lungs. Some cases of tubercular consumption of low vitality and feeble circulation may be benefited and life prolonged to an indefinite period by the moderate use of pure corn whiskey at each meal, and the only objection to the remedy is the danger of forming the habit of drinking and continuing the treatment too long and in too great quantities. It is not adapted, however, to all cases of tubercular consumption, and especially not to cases of catarrhal consump

There are certain occupations and professions that should never be engaged in by patients having weak lungs or consumptive tendencies. Engage in no employment where close confinement in-doors is imperative and where fine particles of dust or cinders of any description are a part of the breathing atomosphere. Avoid all occupations that do not afford plenty of fresh air and exercise. If you are a book-keeper, you must quit the desk

and seek the pure air of heaven. If you are a professor or teacher, you must quit the books and benches and revel amid nature's volumes and seats prepared in the forests and fields for God's creatures who are wearied and burdened with care.

To sum up the treatment of consumption in a few words, I would give the following directions:

1. Eat all the nutritious food that your stomach will digest.

2. Take all the out-door exercise your physical strength will admit of.

3. Breathe all the air your lung surface will admit without pain.

4. Employ your time in some agreeable occupation that will keep your mind from yourself and your disease.

Outside of a sea-faring life, I know of no employment more conducive to the health of a consumptive than the profession of a country doctor. A good horse, bridle and saddle and a pair of medical bags forms his armamentarium, and if he plies them well, he will be placed in the most favorable condition to enjoy health and a good conscience. Your humble servant is an exemplification of what he preaches Two of my uncles and a sister died of pulmonary consumption, and until I was 35 or 40 years of age I only weighed from 125 to 130 pounds, threatenel all the time with pulmonary trouble; but, adopting the treatmeat I recommend, I weighed, before I was 50, 170 pounds, and now I have passed my three-score years and ten, and am still practicing medicine in the country--a country doctor.

GOOD DRINKING-WATER VS. MALARIA-TWELVE MONTH'S EXPERIENCE WITH MALARIA ON ROANOKE RIVER.

BY GEORGE H. WEST, M.D., Weldon, N. C.

This is a subject pregnant with interest to the general public as well as to the medical profession. It has been the generally accepted opinion of the profession for years, and I may say until 1886, that the poison of malaria was gaseous in character. Since that time a complete revolution has taken place, by the aid of the microscope, through the labor of Laveran and numerous other investigators, who have corroborated his testimony; and from these scientific investgations, it is generally conceded that "malaria is due to the introduction of plasmodium malaria into the system," and to prove that this poison is taken into the system through the medium of drinking-water will be the object of the following remarks I shall offer for your consideration.

From the remotest antiquity swamp-waters and others of a similar character have been regarded as unwholesome and productive of febrile diseases; but since the time of Lancisï the theory of a malarial exhalation from a rich soil absorbed into the system from the air, has been accepted by the profession as explanatory of all cases which occur, and the possibility of the transmission of the poison or disease-essence by water, because forgotten. Vestiges of the old doctrine remained, however, in all malarious countries, not so much in the professional mind and literature as in the opinions of the people. The natives of malarial sections very generally continued to regard an impure water as the cause of paroxysmal fevers, and medical men from time to time suggested the possibility of the transmission of such diseases by the water supply or recorded instances where the supply was conceived to be connected with the appearance of a localized epidemic.

I shall offer only my own experience and observation during my twelve months residence as physician to the State Farms on Roanoke river. When I assumed control of the medical supervision of the convicts, May 9th, 1894, I found malarial diseases quite prevalent, in fact, almost to the exclusion of all other diseases. On Halifax Farm, situated three miles from Weldon, I found sixteen cases of intermittent fever in the wards of the male and female hospitals. On Northland Farm, two and a half miles from Halifax, directly on Roanoke river, I found eleven cases of intermittent fever, and from examination of case-book of hospitals on both farms I found malarial trouble prevailed during the months of January, February, March and April. This state of affairs still continued until I began to investigate the source of the water supply. From January 1st until August 31st there was a force of convicts working on the dikes of Roanoke river, on Northampton Farm, directly

*Read before the North Carolina Medical Society, May 15, 1895

opposite the town of Halifax, using spring water, and in the month of June (the force averaging 70 men) there were thirty-nine cases of intermittent and one of remittent fever. From the 1st to the 31st of August I had the drinking water carried from the quarters, two miles distant, in barrels, and strange to relate, not a single case of malarial trouble occurred. After this time, the force having completed the dike, were put to work on the farm, using spring water on different parts of the plantation, and, as the result, intermittent fever again manifested itself.

On several places on this farm they have driven pumps, and when I could get the overseers to get their water supply from them, which necessitated a little more trouble and distance to carry, the change was very gratifying and the sickness amounted to almost nothing.

On Halifax farm, from January 1st until May 1st, 1894, there were fiftyone cases of intermittent fever; from January 1st to May 1st, 1895, five cases. This result I attribute to water used from driven pumps.

On Northampton farm, from January 1st until May 1st, 1894, there were one hundred and twenty-one cases of intermittent fever; from January 1st to May 1st, 1895, thirty-two cases. Prior to May, 1894, there were several cases of hemorrhagic malarial fever, or, as the natives term it, "yellow chills," among employees and convicts on Northampton farm, and one last August, which proved fatal, on an adjoining farm. I did not see the case (not doing

any private practice), but I learned the water supply was derived from springs and surface wells.

On the 1st of June, 1894, the Roanoke Rapids Power Company hired fiftyfive convicts from the Penitentiary authorities to do some excavating-digging a bulkhead to convey the water from the canal to the river, furnishing the water power for two large mills that are now in course of construction. Unfortunately, the camp was located in a very unhealthy situation between two canals and a low, marshy bottom on the east, subject to overflow from Roanoke river. I will say here that I had nothing to do with the location of this camp, and after I was assigned to the medical care of the same I protested against the location, as figures will show.

For the first month there were thirty-one cases of intermittent fever, eleven cases of dysentery and twenty of diarrhoea. I was fully aware that in organizing a new camp, with men fresh from the Penitentiary, the greater portion not accustomed to work, being sneak-thieves and loafers around the towns, there would be more or less sickness until they became accustomed to the work, but I was not prepared to find this amount, and I began to think the trouble must be due to the water. After investigation, I found they were using water from a spring and an open shallow well. This I ordered stopped, with a very grati.ying decrease in the amount of sickness for July.

Since then the health of the camp has steadily improved and I seldom have intermittent fever to contend with. I am not a prophet nor the son of a prophet, but I predict, and that in the near future, the malarial problem will be solved simply by the use of good drinking-water.