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DUSTY AIR AND ILL HEALTH 
 
"Having long been a student, I thought myself qualified 
 in time to become an author .... 
 
 "At last I began to write, and as I finished any section of 
 my book, read it to such of my friends as were most skilled in 
 the matter which it treated. None of them were satisfied ; 
 one disliked the disposition of the parts, another the colours 
 of the style; one advised me to enlarge, another to abridge. 
 
 1 resolved to take my own way and write on, for 
 
 by consultation I only perplexed my thoughts and retarded 
 my work .... 
 
 "At last there came a grave man, who desired to see the 
 work, and without opening it told me, that a book of that size 
 'would never do.' " 
 
 SAMUEL JOHNSON. 
 
DUSTY AIR 
 
 AND 
 
 ILL HEALTH 
 
 A STUDY OF 
 PREVALENT ILL HEALTH AND CAUSES 
 
 BY 
 
 ROBERT HESSLER, A. M., M. D. 
 
 PKINTED PRIVATELY 
 1912 
 
Copyright 1912 
 
 by 
 Robert Hcssler 
 
 B. IURFOR0 PRIN1 
 INDIANAPOLIS 
 
PREFACE 
 
 111 health is a topic that concerns all of us. If we do not have 
 ill health ourselves there a,re sure to be relatives or friends to give 
 us concern. In order to suffer one need not be sick. 
 
 An observant patient told me there are two classes of people 
 whom one can always interest. First, those who have saved a little 
 money and want to know how to invest it safely so it will bring in 
 some returns. Second, those who have not the best of health and 
 Avant to know how to better it. These two classes will exist as long 
 as human society lasts. 
 
 It is generally admitted that ill health, and particularly chronic 
 ill health, is one of the great causes of misery and of poverty. 
 
 We should try to discriminate between ill health and disease. 
 Few men living under unsanitary surroundings, as found in cities 
 and towns, or who occasionally come in contact with them, are 
 wholly free from symptoms of ill health. As a matter of fact, ill 
 health (that is symptoms) affects many of us constantly. Well- 
 defined disease on the other hand occurs only at long intervals, 
 indeed may not appear until near the close of life. Moreover 
 well-defined specific diseases are as a rule readily diagnosed by 
 the skilled physician, while in the case of many common ills diag- 
 noses vary greatly. An old chronic is apt to get all sorts of diag- 
 noses, including that of imaginary ill. 
 
 To what extent shall we ignore minor ills or symptoms? To 
 what extent shall we heed them and indeed study them and find 
 out the reason or cause? (If the "old chronic" relies solely on 
 the medical profession for relief he is apt to be disappointed — he 
 must study himself.) 
 
 The manuscript of this volume has been discussed with a num- 
 ber of people, especially with "dust victims," with people who 
 react to dusty air, and with people who have had much experience 
 
 (5) 
 
O DUSTY AIR AND ILL HEALTH. 
 
 with ill health. .Many topics here briefly touched upon have been 
 discussed at length. 
 
 This is not a "family doctor book," nor is it a "complete guide 
 to health," because certain kinds of cases only are considered and 
 a certain factor is emphasized. Properly considered this is a mon- 
 ograph on dust influences. 
 
 A physician meets all sorts of patients, all sorts of dust victims. 
 For some a short explanation suffices, others require details and 
 repetitions. A book like this may be compared to a newspaper: 
 it appeals to a variety of readers. Some things are read by head- 
 lines, entire pages may be skipped. 
 
 This volume is not written for the practitioner of medicine : he 
 wants greater details, he wants detailed case reports and facts 
 rather than explanations and discussions. Nor is it written for 
 those who want positive or dogmatic statements; on the contrary 
 the aim is to show that much is still to be learned and that the 
 general reader can assist in solving some of the problems relating 
 to ill health. 
 
 The primary ideas underlying this volume are based on observa- 
 tions on first entering medical college in the fall of 1889. The 
 author's first "Dust paper" w r as written in 1893. Since the sum- 
 mer of 1900 he has made a systematic study of dust influences and 
 has presented papers before medical and scientific societies. In the 
 preparation of this volume published papers have been freely 
 drawn upon. The case reports and discussions were selected from 
 a large original collection. 
 
 It is said that facts are stupid things until brought into connec- 
 tion with some general law. Often a mass of facts are explained 
 by some hypothesis. A theory that satisfactorily explains many 
 facts and that enables us to predict becomes a working theory, of 
 value in our daily life. 
 
 This volume may be considered as a contribution to the dis- 
 cussion of the dust evil or the dust problem, especially in relation 
 to ill health. Dust is a neglected factor in ill health. 
 
 March, 1912. 
 
CONTENTS 
 
 PREFACE. 
 
 I. Introductory Chapter 11 
 
 The kind of people the physician meets. Chronics. The exceptional 
 tenth case. Ill health as a biological problem. The simple vs. the complex. 
 Farmers and the simple life. Farmers and change of environment. A 
 simple Case Report. New-fangled diseases. Family physician vs. special- 
 ist. Our "Triad of National Diseases" — catarrh, dyspepsia, and nervous 
 prostration. "Dust Victims." "It's malaria" as an explanation of ill 
 health. "It's what I eat" as an explanation. Open air vs. indoor air life. 
 Remarks on food and drink, alcohol, clothing. "Overwork" as an explana- 
 tion. School children. Need of a National Department of Health. Dis- 
 eases and their causes. Delicate school children vs. robust teachers. "It's 
 the noise" as an explanation of ill health. Unhealthy towns and homes. 
 "The New Doctor in Town." People who move. Occupational influences. 
 Ancestry, rural and urban. Inheritance vs. environment. Family histories. 
 Symptoms as warnings. Adaptation to environment. Some simple expla- 
 nations of ill health. "It's the stomach," "It's dyspepsia," etc. "Threat- 
 ened with" as an explanation. Old chronics and the physician. Newspaper 
 medicine. Fashionable explanations : neurasthenia, uric acid, auto-intoxi- 
 cation. "Interesting cases." Physician and returns for efforts. Medicine 
 a? an evolution. Symptoms as reactions. Pathology of the living. Breath- 
 ing, drinking, eating. Perils. 
 
 II. Local Conditions and Changes in Time 45 
 
 (Mesology and Ecology.) 
 
 Topography. Climate. Natives. Early Immigrants. Early Settlers. 
 "Natives." Foreigners. Pests and Parasites. Diseases and their Causes. 
 Occupation vs. Ill Health and Disease. Occupations and Meeting Places. 
 Tropical Diseases. Introduced Weeds. Disease vs. Ill Health. Classifi- 
 cation of Diseases. Studying Diseases and 111 Health. Evolution of the 
 Physician (table). The Indian Medicine Man. Early Army Surgeons. 
 Medical Schools. To Doctor and Doctoring. Medical Inspection and 
 Health Supervision. 
 
 (7) 
 
8 DUSTY AIR AND ILL HEALTH. 
 
 III. Dust and Dust Victims 62 
 
 The Evolution of Dust (table). Country Road Dust. Dust From 
 Paved" streets. Class Dust. Pollen Dust. Spit Dust. Smoke and Smog. 
 Indoor Dust. Dust of Dwellings. Featherbed Dust. Sterilized and Un- 
 sterilized Dust. "Beneficent Dust." 
 
 Spitting or Expectoration. Spitting Black. "Do Not Spit." Sidewalk 
 Spitting. Coniosis. Crowd Poison. Dust Poison. 
 
 Dust Victims. Classification of Dust Victims: Simple Type; Rheu- 
 matic Type; Digestive Tract Type; Nervous Type; Cardie- Vascular Type, 
 Classifying Patients. Classifying the People. Patients or Fellow-students. 
 Missionary Spirit. A Personal Mention. 
 
 A few Case Reports or Case Histories of Simple Dust Victims. Young 
 Farmer. Middle-aged Housewife in City. A Young Woman in City. 
 The Seasonal Factor. Darkest Before Dawn. 
 
 IV. Colds and Catarrh 103 
 
 "Everybody has Catarrh." "American Catarrh." Colds and Catarrh 
 as Synonyms. "Triad of American Diseases" — Catarrh, Dyspepsia, and 
 Nervous Prostration. 
 
 Kinds of Colds. Classifying Colds: Attic Colds. Automobile Colds. 
 Book Dust Colds. Carpet Colds. Church Colds. Court House Colds. 
 Dance Hall Colds. House-cleaning Colds. Railway Colds. School Colds. 
 Vacuum Cleaner Colds. X-Colds. Under What Conditions Does One 
 Catch Colds? Overheated Rooms. Varying Manifestations of Colds. 
 
 Family Histories. Three Histories. 
 
 Dust Infection and Age. Time Lost on Account of 111 Health. 
 
 Climate. Climatic. Weather, and Dusty Air Influences. Dust-free 
 Air. Change in Climate. 
 
 Localized Pain. Backache. Rheumatic Cases. A Mention of Several 
 Case Reports. 
 
 Health in the Country and in the City. A Rheumatic Case. The Air 
 of Places. 
 
 V. Dyspepsia 151 
 
 Early Misunderstood Cases. Cases in which the Dust Factor was 
 Recognized. Some Simple Cases. 
 
 Constipation. Auto-intoxication. Biliousness. Differential Diagnosis. 
 Ruling Out. Cancer of the Stomach and Cases. 
 
 Membranous Catarrh of the Intestines. A Series of Case Reports. 
 Discussion of Symptoms of 111 Health with Patients. List of Symptoms 
 Case Report and Medical Ethics. 
 
CONTENTS. 9 
 
 Weeding Out on Account of 111 Health and Disease. Several Case 
 Reports. 
 
 Weeding Out and Schools. Several Case Reports. Who makes the 
 best family physician? 
 
 VI. Nervous Prostration 212 
 
 Misunderstood Patients. "The short and simple annals of the poor." 
 Case Reports. Clerks in Stores. Patent Medicines. Routine Attention. 
 High or Low Blood Pressure. Unsanitary Municipal Conditions. The 
 Advertising Doctor. The Nostrum Evil. Newspaper Medicine. 
 
 Case Report. Clergyman. Patent Medicines and Adverti'sements. 
 Cure vs. Relief. Newspapers and Patent Medicine Advertisements. Clean- 
 ing up as a Remedy. Women and the Politicians. 
 
 Case Report. Middle-aged Housewife, neither sick nor well. Bug- 
 bears. Disease, 111 Health, Symptoms. Should a patient be told the truth? 
 Experimenting and being Experimented upon. Fears and Phobias. Dust 
 Fear. 
 
 Hospital Physicians and Physicians in Private Practice. Medical 
 Supervision, Health Supervision. "Old Age Deferred." 
 
 VII. Cardio- Vascular Affections or Heart and Kidney 
 
 Cases 258 
 
 High and Low Blood Pressures. Subjective and Objective Symptoms. 
 Best of Health and Life Insurance. Prediction, the Test of Science. 
 Chronic Diseases and Occupation. High Pressure Life. The Strenuous 
 Life. 
 
 Cardio-Vascular Case. Middle-aged Housewife. Discussions with 
 Patients. Living in Isolation. To what extent shall one advise a life of 
 seclusion? Going to Church or Not. "The Door-keeper in the House of 
 the Lord." Advising a Patient to Move. Keeping a Daily Record. Mental 
 Influences. Neglecting Symptoms. Euthanasia. Discussion of Symptoms. 
 Symptoms of 111 Health vs. Symptoms of Disease. Symptoms of 111 Health 
 as Warnings from Nature. List of Symptoms. Diseases vs. Affections, vs. 
 Symptoms. 
 
 VIII. Specific Diseases 289 
 
 Analogies Between Diseases and Plants. Native vs. Introduced Dis- 
 eases. Milk-Sickness. Malaria. Yellow Fever. Cholera. Leprosy. 
 Smallpox. Measles Scarlet Fever. Influenza. The Plague. Tubercu- 
 losis. Diphtheria. Typhoid Fever. Pneumonia. Syphilis and Gonorrhea. 
 
 Weeds and Diseases. Collecting Specimens, Collecting Case Reports. 
 
10 DUSTY AIR AND ILL HEALTH. 
 
 IX. Biography and III Health 302 
 
 Collecting Letters and Autobiographies. Autobiographic Case Report. 
 Physical vs. Mental Life. Case Reports at Second-hand. Case Reports 
 from Newspapers or Journals. 
 
 Biography and the Influence of Environment. Indiana Biographies: 
 Governor O. P. Morton. New England Biographies: Louisa M. Alcott. 
 J. G. Whittler. W. H. Prescott English Biographies: Mrs. E. B. Brown- 
 ing. Thomas Carlyle. George Eliot. Charles Darwin. Three Visiting 
 Englishmen : Charles Dickens, Thomas H. Huxley, Herbert Spencer. 
 
 X. Perils and a Remedy 328 
 
 APPENDIX. 
 
 Photographs of Sidewalk Conditions 338 
 
 Index 341 
 
I. 
 
 INTRODUCTORY. 
 
 In the course of time a physician meets all sorts of people hav- 
 ing all sorts of ill health (not to speak of well-defined diseases) 
 Math all sorts of explanations, both for their own ills and for those 
 of others and of whole communities. It is the exceptional indi- 
 vidual who does not have some sort of explanation. Those with 
 much ill health as a rule give attention to matters with which the 
 well or healthy are not at all concerned. 
 
 From what sources do the people learn about common ills and 
 common ill health and causes? Manifestly from observations, from 
 discussions, from readings, and from consultations and perhaps 
 from discussions with physicians. 
 
 The interest a man takes in a subject often depends on how 
 intimately it concerns his welfare; he may neglect mild symptoms 
 but he must heed severe ones. 
 
 Among individuals in chronic ill health are those who neglect 
 symptoms ; they are few in contrast to the many who are inquisitive, 
 some so much so that they become an annoyance to the physician 
 who is not interested in ordinary ill health, only in well-defined 
 diseases. As a rule chronics make the rounds of the doctors and 
 perhaps try all modes of treatment; some try all the patent medi- 
 cines that appear, even faith or mind cures. Some believe in try- 
 ing all things and holding on to that which is good. Some will 
 try a thing only if it appeals to their reason. I know old chronics 
 who never took patent medicines; one may say such persons are 
 exceptional. 
 
 Need it be added that there are all sorts of people with all sorts 
 of wants and needs and that there are all sorts of "medicine men" 
 to supply wants? Some people expect medicine only, they want 
 no explanations. Some want large doses, other small doses. Some 
 want a maximum of explanation with a minimum of medicine. 
 Exceptionally a man may apply for advice only, not for medicine 
 
 (id 
 
12 DUSTY AIR AND ILL HEALTH. 
 
 — such exceptional cases have become more and more common in 
 the last few years. 
 
 Now in the very beginning it should be kept in mind that there 
 are exceptions to every general statement. One can scarcely make 
 a general remark without adding some qualifying words or clause, 
 and one can scarcely make any remark but some one cites an ex- 
 ceptional case. Therefore it should be understood that in this 
 volume I have in mind the nine-tenths that come within the scope 
 of general remarks, neglecting the tenth as perhaps wholly excep- 
 tional. Out of ten cases, or patients, nine may have traits, com- 
 plaints, wants and desires in common, the tenth may differ radi- 
 cally. Out of ten people who complain of ill health, perhaps only 
 one goes to a scientific physician. Out of those who do apply to 
 physicians, likely nine-tenths complain of common ills; it is the 
 tenth, the exceptional case, that may have a specific disease de- 
 manding specific or special treatment. Of ten physicians, nine will 
 likely have certain traits or characteristics in common, people know 
 what to expect ; the tenth may be exceptional, he may be an unusu- 
 ally skilled physician, or, on the other hand, he may be a charlatan 
 of the worst kind. 
 
 Somewhat similar remarks may be made regarding our news- 
 papers: they get all sorts of criticism. And yet, after all, nine 
 may be little criticised ; it is the tenth that comes in for any amount 
 of denunciation on one side or praise on the other. Again, we 
 constantly speak about the weather, but no one speaks of the ordi- 
 nary or average weather ; we only talk about the extremes of heat 
 or cold, of dry or wet; ordinary weather is scarcely considered, 
 and yet extreme variations are exceptional. 
 
 In this work my intention is to speak of people in ill health; 
 moreover of the "general run of cases," not of the exceptional 
 case. The kinds of cases to be dealt with are what may be called 
 "old chronics," people who have been complaining for some time, 
 who have perhaps made the rounds of the doctors, in short have 
 tried all sorts of remedies and modes of treatment. In other words, 
 I am writing about people who complain of ill health for people 
 who have more or less ill health. Perhaps nine-tenths may be 
 
INTRODUCTORY. 13 
 
 benefited by my advice ; the tenth, the exceptional case, may neither 
 be interested nor does my advice apply. 
 
 In order that a physician may give good advice he must study 
 his patient, his family history, and the surroundings under which 
 he lives. Good advice implies investigation. If both patient and 
 physician work together they may arrive at some definite conclu- 
 sions. If the doctor assumes that he knows it all and his patients 
 know nothing there is not apt to be a lasting relationship of pa- 
 tient and physician. If a man doubts the abilities and knowledge 
 of a physician no relationship may be established. On the other 
 hand, if a man is too ignorant to make long explanations worth 
 while, the physician may not accept him at all or else dismiss him 
 at the first opportunity. "With ignorance even the gods strive in 
 vain. There may be exceptions to all these statements. 
 
 The problem of ill health is really a biological problem, to be 
 solved like any other problem, by patient study and observation! 
 
 Discussion is necessary to arrive at the truth, but discussions 
 should be of essentials. The physician may assume certain things 
 to be of prime importance, but his patient may be inclined to dwell 
 on unessential details. "Old experienced patients" soon learn to 
 make distinctions. 
 
 From my notes and "case reports" for the last twelve years, 
 I have laid aside a number for remarks on topics connected with 
 the subject of ill health, and particularly chronic ill health, as 
 opposed on the one hand to health and on the other to well-defined 
 or specific diseases. With some patients I had many and long 
 discussions; we tried to learn. I shall briefly refer to a few cases 
 and supposed causes. Needless to say in cases where notes extend 
 over a long series of years only brief abstracts can be given ; to do 
 some cases justice would require a volume for each. 
 
 In studying anything it is best to begin with the simple and 
 gradually trace it into the complex. The farmer leads a compara- 
 tively simple life and lives under a simple environment and causes 
 of ill health may perhaps be more readily traced. But the term 
 farmer is rather vague, there are all sorts of farmers. Similar 
 
14 DUSTY AIR AND ILL HEALTH. 
 
 remarks apply to the term country or city or "out West." What 
 do we mean by these terms? There are all sorts of farmers, good, 
 bad and indifferent. What do we understand by a "typical 
 farmer?" Manifestly the one who regularly attends farmer's in- 
 stitutes, who takes prizes at farm and poultry shows, is a different 
 individual from the mossback, hayseed or rube who comes to town 
 at short intervals to loaf on street corners and spit tobacco juice. 
 Only too often the latter is merely a tenant on a rundown farm, 
 with no inducement to look ahead and build up the soil. 
 
 I shall have frequent occasion to refer to farmers and unless 
 the contrary is mentioned it should be understood that I am refer- 
 ring to those of the better class. Needless to say I have had some 
 of the worst type as patients, often for only a short time because 
 there was little in common between us. Next to being a physician 
 I should like to be a farmer; although I have never lived on a 
 farm, I believe I should enjoy it. 
 
 A farmer of eighty years, one of the original "old settlers," 
 from an adjoining county, came to me complaining of an irritation 
 of the respiratory mucous membranes marked by more or less pro- 
 fuse secretions. He had always lived in the country, remote from 
 town life, until a year ago when he rented out his large farm and 
 removed to a small village. He now spent much time at the village 
 store on the proverbial cracker barrel. Soon he began to complain. 
 He consulted first one, then the other of the two village or country 
 doctors, but since neither helped him he came to the conclusion he 
 had some "new-fangled disease which the country doctors did not 
 understand. ? ' He concluded to consult a town doctor. On coming 
 to me he said, ' ' The country doctor is good enough for the common 
 ills and ailments, but it takes somebody who has studied more and 
 has had more experience to treat these new-fangled diseases that 
 are constantly coming in." The man had had little schooling and 
 had little book learning, but he was a shrewd observer. He thought 
 he had some new or unusual disease, possibly due to "change in 
 the climate." It turned out, however, that his affliction was due 
 to change of environment, of exchanging the air of an isolated 
 
INTRODUCTORY. 15 
 
 country home for that of a village, and particularly of the village 
 store where spitters congregate about the stove, especially on winter 
 days, and contaminate the air. Instead of having a rare disease, 
 he had become afflicted with a very ordinary malady, nothing more 
 than common catarrh. 
 
 Now a physician can make an offhand diagnosis, merely saying, 
 You have catarrh, and give a prescription or dispense a medicine, 
 or give more or less general advice regarding treatment, perhaps 
 with some advice regarding prevention, but unless the patient 
 clearly understands the relationship of cause and effect he may be 
 wholly unable to guard himself. Quite probably in time he tries 
 other physicians and also "catarrh cures" advertised in the news- 
 papers or recommended by druggists. Some people will save and 
 starve in order to buy medicines "guaranteed to cure," nostrums 
 which a physician knows can not cure ; they meet others who have 
 been doing the same thing, who have made the rounds, and in time 
 they come to believe that catarrh is incurable, and, since it is so 
 prevalent, they are inclined to believe that "everybody has ca- 
 tarrh. ' ' 
 
 To what extent do physicians explain the why and the wherefore 
 and the nature of catarrh and how it passes or travels from one to 
 another (by means of dried catarrhal spittle inhaled as dust) , and 
 that it should be looked upon as a preventable reaction rather than 
 as an incurable disease? 
 
 My patient spoke of "new-fangled disease," meaning some 
 newly arrived or recently discovered disease. To some extent a 
 similar explanation dwells in the minds of some physicians — in- 
 stead of looking for common causes and for common affections 
 they are always looking for uncommon ones and for rare diseases, 
 reasoning that others overlooked them or else did not recognize 
 them. 
 
 The farmer also spoke of "changes in climate." "It's the 
 climate" is a common explanation of ill health (not to speak of 
 disease) that can not otherwise be accounted for. But people for- 
 get that we really have two climates, a natural one out of doors, 
 an artificial one indoors. Many house-plants do not nourish in- 
 
16 DUSTY AIR AND TLL HEALTH. 
 
 doors, they merely winter over; on being put out in the spring 
 they thrive. Many people are in the same position. Moreover the 
 natural climate may itself be modified, as in the large city with 
 an absence of trees and grass, with dense smog clouds obscuring 
 the sun. 
 
 This old farmer was shrewd. When I pointed out what had 
 occurred, he promptly changed his mode of life, particularly by 
 avoiding "bad air," and the reaction ceased, in other words, his 
 "disease" disappeared. 
 
 We had many discussions regarding early Indiana conditions, 
 he was one of the pioneers. I have made these discussions the 
 basis for a short chapter on Changes in our State, changes that 
 are more or less common to other States. The subject of climate 
 will also be briefly considered later. 
 
 The farmer's ideas that "city doctors know more" referred to 
 a very debatable topic. A doctor may cover the whole field of 
 medicine, treat everybody that applies, or he may devote himself 
 to a very small field and know that field thoroughly. No man can 
 know it all ; he may have a general knowledge, more or less diffuse, 
 or special knowledge applicable to comparatively few cases. From 
 whom will the mass of people, the nine-tenths, complaining of 
 common ills get the best service? 
 
 Specialists of necessity are found only in cities where they find 
 enough cases to keep them busy and where people go to find them. 
 A country specialist "can not be a good one," people reason, or 
 he would go to the large city. In general this is true, but there 
 are exceptions. 
 
 In the city the "family physician" has largely disappeared, 
 each member of a family may have a different physician or con- 
 sult different ones on different occasions or for different ailments. 
 In the country the family doctor still flourishes. In the case of 
 common ills he is the bast man to consult. But naturally enough 
 if a man finds his complaints persisting and if he gets no satisfac- 
 tory explanation why he is still uncured and is perhaps incurable 
 (although his complaints may be wholly preventable), he may 
 feel like consulting the city doctor who is supposed to know more 
 
INTRODUCTORY. 17 
 
 — just as some people go to the great German specialists who are 
 also supposed to know more. In the case of our common ills, espe- 
 cially our "Triad of National Diseases" (catarrh, dyspepsia, and 
 nervous prostration) we may question whether foreigners know 
 more than our own physicians. The best physician, like the best 
 naturalist, is the one who knows his own parish best. 
 
 Another farmer, a middle-aged man of unusual intelligence, 
 came to me saying he was told I had the reputation of trying to 
 find out the causes of ill health and disease. 1 He said he felt bad 
 every time he came to town or went into a crowd, he would feel 
 achy throughout the body, with more or less mental dulness or 
 headache, and an irritation of the throat, at times he would have 
 a decided cold. He had had various explanations from physicians 
 but none enabled him to prevent attacks. Could I explain the 
 nature of the attacks and give some advice on how to prevent them ? 
 
 I promptly recognized him as a "Dust Victim" and told him 
 I knew a lot about such eases, for I myself reacted when air con- 
 ditions were very bad. He listened closely to what I told him 
 about my own experiences and to my explanations; said he had 
 long suspected dust as the cause of his attacks, but he now saw 
 that he did not distinguish between kinds. I explained what "in- 
 fected dust" meant. Kinds of Dust will be considered later. 
 
 I assumed he would return "for further instruction" and that 
 I would get more data, but he did not return. The simple expla- 
 nation was all he needed ; I learned this a few years later through 
 a common friend. 
 
 Another patient, a farmer's wife living near the first men- 
 tioned farmer, came to me with symptoms of ill health which were 
 supposed to be due to malaria. She had been dosed with quinine, 
 at times to such an extent that she became weak and anemic and 
 had to "rest up" — in order to take more quinine. She had been 
 given various explanations for her continued ill health, "malaria" 
 
 1 As a matter of fact I had the reputation of being a pathologist; physicians often sent me obscure cases to 
 be worked out. 
 
 Since this volume is based mainly on personal experiences and observations and a first-hand study of people 
 in ill health, there of necessity is frequent occurrence of the pronoun I. 
 
 12 
 
18 DUSTY AIR AND ILL HEALTH. 
 
 was most frequent. She had also been told "It's grip." I was 
 able to point out to her that something else was at the bottom of 
 her symptoms and that what she needed was not quinine but out- 
 of-door air. When she lived up to my advice she soon found that 
 it was not malaria. 
 
 The belief that malaria is the cause of much of the common ill 
 health is an old one; if it is not malaria outright then it is "ma- 
 larial," "concealed malaria," "a touch of malaria," if not "mias- 
 matic." Real malaria (malarial fever) was formerly very common 
 in Indiana and any case of illness was at once supposed to be ma- 
 laria or due to malarial or miasmatic influences. The belief in 
 malaria as a cause of common ill health has largely disappeared 
 among medical men, but lives on among the people, fostered by 
 some patent medicine men. With no instructions how are the peo- 
 ple to know better? The belief will no doubt gradually die out 
 with the disappearance of people who lived when malaria was 
 widely prevalent. The term malaria literally means bad air; it 
 goes back to ancient days. 
 
 There is an old time belief that night air is injurious. This 
 belief goes back to the early days when people who went indoors 
 at sundown were less likely to be affected by malaria, because the 
 mosquito that transmits malaria flies and bites by night. Log 
 houses filled with more or less smoke from the open fireplace or 
 merely the odor of smoke, were not visited by mosquitoes. There 
 is still another factor, the smoking of tobacco. To smoke means 
 to drive away mosquitoes. What is more natural than that people 
 living under simple life conditions should smoke in the evening, 
 not only the men but also the women ? The plea that tobacco keeps 
 away disease and ill health might at one time have been made with 
 good reason, but it no longer holds. Malaria today is a rare dis- 
 ease. (I live in a locality once highly malarial, but the disease is 
 now rare; I have not seen a single case for nine years.) 
 
 When we read biographies of men who have had much ill health, 
 we find that at various times different explanations have been used 
 to a large extent. William Cullen Bryant mentions how the doc- 
 tors of his time explained all ill-defined eases by "It's malaria." 
 
INTRODUCTORY. 19 
 
 "It's malaria" was a common explanation in our State. It is 
 still used to some extent but is falling 1 into disuse, because real 
 malaria has almost disappeared. People are beginning to under- 
 stand that a certain kind of mosquito transmits the disease and 
 that before the mosquito can transmit it it must have bitten some- 
 body who has real malaria. Hence a suspected case of malaria 
 without any other cases of malaria about, or occurring in mid- 
 winter when there are no mosquitoes, leads to suspicion regarding 
 the correctness of the diagnosis. Moreover the careful physician 
 nowadays examines the blood of his patient and is able to make a 
 definite diagnosis, whether malaria is present or not, he no longer 
 guesses or even ventures a guess at the diagnosis, and he no longer 
 overdrugs his patient with quinine. 
 
 "It's grip" is still a common explanation especially when many 
 are attacked, as after a midwinter thaw. Since the appearance of 
 influenza in the winter of 1889-90, "It's the grip" has been fre- 
 quently heard. Grip is one of the synonyms for influenza. It has 
 largely taken the place of " It 's malaria. " As a matter of fact, real 
 grip is an epidemic disease that comes at intervals of years and at- 
 tacks practically everybody, killing many. What is now commonly 
 called ' ' grip ' ' may be said to be merely a severe form of ' ' common 
 cold." Is the term "grip" more terrifying than "cold?" Are 
 the doctor's patients more likely to follow his advice if told they 
 have the grip? 
 
 "It's what I eat" is a frequent explanation. People accuse 
 this and that article of food and avoid it. A physician occasion- 
 ally meets people who live on toast and weak tea. Food may of 
 course be a cause or factor of ill health and continued ill health 
 but more often it is less a question of what is eaten than of con- 
 ditions under which food is eaten. Take, for instance, pie ; whether 
 one eats it at home fresh from the oven or at a restaurant where 
 it has been exposed to the air and flies and dust for hours may 
 make a marked difference in after-effects. Similarly with foods 
 that have been exposed before stores to the dust of side-walks. 
 Sanitarians fully recognize the importance of clean food. Today 
 there are all sorts of laws and ordinances, the latest prohibiting 
 
20 DUSTY AIR AND ILL HEALTH. 
 
 exposure of food to street dust. Such restrictions do not apply to 
 the farmer living in isolation ; he gets clean or pure food at first 
 hand. 
 
 For countless ages man, like other animals, has been thriving 
 on natural foods. Some animals thrive only on certain foods ; they 
 become extinct with a disappearance of the supply. It is only 
 comparatively recent that the process of adaptation to artificial 
 foods has begun. Manufacturers make all sorts of foods to sell, 
 some is so injurious that it must be prohibited. Improper food is 
 especially severe on infants and those whose digestion is impaired. 
 Of the average person of our country it may be said that he sub- 
 sists on plain substantial and nutritious food and that in the ab- 
 sence of other injurious factors he thrives on it. The underfed 
 people of many countries readily fall a prey to ravaging diseases. 
 With us starvation is practically unknown but cases do occur now 
 and then, mainly in the slums of large cities. The isolated trav- 
 eller on the desert dying from starvation belongs to an entirely 
 different category. 
 
 Primitive man was an open air animal, seeking shelter only 
 at night and during cold weather. Under a nomadic mode of life 
 there was no accumulation of filth. Two thousand years ago the 
 people of northern Europe were still open air people. In many 
 countries today the urban population exceeds the rural, indeed, 
 many rural people are massed in villages, more or less constantly 
 in contact with each other, giving diseases an opportunity to go 
 from one to another, just as in large cities. People who may be 
 considered truly rural are becoming rare. The modern fiat dweller 
 is an extreme development of the indoor life habit, but such a mode 
 of life is very destructive to the race; it virtually means race 
 suicide. 
 
 Old time cities were very unsanitary, there was a constant weed- 
 ing out of humanity, especially where there was impure water and 
 bad food. But old time cities were not overhung with smoke and 
 dust clouds like our modern industrial cities, consequently there 
 was no weeding out on account of such air conditions. 
 
 In a general way it may be said that a given number of hours 
 
INTRODUCTORY. 
 
 21 
 
 out of doors offsets life under indoor air conditions. The time 
 necessary may vary greatly in different individuals. Some can 
 maintain health with a minimum of outdoor air; others are so sus- 
 ceptible to indoor air that they can not live in a city at all. 
 
 People of course vary in their tolerance of bad food. Among 
 slum children who live out of garbage pails the mortality rate is 
 high, but a certain number will reach maturity. Some foods we 
 know are very indigestible and yet some persons are able to thrive 
 on them. For instance, we hear it said that men can thrive on 
 sauerkraut and limburger cheese, rye bread and beer. Usually we 
 say they have • ' strong stomachs. ' ' But what of those who live on 
 fried potatoes, pancakes, soda biscuits and steak fried in grease? 
 
 When our State was first settled game was abundant. The only 
 kitchen utensil some of the early settlers had was a skillet, even 
 today the prospector going into the wilderness has his skillet. It 
 would seem that people who live under good air conditions can 
 thrive on foods fried in grease to an extent that people massed in 
 unsanitary cities can not. Food fads of all kinds thrive in unsan- 
 itary cities. City physicians generally advise against the use of 
 fried food. It is perhaps needless to add that people who thrive 
 on fried food are not apt to consult a physician at all. 
 
 The early settlers took advantage of the native food supplies, 
 game of all kind and wild fruits. They had a good supply of the 
 latter and some were looked upon as delicacies. My old patient, 
 mentioned a few pages back, spoke of papaws, how they were eaten 
 freely, and yet some people today think them rank poison. In dis- 
 cussing the question we came to the conclusion that people leading 
 the simple open air life can tolerate many things that city stomachs 
 can not. But perhaps the greatest factor in giving the papaw an 
 evil reputation is the fact that city people get them after the fruit 
 has passed through many hands and is black, soft, partly decayed, 
 in fact must be regarded as a culture medium for all sorts of micro- 
 organisms. No wonder their use produces bad effects. I have met 
 people who could not eat a papaw in the city but could eat them 
 without evil effects direct from the tree. One may say similar 
 arguments apply in the case of milk. There are undoubtedly in- 
 
22 DUSTY AIR AND ILL HEALTH. 
 
 dividuals with whom milk disagrees but they are rare, provided 
 they use milk direct from a healthy cow. Milk bought at the corner 
 grocery may be loaded with micro-organisms of all kinds; no 
 wonder it is injurious. 
 
 A young farmer came to me complaining greatly, expressing 
 his belief that "It's what I eat." Later on I shall tell how we 
 found out differently. 
 
 Drinking water is often accused of being the cause of more or 
 less continued ill health. Water supplies vary greatly. A spring 
 on an isolated farm may supply pure or clean water while one in 
 or near a town may be highly contaminated. Similarly with wells ; 
 well water may be clear and sparkling yet highly polluted. Dis- 
 ease germs are very minute and water may be full of tliem with- 
 out showing any turbidity. It is the invisible dangers we have to 
 guard against. In cities that have muddy water in the mains, 
 people often or usually resort to clear well water. City people 
 with water at times of doubtful purity are of course familiar with 
 the cry of "Boil the water," especially when an epidemic threatens, 
 particularly typhoid fever. The prevalence of typhoid fever in a 
 city is regarded as a general index of its salubrity. Well-managed 
 cities have practically no typhoid fever. But there may be much 
 ill health erroneously ascribed to water. Bad water is undoubtedly 
 an important source of disease, as typhoid fever and diarrheal 
 affections, but to what extent general ill health is dependent upon 
 it is a problem, often it is difficult to rule out complicating factors. 
 
 In a general way it may be said that people who pay no atten- 
 tion to the purity of their drinking water are equally careless in 
 other respects. Often the physician finds it difficult to discover 
 the actual cause of ill health, he may not even attempt to rule out 
 one thing after another. A man who lives under unsanitary sur- 
 roundings, or comes in contact with the sick and diseased, who 
 drinks bad water and eats food of doubtful purity, and breathes 
 contaminated air, such a man is a problem to a physician. On the 
 other hand the student of ill health may more or less readily trace 
 causes among people living in isolation, as the farmers just men- 
 
INTRODUCTORY. 23 
 
 tioned as well as city people who are cleanly, who use clean water 
 and clean food and who will give attention to the matter of good 
 or bad air. The moment a city gets a clean water supply the gen- 
 eral standard of cleanliness is raised and ill health and disease are 
 reduced. 
 
 ''Abe Martin" speaks of "pump towns," meaning that a town 
 either has no municipal supply or that the supply is of such a 
 character that pumps are still in use, hydrant water may be too 
 dirty even to bathe in. Some people when they come to a doctor 
 expect a lot of sympathy besides a valuable prescription, but like 
 the Pharisee of old, instead of high sounding phrases they may be 
 told to wash and be clean. Clean water and clean streets go to- 
 gether. Some cities, Berlin for instance, scrub their streets. In 
 some small cities for a woman even to sweep the sidewalk in front 
 of her house is regarded as an oddity. 
 
 One of my early patients ascribed all her ills to the matter of 
 clothing. She was either dressed too little or too much. She could 
 not tell when to wear wool or cotton. Every little cold she caught 
 was ascribed either to getting chilled or getting overheated. I was 
 able finally to make it clear to her that the matter of clothing was 
 a secondary one, that under good air conditions all that was neces- 
 sary was to be comfortably dressed. 
 
 Many of us can remember how red flannel around the throat 
 was supposed to be both curative and preventive of colds and sore 
 throat. Indeed red flannel was reputed to ward off illness, espe- 
 cially that due to cold, and underclothing was made of it. Today 
 red flannel has practically disappeared but we still hear and read 
 regarding the value of different fibers, especially cotton and wool. 
 The question is sometimes asked, What is the "healthiest color" 
 to wear? "White, I promptly reply. "But white shows dirt." 
 Exactly, that means to keep clean. Men are constantly making 
 fun of women's dresses 1 but from a sanitary standpoint they are 
 
 1 From the standpoint of the physician the present style of short and narrow skirts is a great 
 improvement over the former full and trailing skirt that collected any amount of filth. Incidentally, 
 the nostrum maker who advertises obesity cures has reaped a harvest from fleshy women who only 
 too often suffer in health in attempting to reduce their weight. Although fashions go to extremes, 
 there is no need for an individual to resort to extreme measures in order to be fashionable. 
 
24 DUSTY AIR AND ILL HEALTH. 
 
 ahead because their dresses are frequently laundered while men's 
 clothing (we need only think of the old greasy tramp) is worn 
 week after week and month after month, and if there is anything 
 that accumulates microbes it certainly is an old suit. 
 
 The Chinese wear clothing that, can be washed ; they are more 
 cleanly than we in the matter of dress. The Japanese in their last 
 war with Russia appreciated the importance of clean clothing free 
 from infection. They put on clean (that means sterilized) cloth- 
 ing before going into battle and as a consequence they had a very 
 low death rate on account of injuries. Clean clothing meant no 
 infection was carried into the wounds. I recall a statement re- 
 garding the Communists of Paris, how even slight injuries proved 
 fatal, the reason assigned being the use of alcohol. 
 
 Now alcohol for a long time has been accused of doing all sorts 
 of things. It makes the sick well and the well sick. It cheers and 
 it dulls sensibilities. According to some (not only doctors but also 
 scientists who are supposed to have made careful studies, perhaps 
 experiments) alcohol is a food, according to others it is a poison. 
 Formerly physicians used it freely, now some never prescribe it. 
 The people themselves are divided into two camps, those who use 
 it and those opposed to its use. In our State the alcohol question 
 is a great political issue. 
 
 Since the Commune of 1871 a new science has arisen, bacteri- 
 ology. At that time practically nothing was known regarding 
 microbes and the role they play in infection, not only of wound 
 infection but general infection. In the light of bacteriology phy- 
 sicians now readily understand how soldiers in the city were sur- 
 rounded with infection on all sides and how injuries through dirty 
 clothing brought on infection, why even slight wounds were fatal, 
 and why on the other hand, the Japanese in the Russo-Japanese 
 war so largely escaped infection by acting upon the principles of 
 bacteriology and wearing sterilized clothing. The latter moreover 
 lived in the open air. 
 
 In our Civil War, General Sherman noticed that his soldiers 
 while on the march or in camps away from towns escaped much 
 sickness and even common colds. The mortality from wounds and 
 
INTRODUCTORY. 25 
 
 from sickness was much greater in city hospitals than in field 
 camps. The surgeon today is fully alive to the question of clean- 
 liness. 
 
 In a general way it may be said that pathogenic or disease- 
 producing microbes occur only where men are massed together. 
 Practically speaking they do not occur in the isolated country. A 
 hunter and trapper in the wilderness, for instance, can injure him- 
 self in all sorts of ways and recover promptly, while a mere pin 
 scratch under dirty city conditions may lead to ' ' blood poisoning, ' ' 
 to infection. Not only are our clothing and skin full of infection 
 but also our food and water and air; common pus germs (staphyl- 
 ococci and streptococci) are abundant where people are massed. 
 The city resident must be cautious. People living in isolation es- 
 cape many dangers due to infection from others. 
 
 A long chapter might be written on the influence or relation- 
 ship of clothing to health and ill health, but there is one point that 
 is generally overlooked, the relationship of clothing to the purity 
 of the air. People living under bad air conditions find it difficult 
 to regulate the amount of clothing, while people living under good 
 air conditions scarcely notice even marked changes in temperature. 
 The same is true regarding the heating of houses. Under good air 
 conditions a lower temperature suffices to feel comfortable, while 
 under bad air conditions we want houses and halls and railway 
 coaches overheated. The reason Europeans complain of our houses 
 being overheated is perhaps not far to seek. When we consider 
 that the spitting habit (and that means air pollution) prevails in 
 our country as nowhere in Europe the explanation is plain. 
 
 A very common explanation of ill health in school children is 
 "overwork. ' ' The fact that school houses are poorly ventilated and 
 that the air is bad is very seldom considered at all. As a matter 
 of fact there is "overwork," but it is an overworking of the de- 
 fences of the body in keeping off infection. But that is not the 
 kind of overwork that parents and teachers have in mind. 
 
 In the local high school, for instance, the question of overwork 
 is intimately connected with the question of proper clothing, as 
 
26 DUSTY AIR AND ILL HEALTH. 
 
 these in turn are connected with the matter of ventilation, and 
 that, means more particularly supplying the students with dust- 
 free air of proper temperature. Here I can not. go into details. 
 I will merely state that the laboratory class room is in the cold and 
 dark basement and children need to be warmly dressed. The next 
 hour they are in the Assembly room on the top floor, with a trop- 
 ical, an overheated, atmosphere, and then they complain of the 
 heat. How are the children to know what is a proper amount of 
 clothing! The basement teacher tells them to dress warmer, while 
 the teacher in the upstairs rooms may tell them they are too warmly 
 dressed. 
 
 In this connection T am reminded of the remarks of a plumber 
 who was consulted about the heating defects of a large two-story 
 school building in an adjoining town. A few of the rooms received 
 most of the heat of the boiler and usually were overheated; other 
 rooms were too cold. He found that the school authorities at- 
 tempted to produce an "equable temperature" in a ridiculous way, 
 using thermometers that did not read true. They attempted to 
 mislead those who judged a comfortable temperature by some in- 
 strument. Rooms that had too much heat were supplied with ther- 
 mometers that read too low, and cold rooms with some that read too 
 high, the extreme variations between thermometers being eleven 
 degrees. In these days of instruments of all kinds there is a tend- 
 ency to overlook the feelings and sensibilities. It should be re- 
 membered that the teacher is constantly moving about while the 
 pupil sits still. 
 
 It was just mentioned that microbes and disease germs occur 
 in proportion as people are massed together. The explanation for 
 that is simple : There are all sorts of pathogenic or disease germs 
 growing in all sorts of animals (not to speak of plants, for they 
 also have diseases). Some grow in one animal, some in another; 
 for instance, there is chicken cholera and hog cholera and human 
 cholera Disease prevails in proportion as there is a massing to- 
 gether under unsanitary conditions. Farmers have learned that 
 hogs do not thrive under unsanitary conditions, no more than 
 human beings. The Agricultural Department is constantly telling 
 
INTRODUCTORY. 27 
 
 the farmer how to protect his chickens and hogs and plants but it 
 has nothing to say how to protect himself or his children. We need 
 a National Department of Health. 
 
 Many germs grow in or upon the human body and the body in 
 attempting to get rid of them reacts and the reaction is known as 
 disease. Diseases may be recognized either by their active causes 
 or the grouping of their symptoms. Microbes or parasites may be 
 very minute or they may be large. The active causes of influenza, 
 or diphtheria, or of consumption, for instance, are very minute. 
 On the other hand there are parasites living in the intestinal tract 
 that may be many feet in length, tape worms. In the South the 
 hookworm is a very important cause of ill health and disease. It 
 is just visible to the unaided eye. 
 
 Microbes and parasites from the sick get into and on to the 
 bodies of the well by various ways, by direct contact, or through 
 clothing, or through food, through water or air. Itch or ringworm, 
 etc., travel from one to another, many through direct contact. 
 Typhoid fever and cholera are transmitted from one to the other 
 mainly through drinking water. Consumption, bronchitis, catarrh 
 and colds travel mainly through the agency of dust particles in 
 the air, that is, the secretions and excretions on the floor or ground 
 are dried and pulverized and float in the air as dust and when 
 inhaled reproduce the affection or disease. 
 
 Some individuals are very susceptible to infection, others quite 
 resistent. It is the old story of seed falling on good or on stony 
 ground. (But in general it may be said that if conditions are 
 favorable no one escapes infection.) Weeds do not appear in a 
 field unless the seed is brought in and the seed must be in a con- 
 dition to germinate and find conditions for germination favorable. 
 So with disease germs. If the seed is too old or perhaps has been 
 sterilized by bright sunlight, it is no longer able to germinate, and 
 hence "dust full of germs" may or may not produce disease and 
 ill health. Dust exposed to bright sunlight for even an hour or 
 two is sterilized. Such an exposure is equivalent to cooking the 
 seed, in fact, "boil the water" means to kill typhoid and other 
 germs. On the other hand, the seed, i. e., disease germs, preserved 
 
28 DUSTY AIR AND ILL HEALTH. 
 
 indoors may retain vitality for a long: time. The farmer knows the 
 importance of exposing vessels for milk to the bright sunlight and 
 of freely ventilating the cellar where fruit is kept, keeping the air 
 sweet, not mouldy. The spittle in dust of public halls may retain 
 its virulency for months. 
 
 As a rule school children do not spit on the floor but they bring 
 in filth and germs from the sidewalks and they distribute infec- 
 tious matter from running noses, as when they shake out the hand- 
 kerchief previous to use. Unless there is free ventilation constantly 
 carrying off the infection children may suffer severely. When 
 infection enters the body there is a reaction, the body tries to get 
 rid of it, to destroy it. In reality it is a battle between host and 
 invader, just like the battle between those in the fort and the en- 
 emy, one or the other will prevail. In a general way it may be 
 said that if the body is placed under good conditions it will throw 
 off infection. Sickness that keeps a child at home from school 
 may really be a conservative process; it enables the body to get 
 rid of infection, assuming that the air of the home is better than 
 that of the school room. 
 
 This struggle is an important one and determines whether a 
 child will live or not, and yet it is generally misunderstood. As 
 already mentioned, when a child is not feeling well physically or 
 mentally, it is only too often ascribed to ' ' overwork, " that is the 
 child is "studying too hard," while as a matter of fact the over- 
 work is on the part of the body in trying to get rid of infection. 
 Perhaps the value of open air schools can be understood in the 
 light of these remarks. Children under good air conditions do not 
 readily break down; they can do a large amount of studying. I 
 frequently see high school students on the point of "breaking 
 down" under bad air conditions and barely able to pull through, 
 but they may be able to do an immense amount of work while 
 going to college or a university where attention is given to air con- 
 ditions. If such a student after graduating from the high school 
 becomes a teacher in a small country school where air conditions 
 are good, there probably is good health ; if he teaches in an unsani- 
 tary school, in town or city, he may and usually does break down. 
 
INTRODUCTORY. 29 
 
 Today there is a demand for "robust" school teachers, those 
 who are sickly or complain are not wanted. Now in times past the 
 farmer boy or girl whom the parents thought "delicate" would be 
 sent to school and given an education that would qualify him to 
 teach. The same of course is true of many a city child; parents 
 have an idea that delicate children should have an indoor occupa- 
 tion. But teachers drawn from such a class of "delicate people" 
 are apt to react under bad air conditions found in schools with 
 poor ventilation and not kept clean. On account of this there 
 were so many teachers who were always complaining that now 
 there is a demand for robust, non-complaining ones. Instead of 
 cleaning up and ventilating freely and making air conditions suit- 
 able for people who are apt to complain on account of bad air, we 
 adopt an opposite course, we rule out those who react, those who 
 complain. The teacher who in reality is a living barometer is not 
 wanted. 
 
 But the robust teacher like the robust doctor wholly misunder- 
 stands the problem of ventilation, of good air, in school rooms. 
 To be sure the sickly teacher may also fail to understand the why 
 and the wherefore. Some come from homes where the old idea of 
 the injuriousness of draughts and open windows still prevails. In- 
 stead of admitting fresh air they close up everything, thereby ag- 
 gravating their ills. What the teacher needs is education! Is it 
 necessary to add that the intelligent teacher who has always com- 
 plained about ill health readily adopts good air advice? Shall we 
 go a step further and say that many physicians come from homes 
 where similar ideas regarding draughts and open windows prevail 
 and that if they are taught nothing about the importance of good 
 air, neither in school nor in medical college, they may wholly fail 
 to understand the present pure air movement ? 
 
 The common ill health and common ailments of school children 
 will be taken up separately. 
 
 This is not the place to discuss bacteriology, that is a vast sub- 
 ject. It has become so important that colleges teach it and indeed 
 some high schools even have elementary courses to instill definite 
 ideas. The causes of many diseases can be cultivated in glass tubes 
 
30 DUSTY AIR AND ILL HEALTH. 
 
 on proper "culture media," just as large species of plants can be 
 grown in the garden. Readers interested in the subject can likely 
 obtain a volume or the information through their public library. 
 It is not my intention to consider a large number of causes of 
 ill health, but I should like to refer briefly to a few in addition to 
 those already mentioned. 
 
 "It's the noise," I have had several patients tell me. They 
 had an idea that the noises of the city made them ill. One farmer 
 told me he had noticed that every time he comes to town he gets 
 ill, he feels bad even if he goes to a country church, or wherever 
 people are massed together and there is a buzzing of voices. Farm- 
 ers on moving to town may have continued ill health, ascribing it 
 to noises; similarly people who remove from the suburbs to the 
 heart of the city. When one critically studies such individuals 
 one finds that it is not so much what goes into the ear as what 
 goes into the nose and mouth that makes them ill. 
 
 Noise, smoke, and dust are of course intimately bound up. The 
 noisy city is also apt to be a smoky and dusty one. In the large 
 city a physician may have difficulty in separating noise and dust 
 and other influences. The isolated country doctor finds it less diffi- 
 cult to discriminate, in fact he may have unusual opportunities. 
 
 When a country doctor meets a case of smallpox or scarlet fever 
 or measles he most likely at once inquires, Where did you get it? 
 The patient living on the isolated farm must of course have 
 "caught" the disease somewhere. Exceptionally it may have been 
 brought in by a letter or on clothing or things that come from 
 town or from neighbors, but more commonly the individual came 
 in contact with some on who had the same disease. We all know 
 how some diseases are regarded as very "catching" and how ef- 
 forts are made to isolate those who are sick and how houses are 
 placarded. Now while the country doctor may have little difficulty 
 in tracing the exposure, the city doctor may utterly fail, because 
 his patients are constantly coming in contact with countless others. 
 
 The country" man who goes to the city not only encounters noises 
 but also other factors that produce ill health, notably bad air. He 
 
INTRODUCTORY. 31 
 
 may refuse to drink water and escape water-borne diseases ; he may 
 refuse to eat in the city and thus avoid food-borne diseases, but he 
 can not avoid breathing. 
 
 The matter of influence of noise vs. bad air is an interesting 
 one and even people who have no medical education can make 
 observations that are of value. As a matter of fact, many obser- 
 vations regarding dust influences are of a nature that do not re- 
 quire a medical education, just plain common sense. In making 
 such a statement one feels impelled at the same time to criticise 
 our schools for their failure to teach children to observe things; 
 there is too much memorizing from books. 
 
 "It's unhealthy towns and homes that make one sick," some 
 say. There is of course much truth in such or similar statements 
 but one must inquire why, in what way do home and town condi- 
 tions differ? Why are some towns unhealthy or unsanitary and 
 others not? Do the people get the essentials of a healthy life: 
 proper housing, proper rest and recreation, pure water, pure food 
 pure air? These are questions one must ask. To what extent is 
 there overcrowding and a mere struggle for existence? 
 
 Many towns and most cities for a long time have given atten- 
 tion to the securing of good water and they have laws and ordi- 
 nances regarding food, but so far practically no attention has been 
 paid to the matter of pure air, and this is one of the great causes 
 of common ill health, how great we are only beginning to find out. 
 
 How do we get our ideas regarding comparative salubrity or 
 healthfulness of cities and towns? Primarily through mortality 
 statistics. We are told how many people died, what percentage of 
 the population, and of what diseases. But such ideas may be very 
 erroneous because mortality statistics concern themselves only with 
 deaths, with people who died; they take no account of people in 
 ill health. A man may have years of ill health before he dies; we 
 hear only of the cause of his death and his age. A strong country 
 boy goes to the city, he soon becomes ill and returns to his country 
 home, to die; his death is accredited to the country and not to the 
 city where it rightfully belongs. We constantly find people once 
 
32 DUSTY AIR AND ILL HEALTH. 
 
 strong drifting back to the country, to the scenes of their child- 
 hood. Probably the best method of judging the comparative salu- 
 brity (or morbidity as opposed to mortality) of communities is by 
 the ratio of physicians and druggists and the number and size of 
 patent medicine advertisements, not forgetting a city's water sup- 
 ply and the condition of its streets. Good water and clean streets 
 mean healthy people. 
 
 A young physician is apt to get all sorts of advice from his 
 friends where to locate. He may be told to locate in a certain 
 community, because there are few physicians and there is little 
 competition. But every experienced physician knows that a com- 
 munity with many physicians offers better opportunities for the 
 young man. Many doctors means much "doctoring." There is 
 much sickness, i. e., ill health due to unsanitary surroundings and 
 reactions due to an abnormal environment (really incurable but 
 largely, if not wholly, preventable). The sick are constantly drift- 
 ing around ready to try "the new doctor in town." An unsani- 
 tary city contains any amount of ill health that is not curable 
 through the use of medicine but which is curable or certainly re- 
 duceable to a minimum by attention to things other than the taking 
 of medicine. One of the widely read popular medical journals has 
 a slogan, Clean Up, Clean Out, and Keep Clean. If the people 
 only knew what that implies ! In short, cleanliness is next to god- 
 liness. 
 
 Much illness is dependent on overcrowding. Leaving the 
 crowded city may mean a return of health. City life may mean 
 bad water and bad food and especially bad air. When a man goes 
 to the country and eats "good country grub" he likely also gets 
 good water and good air, and that may mean a return of health. 
 If there has been no serious injury to the body on account of in- 
 flammations and scars there may be a relatively complete restora- 
 tion of health; but we all know that many wait too long before 
 making a change, a change may no longer bring the expected 
 improvement. Poor people are often unable to make a change; 
 they will continue to work as long as possible, until they break 
 down. Formerly when land was plentiful a man could go out and 
 
INTRODUCTORY. 33 
 
 take up a quarter section but those days are past. Many towns 
 have unhealthy trades and occupations and as long as men follow 
 them they will have ill health. 
 
 The fact that much of the common ill health and failure of 
 people in the city is due to congested population, with all that this 
 implies, is evidenced by the formation of societies that colonize 
 people in the country, virtually giving a man a new chance to 
 maintain an independent existence. Cities of today have greatly 
 improved over those of a hundred years ago but much is still to 
 be desired. 
 
 The physician meets people often who are constantly moving 
 about. They move from one house to another, from one street to 
 another, and from one town to another and perhaps from one State 
 to another. In studying a number of these individuals I found 
 that moving was often really a search for better health. To a 
 number of these individuals I have been able to point out that the 
 chief factor in their ill health was bad air conditions. 
 
 Occasionally one meets people w T ho say, "It is my occupation 
 that is killing me." They are confident that if they had a differ- 
 ent occupation, especially an outdoor one, they would have better 
 health. Often they speak positively because they have tried it. 
 Many have made changes and then again gone back to the old 
 occupation. The physician may be able to point out to them the 
 reason why, that many occupations are carried on in an "indoor 
 climate," under artificial air conditions. We are just beginning 
 to realize that it pays to have good air in factories. 
 
 I have case histories of men who moved about and tried all 
 sorts of occupations after leaving school. They tried this and they 
 tried that; at times they felt better and then again worse. Yet 
 it is the exceptional individual who has any idea that air condi- 
 tions are at the bottom of it. Many a country boy on beginning 
 city life has among his duties the sweeping of a store or office. 
 Having always been accustomed to good air, he may promptly 
 react to bad air, air full of infection. He may try all sorts of 
 occupations and finally drift back to the farm without ever fully 
 realizing why he could not live with comfort in the city. In many 
 
 [3] 
 
34 DUSTY AIR AND ILL HEALTH. 
 
 factories there is dust that is very injurious. It is the exceptional 
 individual who can tolerate it. Many occupational diseases so- 
 called are due to dust conditions. This is a suhject to which sani- 
 tarians are giving a good deal of attention. 
 
 When we study a large number of people we are apt to find 
 that they fall into two groups, those whose ancestors have always 
 lived under rural conditions, country people as we say, and those 
 whose ancestors have perhaps for generations been living under 
 city conditions. Now old time city conditions were very bad and 
 there was a very active weeding out of those who were not adapted. 
 This is markedly shown by the Jews. In old European cities they 
 were confined to ghettoes with gates locked at night, the overcrowd- 
 ing was fearful; many perished under such conditions. The de- 
 scendants of those who survived are able to thrive under present 
 city conditions. On the other hand there are Jews who have been 
 living under rural conditions, especially Russian Jews, who are 
 now crowding into our cities; many of these fail quickly. The 
 weeding out now goes on among these as it did among the an- 
 cestors of the others. 
 
 We see this weeding out process again among the descendants 
 of the southern mountaineers. When people for several genera- 
 tions have been living under very primitive conditions practically 
 all have a chance to grow to maturity and reproduce their kind. 
 When these mountaineers or their descendants crowd into cities 
 many promptly fail, the "weak" are constantly killed off. 
 
 A middle-aged woman from an adjoining town came to me 
 several years ago with a history of chronic ill health. She had the 
 peculiar faded appearance which at once led me to suspect she was 
 of southern mountaineer stock, and so I promptly asked regarding 
 her family history. My suspicions were confirmed. Her ancestors 
 were mountaineer people who came to this State when she was a 
 small girl ; they settled on an isolated farm. From the time she 
 became of school age and went to school she complained of ill 
 health. After school days there was better health and then she 
 married a small town storekeeper. Ill health now reappeared, 
 marked by colds and catarrh, headache and dyspepsia, and a "good 
 
ttrTfcobucToft?. 35 
 
 for nothing feeling generally." She had an idea that the town 
 was unhealthy and induced her husband to sell out and move to 
 another. In fact, there were repeated moves and her husband 
 became a "ne'er do well." I tried to explain why she was not 
 adapted to town life. 
 
 When the woman understood she spoke of her only child, a 
 daughter now almost grown, who was following in her footsteps, 
 had similar ill health. Her ancestors had raised large families; 
 she had only the one child. Perhaps such cases explain the ex- 
 tinction of families. 
 
 About the second or third consultation she came in accompanied 
 by her husband, a stout full blooded man who did not give her 
 any sympathy and believed her ills were imaginary. Moreover he 
 was quite bitter against the medical profession because he had 
 spent thousands of dollars "all for nothing." A woman with such 
 ill health and under such circumstances is to be pitied. 
 
 Another common explanation is that of inheritance. People 
 feeling ill may say they know they have, or are going to die of, a 
 certain disease, because some other member of the family has or 
 had it. On the other hand some say they know they do not have 
 such and such a disease "because nobody in the family ever had 
 it." "When people feel bad or have chronic ill health they attempt 
 to account for it by the presence of some disease or being perhaps 
 in an " early stage. ' ' Many physicians do the same. As a general 
 rule however specific diseases are of comparative short duration. 
 The "terminal disease," the one that ends life, may kill quickly 
 and perhaps have no relationship whatever to the preceding years 
 of ill health. 
 
 One of the great questions discussed by scientists today is the 
 relative influence of heredity and environment. The subject is 
 complex. Many factors must be considered. To the physician 
 the question is important from the fact that he must distinguish 
 between well defined diseases, minor maladies, and common ill 
 health. In the case of many diseases there is developed a mutual 
 adaptation, but many individuals not feeling well are not diseased. 
 
36 DUSTY AIR AND ILL HEALTH. 
 
 To what extent is their ill health due to inheritance, to what extent 
 due to the influence of environment? 
 
 I have a little story which I tell those who are so positive about 
 the matter of inheritance, who say that certain disease or diseases 
 are present or absent in their families, in substance: An Indian 
 and a white man applied for life insurance. The Indian gave a 
 "good family history;" there was no consumption, no cancer, no 
 Bright 's disease, etc., in his family; he was promptly accepted. 
 The white man had to admit that in the past some members of his 
 family had died of one or another of these diseases, in other words, 
 his "family history was bad;" he was rejected. A year later the 
 Indian was dead; he and his ancestors had never been exposed to 
 the "diseases of civilization," diseases which had ravaged among 
 the white man's ancestors and killed off the susceptible. The 
 white man, in spite of his "bad family history," lived on and on. 
 
 Often people who have much ill health express the belief that 
 they will not live long, confusing ill health with disease that kills. 
 To such I quote the old English saying, In order to live long, ac- 
 quire an incurable disease, explaining that really there is no disease 
 at all, only ill health, and that the symptoms are to be considered 
 in the light of warnings from nature not to go to extremes. As a 
 rule the old chronic is prudent: his pains and aches tell him how 
 far he can go and when to desist, and because he is careful he lives 
 on and on. 
 
 Years ago I read about a titled Englishman, the last of his line, 
 all his ancestors died in early manhood. If there was anything in 
 heredity he knew his own fate. On the other hand, if there is 
 anything in the influence of environment and watching oneself he 
 was determined to prolong his life. To do this he studied medicine 
 and became his own patient. As a doctor of medicine he of course 
 felt free to consult his fellow-physicians and get their best advice. 
 He studied his own case and watched himself. He regarded pains 
 and aches as warnings, to be heeded and their causes to be avoided. 
 He died of old age. "Whether the story was true of course I do not 
 know, but it is a good story to tell pessimistic patients. Care and 
 prudence pay. 
 
INTRODUCTORY. 37 
 
 On considering eases one has actually studied, a physician might 
 arrive at the conclusion that for the average individual the in- 
 fluence of environment is the greater factor. This is fortunate 
 because we can largely alter our environment, make an unfavorable 
 one favorable, or remove from an unfavorable one, while we have 
 practically no control over the influence of heredity. It should be 
 kept in mind that in this volume we are considering people of 
 European descent. If the Eskimo and the South Sea Islander 
 were to change habitats each would likely promptly perish, but 
 how much to ascribe to environment and how much to heredity and 
 the weeding-out factor would be impossible to determine. We of 
 the temperate zone are exposed half the year to winter and half to 
 summer; we can bear exposures that those of the arctic and torrid 
 zones can not. Need it be added that well-to-do people who are 
 delicate or susceptible, who can not bear the heat of summer, can 
 go north, or those who can not bear the rigors of our winter go 
 south? 
 
 People whose ancestors have lived under city conditions are 
 likely to bear unsanitary conditions to which the descendants of 
 people who have always lived in the country would promptly suc- 
 cumb. Some people are able to live in the worst slums, but the 
 "survival of the fittest" may not at all mean the survival of the 
 best. 
 
 People have all sorts of explanations regarding their ill health 
 and its causes. Among them are explanations obtained from prac- 
 titioners of medicine. But often such explanations are very simple : 
 "It's the stomach," "It's the liver," "It's dyspepsia," "It's uric 
 acid," etc. People of course want an explanation when they are 
 not feeling well and if they can not explain to their own satisfac- 
 tion, then some one must explain for them — and usually the busy 
 doctor gives an explanation that he thinks his patient can under- 
 stand. He has no time for lengthy discussions, and so he uses 
 common explanations, such as the above. (For a longer list see 
 the advertisements and testimonials of patent medicines in the 
 newspapers.) 
 
38 DU8TY AIR AND ILL HEALTH. 
 
 At times the name of some definite disease may be given. An 
 individual may be told he has tuberculosis, or "threatened with 
 consumption." Exceptionally an individual may be told he has 
 cancer (chronic dyspeptics often have a fear of cancer of the 
 stomach). Another may be told he has Bright 's disease. As a rule 
 however practitioners of medicine avoid "diagnoses," that is ex- 
 planations, of this kind because if people "get scared" they may 
 go to some other physician or to a specialist. Merely to say, "It's 
 the stomach," "It's dyspepsia," is rather non-committal and is 
 more apt to lead the patient to believe he is going to be cured than 
 if he is given the diagnosis of cancer, or consumption or Bright 's 
 disease. A good doctor promises no cure, only to do his best. The 
 poor doctor readily promises ; ignorant people want a man who 
 promises to cure. 
 
 In case of an acute attack, perhaps only a cold, the patient may 
 be told he is "threatened with pneumonia" or some other disease, 
 but the threat does not materialize. What was really the matter 
 and what was the cause of the attack? One wonders, especially in 
 cases where the individual in a day or two is out on the street again. 
 
 One of my old patients told me she had four or five attacks of 
 diphtheria in so many years. She had a "sore throat" the first 
 winter she was my patient; cautioned about the influence of bad 
 air she had no other attack for several years. (She was a dust 
 victim.) 
 
 There are various reasons why people get such explanations or 
 diagnoses, which however are not real diagnoses. For one thing 
 people are not willing to have the physician investigate properly 
 and make explanations that explain. People are usually willing 
 to pay for medicine but not for advice and where competition 
 among practitioners is keen a doctor can not afford to make lengthy 
 explanations. Then there are practitioners who are too lazy to in- 
 vestigate. A patient may drift around until he reaches a man who 
 does investigate and finds and makes the right explanation, one 
 that is fully verified in the course of time, and then such individu- 
 als are taken out of the drifting-about class. Then too there are 
 practitioners who are not above scaring people in order to get them 
 
INTRODUCTORY. 39 
 
 to take treatment. They usually are of the busy kind, so "busy" 
 that they have no time to belong to a good medical society, or if 
 they nominally belong, never take part in discussions. 
 
 Old chronics who have "made the rounds" of course have met 
 all sorts of doctors and when one questions them one gets all sorts 
 of information regarding the practices of "medicine men," reg- 
 ular and irregular, licensed and unlicensed, including the "fly-by- 
 night" who comes to town and announces his wonderful accomplish- 
 ments in the newspapers but in a short time disappears, and also 
 the quack who diagnoses and prescribes by mail, and the druggist 
 who prescribes over the counter, and the faith healer who gives 
 "absent treatment." 
 
 The subject of "newspaper medicine" is an interesting one. 
 Under this term is understood the alliance of the newspapers with 
 "medicine men" who may not at all be physicians or who are not 
 in contact with the regular profession. Patent medicine men may 
 not be doctors at all ; they are usually shrewd business men. Quacks 
 and charlatans may have medical degrees, even a license, but they 
 are pariahs not recognized by the profession. To all these the news- 
 papers are important. In other words, the newspapers help these 
 "medicine men" to humbug the people. I shall have something 
 to say about these further on. 
 
 As already mentioned, everybody has an explanation or wants 
 one. Some explanations are simple, others complex. Doctors them- 
 selves have explanations for use in speaking with their patients, 
 but perhaps a wholly different one in discussion among themselves, 
 or when about to sign a death certificate. There are some diseases 
 from which respectable people do not die — only poor people or 
 those without friends or relatives. Again, some explanations of 
 ill health may be considered "fashionable," but when too freely 
 used lose cast. The diagnosis of "neurasthenia," for instance, was 
 a fashionable one until too many poor people also had it. "Neu- 
 rasthenia" has many synonyms; one may be applied more appro- 
 priately than another. 
 
 Another explanation in vogue a decade or two ago was "uric 
 acid in the blood." This explanation was widely used by physi- 
 
40 DUSTY AIR AND ILL HEALTH. 
 
 cians but has now been practically abandoned. It still lives on 
 among the people, kept up through the advertisements of patent 
 medicine men, with some of whom uric acid in the blood is the 
 foundation for practically all the common ills. 
 
 The explanations of physicians differ from those of the laity in 
 that they are based on a larger number of cases. A sick man may 
 know of very few cases. The theories of scientists are also expla- 
 nations. If a theory explains many facts and can be used in pre- 
 dicting it may form a " working theory," 1 to be used until a better 
 explanation is found. Each change likely means a nearer approach 
 to the truth. Perhaps it should be added that some theories or 
 explanations are wholly devoid of any connection with dollars and 
 cents — but old medical theories may still be used on account of 
 their financial importance. The "uric acid theory" is still of finan- 
 cial use to patent medicine men. 
 
 More recently another explanation for much of the common ill 
 health has come into use, the theory of auto-intoxication, and here 
 too the patent medicine men are catching on. 
 
 Occasionally the physician meets individuals who state their 
 symptoms and assume that some disease is present but say, I don 't 
 know what it is. Often such persons have made the rounds of the 
 doctors and have had all sorts of opinions and finally they come 
 to believe in none, and being unable to arrive at any conclusions 
 from their own observations, they naturally say, "I do not know 
 what it is." They may not want any more opinions; they want to 
 be cured or have symptoms reduced to a minimum. Some physi- 
 cians like to get hold of such individuals and "work out the case" 
 as they would any other problem. 
 
 Now those in ill health soon discover that doctors differ greatly, 
 that they are interested in some kinds of cases and some people but 
 not in others. A specialist is interested only in a certain kind of 
 cases, he may wholly refuse to take an interest in others. The 
 general practitioner is supposed not only to be interested in every 
 
 1 Some of my patients, e8pecially!old|onesjwho^havelbeentwith*me!for a long time, speak of the subject as 
 discussed in this volume as the "dust theory." They are firmly convinced of its truth. The reader must him- 
 self determine to what extent it is a "working theory." 
 
INTRODUCTORY. 41 
 
 case, in every individual who applies to him, but to know just how 
 to treat the almost innumerable kinds of diseases, maladies, dis- 
 orders and states of ill health. Does he? By no means. The "in- 
 teresting case" of one physician or surgeon or specialist may be of 
 no interest to another; if he gives any attention at all it may be 
 purely of a routine kind. He may not make a proper study of the 
 case according to the present state of medical science. 
 
 Our age has been characterized as a mercenary one, that a man 
 will do nothing unless "there is money in it for me," and phy- 
 sicians have not escaped the accusation. In olden times physicians 
 depended on an honorarium ; they left the matter of pay to their 
 patients. The medical profession has always been a poorly paid 
 one. Unlike lawyers, physicians do not ask for a contingent fee 
 and only too often there is no clear understanding of what they 
 are to get in return for services. In Europe and in all countries 
 where people are not much given to moving about, people learn to 
 know to what extent to depend upon one another, the physician 
 may be willing to give unlimited credit. But in our country where 
 people are constantly on the move unlimited credit is not feasible. 
 The telephone company collects in advance. The grocer wants 
 prompt pay. The newspapers send out their collectors at the end 
 of the month. Even physicians have found it imperative to look 
 after prompt collections. Just as the grocer will not trust and the 
 newspaper will not trust, so many physicians will not trust. If a 
 man has nothing to give in return he is probably given scant at- 
 tention. A physician may be so overloaded with poor patients that 
 he can not make a decent living — and yet the stranger in acute 
 distress will likely receive attention without question, "according 
 to the traditions of the profession." 
 
 Medicine is an evolution. Fortunately (or shall we say unfor- 
 tunately?) there is no tradition regarding what the "laboratory 
 doctor" should do in the case of applicants, especially where the 
 applicant is an old chronic and where there is no emergency. The 
 student of chronic ill health may make all sorts of inquiries, includ- 
 ing what he is to get in return for his services, before he accepts a 
 new patient. 
 
42 /" DUSTY AIR AND ILL HEALTH. 
 
 If the good physicians were less backward and the poor ones, 
 especially the advertising quacks, were less forward in speaking 
 about fees, and if people clearly understood that the laborer is 
 worthy of his hire, there would soon be a change. 
 
 What many of those in chronic ill health and especially poor 
 people need is good advice. Many ills are not curable by the taking 
 of a "little medicine." But good advice means investigation and 
 that means to take up a lot of time and time must be paid for. The 
 physician who practices medicine purely from the humanitarian 
 standpoint is an exceptional individual ; few can afford to do it. 
 
 If the old chronics are neglected by the physician, if they get 
 only routine attention, "a lick and a promise," what do they do? 
 For one thing they buy patent medicines. Having tried all doc- 
 tors and all the advertised nostrums and finding themselves still 
 uncured, they are ready to try everything else, even faith and mind 
 cures. 
 
 Now according to my experience (and I have given the subject 
 of chronic ill health much attention) many individuals who are 
 complaining are not really "diseased," they are merely reacting 
 to an unsanitary environment, one to which they are not adapted. 
 Much of the prevalent ill health in reality is due to the ' ' influence 
 of environment," it is a reaction to unsanitary conditions. Such 
 ill health is not curable by the taking of drugs nor any outlandish 
 mode of treatment. Change of environment or change in habits 
 may be the cure, that is, cause symptoms to disappear. Symptoms 
 like everything else have a cause ; by removing the cause they dis- 
 appear. Symptoms are to be regarded as warnings; they are to 
 be heeded. There is something wrong. The automobilist when he 
 hears any peculiar noise about his machine knows there is some- 
 thing wrong. Pains and aches are nature's way of letting us know 
 something is wrong with the human machine. The doctor who tells 
 a patient to neglect symptoms and tells him not to worry is not apt 
 to be a student of common ill health, and the people soon discover it. 
 
 There is a vast difference in attempting to explain a man's 
 ill health (symptoms of ill health) in the light of postmortem 
 pathology or in the light of the "pathology of the living," between 
 
INTRODUCTORY. 43 
 
 attempting to trace ill health to the presence of some well-defined 
 disease or to the influence of an unsanitary environment. Some 
 explanations do not appeal to patients, the explanation may be 
 the correct one or not. Although it may take much time to inves- 
 tigate, it may take more time to make proper explanations so that 
 the patient will understand. Some cases the physician can readily 
 explain, that is to his own satisfaction, he may have seen many 
 cases of the same kind; but at times it is a problem how to make 
 explanations that make the subject clear to the patient. Other 
 things being equal, the patient who most fully comprehends will 
 likely most fully co-operate. 
 
 Old chronics as a rule have had all sorts of advice; they may 
 have been to specialists who insist on the importance of one thing 
 or another, but according to my experience the man who has been 
 advised regarding a neglected factor, bad air, is very exceptional. 
 
 The subject of ill health, especially chronic ill health, can be 
 studied from different standpoints. Here I shall pursue it (as 
 may have been suspected from the tone of this introductory) from 
 the standpoint of air conditions. Man eats about three times a 
 day; he drinks perhaps five times a day on the average, but he 
 breathes fifteen to eighteen times a minute. He can do without 
 food many days; he can do without drink for several days, but he 
 can do without breathing for only a few minutes. A farmer or 
 a suburbanite can go to the city without eating or drinking but 
 he can not do without breathing. He can avoid sickness and ill 
 health due to food or drink, but he may be wholly unable to avoid 
 ill health due to breathing bad air. If he knows what bad air is 
 and chooses to remain away from it, he may escape. In this work 
 I purpose to point out what is meant by good and bad air and the 
 kind of ill health that may be caused by it. 
 
 After a physician has given a subject attention for years and 
 has seen hundreds of cases and had innumerable discussions with 
 patients on all sorts of topics relating to common ill health and 
 more particularly on ill health traceable to air conditions, it be- 
 comes a problem what to include and what to exclude from a book 
 
44 DUSTY AIR AND ILL HEALTH. 
 
 for the general reader. Of necessity one must confine himself to 
 more or less general statements, unusual or rare cases can not be 
 cited at all, neither can one go into details that may be of interest 
 only to the few. The subject is really a vast one and some things 
 can not be taken up at all, some only very briefly. It is hoped 
 enough is given to enable the intelligent reader to arrive at some 
 conclusions. 
 
 It may be proper here to say that those who have never given 
 the subject of dust influences and dust infection any attention 
 may view this subject with alarm. They may think we are threat- 
 ened with a new peril. Every now and then we see accounts by 
 some alarmist of some "chief peril" that threatens destruction to 
 the nation — and yet the world lives on. 
 
 When the germ theory was first advanced timid people saw 
 germs everywhere ; they became fearful. In time they learned that 
 only certain kinds are injurious and that their destructive in- 
 fluences are limited. We have learned where to expect them and 
 to know where they are not apt to occur. The same may be said 
 of dust. Only certain kinds of dust are injurious and when we 
 learn where these occur and where not we may find there is no 
 need to be alarmed. Prudent people know that to be forewarned 
 is to be forearmed; they also know that there are those who are 
 heedless and as a consequence suffer. 
 
II 
 
 LOCAL CONDITIONS AND CHANGES IN TIME. 1 
 
 (Mesology and Ecology.) 
 
 Changes in my own State have been discussed with many pa- 
 tients, particularly with old people, early settlers. 2 The present 
 generation, especially people living under city conditions, has little 
 idea of the early conditions under which people live and of the 
 changes that have taken place since clearing the forests and drain- 
 ing the wet lands and building towns and cities. To understand 
 present complex conditions we must study earlier simpler condi- 
 tions. 
 
 Indiana like surrounding states lies in the north temperate 
 zone and has an annual variation of temperature of approximately 
 125 degrees, from 25 below zero to 100 above. On account of the 
 fairly equal distribution of rainfall (about 40 inches a year) there 
 is an abundant supply of water for man and beast and plants. 
 When the white man first came to what is now Indiana, dense for- 
 ests covered the country except parts of the northern level marsh 
 and prairie land. In a general way it may be said that the south- 
 ern third of our State is hilly, the central slightly rolling, while 
 the northern third is flat and wet, but recently modified greatly 
 by drainage. 
 
 Natives. Our State when the white man first came in was in 
 possession of the American Indians. They were still in the hunt- 
 ing and fishing stage of civilization. They were a "strong and 
 healthy race," mainly on account of their simple life and because 
 not exposed to the active causes of diseases ; they lived in isolation. 
 
 1 The original title of this chapter was CHANGES IN INDIANA, but manuscript critics objected, 
 saying that that would give the reader the impression that the volume was local, that the conditions 
 described existed only in Indiana, while in reality similar changes occur in surrounding States and in 
 fact all over the United States. 
 
 Here I am merely writing about things I know and have discussed with patients. The French 
 have a saying, He may lie boldly who comes from afar. The reader in a distant country may regard 
 some of my descriptions as imaginary but my patients know they are true. To what extent descriptions 
 and conditions apply to other localities the reader must determine for himself. 
 
 2 I have already referred to an old farmer and his ideas on the changes in diseases and climate. 
 
 (45) 
 
46 DUSTY AIR AND ILL HEALTH. 
 
 Early Immigrants. These were French hunters and trappers, 
 roaming over the country. They were soon followed by people of 
 English descent, The history of the white man in this State goes 
 back a little over two hundred years. 
 
 Early Settlers. The first "foreigners" who came to make 
 this State their home were the French, settling along the lower 
 Wabash river. They settled in communities, thus differing from 
 people of other European countries, especially the British who took 
 to the open country. The latter came in two main streams, one 
 from the south, composed mainly of descendants of southern moun- 
 taineers, the other from the east, mainly descendants of Atlantic 
 colonists. In time people came here direct from Europe. 
 
 An interesting study is that of motives that prompt people to 
 leave their ancestral homes and seek out a new home in the wilder- 
 ness. The early English immigrants to this country seem to have 
 left their old homes mainly on account of religious restrictions. 
 They wanted to worship in their own way — and yet as soon as they 
 attained their end they tried to force others to do as they did; 
 they became more oppressive than their own oppressors. For this 
 reason again many early settlers in the New England States went 
 still further west. 
 
 "Natives." The term "natives" is frequently heard, especi- 
 ally by the descendants of the early comers in contrasting them- 
 selves with recent arrivals — but at the rate they are dying off or 
 rather not propagating themselves they will soon be extinct, es- 
 pecially under unsanitary city conditions. Then we must consider 
 the fact that this "native" blood is constantly being diluted by 
 intermarriage with "foreigners," with new arrivals. 
 
 Other Nationalities. Immigrants from other countries, from 
 Germany, Ireland, Sweden, from Italy, etc., began to come early 
 but only recently in large numbers, comparatively speaking. In 
 proportion as immigration from northern European countries di- 
 minished, that from the southern countries increased. The motive 
 that impels most new comers seems to be easier life conditions 
 existing here, escaping overcrowded European conditions. But 
 
LOCAL CONDITIONS AND CHANGES IN TIME. 47 
 
 since practically all public land is now taken up many of these 
 come to our cities only to lead a mere struggle for existence. 
 
 Other Races. The white man was followed by other races. 
 First came negroes, brought in as slaves. In recent years Chinese 
 and Japanese have come in. But our State at present is essentially 
 peopled by the descendants of immigrants from Great Britain and 
 Germany, with a fair sprinkling of other nationalities. 
 
 The first white men coming to our State were hardy specimens. 
 The weak and decrepit were left behind or perished on the long 
 overland journey. The first settlers brought in few goods, simple 
 household utensils, a few domestic animals and seed of various 
 plants. Life at first was very simple, especially as long as game 
 lasted. A small truck patch supplied the table. 
 
 Another Kind op Immigrant. In time all kinds of "immi- 
 grants" came, the Old World pests and parasites. The European 
 rat came in early. European weeds 1 of all kinds came in gradually 
 and compelled the settler or farmer to war against them. These 
 weeds have for years resisted destruction at the hands of man and 
 have developed staying qualities. They rapidly crowd out native 
 plants and if not kept down also crowd out cultivated plants, just 
 as the white man crowds out the native Indians. 
 
 Besides a host of animal parasites varying from quadrupeds 
 down to insects that attack crops, there have come in a variety of 
 rusts and blights that attack the farmer's grains and trees. Just 
 as in the case of new weeds, rusts and blights 2 are constantly com- 
 ing in, often producing serious damage. 
 
 1 Several years ago on a tour through the Yellowstone National Park I was surprised to find an 
 almost complete absence of our common weeds, weeds that originally came from Europe. Only a 
 short time ago a friend told me of a man here on a visit from the Saskatchewan who gave a glowing 
 account of the large crops raised and the immense size of potatoes, cabbages and turnips. He ascribed 
 it to the climate, while as a matter of fact it was due to the virgin soil and the absence of common 
 weeds which had not yet come in and warred with cultivated plants for possession of the soil. 
 
 2 Our State Agricultural College is studying this subject. A friend periodically sends me a blank 
 to fill out regarding the ravages of rusts and blights in the county but unfortunately I know so little 
 about such things that I can be of little service. If I did report without knowing the real facts I might 
 be misleading those who are supposed to know; hence I prefer not to report at all. But I am ready 
 and willing to gather and send material, specimens, that will enable these who do know how to determine 
 the facts in the case. 
 
48 DUSTY AIR AND ILL HEALTH. 
 
 Other Parasites. As already mentioned the native Indians 
 were strong and healthy. The first immigrants were also a hardy 
 race, they left their diseased and diseases behind. Now every stu- 
 dent of nature knows that human beings are afflicted by various 
 parasites, just as animals and plants are, and that it is only a 
 matter of time until many come to a community where they had 
 never been seen before. Many diseases of man are due to the pres- 
 ence of parasites, both animal and vegetable. The first appearance 
 of many of these parasites, and that means the resulting diseases, 
 is known ; there is a record in the books or journals. Some para- 
 sites are large enough to be seen by the unaided eye; others are 
 so minute that they must be highly magnified. The active causes 
 of such diseases as typhoid fever, cholera, tuberculosis, malaria, 
 are very minute, but they make up in number what they lack in 
 size ; they may simply overpower the body ; then we say the disease 
 killed. 
 
 Some of the now common diseases came in early. There is for 
 instance a history of smallpox brought in by the French and killing 
 off many Indians. The Indians never having had such a disease 
 proved very susceptible and died off in great numbers. Similarly 
 when tuberculosis, or consumption, was brought in to them they 
 died off at a great rate. Unfortunately there are few records of 
 the appearance of many of the common diseases in our State and 
 there are no records of the sort of specific diseases the Indians had 
 before the time of the white man's first coming among them. 
 
 Diseases and Their Causes. There are all sorts of diseases 
 as there are all kinds of causes, native and foreign, internal and 
 external. It may be said that a disease is a reaction of the body 
 toward a cause and that the reaction depends upon the kind of 
 cause. Some causes produce a mere disturbance or malaise, others 
 ill health, still others produce a reaction so severe that it kills 
 quickly. Many of the active causes of disease when growing in 
 the body produce poisons and these poisons act upon the body; 
 this reaction is termed specific disease. 
 
 Many substances when they gain entrance into the system bring 
 
LOCAL CONDITIONS AND CHANGES IN TIME. 49 
 
 on a reaction that is characteristic. Thus when lead gets into tin; 
 body there results lead poisoning or plumbism, a disease that oc- 
 curs especially among lead workers and painters. Now we are 
 reasonably safe in asserting that before the advent of the white 
 man the Indian knew nothing about lead and he was free from lead 
 poisoning, just as he was free from morphinism and alcoholism, 
 and in all probability he likewise escaped poisoning by the activity 
 of the typhoid bacillus and the tubercle bacillus ; they had not yet 
 been introduced. 
 
 One need scarcely go into a discussion of the active causes of 
 diseases to which the Indian was subject. 1 They were relatively 
 few. Among native causes one is apt to think of the pollen of Rag 
 weed or Goldenrod; one wonders whether the Indians had "hay- 
 fever." But at least one "native disease" should be mentioned, 
 namely, milk sickness; this severely attacked the first settlers, kill- 
 ing many; it has now practically disappeared. Whether malaria 
 existed among the Indians before the white man came is very 
 doubtful. It seems to have come in some time after the white man 
 and soon became a serious and fatal disease. But in time as the 
 State settled up and wet lands were drained it became less and less 
 common until now it is a comparatively rare disease. (The term 
 malarial so frequently used at the present time as a rule has noth- 
 ing whatever to do with malarial fever. Recently it has been pro- 
 posed to rename malaria Anophelesis, because it is transmitted 
 through the bite of the Anopheles mosquito.) 
 
 Occupation, III Health, Disease. There is a close relation- 
 ship between the occupation of an individual and the amount and 
 kind of his ill health and disease. The native Indians were hunters 
 and fishers and moved about constantly ; they led an active out-of- 
 door life ; they had pure water, pure food and pure air and came 
 little in contact with diseased people and hence were "healthy." 
 We should keep clearly in mind that "healthy" under such con- 
 ditions is the result of not coming in contact with the causes of ill 
 health and disease. 
 
 1 The Indians of today can no longer be regarded as "primitive people," for they have been exposed 
 to all kinds of introduced diseases and there is more or less "mixed blood" among them. 
 
 [41 
 
50 DUSTY AIR AND ILL HEALTH. 
 
 The first white men, as already mentioned, were also hunters 
 and trappers. Leading a simple life after the manner of the Indian. 
 They had no fixed homes. They likewise were "healthy," or, as 
 we commonly say, hardy. The settlers, in distinction to the hunters 
 and trappers, were accompanied by their wives and children ; they 
 established homes and that means more or less exchanged an out- 
 door life for an indoor one. This means that the sick were housed 
 up and kept alive as long as possible, and it means too that the 
 healthy constantly came in contact with the sick and with the 
 causes of sickness and disease. Many diseases keep themselves 
 alive, so to speak, by wandering from one individual to another, 
 and in proportion as the healthy are exposed to the sick the oppor- 
 tunities for such propagation are favorable. The Indian with no 
 fixed home neglected his sick and they quickly perished, just as the 
 sick of the white man perished on the long march to the new home. 
 Some diseases may be regarded as house diseases, notably tubercu- 
 losis ; they do not thrive among open air people. 
 
 The susceptibility to ill health and disease varies greatly, as we 
 all know. Some succumb readily, others are highly resistent. This 
 depends partly on a more or less close contact with the sick and 
 partly on the ancestral history. When the ancestors had for ages 
 been exposed to a disease the very susceptible were constantly 
 killed off, the survivors being more or less resistent. One might 
 say there is more or less adaptation toward the disease and the 
 people among whom the disease lives. If a disease is so severe 
 that it kills off all the people of a region then the disease itself 
 perishes for want of material. If on the other hand it is not strong 
 enough to attack some of the people then it also perishes or dis- 
 appears. If the descendants of highly resistent people go to an 
 isolated region where they are not constantly exposed to the rav- 
 ages of disease they reach maturity and leave offspring that in 
 time becomes susceptible, that is on coming in contact with dis- 
 eases. There is no weeding out until the individuals come in con- 
 tact with diseases that cause a weeding out. This explains why 
 the descendants of southern mountaineers are so susceptible to 
 many of our common diseases on leaving their mountain or good 
 
LOCAL CONDITIONS AND CHANGES IN TIME. 51 
 
 air homes. The usual but erroneous explanation is that they "lack 
 stamina;" as a matter of fact they have not been exposed to dis- 
 ease and there has been no weeding out. To exchange an out-of- 
 door life for an indoor one or exchange an isolated country life for 
 a complex city one means that many will be weeded out. 
 
 This weeding-out process occurs everywhere, even among plants. 
 Every now and then some blight or rust gets among cultivated 
 plants and destroys them. Perhaps a few out of a large field sur- 
 vive and the plant breeder by saving the seed of these in time 
 produces a "disease proof," i. e., rust or blight proof, variety to 
 take the place of the other, the susceptible kind. Thus we have 
 the present "rust proof oats" and many disease and rust and 
 blight proof fruits and vegetables. The naturalist would say they 
 are the survival of the fittest. There is increasing difficulty in 
 raising many plants on account of the appearance of all kinds of 
 plant diseases. 
 
 Many if not most domesticated plants and animals would quickly 
 perish if left to nature ; they are not adapted. Chickens and geese 
 unable to fly would fall a prey to their enemies, especially to the 
 fox. A cow without powerful horns would fall a prey to the wolf. 
 The seed of plants such as corn and melons would not "winter 
 over." It is man who makes the conditions for their existence 
 possible, just as he makes conditions for his own existence favor- 
 able. To neglect sanitation in large cities would mean that the 
 inhabitants would die off in vast numbers from epidemic diseases; 
 we need only keep in mind how Asiatic cholera and the Bubonic 
 plague are kept out of the country or kept under control. 
 
 Occupations and Meeting Places. It would be interesting to 
 follow up the different occupations taken up in our State in the 
 course of time, beginning with that of hunting and trapping and 
 followed by farming. Perhaps the first differentiation, that is the 
 first sedentary occupation, was that of store-keeper, the man who 
 supplied the simple wants of the settlers, taking in return the 
 produce of woods and fields. From the standpoint of the evolu- 
 tion of diseases, one may say that the store is an important factor 
 
52 DUSTY AIR AND ILL HEALTH. 
 
 because it formed a meeting place for all sorts of individuals. On 
 long winter evenings the men crowded about the stove to exchange 
 stories, at the same time smoking and chewing and spitting. Un- 
 der such conditions the germs of disease are readily transmitted 
 from one to another. 
 
 The preacher too came in early and churches were built, and 
 that means that another place for the propagation and exchange of 
 diseases was established ; the sick and the healthy met. One may 
 say that in proportion as there was poor ventilation the chances of 
 transmitting diseases were increased. Some churches are not 
 opened from one Sunday to another. 
 
 Trades came in gradually. The blacksmith early set up his 
 forge in the new settlement. "The butcher, the baker, the candle- 
 stick maker" all followed in time, as the country grew. The ad- 
 vent of steam led to the formation of industrial communities, of 
 factory towns, with men confined indoors, often under very bad 
 sanitary surroundings all day long. Some parents have an idea 
 that their weak or delicate children should take up some indoor 
 occupation, that they are not strong enough to be "exposed;" what 
 they may really require is an outdoor occupation. 
 
 Schools are places where children congregate. They came in 
 early. Here we have the great agency for the spread of diseases 
 among children, the children from the homes of the well or healthy 
 coming in contact with the sick and diseased. Even today the 
 annual fall opening of the schools is followed by a great increase, 
 often an epidemic, of certain diseases. Children may take infec- 
 tion home to their parents. 
 
 Every county has its court house and this again is a meeting 
 place for the people of a large area. The poor ventilation and 
 unsanitary condition of many court houses are notorious. One can 
 readily see how a court house may form a focus for the dissemina- 
 tion of diseases among country people. When a small community 
 reaches the size of a town it likely has its opera house. Today in 
 addition there are one or more five cent theaters, often very poorly 
 ventilated, regular incubators for ill health and disease, as many 
 have discovered and with the discovery remain away. 
 
LOCAL CONDITIONS AND CHANGES IN TIME. 53 
 
 Disease and III Health. Disease like every other phenome- 
 non in this world has a cause. In the absence of the cause the 
 reaction, that is, the disease, is absent. For instance, there can 
 be no alcoholism in the absence of alcohol ; there is no typhoid fever 
 in the absence of the bacillus typhosus. Often the relationship is 
 not so simple, as in the case of malaria, which on the one hand 
 requires the presence of the active cause (a plasmodium) and on 
 the other the presence of the transmitting agent (a certain kind 
 of mosquito, genus Anopheles) which carries the disease from one 
 to another. 
 
 Ill health scarcely reaching a condition or stage of severity 
 where it can be dignified by the name of disease is largely due to 
 environmental influences, that is, the place where we live or the 
 conditions under which we live. (The coming in contact with the 
 sick, using bad food, bad water, bad air, living under depressing 
 conditions, etc., all are factors.) Ill health and disease of course 
 shade off; there may be no sharp dividing line. 
 
 The word disease is in the mouth of everybody. We all have 
 some idea what it means. Physicians know and many sick know 
 that there may be ill health and yet no well-defined disease, just 
 as there may be well-defined disease, especially in its early stages, 
 and yet on account of the absence of symptoms the individual may 
 not be aware of it, symptoms may appear later. One may argue, 
 "If there are no symptoms there is no disease." 
 
 The body reacts to all sorts of causes, material and immaterial. 
 We may feel bad on account of bad news, worry, or fright, just as 
 we may feel bad by using improper food and drink. Food may 
 undergo a change with the production of poisons (as ptomaines), 
 and the reaction may be a poisoning, perhaps not strong enough 
 to kill but certainly to produce ill health or sickness. Bad water 
 and bad air are often a cause for continued ill health, not to speak 
 of definite diseases. The causes of many specific diseases have 
 been definitely determined. It is positively known that in the ab- 
 sence of the cause there can be no disease, just as a field will be 
 free from weeds unless seed of weeds is brought in, each kind re- 
 producing itself and no other. But strange to say the cause of 
 
54 DUSTY AIR AND ILL HEALTH. 
 
 much common ill health is not known. In fact, ill health may be 
 due to a great variety of causes, often difficult to determine. Here 
 again we may question to what extent common ill health prevailed 
 among the Indians and the first white men. 
 
 All sorts of speculations may be made regarding the amount of 
 ill health dependent upon complex life conditions. It can not be 
 too strongly emphasized that the Indian and the early white settler 
 led simple lives, coming in contact with few, while today there is 
 a many-sided contact, especially among city people. There are 
 even individuals who have come from far away countries who have 
 brought with them the germs of foreign diseases. We need only 
 think of our soldiers and teachers and missionaries in the Philip- 
 pines bringing in new and strange diseases. Such diseases should 
 be carefully studied and kept under observation to prevent their 
 spread. 1 It is perhaps unnecessary to say that tropical diseases 
 may find the temperate zone as unfavorable for their propagation 
 as tropical weeds find climatic conditions unfavorable. Out of a. 
 great number of weeds constantly introduced only a comparative 
 few are able to maintain themselves in the new environment or 
 climate. 2 
 
 If we were to review the different diseases known to occur or 
 to have occurred in Indiana it would be necessary to distinguish 
 between native and foreign diseases, just as we must distinguish 
 between native and foreign plants and animals and native and 
 foreign weeds and pests and parasites of all kinds. Unfortunately 
 early records of the first appearance of new diseases as of new 
 weeds and parasites are scant. Now that many are common it is 
 difficult to determine whether they were natives or not. The first 
 white men were not observers or if so left no records. 
 
 The first medical men coming into our State were army sur- 
 
 1 A few years ago I had an opportunity to study a tropical disease, Psilosis, in a missionary returned 
 from Asia. Fortunately this disease did not spread, perhaps on account of unfavorable climatic 
 conditions. 
 
 2 While keeping track of new plants, mainly weeds, coming into Fayette county (Indiana), from 
 1883 to 1890, especially along the railroads, I was interested in noting that out of thirty-five new arrivals 
 only nine were able to maintain themselves from year to year, and that not more than half a dozen 
 of these became common weeds. (For details see Proceedings Indiana Academy of Science, 1893, 
 pp. 258-262.) 
 
LOCAL CONDITIONS AND CHANGES IN TIME. 55 
 
 geons and they left scarcely any records. It should be borne in 
 mind that when we speak of a new disease we mean an old disease 
 in a new locality, just as a new weed means an old weed now for 
 the first time found in a new locality. Many old diseases are still 
 absent in certain parts of the world, they have not been introduced 
 Some small islands are still free from a number of the common 
 diseases but it is only a question of time until they will be intro- 
 duced. 
 
 Disease vs. Ill Health. Well-defined diseases shade off into 
 ill-defined states of "ill health" where one can hardly speak of 
 "disease." Diseases like conditions of ill health manifest them- 
 selves by symptoms. Is a slight headache a disease, a condition of 
 ill health, or only a symptom? If stomach distress is persistent, 
 or recurs frequently, we may speak of ill health, and yet the best 
 medical skill may be unable to diagnose the presence of disease. 
 Common stomach disturbances are commonly called "dyspepsia," 
 due perhaps to one or several of a great variety of causes, as im- 
 proper food, spoiled food, food that is too hot or too cold, or be- 
 cause of defective mastication, depressing conditions, etc., yet dys- 
 pepsia may not be a well-defined disease. 
 
 Many so-called diseases are really states of ill health often with- 
 out ascertainable cause. The tendency nowadays is to classify dis- 
 eases according to their causes. The highly artificial classifications 
 of, say, a hundred years ago have practically disappeared. 
 
 The classification of diseases a hundred years ago, at the time when 
 our State was first being settled, was by classes, orders, genera and 
 species, just as in the case of botany and zoology. Many systems of class- 
 ification have appeared, each one supposed to be an improvement over pre- 
 ceding ones, and physicians are just now working upon a new system 
 which they believe will stand the test of time. Old systems were based on 
 symptoms, the new is based on the recognition of the cause of the dis- 
 ease. Thus Osier's recent treatise takes up first the diseases due to ani- 
 mal parasites — those due, in order, to protozoa, parasitic infusoria, to 
 flukes, cestodes, uematodes, and so on — followed by the specific infectious 
 diseases, from typhoid and typhus fever running down to tuberculosis and 
 leprosy, including some whose causes have not been definitely identified, 
 analogy admitting their inclusion. The reactions or intoxications due to 
 the ingestion of chemical substances, such as alcohol, morphia and lead. 
 
56 DUSTY AIK AND ILL HEALTH. 
 
 follow, with i mention of sunstroke — and then all at once there is a classi- 
 fication riot. For want of something better, a number of diesases are de- 
 scribed under the head of •Constitutional Diseases.' Then follow a host 
 of affections and diseases that for convenience are grouped under their 
 respective organs, beginning with the diseases of the mouth and running 
 down the alimentary tract, followed by the affections of the other organic 
 systems — the respiratory, the nervous, etc. One-third of the book is thus 
 definite, based on a scientific system, the rest is simply based on conven- 
 ience of reference. Although we have here real progress, yet how much 
 still remains to be done." 1 
 
 Many of the common every day symptoms such as pain, head- 
 ache, lack of appetite, cough, insomnia, constipation, may occur 
 under a variety of conditions, as for instance a ride on a train or a 
 visit to the theater. Those who have traced the relationship often 
 prevent symptoms by avoiding the cause. Many have learned the 
 lesson that prevention is easier than cure. 
 
 Some disturbances of the body are known as "occupational 
 diseases;" there is a large number of them among men confined 
 indoors, especially when employed in factories and exposed to 
 various sorts of irritating dusts. We need only think of "knife 
 grinder's rot," where the lungs are worn away on account of in- 
 halation of gritty matter, usually followed or complicated by the 
 entrance of micro-organisms that hasten the breaking-down process. 
 "Industrial diseases are mostly dusty diseases." 
 
 Disease and ill health go largely with kinds of people and kinds 
 of occupation. Some people are readily killed off by certain occu- 
 pational or indoor diseases, while others are quite resistent. The 
 Indian, for instance, who has always led an active out-of-door 
 life is quickly killed off by so-called city or house diseases to which 
 the Jews are quite resistent ; the latter have long been exposed to 
 them ; the susceptible were weeded out for generations. Some oc- 
 cupations are highly injurious to life; those who follow them are 
 short-lived, a fact considered by insurance companies in their mor- 
 tality tables. Other occupations "take it out" of the men, dis- 
 abling them so that when they reach the age of about forty years 
 they are worn out. (A big industrial city has little use for men 
 over forty.) A man's mode of life and habits are important fac- 
 
 1 The Evolution of Medicine in Indiana. Proc. Ind. Acad. Science, 1906. 
 
LOCAL CONDITIONS AND CHANGES IN TIME. 57 
 
 tors. The place of residence is important, whether in the heart of 
 the city or in the suhurbs, or in the country. In general it may be 
 said that city life is very deteriorating and leads to "race suicide." 
 A new born child must run the gauntlet of all kinds of diseases. 
 Out of the many born comparatively few reach old age. In pro- 
 portion as people live under simple conditions, in isolation, a larger 
 number is apt to reach maturity and old age. Until recently san- 
 itary conditions in large cities were so bad that cities were wholly 
 unable to maintain themselves; they required the constant influx 
 of new country blood. 
 
 Studying Diseases and III Health. We all know that med- 
 ical men are especially interested in diseases but some individuals 
 in ill health have discovered that many doctors are not interested 
 in ill health, as distinct from actual disease. Some physieians will 
 discuss diseases with patients but have little to say about common 
 ill health. x\s Moliere long ago observed, they want cases of severe 
 diseases. As a rule their medical society discussions and articles 
 in medical journals relate to diseases rather than to ill health. 
 
 Because of the fact that physicians do not discuss common ill 
 health many communities are very backward in the matter of san- 
 itation. A family physician may fully advise his patient and his 
 family and yet not have a single word to say to the community as 
 a whole. Indeed, there are not lacking doctors who merely sell 
 medicine in competition with the druggist; they never give any 
 general advice regarding the care of the sick and the prevention of 
 ill health and disease. A common explanation is that "we are not 
 paid for it, ' ' and some do little or nothing unless paid. Then there 
 are not lacking physicians who are so ultra-scientific that their 
 whole attention is given to the patient's disease in contrast to the 
 faithful family physician who looks after his patient and helps 
 him to throw off the disease. 
 
 The following table 1 ma}'' give some general idea of the evolu- 
 tion of the common medical man of today, showing how there has 
 been a successive branching off. (Read from below up.) 
 
 1 The Evolution of Medicine in Indiana. Presidential address Indiana Academy of Science, 1906 
 
58 
 
 DUSTY AIR AND ILL HEALTH. 
 
 <P 
 
 V 
 
 J? 
 
 
 4f 
 
 
 - 4 &s 
 
 
 
 
 V </ a* ^> 
 
 
 
 
 pP* S. v <K 
 
 £>> 
 
 N°VV 
 
 -Specialization in Medicine — eye, throat, stomach, 
 nerves, etc. 
 
 -Separation of the Surgeon (Barber's pole a survival of 
 early times.) 
 
 5 2 
 
 «> o a> 
 so Pin 
 
 «■ M< _ 
 
 moo 
 
 I — Separation of Sanitarian. 
 [ — Separation of Bacteriologist. 
 
 -Separation of Physiologist. 
 
 -Separation of Anatomist. 
 
 -Differentiation of Alchemist, developing into the Chem- 
 ist. 
 
 I — Dif. of Herbalist, from whom developed the Pharmacist 
 and Botanist. 
 
 — Dif. of the Astrologer, ultimately developing into the 
 Astronomer. 
 
 | — Dif. of Chief (survival of belief in the King's Touch for 
 scrofula, and of the belief in the Divine Right of 
 Kings.) 
 
 I — Dif. of the Priest. (Survival of Faith Cures and the power 
 of prayer in arresting epidemics.) 
 
 Differentiation of the Primitive Medicine Man. (Survival 
 today of primitive beliefs, in charms, amnlets incanta- 
 tion, nauseous drugs, etc. ) 
 
 All men alike. 
 
LOCAL CONDITIONS AND CHANGES IN TIME. 59 
 
 The Indian ''medicine man" needs scarcely be mentioned be- 
 cause he was an ignoramus of the first water. The white man has 
 nothing to learn from him. 
 
 The first white medical men in Indiana were United States army 
 surgeons who accompanied the soldiers to treat the wounds in- 
 flicted in battle rather than those inflicted by nature. They left 
 practically no records of conditions found. Gradually venture- 
 some doctors from older communities came to the new settlements 
 to treat the wounds and injuries and the simple ailments of the 
 people, in time getting more and more to do as the old "diseases 
 of civilization" came in. The first doctors were largely of the 
 rough and ready kind; they used heroic measures and remedies; 
 they bled and purged and vomited and resorted freely to the use 
 of mercury. They were abhored by women and children and so 
 it was not long before physicians of a different type gained a foot- 
 hold, men who were opposed to bleeding and purging. Some of the 
 old time diseases may have demanded heroic treatment but as a 
 rule ill health (in the absence of well-defined disease) demands 
 gentle measures, and often attention to a variety of little things 
 rather than a lot of strong medicine. 
 
 In looking over the old Transactions of the Indiana State Med- 
 ical Society one finds that some physicians believed there was a 
 change going on in diseases, that not only were new ones coming 
 in but old ones were undergoing a modification and required a 
 different mode of treatment. 
 
 In the course of time medical schools were established. These 
 at first had low standards; the students came mainly direct from 
 the farm ; high schools were unknown. Today Indiana has a com- 
 paratively high standard and instead of a number of small poorly 
 equipped schools there is one good one. It may be said this is due 
 to the activity of physicians themselves — often the people antag- 
 onize higher standards, being satisfied with cheap poorly qualified 
 doctors, not real physicians. 
 
 Medical instruction at first was purely by lectures, the same 
 lectures being repeated from year to year. Listening to them for 
 two years was about the only requirement. In the course of time 
 
60 DUSTY AIR AND ILL HEALTH. 
 
 laboratories came. The students handle things and experiment. 
 But there is danger of neglecting ordinary observations, especially 
 by neglecting a study of people who have ill health rather than 
 well-defined disease. There are no instruments for estimating 
 pains and aches. 
 
 In time also specialists arose. At first there was a separation 
 into physicians and surgeons. The surgeons sub-divided into dif- 
 ferent specialities, as eye and ear, nose and throat, etc. Physi- 
 cians also divided into specialists, taking up the internal organs of 
 the body. In the course of time general sanitation was given at- 
 tention. The State was prevailed upon by progressive physicians 
 to look after the community as a whole through a State Board of 
 Health, followed by county health boards and this in turn by city 
 boards of health. Unfortunately all of this work is still quite ele- 
 mentary. As a people we have not yet reached a stage where we 
 fully appreciate disease prevention. Only recently an effort was 
 made at Washington to organize a National Department of Health, 
 co-ordinating all the various agencies in the interest of the people, 
 just as the Agricultural Department, for instance, works in the 
 interest of the farmer in giving him information about his animals 
 and plants. But there is always bitter opposition to medical men 
 and their aims and methods. When we study the question of 
 chronic ill health we may find that many are opposed to physicians 
 on account of their failure to "cure" common ill health, especially 
 by the use of drugs. Much of the common everyday ill health is 
 incurable but preventable, as I shall attempt to show later. 
 
 The term "doctor" originally meant a teacher; it still means 
 that when applied to the college professor, but it has degenerated 
 and from it we have the verb "to doctor." Many of the sick keep 
 themselves poor by "doctoring," never getting the best that the 
 art or science of medicine has to offer. Just as bad money drives 
 out good money, so bad or poor doctors drive out good ones. When 
 the people demand better doctors than they now have they will get 
 them. 
 
 As already mentioned, there are all sorts of causes that derange 
 health and bring on ill health, as there are all kinds of causes for 
 
LOCAL CONDITIONS AND CHANQES IN TIME. 61 
 
 accidents and fatalities. Many causes are avoidable and ill health 
 and disease and accidents preventable. People living under good 
 surroundings and leading "healthful" lives as a rule have little 
 sickness. But in proportion as people live under or come in con- 
 tact with unsanitary conditions, or are careless, they may suffer. 
 
 What the people expected from the old time doctor was mainly 
 a lot of medicine. Many moreover had a belief that the nastier 
 medicine was the more powerful it was apt to be. Intelligent 
 people are gradually getting further away from that idea; they 
 want less and less medicine and more and more advice. Physicians 
 themselves have long realized that many ills are incurable by drugs 
 but that symptoms can be modified or palliated. But there are 
 still too many people who want only palliation, who only come to 
 the doctor when feeling bad; the moment they feel better they 
 cease to report. Many give him no opportunity at all to "super- 
 vise health" and reduce their ill health to a minimum. 
 
 Today we frequently hear the terms Health Inspection, Med- 
 ical Inspection and Health Supervision. These terms are especially 
 used in connection with school children. The people are gradually 
 beginning to realize that there is more in the practice of medicine 
 than the simple giving of drugs. 
 
62 
 
 DUSTY AIR AND ILL HEALTH. 
 
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III. 
 
 DUST AND DUST VICTIMS. 
 
 There are numerous kinds of dust. We can classify them un- 
 der two heads: Dust found in nature independent of man, and 
 dust due to human activity. The divisions of course overlap, as 
 dust coming from a field which originally was a forest. One can 
 easily see how in the absence of man there would be no such dust 
 and yet at present we speak of this as dust independent of man. 
 The table 1 opposite in a general way classifies dusts in the order 
 of their probable appearance during the different stages of man's 
 development. 
 
 Dust due to human activity may in a general way be divided 
 into Country Dust and City Dust. The kinds to be found in the 
 country are few in number although making up in volume. In 
 large cities there are almost innumerable kinds, especially in dusty 
 occupations. It would be an almost endless task to attempt to 
 describe occupational dusts and their deleterious influence on hu- 
 man welfare, but if we narrow our inquiry down to say nine-tenths 
 of the people and to nine-tenths of the prevalent kinds of dust we 
 can better arrive at some general conclusions. 
 
 Country Road Dust. This is the commonest form of dust. It 
 consists almost exclusively of pulverized mineral matter. People 
 who live in cities with well-paved streets or in countries with well- 
 kept roads have no idea of dust conditions that at times prevail 
 in backward communities. Many of our roads and so-called city 
 streets are covered with from two to three inches of dust (accord- 
 ing to some of our local newspapers even to a depth of half a foot, 
 but this is clearly an exaggeration). This dust is more or less 
 constantly arising and is carried about by air currents. A strong 
 wind will fill the air with a large amount of fine particles, dust 
 proper, while the larger particles are forced along the surface until 
 they come to rest, giving protection to the finer particles under- 
 
 1 Proceedings Indiana Academy of Science, Presidential Address, 1906. 
 
64 DUSTY AIR AND ILL HEALTH. 
 
 neath. With continued high wind there will he less and less dust 
 blown about At times the surface of some streets shows peculiar 
 markings, ridges, resembling those of wave marks along a shore. 
 Any unusual gust of wind disturbs this natural arrangement of 
 particles; it is of course disturbed by passing vehicles, that means 
 on streets that are much travelled there are constant dust clouds. 
 At times a street will be wind-swept down to the hard underlying 
 "bed rock," that is, to the gravel or stone which has not yet been 
 pulverized. This condition is frequently seen on long, wide east 
 and west streets where the wind has free scope. 
 
 Dust from Paved Streets. This varies in quantity and in 
 composition. In a large city with paved streets everywhere and 
 with practically no mud tracked on from unpaved streets, dust is 
 composed chifly of horse droppings and coal dust, including under 
 this term dust traceable to or derived from coal. In manufactur- 
 ing towns there may be a large amount of this latter. Then there 
 are dust particles derived from the wear and tear of the paving 
 material itself, besides various additions from human beings. 
 
 The small city as a rule has only a few paved streets in the 
 heart of the city and "paved street dust" is mainly that brought 
 from the unpaved streets, either blown on by the wind or more 
 commonly tracked on by vehicles, that is, the material adheres to 
 the hoofs of horses and wheels of wagons in the form of mud. On 
 paved streets this dries out rapidly and becomes pulverized, differ- 
 ing little in composition from unpaved street dust. After a rain 
 unpaved streets may be "seas of mud," while a nearby paved 
 street gives off a heavy dust-cloud. 
 
 Glass Dust. One very important ingredient in town dust is 
 pulverized glass. The amount of glass thrown on to streets which 
 ultimately becomes pulverized, and of course blown about, is really 
 remarkable. It seems strange that such conditions should be al- 
 lowed to exist — but what is everybody's business is nobody's bus- 
 iness. 
 
 Pollen Dust. The amount of pollen in the air during the 
 summer varies greatly. Pollen is derived from many plants, both 
 
DUST AND DUST VICTIMS. 65 
 
 wild and cultivated. We need only think of the clouds of pollen 
 dust near pine forests, of which we have none here, however. Of 
 pollen dust due to wild plants perhaps the most noted is that de- 
 rived from the Ragweed (Ambrosia artemisiaefolia), which man- 
 ifests its presence in those susceptible as "Autumnal Catarrh," 
 commonly known as Hay-fever. There are of course many differ- 
 ent kinds of pollen; some individuals react to one kind, some to 
 another. "Rose Cold" is ascribed to the pollen from roses. 
 
 Spit Dust. This is the most important kind of dust from the 
 standpoint of the sanitarian. It varies in different cities and in 
 parts of the same city. European cities as a rule are remarkably 
 free from it, while in our country where the tobacco chewing habit 
 prevails it is very common. In large cities it is apt to occur most 
 plentifully in neglected sections, especially in slums, while in the 
 smaller communities it is mainly found in the heart of the city 
 where street loafers meet. 
 
 The amount of tobacco spittle on sidewalks of smaller commu- 
 nities is really remarkable. The photographic reproductions in 
 the Appendix will perhaps give some idea to those unacquainted 
 with small city conditions. The student of dust influences natur- 
 ally goes to a community where the kind of dust he proposes to 
 study is most abundant, just as the hay-fever student goes to a 
 country where hay-fever or its particular pollen dust is found. 
 The effects of coal dust and soot and smoke are best studied in a 
 smoky city. The effects of spit dust are best studied in a com- 
 munity where the spitting habit prevails, not only sidewalk spit- 
 ting but also floor spitting. Spittle is tracked about, it dries and 
 becomes pulverized and fills the air. Spit dust is common not only 
 on down town streets but also in stores and offices. It is carried 
 home on shoes and dresses. Country women with trailing dresses 
 may carry a large amount to their homes. The term spit dust is 
 not an elegant one; it grates on the ears when heard repeatedly, 
 therefore in this volume the simple term dust should be understood 
 as applying to spit dust. The terms bad air, crowd poison, and 
 similar references in this volume should also be understood as 
 synonyms. 
 
 15] 
 
66 DUSTY AIR AND ILL HEALTIT. 
 
 Smoke and Smog. Some cities and towns are smoky rather 
 than dusty, especially manufacturing communities where no atten- 
 tion is given to smoke prevention. A smoky city is naturally more 
 or less dusty because no special efforts at cleanliness are made. 
 Recently the term smog came into use, signifying the smoke, dust, 
 and fog cloud which overhangs cities. There are all sorts of opin- 
 ions regarding the injuriousness of smoke. It is well known that 
 carbon particles are deposited in the lungs. The lungs of old city 
 residents may be coal black, yet some of these people live on to 
 old age ; they are exceptional of course. That the effects of smoke 
 on comfort, on clothing and on furniture, and on health are more 
 or less marked must be self-evident. The air of a smoky city may 
 be so bad that trees can not thrive in it — but human beings are 
 expected to thrive. Since this volume is a study of the influence 
 of dust, the subject of smoke must be dismissed with this brief 
 mention. 
 
 Indoor Dust. Many people when they hear the word dust 
 think of the dust clouds blowing about out of doors ; the physician 
 thinks mainly of indoor dust. This latter of course varies greatly, 
 depending on the nature of the building, whether a home, store, 
 factory, school house, church or theater, etc. It will also vary ac- 
 cording to the kind of people who occupy such structures, whether 
 or not they are cleanly in their habits. Thus a five cent theater 
 may have a very filthy floor, giving off a virulent dust, while a fine 
 opera house patronized by clean people only may be relatively 
 clean. The location of a house may be very important. To realize 
 this one need only look at a down town stairway leading from the 
 sidewalk to the upper floors ; some have a mass of filth all the way 
 up, with much dust blowing up into the rooms. In the suburbs a 
 stairways may be clean. Some buildings have special forms of dust ; 
 we need only think of school houses and chalk dust, to which some 
 individuals are susceptible. 
 
 There are all kinds of indoor dusts to which special names may 
 be applied. To some bookdust or library dust is important. It 
 will readily be seen that this is mainly an accumulation of dust 
 that has been in the air and has settled down on the books, espe- 
 
DUST AND DUST VICTIMS. 67 
 
 cially on those with rough edges. However one must not forget 
 that infective material may be deposited between the leaves by 
 coughing or sneezing, as well as by soiled fingers. Whether a li- 
 brary is in the heart of a dirty city or in a clean suburb inhabited 
 by cleanly people may make a marked difference to the reader who 
 is a dust victim. 
 
 Dust of Dwellings. In a general way this can be divided 
 into several varieties, the most common being Floor Dust. The 
 amount varies greatly in different homes and is dependent on a 
 number of factors, especially on proximity to dust sources and on 
 the nature of the floor covering, being least with waxed floors and 
 greatest with a carpet that is tacked down and very seldom cleaned. 
 (I have known carpets that have been down for several years; any 
 one walking over them would stir up a cloud of dust, clearly vis- 
 ible in a beam of sunlight.) One can readily understand how 
 people living in rooms heavily carpeted may be constantly inhaling 
 dust and why there should be complaint of symptoms of ill health. 
 At times people will complain of windstorms bringing on certain 
 symptoms or an attack of ill health. Further on I mention a 
 patient who thus complained. The cause was floor dust, blown out 
 of crevices and carpets. Another dust that should be mentioned 
 is that derived from hot air furnaces, especially from old leaky 
 ones. The question, What is the best method of heating a house? 
 is not at all a simple one. 
 
 The different sources of house dust need not be enumerated. 
 I recall the home of a patient where the wall paper contained 
 glistening mineral matter, which was constantly falling off in the 
 form of a very irritating dust, this being most marked on windy 
 days when the accumulated matter would be blown out of the 
 cracks in the floor and fill the room. 
 
 In households where featherbeds are still used the bedrooms 
 may be filled with an irritating "feather-bed dust" to which some 
 react. 1 
 
 1 Feather bed dust is one of the few kinds of dust to which I react, as I discovered on sleeping in 
 an old feather bed in an isolated mountain inn among the Alps. This dust seti up a profuse mucus 
 flow. The experience seemed so odd that I made a note for a medical journal (Indiana Medical Journal 
 January, 1901). 
 
68 DUSTY AIR AND ILL HEALTH. 
 
 Sterilized and Unsterilized Dust. Dust containing dried 
 spittle may contain all sorts of infectious matter, especially that 
 derived from people in ill health or diseased, those having colds 
 and catarrh, bronchitis, etc., including pneumonia, and tubercu- 
 losis. But such infectious matter becomes sterile, harmless, in the 
 course of time, both under the influence of age and of bright sun- 
 light, Strong sunlight quickly destroys microbic life. Protected 
 from sunlight, as in a closed room, infected dust may retain its 
 virulency for a long time, for months. 
 
 Popularly it is believed that the air of the country home is 
 good; as a matter of fact often it is worse than that of the city 
 home. Country women will trail their dresses over filthy sidewalks 
 and then clean them in the living room, filling the house with in- 
 fection. Many city homes have waxed floors and rugs that are 
 taken out and cleaned frequently, but country homes as a rule 
 have a carpet that is taken up only at long intervals, perhaps not 
 even once a year. The mode of heating a house must also be con- 
 sidered, whether there is constant ingress of outdoor air. 
 
 A farmer who sees clouds of dust blowing off a road or from the 
 fields (in harrowing a field great clouds may be given off) may not 
 realize that dust from a filthy city or from an old carpet is some- 
 thing entirely different, a something to be avoided. 
 
 In studying dust influences one must not only consider the 
 place of residence, the kind of home, but also habits of general 
 cleanliness. As a matter of fact, the study of dust influences is a 
 study of endless details, as case reports cited later on may show. 
 
 "Beneficent Dust." Several years ago a short article under 
 this caption made the rounds of the newspapers. Several of my 
 a-b-c patients gave me copies, thinking that the article was antag- 
 onistic to my own ideas regarding the injuriousness of dust. That 
 article was evidently written by a physicist and the kind of dust 
 he had in mind was more particularly the cosmic dust that floats 
 high in the atmosphere, modifying light and moisture. My "old 
 experienced patients" readily saw that the article and the kind of 
 dust had nothing whatever to do with the very practical aspects 
 
DUST AND DUST VICTIMS. 69 
 
 of the dust problem as seen in every-day life, the battle of the 
 housewife against dust and of communities warring against dirt 
 and dust. 
 
 SPITTING OR EXPECTORATION. 
 
 We must distinguish between two kinds of spitting, one neces- 
 sary, the other needless. Spitting tobacco juice is wholly senseless. 
 It seems strange that men should fill the mouth with a poisonous 
 weed and then begin to work the jaws and secrete a lot of fluid 
 which, discolored by tobacco, is spit out promiscuously. That 
 many of these spitters have catarrh and bronchitis and tonsillitis 
 and consumption must be self-evident. Moreover the tobacco user 
 encourages others to spit. In European countries where the chew- 
 ing of tobacco is unknown one sees little spittle on the sidewalks. 
 One of the first things Dickens noticed on coming to our country 
 was the American spitting habit. He also wrote of American 
 catarrh, but he evidently did not see the relationship. When 
 spittle is pulverized, it arises as dust and is inhaled by others, the 
 germs in it ready to set up disturbances. As the seed of weeds go 
 from one field to another, so the germs of diseases go from one 
 individual to another. 
 
 The practice of spitting upon or at a person to show utter con- 
 tempt has practically disappeared. It is to be hoped that the 
 practice of chewing tobacco and soiling floors and sidewalks will 
 also disappear. Some even advocate anti-smoking laws because 
 the smoker (men, women seldom smoke) spits more or less. 
 
 The other kind of spitting, perhaps it should be called expec- 
 toration, is a normal or physiological process, especially common 
 among people living under dusty air conditions. Dust inhaled 
 lodges on the mucous membranes, all the way from the nose down 
 into the lungs (a small quantity may lodge in the lungs and be im- 
 bedded in the tissues and the lungs in time become black; the 
 lungs of people of smoky and dusty cities are usually coal black) . 
 Mucous membranes contain glands which give off mucus which 
 forms a coating, protecting them. But a more important function 
 of mucus is to entangle dust. The city man when he blows his 
 
70 DUSTY AIR AND ILL HEALTH. 
 
 nose "blows black." When sufficient mucus has accumulated in 
 the throat it can be hawked up. Students of bird lore know how 
 the owl ejects pellets; it swallows mice and absorbs the nutriment 
 and then the bones are wrapped in the skin and cast out. A sim- 
 ilar process occurs when dusty air is inhaled, we "spit black." 
 One need scarcely refer to the fact that the body absorbs the life- 
 giving oxygen from the air and emits carbonic acid gas, the latter 
 a union of the oxygen inhaled with the carbon ingested as food, 
 the result of the decomposition being heat and force. 
 
 But we should clearly distinguish between these two kinds of 
 spitting, more properly speaking between spitting and expectora- 
 tion, the one is useless and unnecessary, the other a normal process 
 that should be encouraged. 
 
 During the last few years there has been a general command, 
 Do Not Spit. This has led many to retain what nature intended 
 should be spewed out. Children are often reproved for expecto- 
 rating when in fact they should be encouraged. But where should 
 abnormal secretions be deposited ? Spittle, or expectoration, should 
 be deposited where it does not become pulverized and fill the air! 
 This is particularly necessary in the case of those afflicted with 
 disease. Some persons think they are cleanly when they expec- 
 torate into a handkerchief, but if we observe how some shake their 
 handkerchiefs in the air, especially in closed rooms, we will come 
 to the conclusion that that is not at all a sanitary practice. The 
 Chautauqua salute for this reason is now recognized as objection- 
 able. 
 
 Railway passengers are often compelled to inhale much smoke 
 and dust ; this is followed by a free formation of mucus. What 
 shall be done with this? Some railroad companies furnish cuspi- 
 dors; others have conspicuous signs, Do Not Spit, leaving the pas- 
 senger at a. loss what to do. He will either spit into his handker- 
 chief, out of the window, or stealthily on the floor, or perhaps swal- 
 low what nature intended should be spat out. Riding on cleanly 
 trolley cars is less apt to be followed by a mucus flow. Although 
 the average trolley car may show less dust than the average day 
 coach, yet the dust may be more objectionable because containing 
 
DUST AND DUST VICTIMS. 7] 
 
 more infection from spitters; spitters are more apt to patronize 
 trolleys. 
 
 What about sidewalk spitting? Some European cities have a 
 small stream of water flowing along the gutter. 
 
 The solution of the anti-spitting question may seem complex ; 
 in reality it is simple. People who inhale clean air have no abnor- 
 mal respiratory secretions, they have no need to spit at all ! The 
 remedy is to clean up ! When our cities give their people clean 
 air as they now attempt to give them clean water the necessity for 
 expectorating will disappear. And as to the tobacco chewer, he 
 should be sternly repressed. He is an anomaly under present-day 
 civilization, and no doubt the smoker also will become an anomaly 
 before long. 
 
 Sometimes people question, Is dust after all injurious? We 
 might refer them to the watch maker or the automobilist ; they 
 have some decided opinions ! Why should dust be less injurious 
 to the human machinery? 
 
 Every housewife knows that a small particle of infection in 
 her canned fruit produces a certain effect. A large amount of 
 common dust may choke up a man but a smaller quantity of in- 
 fected dust may produce effects not so quickly apparent, although 
 perhaps much more serious, as I shall attempt to show in Case 
 Reports. 
 
 Some ask. What becomes of the dust that is inhaled, how does 
 it affect the body? How does it affect the organs? How does it 
 affect states of the body designated as health and ill health and 
 disease ? Some people are constantly hawking and spitting ; what- 
 ever they inhale comes up entangled with mucus; others never 
 hawk and spit ; all the dust inhaled seems to remain. I have some 
 patients under observation who the moment they cease to "spit 
 black" begin to complain but with a return of this expectoration 
 feel better. Some may actually be sick during this interval; ap- 
 parently there is an overworking of the defences of the body. It 
 would seem that the resulting sickness is really a conservative 
 process and that the pains and aches are merely warnings that a 
 struggle is going on in the body. 
 
72 DUSTY AIR AND ILL HEALTH. 
 
 While these notes were being put together one of ray old pa- 
 tients, who has been with me for years, had undergone a siege of 
 "lumbago." He is a dust victim who complains hoth of "dys- 
 pepsia 1 ' and of '• rheumatism." His occupation is one that com- 
 pels him to inhale much coal smoke; he always "spits black" but 
 he does not complain unless he also inhales infected dust. Recently 
 he had a disturbed stomach and then lumbago developed; this 
 rendered him bedfast or at least "housefast" for several weeks. 
 It was really an enforced vacation. He soon noticed that his stom- 
 ach was "all right" and that he no longer spit black. On getting 
 back to work he promptly began to "spit black" and it will be 
 only a question of time until he again complains of "dyspepsia." 
 
 This patient had had all sorts of experience among physicians 
 before coming to me. The last one blistered him to such an extent 
 that he had to stop work — he got better however. He now wonders 
 whether the best place for a blister is not on the soles of the feet ; 
 that will keep a man at home and give nature a chance, to cause 
 symptoms to disappear, not to speak of "bringing back health." 
 
 Medical men have names for the effects produced by the in- 
 halation of different forms of dust: Anthracosis for the effects 
 produced especially in coal miners ; Byssinosis due to inhaling cot- 
 ton dust, as in cotton factories; Chalicosis, Silicosis and Siderosis 
 are names applied to affections in potters, stonemasons and iron- 
 workers who inhale gritty matter. The term Pollenosis is now com- 
 ing into general use ; the name indicates a state or condition pro- 
 duced by inhaling pollen, that is in those susceptible. Lack of 
 space prevents entering into further details. From now on we 
 shall consider the effects of infected dust, Coniosis. 
 
 The photographs in the Appendix show why infected dust is 
 common in some communities — communities where the tobacco 
 spitting habit is unrestricted. The tobacco chewer encourages 
 others to spit, not only on sidewalks but also on the floors of build- 
 ings and street cars. 
 
DUST AND DUST VICTIMS. 73 
 
 DUST VICTIMS. 
 
 Individuals who react to infected dust (spit dust) may prop- 
 erly be called Dust Victims. There is a marked variation in sus- 
 ceptibility. Some react readily, others scarcely at all. We do not 
 know why some individuals react to some things or causes and not 
 to others, why for instance one may have rose cold and another 
 bay-fever, no more than we know why some people can not eat 
 strawberries or papaws or cheese without feeling bad. Some can 
 not drink soda water. Some teachers can not work at the black- 
 board on account of irritating chalk dust. Because we do not know 
 why they react, we say the individual has an idiosyncrasy, dismiss- 
 ing the explanation with a long word, which after all does not 
 explain. Some men on attempting to work in certain factories 
 encounter certain kinds of dust to which they react; they "give 
 up the job, just can't stand it." That also is a simple explanation. 
 
 I have frequently talked with individuals who believed they 
 were subject to crowd poison, they avoided certain places. "Crowd 
 Poison" is a vague abstraction, it does not enable a man to guard 
 himself. He assumes crowd poison to be an entity, and yet he does 
 not know where or when it is found nor how avoided. How many 
 individuals are required to make a crowd? Is one's own family a 
 crowd? Is a man living at home subject to crowd poison? Some 
 of these individuals became my patients and in time learned that 
 crowd poison really means Dust Poison, that they were Dust Vic- 
 tims. By learning whether infected dust is present they can largely 
 avoid symptoms of ill health. They can go into crowds of neat and 
 clean people where the air is reasonably pure, but it is risky for 
 them to go, for instance, to a political meeting where men spit on 
 the floor. (Perhaps this explains why some men take no interest 
 in ward politics.) 
 
 Classification of Dust Victims. In studying a large number 
 of dust victims one can divide them into groups, according to how 
 they react or how they complain, or as a physician would say, ac- 
 cording to their syndromes or symptom-complexes. In other words, 
 
74 DUSTY AIR AND ILL HEALTII. 
 
 there are different, kinds of dust victims. At the one extreme the 
 reaction may be so slight that one can scarcely speak of ill health 
 or sickness ; there may be a mere sense of discomfort, there are not 
 even well-defined aches or pains, yet the individual recognizes the 
 fact that he is "not up to standard." At the other extreme, at- 
 tacks may be so marked that the individual is promptly disabled. 
 The chief kinds of types of dust victims may be classified about 
 as follows: 
 
 1. Simple Dust Victims may complain of a mere sense of dis- 
 comfort. There is no localization in the body unless it be in the 
 respiratory mucous membranes, which may be more or less irritated. 
 An acute attack often manifests itself as a "cold," and we know 
 that that usually means an irritation of the air passages accom- 
 panied by cough. (Cough is mainly a conservative process, it helps 
 to bring up abnormal secretions and inhaled dust.) There is more 
 or less secretion from the mucous membranes, commonly called 
 catarrh, varying from very thin and watery to thick and purulent. 
 It is rather unfortunate that the term "Cold" is used but since 
 "everybody knows what a cold is," even physicians continue to 
 use the term. 
 
 Colds are most common during the cold season because then 
 people house themselves up, they live in an "indoor climate." 
 People who live in the open are no more subject to colds in the 
 winter than they are in summer. Often an attack of dust infection 
 manifests itself by what may be called a pre-cold; "sitting in a 
 draught." "getting the feet wet" may bring a cold to the surface. 
 I know from personal experience that colds can be largely pre- 
 vented by giving attention to air conditions. 
 
 Perhaps it is needless to refer to the well-known observation 
 that colds often "change to something else." A deranged ali- 
 mentary tract is very common, likewise nervous symptoms, notably 
 headache and restlessness and sleeplessness. That colds are often 
 the foundation for fatal diseases is well known, embodied in the 
 old saying, "Caught his death o' cold." To the physician it is 
 interesting to find out what preceded the fatal termination. 
 
DUST AND DUST VICTIMS. 75 
 
 People habitually living under bad air conditions are more or 
 less annoyed by what is known as catarrh and hence many people 
 have the idea that catarrh is universal, that everybody has catarrh. 
 This is not true. Dyspepsia is also very common, especially among 
 city people, some of whom are constantly dosing themselves with 
 dyspepsia cures. Yet when such individuals exchange air condi- 
 tions and get into good air their so-called dyspepsia may promptly 
 leave them, to return with a return to bad air conditions. An at- 
 tack of dust infection that produces a "cold" in one may produce 
 an attack of dyspepsia in another. Still another may have a head- 
 ache, or an attack of so-called nervous prostration. 
 
 2. Rheumatic Type. In this type an attack is manifested by 
 pains and aches, at times localized. In many the pain regularly 
 recurs at the site of an old injury, that is, every time there is an 
 exposure to bad air a certain part of the body begins to ache. Dust 
 victims of this type are often referred to as being rheumatic or 
 gouty. The latter term is rarely used in this country, but is very 
 common in England. Individuals who are said to have gout or to 
 be gouty are often found to be dust victims ; a sedentary life and 
 overeating are factors. 
 
 We all have heard of the old soldier who carries a bullet in his 
 leg and who is said to be able to prognosticate the weather; he 
 feels the pain at the site of an old injury. These "human barom- 
 eters" are usually dust victims. 
 
 3. Digestive Tract Type. In some individuals the alimentary 
 tract rather than the respiratory reacts, there are all sorts of dis- 
 turbances in the stomach and bowels, perhaps also in the liver. In 
 a general way one can divide this group into two classes, those in 
 whom the reaction is mainly in the stomach, manifested by so- 
 called "dyspepsia," and in the other where the disturbance is 
 chiefly in the intestines manifested mainly by constipation. A 
 large number of individuals however have disturbances throughout 
 the alimentary tract. In some the disturbance begins in the stom- 
 ach and gradually extends into and through the intestines, with all 
 sorts of symptoms and with more or less mucus. At times much 
 
76 DUSTY AIR AND ILL HEALTH. 
 
 mucus is vomited and then again mucus is passed off from the 
 bowels, often in the form of strings or ribbons (membranous 
 catarrh of the intestines). Dust Victims of this latter kind usually 
 have a train of symptoms referable to the nervous system and hence 
 this class forms a connecting link with the next group. 
 
 4. Nervous Type. Europeans sometimes speak of a Triad of 
 American Diseases, namely, catarrh, dyspepsia, and nervous pros- 
 tration. Some dust victims manifest a train of nervous symptoirs, 
 headache being the most common. The names commonly applied 
 are nervous prostration, neurasthenia, hysteria, hypochondria, 
 imaginary illness, etc. They exhibit no well marked evidences of 
 "disease" and because the physician is unable to find "lesions," 
 that is, organic changes, individuals are at times referred to as hav- 
 ing an "imaginary disease." If they get no satisfaction from reg- 
 ular physicians, they naturally apply to irregulars and quacks of 
 all kinds in their attempt to get relief. Often individuals present 
 the picture of health ; they may complain very little — only to the 
 physician who understands them. This form of dust infection 
 is common among people who use their brains rather than their 
 hands. In illustration one may say that a headache disables a 
 brain worker, while a backache disables a manual laborer. 
 
 5. Cardio-vascular Type. In this type the reaction manifests 
 itself mainly by disturbances in the blood-vessels and heart, includ- 
 ing at times the blood-vessels of the organs, notably the kidneys. 
 This type is to be especially looked for in individuals past middle 
 life; there is a progressive development more or less rapid. 
 
 Dust victims as a whole fall into two groups: (a) Those in 
 Avhom there is low blood pressure with a tendency to end in such 
 wasting diseases as tuberculosis and catarrhal pneumonia; (b) 
 Those with a high blood pressure, tending to so-called heart and 
 kidney diseases, perishing especially from apoplexy or paralysis or 
 from Bright 's disease. 
 
 Classifying Pateents. Ill health like disease is no respector of 
 persons, but the ill health of small children may differ from that of 
 
DUST AND DUST VICTIMS. 77 
 
 old people, as the ill health of the man in active life may differ 
 from either. One can group patients as follows: 
 
 1. Small children up to school age. 
 
 2. School children up to the time of getting into some occupation. 
 
 3. Occupational life, that lis, the active period of a man's (or 
 woman's) life. 
 
 4. The time when a man is "no longer wanted," that is about the 
 time gray hair begin to appear. This is the time when the busy city has 
 little use for a man and when employers are on the lookout for a younger 
 man. 
 
 5. Old age, when a man is no longer able to work. 
 
 A physician can also classify his patients according to their 
 occupation. But in this case the physician's location largely de- 
 termines. We need only think of the physician in the agricultural 
 community or in a mining town or in a manufacturing city. A 
 physician in the heart of a large city encounters a different class of 
 people from one who is located in the suburbs. The small town 
 doctor usually has good opportunity for studying a variety of 
 people, including of course farmers. 
 
 All sorts of classifications are possible, including such simple 
 ones as patients able to pay for services, or not able to pay; pa- 
 tients who ask few questions but ready to swallow any medicine, 
 those who ask many questions, who want to know and who hesitate 
 to take a lot of medicine. The people themselves have the doctors 
 classified and they have their preferences. They may consult one 
 and wholly neglect the other. There are all sorts of people, all 
 sorts of patients, and there are all sorts of "medicine men" to sup- 
 ply wants and needs. 
 
 Classifying the People. The people of a community can be 
 classified in the light of "case reports" to be given in this volume 
 about as follows : 
 
 1. The Healthy. Naturally people of this kind do not come to the 
 physician. If he wants to study them he must look them up. 
 
 2. Those in ill health (without any well-defined disease). Individu- 
 als of this kind often drift about among physicians, getting plenty of 
 medicine and more or less advice, but rarely any study regarding the 
 causes of their ill health. This is the kind of cases here especially con- 
 
78 DUSTY AIB AND ILL HEALTH. 
 
 sidered. Out of this group those who are willing aud able to follow the 
 physician's advice are the desirables. 
 
 3. The diseased, that is those afflicted with a disease (well-defined 
 disease or disease due to a definite specific cause). We need only think 
 of cases of tuberculosis or typhoid fever, of cancer, of lead poisoning, etc. 
 
 4. The moribund, where the sand of life has about run down, with 
 death in sight, where little is to be expected from any sort of treatment. 
 There may be so little health left that the student of dust influence does 
 not want them at all. (That an individual is in a critical condition can 
 often be discovered only upon thorough investigation — and then it may 
 seem cruel to refuse services.) 
 
 Patients or Fellow Students. In order to study the subject 
 of Dust Influences fully and follow up developments, a physician 
 must have patients who are willing to help, who will observe how 
 they are affected and report faithfully. The best patients of course 
 are those who are both willing and fully able to live up to the 
 physician's best advice. Those who can not do this can scarcely 
 expect much from a physician. The poor man who works when he 
 should rest is to be pitied. He requires more than a "little medi- 
 cine. ' ' 
 
 Missionary Spirit. When an individual who has had more or 
 less ill health gets relief he may manifest a desire or disposition to 
 help others. Some recommend "my doctor;" others give copies 
 of a prescription which helped them. Some recommend some nos- 
 trum or patent medicine which seemed to have benefited, they even 
 write testimonials. A man cured by some "faith cure" may pub- 
 lish an account of it. 
 
 There is another way in which this disposition manifests 
 itself: allowing the physician to use case reports. Physicians of 
 course constantly use case reports and case histories without asking 
 permission or saying anything to their patients, but such reports 
 are usually so written that the patient is not likely to be identified. 
 The physician practising in a small community however can not do 
 as he pleases about reporting cases One very potent reason why 
 the country doctor writes so little for the medical journals and 
 reports cases is that if he characterizes too closely there is apt to 
 be identification and as a result perhaps get him into difficulties. 
 
DUST AND DUST VICTIMS. 79 
 
 Although many people do not object to being talked about by tin: 
 doctor, others object seriously. Some do not want "a doctor who 
 talks." 
 
 At times a physician may give service to individuals in return 
 for data, that is allow him to use case reports. Every community 
 has poor people but unfortunately their lives are so monotonous 
 that to cite one or two instances would answer for a whole series. 
 People leading more or less eventful lives and who stand out in a 
 community can not readily be cited (except of course those coming 
 from a distance), but now and then an individual willingly allows 
 his case report to be used in what may be called a Missionary 
 Spirit. There are all sorts of movements in which people enlist as 
 missionaries; today there is even a good air movement. 
 
 A Personal Mention. The dust victim that I know longest is 
 myself. That I reacted to bad air conditions I first fully realized 
 on entering medical college. Naturally .1 have given the subject 
 of bad air, of dust influences, more or less attention ever since. In 
 a volume like this, one does not care to speak about oneself but 
 some of my patients have allowed me to use their case histories on 
 condition that I make mention of ray own. 
 
 When I first entered medical college in the heart of a large and 
 dirty city in the fall of 1889, I had a constant succession of "colds," 
 with catarrh and aching throughout the body, with malaise and 
 finally eye trouble. I felt bad, I was not really sick and yet I was 
 not well. Naturally I asked advice and got all sorts of explanations 
 (all but the right one), as well as all kinds of prescriptions and 
 medicines (all but the right kind). One soon comes to question 
 opinions concerning the presence of diseases as opposed to ill health. 
 I found out for myself that I was reacting to bad air, not alone of 
 the college whose many clinics were visited by all sorts of sick 
 people and where ventilation was very poor, but also to the air of 
 the heart of the city itself, where the medical student rooms. I 
 had always been used to good air. I came near not passing through 
 medical college at all on account of ill health. When I got back to 
 good air my troubles vanished, but every now and then I had an 
 
80 DUSTY AIR AND ILL HEALTH. 
 
 acute attack and 1 naturally attempted to trace it and find out how 
 I "caught cold/' 
 
 After a number of years spent in hospitals, I decided to make a 
 systematic study of common ill health dependent on bad air, i. e., 
 air filled with infection mainly due to the spitting habit. That 
 was the kind of air that affected me. In order to get a variety of 
 cases, i. e., a variety of people living under different surroundings, 
 including country people, I located in a "spitter's town," con- 
 fining myself to "internal medicine,"' that means especially to ex- 
 clude surgical cases. As a new doctor in town (in 1900) I natur- 
 ally got all sorts of applicants for professional services. Old chron- 
 ics especially seek out the new doctor, hoping he may have some- 
 thing that will cure or benefit them. Among the applicants were 
 some who reacted to bad air as T did: I understood them at once 
 and my advice benefited them. But there was a large number of 
 "old chronics" that I did not understand and in a short time they 
 discovered this and left, to try somebody else. Gradually I learned 
 that many "old dyspeptics" were really dust victims, that expos- 
 ures to bad air were followed by a reaction which manifested itself 
 mainly by a disturbed alimentary tract. Later I found that in 
 some dust victims the nervous sj'stem is disturbed and still later 
 that the circulation may be disturbed. All these things I had to 
 learn ; I did not find them in the books. Since I myself had only 
 what may be called a simple form of dust infection, I did not real- 
 ize that others reacted differently, nor that as people grow older 
 they may react more acutely. 
 
 In time, after I had considerable experience, I began to write 
 papers and present them before various medical and scientific so- 
 cieties. I not only wanted to tell what I had observed but I also 
 wanted criticism, wanted to learn of the experiences of others. 
 
 In the course of time as I took up different types of dust vic- 
 tims, I had to abandon earlier-studied forms on account of limited 
 time, and then it became a problem what to do with applicants. 
 One cannot briefly refuse an old chronic who has had years of ill 
 health. But to properly work out a case, to make a diagnosis and 
 
DUST AND DUST VICTIMS. 81 
 
 at the same time rule out the presence of definite diseases, often 
 takes much time ; and then too, some people require a lot of expla- 
 nation in order to understand and follow advice. 
 
 In publishing papers I usually obtained a lot of reprints. These 
 I distributed to those who might profit by them. The question of 
 gathering together papers and reprinting them or of getting out 
 and publishing a volume has been considered for several years. 
 
 Since my first year in medical college I have not beer, exposed 
 to air conditions as bad as those. I obtained my medical degree 
 from a smaller school in a smaller city where air conditions were 
 relatively good. They were bad enough but comparatively speak- 
 ing they were fairly good, and I held out until near the close of the 
 year, and then mucous membranes became irritable, and that is apt 
 to make one feel irritable generally. On account of the nearness 
 of the eyes to the irritated air passages, the eyes became affected 
 and since then I have been compelled to wear glasses. During 
 later years there have been occasional short exposures to bad air 
 conditions but the reaction has rarely resulted in continued colds 
 or in purulent catarrh. The transient catarrh has been of the mu- 
 cous kind, really a physiological process designed by nature to en- 
 tangle solid matter inhaled in the air, enabling one to cast it out. 
 I average perhaps two decided colds a year, but a condition which 
 may be regarded as an "incipient cold" or threatened cold occurs 
 frequently, whenever there is a sufficient exposure. I shall refer 
 to this again later, under ' : Kinds of Colds. ' ' But in time one learns 
 how to head off, especially by avoiding additional exposure and 
 spending time in good air. 
 
 But gradually other symptoms of dust infection appeared. In 
 other words, as one gets older the disturbances may manifest them- 
 selves differently and in different parts of the body. Thus since 
 spraining my back I now and then get a backache after being ex- 
 posed to bad air, in fact at times a mild backache may be the only 
 evidence of an attack of dust infection. 
 
 At first when I discovered I was a dust victim and could not 
 live under bad air conditions as others, I was inclined to bewail 
 
82 DUSTY AIR AND ILL HEALTH. 
 
 my fate, but in time I learned that there are compensations. Be- 
 cause I am susceptible T am in a position to understand those who 
 are similarly sensitive, a class of people whom the physician in 
 robust health ma}' wholly misunderstand. Today many complain 
 of ill health rather than of disease: there are many who have ill 
 health to one who has well-defined disease. If one patient in fifty 
 who apply to the physician had disease and died the race would 
 soon become extinct. 
 
 The reader will soon notice that my practice differs from that 
 customary among physicians, the reason is simple : I was, and still 
 am, after data regarding common ills and ill health and causes, 
 data usually obtained with difficulty. The practice of medicine is 
 greatly simplified by calling every complaint "disease," and it is 
 still more simplified by merely "treating" cases and not making 
 any inquires about causes or giving advice on how to prevent re- 
 currences. 
 
 In questioning old chronics who have had much experience 
 among physicians one constantly meets those who complain of not 
 having had the square deal — and physicians complain similarly. 
 This is a painful subject. Is it necessary to add that a physician 
 who is not earning enough to make a decent living in time loses 
 interest in many things that bring in no returns? 
 
 Does it pay? is a question constantly heard when anything new 
 is proposed. Does it pay to give attention to dust? Here and 
 there throughout this volume I have asked and answered this very 
 practical question — but each man must find his own answer. 
 
 To me this volume is of value in that it enables me to avoid 
 lengthy explanations by words of mouth (not to speak of writing 
 long letters). I can now refer people, especially new patients, to 
 "my book." 
 
 There is an old saying, God helps those who help themselves. 
 Concerning the "old chronic" who has ill health rather than well- 
 defined disease (especially he who reacts to bad air) one may par- 
 aphrase: The physician helps those who help themselves. There 
 
DUST AND DUST VICTIMS. 83 
 
 must at least be full co-operation — and the man who is not fully 
 able to live up to the physician's best advice is to be pitied, only 
 too often he is left to his fate. 
 
 In general it may be said that it is as easy to get data on the 
 evil influences of dust among poor people as it is difficult to get 
 data on good air influences — because few people are willing or able 
 to live up to good air advice with all that this implies. 
 
 If Pure Air could be bought at the drugstore (and taken with 
 all that the good air treatment implies) it would be a more popular 
 remedy than at present. 
 
 Since this is not a systematic treatise but merely an account of 
 my work and observations, the personal pronoun I constantly 
 occurs. 
 
 To old patients and to friends I am under many obligations for 
 data, for records, for newspaper clippings, for references to liter- 
 ature, and for criticism. I herewith thank them all. 
 
84 DUSTY AIR AND ILL HEALTH. 
 
 A FEW CASE REPORTS OR CASE HISTORIES OF SIMPLE 
 DUST VICTIMS 
 
 G. T. Well developed fanner boy of 18 years. Typical history of 
 dust iufection. Every time he goes to town, or, rather, returns from 
 town, he feels feverish, followed by headache, soreness in the chest and 
 at times in the larger joints, with profuse expectoration. 
 
 Excepting much hypertrophied tissue in the throat, due to repeated 
 inflammation, I could detect nothing wrong about him. He seemed to be 
 a picture of health. We discussed the nature of the difficulty and 1 
 advised him to remain away from town or to go only on wet days, when 
 there was uo dust. He has since acted on this advice and gets along in 
 comfort. 
 
 This was the only case, excepting another farmer, where the patient 
 himself was able to recognize the dust as the one factor in bringing on 
 the illness. 
 
 The above is a simple "illustrative case report," taken from 
 a paper on Dust, A Neglected Factor in 111 Health, 1 which I pre- 
 sented before the Indiana State Medical Association, 1904. 
 
 Since I had seen a number of similar cases, I at once "under- 
 stood the case." As a matter of fact, the young man reacted much 
 as I did myself under bad air conditions, only he was much more 
 susceptible. That I promptly classified him as a dust victim was 
 of course natural. 
 
 A physician constantly finds himself in the position of a novel 
 reader who opens a book in the middle of a story : he wonders how 
 it all began and how it will end. But the novel reader, unlike the 
 physician, can readily find out. The amount of reliable informa- 
 tion a physician gets from people regarding their past lives varies 
 greatly; as a rule people are poor observers and readily forget. 
 For this very reason it is really the exceptional individual who gets 
 the physician's best attention, who gets more than routine attention. 
 
 Such an individual usually gives a history of good health up to 
 the time of going to school, after that ill health or attacks of ill 
 health may be common. Many country children promptly react to 
 the air of the school room ; they have irritable throats and more or 
 
 1 This paper was written mainly in general terms and reprints were distributed to patients and 
 later on as long as they lasted to applicants who could not be accepted as patients. 
 
DUST AND DUST VICTIMS. 85 
 
 less inflammation followed by scar tissue, as in the case just men- 
 tioned. There may be adenoids and enlarged tonsils, defects of 
 sight and hearing, etc. Some are not able to bear school life at all 
 and if the parents persist in sending such a child it is likely to 
 perish. The very fact that a child survives school life must be 
 taken as evidence that something can be accomplished by good ad- 
 vice regarding the future of the individual. To what extent shall 
 one make explanations to a young man like the above? 
 
 "We all make explanations by drawing analogies. A farmer boy 
 readily understands illustrations drawn from plant and animal life. 
 In this case I explained that of many seedlings comparatively few 
 develop into plants that produce seed and are able to reproduce 
 themselves. Plants may spring up so thickly that there is a struggle 
 for mastery of the soil and many perish. A late frost may kill or 
 the hot rays of the sun may be fatal. Too little or too much moist- 
 ure may also be fatal. Plants must run the gauntlet of destructive 
 insects, not to speak of being destroyed by large animals or by man. 
 Out of thousands of seed or wild seedlings only one or two may 
 reach maturity. Then too some plants grow only in certain situa- 
 tions. Plants accustomed to the shade of the forest are destroyed 
 when the forest is destroyed. Others are destroyed when wet places 
 are drained. Then again some plants are very resistent; they are 
 commonly called weeds. 
 
 Somewhat similar remarks may be made regarding wild animals. 
 Some of the lower animals lay thousands upon thousands of eggs 
 and yet the destruction of the young is so great that only one or 
 two reach maturity. Animals are constantly warring on each other. 
 The weak fall victims to the strong ; the strong may fall by a com- 
 bined attack of the weak. 
 
 Cultivated plants and domestic animals tend to survive in pro- 
 portion as man gives them protection. He plants seed at the proper 
 time and at proper distances to avoid overcrowding, and he pro- 
 tects the seedling plants from destruction. His domestic animals 
 survive in proportion as they are given protection. If left to na- 
 ture they would quickly perish. 
 
86 DUSTY AIR AND ILL HEALTH. 
 
 Compared to animals, man takes excessive care of his young, 
 but in spite of all his care there are always some individuals who 
 do not reach maturity. Many children are born under unfavorable 
 surroundings ; like plants in uncongenial soil, they do not flourish. 
 Some perish on account of too much heat in summer or too great 
 cold in winter. Many perish on account of insufficient food. In 
 the slums of large cities the death rate among small children is 
 terrific. 
 
 In the average isolated country home children are apt to reach 
 maturity; comparatively few fall by the wayside. Many children 
 have good health on the farm but the moment they reach school 
 age and mingle with those who have more or less ill health or dis- 
 ease difficulties arise. We all know how on the opening of school 
 the acute diseases of childhood, notably measles and scarlet fever, 
 at times become epidemic. This is the time too for colds and ca- 
 tarrhs and all kinds of disturbances, many directly traceable to 
 unsanitary school conditions under which children are massed. 
 School children are like plants massed in a hothouse : great care is 
 required to keep off disease. Farmer boys, like trees taken from 
 the forest, do not tend to thrive in the city. They may drift from 
 one occupation to another and still complain. Out of the hundreds 
 of country boys who try city life only a few succeed. We hear of 
 the successes but not of the failures. 
 
 In the forest a tree is apt to grow up tall and slender, with a 
 smooth bark. A tree transplanted along a city street receives all 
 sorts of injuries, the bark soon becomes disfigured and scarred, the 
 tree itself becomes gnarled and decayed at heart. A child in its 
 rough and tumble plays may receive all sorts of bruises and in- 
 juries, leaving scars. Infective matter produces inflammations and 
 is followed by scar tissue. Scarring is especially common where 
 people are massed closely and where infection readily goes from 
 one to another, either by contact or through food or water or 
 through the air. Children growing up under isolated country con- 
 ditions and not constantly coming in contact with infection are 
 apt to grow up well formed, with straight limbs and good vision, 
 
DUST AND DUST VICTIMS. 87 
 
 like the Indian. 1 On the other hand, children growing up in cities, 
 especially in the slums, where sanitation is neglected, are apt to 
 be deformed ; they have all sorts of defects ; many have an old age 
 look. 
 
 The bodies of slum people, both old and young, when examined 
 at city hospital morgues, often show all sorts of acute inflamma- 
 tions and the scars of old ones. Some are described as "patholog- 
 ical museums," meaning that like the gnarled tree along the city 
 street there has been a many-sided contact with destructive agencies. 
 
 When we examine children, as in a medical inspection of school 
 children, we may find all sorts of disturbances. We may speak of 
 a pathology of the living. Pains and aches can not be seen, but 
 we can see the effects or results of inflammations. Thus, looking 
 down the throat, we may find it full of abnormal tissue, some in 
 active formation and some as scar tissue. On account of the diffi- 
 culty of air getting through the nose, there may be mouth breath- 
 ing. On account of the nearness of the eyes and ears to the air 
 passages where infection is constantly passing, there may be all 
 sorts of disturbances of vision not to speak of disturbances in the 
 sense of taste and smell. 
 
 In a general way, it may be said that health is a product of the 
 country. Ill health on the other hand is due mainly to the massing 
 together of people in towns and cities. God made the country and 
 man made the town. Our towns are usually so unsanitary that 
 there is a great deal of preventable ill health and disease. Here 
 again we may draw an analogy between human beings and plants. 
 Plants growing in isolation are health}' but in proportion as they 
 are massed disease is apt to get among them. The florist watches 
 
 1 At times one's work passes into one's dreams. One may also lie awake at night thinking over 
 one's work, not to say dreams. In the early morning hours of August 24, 1911, I had a vivid dream 
 in which I saw an Indian and a white man on the plain (or perhaps I was looking at a picture of such a 
 scene, a Remington drawing, perhaps). Both men were looking into the distance. The Indian stood 
 up straight and tall, shading his eyes with his hand. The white man was slightly stooped and slightly 
 twisted his head as though he were trying to focus both eyes alike — after the fashion of the school boy 
 who twists his head to get an equal focus on his book. 
 
 The underlying idea of course was this: The Indian had good eyes, the white man's eyes focused 
 unequally on account of a defect, the defect being due to his (former) mode of life and having had 
 infection pass from the nose to the eyes and slightly altering them. 
 
88 Dl STY A IK .VXD ILL HEALTH. 
 
 for epidemic diseases that threaten his plants, his knowledge en- 
 ables him to raise fine plants, while the housewife may fail to winter 
 over her single houseplant. 
 
 Only a few weeks ago I visited a farmer who has a "Seng 
 patch." Several years ago he found several ginseng plants in the 
 woods and planted them near his home. The next year he got a 
 number of seed, the year after he had a large number. He then 
 decided to make a regular plantation. The plants, several thou- 
 sand, were close together, entirely different from the conditions 
 under which they grow in the woods. After several years he sud- 
 denly discovered that some disease had gotten into his patch which 
 attacked the roots and killed the plants. When T visited the patch 
 he lamented the fact that his plants were dying and he did not 
 know what to do. I pointed out how the physician sees a similar 
 condition of affairs where people are massed densely in slums of 
 cities. Diseases readily go from one to another. The proper rem- 
 edy is to get out, to get more breathing space. He saw the appli- 
 cation at once, that patches should be smaller and that plants 
 affected should promptly be taken out so that others will not be 
 attacked. 
 
 One may go a little further and explain to a farmer that per- 
 haps a few of his ginseng plants may survive and that by taking 
 seed from these and cultivating he may in time produce a disease- 
 proof ginseng plant, just as we have rust proof oats. But such an 
 explanation may not appeal to the man who is losing a valuable 
 crop. 
 
 The evolutionist might say that nature is experimenting on a 
 large scale in producing a "disease proof" strain of man by elim- 
 inating those not adapted to their surroundings. But such an ex- 
 planation does not appeal to parents; they are not interested in 
 future generations but they are greatly concerned in raising their 
 children. They see the importance of altering the environment to 
 make the conditions for their existence favorable. 
 
 Even the physician under the present mode of practice is not 
 concerned with the future, only with the present. Is it not true 
 
DUST AND DUST VICTIMS. 
 
 89 
 
 that the people usually come to him only for a "little medicine"? 
 The matter of health supervision and looking ahead is in its infancy. 
 
 To what extent can the physician speak more or less positively 
 regarding the future to a young man of the kind here under dis- 
 cussion? To what extent will he take special pains to instruct 
 bright young people how to maintain good health, to reduce symp- 
 toms of ill health to a minimum? By using illustrations and anal- 
 ogies like the above they may be led to understand why their ills 
 are not curable by the use of medicine. 
 
 As already mentioned, this patient was well developed. The 
 only visible inflammations and scars he had were in the air pas- 
 sages. The back of the throat is a better guide to the physician 
 interested in air conditions than the tongue ; dilated capillaries and 
 distended mucous follicles tell tales. A "coated tongue" is com- 
 mon in people living under unsanitary surroundings. Some pa- 
 tients think they are neglected if not asked to "stick out your 
 tongue. ' ' 
 
 I explained his ill health, his attacks, as a reaction to bad air 
 conditions, that he had no definite disease. But to what extent 
 shall the physician tell of the possibility of real disease coming on 
 — that nose and throat manifestations may later present themselves 
 in the lungs, in the stomach, or in the cardio-vascular system? 
 Physicians well know that an acute pulmonitis or gastritis or ne- 
 phritis may follow a cold. To what extent do physicians speak of 
 these things? It depends on the physician and on the patient; a 
 doctor is not necessarily a teacher, and there are people who do not 
 want to know or learn. 
 
 What will be the outcome ? Perhaps in the course of time there 
 may be so much scar tissue that there will be no longer any com- 
 plaint of an irritable throat. Scar tissue lacks sensibility. Then 
 the presence of infection may manifest itself elsewhere and per- 
 haps differently. It is interesting to watch the development in the 
 course of years — but unless a patient reports the physician is left 
 in darkness as to the outcome. 
 
 The following is another illustrative case report taken from my 
 
90 DUSTY AIR AND ILL HEALTH. 
 
 paper on Dust, A Neglected Factor in 111 Health. The case is that 
 of a middle-aged housewife living in a clean part of the city and 
 very seldom going to the heart of the city or into crowds because 
 of attacks of ill health that follow. She belongs to that class of 
 women who are called peculiar. When we study such cases we 
 may find that the reason people are considered "peculiar" is quite 
 simple. 
 
 Mrs. S. Middle-aged housewife. History of frequent headache, vague 
 wauderiug paius in extremities and chest; at times the pains are severe, 
 accompanied by a disturbed stomach and an irritable bladder; attacks last 
 a few days. Says she gets sick after going to church or to a party, and 
 also gets sick on sweeping in the house. This patient dimly recognized 
 the influence of dust, as I soon learned without asking any leading 
 questions along the line of dust infection. She says that formerly she 
 could not take a ride over a dusty road or in a street car without getting 
 ill ; she goes to church or to a party only at times when all the doors and 
 windows are open, and even then she does not always escape. 
 
 This case belongs to that class of women who regularly have a "Blue 
 Monday," the result of house cleaning on Saturday and attending an ill 
 ventilated church on Sunday. After the source of the "blueuess" is 
 pointed out, many women get along in comfort without any special medi- 
 cation. 
 
 As may be surmised, I promptly tried to explain that she was 
 a dust victim. As mentioned, she herself had noticed that dust 
 affects her, but she could not distinguish between kinds. She 
 could not understand why she should be so sensitive and why her 
 husband, working under bad air conditions, was "thoroughly 
 healthy. ' ' Pie did not complain although he had some catarrh ; 
 she did not consider this a disease because "Everybody had ca- 
 tarrh." She herself had transient mucus formation only after an 
 acute exposure. 
 
 When she first came to me she complained of pain in the chest 
 and expressed a fear of consumption ; at the same time she told me 
 she belonged to a long-lived family and that there was no consump- 
 tion in her family. Some time later she complained of pain in the 
 stomach and then expressed her fear of the possibility of cancer, 
 but again denying any such disease in her family. Why do some 
 people alwaj's look for the worst? (Some physicians do the same."! 
 
DUST AND DUST VICTIMS. 91 
 
 There may be various explanations why she had a "good family 
 history," and why she complained much of ill health, while her 
 husband did not complain. I explained it in this wise: Her hus- 
 band came direct from continental Europe where his ancestors for 
 ages had been exposed to unsanitary city conditions and where the 
 weeding out on this account was severe. He might be considered 
 as a survival of the fittest, able to live under more or less unsani- 
 tary surroundings. Her own ancestry goes back to the mountains 
 of the south where under simple life conditions people flourish and 
 where there is little weeding out on account of unsanitary condi- 
 tions and disease. Practically all children reach maturity and 
 leave offspring. When the descendants of these mountaineers come 
 to live under unsanitary city conditions the weeding out process 
 promptly becomes effective. But such individuals may escape pre- 
 mature death by getting out in time or by avoiding surroundings 
 or influences that produce symptoms. 
 
 This patient had a "good family history" simply because her 
 ancestors had not been exposed to the cause of ill health and dis- 
 ease. She herself is reacting to the "diseases of civilization" be- 
 cause exposed to them. She largely avoids ill health or disagree- 
 able symptoms, however, by staying away from the heart of the 
 city where air is bad. 
 
 One day she expressed her belief that she would not live long, 
 that she would die before her husband. At that time (1904) I 
 only dimly understood how men who complain little may go to 
 pieces suddenly and prematurely, but on the other hand I knew 
 that "old chronics" tend to live on and on. Merely to console her, 
 I told her how old chronics by being prudent live on to old age, 
 their symptoms are constantly warning them not to go to extremes. 
 At that time I did not realize that men living under highly un- 
 sanitary air conditions may and do react, although they may not 
 complain or at least not to such an extent that they will consult a 
 physician, that instead of having all sorts of aches and pains, colds 
 and coughs, derangements of the alimentary tract or nervous sys- 
 tem, they (the body) may react by an increase in the blood pres- 
 
92 DUSTY AIR AND ILL HEALTH. 
 
 sure, and that they may fail suddenly and prematurely, as from 
 an apoplexy or from Bright 's disease. I may here add that since 
 then I have had a number of somewhat similar cases and at times 
 it has been a problem to what extent to make explanations to a 
 "sickly wife" so she does not worry on account of the "too good 
 health" of the husband, when it is the husband who is in danger of 
 dying first. 
 
 This patient was kept under observation for several years. The 
 idea that she was a dust victim was fully verified. She is alive 
 today and has better health than she had for years. Her husband 
 died suddenly a few years ago. 
 
 The reason some people live retired in town, perhaps on the 
 very edge of it, or live retired in the country, and are considered 
 peculiar, may not be far to seek in the light of such cases. The 
 woman, like the farmer boy just cited, had learned something about 
 her limitations and tried to live within them. But she did not 
 know just where the danger lay — I was able to point out the neg- 
 lected factor. Perhaps the reason a certain class of individuals 
 are always on the move further west, feel crowded when another 
 settles within a mile of them, is an extreme form of sensitiveness 
 to "crowd poison." 
 
 The Arab of the desert is said to be so sensitive to the odors of 
 towns that he does not enter them. Perhaps he has noticed the 
 after-effects and avoids them. People who have much catarrh and 
 altered nasal membranes may be wholly unable to detect odors. 
 The extent to which the inhabitants of some of the small towns 
 tolerate odors arising from neglected streets is remarkable. The 
 two preceding case reports as originally given were brief; they 
 were "illustrative case reports." There was nothing said about 
 a "cure." 
 
 Now when a physician promptly "cures" a patient of some 
 acute or specific disease, the ease report, if he reports the case, may 
 be very brief and to the point, but when an old chronic has been 
 with a physician for years (greatly benefited but still uncured) it 
 becomes a problem what should go into a case report or history. 
 
DUST AND DUST VICTIMS. 93 
 
 There may be a great mass of data. In writing a volume it be- 
 comes a problem what to include and what to exclude; opinions 
 may differ greatly. A weekly or even a monthly note in the course 
 of years might make a volume. That matters of interest to one may 
 not be of interest to others is of course self-evident. Indeed case 
 reports by physicians, which usually relate to diseases rather than 
 to ill health, differ greatly. On the one hand are those given in 
 scientific journals of limited circulation: they may be so dry, "dry 
 as dust," that few read them. On the other hand are those writ- 
 ten more diffusely for the popular medical journals. As a rule 
 case reports given in books are very brief and lack all human in- 
 terest matter. 
 
 Somewhat similar remarks apply to biographies. Few are writ- 
 ten so that they will hold the interest of the general reader; most 
 of them are written by specialists. The life of a musician is usu- 
 ally written by a musician; the life of a scientist by a scientist. 
 The life of a literary man, full of literary criticism, may appeal to 
 comparatively few only, more popularly written it may appeal to 
 many. The biography of a man or woman of varied experience 
 appeals to most of us. The biography of a man or woman who had 
 much ill health may appeal only to those who have apparently 
 similar ill health. Case reports here cited may be considered as 
 brief or partial biographies of people in ill health or they may be 
 considered as a chapter out of their lives. 
 
 Of the two case histories given, the first is that of a young 
 farmer living in isolation; the second is that of a middle aged 
 housewife living in isolation near the edge of town. Here I shall 
 give the history of a young woman who has an indoor occupation 
 in the heart of the city. She is relatively immune. When on a 
 vacation or during idleness she has the "best of health." The 
 ease report is simple, written with more or less human interest 
 matter. 
 
 Case of Miss — . A young woman who first came to me in 1902 
 and has been with me ever since. This patient reacts only when 
 
94 DUSTY AIR AND ILL HEALTH. 
 
 air conditions are very bad, being able to withstand a large amount 
 of infection, or in other words live in spit dust air. She belongs 
 to a long-lived "weeded-out" family, her parents coming from a 
 part of Germany where wars were frequent. We know what 
 crowding into fortified cities meant : the death rate was terrific on 
 account of overcrowding, bad water, insufficient food and bad air. 
 It was the "survival of the fittest" who when wars were over went 
 into the country to repeople it. 
 
 Her home is in a part of the city where air conditions are 
 relatively good. There are five brothers and sisters living, several 
 having died in childhood. One of the living is quite susceptible 
 and is constantly subject to dust infection, and it would seem that 
 it was mere chance that this one survived. I can readily see how 
 if there were removal to bad air conditions weeding out would 
 promptly take place. Moreover one of the brothers for several 
 years was exposed to bad air but he held out fairly well; since 
 then he has lost his immunity and now complains after the least 
 exposure. 
 
 I shall run over my notes very briefly. And I may here say 
 that when she first came to me I took few notes on her common 
 colds, as I already had many case reports of this kind. Often it 
 seemed a waste of time to take notes on additional ' ' Simple Cases. ' ' 
 On the other hand during the last few years the patient has largely 
 been able to avoid colds and ill health and in case of an attack took 
 the remedies recommended, without consulting me. At present she 
 consults me only for things out of the usual. Even the simplest 
 case in the course of time is apt to give one interesting data. 
 
 Before this patient came to me she, as well as other members of 
 the family, was constantly running to the doctor for every little 
 pain or ache, to be handed a bottle of medicine or a box of pills. 
 When she began to realize what the symptoms meant and to what 
 they are due, she became indignant at the practices of "symptom- 
 prescribers. ' ' It should be said that this patient has a clerical po- 
 sition and has changed offices several times and according to whether 
 
DUST AND DUST VICTIMS. 95 
 
 the office is sanitary or not, that is, whether the air conditions are 
 good or bad, there is little or much complaint. 
 
 In 1902 when she first came to me she was complaining of a 
 deranged stomach, with backache and dizziness. She was working 
 under horribly bad air conditions. I promptly ascribed her ill 
 health as a reaction. As she was a sensible young woman I fully 
 advised regarding good and bad air. By reducing the length of 
 time in bad air and increasing the time in good air, there was im- 
 provement. 
 
 Early in 1903 she was greatly run down, anemic, with a weak 
 heart action and puffiness under the eyes and complaints of dim- 
 ness of vision. There was also complaint of a deranged alimentary 
 tract. I explained to her that evidently she was ' ' full of infection ' ' 
 and advised the pure air treatment, remaining under good air con- 
 ditions as much as possible. But just then her work required much 
 time indoors under bad air conditions; the symptoms continued 
 until the open door season was well advanced. 
 
 In 1904 just before the open door season there was again great 
 complaint, clearly due to bad air. When my paper on Dust, A 
 Neglected Factor in 111 Health appeared, I gave her a copy and 
 she then gave me a number of observations, especially of times 
 previous to coming to me, of attacks that she now clearly traced 
 to bad air, as going to the skating rink where the floor was cov- 
 ered with powdered pumice stone which settled over everything. 
 The sharp gritty matter was of course mixed with more or less 
 infected matter and for this reason purulent catarrhs were quite 
 common. We had a discussion regarding the amusements of a 
 small town, how few there are and when anything does go on the 
 people are apt to go frequently until the novelty wears off or until 
 they notice bad effects. A number of my patients began to realize 
 that they had bad health on account of attending polo games at 
 the skating rink. 
 
 In the fall of 1904 while attending the State Fair she got a 
 "bad cold" that lasted for six weeks. This cold was complicated 
 
96 DUSTY AIR AND ILL HEALTH. 
 
 by a sore foot. On inquiry 1 got first a history of very bad air 
 conditions at the Fair with its large crowds, with practically no 
 ventilation in some of the buildings. It seems buildiugs were kept 
 closed to keep out the clouds of dust, and that meant to confine the 
 dust produced inside, especially the spit dust. Regarding the sore 
 foot, I learned that when she was nine or ten years old she sprained 
 the foot and that for several years it was sore but she gradually 
 got over it, the pain returning during this ' ' State Fair Cold. ' ' At 
 times she complained greatly. Locally, air conditions were very 
 bad at this time on account of dry weather, and she continued to 
 complain until rains set in and cleared the air, and, more impor- 
 tant, washed away the accumulated filth from the streets. 
 
 Early in January, 1905, she had a severe cold which assumed 
 a continued form and annoyed her very much up to the open door 
 season. There was much soreness in the chest and general aching 
 throughout the body and the foot, with of course sore throat, head- 
 ache, deranged alimentary tract and general weakness — one might 
 almost term it nervous prostration. The air conditions at the time 
 were bad with little chance to increase the hours in good air. The 
 pain in the foot was especially marked at ' ' darkest before dawn. ' ' 
 In midsummer (1905) there was an attack of dust infection with 
 deranged stomach, clearly traceable to "indoor climate" under 
 dusty air. 
 
 She was a good observer and told me of a number of her obser- 
 vations. Thus, with the return of the closed door season one of 
 her fellow-workers went to a polo game and the next day had a bad 
 cold. Games were played twice a week and when the next game 
 came she again went, and that "did her up" to such an extent 
 that she had to remain at home several days, then when she did 
 return she was scarcely able to be about and was very annoying 
 to others in the office on account of her coughing and complaining. 
 My patient was very indignant. She said she tried to explain the 
 matter to her but got scant attention, perhaps some ridicule. It is 
 the old story of people not believing in the injuriousness of dust. 
 As a matter of fact many of my patients realize that it is difficult 
 
DUST AND DUST VICTIMS. Vi 
 
 to explain and so they do not even attempt it. It has frequently 
 occurred that some patients would not even explain it to their own 
 relatives. (In this connection see case of Miss — , p. 202. 
 
 Early in 1906 and up to the open door season there was much 
 complaint of periodical headaches. For a time she remained at 
 home entirely and during this time had "'good health." 
 
 She has frequent occasions to be at the Court House and after 
 the election in November, 1906, described to me the condition about 
 the Court House where there had been an election booth. The spit 
 conditions must have been awful. This was an acute exposure, 
 followed by an acute cold, which kept getting worse until she finally 
 came to consult me. 
 
 In January, 1907, she was complaining greatly of aching all 
 over, of having a peculiar feeling '"as though getting rheumatism." 
 The pain was first noticed in the sprained foot, gradually spread- 
 ing throughout the body. I have a short note referring to a con- 
 sultation regarding the onset of this prolonged attack, that it was 
 due to going to a polo game but that for a time she concealed this 
 fact from me from fear of ridicule — it is the old story of expecting 
 to hear "I told you so." I may add that the "rheumatic sensa- 
 tions" were most marked in the forearms; one might almost regard 
 it as an " occupational disease ; ' ' she w as manipulating the type- 
 writer most of the time. 
 
 It is customary here to explain many obscure attacks of ill 
 health not otherwise explainable as due to "grip," and when one 
 day she came in it began to look as though she had "real grip," 
 that is influenza. The general symptoms gradually subsided. At 
 "darkest before dawn," that is, the middle of March, she came in 
 on account of her foot which continued to annoy her. She said 
 she had an idea what I would say regarding treatment: that I 
 would advise a change of occupation, to get into better air. But 
 she did not see her way clear to do this, and hence did not come 
 in to report ; she now came only because a sister urged her, saying 
 she would get no further sympathy unless she did so. This con- 
 tinued attack was traceable to handling large dusty abstract rec- 
 
 [7] 
 
98 DUSTY AIR AND ILL HEALTH. 
 
 ords, thick with dust and in a room that practically had no ven- 
 tilation. She clearly recognized the relationship of cause and effect 
 and knew that as soon as the op«-n door season arrived she would 
 get better. Moreover the filth conditions in town were very bad 
 at the time; there was no street cleaning and filth accumulations 
 were held by snow and ice. This filth and attendant dust (dust 
 on sidewalks and in stores, tracked in from the thawed mass on 
 the streets) went out suddenly with a heavy rain and health con- 
 ditions improved. She herself improved as soon as the open door 
 season arrived. 1 
 
 For the last three years I have seen little of her because she 
 has learned her limitations and tries to live within them. She 
 realizes the uselessness of medicine in effecting a permanent cure 
 and its limited influence in acute attacks, and yet she does not go 
 to the other extreme of laissez-faire. She knows that many symp- 
 toms can be modified by the use of remedies. 
 
 There are a number of incidents that might be mentioned along 
 with a number of her observations but here I have room for only 
 a few. 
 
 One day in discussing "Tax Payer's Colds" she told me of 
 speaking with an old farmer who came in to pay taxes for a number 
 of his neighbors. It was during the height of tax-paying time and 
 it required several hours to get through at the court house, and 
 that meant that the long line of tax payers had to wait. I can 
 testify to the horrible spit dust air conditions prevailing at such 
 times in a small room full of tobacco-spitting catarrh-afflicted men. 
 No wonder people have "Tax Payer's Colds." 
 
 One often wonders to what extent one's "preaching" regarding 
 the dust evil and the importance of clean air is productive of re- 
 sults. I have been preaching so often and so long that at times I 
 feel almost ashamed to bring up the subject. But sometimes one 
 gets evidence that there are results. Thus one day my patient told 
 me of visiting a neighbor who had a "bad cold." She had just 
 
 1 Her employer was constantly reacting to bad air without however realizing it. He continued 
 to go to the office and went from bad to worse, until he finally placed himself in the hands of a surgeon 
 but alasi too late; he fills a premature grave. 
 
DUST AND DUST VICTIMS. 99 
 
 returned from a trip to Chicago. Rather to ray patient's surprise 
 she said in a matter of fact way, "I guess that is one of Dr. Hess- 
 ler's dust colds." I did not know the woman. 
 
 By way of summary one can say that here is a young woman 
 who at times has "common colds" which under bad air conditions 
 "hang on." Coryza at times may he very marked and then again 
 absent. At times there are dyspeptic disturbances; one can speak 
 of her as a dyspeptic. At times again symptoms referable to "nerv- 
 ous prostration" occur. All these symptoms are dependent upon 
 bad air, or to be specific, on spit dust, as verified over and over. 
 
 There is one other point that might be mentioned. The patient 
 regretted that the history of a relative can not be given in this 
 connection, one very susceptible to exposure to bad air, quickly 
 manifested by irritable respiratory membranes and enlarged lym- 
 phatics. "Catching Cold" occurs immediately and colds hang on; 
 at times there may be great systemic disturbances. It took a long 
 time for this relative to learn to live within limitations. People, 
 especially young people, think they ought to be able to do as others. 
 For instance, after having good health all through the summer 
 with free ventilation, the going into the first social gathering or 
 theater in the fall brings on a prompt reaction. Or, again, during 
 the closed door season after having had good health by living in 
 isolation for some time and then going out, perhaps only to do shop- 
 ping, ill health comes on. 
 
 In discussing the "Air of Places" with an observant patient 
 of this kind, one may get all sorts of information regarding com- 
 parative air conditions, varying from good to very bad. The sub- 
 ject will be taken up subsequently. It may here be said that it 
 can be looked at from two standpoints, locally and generally. "What 
 kind of air do we encounter in our daily life at home? on the 
 street car? at the office, shop, store or factory, at places of amuse- 
 ment and recreation? And on the other hand what kind of air do 
 we find in travelling to distant countries? Unless our attention is 
 called to it, to what extent do we consider air conditions under 
 which we live ? 
 
100 DUSTY AIR AND ILL HEALTH. 
 
 Formerly she became alarmed at every little pain and ache. 
 Her physician, inherited, so to speak, from her parents, was of the 
 simple prescribing kind : he gave out medicine on the merest state- 
 ment of symptoms and with never any general advice. He was 
 truly a "medicine man." She now clearly recognizes the relation- 
 ship of cause and effect, but being compelled to work for a living 
 she can not choose air conditions to her liking. As a consequence 
 she must suffer more or less. One may say that if the community 
 took an interest in sanitary matters, especially in giving people 
 good air, she would have "perfect health." 
 
 The amount of bad air and infection she can bear is really re- 
 markable. She clearly recognizes this (especially when contrasting 
 herself with a relative who is very susceptible) but feels confident 
 that at times if the exposure were a little worse or longer con- 
 tinued, she would break down. As a well-known young woman 
 and valued friend, I can not here go into further details nor state 
 facts on which conclusions are based. 
 
 Cases where the relationship of patient and physician, or phy- 
 sician and patient, did not last long are very common. The length 
 of such relationship is often determined by what is called tact. 
 Deliberately to call attention to what might be regarded as "un- 
 tidy housekeeping" (in the following case not really so, because 
 the house was old and high winds stirred up things) is usually con- 
 sidered highly offensive, just as pointing out untidy and unsanitary 
 city conditions is apt to give one the reputation of being a 
 "knocker." A physician has "smoothest sailing" by keeping still 
 and merely giving what is wanted, medicine. 
 
 During 1902 I made many visits to people at their homes (1 
 had an automobile, the first in town), but I soon abandoned this 
 Although one sees many cases one is not apt to take many notes, 
 one may be too tired to write. 
 
 One day while visiting a patient a neighbor called me in to see 
 her old mother, whom I found had "winter cough of the aged." 
 I wrote her a prescription that was indicated, to palliate. The 
 
DUST AND DUST VICTIMS. 101 
 
 next day she again asked me to stop in, her mother was worse, 
 "coughing harder than ever." She wanted to know whether I had 
 not given the "wrong medicine." 
 
 On my first visit I had laid my medicine case on top of the 
 dresser, the only furniture in the room besides the bed and two 
 chairs. I did this again the second day, when I noticed that there 
 was a heavy layer of dust on it. T drew my finger through it, trac- 
 ing d-u-s-t. I at once saw why the old lady was "coughing worse 
 than ever ; ' ' there had been a strong wind storm all night and the 
 dust had been blown out of cracks and crevices of the old loosely 
 jointed flooring; naturally the cough was aggravated. I explained 
 that it was not the medicine that aggravated the cough and then 1 
 pointed out what I had traced on top of the dresser. The daughter 
 was greatly offended and I was not called into that house again — 
 perhaps if she sees this volume she will understand the relationship 
 of cause and effect. A heavy layer of dust on furniture is good 
 evidence that dust must have been inhaled. It is in the air before 
 it settles down. 
 
 Seasonal Factor. This is an expression I constantly use in 
 explanations to patients. It refers especially to the open and closed 
 door season. In the summer time there is free ventilation and 
 infective dust on streets and sidewalks is sterilized by the bright 
 rays of the sun. In the winter time on the other hand doors and 
 windows are closed, people house themselves closely. When the 
 sun is low in the horizon or hidden by clouds, infection remains 
 active. Filth tracked in remains virulent for a long time. Many 
 ailments are seasonal. Dust infection is most prevalent during the 
 closed door season. 
 
 Darkest Before Dawn. This refers to the time when dust 
 infection is at its height, on the close of winter. This is the time 
 when patent medicine advertisements are at their maximum, when 
 the doctors are busiest and the sick most commonly make a change, 
 going to some new doctor or trying some new nostrum. An indi- 
 vidual may have been complaining all winter and then tries a new 
 
102 DUSTY AIR AND ILL HEALTH. 
 
 doctor or a new medicine and in a short, time improves, on the 
 return of the open door season (seasonal influence). Many people 
 have a distinct idea that they get better every spring, no matter 
 what, they take. Unfortunately the remedies that "bring back 
 health" in the spring are unable to maintain health on the return 
 of the closed door season. Many have an idea that the blood needs 
 purifying in the spring, they take a "blood purifier." Some 
 farmers on poor soils where sassafras grows come to town and sell 
 sassafras root. Greens also have a reputation for being "good for 
 the blood." 
 
 The Neglected Factor, the Missing Factor, or the Common Fac- 
 tor are other expressions frequent in my case reports. What they 
 mean must be self-evident to the reader by this time. 
 
IV. 
 COLDS AND CATARRH. 
 
 Everybody knows what a cold is because practically everybody 
 now and then has one. Catarrh is also very common, indeed some 
 believe that "Everybody has catarrh." As a matter of fact some 
 people are very susceptible to colds and catarrh, others quite re- 
 sistent ; conditions must be very bad before some are attacked, that 
 is before they react. 
 
 Colds as we all know are most prevalent during the cold or 
 closed door season. Many believe that colds and cold are related, 
 but when we critically study a large number of cases we may come 
 to the conclusion that there is something else at bottom. Colds and 
 catarrh like everything else of course must have a cause. In the 
 absence of a cause there will be no effect. Because of the belief 
 that "Everybody has catarrh" many fail to make an effort to find 
 out the reason. If people went to a country where catarrh is not 
 common they might be induced to ask themselves why it is so com- 
 mon at home. Then perhaps they may see that Dickens was jus- 
 tified in speaking of "American Catarrh." 
 
 The terms cold and catarrh are old names and of indefinite 
 application. They correspond to such names as tree or house. 
 There are all sorts of trees and there are all sorts of houses. The 
 same criticism applies to many other terms that are used in regard 
 to symptoms of ill health and disease. A physician may spend 
 much time in attempting to learn what his patients mean by certain 
 terms. 
 
 The terms cold and catarrh are often used interchangeably. 
 Some speak of catarrh when others speak of colds. Then we hear 
 of colds changing into catarrh, and chronic colds are referred to as 
 catarrh. A patient may speak of a cold in the nose while his phy- 
 
 (103) 
 
10-1 .'1 -IV A1K AND 11. L HEALTH. 
 
 sician may call it an acute catarrhal rhinitis, literally an acute 
 catarrh of the nose. The physician likely speaks of a cold in the 
 throat (manifesting itself also in the nose) as an acute coryza, if 
 not as an acute pharyngitis or laryngitis. Both physician and pa- 
 t i i * 1 1 1 recognize the fact that there is an irritation of the mucous 
 membranes with the formation of more or less mucus. The term 
 catarrh primarily means a flowing down. One can readily under- 
 stand why a cohl characterized by the production of much mucus 
 should be called catarrh and similarly why continued colds should 
 be given the same name. 
 
 An irritation of the respiratory membranes may be brought on 
 by or through man}' substances. We know what happens when 
 peeling strong onions, how the air passages and the mucous mem- 
 branes of the eyes will be irritated. Those subject to "hay-fever" 
 begin to react as soon as certain plants begin to bloom. People who 
 inhale much dust, as for instance railroad firemen, have constant 
 irritation of the respiratory membranes. 
 
 The tendency to catarrh is very marked in some individuals. 
 Old physicians spoke of a catarrhal diathesis. Now and then we 
 hear physicians speaking of "'poisoned secretions." Besides the 
 catarrh proper there may be all sorts of symptoms accompanying 
 the mucus formation and perhaps in the end leading to all sorts of 
 "diseases," as bronchitis, consumption of the lungs, dyspepsia, in- 
 testinal derangement, etc. Mucus may pass from the kidneys in 
 the form of casts and be misdiagnosed as Bright's disease. The 
 maker of a widely advertised nostrum or patent medicine says that 
 nearly all ills and diseases are due to catarrh. There is certainly 
 much truth in such a statement, but we must at once inquire, What 
 makes catarrh so common in our country and why the need for so 
 many advertised catarrh remedies? 
 
 We should keep in mind that there are two classes of catarrhs 
 or colds, the infective and the non-infective, those that go from one 
 individual to another and those that do not. Common colds and 
 common catarrh go from one to another just as the seed of weeds 
 travels from one field to another, while such affections as rose cold 
 
COLDS AND CATARRH. 105 
 
 qnd autumnal catarrh or hay-fever manifest themselves only in 
 those who are susceptible. In other words, one does not "catch" 
 hay-fever from another. The individual subject to hay-fever can 
 go to a country where the particular pollen that affects him is ab- 
 sent and thereby escape an attack. But the individual who is sub- 
 ject to common colds and common catarrh is less fortunate; he is 
 constantly coming in contact with people from whom he is liable 
 to "catch" colds and catarrh. Colds and catarrh are more common 
 in some communities than others. They are more common in the 
 northern states where people are massed together than in the 
 warmer southern states where people live more out of doors. For 
 the same reason colds are less common with us in summer than in 
 winter when people lead an indoor life. 
 
 "American Catarrh/' Europeans tell us that catarrh is much 
 more common in our country than in Europe, an idea verified by 
 our own countrymen who have been to Europe. I recall that as a 
 boy I heard a recently arrived German immigrant complain, say- 
 ing he suspected he was ' ' getting the American catarrh. ' ' Charles 
 Dickens in his Letters from America while on his reading tour 
 complains of an "American Catarrh" and how closely it stuck to 
 him. He also writes about the American spitting habit and here 
 T believe we at once find the explanation. He used the terms colds 
 and catarrh interchangably, now one and then the other. As al- 
 ready mentioned, European physicians speak of our Triad of Amer- 
 ican Diseases — catarrh, dyspepsia, and nervous prostration, and 
 here again we can trace relationships. 
 
106 DUSTY AIR AND ILL HEALTH. 
 
 KINDS OF COLDS. 
 
 A cold may be regarded as a reaction. Individuals react differ- 
 ently and there are different kinds of colds, as there are different 
 kinds of causes. Some react very promptly and energetically, 
 others scarcely at all. Some are very susceptible, others practically 
 immune. Some require much exposure to the cause, others little. 
 An organ or one part of the body may react more strongly than 
 another; a cold may localize in some part of the body. 
 
 In this volume the term cold is used as a synonym for dust in- 
 fection. Some dust victims very readily contract common colds 
 while in others there may be a different manifestation, a disturb- 
 ance of the alimentary tract, of the nervous or circulatory systems, 
 etc. 
 
 I have in mind one of my patients who classified his colds ac- 
 cording to the place where or the conditions under which he caught 
 them. He was the son of a well-to-do farmer and came to me while 
 in high school, years ago. While attending the common schools he 
 had "school colds," with much coughing. In the high school he 
 also had colds with more or less catarrh, that is more or less con- 
 stant abnormal secretions from the respiratory mucous membranes. 
 While attending college in a clean college town he largely escaped, 
 but during this time he occasionally had "railway colds," "theater 
 colds," "dance hall colds," etc. I was led to classify my own 
 notes on colds under such and similar headings. 
 
 It might be added that he soon learned how to reduce attacks 
 to a minimum and that his parents were subject to high blood pres- 
 sure. His colds now tend to manifest themselves differently, that 
 is besides common colds there may be a disturbance in the circu- 
 lation. 
 
 The following list of colds is not to be regarded in the light of 
 a scientific statement of facts ; it is merely a practical classification 
 of common colds. Out of the "fifty-seven varieties" I can make 
 mention of only a few. The remarks are to be regarded as sug- 
 gestive, to lead the individual subject to colds to ask himself how 
 and under what conditions he got his cold. 
 
COLDS AND CATARRH. 107 
 
 Attic Colds. Among my early patients was a middle aged 
 housewife who occasionally went into an attic to look over old mag- 
 azines and books. She would almost invariably have a cold after- 
 wards. At that time it had not occurred to me to classify colds or 
 I might have spoken of "attic colds," but I did speak to her about 
 there being more or less infection in such dust, depending largely 
 on the location of the house and the amount of infected dust car- 
 ried or blown in. 
 
 I have observed similar cases now and then. About three years 
 ago an elderly housewife whom I had sometime before accepted as 
 a patient came in one day with a severe cold, saying she had had 
 similar colds in years past. She ascribed it to draughts or to put- 
 ting the hands into cold water. I promptly told her it was an 
 attack of cold due to the inhalation of dust. She realized that she 
 had inhaled dust freely from the fact that she had been spitting 
 black. Subsequently she found it was more profitable to let some- 
 body else do the cleaning up of the attic. 
 
 Automobile Colds. Patients at times complain of having 
 caught a cold during an automobile ride. I at once inquire re- 
 garding the streets or roads traversed. One quickly discovers, 
 assuming that there had been no exposure otherwise, that riding 
 over dusty down town streets may be followed by a cold, but that 
 this does not occur on a ride over country roads, dusty as they 
 maj r be. Some individuals who can not ride about city streets (or 
 in a railway coach) without getting ill can take long automobile 
 rides over country roads and feel good afterward. It is some- 
 times said there is nothing new under the sun but the ancient 
 Greeks certainly knew nothing of automobile colds, although the 
 old Romans perhaps had chariot race colds. 
 
 Book Dust Colds. These are apt to occur in the susceptible 
 on handling old books and especially books obtained from libraries 
 in the heart of a city, particularly old books that have rough tops 
 which accumulate a large amount of dust. Sometimes people feel 
 too ill to be about yet will lie on a couch with a book held above 
 them. There may not only be colds and irritation of the respira- 
 
108 DUSTY AIR AND ILL HEALTH. 
 
 tory mucous membranes but also irritated eyes, and then the spec- 
 tacle man may advise the use of glasses. Some advertise "Exam- 
 ination free;" one wonders what such examinations amount to. 
 
 Carpet Colds. A mention of carpet colds is frequent among 
 my case reports. One may speak of varieties, as where a crowd 
 of children visit the grandparents and fill the house with dust, or 
 at a Christmas entertainment at a church with an old dusty car- 
 pet on the floor. Then there is the dust from carpets at the an- 
 nual housecleaning. A carpet cleaning establishment sending 
 clouds of dust into the air may be the source of continued colds 
 for a whole neighborhood. It is strange that such establishments 
 are allowed to exist in a town but they do exist where the people 
 are negligent. 
 
 Church Colds. One of my newly accepted patients com 
 plained of having Blue Mondays, with more or less cold and cough 
 and catarrh. She went to a church near the heart of a city that 
 had an old dirty carpet on the floor. A physician never knows 
 how people will take his remarks that reflect on their church going 
 and so I explained in a round-about way about dust infection, 
 also how people get colds and all sorts of disturbances on going 
 to a poorly ventilated theater. She promptly said she did not 
 believe in people going to theaters; it served them right if they 
 got sick. Such a remark is a straw that showed her attitude re- 
 garding theater going and church going. Now a physician after 
 he has seen a large number of cases of a certain kind and does not 
 care about having more of the same kind may speak plainly. If 
 his explanation is accepted in the proper spirit he may accept the 
 applicant as a patient; if not there will not be established the 
 relationship of physician and patient or patient and physician. 
 I promptly told her I believed her Blue Monday was due to going 
 to church on Sunday. She was at first inclined to deny it but she 
 agreed to observe. Occasionally remaining away from church 
 soon convinced her that her attacks were "church colds." It may 
 be added that this really is one of the most serious kinds of cold, 
 from the fact that many people, especially old people, think they 
 
COLDS AND CATARRH. I' 1 !) 
 
 must go to church. Physicians are often accused of being ma- 
 terialists; we can readily understand why some physicians if they 
 insist that advice regarding physical health be followed, will get 
 such a reputation. 
 
 Court-house Colds. A large chapter could be written under 
 this head. From the fact that in the average county-seat the court- 
 house is a sort of social center for men, that the court room often 
 is overcrowded, one can see how colds are carried from one to an- 
 other. Then too clubs and societies and associations may use the 
 court room as a meeting place. Teachers' Institutes are often 
 held there. Sometimes members of a church who have no build- 
 ing of their own may meet in the court-house on Sundays. Then 
 too we must consider the officials who all day long inhale court- 
 house air, usually pungent with the odor of tobacco, not alone of 
 smoke but also of quids; some bear court-house air without com- 
 plaining, others complain greatly. 
 
 Court-house air is especially severe on the retired farmer who 
 comes to town and has little to do. 
 
 Dance-hall Colds. Dance halls differ widely according to 
 their location and the kind of people who visit them and their air 
 conditions. A clean, well-ventilated dance hall with a waxed floor 
 and with the dancers coming in carriages is a vastly different thing 
 from a dance hall with a rough floor to which women come with 
 their street dresses that have trailed over filthy sidewalks. When 
 the hygienist advises dancing as a healthful exercise he likely has 
 in mind open air dances or at least a hall that is clean and well 
 ventilated. 
 
 A physician can never be sure how fully his advice is followed ; 
 some patients live up to the letter but not to the spirit of his ad- 
 vice. One of my patients, for instance, who frequently went to 
 dances and as a consequence had continued colds and sore throat, 
 discontinued dancing but still went to dances as a "wall flower." 
 The simple injunction, "Do Not Dance," is not sufficient; one 
 must say, "Do not go to dance halls," meaning of course those 
 where air conditions are objectionable. 
 
110 DUSTY AIR AND ILL HEALTH. 
 
 Space forbids enumerating the many different kinds of colds 
 on which 1 have notes, but I want to make mention of a few addi- 
 tional ones. 
 
 Housecleaning Colds. These are very common, especially 
 among housewives. There are two periods when they prevail, at 
 the annual spring housecleaning and at the fall housecleaning. 
 It is customary to have a thorough housecleaning, perhaps a reno- 
 vating, in the spring, with a minor one on the approach of cooler 
 weather. During the summer the housewife, in fact the house- 
 hold, may have had good health; doors and windows were open, 
 there was free ventilation. Then come the cooler days and doors 
 and windows are closed, ushering in seasonal ailments, aggravated 
 by the fall housecleaning. Some people have colds and catarrh 
 all through the winter which reach their maximum with the spring 
 housecleaning. Then comes a period of good health or at least 
 improved health. The husband usually escapes housecleaning 
 colds, but if he helps, as taking up the carpets, he too may suffer. 
 
 Railway Colds. I have already referred to the fact that some 
 people can not take a ride in a railway coach without getting ill. 
 This is especially true during the cold season of the year. But 
 when one critically studies the subject one finds a marked differ- 
 ence in railway coaches. We need only consider the kind of air 
 to be found in a Pullman coach and the kind of people who use 
 it, and on the other hand the air of a smoking car on a small local 
 train, patronized by the tobacco chewer and spitter, with an odor 
 so overpowering that many men will not enter it. Besides in- 
 fective dust proper there is of course the cinder dust from the 
 locomotive and the dust stirred up from along the roadbed. 
 
 It is sometimes said that air conditions of trolley cars are su- 
 perior because there is no smoke and no dust from cars ahead, 
 but according to my observations more spitters travel on trolley 
 cars than in day coaches of through passenger trains. Moreover 
 many railway companies have a very efficient system of ventila- 
 tion. Although smoke and cinders come in, yet there may be prac- 
 
COLDS AND CATARRH. Ill 
 
 tically no infective dust. From personal experience I know 1 can 
 travel on clean through passenger trains (not being a smoker I 
 never travel in a smoking car) with comfort but I can not say 
 the same of the average trolley car. I have a lot of data from 
 travelling men who observe conditions. They say the man who 
 spits tobacco juice travels by the cheapest mode; that means he 
 travels in a trolley rather than in a through passenger coach or 
 in a Pullman. 
 
 School Colds. These are especially important. A child may 
 have had good health up to the time of going to school, then there 
 may be a succession of colds, if not constant colds. Moreover the 
 colds are brought home to the other children and to the mother. The 
 fact that the specific diseases of childhood are disseminated at the 
 school house is well known. Parents are likely to keep their chil- 
 dren at home at times of an epidemic of measles or scarlet fever. 
 That colds are similarly distributed seems to be known to but few 
 parents. Cleanliness and thorough ventilation are the best pre- 
 ventative, not only of school colds but also of the common diseases 
 of childhood. 
 
 School colds form a frequent subject of discussion with par- 
 ents. Often when parents learn why their children or perhaps an 
 only child has so many colds and so much continued ill health 
 they become indignant. When unsanitary school conditions are 
 pointed out, they exclaim, "They ought not to be allowed to ex- 
 ist." Of course not but who is to alter or prevent? "Well, the 
 teachers ought to look after the matter. ' ' So they ought ; but we 
 know they do not. "Well, the School Board ought to look after 
 it. ' ' True, but the fact is they do not. ' ' Well, the Board of Health 
 should compel the school authorities to make the school sanitary.' 1 
 Of course ; but as a rule such Boards fail to do so — why ? Because 
 the people fail to look after health matters and fail to support 
 and endorse the local boards of health. 
 
 People often find it difficult to realize that health matters are 
 in their own hands, if they would only act. 
 
112 DUSTY AIR AND ILL HEALTH. 
 
 Some parents send their children to school and then leave 
 everything to the teacher or the authorities — our ex-President 
 •-•alls them li Cuckoo parents." 
 
 Similarly we find people who "leave everything to the doctor." 
 The physician ordinarily discusses things medical only with those 
 who come to him. In the preparation of this manuscript I asked 
 the opinion of people who do not or only rarely come to a phy- 
 sician. I found some who openly told me they were not interested 
 in the matter of ill health and disease and causes ; if they did need 
 the services of a physician they expected to place themselves in 
 his care and let him do the best possible. This at once brings up 
 the question of what is the best possible? How can a man know 
 unless he gives personal attention? How can we know that the 
 school authorities are doing the best possible for the child ? There 
 are any number of details apt to be overlooked unless there is per- 
 sonal interest. 
 
 Vacuum Cleaner Colds. Kinds of colds, as here described, 
 are almost endless; every now 7 and then one finds a "new kind." 
 At times one may see reason for some kind to occur but it may take 
 a long time before an actual case presents itself. For instance, 
 within the last few years vacuum cleaners have come into common 
 use. At the one extreme are household machines to which neither 
 sanitarians nor physicians can find objection, while at the other 
 extreme are those that are highly objectionable, with a very coarse 
 filter that retains only the coarse particles and allows the fine dust 
 to go through. In a closed room the air may be densely filled and 
 those in it may react. 
 
 For a long time I had no data on such a kind of cold. My first 
 notes relate to a poor woman with a cheap machine who goes about 
 cleaning houses, especially carpets. Her health quickly declined, 
 in spite of the fact that "her doctor" had told her the exercise of 
 using her hand-power machine would be good for her. He failed 
 to consider an important factor, one on which I myself insist in 
 discussing ill health with patients. 
 
COLDS AND CATARRH. 113 
 
 X Colds. After patients have learned to classify their colds 
 according to the place where or the conditions under which caught, 
 they at times vainly try to account for every attack. But at times 
 it is almost impossible to trace the source. Then some patients 
 want to discuss probabilities; they often forget that a physician's 
 time may be quite limited and he may then have no time for dis- 
 cussion or perhaps no inclination — the subject may be old to him. 
 
 For convenience of classification and explanation 1 have a name 
 for colds whose origin can not be traced, X Colds, meaning a 
 cold of unknown origin. 
 
 But one must use such an explanation sparingly. It is similar 
 to many in common use, as the very name "cold." Is it not true 
 that when a patient is told he has a cold he ceases to make further 
 inquiries, he assumes he knows, just as he fails to inquire when 
 given the "explanation" dyspepsia or nervous prostration? Some 
 terms conceal ignorance. We should inquire the why and the 
 wherefore. 
 
 At times the cause of an X Cold may be found. For instance, 
 one of my patients living in the country had acute attacks at times 
 when she did not come to town. The attacks were mysterious until 
 it was found that she was in the habit of cleaning dresses that had 
 been trailed over filthy sidewalks. That is where she got the in- 
 fection. It was no longer an X Cold. In such a case should one 
 apply a definite although clumsy name, Dress Cleaning Colds? 
 
 Under What Conditions Does One Catch Colds ? In attempt- 
 ing to answer such a question one would have to ask, Under what 
 conditions does one not contract colds? The city men who write 
 the books speak of the importance of physical cold, of getting 
 chilled, of sitting in draughts, or getting the feet wet, of hot, dry 
 air, of being insufficiently clothed, and of similar ' ' exciting causes. ' ' 
 The country doctor who sees people who are not constantly ex- 
 posed to infected dust may find that such an exposure may or may 
 not be followed by a cold; it depends. The farmer may expose 
 himself in all sorts of weather and yet have no cold — and then 
 
 18] 
 
114 DUSTY AIR AND ILL HEALTH. 
 
 some day he goes to town and breathes a lot of bad air and then 
 any ''exposure" promptly brings on a cold. 
 
 According to my own experience, I can expose myself to all 
 the commonly accepted causes of colds without contracting a cold, 
 provided I have not been exposed to infected dust for twenty-four 
 or more hours. For instance, last fall when the weather was quite 
 cool I one day worked in the garden, that is how I get my physical 
 exercise. Soon I began to perspire and then I drank a lot of cold 
 water and that brought the perspiration profusely to the surface, 
 my shirt was wet. A rain storm came up and I was soaked through. 
 Then while still warm from the exertion 1 took a cold bath, and 
 for a time was exposed to a strong draught going through the up- 
 stairs rooms ; I was taking an air bath after the fashion of Benja- 
 min Franklin. My supper was eaten rather hurriedly ; under good 
 air conditions I am apt to bolt my meals. After reading the even- 
 ing papers for an hour or so, I went to bed. The next morning 
 I arose feeling fine, not the slightest evidence of a "cold" after all 
 this "exposure." 
 
 In cold weather when the temperature is below zero I at times 
 go out with very thin clothing. Of course I feel cold and it feels 
 good to get back into the warm room, but there is no after-effect. 
 Now for the other side of the story. 
 
 I live on the edge of town on a four acre lot, under what must 
 he considered good air conditions. For the last year or two I have 
 been exposed to bad air only occasionally, as by going into the 
 heart of the city say for an hour or two. On going down I feel 
 perfectly comfortable but when I get back, after inhaling a lot of 
 infected dust, I have a feeling as though not warmly enough 
 dressed and a similar feeling that the house is not sufficiently 
 heated, and then if I am not "careful," that is in avoiding the 
 commonly accepted causes of colds, as those just mentioned, I am 
 apt to have a cold, perhaps a "bad cold." 
 
 I have numerous notes relating to conditions under which I do 
 or may contract a cold and under what conditions I am apt to es- 
 
COLDS AND CATARRH. 115 
 
 cape, and yet I do not claim to know all about colds. Being sub- 
 ject to colds but not to attacks of dyspepsia or of "nervous pros- 
 tration," I can not speak about these latter. I did however have 
 one dyspeptic attack in the fall of 1908 when returning from the 
 International Congress on Tuberculosis, at Washington. I was in 
 a Pullman sleeper with every berth taken. Evidences of a de- 
 ranged stomach promptly appeared and did not fully disappear 
 for two or three weeks. Had I been more susceptible I might 
 earlier have understood patients who complained of dyspepsia, but 
 on the other hand had I been more susceptible likely I would not 
 have passed through medical school at all and would not now be 
 writing as a physician. 
 
 I have a number of notes on patients and from friends who 
 have been experimenting to find out under what conditions they 
 contract colds. A professional man who is fond of hunting had 
 noticed that it makes a difference how he goes to the hunting 
 grounds, whether he walks out or goes in a buggy or automobile 
 or goes by train. If the latter he must be very careful not to get 
 chilled or break through the ice, because then he is sure to con- 
 tract a cold, while if he did not inhale infected air he will prob- 
 ably escape a cold. 
 
 Another professional man who takes an occasional hunting and 
 fishing trip to the north has learned that while in the wilderness 
 he can do almost anything, expose himself in every way, indeed 
 eat all sorts of food, without having a dyspeptic attack or com- 
 plaining of symptoms of dyspepsia. What would be a "throat 
 cold" in others in him manifests itself as a "stomach cold," per- 
 haps a derangement of the entire alimentary tract. 
 
 Perhaps in the light of such facts the reason north pole ex- 
 plorers escape not only colds but all sorts of acute disturbances 
 is not difficult to understand, nor why weather observers on high 
 mountains should complain on coming down and mixing with peo- 
 ple. That colds are contagious is a fact well recognized by my 
 old patients. 
 
116 DUSTY AIR AND ILL HEALTH. 
 
 Overheated Rooms. A young woman living in a thinly set- 
 tled part of the city, one of my recent patients not fully informed 
 regarding dust influences, was talking with one of my old patients. 
 
 "Why is it," she was asking, "that my father when he comes 
 home wants the house overheated, while my mother and I are per- 
 fectly comfortable with a much lower temperature? And that is 
 the way with Mr. — (a neighbor) ; the moment he gets home he 
 wants the house overheated. And there is Dr. X ; he is never warm 
 at home. It seems the doctors all have their offices overheated 
 and yet they speak of the evils of close, overheated rooms." 
 
 My old patient mentioned that her doctor (myself) does not 
 have his office overheated. The new patient suddenly saw a light. 
 "Oh, he does not go down town." The subsequent conversation 
 developed that she saw that when men are constantly exposed to 
 infection down town they want the rooms overheated while those 
 living under good air conditions all the time are comfortable under 
 a much lower temperature. 
 
 But this patient could not understand the case of two sisters, 
 one of whom was at home most of the time and always wanted the 
 house overheated, while the other sister who was down town all 
 day, much exposed to bad air, wanted more ventilation the moment 
 she came home; she did not complain of a low temperature. How 
 is that to be explained ? The reason is not far to seek : The one 
 sister is a marked dust victim; the other is an immune (at least 
 as far as known, perhaps she does react, symptoms may appear 
 later) . 
 
 Varying Manifestations of Colds. The term "cold" as used 
 in this volume and as already mentioned is synonymous with Dust 
 Infection. Individuals react differently and indeed an individual 
 may be differently attacked. An attack may be so slight that there 
 is a mere sense of discomfort, a feeling of malaise or feeling achy ; 
 there may be even a chilly sensation. With additional exposure 
 decided evidences of a cold may appear. There may be a disturb- 
 ance in the respiratory tract or in the alimentary tract or else- 
 where. 
 
COLDS AND CATARRH. 117 
 
 "Caught more cold" commonly means more exposure to bad 
 air. At times colds seem to be epidemic, especially in the early 
 part of the new year. Locally the usual explanation is this : Snow 
 and ice on streets and sidewalks hold down infection; the snow 
 and ice may be discolored by a large amount of tobacco juice, not 
 to mention soot that comes from burning soft coal. Street clean- 
 ing stops when there is ice and snow and then comes a thaw and 
 the accumulated filth is liquified and tracked indoors where it be- 
 comes dry and is pulverized under foot and arises as infected dust. 
 A few days of thaw may dry out the filth on streets and sidewalks 
 and then it is blown about and practically everybody may complain. 
 That is the time when the doctors are busy day and night. On 
 the other hand if the accumulation goes out suddenly with a warm 
 rain the "expected epidemic" fails to materialize. 
 
 To show how dust infection affects different members of the 
 family I shall briefly mention a few family histories. 
 
 FAMILY HISTORIES. 
 
 Several years ago a high school student came to me complain- 
 ing greatly of ill health, she was on the point of breaking down. 
 T knew the air and dust conditions of that school and promptly 
 told her what I thought was at the bottom of her difficulties. On 
 getting her family history I found that her father was much ex- 
 posed to infected dust and was constantly complaining of colds 
 and catarrh. That meant he brought home infection ; that in turn 
 meant she was getting bad air at school and at home. Her mother 
 was apparently an immune; she never complained. Her eldest 
 sister was also an immune, could go everywhere and anywhere. 
 (She recently removed to a large city and now complains of 
 "rheumatism.") Her second sister was very susceptible; could 
 not go anywhere without becoming ill and complained greatly 
 during the closed door season at home on account of infection 
 brought by her father. When she took vacations in a clean com- 
 munity she got along very well but suffered coming and going on 
 account of air of railway coaches. Her susceptibility to colds 
 
118 DUSTY AIR AND ILL HEALTH. 
 
 reminds one of the remark of Robert Louis Stevenson. He re- 
 quested people with colds to stay away from him as far as pos- 
 sible, because otherwise he was sure to catch a cold. 
 
 My patient apparently was not as susceptible as the last men- 
 tioned sister. Had she been she would not have been in high 
 school. I explained that likely she would continue to suffer more 
 or less until she finished high school and that her future health 
 would depend upon her environment, whether she lived under 
 good or bad air conditions. It was interesting to follow develop- 
 ments. She managed to complete the high school course and then 
 went to a college where air conditions are good and there had 
 good health. Although she "studied harder than ever," she 
 showed no signs of being "overworked." Then she taught in the 
 local schools for a year and was complaining more or less con- 
 stantly, her complaints being traceable to air conditions. At one 
 time there was an acute inflammatory process. Then she obtained 
 a position in a suburban school near a large city. Here every- 
 thing is neat and clean, especial attention is paid to cleanliness 
 and to ventilation. She now has the best of health, never com- 
 plains. I may add that I now and then prescribe for every mem- 
 ber of that family. Such a family history clearly shows the in- 
 fluence of environment. 
 
 People who have drifted about among physicians and are still 
 "uncured" as a rule have a poor opinion of "medical science." 
 When their susceptibility and the nature of their ill health is 
 properly explained to them, and when they see explanations veri- 
 fied, they get a better opinion of the art or science of Medicine. 
 
 Unfortunately few physicians make any detailed inquiry into 
 family histories. I failed to do so myself at first. I recall the case 
 of a middle-aged woman who when asked if she had a family re- 
 plied, Yes, a husband and two children. Are they strong and 
 healthy? Yes, the boys are thoroughly healthy but my husband 
 complains some of catarrh. I inquired no further and on my notes 
 entered, "Family history negative," a standard phrase in medical 
 case reports. Some time later when we were well acquainted and 
 
COLDS AND CATARRH. 119 
 
 when I was after details I learned that she had lost five children 
 in infancy. In the light of such a history it is no wonder that 
 the two remaining ones are "thoroughly healthy." The weak ones 
 died off. 
 
 We sometimes hear the Scotch spoken of as a "hardy race." 
 Adam Smith tells that of a large number of children born to 
 Scotch families only one or two reach maturity. Perhaps that 
 explains it. Those who advocate large families may or may not 
 know about this weeding out factor. In large families children 
 receive less attention than where there are only one or two. But 
 there may not be the survival of the best. There is an old saying, 
 The good die young. As matters stand now the "survival of the 
 fittest" means the survival of those best adapted to live under 
 unsanitary surroundings. If conditions were improved many more 
 would survive. 
 
 Several years ago while visiting in a large and dirty city I 
 accompanied a friend to the home of one of his friends and was 
 asked to stay for dinner. Besides the father and mother there 
 were a boy of about eight years and a girl who had just reached 
 school age. All the family "looked healthy," a fact to which my 
 friend directed my attention as an argument against my idea that 
 a dirty city is an unsanitary city. I suspected that at the first 
 opportunity he would bring up the subject for discussion. Now 
 when a doctor visits people naturally there is a tendency to direct 
 the conversation along the line of things medical. Some do it to 
 get free medical advice, others "to make talk." "We all know how 
 readily the doctor will talk shop. He may talk entertainingly 
 when otherwise he would be dull. There was no difficulty in get- 
 ting data, A few properly directed questions led me to arrive at 
 some conclusions regarding the remark of my friend that all the 
 family looked healthy. Here are some data on which to base con- 
 clusions : 
 
 The father's family was country bred and healthy. He came 
 to the city years ago and city life agreed with him. Two of his 
 brothers also tried city life but had to return to the country. The 
 
320 DUSTY AIR AND ILL HEALTH. 
 
 mother was city born and so were her parents. She has "robust 
 health." She belongs to the apoplectic type and one feels like 
 predicting premature death from cardio-vascular disturbance. The 
 first two children died in infancy. Then came the two living 
 children. The boy is healthy, ''only he gets very nervous at 
 times." A little questioning led me to assume that he reacts when 
 conditions are very bad. The girl is just reaching school age and 
 the effects of school air are to be determined. Then came another 
 child that also died in youth. 
 
 Here then we have a father who is adapted to city life; a 
 mother who is adapted ; two children who are the survivors out 
 of five. Had the father been susceptible he would not have re- 
 mained in the city; he would have gone back to the country with 
 his brothers. Had the mother not been adapted she likely would 
 have perished long ago. From such a parentage one may expect 
 children more or less adapted to city conditions. And where three 
 out of five fail one may look for "healthy looking children." It 
 would be interesting to know the subsequent fate of such a family. 
 
 In this connection I recall another family history, three grown 
 brothers and two sisters. One of the brothers came to me ten 
 years ago, complaining of continued ill health, saying he and a 
 sister had more than their share, that they more than made up 
 the family average, the three others practically never complain- 
 ing. Today these two sickly ones are still living. The sister who 
 never complained died suddenly of pneumonia and one of the 
 brothers may at any moment die of apoplexy. My patient is pru- 
 dent and in spite of his more or less complaining is likely to live 
 on to old age. 
 
 Environment and heredity are closely bound up. It may be all 
 but impossible to determine where the one begins and the other 
 ends. Every now and then we meet people where one or the 
 other is very susceptible, having constant ill health, the other 
 being immune. Of the children some are susceptible. Thus in 
 the case of the — family, country people living in isolation, men- 
 tioned later on, the father is immune to dust influences, the mother 
 
COLDS AND CATARRH. 121 
 
 very susceptible. The two oldest, boys, follow their mother, like- 
 wise the youngest, a girl, two daughters being immunes. 
 
 Out of the family histories I will quote that of — family. It 
 is an average prosperous family, dependent on daily labor. 
 
 This family was with me for a number of years. The children 
 are given in order of their ages ; there is an interval of about two 
 years between each; the youngest has just arrived at maturity; 
 all are unmarried. 
 
 Father : has an occupation that keeps him out of doors most of 
 the time; is never ill and never complains of an ache nor a pain. 
 
 Mother: has been subject to colds and sore throat all her life; 
 throat full of scar tissue; mucus forms readily on exposure to 
 dusty air; rheumatic and neuralgic pains frequent, at times one 
 can diagnose fibromyositis and again neuritis; had an attack of 
 pneumonia recently, recovered promptly in good air ; is a i ' chronic 
 neurastheniac." Ill health is very largely dependent on air con- 
 ditions. Her parents were farmers and susceptible to bad air. 
 
 Daughter: has an indoor occupation with fair air conditions; 
 has frequent colds and an irritable throat, but looks the picture 
 of health. 
 
 Daughter : indoor occupation with poor air conditions ; belongs 
 to the rheumatic type of dust infection and complains more or 
 less constantly; aches severely all over after an exposure to un- 
 usually bad air. 
 
 Son: indoor occupation under bad air conditions; has always 
 been subject to colds and coughs and had two attacks of "lung 
 fever" as a child; has tried a number of occupations since leaving 
 school but has not yet found the right one, the one compatible 
 with "good health." He is the only member of the family who 
 under-estimates dust influences — and suffers proportionately. 
 
 Daughter : exposure to bad air means dysmenorrhea, with more 
 or less aching along the spinal column. She remains at home, goes 
 out but little. 
 
 To make such a family history of greater value one should in- 
 quire further back regarding the grandparents and greatgrandpar- 
 
122 DUSTY AIR AND ILL HEALTH. 
 
 ents, in fact back as far as possible although we should keep in mind 
 that the further back we go the less reliable data become as well as 
 causes from which people died. This is especially true in new 
 countries where physicians are few and where the methods of 
 diagnosing are of the rough and ready sort, where people die of 
 "'lung trouble" and stomach trouble," terms that may include all 
 kinds of diseases and causes of death. The place where the an- 
 cestors lived is important. People who have always lived in the 
 country may be healthy simply because not exposed to the causes 
 of disease. People on the other hand may be healthy because they 
 are the survival of the fittest. We trace our ancestry to Europe : 
 Under what conditions did our forefathers live? To what ex- 
 tent w r as there a weeding out? The descendants of people long 
 accustomed to city conditions are more apt to thrive under city 
 life than those whose ancestors have always lived under rural con- 
 ditions. The robust country man coming to the city may not last 
 long, while the anemic city man lives on and on. The Jew who 
 traces his ancestry to some European ghetto may be able to live 
 under city conditions here where another whose ancestors have 
 been country people, as most of the European Jews coming to our 
 country now, may utterly fail. In a larger sense, these remarks 
 apply to the prevalence of diseases, as for instance to the immunity 
 of the West Coast negro to malaria, the susceptible have been and 
 are constantly being killed off. Our own people would become 
 similarly immune if long enough exposed, but naturally at a great 
 loss of life. 
 
 In discussing the influence of an unsanitary environment on 
 offspring one should also mention the reverse. I have several his- 
 tories of individuals who many years ago were brought from large 
 eastern cities as foundlings or "refugees." Some at least were 
 children that come under the head of "gutter-snipes," they were 
 ill-formed, prematurely old, and showed the scars of conflicts with 
 unsanitary city conditions. Such individuals are usually adopted 
 by childless couples, at times by families wnth many children, and 
 the contrast between "strong and healthy country children" and 
 
COLDS AND CATARRH. 123 
 
 the "weak and sickly city child" may be very marked. In time 
 the child grows into a man, the man marries — and in his children 
 Nature reasserts herself, his children as a rule are "strong and 
 healthy." 
 
 Shall we say that man like animals and plants reverts to the 
 aboriginal state if "left to nature," if freed from artificial condi- 
 tions and restraints to which man subjects himself, his children, 
 his animals and plants? 
 
 Shall we go a step further and say that "strong and healthy" 
 means such only under good surroundings and that the strong and 
 healthy fail on going into an unsanitary environment? 
 
 Civilization means cleaning up. We differ from savages in 
 that we do not tolerate lousiness and filthiness, we bathe frequently 
 and wear clean clothing, we have clean homes and clean cities. 
 To understand this fully we must read about former days. Shall 
 we say that in proportion as cities do not clean up they do not 
 represent the civilization of today? 
 
 In whatever manner we follow up the subject the need for 
 cleaning up crops out. 
 
 DUST INFECTION AND AGE. 
 
 When one studies many dust victims, covering a large number 
 of years, one feels inclined to divide them into groups about as 
 follows : 
 
 The New Born. We all know that it is impossible for every 
 child to live; some die at once, some lead a precarious existence 
 for days or weeks or months and then perish. Children living 
 under sanitary conditions and having the best of care naturally 
 stand the best chance of surviving, but we should not forget that 
 such children may be "delicate," they readily react to unsanitary 
 surroundings and may develop into "chronics." 
 
 The second period may be said to begin with school life, that 
 means coming in contact with others under more or less unsanitary 
 surroundings. The air of schools as a weeding out factor of 
 course varies greatly. Some schools are very unsanitary, in none 
 
124 DUSTT AIR AND ILL HEALTH. 
 
 is the ventilation perfect. The child from a clean suburban home 
 en attending the school half way to the heart of the city may find 
 conditions very bad; there may be constant colds and ill health 
 of all kinds, not to speak of contracting the specific diseases of 
 childhood. On the other hand the child from the heart of the 
 city, living under bad air conditions at home, may find that same 
 school sanitary, that is comparatively speaking. We thus have a 
 paradox: children of some parents are sent to an "unsanitary 
 school" -while children of others, those from the heart of the city, 
 are sent to a "sanitary school." The slum child may actually 
 have better health while going to the school half way out to the 
 suburbs or edge of town. 
 
 Third, a period beginning with the close of the graded school 
 period. Here we must divide individuals into two subgroups, those 
 who continue their schooling and those who get into some gainful 
 employment, including the girl who stays at home and docs house- 
 work. The boy or girl who has been going to a comparatively 
 sanitary graded school now goes to the unsanitary high school lo- 
 cated in the heart of the city where air conditions are very bad. 
 There may now be so much ill health that the student drops out. 
 Those who pass through an unsanitary high school may be con- 
 sidered the survival of the fittest, meaning that they are able to 
 thrive or at least exist under unsanitary conditions. When they go 
 to college, especially to one where some attention is given to air 
 conditions, they may have no difficulties at all. They may even 
 survive the air conditions found in professional schools in the 
 very heart of large cities. 
 
 Fourth, the period when an individual begins an independent 
 existence by taking up some occupation. Whether an individual 
 leads the life of a farmer or market gardener or whether he leads 
 the life of a clerk down town or as a mechanic in some factory 
 may make a marked difference in his future life. It is the ex- 
 ceptional man who becomes an employer instead of being the em- 
 ployed. The industrial city is constantly calling for strong men 
 but it may be only a few years until it has "taken it out" of them 
 
COLDS AND CATARRH. 125 
 
 and has no further use for them. Unfortunately we have no re- 
 liable statistics regarding the longevity of men in different trades 
 and professions in our country. People are not born to trades and 
 professions as they are in the old world ; foreign statistics can not 
 properly be applied. 
 
 Fifth, the decline of life, when an individual begins to realise 
 his limitations, that he can no longer do as in youthful years. 
 Many have chronic ill health, others frequent acute attacks. When 
 we critically study symptoms we often find that attacks are con- 
 servative processes, just as symptoms are warnings from nature. 
 The city man who has constant ill health may have a return of 
 good health on going to the country. 
 
 Sixth, finally we may consider people who have attained the 
 proverbial three score and ten. It is interesting to study the lives 
 of old people, the conditions under which they live and have lived, 
 and whether they have or have had much or little ill health or 
 sickness. In thinly settled communities many may reach old age, 
 while in crowded cities it is the exceptional individual who at- 
 tains it. With infection all about it is a wonder that a city man 
 reaches old age at all. Golden weddings are rather frequent in 
 the country. One of my friends has a belief that a fatality soon 
 follows a celebration. Perhaps it is due to the fact that the quiet 
 of the home is disturbed by a large crowd, some of whom bring 
 infection. 
 
 TIME LOST ON ACCOUNT OF ILL HEALTH. 
 
 The amount of time lost on account of ill health and disease 
 is an interesting question. Some individuals lose much time, 
 others little, A headache may disable a brain worker, a backache 
 a laborer. Slight pains and aches may be neglected, severe pains 
 call for rest from work. Some persons are disabled from a slight 
 ailment, others, especially poor people, keep on working even when 
 seriously diseased. 
 
 Acute specific diseases may appear suddenly, but chronic dis- 
 eases as a rule appear only after repeated premonitions. The abil- 
 
12G DUSTY AIR AND ILL HEALTH. 
 
 ity to take a timely day or a week off may mean to escape serious 
 ill health and disease, as well as chronic ill health. To some Sun- 
 day as a day of rest means much. The subject is especially in- 
 teresting- from the standpoint of dust. 
 
 I have already referred to a patient (p. 93) who soon recog- 
 nized the value of a vacation, a day or a week or even several 
 weeks off, and now avoids much ill health. Here is a patient, one 
 of several similar ones, who was sent me by a physician as a 
 "peculiar case" which he wanted me to "work out." 
 
 I found the man to be a dust victim "with a stomach." He 
 promptly improved by following good air advice, plus taking a 
 little medicine, and then was ready to go to work. I advised 
 against this, telling him to get himself in good shape first or he 
 would relapse. A few weeks made a wonderful difference in his 
 appearance. Then a brother who has a poolroom 1 became ill and 
 another brother took his place ; the latter however began to ' ' give 
 out" in the course of two or three weeks, and then my patient 
 thought it his duty to relieve him, for an hour or two at meal 
 times at least. I advised against this also but he thought it was 
 his duty. He remained for less than a week when he ' ' was all in. ' ' 
 He was now glad enough to remain under good air conditions, 
 chiefly by going out along the river, fishing. About two weeks later 
 the substituting brother was again on the point of breaking down, 
 and my patient again went to the rescue, daily remaining a short 
 time, at meal hours. I questioned him closely. It was inter- 
 esting to find how in proportion as he was exposed to bad air con- 
 ditions he felt bad, while his brother, by being out under good 
 air conditions for a few hours every day, improved. Neither of 
 these two men is adapted to indoor-bad-air life conditions. As 
 a matter of fact, the other brother, the poolroom owner, himself is 
 not adapted but has simply continued, not knowing what else to 
 do. If my patient discusses these matters freely with his brothers 
 it is likely that all may adopt the pure air advice. I am curious 
 to see how these three cases, one of whom is my patient, will ulti- 
 mately work out. 
 
 1 On the window is painted "Shine and Cigars." That means that the room is filled both with 
 dust and smoke. 
 
COLDS AND CATARRH. 127 
 
 CLIMATE. 
 
 If people can not otherwise account for their ills they will 
 ascribe them to the climate or accuse the climate. 
 
 Man is peculiar in that his kind is found everywhere, from 
 pole to pole. At the same time we must consider that there ar<i 
 different races or strains of man, some adapted to one region, 
 some to another. If the Eskimo from the far north and the tropi- 
 cal South Sea Islander exchanged places both would likely 
 promptly perish. 
 
 People of the temperate zone with half a year of summer and 
 half of winter bear such changes quite well — they become adapted 
 to variations. But if the change is too great they may not nourish, 
 as our people among the Eskimos or in the hot moist tropics. The 
 term climate of course includes many things besides changes in 
 temperature — food, clothing, housing must be considered. 
 
 When we ordinarly speak of "change of climate" we have no 
 radical change in mind. As a rule people move along lines of 
 latitude rather than longitude. It is the exceptional man who 
 goes to the tropics and returns home with some tropical disease, 
 or returns from the far north with feet or hands or ears frozen 
 off. 
 
 Our people, my folks and your folks, are accustomed to the 
 alternation of a warm and cold country, half the year we have 
 winter weather and half the year summer. We are used to this. 
 The very young and the very old may react acutely, may even 
 perish, but ordinarily we do not look for such effects nor do we 
 expect ill health or disease on account of the annual changes — 
 barring such affections as, for instance, hay-fever and sunstroke 
 in summer, chilblains and frozen ears in winter, not to speak of 
 freezing to death. 
 
 We constantly make efforts to counteract disagreeable effects 
 — dress warmly in winter and live in warm houses, or keep cool 
 and in the shade in summer. Yet many take few precautions at 
 all and still are healthy and live on to old age. 
 
 But people in ill health or diseased may be acutely sensitive 
 
128 DUSTY AIR AND ILL HEALTH. 
 
 to annual changes, they complain of the heat of summer and the 
 cold of winter, but that these annual changes are productive of ill 
 health and disease is another question. People who do complain 
 of weather and seasonal changes likely have something the matter 
 with them due to causes other than climate. 
 
 When we critically consider causes of ill health we may con- 
 clude that climate by itself has little influence in producing ill 
 health, not to speak of disease. We must consider that man is 
 constantly interfering with nature, that he is altering the condi- 
 tions under which he lives. For one thing he creates an indoor 
 climate for himself, just as he does for his house plants. Many 
 ills are traceable to an "indoor climate" and that means especially 
 to conditions found in homes, in public places of all kinds, stores, 
 shops, factories, offices, churches, theaters, schools. Indeed the 
 very air out of doors is modified, filled with smoke and dust, ob- 
 scuring the life-giving sunlight. 
 
 Climatic influences, weather influences and dusty air influences 
 are usually intimately bound up. The man who has ill health and 
 "changes climate" by going say to southern California and clerk- 
 ing in a store in the heart of a large city, perhaps living close by, 
 is not at all getting the "benefit of the climate." The real climate 
 is out of doors and away from the city. The invalid who goes 
 south on the approach of cold weather does so mainly to escape 
 northern indoor life ; in proportion as he lives in hotels or health 
 resorts indoors he misses the climatic influence. When a physician 
 has seen many such cases he may have some decided views which 
 he will impart to patients who think of changing climate. 
 
 The hay-fever victim who ' ' changes climate ' ' in reality escapes 
 his usual affliction by going to a place where the cause of his ill 
 health or disease (the pollen of certain plants) is absent. It may 
 not be a matter of climate at all. Some plants depend on climatic 
 conditions, others on conditions made by man himself. The Rag- 
 weed does not grow in shaded forests nor in undrained, wet places. 
 Making the soil arable usually means to make it favorable also for 
 the growth of the Ragweed and for weeds in general. Pollen dust 
 
COLDS AND CATARRH. 129 
 
 as a cause of ill health should he differentiated from "climate" as 
 a cause of ill health. Different kinds of pollen produce different 
 kinds of ' ' colds ' ' or ' ' catarrh. ' ' 
 
 Physicians are constantly sending patients "to a different 
 climate." But they do not send healthy people, there must be 
 "something the matter." It is the strong and healthy who go to 
 a new country to settle; they leave the sick and diseased, the 
 feeble and decrepit, behind — at least that was true before the days 
 of easy travelling facilities. The new settlers are healthy; it is 
 only gradually that the old diseases of civilization come in. 
 
 It is not likely that the home climate produces the ill health 
 and it is not likely that a change of climate pure and simple will 
 cure, although such a change may produce a marked effect, per- 
 haps less due to climate itself, however, than change of life and 
 surroundings, habits, rest, food, water, etc., all must be considered. 
 Many, like the Knight of the Holy Grail, seek in a distant country 
 for that which they will likely find near at home. Dust-free-air 
 is advertised by German sanatoria. But there is no need for the 
 dust victim to go to Germany; he can have dust-free air near at 
 home. 
 
 Formerly on account of limited travelling facilities it was dif- 
 ficult for a physician to determine whether a patient, ill from any 
 one or more of many causes, was influenced by climate or not, but 
 today he may arrive at definite conclusions. Some physicians are 
 constantly sending patients away. In reading English biographies 
 one constantly finds references to London physicians sending their 
 patients away. Some are sent south on the approach of cold 
 weather and north on the return of warm weather. Some people 
 try all sorts of climates, seashore, plain and mountain, not to speak 
 of hot and cold climates. 
 
 A physician is constantly meeting patients where the matter of 
 climate comes up, as in the following case. A young housewife 
 who had always lived in this locality complained more or less of 
 general ill health and every now and then of sharp pains, especial- 
 ly pains localized in the chest. Such pains are variously referred 
 
130 DUSTY AIR AND ILL HEALTH. 
 
 to as pleurisy or a stitch in the side, intercostal neuralgia, neu- 
 ralgia or rheumatism. She had tried different physicians and had 
 been dosed with all sorts of "anti" remedies, especially with sup- 
 posed anti-rheumatic drugs. She complained that she had more 
 difficulty in the winter than in the summer and accused the cli- 
 mate. She came to give me a trial. When I studied her history, 
 including her symptomatology, I came to the conclusion she was 
 a dust victim. I found her ill health varied according to where 
 she had lived in town ; she complained greatly in the heart of the 
 city and comparatively little in the outskirts where she now lives, 
 here mainly after acute exposures. I tried to explain the nature 
 and cause of her ill health, that it was not due to our climate. In 
 the course of time the assumption was verified. She had a number 
 of exposures, as on railway trips, shopping, etc. Her experience 
 soon convinced her that the only thing she had to guard against 
 was infection in the air. 
 
 One day she spoke of some friends who had removed to the 
 northwest. One had been complaining like herself but in the new 
 home all troubles disappeared. Naturally the change was ascribed 
 to the "wonderful climate." My patient knew better; but when 
 she continued to receive glowing accounts of the "wonderful cli- 
 mate" and how easy it was to maintain health, she concluded to 
 go there with her family, especially as one of her children was 
 complaining greatly, being also a dust victim. 
 
 Before my patient left I explained to her quite fully how man 
 modifies his surroundings and indeed the very air he breathes. 
 He entirely alters the face of the earth. He cuts down the forest, 
 and fields of grain, or crowded cities, take its place; the bare 
 prairie or desert is altered. In a new country potatoes or peach 
 trees are not found growing wild, nor does one find the common 
 household pests and parasites, nor the common diseases of civiliza- 
 tion. People are healthy in the new home because the old diseases 
 have not yet been brought in, they will all appear in time. 
 
 Now there are people, patients, who readily understand ex- 
 planations and always remember them. They will live up to the 
 
Cotj>ft and catarrh. 131 
 
 spirit of the explanation and not merely to the letter, in other 
 words, they reason about things. I had assumed that this patient, 
 would always remember what had been told her, but subsequent 
 events showed that it was the old story, Out of sight, out of mind. 
 Unless some people are constantly in the care of a physician to re- 
 mind them they forget. 
 
 This patient in her new home in North Dakota had good health. 
 Tier sickly child also had good health and grew up "strong and 
 health}'. " But life in the new community was quite primitive 
 and she soon tired of it; she wanted to live among people. She 
 was still influenced by the idea of healthy and unhealthy climates 
 and induced her husband to remove to arid Colorado, the land of 
 much sunshine. Here she lived in a small and clean town and had 
 good health, but her husband's business was not good and soon 
 another change was made, this time to southern California, which 
 also is said to have a "healthy climate." Unfortunately her new 
 home was near the heart of a large city and then both she and her 
 daughter began to complain more and more. I learned this through 
 mutual friends who saw the explanation and marvelled that she 
 did not see it and that others do not see it. 
 
 What does a man do in a new home? Does he take up farming 
 and lead an outdoor life, or does he work in a store in the heart 
 of a crowded city? Does his family live in the suburbs or in the 
 heart of the city ? To what extent are dust influences and weather 
 and climatic influences confounded? 
 
 LOCALIZED PAIN. BACKACHE. "RHEUMATIC CASES." 
 
 My first practical experience as a physician was obtained in a 
 large city. I treated people to the best of my ability. I now see 
 how I wholly misunderstood many. 
 
 One of my first patients was a "backache case," a man ap- 
 proaching middle age. He gave a history of "specific infection" 
 followed by "blood poisoning" and that in turn followed by 
 "rheumatism of the back." Under the free use of iodides the 
 "backache or rheumatism or whatever it was" quickly left. The 
 
132 DUSTY AIR AND ILL HEALTH. 
 
 man was so pleased that he recommended me right and left, espe- 
 cially to people who were "rheumatic." Unfortunately I failed in 
 practically every case; some had had iodides before — and if that- 
 had been the cure they would not have come to me. 
 
 Individuals who have localized pains (as a backache or lum- 
 bago, chest pains, especially in cases where such names as pleurisy, 
 pleurodynia and intercostal neuralgia are used, or where the pain 
 is in one of the extremities) often vainly try all sorts of remedies 
 and means to get relief. One meets all kinds of cases, people who 
 have tried all the doctors of the neighborhood, and perhaps large 
 city specialists, and who in their desperation tried patent medi- 
 cines in the hope of stumbling on to something that would help. 1 
 We all know how people are influenced when some nostrum is 
 strongly recommended to them. Some go to sanatoria and mineral 
 springs; some are sent by their doctor who is unable to benefit 
 them. "When otherwise sensible men and women who see the 
 ridiculousness of faith and mind cures are willing to give these 
 a trial in the hope of being benefited, one can see to what ex- 
 tent people will go to get relief. 
 
 There are of course all sorts of causes bringing on localized 
 pains and producing ill health, but a very common one is generally 
 overlooked. Many of these individuals are dust victims and when 
 they properly understand what that means and live up to good 
 air advice they are greatly benefited. 
 
 A young man, cashier in a bank, came to me complaining of 
 rheumatism; besides severe pain in the shoulder there was more 
 or less aching throughout the body, particularly along towards 
 spring, more especially at times when liquified filth was tracked in- 
 doors and pulverized, when there would be a black streak from 
 the door to the cashier's window. My explanation of dust in- 
 fection was too simple; he did not believe it and moreover "no 
 doctor ever told me of that before." He did not return. I 
 should have made the explanation more guardedly. A year later 
 he returned, saying he had observed himself and he believed there 
 
 1 People afflicted in this way can perhaps profitably read Lent's "Being Done Good." It gives a 
 more or less humorous account of a man who was sadly afflicted and was trying to find relief. 
 
COLDS AND CATARRH. 133 
 
 was something in the dust theory after all, and then he told of 
 recently having been to a physician who proposed to ''knock out 
 the rheumatism" but instead "knocked out the stomach." In 
 addition to his other complaints he was now suffering from a de- 
 ranged alimentary tract. 
 
 In the course of time this man discovered that there was no 
 cure properly speaking, that it was a matter of prevention, and 
 then one day he packed up and went to the Pacific Coast and since 
 then has had "the best of health." 
 
 Mr. — , a middle-aged mechanic, has been with me since early 
 1903. He has had all sorts of experiences. Being a man with a 
 family and not being foot-loose like the man just mentioned, he 
 can not make any radical change, in fact being a poor man he is 
 compelled to work under adverse air conditions and continues to 
 suffer. At times he has severe attacks of pain, "rheumatism or 
 neuralgia or whatever it is," in the side and back. The man is 
 a good citizen, in short the kind of man who is apt to get the 
 best one has to give — but what is to be expected in the case of a 
 poor man dependent on his daily labor who has nothing laid up 
 for the proverbial rainy day; who can not take a needed vacation 
 or a few days' rest when sickness impends; who can not afford a 
 trained nurse in case of confinement to bed, and who is wholly 
 unable to live up to good air advice? 
 
 I soon determined the man was a dust victim and attempted to 
 explain what that meant, what he must do to be saved. One must 
 give more or less medicine along with good advice. I tried to 
 supervise health, to point out how he could reduce his ill health 
 and acute attacks to a minimum, but perhaps needless to say the 
 man who can not live up to advice will continue to suffer. He gets 
 along fairly well during the open door season but complains great- 
 ly during the closed door season, and especially at darkest before 
 dawn. He is able to pay only small fees, yet I was willing to 
 carry him because I was getting data. True it is only a repe- 
 tition, but this very repetition is what confirms one's belief in the 
 correctness of a theory, the theory of dust infection. 
 
134 1H STY AIR AND ILL HEALTH. 
 
 He had consulted a number of physicians before coming to me, 
 including men who claim to be specialists, but who were not such 
 properly speaking. The fact that he remained with me all these 
 years must, be considered good evidence that I benefit him more 
 than any other physician. In the course of years the reaction 
 at darkest before dawn has been more and more severe and this 
 last year he became desperate. 
 
 Occasionally I had an opportunity of discussing specialists with 
 him not only regarding himself but also other members of his 
 family. He may or may not have followed my advice. 
 
 People in ill health and disease often need the services of a 
 specialist, of the man who has special knowledge. How do people 
 know who is the proper man. the best man, to consult ? Many are 
 woefully ignorant, so ignorant that they believe the man who ad- 
 vertises himself as a specialist in the newspapers is the one to 
 consult, when as a matter of fact he is the last man in the world 
 to consult. The real specialist does not advertise, unless it be by 
 presenting papers before medical societies and publishing papers 
 regarding his work and cases and thereby acquainting fellow- 
 ph} r sicians with his work and the kind of cases for which he is 
 qualified and which he seeks. The general practitioners, not to 
 speak of specialists, send him cases — and often the best service the 
 physician can do an applicant is to refer him to the proper spe- 
 cialist. 
 
 But when a physician has repeatedly made all necessary ar- 
 rangements and has written the specialist to be on the lookout, 
 and when one finds that the individual, "the case," went else- 
 where, one questions, "Is it worth while?" 
 
 During the unusually severe attack of last spring he became 
 desperate. He asked me what I thought of going to a large city 
 specialist, one recommended by fellow-workmen. What shall one 
 say? How much time and attention does a. poor man get from a 
 busy large city specialist who counts his time by minutes and who 
 may not give a poor man the necessary time to make a proper in- 
 vestigation, and failing to do so how can he benefit? My patient 
 
COLDS AND CATARRH. 135 
 
 thought the experience of a great specialist might enable him 
 promptly to recommend something that would help. We discussed 
 the pros and con. 
 
 Unfortunately I did not know the specialist who had been rec- 
 ommended to him. I told my patient there are sorts of specialists, 
 some real, others pseudo. The real specialist who cultivates a 
 small field likely knows his field well, if a man properly "belongs" 
 to such a specialist he is apt to get the best that Medicine has to 
 offer. On the other hand the specialist who "specializes" in every- 
 thing that those Avho come to him complain of, and who scarcely 
 rejects any applicant, is only too common; the patients, or "cases" 
 (or shall one say dupes?) of such men are to be pitied. How shall 
 one distinguish between the two? 
 
 The real specialist gets his patients through the recommenda- 
 tion of fellow-physicians and of people who have been benefited by 
 him. He does not advertise in the newspapers. The pseudo- 
 specialist on the other hand gets his patients mainly through news- 
 paper advertising. 
 
 The real specialist writes for the medical journals, as already 
 mentioned; he tells of his experiences for the benefit of other 
 physicians. If he finds or discovers anything new he tells it; he 
 does not have any secret remedies or methods. The man who has 
 such quickly finds himself repudiated by his fellow-physicians. 
 Just to what extent a man writes for the medical journals, or in- 
 deed a book, may depend on many factors, but usually men who 
 are specialists go on record so that other physicians know what 
 they do. What a man publishes largely determines the kind of 
 cases physicians send him. When a physician is asked to recom- 
 mend a specialist, if he does not know the man he is likely to look 
 up what he has written. 
 
 The pseudo-specialist or charlatan or quack, on the other hand, 
 neither tells of his discoveries nor writes for reputable medical 
 journals. He is very apt however to tell of "wonderful discover- 
 ies" and of great skill and "eminent success" in the newspapers. 
 But there is nothing tangible; his "discoveries" are kept secret. 
 
136 DUSTY AIR AND ILL HEALTH. 
 
 Now the specialist ray patient had heard of through fellow- 
 shopmen was a man whom I did not know; I did not even recall 
 that I had ever heard of him. I told my patient I would look him 
 up to see what he had written on the subject, about the particular 
 complaints of my patient. He at once assured me that the man 
 was "all right," and when I saw that he was determined to go to 
 him, was it worth while to continue the discussion? Under such 
 circumstances a physician usually washes his hands of the case, 
 in other words he severs the relationship of physician and patient. 
 I felt inclined to do that — but I wanted more data, and unless the 
 man reported I would get little or nothing. I asked him to let 
 me know what the specialist said. 
 
 He returned in a week. It was clearly to be seen that he came 
 in the spirit of the man who obliges another, as one who has some 
 valuable information to give. He told me of the "thorough ex- 
 amination" he had received ; as a matter of fact it was less thorough 
 than my own, as he soon admitted. He showed me the prescription 
 which he was given ; it was the usual ' ' anti-rheumatic ' ' kind. 
 
 Parenthetically it may be said that this prescription differed 
 from one previously given him by a "specialist," of the kind who 
 specializes in practically everything, in that it contained no "pain 
 killer," that is, opiates were absent. An observing druggist has 
 repeatedly told me that "the old chronics are very grateful for a 
 little anodyne or narcotic that is slipped into the prescription ; 
 they notice it at once." This may make them feel better immedi- 
 ately and they may be more grateful to the symptom-prescriber 
 who does "slip in" things than to the scientific physician whose 
 prescription is aimed to "gradually remove the cause" — but just 
 what some assume the cause to be is difficult to determine. In the 
 light of cases cited in this volume it would be necessary to remove 
 some patients from the cause, change their environment, rather 
 than try to remove some internal cause. 
 
 I judged from my patient's remarks that the physician he con- 
 sulted was really a good man who examined according to the 
 usual methods of the thorough-going physician, but it was clearly 
 
COLDS AND CATARRH. 137 
 
 evident that he was looking for well-defined disease and did not 
 suspect the man was reacting to environmental influences. Finally 
 I asked what the city doctor charged: it was as much for the 
 single consultation and examination as he paid me for a whole 
 year. 
 
 It was clearly evident that the man no longer regarded himself 
 as my patient. He was taking "the other doctor's medicine." 
 Under such conditions one does indeed feel that the relationship 
 of patient and physician is severed. But I had had the man under 
 observation for so long that I knew what would likely happen: 
 he would improve now that the open door season was at hand, but 
 in all probability later on would relapse. What I did say was 
 merely to express the hope that the prescription would benefit him 
 and that I would be glad to hear from him later on. 
 
 Then one week after another passed. Finally the closed door 
 season arrived and then one day he telephoned that the old pains 
 had returned, and would I please send him some of the old medi- 
 cine, "You know what you used to give me." The man is still 
 my patient. One often swallows his pride in order to get con- 
 tinued data. He now regards that trip to the city as an "experi- 
 ment. ' ' 
 
 Shall one say that the poor man who must work daily must 
 also suffer more or less on account of bad air conditions? Shall 
 one say that if workmen were properly organized through Unions 
 they could make a demand for better ventilation? 
 
 These are pitiable cases. What can such a man do? What can 
 the physician do? Is there any cure, any drug that will cure? 
 How will it all end? Will the pain increase to such an extent that 
 finally there must be a radical change? 
 
 Here is a brief mention of several cases that may shed some 
 side-light on the practice of medicine in the small community. 
 
 Mr. — , a middle-aged farmer who loafed much about the store 
 of a small village, came to me at the end of winter on account of 
 "rheumatism." The man was so ignorant that I did not deem 
 explanations worth while, but merely gave what he wanted, medi- 
 
138 DUSTY AIR AND ILL HEALTH. 
 
 cine. He got well as soon as the open door season arrived; of 
 course he ascribed it to the medicine. 
 
 Among the people he sent me was an intelligent farmer who 
 had complained of rheumatism every winter for years; he was now 
 thinking of going to California to escape our "horrible climate." 
 1 might have given him what he wanted, medicine, but I thought it 
 best to explain, beginning with indoor climate and bad air and in 
 time pointing out what this means. How much time shall one give 
 in making explanations, especially if they seem not acceptable? 
 He finally told me he would consider the matter of taking treat- 
 ment from me; he failed to return. 
 
 A few weeks later I met him on a trolley car; from some re- 
 marks on the weather we soon got to discussing common ailments, 
 rheumatism in particular. With ample time I went into details 
 and answered his objections. A few days later he became my 
 patient and remained for a long time. All some people need is a 
 proper explanation. 
 
 The first mentioned farmer relapsed next winter, as I thought 
 he would, and then I attempted to explain to him also — but he 
 wanted medicine, he did not want any "ridiculous explanations." 
 He sent me no more "new patients;" far from it, he heralded me 
 as a crank. 
 
 To what extent shall one head off getting such a reputation? 
 To what extent shall one strive to acquire the reputation of being 
 a "good doctor, so kind to the poor?" It requires only a few 
 minutes to hand out the desired medicine. 
 
 One of my old patients who has "sciatic rheumatism" but who 
 in reality is a dust victim and has learned to live within his limi- 
 tations and thereby reduce attacks to a minimum, recently sent 
 me a new patient whom he suspected was also a dust victim but 
 who resented the idea of dust being injurious. My old patient did 
 not enter into discussion with the man; he thought I could ex- 
 plain better. 
 
 I gave the man two hours in examining and ruling out affec- 
 tions and diseases and in advising him and of course telling him 
 
COLDS AND CATARRH. 139 
 
 about dust influences. He offered some objections which I an- 
 swered briefly. I referred him back to my old patient who could 
 make explanations perhaps as well as I could, he could speak from 
 personal experience. I gave him a prescription, for salicylates, to 
 be used only when pains were very marked. I charged him a dol- 
 lar, telling him in case he returned the fee would be doubled. 
 
 A week or so later I saw my old patient. He had a poor 
 opinion of the man, pronounced him "no good," that he would 
 not listen to explanations and that he expressed himself emphatic- 
 ally on the most doubtful points. A short time after the man 
 came back to me. Often the printed page influences people when 
 words of mouth will not, and so I gave him several of my reprints, 
 some of them rare, asking him to read and return them. That 
 was the last I saw of the mail and my reprints. 
 
 Mr. — , another "rheumatic," came to me recommended by an 
 old patient, because I "study my cases." Now I was willing 
 enough to study the case but I was unwilling to make continued 
 a-b-c explanations and so I referred the man to a young physician 
 who himself is influenced by dusty air and who had a lot of time 
 to make explanations and likely would give as good service as I 
 could. Instead of following this well meant advice, the man 
 "talked," said I wanted only rich patients, that I did not want 
 anything to do with poor people, etc. 
 
 Mr — , a middle-aged man, working in a grain elevator with 
 much time spent in a filthy office where men who chew and spit 
 loaf, came to me from an adjoining town, "crippled by rheuma- 
 tism." The pain extended from the back down the left leg. The 
 man seemed greatly discouraged and I gave him nearly two hours 
 in examining and explaining and advising, in the end telling him 
 I was working on a manuscript for a book which when it appeared 
 would tell him of dust infection in some detail. He expressed 
 himself so enthusiastically about the idea that I gave him two of 
 my very rare reprints to read and to be carefully returned. Then 
 one week after another passed and I heard nothing further. Sev- 
 eral months later an old patient from that neighborhood said the 
 
140 DUSTY AIR AND ILL HEALTH. 
 
 man had promptly packed up and gone to the southwest where lie 
 could lead an open air life. 
 
 Cases like the above could be cited in number and variety. 
 A physician has all sorts of experiences. Were these men really 
 dust victims ? I do not know but I do know that poor people who 
 must work and ignorant people who will not learn must continue 
 to suffer. Like all other physicians I would rather speak of suc- 
 cessful cases than of failures. Many failures are due to the fact 
 that the patients did not live up to advice. I am telling about 
 these things in order that others may profit. 
 
 At times individuals who have localized pains and aches re- 
 cover suddenly. When this occurs under certain conditions people 
 are apt to marvel. I might mention a case. 
 
 One of my patients, a middle-aged housewife, had a localized 
 chest pain, a "stitch in the side," due to an adhesion of the lung 
 to the chest wall, which was due to an old inflammation. She 
 was a dust victim and whenever there was an acute exposure the 
 pain was severe. Moreover she had lost a sister through tubercu- 
 losis and was constantly worrying that she herself had it or would 
 get it. She was greatly benefited by good air advice, but since it 
 is practically impossible wholly to avoid exposure every now and 
 then she had an acute attack. One day she was standing on a 
 chair picking cherries when she felt herself slipping, and suddenly 
 threw out her hands to grasp a branch. Immediately there was a 
 sharp pain in the side or chest. Soon she began to spit a little 
 blood. She sent for me in great alarm. I inquired whether she 
 had recently been exposed to bad air; she had not. I offered her 
 this explanation: in reaching out suddenly and violently the ad- 
 hesion to the chest wall was torn loose and there was some bleed- 
 ing, but since she had not been exposed to infection recently I 
 thought there would be no inflammatory process. My fear that 
 there might be internal hemorrhage I kept to myself. I would 
 keep her under observation and if that did occur speak of it at 
 the proper time. I expressed my belief that now that the adhesion 
 
COLDS AND CATARRH. 141 
 
 Was torn loose there would be no more stitches in the side. My 
 explanation was a good one. In a day or two she was all right 
 and since then there has been no localized pain, although she still 
 complains, after the fashion of simple dust victims, on exposures 
 to bad air. Such an explanation may be regarded as a rational 
 one, at least she regarded it so. 
 
 We sometimes hear of people who are suddenly cured of some 
 affliction that confined them to bed, as the woman who was bed- 
 fast on account of a stiff or "rheumatic" knee, who suddenly 
 jumped out of bed when her house was on fire and "was cured." 
 Often the adhesion is such that there is a very limited motion. 
 When a certain tension is reached there is pain and the individual 
 stops further movement, but if a sudden violent motion is made 
 the adhesion may be torn and a "cure result." Unfortunately 
 the physician never knows how far to go in making violent ex- 
 ertions for fear of doing more harm than. good. On the other 
 hand there are men who do not hesitate; indeed, there is one 
 "school of practitioners" who use violent methods and who in 
 this way cure some, but on the other hand there may be irre- 
 parable damage. 
 
 An old patient with internal adhesion asked about consulting 
 such a practitioner, or shall one say manipulator? I advised 
 against it. Some time later she told me she had gone and "the 
 treatment nearly killed me." People often speak about doctors 
 "either curing or killing." That is no joke with some modes of 
 practice. Veterinarians largely practice on that plan. The very 
 fact that such simple modes of treatment are not in general use, 
 are often wholly neglected by regular physicians, means there is 
 too much danger connected with them compared to the small 
 amount of good results. 
 
 That violent exertion may be the cause of acute pain is shown 
 in the following: 
 
 Mr. — had "rheumatism of the shoulder." He lived on the. 
 edge of town and was little exposed to bad air. I hesitated to 
 
14:2 nrsi'Y air and tll health. 
 
 speak of dusty air but thought it my duty to do so. He listened 
 closely aud agreed to observe himself. Incidentally he spoke of 
 gardening and how his neighbor's chickens annoyed him, how the 
 other day when he found them scratching a newly made bed he 
 threw a heavy chunk of wood determined to kill some. I recalled 
 that under such conditions one's arm may ache and the pain be 
 misinterpreted as rheumatism. When I mentioned this he ex- 
 claimed, "By George, I guess that is the cause of my rheumatism." 
 There are all sorts of explanations for "rheumatism." 
 
 HEALTH IN THE COUNTRY AND IN THE CITY. 
 
 From all the preceding one may get an idea that the city (or 
 urban as opposed to rural life) is the home of ill health and dis- 
 ease, but when we examine into the matter we find exceptions. 
 The term city includes all sorts of communities; it is as broad as 
 the term civilization, which primarily goes back to "city," mean- 
 ing that cities are an index of a country's civilization. While some 
 cities are in the advance, many are in the rear; we speak of "back- 
 ward cities." 
 
 The modern well-managed city is very different from that of 
 a hundred years ago, a fact one fully realizes on visiting European 
 cities where the heart is closely built up, quite different from the 
 suburbs. Cities in olden days were fortified and there were good 
 reasons for having crooked streets, namely to get out of range of 
 the invading enemy. Naturally in fortified cities in times of war 
 the weeding out was terrific. The death rate of every large 
 European city even a hundred years ago was enormous. It was a 
 long time before cities began to supply themselves with pure water 
 and good food, and only today are they making an effort to get 
 good air. Unless one visits a city like Berlin one has no proper 
 conception of what a clean and well managed city means and how 
 ill health and disease can be reduced to a minimum, that is ill 
 health from preventable causes. In all countries where the soil 
 has become exhausted the food problem is of course an important 
 cne. 
 
COLDS AND CATARRH. 143 
 
 Some cities are making commendable efforts to get rid of nar- 
 row and crooked streets and to keep streets clean and to get good 
 water, as well as to inspect food supplies. The well-managed large 
 city has all sorts of inspectors. There are hundreds of men who 
 look after sanitary matters; it will pay anyone to look up the 
 health report of such a city. At the other extreme is the "city" 
 (really an overgrown village) where everybody does about as he 
 pleases. If there are laws and ordinances at all they are not 
 obeyed. Unsanitary conditions of all kinds abound and there is 
 much preventable ill health and disease. 
 
 The experience of physicians in treating people in ill health, 
 not to speak of actual disease, varies greatly. The country doctor, 
 living among people leading a simple life and seldom coming un- 
 der city influences, may be able to trace causes, he may be able 
 to trace ill health to its source, just as he may be able to trace 
 smallpox and scarlet fever. The physician practicing in a cleanly 
 suburb may also be able to trace causes of ill health. On the other 
 hand the physician in the slums may meet so much common ill 
 health that he may not make any attempt to treat cases other than 
 by giving a little medicine, and that is all many poor people ex- 
 pect: the same is true of physicians in backward towns and neg- 
 lected county-seats where no attention is paid to sanitation. If 
 they attempt to trace the causes of ill health at all they may be 
 baffled on account of many factors that enter into the matter, 
 including bad water and bad food. The term baffled is the proper 
 one to use ; newspapers are constantly telling about how the doc- 
 tors are baffled. 
 
 At this place it is proper to say that my own studies of Dust 
 Influences have been pursued during the last eleven years in a 
 small spitter's town of about 20,000, where little attention is given 
 to sanitation and where the bad air factor is especially noticeable. 
 Besides townspeople one of course meets any number of country 
 people, some from remote and isolated portions of the county or 
 adjoining counties, like the farmer boy already mentioned. But 
 one also meets people from large cities, as for instance people 
 
144 DUSTY AIR AND ILL HEALTH. 
 
 visiting relatives. They may have had much ill health iu large 
 cities and may be induced to consult the small town doctor, for we 
 all know how people will recommend "my doctor." And then 
 there are people from the large city who come to the small one 
 to make a home. People coming from the densely settled heart 
 of a large city to a small town may find conditions far healthier 
 than in the old home; for one thing rent is cheaper and there is 
 less crowding. Then again, the man who had an office in a tall 
 clean office building down town may find his new office on a spit 
 street in a small city quite different. He may have had good 
 health in the large city but suffers in the small one. I might 
 briefly mention an illustrative case report, a young man who came 
 here from a clean Eastern city. 
 
 A Rheumatic Case. One of my old patients, a down town 
 business man, several years ago brought in a clean, fine looking 
 young man of about 25 years, who had recently come here, on the 
 close of winter. After a few preliminary remarks he said: Now 
 Doctor, in the very beginning I want to tell you that until I came 
 here I never had any illness since I had the common affections of 
 childhood. I have always had the best of health. I take care of 
 myself and have no bad habits. I am a moderate eater and re- 
 cently have been undereating thinking that would help. I do not 
 drink and use very little tobacco. Now I can not understand what 
 is the matter. Soon after I came here I began to feel sore in the 
 chest; my family never had any lung trouble. Then the pains 
 became more severe and travelled into the shoulder and down the 
 arm ; I thought it must be rheumatism, but when I began to ache 
 all over the body I thought it must be something else. I wanted 
 to go to a doctor but did not know to whom, and so I asked my 
 friend here and he said you would quickly tell me what my trouble 
 is. (I looked at my old patient; he winked but did not say any- 
 thing.) 
 
 Well, did Mr. X (my old patient) tell you what he thought 
 your trouble is? "No." 
 
COLDS AND CATARRH. ]45 
 
 Mr. X spoke up. "If I had tried to tell him, he would not 
 have believed me and so 1 brought him up for you to tell him." 
 
 Now here was a young man in a small town, with an office on 
 one of our worst spit streets and with clouds of infected dust blow- 
 ing about. He reacted almost at once. I explained his difficulties 
 as being a reaction to an unsanitary environment. He listened 
 closely, asking a question now and then, and finally said, "Well, 
 if that is the cause of my ill health I know what to do" — he left 
 town shortly after. In his old home in the East he had good air. 
 
 This patient of course was under observation too short a time 
 to enable one to speak definitely. Instead of speaking of patient 
 I should have said "case," for nothing further was done; I did 
 not prescribe any medicine. Perhaps the diagnosis made by my 
 old patient who brought the man to me is as good as any, "Spit 
 Dust Rheumatism," not on elegant name but certainly expressive. 
 
 The term Rheumatism is an old one, like many another; it is 
 vague, all sorts of cases, of pains and aches, are grouped under it. 
 Acute articular rheumatism (a supposed definite disease) is rare 
 in this community, "rheumatism" itself is excessively common. 
 There are of course all sorts of causes for ' ' rheumatism, ' ' but a very 
 common one, the inhalation of infected dust, is generally overlooked. 
 The connection of "rheumatism" with tonsillitis or sore throat has 
 long been recognized and some throat troubles are called "Rheu- 
 matic Sore Throat," but that air conditions are at the bottom is 
 seldom mentioned. 
 
 Often "rheumatism" or "rheumatic pain" is localized perhaps 
 at the site of an old injury. Since my personal experience with 
 backaches (p. 81) I have realized the importance of making in- 
 quiries into past histories, and one of my earliest "dust papers" 
 was on just such cases. I have seen a large number of cases and 
 the advice to avoid bad air has helped many a patient to reduce 
 his pains and aches to a minimum, after trying all sorts of rem- 
 edies, cures and treatments. 
 
 Perhaps it should be added that a large percent of such cases 
 have the pain localized in the back, and if the pain is "over the 
 
 [10] 
 
146 DUSTY AIR AND ILL HEALTH. 
 
 kidneys" many have a belief that there may be "kidney disease." 
 This idea is fostered by some patent medicine men who say back- 
 ache means Bright 's disease. As a matter of fact there may be 
 no pain at all in the back in cases called Bright 's disease. 
 
 THE AIR OP PLACES. 
 
 The idea that the air of a place has an influence on health and 
 ill health and disease is a very old one. Hippocrates twenty-five 
 hundred years ago wrote a treatise on The Air of Places; it is 
 still interesting reading. As a rule medical writers have specific 
 diseases in mind ; malaria is perhaps more frequently considered 
 than any other disease. The subject is a large one; here I desire 
 to make a few remarks. It should constantly be kept in mind that 
 in this volume I am concerned with ill health ; remarks on diseases 
 are to be considered incidental. 
 
 Men explain things in the light of existing knowledge. The 
 explanations of Hippocrates seem very crude to us; they are quite 
 different from those of the chemist of say fifty years ago, just as 
 those of the latter are different from those of the bacteriologist 
 of today. The books of different generations explain things differ- 
 ently. Explanations of the causes of ill health are now mostly in 
 terms of bacteriology. The chemist explained bad air mainly by 
 the amount of carbonic acid gas, the bacteriologist by the kind and 
 number of microbes. Naturally one questions, Is bacteriology able 
 to explain all? Medicine like everything else is an evolution. 
 
 "We sometimes see the statement in print that "Germs are 
 everywhere," meaning of course disease germs. The statement 
 however is not true, not even when applied to harmless bacteria, 
 and harmless bacteria immensely outnumber injurious ones. The 
 air on high mountains is free from germ life, likewise the air on 
 midocean. They can not and do not flourish under such surround- 
 ings. 
 
 It has been observed that some small islands in the ocean have 
 insects that are wingless. This at first sight is mystifying but 
 
COLDS AND CATARRH. 147 
 
 the explanation is not far to seek. Insects that fly are swept out 
 into the ocean by strong winds, only those that are wingless and 
 live near the ground survive. Just as insects that rise up into the 
 air are blown out into the ocean so disease germs are blown away 
 and the small island is "healthy." 
 
 In reading about the buffalo on the dry arid plains of the 
 southwest, we learn that the Indians and early white hunters hung 
 up pieces of meat to dry in the air, making jerked beef. The air 
 of that thinly settled country was so pure that there were not even 
 the common germs of putrifaction. Things dried without under- 
 going decomposition. Today we can dry meat only in a hot oven 
 that sterilizes everything. The air of cities is so full of bacteria 
 and fungoid forms of life that produce decomposition that a few 
 hours exposure to the air in warm weather is sufficient to spoil 
 food. 
 
 Again, we are constantly reading about milk full of bacteria, 
 but we should keep in mind that that means milk sold in the city. 
 Milk in isolation, in the country, is as pure as ever ; when it leaves 
 the farm it tends to become contaminated, especially when handled 
 by careless and dirty people. 
 
 "We also hear it said that the Bacillus tuberculosis, the germ 
 of consumption, is found everywhere. In reality the statement 
 applies only to communities where people are massed together. 
 It is absent on mountain and sea, in forest and field, but is plenti- 
 ful in cities, and especially in places occupied by the sick who are 
 careless about their expectorations. It is under such conditions 
 that the Bacillus tuberculosis and other germs are common. For 
 the same reason morbidity and mortality rates of some communi- 
 ties are high. Old time prisons were very unsanitary. Air con- 
 ditions were often terrible and few of the prisoners escaped falling 
 victims to consumption. Since giving attention to sanitation the 
 death rate on this account has been reduced to a remarkable ex- 
 tent. (It is rather anamolous that today people of this kind often 
 get more attention, are better housed and fed, than poor and hon- 
 est people.) 
 
148 DUSTY AIR AND ILL HEALTH. 
 
 The Air of Places under which people live and work is an in- 
 teresting subject. 1 We need only consider what occurs in the life 
 
 of any of us on getting up in the morning. We get up with a 
 bitter taste in the mouth, perhaps indicative of having slept in an 
 ill ventilated bedroom, or having visited a poorly ventilated the- 
 ater last night, or having been to a poorly ventilated church. We 
 take the street car down town, it may be crowded and poorly 
 ventilated and we get our first whiff of bad air. People who live 
 in the heart of the city get bad air all night, perhaps the entire 
 twenty-four hours. Some individuals go down town to stay all 
 day, to work, others go for only a short time. Under what sort of 
 air conditions do they work? The air conditions of an office in a 
 tall building where attention is given to the matter of ventilation 
 may be comparatively good, while the air of a store with much 
 sidewalk filth tracked in may be very bad. But we should not for- 
 get that although a woman who goes down town to shop for an 
 hour or two may come home feeling bad, yet the clerk who waits 
 on her and others all day long may scarcely complain at all. Is 
 it necessary to add that the clerk who can not "stand the racket" 
 is not apt to occupy such a position? Out of the many who try, 
 only a few succeed. 
 
 If we go by rail we may feel the closeness of the air in the 
 coach and yet the conductor may not complain. He too is the 
 survival of the fittest. The conductor subject to colds and ca- 
 tarrh and weeping eyes and nose and frequently disabled on ac- 
 count of sickness is not apt to occupy such a position. Hence in 
 considering the air of places we must also consider the people and 
 their adaptation to it. Some are better adapted than others to 
 live under unsanitary surroundings. When we read of crowded 
 Chinese cities we may not be surprised that the Chinese can live 
 in our large cities under surroundings that are fatal to the white 
 man. 
 
 1 In small communities, especially county-seats, certain street corners are favorite loafing places 
 and in the absence of "moving on" and "anti-spitting" ordnances, or if there are such, their non- 
 enforcement, the sidewalks may present sights almost unbelievable. The need for cleaning up and 
 flushing streets and sidewalks frequently must be apparent — and the need for repressing the spitter 
 more so. 
 
COLDS AND CATARRH. 140 
 
 We all know that some trades and professions are regarded as 
 healthy, others unhealthy. Open air people are apt to live long, 
 those living under confined air conditions, perhaps much in con- 
 tact with people in ill health or disease or the causes thereof, 
 may be short lived. The preacher who is exposed to bad air once 
 or twice a week may yet have a better expectancy for long life 
 than the physician who is constantly visiting poor sick people in 
 neglected homes. 1 
 
 The physician who goes to a distant country to study yellow 
 fever or plague victims may be virtually committing suicide. The 
 same may be said of the missionary who goes to a country where 
 diseases prevail to which his ancestors had not been exposed. 
 
 As already mentioned, the Father of Medicine twenty -five hun- 
 dred years ago wrote about the Air of Places. Benjamin Franklin 
 had some good ideas regarding the importance of proper ventila- 
 tion. Physicians today are fully alive to the importance of good 
 air in the prevention and treatment of tuberculosis ; they are just 
 beginning to realize the value of good air in the prevention and 
 treatment of ill health. We are only beginning to realize the sig- 
 nificance of air and dust influences. A short time ago I received 
 a circular from a German sanatorium which laid special emphasis 
 on "Staub — freie Luft." Moreover there is developing a tendency 
 for hospitals to leave the heart of the city and go to the suburbs. 
 We of course must make distinctions between surgical cases and 
 cases of well-defined disease and of mere ill health. Some hospitals 
 of necessity must be in the heart of the city. Sanatoria should be 
 in the suburbs or country. 
 
 Men in writing about phenomena, about facts, are inclined to 
 add their explanations. When we read old time accounts we may 
 be willing to accept statements of facts but we may wholly reject 
 the explanation; we say we know better. 
 
 1 And what shall be said of air conditions under which doctors meet? Are doctors so accustomed 
 to bad air that they pay no attention to the air of their meeting places? I have frequently attended 
 meetings in tightly closed rooms with the air densely filled with tobacco smoke. One almost feels 
 like saying that the doctors of least importance in a community and of least importance to medical 
 societies are the inveterate smokers, with few exceptions. Chewers with decorated shirt fronts are 
 now seldom seen at medical society meetings. 
 
150 DUSTY AIR AND ILL HEALTH. 
 
 In going: over my ease reports the reader should keep in mind 
 what are statements of facts and what are conclusions or expla- 
 nations. Explanations given in this volume may appeal to the 
 reader who is a dust victim and who has been observant; others 
 may be strongly inclined to reject them. Some of my best pa- 
 tients were at first strongly opposed to the idea that dust affected 
 them, that they were dust victims. The willingness, not to speak 
 of the ability, to observe and keep a record is an important factor 
 in deciding who are "best patients" and who remain from one 
 year to another. It is from such patients that physicians may 
 learn much in the course of years. 
 
 When patients object to the explanation offered, the question 
 arises, Do you know a better one for the facts? How do you ex- 
 plain the presence of so much ill health in some communities, the 
 sallow complexions of people, with newspapers full of patent medi- 
 cine advertisements? 
 
 Needless to say all case reports are partial ; they dwell on cer- 
 tain facts and neglect others. To arrive at valid conclusions the 
 reader should study nature at first hand; he should not form his 
 opinions altogether from books. The reader who has ill health 
 that has not been satisfactorily explained may learn much by 
 studying The Air of Places, the air which he breathes. 
 
V. 
 DYSPEPSIA. 
 
 Everybody has an idea of the significance of this term. It is 
 
 an old word, going back to the ancient Greeks, literally meaning 
 
 difficult or poor digestion. The Century Dictionary says: 
 
 "Impaired power of digestion. The terra is applied with a certain 
 freedom to all forms of gastric derangement, whether involving impaired 
 power of digestion or not. But it i's usually discarded when some more 
 definite diagnosis can be made, as gastric cancer, gastric ulcer, gastritis, 
 gastrectasia, or when it depends on poisonous ingesta or appears as a 
 feature of some other disease, especially if that is acute. Functional dys- 
 pepsia, also called atonic and nervous dyspepsia, is gastric derangement, 
 not exclusively neuralgic, which may involve a diminished or excessive 
 secretion of the gastric juice, or diminished or excessive acidity in that 
 secretion, or an irritability of the stomach walls or an impairment of their 
 motor functions, and which appears to depend on some defect in the inner- 
 vation of the stomach, and not on some grosser lesion." 
 
 The term is one of convenience used by people in discussing 
 their ills; it is also used by the doctor in giving superficial ex- 
 planations to his patients. 
 
 There are all sorts of causes that produce derangement of the 
 digestive functions, some readily ascertainable, others only after 
 much investigation, if at all. 
 
 Many of my early patients complained of dyspepsia, of a dis- 
 turbance of the digestive tract, but unfortunately I did not under- 
 stand them. Because they did not complain of colds and catarrh 
 as I then understood the effects of dust inhalation, I was misled 
 and did not even suspect that they were dust victims. But I soon 
 found that some who were subject to "stomach troubles" in addi- 
 tion to colds and catarrh were benefited by good air advice, that 
 is they complained less of dyspepsia, and that opened my eyes. It 
 gradually dawned on me that some dyspeptics were in reality dust 
 victims, dust influences manifesting themselves differently from 
 what I had heretofore observed, in fact so differently that one can 
 speak of a dyspeptic or a stomach type of dust infection. 
 
 (151) 
 
152 DUSTY AIR AND ILL HEALTH. 
 
 Many of my early patients were misunderstood. This of course 
 is a confession of ignorance. I no more understood them than my 
 predecessors and when patients find out that a doctor does not 
 understand them and is not henefiting them they naturally go 
 elsewhere. 
 
 Out of a large number of cases I shall make a more or less 
 brief reference to several that have been written up in a volume 
 for physicians, who want more details. 1 In a volume like this one 
 can not go into, for instance, the matter of laboratory findings 
 or details of chemical or microscopical analysis. 
 
 Among my first patients on coming here in the summer of 1900 
 was a young carpenter. He complained of dyspepsia. He had 
 consulted a number of physicians ; I was the "new doctor in town" 
 and he came to "give you a trial." I investigated, examined, ad- 
 vised and prescribed but since I was not benefiting him he soon 
 left. I kept full notes on the case. I begin a new set of notes each 
 year and file away the old ones. From time to time I go over 
 them for ideas or conclusions. Then it dawned on me that while 
 temporarily out of the city doing country work he felt all right. 
 While he was my patient I had not noticed the effects of exchang- 
 ing city air for country air, neither did I reason about a carpen- 
 ter's occupation: that besides doing new work he also does much 
 repair work on old houses, especially ripping up dusty floors. 
 
 Among early cases I might mention Mr. — . He had for years 
 been with one of the old practitioners who was about to retire and 
 was now in search of a new physician. The man asked many 
 questions. I was at first surprised but when I considered that his 
 family physician discussed things freely with his patients I knew 
 that was no more than one would expect. He asked me regarding 
 
 1 It was thought best to abstract cases from that volume as a rule rather than to make mention 
 of other cases. The reader who wants more details can likely borrow that volume from some physician. 
 
 It should be said however that that volume was written from a very practical standpoint, its aim 
 being to show that many misunderstood and neglected cases are dust victims that can be greatly 
 benefited by pure air advice. 
 
 Although Medicine is commonly regarded as a science or at least as an art, in reality it is a business, 
 just as any other business, and some doctors find it very hard to make a decent living. To interest 
 the general practitioner of medicine one must write from a very practical standpoint. The very 
 scientific physician may not be at all interested in the common ills of the people. 
 
DYSPEPSIA. 153 
 
 the causes of dyspepsia. I told him there were all sorts of causes, 
 some readily discoverable, others with difficulty, some not at all. 
 He approved of my explanations, adding that old Dr. X all these 
 years had never been able to find out the cause of his recurrent 
 attacks, occasionally lasting for weeks. He knew I had been to 
 Germany and asked regarding stomach examinations. I explained 
 briefly. The fact that I was willing to answer questions and that 
 T could make laboratory examinations induced him to give me a 
 trial. He gave me all the opportunities possible to investigate 
 and to advise and prescribe, but alas I benefited him so little that 
 in time he tried another doctor. I may add that when I know I 
 am not benefiting a patient and see no prospect for doing so, I 
 do not try to hold him. I no more understood the cause of this 
 man's attacks than his old family physician had understood them. 
 
 Looking over my notes now the case is perfectly clear to me: 
 the man was reacting to the air of an unsanitary, unventilated 
 crowded store. If he came back to me now I likely could give him 
 advice that would benefit him. But after all would he follow 
 advice? In small communities where everybody knows everybody 
 else, the people are apt to talk about the physicians and their 
 views and modes of treatment. He likely knows that I would ad- 
 vise " change of air," if not "change of climate," and he may be 
 wholly unwilling to do this. At any rate he has not come back 
 to me; he still hopes to be cured by taking drugs. 
 
 Since then I have seen a number of similar cases and was able 
 to give advice that was followed by good results. If I were to 
 write a chronological account of my experiences, I would have to 
 mention a number of cases that I misunderstood before coming 
 to those I partly understood, finally coming to those I understood 
 at once. Here I shall skip and take up cases where I at once sus- 
 pected air conditions. I have already cited two case reports from 
 my paper on Dust, A Neglected Factor in 111 Health (see pp. 84 
 and 90). I shall briefly refer to a third case. This case will be 
 cited in detail in a volume for physicians. 
 
 A young country woman, farmer's maid, had severe recurrent 
 
154 DUSTY AIR AND ILL HEALTH. 
 
 attacks of "stomach trouble" or acute gastritis, with severe vomit- 
 ing followed by great prostration. Her mother, a country woman, 
 had been similarly afflicted and indeed on removing to the city 
 quickly perished. I discovered that the young woman's attacks 
 followed trips to town. Like most country people, she came in 
 only on fine days. Now it happened that the day she came for an 
 examination of the stomach contents was a rainy one. I asked 
 her to return the next day and I would explain and discuss the 
 laboratory findings. She said she would be unable to come be- 
 cause she was sure to be sick, that she got sick every time she came 
 to town ! I expressed my belief that she would be able to come, 
 without giving any reason. 
 
 The next morning she promptly expressed her surprise that 
 she was able to come, for she certainly expected to get sick. I ex- 
 plained that she was a dust victim and that she did not get sick 
 because the day had been rainy and she was in town only a few 
 minutes, that she did not do any shopping and did not inhale a 
 lot of dust. 
 
 Dust influences in this case manifested themselves at once by 
 an irritation of the respiratory membranes, quickly spreading to 
 the esophagus and stomach. The treatment she had been getting 
 (hypodermics to allay the excessive irritability of the stomach) 
 only aggravated her condition. I myself gave no hypodermics. 
 
 That was eight years ago, the patient has been with me ever 
 since. At first she required much attention and reported at short 
 intervals. It was difficult for her to learn the lesson of pure air, 
 or of avoiding bad air, but she finally did learn. She reduced her 
 attacks to a minimum by avoiding exposure. 
 
 But at times there were attacks when I could get no history 
 of an exposure, when she had been living quietly in the country 
 for weeks at a time. Occasionally I was in doubt whether she was 
 really a dust victim or whether after all there might not be present 
 some disease or some organic alteration of the stomach. But sud- 
 denly some of these mysterious unaccountable attacks would clear 
 up. One day, for instance, I saw the farmer's wife, her employer, 
 
DYSPEPSIA. 155 
 
 walking along with her dress trailing over the filthy sidewalks. 
 Then I thought I saw a solution. The next time the girl came in 
 I asked whether it was her work to clean soiled dresses; it was, 
 and that is where she got the infected dust. 
 
 There were occasional house parties, people would come out 
 from town. During the open door season these had no influence 
 on her, but she would react during the closed door season. People 
 from a dirty city naturally carry a lot of infection to an other- 
 wise clean country home. 
 
 There were a number of incidental exposures, as taking a short 
 trip by rail or going to Sunday School or to church. She could 
 take a short ride or go to Sunday School or attend a short church 
 service during the open door season but suffered during the closed 
 door season. One time she attended an entertainment at the opera 
 house for the benefit of her church. She thought it her duty to 
 attend. The reaction that followed was so severe that she nearly 
 perished. 
 
 In the course of several years her health improved to such an 
 extent that symptoms and attacks were reduced to a minimum 
 and then she decided to marry, moving to the edge of a county- 
 seat and living under good air conditions. From now on health 
 supervision was merely nominal. She still has an occasional at- 
 tack due to unwitting exposure or an error of judgment. The 
 unpaved streets in the resident portion, for instance, may be quite 
 muddy shortly after a shower and she assumes that air conditions 
 down town are good, when as a matter of fact dust is flying on 
 the few paved streets in the heart of the city. Or, again, during 
 the winter time the ground is covered with snow. Under such 
 conditions one naturally assumes that there is no dust down town. 
 But in the heart of the city the snow with its accumulated filth 
 is more or less melted and is tracked in, filth is pulverized and 
 suspended in the air as dust. 
 
 When a physician has kept such a patient under observation 
 for years, and has even obtained an autobiography, enough data 
 accumulate to enable one to write a book. In cases of this kind 
 
156 DUSTY AIR AND ILL HEALTH. 
 
 one almost feels inclined to speak dogmatically, something one 
 must guard against when dealing with chronics, because people 
 want to know the why and wherefore. But such is the constitution 
 of the human mind that when people get critically ill they want 
 a physician who talks and acts dogmatically about remedies that 
 are supposed to cure — one must even do that to the sick physician 
 or he will not take his medicine. 
 
 I may add that the above patient had had all sorts of diag- 
 noses, none fitted. She was a dust victim. There was no disease, 
 only a reaction to abnormal air. 
 
 In the above case the relationship of attacks to visits to town 
 was fully recognized by the patient. 
 
 In the case of Mrs. — , an elderly farmer's wife, the relation- 
 ship was not so clear, in fact the patient for a. long time denied 
 that visits to the city had any influence at all. But when she kept 
 a daily record Ave found, that attacks marked by severe vomiting 
 came on two or even three days after the exposure — a time suffi- 
 ciently long to mislead. A case of this kind shows the value of 
 keeping a daily record. Such a delayed action is unusual. 
 
 At this place I may say that patients who remain with a phy- 
 sician from year to year and enable him to get continued data are 
 comparatively rare. People in ill health, at least in the begin- 
 ning before they learn through bitter experience, are always ready 
 to change physicians or medicines, they look for "cures." The 
 patent medicine men, in their advertisements, keep up the old time 
 belief that diseases are readily curable — and to the simple all 
 things are simple. A disease is something to be "killed" or 
 "knocked out." A disease name is something definite to most 
 people and is linked with "cure." The terms sickness and ill 
 health are indefinite; they are to be resolved into some common 
 term, into one of the "disease names" that we see in the adver- 
 tisements of patent medicine. 
 
 Unless the physician takes unusual pains he rarely gets con- 
 tinued data. 
 
DYSPEPSIA. 157 
 
 As already mentioned, it may be comparatively easy to trace 
 the causes of ill health, not to speak of disease, among country 
 people living under simple life conditions and only occasionally 
 going into town, into crowds. But it may be almost impossible to 
 trace ill health in those living under a complex environment, city 
 people generally. I have repeatedly met farmers whose attacks of 
 dyspepsia, as well as other forms of dust infection, found their 
 explanation in visits to town. It is rather strange that a man 
 should not himself trace the relationship of cause and effect. The 
 reason is perhaps due to the fact that the farmer is constantly 
 seeing clouds of dust from roads and from his fields and he makes 
 no distinction between such and clouds blowing about on city 
 streets and dust found in stores, churches and theaters. If a 
 farmer got sick every time he came to town he might at least trace 
 a town relationship. When he comes to town on a rainy day he 
 may escape, then the next time he comes on a dusty day and gets 
 an attack he fails to trace the relationship because he escaped the 
 last time. That some farmers have traced their sore throats to 
 visits to the city has already been mentioned. Dust of course 
 irritates the respiratory membranes but that the alimentary tract 
 should react is less obvious, as a matter of fact ordinarily physi- 
 cians fail to consider dust in their obscure stomach cases. When 
 country people are taught and understand these things, how they 
 suffer on visits to the city and how doctors fail to recognize the 
 nature of their ill health, they are apt to wonder in regard to the 
 doctor's medical education, whether something has not been neg- 
 lected. More than one of my patients has expressed the view that 
 before a doctor begins to practice he should have country experi- 
 ence. He should go, or be placed, under simple country conditions 
 to study the common ills and their causes, perhaps at some country 
 crossroads, and then go to the small town and study people. Next 
 he should go to the small city and finally to the metropolis where 
 there are all sorts of sick people and where the environment is so 
 complex that it is difficult to trace what is readily traceable in the 
 country. As matters stand at present, physicians are educated 
 
158 DUSTY AIR AND ILL HEALTH. 
 
 regarding well-defined diseases. They get little instruction re- 
 garding common ill health and if they get any practical experi- 
 ence at all it is in city hospitals with patients drawn mainly from 
 city slums, people who live under radically different surroundings 
 from country people, in fact entirely different from those of the 
 average intelligent citizen. Perhaps it is no wonder that many 
 physicians fail in treating common ill health. Of the many appli- 
 cants coming to the physician only a few are really diseased, the 
 great mass have ill health to which no definite name can be applied. 
 If the physician does give a name the next physician may give an 
 entirely different one. Thus old chronics have all sorts of diag- 
 noses — and come to believe in none. 
 
 The old chronic who has had much experience with physicians 
 knows that they differ greatly. On the one hand he meets the 
 symptom-prescriber who hands out a bottle of medicine or a box 
 of pills on the merest statement of symptoms without giving any 
 advice except how to take the medicine. At the other extreme is 
 the scientific physician who is inclined to take nothing for granted ; 
 he wants to investigate and make his own diagnosis. He will 
 likely have considerable general advice to give and he will cer- 
 tainly advise regarding food. 
 
 Food, or improper eating, is most commonly accused of being 
 the cause of dyspepsia, not to speak of all sorts of ills. On the 
 other hand we have the faddist who claims to cure all ills by diet- 
 ing. People often diet themselves or they are advised to do so by 
 physicians. Often the advice is most arbitrary, as to avoid fresh 
 bread or gravy, or fried meat or raw vegetables or this or that. 
 One often meets patients who have been living on weak tea and 
 toast or crackers for months at a time. What many need is a 
 varied diet. 
 
 But the place where a man eats is often of more importance 
 than what he eats. A city man, for instance, may constantly com- 
 plain of dyspepsia ; he goes to the country on a vacation, perhaps 
 on a hunting or fishing expedition, for a few weeks; soon he is 
 able to eat anything and everything. When he returns to the city 
 
DYSPEPSIA. 159 
 
 his old troubles come back. I have had patients who took their 
 food supplies along, all except fish and game and water, and who 
 took no more exercise than at home. They had no difficulty while 
 away but complained soon after getting back into the old environ- 
 ment. 
 
 Several years ago I had a young farmer as a patient who re- 
 peatedly expressed his belief that "It's what I eat." He was thin 
 and anemic and could scarcely drag himself around. He had been 
 dieting himself. He found so many things disagreed that he was 
 almost starved. He turned out to be a dust victim. Now we know 
 how a man who is too ill to work will make frequent trips to the 
 city or to the heart of the city and stand around on street corners 
 or spend much time back of the stove of the village store. Under 
 such circumstances the dust victim only aggravates his ills. When 
 I pointed out why he probably had a disturbed stomach, he avoided 
 infected dust and in a short time was able to eat anything and 
 everything. Then one day he went to a political rally at his county- 
 seat. He was careful to avoid indoor crowds but he mingled freely 
 with the crowd on the street, assuming that the air would be all 
 right outside. The next day he came in complaining greatly, say- 
 ing he had eaten a little candy and that upset his stomach. He 
 was not going to eat any more candy. He knew, "It's what I 
 eat." The attack passed off promptly and he attended another 
 rally. Again he came in complaining, saying he had eaten a little 
 popcorn and that was the cause ; he was not going to eat any more 
 popcorn. I referred to his previous remark, and since the silly 
 season of politics had now closed, I predicted that he would eat 
 pie before long, for Thanksgiving. He sadly shook his head, "Pie? 
 I don't dare to eat pie." I did not see him again until early in 
 the new year when he came in. He had gained greatly in weight, 
 in fact he looked like a different man. I quickly discovered that 
 his complaints now were really due to overeating. A short time 
 before he had had the annual pig-killing and with a lot of fresh 
 meat in the house he used it too freely. I merely advised him to 
 cut down his rations. That was all that was necessary. 
 
160 DUSTY AIR AND ILL HEALTH. 
 
 The throe eases mentioned above were country people, it was 
 easy to trace the relationship of eause and effect: I will now make 
 a brief reference to some city people. 
 
 One of my early patients was a down town business man who 
 had had ill health for years, the most common diagnoses being 
 such simple ones as "It's the stomach," "It's the liver." He had 
 not only tried a number of local physicians but had even been to 
 Germany. Many regard the German specialist as a sort of su- 
 preme court: if he can not help, nobody can. The German special- 
 ist sent him to one of the mineral springs. He returned home cured, 
 as he thought, and was full of praises for German doctors and 
 their methods. He told me how fully they examined his stomach. 
 
 Having recently visited Germany myself, I determined to ex- 
 amine his stomach according to the German books I brought with 
 me. I investigated, examined, advised and prescribed — but, un- 
 fortunately, the man did not get better. After a time he left me. 
 That he was a dust victim did not even dawn on me. It is only 
 exceptionally that such a disappointed patient comes back and 
 gives one a second trial, and then, after having studied and bene- 
 fited apparently similar cases, one may be able to give relief. 
 
 Another early case was that of an elderly lawyer with chronic 
 dyspepsia, attended with formation of much mucus in the stom- 
 ach, with more or less also in the respiratory passages. Good air 
 advice not only helped his respiratory catarrh but also his stomach 
 catarrh and then I began to suspect he was a dust victim. I began 
 to study his ill health in the light of air conditions. My suspicions 
 were verified in the course of time and then I began to insist that 
 he live up to good air requirements. After several years I was 
 beginning to lose patience and spoke rather positively and then 
 he did make a change — he went to a city specialist who examined 
 and gave him active treatment for several weeks. He had to pay 
 him more for this short course than he had been willing to pay 
 me for all those years he was with me. I saw him some time later. 
 He told me the "stomach specialist was no good." Just then he 
 was taking treatment of a country doctor who had advised him to 
 
DYSPEPSIA. 161 
 
 try a new kind oi' mineral water; he was feeling better under its 
 use. Some people prefer to take nasty tasting medicines and min- 
 eral waters rather than live under good air conditions. One won- 
 ders how long they will hold out. 
 
 A middle-aged woman living in the heart of the city on a very 
 spit dusty street, in fact over a saloon, came to me, accompanied 
 by her husband, for a preliminary consultation. At the time I 
 had more cases than I wanted and to accept a new case was a seri- 
 ous matter. Rather than give superficial attention I would rather 
 not have her as a patient. To get at the bottom of her ill health 
 and its causes would probably require considerable time. But one 
 question led to another and I learned much regarding her illness, 
 her ancestry and the surroundings under which she lived. I came 
 to the conclusion she was a dust victim and I decided to accept 
 her, merely to see whether the supposition would be verified. I 
 investigated as fully as I thought necessary and then explained 
 what I thought was the cause of her attacks and continued ill 
 health. Her case came under the head of chronic dyspepsia or 
 chronic catarrhal gastritis, an affection that has a large and varied 
 number of symptoms. 
 
 The patient entered into the spirit of the investigation and 
 watched herself and the conditions under which she lived. In a 
 short time she was satisfied that her ill health and recurrent at- 
 tacks were dependent on dust influences and largely preventable, 
 but not wholly so. She now spent most of her time in the kitchen, 
 this being in the rear of a very long building, opening on to the 
 yards of others, with plants and trees, and, with the wind coming 
 from the west, making air conditions quite favorable. It was the 
 front of the house and hallway with air coming up the hallway 
 that was to be avoided. 
 
 To show how matters work out at times and how patients differ 
 I might refer to a little incident which occurred at a Fourth of 
 July celebration, held in a little park at the edge of town. The 
 day was a fine one but in the afternoon a thunderstorm came up 
 
 Hi] 
 
162 DUSTY AIR AND ILL HEALTH. 
 
 suddenly and everybody rushed into the large barn-like pavilion. 
 My patient saw the storm coming and was in a quandary. She 
 looked into the pavilion The air was very dusty, said she could 
 smell and taste the dust, it was so thick. She knew what would 
 happen if she went into it. She went around to the east side of 
 the building and noticed that the roof was overhanging. She rea- 
 soned that if she stood on the east side she would escape getting 
 wet ami by keeping out of the dust avoid getting one of her dis- 
 turbed stomach attacks with severe headaches and prostration. 
 Her reasoning was good; she did escape. 
 
 Another patient, the one referred to on p. 153, was also pres- 
 ent at this celebration ; she was undecided what to do when the 
 storm came up. She knew if she went into the pavilion she would 
 get sick, while if she stayed out her new summer dress and hat 
 would be ruined. She went in with the crowd, and as a conse- 
 quence had a severe attack. 
 
 During the same week another one of my patients came in to 
 report. She had also been at the park and went indoors, she had 
 a severe attack (in this case of membranous catarrh of the intes- 
 tines). 
 
 The next time the patient here under discussion came in, I 
 told her about these two and how they suffered. She said, "Now 
 wasn't I smart that I thought of staying out of the rain and stay- 
 ing out of the dusty air too?" When I told one of the other two 
 patients, the farmer's maid, about this incident, she remarked, 
 •'Now why didn't I think of that?" Perhaps needless to say on 
 subsequent occasions she did think of it. 
 
 At times one meets retired farmers who have always led a 
 laborious life and who think to end their days quietly and peace- 
 fully by removing to town, perhaps to live with a son or daughter. 
 But they quickly complain of ill health, perhaps die in a short 
 time. They spend too much time in the heart of the city and get 
 more infection than the body can get rid of. A physician can 
 greatly benefit some of these individuals if they apply in time. 
 
DYSPEPSIA. 163 
 
 An industrious farmer with one grown daughter lost his wife 
 and then suddenly tired of country life and decided to move to 
 town. He had saved enough to pass his days comfortably but like 
 most men he was open to any little job or "chores" that would 
 bring in something. He helped his neighbors in their garden 
 work, repaired fences and barns, did little odd jobs about the 
 house, cleaned carpets and assisted at moving. Naturally with 
 more or less idle time he spent considerable time down town on 
 street corners. He got along fairly well during the open door 
 season but the moment cold weather arrived, when dust was no 
 longer sterilized by the bright rays of the sun, he began to com- 
 plain. 
 
 Often a physician is compelled to spend a lot of time in inves- 
 tigating and ruling out the presence of possible diseases, and es- 
 pecially in cases of the kind here under discussion, cancer of the 
 stomach. This patient wondered whether he did not have some- 
 thing of the kind. But in the light of his history I did not deem 
 it necessary to make any stomach examination. I explained what 
 I thought was at the bottom of his ill health and that with care 
 it would disappear, but if not there would be time to investigate 
 more fully. All he needed was good advice. 
 
 Another widowed farmer came to town to live with a married 
 daughter after renting out his farm. He was not accustomed to 
 city life, reacted constantly, had dyspepsia and constipation. Said 
 he had "tried everything," tried doctors and patent medicine 
 and of course dieting in his attempt to get back the health he had 
 had on the farm. 
 
 He was ready to have his stomach examined but I deemed this 
 unnecessary in the light of his history — but I did propose "health 
 supervision," to have him report once a week. He soon saw that 
 he "would have to make it a business to keep well in the city," 
 while it "was no trouble at all to keep well in the country" and 
 then he decided to go back to the country. 
 
 Perhaps the most pathetic cases the practicing physician meets 
 are fellow-physicians in ill health who have had all sorts of diag- 
 
164 DUSTY AIR AND IT.L HEAtTfl. 
 
 noses and finally come to believe in none, and yet are all the time 
 expecting the worst. I recall a physician in middle life, really in 
 his best years, who bad retired to the country after years of ill 
 health in a small city. He regarded his "case" as peculiar, as 
 obscure and atypical. The fear of cancer of the stomach was con- 
 stantly present, with every recurrent attack of deranged stomach. 
 On getting his history and making a brief examination, I gave him 
 my opinion — in the light of cases here cited. The explanation 
 appealed to him and he soon verified the idea of dust infection. 
 He again took up practice. He now knows how to guard himself 
 and he keeps out of the dust, including dust in neglected doctors' 
 offices where he used to loaf. I have no doubt he is the "best 
 stomach specialist" in his city — if the people only knew it. 
 
 Now I do not want to be understood as minimizing the impor- 
 tance of food, of diet. It is an important matter ; large books have 
 been written regarding the subject. And yet there is a diversity 
 of opinion on the relative importance of a high or low protein 
 diet, on the value of a vegetable dietary, and even to what extent 
 vegetable food should be used in a raw state or cooked. Opinions 
 differ regarding the best drink — water, milk, coffee, tea, wine, beer, 
 all have their advocates. Water drinkers dispute about the use of 
 water at meals and they are often divided regarding the proper 
 temperature of drinking water. "When doctors disagree, who is to 
 decide? There are many things that we have to find out for our- 
 selves, what foods or drinks agree or disagree and under what 
 conditions. Similar remarks apply to all other essentials of life, 
 clothing, housing, occupation. What agrees with one may disagree 
 with another and yet there are certain underlying principles which 
 no one can ignore. We all have some general idea what foods 
 are good and what are bad, as we have some ideas regarding 
 proper and improper housing. All I am trying to do in this vol- 
 ume is to call attention to a neglected factor, dust in the air. 
 
 The world advances; there are higher standards everywhere. 
 We are no longer satisfied with early primitive conditions, but as 
 yet we are not particular about the air we breathe. Cities have 
 
DYSPEPSIA. 165 
 
 provided themselves with good water, with good street lighting, 
 sewers, houses, etc., all beyond the dreams of people of a hundred 
 years ago. This of course is as it should he. When Agassiz was 
 professor at Harvard he made great efforts to build up the Nat- 
 ural History department, and he succeeded so well that other pro- 
 fessors complained of the backwardness of their own departments ; 
 some even tried to pull his down. He pointed out that that was 
 not the proper method; instead of pulling his department down 
 they should try to raise their own. When cities supply the people 
 with good air as they now supply good water we may look for a 
 radical improvement in general health. 
 
 Under Kinds of Dust there was a mention of glass dust. One 
 can readily understand how powdered glass may be injurious to 
 the respiratory tract. We need only consider to what extent glass 
 is used in daily life and how a little chip of glass in the food may 
 injure and allow infection to occur or it may even perforate the 
 stomach or intestines. Bits of bone are often swallowed and pro- 
 duce fear, but bone readily goes into solution in the acids of the 
 stomach ; glass on the other hand is entirely insoluble. Then too 
 one might consider the sharp pointed silicious diatoms occurring 
 in some drinking water ; they may be a factor in scarring the stom- 
 ach and especially the pylorus. 
 
 Bits of glass may often be traced to unusual sources. The 
 suburban resident who has a little garden and raises chickens on 
 filled-in soil with more or less glass must be careful how he handles 
 the soil with his hands so he will not cut himself. His chickens 
 may swallow glass and his teeth may find it later when eating the 
 chicken. Root plants like sweet potatoes in pressing the soil apart 
 may become penetrated by bits of glass and here again the teeth 
 will find it most unexpectedly. Properly considered broken glass 
 is a serious menace. 
 
166 DUSTY AIR AND ILL HEALTH. 
 
 CONSTIPATION. 
 
 Connected with dyspepsia is constipation. This is a very com- 
 mon — what shall one say, disease, minor malady, affection or symp- 
 tom ? Or is it, at least at times, a reaction to an abnormal environ- 
 ment 1 
 
 According to the patent medicine men, constipation is a dis- 
 ease, curable by their particular nostrums. Physicians generally 
 regard it as a symptom; it is only exceptionally that it can be 
 regarded as a disease and can be cured by proper treatment, per- 
 haps by surgical interference. Commonly it is a symptom that 
 attends all sorts of bodily disturbances, especially of the alimentary 
 tract. Constipation is so common that the general practitioner 
 rarely studies his cases sufficiently to discover causes. 
 
 That constipation may be due to dust influences did not dawn 
 upon me for a long time. I had noticed that many of the patent 
 medicine advertisements seemed dependent on air conditions, that 
 they were most common during the closed door season. I noticed 
 that this was also true of anti-constipation remedies. This led me 
 to study cases in the light of air conditions, and I soon found that 
 in many constipation is largely seasonal. During the open door 
 season there is little complaint, but there may be much during the 
 closed door season. 
 
 Cases of course differ greatly. Some individuals must make 
 a radical change in their mode of life in order to get relief. Others 
 may find a mild laxative taken regularly, say at night, sufficient 
 to tide them over, a fact recognized by the patent medicine men 
 who advise the taking of a dose of their nostrum at night. "It 
 works while you sleep." 
 
 It is interesting to study individuals subject to constipation 
 and get their observations, after their attention has been called to 
 the missing factor, in the light of what is written in this volume. 
 This is a subject that I must dismiss with this bare mention. 
 
 There is another group of cases that must be dismissed with a 
 brief mention, that is individuals who most commonly get a diag- 
 
DYSPEPSIA. 167 
 
 nosis of "It's the liver," who are told there is something wrong 
 with the liver or that they are bilious. 
 
 At times a patient is told he has or had gall-stones, which may 
 or may not be true. Under certain conditions false or pseudo- 
 gall-stones are passed, indeed some patent medicines will produce 
 such, leading the patient to believe he is being cured, although he 
 will continue to complain as usual, or on the return of the closed 
 door season. 
 
 Other patients are told they have appendicitis or are threatened 
 with appendicitis. The surgeon most likely gets the real cases, 
 but some are not cured by an operation. When one critically 
 studies such cases, and keeps them under observation for some 
 time one may learn that they are dust victims. 
 
 Old chronics who have made the rounds in time come to attach 
 very little importance to the diagnoses of physicians; they think 
 it is all guess work. In order to benefit such individuals, assum- 
 ing they are dust victims, one must explain fully and get them 
 to co-operate and observe, and then certain factors may stand out 
 very plainly. The number of nostrums advertised in the news- 
 papers for curing what no physician can cure but which the indi- 
 vidual can prevent is remarkable. Our Triad of National Diseases 
 and their varied manifestations furnish a ready field for the pat- 
 ent medicine man, likewise for the superficial symptom-prescriber 
 whose medicines may not be on a higher plane. 
 
 Many physicians when they get hold of a new case promptly 
 clean him out. We all know what that means, indeed there is a 
 slogan, Clean Out, Clean Up, and Keep Clean. Perhaps if we do 
 the second thoroughly there will be little need for the first. 
 
 Under constipation a number of "little practical things" could 
 be mentioned, beginning with the importance of having a regular 
 hour for bowel movements, just as one has regular hours for meals, 
 and the importance of giving the bowels time, and that means to 
 have a decent closet where one does not desire to get out as quickly 
 as possible. No prudent man will rely on laxatives and cathartics. 
 
 Curiously enough some people resent questioning about the 
 
168 DUSTY AIR AND ILL HEALTH. 
 
 bowel movements and object to inspecting the feces and learning 
 whether they are normal or abnormal. 1 have had patients who 
 I suspected were passing intestinal mucus in considerable quan- 
 tity, and. perhaps for months and years, but who had never ex- 
 amined ; some had had physicians who prescribed but never in- 
 quired about passing mucus. People without modern closets are 
 of course at a great disadvantage. 
 
 Auto-Intoxication. Within the last few years people have 
 heard more or less about auto-intoxication. This is or has been a 
 popular explanation among doctors. The term refers more par- 
 ticularly to symptoms or conditions produced by the decomposi- 
 tion of food in the intestinal tract. The term autotoxemia is also 
 used, which might be translated as poisoning one's own blood on 
 account of a deranged intestinal tract. The young doctor fresh 
 from medical school is apt to use these terms instead' of the older 
 term biliousness. 
 
 During my second year here an old farmer from an adjoining 
 county came to me complaining of stomach trouble and constipa- 
 tion. He had had various diagnoses, among them the common ones 
 of "biliousness," "It's the liver," "a touch of malaria," malaria, 
 dyspepsia, indigestion, and similar common explanations. As he 
 did not complain of colds I did not regard him as a dust victim 
 and advised and prescribed as a physician usually does in such 
 cases, in the light of what I had been taught and what is given in 
 the books. I tried my best to help him but after coming in a few 
 times he failed to report. 
 
 Five years later he came back and I now learned that he had 
 been living in another State but now returned to his old home. 
 He now knew what ailed him, "It's auto-intoxication." How do 
 you know? "That is what my son told me; he is a doctor prac- 
 ticing out "West." 
 
 Now when this farmer was with me before I had the impression 
 that he was a very ignorant man, that he farmed as his ancestors 
 had and likely planted his potatoes "when the moon was right." 
 I now questioned and found this was actually the case. Then 
 
DYSPEPSIA. 169 
 
 1 wondered to what extent the son had imbibed, had retained or 
 outgrown such ideas, in other words my interest was transferred 
 from the father to the son. The son attended the common country 
 schools (and we all know what they teach), and then he went to 
 a nearby small county-seat high school where more or less ele- 
 mentary science is taught, and then to medical college — where they 
 teach regarding definite diseases rather than common ill health. 
 1 could not resist wondering to what extent knowledge imbibed 
 in the family circle still influenced him, and on the other hand to 
 what extent his medical training inclined him to consider every 
 patient afflicted with some definite disease. 
 
 The man's ill health I soon found was due to loafing in town 
 and at the village store. The data I got from him did not amount 
 to anything, but I continued him in the hope that I would get 
 some definite details regarding his physician son. 
 
 A short time ago in discussing one of my former patients with 
 a physician who had also had the man under his care, he men- 
 tioned having heard that his present physician had advised some 
 outlandish mode of treatment. When I expressed my surprise, 
 he said, "I'll bet he never learned that in medical college." He 
 expressed his belief that that was something he had learned before 
 becoming a medical student. More recently while visiting a den- 
 tist he made some remark, some recommendation, when I said, I 
 am sure you never learned that in your dental college. "Oh, no, 
 that is some of the knowledge current among the people, ' ' adding, 
 "We doctors like all the rest are drawn from the common lot." 
 This is a profound truth that we often forget. It is difficult to 
 outgrow some things, and where there is no definite knowledge to 
 the contrary a physician may resort to methods, to modes of treat- 
 ment, current among the people. 
 
 Biliousness is an old term current among the people. Some 
 old physicians still use it and even young men may use it in mak- 
 ing explanations to their patients. To say "You are bilious" 
 usually stops further inquiry. People think they know what is 
 the matter. 
 
170 DUSTY AIR AND ILL HEALTH. 
 
 Biliousness of course refers to bile and that in turn to the liver. 
 The old time doctor gave mercury to stimulate the liver, he spoke 
 of getting rid of bile and of stimulating the liver; he noticed that 
 under catharsis his patients felt better. When I was a medical 
 student we were told that the terms biliousness and bilious are 
 unscientific and should not be used. As a matter of fact one rarely 
 sees them in scientific literature. 
 
 But one may question what were the facts underlying such a 
 term, such an explanation. "What kind of cases were they to which 
 the term biliousness applies? Similarly we may question what 
 sort of cases are included under the term auto-intoxication ? The 
 old time doctor purged his patients with mercury ; the doctor 
 today uses a variety of cathartics and laxatives to clean out the 
 intestinal tract and to keep the bowels open. Is the following 
 from a patent medicine advertisement true? 
 
 "Biliousness, Auto-Intoxication. Dr. — 's Laxative Tablets will 
 almost always relieve these ailments and any of these symptoms should 
 always indicate their use. 
 
 "Biliousness : An irritable word for an irritable condition. The old 
 idea of biliousness is the modern auto-intoxication one hears about so 
 much nowadays; that is, there is an absorption of toxins (poisons) from 
 the clogged and sluggish bowels. Everyone seems irritable to you and you 
 probably are to everyone else. You just feel all out of sorts. Probably 
 don't eat well, sleep well or feel well. You are being poisoned by absorb- 
 ing the waste from your body that should be evacuated. 
 
 "When in this condition take Dr. — \s Laxative Tablets — the quicker 
 the better. Better still, take them in time and avoid this condition." 
 
 Such an advertisement at least shows that the patent medicine 
 men are constantly adopting the newer ideas in medicine and at- 
 tempting to show that in spite of the "advance in medicine" 
 their old remedies are still applicable. 
 
 How can we explain the rise and decline of just such adver- 
 tisements, advertisements relating to laxatives and cathartics that 
 are so common during the closed door season and practically dis- 
 appear during the open door season ? I am giving my explana- 
 tion. I wonder if others have a better one? 
 
DYSPEPSIA. 171 
 
 DIFFERENTIAL DIAGNOSIS. RULING OUT. 
 
 One of the most important duties of the physician is to make 
 a differential diagnosis, to rule out diseases and narrow the in- 
 quiry down to some one disease, if possible. Failure to do so may 
 result in serious harm, not alone to the individual hut to the com- 
 munity. We need only think of the danger to a whole school in 
 the failure of a physician to properly diagnose diphtheria, scar- 
 let fever and other acute diseases of childhood, of the danger to 
 a community from the first case of Asiatic cholera or bubonic 
 plague. 
 
 Although good air can do no harm to any one yet in some 
 cases that may be the least that the physician may be able to ad- 
 vise. The man who exhibits symptoms of ill health may be found 
 to have a serious disease requiring active treatment, perhaps a 
 surgical operation, as in cases where there is suppuration and 
 nature seems helpless ; pus in the chest cavity or in the abdominal 
 cavity or in the appendix vermiformis may require prompt surgi- 
 cal treatment. Some one must be able to make the proper diag- 
 nosis and some one must know just what to do, or the individual 
 will perish. 
 
 One of the commonest diseases that must be ruled out in throat 
 and chest diseases is tuberculosis, consumption. In advanced cases 
 this is easy, in early cases it may be very difficult, the individual 
 may have to be kept under observation for some time. In dis- 
 eases of the alimentary tract cancer must constantly be ruled out, 
 and here again it may be difficult to recognize early stages. Men 
 who specialize are naturally supposed to do more thorough work 
 than the general practitioner. In the beginning stages of a dis- 
 ease a timely operation may save or at least prolong life ; to wait 
 until almost any one can make a diagnosis means an early fatality. 
 
 The timely use of the proper remedy, as antitoxin in diphtheria 
 or quinine in malaria, may prevent death or at least much suffer- 
 ing and sickness. In speaking of suffering we should not forget 
 that the anguish of the parents may be much greater than the 
 
172 DUSTY AIR AND ILL HEALTH. 
 
 suffering of the child; and on the other hand children may suffer 
 on account of the illness of the parent. One need not be sick to 
 suffer. 
 
 Is it necessary to say that the best general advice that can be 
 given the people in case of ill health or sickness or disease is to 
 consult a good physician, still better have a consultation of several? 
 A physician constantly dealing with sick people may be considered 
 an expert in such matters, he knows more than those who make 
 no study of diseases. Is it necessary to add that an old experienced 
 chronic may have a fund of knowledge learned through bitter 
 experience that makes him a rival of the physician in that par- 
 ticular kind of ill health? He is the man vitally interested. He 
 may know much more than the young doctor who tries to make 
 light of his complaints. 
 
 The number of symptoms that attend a disease is variable, 
 some are essential symptoms and others secondary, they may be 
 present or absent. Much depends on environment. The "disease 
 pictures" given in the textbooks are mainly based on city cases, 
 only too often on city hospital cases, in other words on poor peo- 
 ple who are sent to city hospitals. The country doctor practicing 
 among a different set of patients may find few "typical cases" but 
 any number of "atypical" ones; some of the common symptoms 
 in city patients may be absent. Consumptives may exhibit few 
 symptoms in good air, likewise the man with typhoid fever and 
 the child with scarlet fever. 
 
 CANCER OF THE STOMACH. 
 
 Although the active cause of cancer is still unknown its course is so 
 definite that it is regarded as a specific disease. There are different kinds 
 of cancer. Any part of the hody may be attacked, from the skin to the 
 internal organs. 
 
 Cancer of the stomach is rather common. Nausea and retching and 
 vomiting may at times be seemingly uncontrollable and yet under good air 
 conditions these may be almost wholly absent. Several years ago I had 
 under observation four cases of cancer of the stomach at about the same 
 time, living under different surroundings, which markedly showed the 
 influence of air conditions. I shall make a brief mention of the cases 
 from memory, without going into details. 
 
DYSPEPSIA. 173 
 
 Mrs. — . Middle-aged housewife living on the edge of the business 
 district, where great clouds of dust blow about. Evidences of cancer of 
 the stomach were well marked when I first saw her. There was constant 
 retching and almost uncontrollable vomiting. She did not last long. 
 
 Mrs. — . Had always lived on a farm until her present illness when 
 she removed to town to live with a married son, just beyond the business 
 district where she got the dust from the heart of the city. Almost imme- 
 diately there were severe attacks of retching and vomiting. I soon diag- 
 nosed cancer of the stomach, the diagnosis being verified by the course of 
 the disease and death. On windy days with clouds of dust on the street, 
 there was much nausea, retching and vomiting. 
 
 Mr. — . A well-to-do farmer with a good home heated by hot air. 
 Hot air means a constant current of outdoor air coming into the house. 
 He gave a history of obscure stomach disturbance that at first was 
 puzzling. He would get along for a week or two with scarcely any symp- 
 toms and then there would be attacks of nausea and vomiting. I soon 
 discovered that as long as he remained on the farm he had practically no 
 difficulty but that after a visit to town the stomach would be disturbed. 
 When he came to me the stomach disturbances were so marked that I 
 at once suspected cancer. He did not take kindly to the idea of remaining 
 away from town, which I hoped would reduce retching and vomiting to a 
 minimum. Finally I had to tell him that I could do very little for him 
 and then he drifted into the hands of a physician who without knowing 
 what the difficulty was promised to cure, or at least benefit him greatly, 
 and had him come in town frequently, only to aggravate the difficulty, 
 and he soon became bedfast. In a short time he died. On account of 
 the discrepancy of opinion among physicians the family had a post 
 mortem and cancer was found. 
 
 Mr. — . Farmer who lived in town from where he supervised his 
 farms. He was a dust victim with occasional disturbances of the stomach. 
 Finally the disturbance became so marked that the presence of cancer was 
 suspected, and when one day "coffee ground vomit" appeared a definite 
 diagnosis was made. In the course of time the stomach no longer re- 
 tained food and feeding by enemas was resorted to. The man lived on 
 a hill overlooking town, under almost ideal air conditions, and to see 
 him lying on a couch before the open window one would scarcely suspect 
 that he had a life-destroying disease, there were no evident symptoms. 
 Then toward fall dry weather set in and the town in the valley was over- 
 hung by a smog cloud. The height varied, at times being low and then 
 again rising so that only the highest church steeple would be visible. 
 Looking out over the valley one would not suspect the presence of a city 
 at all. 
 
 Such conditions appear almost unbelievable. Just how much infection 
 was present in the air is of course difficult to determine. But the dust 
 and smoke cloud was irritating to mucous membranes. It was quickly 
 
174 DUSTY AIR AND ILL HEALTH. 
 
 noticed that whenever it readied his open window and came into the 
 house there was not only bronchial Irritation with cough hut also marked 
 nausea and retching and vomiting of mucus. A rainstorm brought relief. 
 The patient gradually failed. Here too a post mortem verified the diagno- 
 sis of cancer of the pylorus, but so small in size that it could not be diag- 
 nosed through the abdominal walls. 1 
 
 MEMBRANOUS CATARRH OP THE INTESTINES. 
 
 One type of dust infection, or Coniosis, rather frequent when 
 looked for among chronics, is characterized by the passing of more 
 or less intestinal mucus, often in the form of strings or ribbons, 
 and with a long list of symptoms. There may or may not be a 
 mucus formation in the respiratory tract. Because some dust vic- 
 tims do not have colds and catarrh one may be misled regarding 
 dust influences. Some of my own early cases I wholly misunder- 
 stood. This of course is again an admission of ignorance, but T 
 was no more ignorant than those about me, who like myself had 
 not been taught about dust influences. 
 
 One of my earliest patients undoubtedly comes under this type 
 of dust victims. She complained of a large number of symptoms, 
 such as one finds among women who are commonly called "hys- 
 terical. ' ' I myself was inclined to label her as hysterical, that her 
 complaints were largely "imaginary." That she had intestinal 
 mucus and that she was a dust victim I did not at all suspect. 
 I found this out later. Unfortunately she was so disgusted be- 
 cause I did not benefit her that she never returned. Even in some 
 of my early cases that had mucus formation in nose and throat, 
 in other words catarrh, I did not suspect dust influences. But 
 when I began to notice that good air benefits catarrh victims I 
 suspected that it might be good for others who have mucus for- 
 mation elsewhere. 
 
 In the previous chapter I spoke of Kinds of Colds. A similar 
 
 1 In such ca3cs the value of surgery must be considered. Just how much benefit is to be obtained 
 through a timely operation is of course a problem. 
 
 Since the advent of "surgical cleanliness" surgery has made wonderful progress. Often "exploratory 
 operations" are indicated; the internal condition may or may not warrent operations on the cancer. 
 Naturally the man who constantly operates has a greater degree of skill than the occasional operator. 
 Unfortunately the big city surgeon often demands an exorbitant fee — but perhaps not excessive after 
 all when we consider the time he spends away from home, hours in which he might have performed 
 several operations in his own city. 
 
DYSPEPSIA. 175 
 
 explanation could be made regarding attacks of membranous ca- 
 tarrh of the intestines, likewise of dyspepsia, particularly acute 
 attacks of indigestion accompanied by much mucus. 
 
 Although membranous catarrh of the intestines is rather fre- 
 quent among old chronics, yet the books have very little to say 
 and as a rule they are pessimistic regarding treatment. 
 
 Case Report. Among my early patients was a middle-aged 
 Irishman who came to this country while still a boy. He promptly 
 got "American Catarrh." He looked upon it as a disagreeable 
 and necessary evil, rather than as a disease. In the course of a 
 few years the mucus formation travelled down into the stomach 
 and then he had "American Dyspepsia." This soon annoyed him 
 to such an extent that he began to consult the doctors; he had too 
 much sense to try patent medicines. He came to me at a time 
 when the mucus formation apparently was travelling into the is- 
 testinal tract but it took me some time to understand the case and 
 its relationship to air conditions. He had an occupation that ex- 
 posed him to much infected dust. In the course of a few years 
 this intestinal mucus formation became very marked and then he 
 had all sorts of symptoms. At first when working for others he 
 had no business worries but these appeared when he went into 
 business for himself. At one time when his business was seriously 
 threatened he became sleepless and lost his appetite and almost 
 any physician would regard him as a case of "nervous prostra- 
 tion." Then the crisis passed and the nervous symptoms dimin- 
 ished and again he was an "old chronic" with mucous membranes 
 that gave off a lot of mucus, very freely during the closed door 
 season, less so during the open door season and still less on lead- 
 ing an outdoor life for a while. 
 
 One day he spoke about the healthy color he had when he first 
 came here, and how Irish girls have a healthy color and how soon 
 they lose it and become sallow. He noticed the same thing among 
 Germans. After he became convinced that air conditions played 
 a very important role in his own ill health, he saw why there is 
 loss of color on coming to this country. 
 
176 DUSTY AIR AND ILL HEALTH. 
 
 Case Report. Here is a brief case report taken from a paper 
 previously mentioned. Dust, a Neglected Factor in III Health. 
 At that time I did not realize that there was a typq of dust vic- 
 tims in which the intestinal mucus is the chief characteristic. At 
 that time I did not even inquire about the passage of bowel mu- 
 cus; indeed many patients are not aware of it on account of closet 
 arrangements. 
 
 Cask III. — Mrs. II.. a housewife of about 26, lives in the eastern resi- 
 dence portion of the city; she has the appearance of being "run down." 
 She came to ine early in March with a history of various disturbances; 
 pain in the hack, wandering pains in the body, beadache, deranged stomach 
 and bowels with a discharge of much mucus at times. Has a sickly yellow 
 color. Says she has had all sorts of experiences with physicians and was 
 now almost discouraged. I suggested a systematic examination, to which 
 she agreed, with the following results : Bodily development good ; except- 
 ing tenderness in the chest and abdomen and along the spine, the physical 
 examination was practically negative. Red blood cells reduced to 3,800,- 
 000; hemoglobin to 60%. Gastric fluid, after a test-meal, contained much 
 mucus ; small amount of HC1 present, also lactic acid, yeast, and some 
 pus. Sputum mainly mucus with some purulent matter full of bacterial 
 life, but no tubercle bacilli. Urine very concentrated; acidity and phos- 
 phates high. Pulse tracing normal, but nervous and influenced by the 
 respiration. I should have stated before that this patient wore a long 
 trailing dress and came down town frequently. 
 
 After further questioning the patient, and after a study of the re- 
 sults of the examinations, she was advised: 1. To shorten her dresses — 
 to keep them off the ground. 2. To stay at home ; if compelled to go down 
 town, to go only on wet days. 3. To use water more freely and to reduce 
 the amount of animal food. 4. For the excessive amount of mucus in 
 the throat and stomach, she was advised to gargle with a very dilute salt 
 and baking soda solution, and to drink half a glass full, hot, half an hour 
 before meals. 5. She was placed on a laxative organic iron preparation, 
 to be used after meals, and in sufficient amount to keep the bowels open. 
 
 This patient began to improve at once, the bodily functions became 
 normal, color came to the cheeks, and the former disagreeable symptoms 
 disappeared. The only time she complains is during the prevalence of 
 dusty, windy weather, and then only of the wandering pains. The ex- 
 cessive secretion of mucus from the respiratory and alimentary tracts has 
 almost ceased. 
 
 Recently it was explained to her more fully how the dust had and 
 still does affect her, and this has made her more cautious; she is now 
 firmly convinced of the influence of infected dust. 
 
DYSPEPSIA. 177 
 
 It will be noticed that this statement occurs: Claims she has 
 had all sorts of experiences with physicians; is now almost dis- 
 couraged. Such or similar remarks apply to many of these cases. 
 This is a rather painful subject; when one goes into details phy 
 sicians regard it as a reflection on the profession. Much can of 
 course be said but after all the one great reason people get routine 
 attention and no special investigation is that they are unwilling 
 to pay the physician for the time it takes to make the investiga- 
 tions and advise fully. Good advice implies investigation and 
 time must be paid for. That many physicians are not students 
 must of course be self-evident. One may ask, How are people to 
 know who are conscientious and studious physicians? Perhaps if 
 people received more instruction in the common schools, had a 
 better knowledge of their own body and of their surroundings, 
 they could judge. People ought to have sufficient education to 
 enable them to select a family physician properly. Perhaps if the 
 people demanded a higher standard there would be fewer incom- 
 petents. On the other hand we must not forget that the standards 
 may be so high that poor people can not afford a well-trained 
 physician and that perforce they are compelled to resort to the 
 uneducated and unlegalized practitioners. The practice of med- 
 icine is after all a business and the legalized practitioners have 
 all sorts of competitors. 
 
 The number of symptoms accompanying eases of membranous 
 catarrh of the intestines is large. I shall shortly refer to them. 
 They vary with the season of the year, with surroundings and 
 prudence. People in the heart of the city may have a large num- 
 ber, while others in the suburbs may have comparatively few. 
 Often one meets people, patients, who complain that in spite of 
 "being careful," of being very careful, or being "exceedingly 
 careful, ' ' they still suffer. They do not know how to guard them- 
 selves. As a rule such patients have had all sorts of advice re- 
 garding the influence of diet. At the same time most of these 
 patients have been overdrugged. Treatment often is heroic, es- 
 
 [121 
 
178 DUSTY AIR AND ILL HEALTH. 
 
 pecially by injecting large amounts of fluid into the lower bowel. 
 What most of these people need is good air advice, with all that 
 that implies. 
 
 Case Report. A middle-aged woman, while greatly depressed 
 on account of a great sorrow, lost her immunity to bad air and 
 became quite susceptible, acute attacks manifesting themselves by 
 the passage of large quantities of intestinal mucus. During the 
 closed door season mucus was present more or less constantly. Her 
 family physician was one who believed in giving lots of medicine 
 but as she was getting no better she finally rebelled. I promptly 
 explained that her affection properly considered was not a disease 
 at all, only a. reaction to an unsanitary environment, After getting 
 the facts in the case, 1 fully advised her regarding the sources of 
 infection and how to avoid them. The simple advice to remain in 
 good air aided by a little medication reduced the disturbance to 
 a minimum. There were several acute attacks following exposure, 
 emphasizing the fact that she was a dust victim. For a year there 
 was practically no difficulty. Then she was persuaded by a neigh- 
 bor to attend a good opera, the plea being made that "this is a 
 fine opera, attended by the best people of the town only." She 
 went, forgetting that the night before the "worst people" in town 
 attended the vaudeville, leaving the floor sadly soiled with all 
 sorts of infection. She had difficulty in staying out the perform- 
 ance and then had such a severe attack that she almost perished. 
 Perhaps needless to say after such an occurrence people are ex- 
 ceedingly careful. "Exceedingly careful" means living within 
 one's limitations. This is something that must be learned. Often 
 it is a dear lesson. When a physician has such a patient under 
 observation for a number of years and notices how certain causes 
 produce an effect, he is apt to have some decided views and to 
 speak rather dogmatically to patients who react similarly. 
 
 It has already been mentioned that many consider climate as 
 the cause of colds and catarrh, while others consider food as the 
 cause of dyspepsia and constipation As a matter of fact all sorts 
 
DYSPEPSIA. 179 
 
 of causes are assigned in cases of ill health — often all but the right 
 one. Bad air of the kind indicated in this volume is very common 
 in our country and it should be one of the first causes to be ruled 
 out. And yet on inquiry among patients it is remarkable to find 
 how little attention is given to this cause. 
 
 One of my elderly patients (a dust victim who improved under 
 good air advice) had had all sorts of advice and was given all 
 sorts of reasons for her ill health. Every physician, and she con- 
 sulted only good ones, thought it was necessary to advise her re- 
 garding diet. She seemed to think physicians believed her com- 
 plaints were due mainly to what she eats. She herself thought 
 they were principally due to clothing, to underwear, being too 
 thinly or too heavily dressed. When to put on or when to take 
 off underwear was one of the great problems of her life. Then 
 she had an idea that the matter of baths was an important one, 
 when and how often and at what temperature to take them. Old 
 people are often set in their ideas and it is hard to teach them; 
 they will revert to their old beliefs over and over. It was difficult 
 to teach her that the thing she had to guard against was what she 
 inhaled, that all other factors were of minor importance. 
 
 "We still find physicians who have all sorts of ideas regarding 
 the importance of material out of which underwear should be 
 made, wool, silk, linen, cotton, open or close weave, and even its 
 color. After one has studied a large number of cases, one is apt 
 to come to the conclusion to give the simple advice, Live simply, 
 breath good air and dress for comfort. 
 
 It always takes a new doctor in town some time to become es- 
 tablished. But in time he may find more applicants than he can 
 serve and he is apt to raise his requirements. He will no longer 
 accept every Tom, Dick and Harry who applies. Rather than give 
 superficial service he prefers not to give any. 
 
 As a student of ill health, my own practice and methods of 
 course differed from the ordinary. As soon as I had more appli- 
 cants than I desired I raised the requirements. I accepted appli- 
 cants on the promise that they would keep a daily record of how 
 
180 DUSTY AIR AND ILL HEALTH. 
 
 they felt and what they did and to report now and then, the fre- 
 quency depending on the urgency of the ease. A little later I ex- 
 pected a brief autobiographical account, including family history. 
 Such a requirement naturally excluded those who ordinarily come 
 for "a little medicine." On the other hand it brought those who 
 were determined to make the matter of getting well a business. 
 Now men must work as a rule, they can not make any decided 
 change in their daily life. They may prefer a physician who 
 merely gives a lot of medicine and does not demand any change 
 in his occupation, in home environment, or mode of life. On the 
 other hand women, especially those who have more or less leisure, 
 can usually live up to advice and for this reason they may be 
 more desirable as patients, and, one may add, as fellow-students. 
 
 How are we to learn about chronic ill health and its fluctua- 
 tions? Why do we feel better one day, one week, and worse the 
 next ? What is the cause of ups and downs ? Similarly we may ask 
 about the wind and weather changes. We commonly hear it said 
 that there is no accounting for wind and weather and yet the 
 weather service is able to predict many things. The reason is 
 that men have kept daily records for years and years and from 
 these records certain deductions can be made. If more people 
 kept a record of their ill health and an account of their daily life 
 perhaps the student of ill health could likewise arrive at some 
 definite conclusions and make predictions, not only for the life of 
 a particular individual but also regarding the lives of all. 
 
 At first sight it would seem inadvisable to ask an old chronic 
 who has been complaining for years to keep a daily record. What 
 can be more dismal than to enumerate symptoms, perhaps a large 
 number of disagreeable symptoms ! And yet how is he, or how is 
 the physician, to learn unless an account is kept? One should of 
 course distinguish between ill health and disease. It would not be 
 advisable to ask any one with an acute disease to keep a record, 
 nor if there is some fatal disease that is likely to kill in a short 
 time. If any record is to be made in such cases it should be done 
 by relatives, just as is done by hospitals for the information of 
 
DYSPEPSIA. 
 
 181 
 
 the physician; records of the case can be studied by others and 
 conclusions drawn. 
 
 At times one may meet a patient who objects to keeping a rec- 
 ord, saying he, or more commonly she, has so many symptoms that 
 they can not be kept account of. But after all the number of 
 symptoms is limited. It is commonly said that the stars of the 
 heavens are uncountable and yet there are people who keep track 
 of them and if a new one appears they duly record it. In every 
 department of human knowledge there are people who keep track 
 of things; if anything new appears they report it. (I myself have 
 been keeping track of new weeds and new diseases that appear in 
 the community.) When these matters are properly explained to 
 patients they are usually willing to keep a record — if not one may 
 consider them "not worth while" and have nothing further to do 
 with them. 
 
 Case Report. The following is abstracted from a lengthy re- 
 port written for physicians. Perhaps needless to say in a volume 
 of this kind one can not enter into technical details. 
 
 A middle-aged woman who said she had had ill health about 
 all her life and who had made the rounds of the doctors, and natur- 
 ally was discouraged, finally came to me. She agreed to keep a 
 record and that was the chief reason I accepted her as a patient. 
 Some time later after we were well acquainted she wrote me her 
 autobiography. My own notes of observations and discussions 
 with her in connection with her own furnish enough data for a 
 good sized volume. The woman was a good listener and a good 
 questioner, the kind of people with whom one is apt to discuss all 
 sorts of topics relating to chronic ill health. 
 
 When I asked her to give me a list of her symptoms, she said. 
 "You better ask me what symptoms I do not have because I have 
 so many. I have every symptom I ever heard of." People who 
 have had lifelong ill health are apt to acquire a lot of information 
 regarding symptoms. She said she had so many she could not 
 keep count of them. I got out a list of symptoms and told her 
 that symptoms like everything else can be checked off or cata- 
 
182 DUSTY AIR AND ILL HEALTH. 
 
 logued, and then without asking leading questions I had her enu- 
 merate, in the end asking about the presence or absence of some 
 she did not mention. Her list was a typical one; I shall refer to 
 it presently. 
 
 She was being treated for malaria. She complained that her 
 head buzzed almost to bursting on account of the quinine she had 
 been compelled to take and yet she was getting worse all the time. 
 She had tried various methods of getting relief, but she had too 
 much sense to try patent medicines, Christian Science, or suicide, 
 the latter on account of her religion. Although at times she was 
 passing large quantities of intestinal mucus, no one had questioned 
 her about it. She herself had said nothing to physicians because 
 she assumed that it was mucus from the stomach and that it was 
 better to pass it from the bowels than to vomit it. 
 
 She complained of the superficial attention she got from phy- 
 sicians and on the other hand of the large amount of medicines 
 she received, saying she had taken a ''barrel of medicine and a 
 peck of pills and tablets. ' ' She gave a long list of purgative med- 
 icines. She had dieted severely, at times for weeks living on 
 crackers or toast and weak tea. One summer she went to the 
 Rocky Mountains and while there felt well, did not even require 
 laxatives. Her ancestry goes back to rural Ireland, and that means 
 there had not been an active weeding out. 
 
 After getting her history there was, the next day, a systematic 
 examination concerning the secretions and excretions by labora- 
 tory methods, especially to determine the presence or absence of 
 well-defined lesions or disease. A day or two later I explained 
 that I found no evidence of well-defined disease, but that she was 
 a dust victim, explaining what that meant. Of course I advised 
 her fully what to do and what not to do. As a rule people who 
 have been using much medicine expect at least a little from a reg- 
 ular physician ; if they did not expect any they would go to a man 
 who claims to cure without the use of medicine. Now drugs or 
 medicines may be wholly unable to cure but they may help. In 
 this case there were indications for some slight medication and 
 
DYSPEPSIA. 183 
 
 she was accordingly supplied with one or two simple remedies and 
 a prescription. I may here add that in a short time she was able 
 to discontinue all medication except an occasional laxative. 
 
 Now a physician may spend a good deal of time in working 
 out a case and more time in making explanations, going into de- 
 tails and using illustrations, so that the patient will understand 
 that health and ill health are largely in his own hands. They can 
 also be told that if they will report faithfully it really makes no 
 difference to the physician how they act, whether they fully fol- 
 low his advice or not, for he will get notes, good ones if advice is 
 followed, notes of the opposite kind if advice is not followed, but 
 in any event there will be notes. One must explain that ill health 
 can be worked out like almost any other problem in biology and 
 that if the physician and patient fully co-operate in the business 
 of regaining health much may be accomplished. 
 
 So far I have said little about the symptoms that accompany 
 dust infection for the reason that I assumed that the reader knows 
 more or less about symptoms of ill health. I have also assumed 
 that practically the only people who will be interested in this vol- 
 ume are those who have ill health and that those who have robust 
 health will scarcely be interested at all. 
 
 A book in a foreign language appeals only to those who know 
 the language. Many books appeal to a limited class of readers or 
 students, books on science generally. A book like Lent's "Being 
 Done Good" can only be fully understood or appreciated by a 
 "rheumatic" who has made the rounds of doctors, of schools of 
 medicine and modes of treatment; there are allusions that even 
 a physician may fail to understand. 
 
 But although a man in robust health may not fully understand 
 a book on ill health, he can learn many things about those in ill 
 health and he may learn that the complaints of a friend or relative 
 may not be at all imaginary. 
 
 I shall now briefly take up some of the commoner symptoms of 
 which dust victims complain. Later on I shall consider symptoms 
 
184 DUSTY AIR AND ILL HEALTH. 
 
 from another standpoint, as being warnings to be heeded, perhaps 
 as being blessings in disguise. 
 
 In general it may be said that the severity of a disease varies 
 inversely to the number of symptoms. Some of the most serious 
 diseases manifest their presence by but very few symptoms. On 
 the other hand people in ill health may complain of so many that 
 the physician gets tired listening to the recital — he knows from 
 experience that people who complain of many and vague symp- 
 toms are not seriously sick. 
 
 Pains and aches throughout the body may mean little, a local- 
 ized pain may mean much. Recurrent headaches may signify 
 little but a. sudden headache in a man who never had headaches 
 before may put the physician on his guard at once — he is apt to 
 think of all sorts of serious consequences. People called neuras- 
 thenic often have so many symptoms that they can not readily 
 enumerate them, they require time to think. The really sick man 
 can promptly enumerate and moreover the physician usually finds 
 signs of disease. In the case of small children he may have to 
 rely wholly on signs, on objective symptoms. 
 
 A physician often forgets that people have a very vague idea 
 of what symptom names mean, and that a. patient's statements 
 regarding the presence or absence of certain symptoms must be 
 accepted more or less guardedly. One must find out what names 
 mean to them. It may seem a very simple matter to ask a long 
 list of questions and find out whether the patient has such symp- 
 toms or not, but as a matter of fact it may take much time be- 
 cause one must discover what the patient really means. 
 
 Do you have these symptoms? is a familiar question in the 
 advertisements of patent medicines, followed by a long list. Such 
 advertisements as a rule are as common in the newspapers of dirty 
 towns as they are rare in those of clean ones. They refer to states 
 of ill health than to the presence of well-defined disease. 
 
DYSPEPSIA. 185 
 
 DISCUSSING SYMPTOMS OP ILL HEALTH WITH 
 PATIENTS. 
 
 To what extent this shall be done is at times a problem. One 
 may err greatly regarding the attitude of patients, some refuse 
 outright to enter into details regarding their symptoms. One may 
 at times lose an otherwise "good patient" on account of some 
 point that came up incidentally. Naturally a physician may spend 
 much time in "useless discussion" but every now and then he 
 meets individuals with whom discussions are really worth while, 
 they help to clarify ideas. The medical society is ordinarily as- 
 sumed to be the proper place for discussions, but only too often 
 discussions are about specific diseases rather than ill health of the 
 kind considered in this volume. A physician may prefer to dis- 
 cuss with intelligent patients who have experienced the symptoms 
 and the kind of ill health here discussed. Such a remark applies 
 particularly to the country doctor living in isolation. 
 
 In the present case symptoms were frequently discussed, not 
 only their causes but also conditions under which they appear as 
 well as their varied manifestations. One can learn much from 
 intelligent patients. Here I shall briefly mention the chief symp- 
 toms of which the last mentioned patient complained on first com- 
 ing to me, some of which recurred now and then while with me. 
 including some general remarks on symptoms. 
 
 Anemia. She had a sallow complexion ; had been told she had 
 anemia and also "decay of the blood" as a girl. Her complexion 
 had also been explained: "It's the liver." The coloring matter 
 of the blood was approximately three-fourths normal. Sometime 
 after being with me she gradually obtained a "healthy complex- 
 ion." 
 
 The matter of complexion is an important one to women. One 
 can readily understand how if symptoms generally subside there 
 may still be cause for worry and sleeplessness on account of a 
 muddy complexion. Even chronics have periods when they feel 
 comparatively well, but the complexion remains. The remedy for 
 
186 DUSTY AIR AND ILL HEALTH. 
 
 a muddy complexion is good air and especially exercise in good 
 air. This woman had too good sense to try any of the numerous 
 advertised blood purifiers. She reasoned that if physicians could 
 not give her medicines that would bring a good complexion patent 
 medicines would not be apt to do so. 
 
 Anorexia. In a technical enumeration of symptoms loss of 
 appetite would come under this head, just as loss of sleep is listed 
 under insomnia. Loss of appetite is a very common symptom. 
 As already mentioned this patient at times existed on crackers or 
 toast and weak tea. Under such conditions people do not really 
 live, they merely exist. One may see why in the presence of a 
 constantly acting cause all sorts of tonics and appetizers may 
 fail. I did not give her any tonic; the best " appetizer" as well 
 as the best tonic is good air. By watching air conditions, in a 
 short time she was able to eat anything. In the very beginning 
 on coming to me I advised her to eat a little of everything but not 
 to overeat in general nor to overeat on any one thing. That peo- 
 ple who have an impaired digestive tract should chew their food 
 thoroughly must be self-evident. A strong young boy may be able 
 to eat anything and everything, at all hours; the sick or feeble 
 and the aged must be careful. 
 
 In connection with loss of appetite one should also consider 
 the early morning vomiting which is often due to an effort to 
 bring up accumulated phlegm. Mucus in people living under 
 dusty air is colored, at times being black. It is the solid residue 
 of the air inhaled. It is spat out just as the owl ejects pellets 
 after having extracted the nutriment. A coated tongue is usually 
 considered in connection with loss of appetite but often can be 
 assumed to exist, yet some patients think themselves neglected 
 unless asked to show the tongue. 
 
 Chills or Chilling have been a common symptom and being 
 misinterpreted led to the free use of quinine. People exposed to 
 infected dust who house themselves up very frequently complain 
 of a chilly sensation. 
 
DYSPEPSIA. 187 
 
 This patient formerly complained much of chills and chilling. 
 On several occasions since with me she complained of chilling; 
 each time the source was traced to dust except once when there 
 was no clear history (or I failed to make the proper inquiry at 
 the time). Ordinarily the chilling comes on promptly after a re- 
 turn from town. She seldom goes to town but must go at times. 
 At first she did not understand about moist weather and filth 
 being tracked indoors where it is pulverized and that although 
 there may be no dust on the streets, the stores may be thickly 
 filled with it. The effects of an ordinary exposure in her case 
 last from 24 to 36 hours, after that the chilly sensations no longer 
 occur. Here is one of my notes for 16 Dec. 1908, at the time when 
 the idea of dust infection was not so fully fixed in her mind : 
 
 On coming in she said, "You notice I got a cold." She told 
 how she has been getting along so well since with me, how she had 
 remained away from crowds and bad air, but she had risked going 
 into a crowd on Monday — "when there was no dust on the down 
 town streets." However she found the air in the stores full of 
 it; at the X department store the air was very bad and oppres- 
 sive and she did not stay long. She breathed easier on getting 
 into the outer air, but on getting home there was again the feel- 
 ing of oppression, "I felt as though I did not want to be in the 
 house. I opened doors and windows — and that is where I got my 
 cold." 
 
 I called for her diary. She had not entered "shopping" (or 
 rather "wanted to shop" for she did not stay) but she entered 
 "got a cold." I asked her to make mention at the proper place 
 of the shopping, showing cause and effect. "When she had made 
 the entry she said, "And I thought I was so careful." 
 
 I then explained the air conditions of the last two weeks or 
 so, how the deep snow had prevented street cleaning so that there 
 was a great accumulation of filth now tracked into the stores and 
 there pulverized, becoming "powdered poison," to which those 
 susceptible reacted. I told her how some of my old experienced 
 patients, realizing that although there was no dust on the streets, 
 
188 DUSTY AIR AND ILL HEALTH. 
 
 in fact just the opposite, knew that the dust was in the stores 
 and that it was a very virulent, dust, and so they did not go into 
 them. I explained that "inexperienced patients" like herself, 
 those not fully informed, would make just such mistakes and 
 "catch colds," but I felt sure that from now on she would avoid 
 similar repetitions. 
 
 I referred to the fact that I had advised her not know i ugly" to 
 expose herself to dust influences, i. e., simply to prove or disprove 
 my remarks on dust infection; that likely there would be an un- 
 witting exposure — and this is what had now occurred. I expressed 
 my belief that as a new patient she was getting along very well, 
 that she had to learn these things, that there may be an attack now 
 and then in spite of every precaution. During holiday shopping 
 people will run the risk and this may resolve itself into the ques- 
 tion of to shop or not to shop. 
 
 One day some time later in midwinter when it was quite cold, 
 with ice and snow, she told me of how she enjoyed getting out into 
 the cold and snowy weather, and how good she was feeling, "the 
 best for years and years." She contrasted this state with that of 
 former years when she would house herself up and would stay in 
 only to feel worse, while now if there were times when she did 
 not feel perfectly well she went out and that helped at once. She 
 recognized the fact that there was no necessary relationship be- 
 tween "cold" and "colds" but that such a relationship could 
 readily be established. 
 
 Formerly she dreaded a "chill" and especially a so-called 
 "congestive chill" (a term frequently used here and a good one 
 to "scare" patients). "Chills" are now rare, the last one she 
 had did not alarm her at all ; she told me of it over the telephone 
 in the most matter of fact way. 
 
 Colds. In my own enumeration of the complaints of people 
 in ill health, a "cold" is regarded as a symptom, a symptom of 
 some unusual activity of the body, really an indication that the 
 body is trying to get rid of some foreign matter. This patient 
 had had frequent colds, she has had several since with me. After 
 
DYSPEPSIA. 189 
 
 all that has been said regarding colds there is no need to enter into 
 details here nor speak of mucus formation commonly called ca- 
 tarrh. 
 
 Constipation. This again is to be regarded as a symptom 
 rather than an affection or disease. It should be kept in mind that 
 in this volume I am speaking of dust victims who can not be con- 
 sidered as diseased. I have purposely ruled out individuals who 
 have well defined disease. I have already mentioned that this 
 patient tried all sorts of laxatives and cathartics. Here it may 
 be said that there are two great classes of remedies among ' ' symp- 
 tom-prescribers, " those that give relief from pain, anodynes and 
 sedatives, and those that move the bowels, laxatives or cathartics. 
 Chronics are often alternately dosed with one kind and then with 
 the other. The anodyne makes them feel better but tends to lock 
 up the bowels, and then cathartics are used to ' ' open the bowels, ' ' 
 then the pain returns and the process is repeated. Whether a 
 patient receives such treatment at the hands of the lazy physician 
 or buys patent medicines amounts to the same thing. I have al- 
 ready referred to the fact that this patient had not used patent 
 medicine. But she had had her full share of " symptom prescrib- 
 ing." I may add that shortly after she became my patient she 
 required less and less laxative and in time none whatever, ex- 
 cepting after an acute exposure. Here again I would say the best 
 anti-constipation remedy is good air and especially exercise in good 
 air. 
 
 Constriction or Oppression of the Chest. A peculiar sen- 
 sation frequent among dust victims is described by this term. The 
 sensation may be a mere sense of discomfort or actual pain. In 
 some where there is marked pain there is often a history of an 
 injury to the chest, as in the present case where there was a fall 
 on the breast bone. The pain may be marked after an acute ex- 
 posure and especially after dusty housecleaning. 
 
 Cough. This is a very common symptom as one may naturally 
 expect. The primary object of cough is to get rid of irritating 
 
190 DUSTY AIR AND ILL HEALTH. 
 
 matter, which may be readily brought up with the free secretion 
 of mucus but with difficulty in the case of a " dry cough. ' ' 
 
 "Cystitis/' or rather "irritable bladder," should perhaps 
 also be mentioned. This is a condition that frequently occurs in 
 dust victims. They may worry for fear they have kidney dis- 
 ease. A little codeine or heroin that allays the cough of an irri- 
 table throat usually also allays an irritable bladder. 
 
 Dead Finger Symptom. This is a symptom that goes by va- 
 rious names; at times the hand is described as "being asleep." It 
 is often described as a feeling of "pins and needles." Numbness 
 may extend over an entire limb. As is well known, sleeping with 
 the arms under the head may bring on this symptom. 
 
 Dreaming. The conditions under which one dreams much or 
 little or whether the dreams are agreeable or disagreeable is an 
 interesting subject. This patient used to have disagreeable dreams 
 and also had many sleepless hours when she would lie awake and 
 think of her troubles. Not knowing the significance of her symp- 
 toms and imagining the worst, she would fear all sorts of terrible 
 diseases. 
 
 Dryness op the Skin. This is frequent in cases where there 
 is a sallow color. There may be a fine scaling off similar to that 
 found on the head in dandruff. The best remedy is good air. 
 That beauty specialists find many dupes among dust victims has 
 already been referred to. 
 
 Dyspepsia. This term as used in this volume stands for a 
 symptom, not for a disease. Individuals who have many symp- 
 toms, in other words who complain of all sorts of disturbances, 
 likely also complain of disturbances of the stomach and alimentary 
 tract. The term of course is very indefinite. There may be more 
 or less pain referable to the stomach, with gas formation and the 
 presence of acid or disagreeable tasting fluid coming up into the 
 mouth. If there is much mucus there may be vomiting and retch- 
 ing. This was formerly a common symptom in this patient, but as 
 
DYSPEPSIA. 191 
 
 already mentioned now she can eat anything and everything, "even 
 radishes," something about as difficult to digest as one can find. 
 
 Flatulency. A very common symptom in dust victims is flat- 
 ulency, especially common in people living under city conditions. 
 It almost seems that people living under simple life conditions do 
 not complain of this symptom at all. It would be interesting to 
 look up some of the common symptom names, when they first came 
 into use and under what conditions ; in other words, to what extent 
 are they due to unsanitary city conditions? That in turn would 
 bring up the question of the sanitary condition of the early cities, 
 as those of ancient Greece; many medical terms go back to the 
 Greeks. That this patient was formerly annoyed by this common 
 symptom need scarcely be mentioned. 
 
 Emaciation. This may be considered an important symptom 
 or indicator of bodily conditions, not necessarily alarming. One 
 may naturally expect loss in weight in people who eat very little. 
 For the same reason there may be very little bowel movement and 
 yet some people take laxatives and cathartics. 
 
 Flushing. This is an annoying symptom and formerly she 
 complained much, as far back as she can remember, yet she never 
 traced any connection between it and exposure to bad air. She 
 readily saw the connection after attention had been called to it. 
 To some the flushing may indicate the presence of fever, yet the 
 thermometer may not show any rise of temperature or only a 
 slight transient one. 
 
 Headache. Headache is a term that covers a great variety of 
 painful conditions about the head. There are all sorts of headache 
 and all degrees of intensity of pain located in any or every part 
 of the head. At times a previous injury seems to determine a 
 localization. Headache is a very common symptom following an 
 acute exposure to bad air. It may sometimes be the only symptom. 
 At present it is customary to examine all those complaining of 
 headache for defects in the eyes but very few examine air condi- 
 tions to which a patient has been exposed, in my experience one 
 
192 DUSTY AIR AND ILL HEALTH. 
 
 of the commonest causes of headache. The only "pain killer" this 
 patient has had since with me was a few headache tablets. 
 
 Insomnia. Sleeplessness, as already mentioned, is a common 
 symptom in dust victims, especially of the "nervous kind" who 
 may lie awake at night thinking over their symptoms and wonder- 
 ing what it all means. Insomnia usually spells worry. Ordinarily 
 we think of insomnia as a curse but it may be a blessing in dis- 
 guise, telling us to seek the cause and avoid it. To the brain 
 worker, especially to the literary man, insomnia, and rushes of 
 thought that are apt to accompany it, may be of service in his 
 work. He may even find a lot of material in dreams and in "sub- 
 conscious cerebration." Dust victims when they realize what the 
 ordinary symptoms mean, that they are warnings and should be 
 heeded, usually cease to lie awake, assuming that they are getting 
 better air than they had. 
 
 Joint Pains. Dust victims may complain of an aching through- 
 out the body or there may be a localization about the joints, and 
 then we are apt to hear of "rheumatism," if not of gout, or the 
 terms rheumatic and gouty are used. The term uric acid is also 
 used. The idea that uric acid is a factor in ordinary joint pains 
 has been generally abandoned; it applies only to the exceptional 
 case. But the patent medicine men are using the "uric acid 
 theory" to a large extent, some explain all pains and aches on 
 the assumption of uric acid in the blood. This patient after all 
 other pains and aches had disappeared still complained of a local- 
 ized pain in the neck; this was finally traced to an injury due to 
 the fall of an ice chest lid. An acute attack of dust infection may 
 now manifest itself there before any other symptoms appear. 
 
 Lack op Ambition. This is a term often used by dust vic- 
 tims in describing their sensations. The term at times is used as 
 a synonym for the ' ' Blues. " It is interesting to study what may 
 be called the mental symptoms of dust victims, how the mind re- 
 acts under good and bad air. There may be stimulation of the 
 mental faculties or the opposite. Some people lead such a mere 
 
DYSPEPSIA. 193 
 
 vegetative existence, perhaps driven by necessity in the struggle 
 for existence, that they have no time to observe what is going on 
 in the mind. One must distinguish between sensory and motor 
 impulses. There may be a great desire to do, the mind is active, 
 and yet there is a lack of motor power, or the opposite may be 
 true. We hear much regarding "suggestion" and the question 
 to what extent people can be induced to act upon "suggestion" 
 is a very interesting one. One may suggest, in fact, one may out- 
 right lie to a patient in chronic ill health, telling him he is feel- 
 ing better and he may imagine he is, but the effects do not last 
 long. In my own work I do not use ' ' suggestion. ' ' I reason with 
 patients and explain, in other words, I teach them about the causes 
 and nature of their ill health, and if they adopt the advice that 
 is the outcome of a study of similar cases they are apt to be bene- 
 fited as case reports in this volume show. The present patient 
 has had all sorts of moods or mental states and she now clearly 
 realizes the influence of air conditions. 
 
 Muscular Pains. Perhaps everybody has an idea what this 
 expression means. It is used in distinction to pains that are lo- 
 cated at the joints, not to speak of internal pains. But at times 
 it is difficult for a physician to determine where the pain really 
 is. The term is as indefinite as rheumatic or neuralgic, names 
 which go back to the childhood of Medicine, to the ancient Greeks. 
 Pain as ordinarily used by the physician may refer to any pain- 
 ful sensation, from a mere sense of discomfort up to a pain so 
 severe that it may kill. Pain of course is one of the commonest 
 symptoms of ill health and of disease. In the great majority of 
 cases pain is to be regarded as a blessing; it gives us warning 
 that something is wrong. If we heed the warning and discover 
 why there is pain we may be able to prevent it. To use a "pain 
 killer" is the worst form of treatment. The pain of such a dis- 
 ease as cancer belongs to a wholly different category. 
 
 Nervousness. This is a term frequently used by physicians 
 as well as by patients. Sometimes we are referred to as a nervous 
 
 [13] 
 
194 DUSTY AIR AND ILL HEALTH. 
 
 people, in opposition to the primitive inhabitants, the Indians, 
 who were stoical. I imagine that if an Indian were placed in the 
 heart of a busy city and compelled to shift for himself he would 
 quickly lose his stoicism in attempting to avoid dangers, being 
 run down in the street, and in exercising his wits to make a liv- 
 ing. The "guttersnipe" is quite different from the "country 
 clod" on account of his environment. From these remarks one 
 might infer that the remedy for too much nervousness is more or 
 less simple life. Perhaps after all "simple life" spells good air. 
 People differ largely on account of the kind of air they inhale. 
 One hesitates to make such a statement but here it is merely 
 thrown in as a possible explanation — my patient found it ex- 
 plained her so-called neurasthenia. 
 
 Palpitation. Consciousness of the heart's action may appear 
 in any one on undue exertion or from excitement. In some it 
 comes on very readily and still there may be no complaint of ill 
 health. It is often annoying to nervous individuals. When the 
 heart is weak on account of disease or merely from lack of exer- 
 cise, palpitation may occur on the least exertion ; it is always wise 
 to get the opinion of a good physician concerning the probable 
 significance. 
 
 The patient here under discussion at times had palpitation 
 with more or less oppression of the chest, especially after her 
 weekly housecleaning. I quote from my notes: 
 
 "I used to suffer every time I cleaned house. I cleaned up 
 every Friday. It used to make me feel so bad and gave me such 
 a peculiar sensation in the chest so that I wanted to put my hand 
 on my chest, like this, and there would be a peculiar sensation 
 about the heart ; it would not be a flutter really but it was irregu- 
 lar, and I used to think it was the movement [of sweeping], and 
 then at times I thought it might be the dust, that this might have 
 something to do with it. I used to spit up black." 
 
 She had experimented to determine whether it was brisk move- 
 ment that brought on palpitation but found it was just as bad 
 with very slow sweeping; she could not understand it. The ex- 
 
DYSPEPSIA. 195 
 
 planation is of course easy: She swept with the house closed and 
 slow sweeping meant a longer exposure and more inhalation of 
 dust, with shallow breathing, while brisk work meant a shorter 
 exposure but with deep breathing, the end results being the same. 
 "With doors and windows open and the wind blowing through 
 rapid or slow work made no difference. 
 
 The simplest form of spitting black is that which comes on 
 almost immediately after an acute exposure, as in handling dusty 
 coal at the furnace. There may be a free mucus formation which 
 entangles the coal particles and black spit may be marked. On 
 the other hand is the black spit that appears after several days' 
 exposure, as where there has been a continued exposure to smoky 
 and dusty air, when a good air resident, for instance, has spent 
 several days in a smoky city. There may be no spitting while in 
 the city; whatever is inhaled remains in the lungs. During this 
 time the individual may feel bad and finally the black spit comes 
 up. Again, the exposure may last only a few hours, as going to 
 a theater with much infected dust; the process of black spitting 
 may be inhibited for several days. In the meantime the individual 
 complains. 
 
 As a rule the black spit most readily comes up early in the 
 morning, in some while still in a recumbent position, while there 
 is little gravity to overcome; in others as soon as they get up, 
 aided by movement. Every one must determine for himself under 
 what conditions he spits black. 
 
 Perhaps the above list embraces the chief symptoms of which 
 people ordinarily complain. Among other symptoms may be men- 
 tioned tinnitus, a buzzing in the ears, often marked in dust vic- 
 tims; also sensations of dizziness or vertigo, this latter however 
 is more apt to occur in elderly people. Vomiting and worry as 
 symptoms have already been referred to. 
 
 This patient typifies what I frequently see : a large and varied 
 list of symptoms, apparently "too numerous to mention," and 
 yet in a short time, depending chiefly on seasonal and environ- 
 mental influences, symptoms will disappear, and then the patient 
 
196 DUSTY AIR AND ILL HEALTH. 
 
 has nothing to complain about. The patient may question the 
 need for further health supervision. In order to get continued 
 notes a physician may offer medical supervision for a nominal fee. 
 Unless there is some agreement there may be no further report- 
 ing, or the patient may return acutely ill, and then the physician 
 may spend a lot of time in determining present conditions and 
 what happened previously. 
 
 After the brief account of the preliminary investigation and 
 discussion of symptoms, there should now follow a chronological 
 account covering a period of several years. At first the patient 
 reported weekly ; gradually the time was increased to once a month 
 and more recently there was an agreement that she should con- 
 tinue indefinitely without reporting but to report promptly if 
 anything went wrong. 
 
 There were many discussions on various phases of ill health, 
 at first wholly relating to herself but in time when she had "noth- 
 ing to report" about herself there was developed a habit of dis- 
 cussing some of her friends who complained of ill health, which 
 in some cases she interpreted in the light of her own experiences. 
 1 have a lot of what may be called secondhand case notes. But 
 one never knows to what extent one can rely on secondhand state- 
 ments relating to ill health and disease. Naturally the statements 
 of a physician have a higher degree of probability than those of 
 an uneducated layman. But between the statements of an "edu- 
 cated dust victim" and a physician who has never given the sub- 
 ject of dust influences any attention one might be inclined to rely 
 on the former. 
 
 In the course of years there were any number of incidents 
 that occurred which show r ed that the assumption of dust infection 
 was a good one. It enabled the patient to reduce her ill health 
 to a minimum, or in other words to maintain health. After we 
 were well acquainted I asked her to give me her autobiography. 
 She promptly wrote it out in the missionary spirit, to the best of 
 her ability. Quite naturally people can give only an imperfect 
 
DYSPEPSIA. 197 
 
 account of earlier years, many can not give an account of what 
 occurred during the past year. Need it be added that the phy- 
 sician who does not keep notes on his patients is also unable to 
 give a good account? 
 
 A case of this kind can not be done justice in a few pages ; it 
 would really require a volume. But if one characterizes too closely 
 the individual would be identified in a small community where 
 everybody knows everybody else, and so the matter of fuller biog- 
 raphies must be deferred to subsequent years. 
 
 PUZZLING CASES. 
 
 Cases that are puzzling, where one does not always know just 
 what is best to do, constantly arise. I might mention one. 
 
 Case Report. Middle-aged woman from an adjoining county, 
 complained of chronic ill health for years, ever since she was 
 married. On investigating I found she was a descendant of poor 
 white mountaineer stock, wholly unadapted to life under air con- 
 ditions found in most of our villages, towns and small cities. She 
 had always lived in the country but on getting married removed 
 to a small town; her ill health soon led her to lead a life of se- 
 clusion. Naturally she ' ' doctored. ' ' She had had all sorts of ex- 
 planations, all sorts of diagnoses, until in the end she believed in 
 none, that it was all guess work. Moreover she had lost faith in 
 doctors and medicines — but not quite all for she was induced to 
 consult me by some patients living in her neighborhood. I quickly 
 discovered that she was a marked dust victim of the kind just 
 considered and tried to explain what that meant and what she 
 should do and what she should not do in order to reduce symp- 
 toms to a minimum ; of course I proposed health supervision. She 
 had a daughter who was following in her footsteps. She reasoned 
 that if she herself could be helped likely there would be help for 
 her daughter. 
 
 One day she came in accompained by her husband. He was a 
 stout, robust man, florid faced, of the so-called apoplectic type. I 
 
198 DUSTY AIR AND ILL HEALTH. 
 
 at once saw that he was opposed to doctors — he had good reasons. 
 He had spent thousands of dollars on account of his wife's ill 
 health and had repeatedly moved in the hope that a change would 
 help her. Naturally I tried to interest him in the matter of dust 
 influences. In my explanation of her ill health and how this had 
 been misunderstood, I incidentally remarked that she belonged to 
 the "low pressure'' type of individuals while he himself quite 
 likely belonged to the "high pressure" type. He regarded this 
 as a compliment. Out of curiosity I took his blood pressure and 
 found it to be excessively high, in fact he might be considered in 
 constant danger of an apoplexy, and yet he deemed himself "thor- 
 oughly healthy," twitting his wife about her low pressure. 
 
 Now here is a case for medical ethics. What is the duty of 
 the physician in such a case? The man was not my patient; in 
 fact he was opposed to all doctors. If I spoke of the dangers of 
 a high blood pressure it would greatly worry the wife, my patient. 
 Yet both should know that there was imminent danger, so that the 
 man might set his house in order. What was my duty? One is 
 apt to get all sorts of opinions on asking the question. 
 
 Such or similar cases are constantly occurring. One learns in 
 the course of time what to do — but what one does may not con- 
 form to what Mrs. Grundy says. Such a case gives opportunity 
 for making all sorts of comments. One could quickly fill a long 
 chapter. 
 
 All that "medical science" can do in some instances is to point 
 out the why and the wherefore. A "cure" may or may not result 
 from the advice of the physician who works out a case to his own 
 satisfaction. To what extent a physician will humor disagreeable 
 patients and still more disagreeable relatives depends, as all ex- 
 perienced chronics know, shall we say on circumstances? 
 
 And as to ethics, it is easy to say, Do unto others as you want 
 others to do unto you. If a physician knows that medicine can 
 not cure should he refuse to give any to patients who want it? On 
 the other hand if people are opposed to physicians, shall he try to 
 instruct them? Shall we insist that the physician does have a 
 
DYSPEPSIA. 199 
 
 mission, one other than giving drugs, that good advice may be of 
 more value than all medicine? 
 
 How do people look upon the "prophet of evil," upon the phy- 
 sician who makes gloomy prognoses? The physician himself may 
 want to know about his own future, about the probable outcome, 
 but many people do not want to know, they want to live on in 
 ignorance, not only about themselves but also about relatives. In 
 this connection I may say that I have had patients, or applicants 
 for professional services, who in the beginning said if anything 
 serious was found not to tell them. Some physician may not want 
 such individuals as patients at all. 
 
 While examining the sputum of a preacher's wife, I asked him 
 regarding the duty of the physician, whether he should always 
 tell the truth. "Of course, always." A few moments later when 
 I announced the presence of tubercle bacilli, that his wife had con- 
 sumption, he became greatly agitated and said it would never do 
 to tell her the truth, completely reversing his opinion in the course 
 of a few minutes. 
 
 I might add that I failed to impress the couple above cited 
 with the importance of health supervision. The wife expected to 
 be cured by the use of medicine and the husband was opposed to 
 "doctoring." She soon drifted out of my hands. The man did 
 not become my patient at all. 
 
 WEEDING OUT ON ACCOUNT OF ILL HEALTH AND 
 
 DISEASE. 
 
 The following cases coming under the head of Membranous 
 Catarrh of the Intestines may be cited to show how families and 
 individuals are weeded out. 
 
 A middle-aged woman brought her nearly grown daughter to 
 me, saying she feared consumption because her father, the woman's 
 first husband, had died from tuberculosis. The girl had had much 
 ill health in school and complained more or less constantly; she 
 was pale, although well developed. Good air advice helped her 
 very much. 
 
200 DUSTY AIR AND ILL HEALTH. 
 
 Then the mother told of her own ills; she had membranous 
 catarrh of the intestines. Later on the husband also applied; lie 
 was reacting to irritating dust of a shop. 
 
 The people finally understood that they were not adapted to 
 life under dirty and dusty surroundings, and one day they packed 
 up and removed to the northwest. Here under simple outdoor 
 life all three had good health, but unfortunately the girl got lone- 
 some and wanted to come back. The family did return and then 
 all again complained. How the parents will end is problematical 
 but the indications are that the girl will die ere long from tuber- 
 culosis. 1 What more can one do in cases of this kind than advise? 
 Nature is constantly weeding out certain types. To what extent 
 is such weeding out preventable? Some people speak of Nature 
 as others do of Providence, as though things can not be helped. 
 
 One day I received a letter from a woman in an adjoining 
 county indicative of such a degree of illiteracy that I was inclined 
 to ignore it, but since she was referred to me by an old patient 
 whom I had benefited, I read it through and decided to have her 
 come in to talk matters over. I was agreeably surprised when I 
 found the woman's speech and actions belied her letter. She was 
 bright and as later events proved was a good observer. One may 
 compare her to the illiterate Indian who may be a better observer 
 than the educated bookworm. She gave a lifelong history of ill 
 health. She is a descendant of the poor whites of the southern 
 mountains and wholly unadapted to life under unsanitary sur- 
 roundings. Her father died soon after coming to this State. Her 
 mother had "good health," this however was found to be due to 
 the fact that she lived in isolation on a farm; one time when she 
 went on a visit to another State she promptly suffered and nearly 
 died on returning home. Good health merely meant not being 
 exposed to the causes of ill health and disease. 
 
 This woman, now aged forty, was married twice, has one grown 
 
 1 To what extent the free formation of mucus is antagonistic to the invasion of the tubercle bacillus 
 is itself an interesting question. Does the free flow of mucus wash out irritants and infection? The 
 free flow of tears cleanses the eyes. 
 
 I have not studied a sufficient number of consumptives (they are really outside of my present 
 field of work) to enable me to draw any conclusions. 
 
DYSPEPSIA. 201 
 
 daughter by a former husband who was healthy. By the second 
 husband there are three children, the youngest not yet of school 
 age. The husband is a dust victim who readily reacts on visits to 
 town, bringing home colds. The children likewise are constantly 
 having school colds. She had an idea that her colds were due to 
 coming in contact with cold air and as a consequence she housed 
 herself closely. On account of her complaints of chilliness (very 
 common among those who house themselves) her physicians (she 
 has had a number) believed she had malaria or was malarial and 
 dosed her with quinine. She took quinine to such an extent that 
 she was enfeebled and had to stop and rest up — so she could take 
 more quinine. The simple advice to be more out of doors, to ven- 
 tilate the home freely, for the husband to stay away from town 
 and not bring home colds, and to watch the children to reduce 
 their colds to a minimum, was sufficient to cause nearly all her 
 complaints to disappear. 
 
 She kept a record, but not to embarrass her I asked her to read 
 it to me on coming in, which she did fluently. As a rule when 
 people are asked to write they are not longwinded ; they express 
 themselves briefly and to the point. One gets all data concisely, 
 and of course in proper sequence. In the course of time many 
 little things came up that showed how symptoms are dependent 
 on bad air and disappear under good air. I shall mention one 
 instance. 
 
 She complained that a storm, especially at night, made her 
 nervous and restless and sleepless. The explanation was found to 
 be this: The frame house was raised above the ground and the 
 wind blowing under it blew dust out of floors and carpets and 
 filled the house, especially the bed room. The dust naturally con- 
 tained infection from the frequent attacks of colds and catarrh in 
 the family. The simple advice to open doors and windows and 
 let the dust blow out sufficed to cause these symptoms to disappear. 
 
 It will be interesting to follow up the fate of this family, es- 
 pecially the children : What will become of them, will they ' ' out- 
 grow" their susceptibilities or will they die off, especially from 
 
202 DUSTY AIR AND ILL HEALTH. 
 
 tuberculosis? Country life or city life is an important question 
 with such individuals. Such a case too leads one to consider the 
 influence of medication (as too much quinine) as a factor in "race 
 suicide." • 
 
 In the Introductory chapter I referred to a family history 
 where three of the children were very susceptible to dust infection, 
 while two were practically immune. Out of the five, two have 
 been my patients. First one of the sons came to me. Being in- 
 telligent he promptly grasped the idea of dust infection and his 
 symptoms diminished and then practically vanished, to return on 
 exposure. 
 
 Some time later he brought his sister to me, a girl of 18. She 
 was evidently more susceptible than he; she could not go away 
 from the farm without getting ill, the symptomatology being that 
 of membranous catarrh of the intestines, Avith marked disturbance 
 of the whole alimentary tract. When the girl came in I assumed 
 that her brother had told her what I had explained to him about 
 the causes of his ill health, but I found he had not said a word. 
 When I mentioned this to him he excused himself, saying that if 
 he had said anything about dust as a cause of ill health likely his 
 folks would not have believed it (see note below) ; the explanation 
 was so simple that it seemed ridiculous, that people could not be 
 made to understand that there are different kinds of dust. He 
 thought I could explain "the dust theory" better than he. 
 
 The girl was found so susceptible that I had to ask her not to 
 come to town at all, but remain on the farm. For a time I tried 
 to treat her by mail but this was found unsatisfactory. I have 
 no doubt that if she attempts to live under city conditions she 
 will promptly perish. Had she lived under such conditions she 
 undoubtedly would have perished long ago. How to mention such 
 matters to a patient is of course a problem. To some one may 
 speak outright; to others one must be very careful. If the indi- 
 vidual is wise he will attempt to live within limitations and not 
 do as others. The sister is still on the farm. The elder brother 
 
DYSPEPSIA. 203 
 
 whom I never met is also a marked dust victim, living in southern 
 California where he does very well but has ill health as soon as 
 he comes back to this climate. The other brother, the patient re- 
 ferred to, has since also gone to California to stay. 
 
 Note : One of my patients on reading this manuscript thought 
 it necessary to explain why she failed to do this very thing in the 
 case of some of her relatives. She mentioned a specific instance. 
 Her brother has a five year old son, an only child, whom she be- 
 lieves to be a marked dust victim because he feels bad, at times 
 is actually ill, after being taken away from home, a home with 
 good air, as on being taken to a five cent theater or on a railway 
 trip. The doctor is frequently called in; he gives medicine but 
 no explanations. My patient, the aunt, pities the little fellow and 
 has repeatedly tried to explain to the parents the cause and nature 
 of the ill health and acute attacks, but they can not be made to 
 understand. When she tries to explain that it is useless to call 
 in the doctor every time, that the proper thing is to prevent at- 
 tacks, the parents, especially the sister-in-law, think she is hard- 
 hearted and is not interested in the boy. For this reason she is 
 inclined to say less and less and they in turn think she is not 
 sure of her ground. She believes if the matter were presented in 
 detail to her brother, as in this book, he would readily adopt good 
 air advice. She feels herself utterly incapable of explaining dust 
 infection although she is fully convinced of its truth. She fears 
 for the boy when he starts to school. She is a strong believer in 
 citing plenty of case reports. 
 
 One does not like to make addenda after completing a manu- 
 script, but collecting data is a continuous process. At times some 
 little note like the above is pertinent. 
 
 Weeding out and Schools. In old countries where every- 
 thing is crystallized so to speak and life conditions are fixed, peo- 
 ple are born under certain surroundings and "inherit" their 
 trades and occupations. It is difficult for them to become any- 
 
204 DUSTY AIR AND ILL HEALTH. 
 
 thing different from their ancestors. In our country, a new 
 country, life conditions are entirely different ; there is constant 
 change. People are not fixed to their homes, there is moving 
 about and perhaps a frequent change of occupation. Parents 
 often have something better in mind for their children than their 
 own trades and station in life. The son of a poor man may be- 
 come a teacher, a preacher, a lawyer or a doctor, a newspaper 
 editor, perhaps a statesman. People generally realize that a good 
 education is necessary (except perhaps for the role of a ward 
 politician, he is mainly self-taught). They will make sacrifices to 
 send the children to school. 
 
 Unfortunately many schools are so unsanitary that children 
 lose their health and are unable to get a good education. Now 
 the child that can not pass through the common schools is not apt 
 to get a college education or go to a professional school. The boy 
 whose parents intended him to be a doctor may fail to get the 
 necessary education. The following "case reports" are cited to 
 bring out the "weeding-out factor" as it applies to the physician 
 himself, both to the physician in embryo and to the man in active 
 practice. The cases do not necessarily all come under the head of 
 membranous catarrh of the intestines. 
 
 Two of my earliest patients, both dust victims, living near 
 each other in a section of the city where air conditions are fairly 
 good, each had a boy. Although the children's health was not the 
 best, yet they seemed to thrive. Then came the time to go to 
 school. One of the children went to an old school building with 
 defective ventilation; a catarrhal process was set up that soon 
 reached the intestinal tract and the child perished. The other boy 
 went to a new school at the edge of town; although there were at- 
 tacks of ill health now and then he managed to continue. Ill 
 health attacks were readily traceable to exposure. When the par- 
 ents finally were convinced that ill health was due to exposure to 
 bad air acute attacks were reduced to a minimum. The boy bids 
 fair to complete the grade schools; he is bright and his mother 
 wants him to become a doctor and not a mechanic like his father. 
 
dyspepsia. 205 
 
 Now our high school is in the heart of the city ; air conditions in 
 and about are bad and that is where many who complete the grade 
 schools fail — and that is where the boy will likely fail, judging 
 by what happens when he comes to town now and then. The par- 
 ents of course will likely take him out of school when they see 
 that he can not keep up. The boy who does not have a good gen- 
 eral education can no longer enter medical college. Under the old 
 system of attending lectures anybody with a good memory could 
 pass. The man who passed the "best examination," repeating 
 the lecturers' words, perhaps winning a prize, is frequently not 
 heard of in after life. 
 
 A middle-aged woman came to me with a long history of ill 
 health, not only in herself but also in her husband and her only 
 child, a boy who had reached the high school. She had hoped to 
 make a doctor out of her boy. The parents were very saving and 
 neglected their own ills in order to educate their son. He man- 
 aged to complete the grades, but had difficulty on entering the 
 high school. He had to stay at home frequently on account of ill 
 health. The mother had difficulty to understand that people are 
 not born alike and that children may not become what the parents 
 intend. Since I could not "cure" her (she had membranous ca- 
 tarrh of the intestines) she soon ceased to report. 
 
 She had an idea that her boy was overworked at school, not 
 knowing that it was the defences of the body that were "over- 
 worked" in warding off infection. Sometime later I learned that 
 the son was driving a delivery wagon. Outsiders are apt to con- 
 sider the station of the parents and the occupation of the father 
 and say, "It is not in the boy. ' ' Some may even say the boy did 
 not inherit a type of brain that stands schooling which would en- 
 able him to become a physician. As a matter of fact however the 
 boy is bright and I have no doubt if he could be educated privately 
 and be sent to a medical college where attention is given to air 
 conditions he likely would succeed in getting a doctor's degree. 
 It may be added that some of our medical schools today are giving 
 
206 DUSTY AIR AND ILL HEALTH. 
 
 attention to ventilation, some are even teaching the importance of 
 sanitation. The people may expect much from such colleges. It 
 is not. so much a matter of "high standard in medical education" 
 as it is a matter of allowing students susceptible to bad air con- 
 ditions to get a "good medical education." 
 
 Another mother who had much ill health (membranous catarrh 
 of the intestines) told me of her only son who also complained and 
 who had difficulty in attending high school. He wanted a good 
 education and if it had not been for his determination he likely 
 would have dropped out long ago. Now I do not remember whether 
 the boy wanted to become a doctor or a preacher, the same argu- 
 ment applies in each case. The preacher like the doctor must 
 have a good preliminary education before he goes to the profes- 
 sional school. This boy finally managed to get through the high 
 school, although he had one severe sickness that nearly carried 
 him off. Since attending a small literary college in a clean town 
 he has had excellent health. The tug of war will come when he 
 goes to a professional school, perhaps located in the heart of a 
 dirty city with air conditions about as bad as they can be. I do 
 not know about air conditions in theological schools. Perhaps the 
 student who is not weeded out subsequently complains of Clergy- 
 man's Sore Throat. 
 
 One day a young farmer brought his wife to me. 1 quickly 
 discovered that she was a dust victim of the membranous catarrh 
 of the intestine type. I gave the couple a simple explanation of 
 the probable cause of ill health, proposing a systematic investiga- 
 tion to verify the idea of dust infection and rule out the presence 
 of definite disease. Like everybody else, the physician has differ- 
 ent explanations, an a-b-c explanation for simple people, one for 
 educated people, and a technical one for physicians. I gave them 
 an hour of my time. They said they would consider the matter 
 and let me know their decision. When going out the man said, 
 "I studied medicine myself with Dr. X [in an adjoining county] 
 and went to Chicago for a year, but my health broke down and 
 I had to go back to farming." I reproached the man for not tell- 
 
DYSPEPSIA. 207 
 
 ing me this in the beginning, so my explanation could have been 
 given in different terms. He excused himself by saying that the 
 explanation was really for his wife. 
 
 His own history showed that he was a dust victim. This led 
 to a discussion of the weeding out of the embryo doctor. I told 
 him that he was just the kind of man who should have a medical 
 education. On account of his susceptibility to bad air conditions 
 he likely would better understand others in ill health who react 
 to bad air than the robust physician who readily passes through 
 an unsanitary medical college but who unfortunately does not un- 
 derstand common ills and who is apt to speak of people being 
 imaginary ill. 1 The old philosopher Plato believed the physician 
 himself should not be too well or he could not properly under- 
 stand his patients. 
 
 One of my boyhood friends went to one of the best Eastern 
 medical colleges and became a physician, locating in a large city. 
 One day I received a letter from him, asking me about the com- 
 parative advantages of practice in large and small cities. Some 
 time later I again heard from him ; he was located in a small town 
 in one of the new northwestern states. He gave no details. A year 
 or so later I saw an account that he had committed suicide. I won- 
 dered why. "When I last saw him, before he entered medical col- 
 lege, he was in robust health. Some time later I got some details : 
 He had much ill health in the large city where he located, finally 
 he had to leave; he went to a small county seat, greatly disap- 
 pointed. He once more tried city life and finally committed sui- 
 cide. I am inclined to believe he was a dust victim, but I do not 
 know. "We largely judge cases by similar ones. 
 
 I have had patients, more especially young men, who when 
 advised to live a "simple life," i.e., avoid crowded city life, say 
 
 1 An observant physician who has traveled widely on looking over this manuscript asked, "Why 
 is it that some medical colleges turn out so many poor doctors while others turn out so many good 
 ones?" at the same time naming a number of colleges. We readily came to the conclusion that dirty 
 colleges weed out the sensitive students and that those remaining do not get proper training under 
 dirty surroundings. 
 
 The first lesson the university laboratory worker receives is that of order and cleanliness, his 
 success depend on these. 
 
 How can cleanliness be taught in a high school or a medical college where everything is grimy? 
 
208 DUSTY AIR AND ILL HEALTH. 
 
 Ihey would as soou be dead as live in the country or small town. 
 In at least one case I told a young woman that to remain in the 
 heart of the city was equivalent to committing suicide. Not hav- 
 ing any data regarding her movements, I am unable to say whether 
 my prediction was verified. The couple was childless and there 
 at least was "race suicide." 
 
 At the end of this series I shall briefly refer to the history of 
 a physician. He was a country boy but managed to get sufficient 
 education to go to medical college and get his degree. The col- 
 lege was in one of the smaller cities where classes are not large 
 and that means among other things that air conditions are not as 
 bad as in some of the large crowded cities. After several years 
 of country practice, he decided to specialize. He took a post- 
 graduate course and then located in a county-seat, a regular spit- 
 ter's town. Naturally his office was in the very heart of the city. 
 His home was also in the heart of the city. That meant he was 
 inhaling infected air twenty-four hours each day. Soon he began 
 to complain. Like other physicians, he asked advice of his col- 
 leagues and got all sorts of opinions, finally he came to me. After 
 getting his history, I came to the conclusion he was reacting to 
 his environment, that he was a dust victim, and that he was not 
 fitted to practice medicine in the heart of an unsanitary city. That 
 was all new to him. "I was never taught anything like that in 
 medical college." I advised him to observe himself and if my 
 diagnosis was verified either to go to the suburbs or back to the 
 country. He continued some time longer and then one day he 
 packed up and went to a little country town. He soon again had 
 good health. The assumption that he was a dust victim was cor- 
 rect. 
 
 There is a current belief that the best physicians are drawn 
 to large cities. Cases like the above show that there is another 
 side to the story. Many good men are living in the country be- 
 cause they can not bear city life. Or again it is the doctor's wife 
 or a child that compels him to stay away from large cities. The 
 
DYSPEPSIA. 209 
 
 physician may or may not know what is the real factor, but he 
 may know that country life agrees while city life does not. Beim/ 
 a city doctor may mean that a man can stand life under city con- 
 ditions, that he can inhale a lot of bad air with impunity — and 
 this may be the very reason why many city doctors fail to under- 
 stand the people who do react. Because of this there is quackery 
 of all kinds and city people have less faith in the doctor than 
 country people. Physicians themselves who do not understand 
 that they are dust victims may have lost confidence in "medical 
 science" as in the case mentioned under dyspepsia. Will such a 
 man go to the large city where he has an opportunity of seeing 
 and treating many cases, or will he be content to remain in a 
 small community on account of his own ill health ? 
 
 This is a railroad town and analogous cases are common among 
 railroaders. Out of the many who enter the service comparatively 
 few are fully adapted to live in smoking cars. 
 
 Some of the most annoying cases to treat are railroad people. 
 When the wife is susceptible to dust infection and the husband is 
 immune, he constantly makes fun of the doctor who says dust is 
 injurious. He simply can not understand the ill health of his wife 
 and when a man has been paying thousands of dollars "uselessly" 
 he may object to his wife taking treatment from a "crank doctor." 
 
 At the other extreme is the man who finds himself unadapted 
 when he is advanced. He may have a wife who is immune and she 
 is the one who is unable to understand why her husband can not 
 be a passenger conductor. From the society standpoint, a man's 
 business may be important to the wife and children and they may 
 insist that he attempt to get "used to it," but only too often the 
 man fails completely. 
 
 Who Makes the Best Family Physician? Dr. — is an old 
 family practitioner in a distant city. He has the reputation of 
 being a reliable man; he has had much experience among sick 
 people, reaching back to the days when prevalent ill health was 
 largely due to malaria. He has one son, a boy who is still in the 
 high school. This son means to be a doctor; he intends to go to 
 
 114] 
 
210 DUSTY AIR AND ILL HEALTH. 
 
 X Medical School, by many supposed to head the list of our med- 
 ical schools. People say he will make a good doctor, "it is in the 
 family." Let us examine into the matter. 
 
 What do we mean by a good doctor? Hippocrates twenty-five 
 hundred years ago characterized him fairly well; among other 
 things he says of the art of medicine : 
 
 "Whoever treats of this art should treat of the things which are 
 familiar to the common people. For of nothing else will such an one have 
 to inquire or treat, hut of the diseases and the causes of their origin and 
 departure, their increase and decline, illiterate persons can not easily 
 find out themselves, hut still it is easy for them to understand these things 
 when discovered and expounded by others. For it is nothing more than 
 that every one is put in mind of what has occurred to himself." .... 
 
 The young man is ambitious, proud of the fact that his father 
 is a doctor and he hopes to get the best medical education to be 
 had. Why should he not make a good doctor? Here are some 
 arguments that go against the popular conception. 
 
 Old Dr. — had six children, only this one, the youngest, reached 
 high school age; the others died early from the "diseases of civil- 
 ization." This one son has "robust health." He will likely be 
 able to complete the high school course and, being the survival of 
 the fittest, he will likely be able to complete a medical college 
 course. The weak in his family have been killed off. 
 
 Now the medical college where he intends to go is one that 
 gives special attention to diseases — common ill health is apparently 
 not worth studying. If he goes to that college he will be well 
 grounded in many diseases. Then what will he become, a special- 
 ist or a teacher or a good doctor, one that treats the ills of the 
 common people? The chances are he will not be satisfied in a 
 small town but will go to a large city, and, with the prestige of 
 his college, concern himself only with the well-to-do. Having "ro- 
 bust health" will he be able to understand common ill health that 
 can not be dignified by the name of disease? If he does go to a 
 small community he will lead a monotonous life, there will be 
 little to stimulate him — but in spite of all that he may turn out 
 to be a good doctor. Time will tell. 
 
DTSPEP8TA. 211 
 
 Now and then the physican meets young women who want to 
 become trained nurses, they go to a training school and get a good 
 training, and then perhaps go back to their home town. Perhaps 
 the first case will be in a family that lacks all the modern house- 
 hold conveniences — the poor do not, can not, employ a trained 
 nurse at all. Is it any wonder that some quickly become discour- 
 aged and are ready to try something else? 
 
 A short time ago I read of a school that trains servant girls. 
 They receive all sorts of instruction, including the use of the 
 vacuum cleaner and the automatic regulation of the furnace and 
 cooking by electricity. Is it any wonder that such a graduate is 
 greatly discouraged on getting into active work where things are 
 radically different from what she expected? 
 
 What the servant girl needs, and what the trained nurse needs, 
 and what the doctor needs is not a knowledge of the refinements 
 but a good knowledge regarding the common everyday things 
 found in every day homes, they should not be above the "little 
 things" of daily life. 
 
 Is it not true that those who get the ' ' best education ' ' and the 
 "best training" are often dissatisfied with the common humdrum 
 tasks of daily life, always dissatisfied? 
 
VI. 
 
 NERVOUS PROSTRATION. 
 
 Nervous Prostration is the third of our Triad of National Dis- 
 eases. But it is not an entity, it is not a definite disease that has 
 characteristic earmarks by which it may be identified, no more 
 than dyspepsia. All sorts of cases are grouped under the term. 
 At the one extreme are what must undoubtedly be regarded as 
 cases of nervous prostration, at the other extreme cases that are 
 anything but that. Neurasthenia is a synonym ; it is a good mouth- 
 tilling word. Another synonym is overwork, this is especially used 
 in the case of school children and of men who use their brains 
 rather than their hands. We also hear of nervous exhaustion, 
 nervous debility and psychasthenia. The term hysteria is also 
 usually a synonym, but is rarely used because people object to it; 
 the doctor who makes such a diagnosis is apt to lose his patient. 
 
 The Blues is also used. People with catarrh and dyspepsia 
 often have the Blues, thinking their condition hopeless and often 
 imagining the presence of diseases that will soon carry them off. 
 The catarrh victim is apt to imagine he has or is going to have 
 consumption, while the dyspepsia victim thinks more or less of 
 cancer of the stomach. In chronic dyspepsia there are a large 
 number of symptoms, many of them nervous if not mental, and 
 one may speak of many dyspeptics as being also cases of neuras- 
 thenia. Cases shade off and symptoms are curiously linked to- 
 gether and quite naturally people receive all sorts of diagnoses 
 at the hands of physicians. 
 
 Diseases are classifiable according to their causes or according 
 to their symptom-complexes or syndromes. Tuberculosis, typhoid 
 fever and malaria are diseases that can be classified according to 
 the active cause and the cause can be readily found by any qual- 
 ified physician. In such cases there can be no doubt of the diag- 
 nosis. There will be no disagreement of opinion as to what is the 
 
 (212) 
 
NERVOUS PROSTRATION. 213 
 
 matter. On the other hand diseases based on symptomatology or 
 group of symptoms always leave room for doubt. The cases cited 
 in this volume are of the kind where diagnoses are based on symp- 
 toms and where the opinions of physicians have often greatly 
 differed. The one common factor is that the symptoms are trace- 
 able to bad air. 
 
 People often regard symptoms as disease. Many look upon 
 cough as a disease curable by medicine. Asthma and dropsy not 
 many years ago were looked upon as diseases; by the people they 
 are still so regarded. Some diseases have a very definite cause, 
 as tuberculosis, typhoid fever, malaria. In other diseases it may 
 be difficult to find any cause at all, but in the course of time it 
 may be found that diseases that seem to have no definite cause do 
 have one. Men are constantly at work trying to find causes. Just 
 now there is an active search for the cause of poliomyelitis. 
 
 Catarrh as already mentioned may be due to many and varied 
 causes. The respiratory mucous membranes of some individuals 
 are very readily irritated. Dyspepsia also has many causes, or in 
 other words, all sorts of causes bring on disturbances of the ali- 
 mentary tract to which the name of dyspepsia is given. Nervous 
 prostration also has a multitude of causes. Men have singled out 
 certain causes and written books showing how people react, but, 
 strangely enough, one very common cause of American Nervous- 
 ness or Neurasthenia is usually overlooked. 
 
 Among Benjamin Franklin's writings are many notes regard- 
 ing colds. He evidently intended to write a treatise on the sub- 
 ject but did not live long enough to do it. The amount of data 
 he brought together is really remarkable. He evidently had a 
 better insight into colds than the physicians of his time. It is the 
 man who is himself subject to colds who gives special attention. 
 Benjamin Franklin might be considered our first pure air advo- 
 cate. 
 
 The term neurasthenia was first used, or at least brought into 
 general use, by an American physician, George M. Beard, who 
 died prematurely. Reading between the lines, one sees how he 
 
214 DUSTY AIR AND ILL HEALTH. 
 
 wrote all around the eause, or the reason, why this affection is so 
 common in the United States. Had he lived longer he likely would 
 have traced the relationship of cause and effect. 1 
 
 The subject of neurasthenia or nervous prostration is a vast 
 one; I can not go into details here. I shall content myself with 
 citing briefly a few case reports which may bring out some points. 
 Neurasthenia or nervous prostration is so common that everybody 
 has an idea what it is, just as everybody knows about colds and 
 catarrh and dyspepsia. There is no need to give any description 
 nor to detail symptoms that go with it. 
 
 In taking up this group I must again confess my ignorance as 
 in the case of dyspepsia. I did not understand early cases, par- 
 ticularly those that were not subject to colds and catarrh, but 
 when I found that good air advice benefited nervous symptoms 
 as well as coughs and colds, I began to suspect that dust influences 
 might have something to do with symptoms of nervous prostra- 
 tion so-called. 
 
 Neurastheniacs (or neurasthenics) are people par excellence 
 who are embittered against doctors. As a rule they have tried 
 everybody and everything, being still uncured they often are very 
 bitter. Because of their antagonism many physicians give them 
 scant attention ; some want nothing to do with them at all ; others 
 charge prohibitive fees; still others give bitter nasty medicine that 
 drives them away. In the case of the rich the physician may 
 swallow his pride and humor the patient. 
 
 Among my earliest applicants for professional services on com- 
 ing here was a woman approaching middle age, clerk in a down 
 town store. She had a sharp tongue and did not have a good 
 word for any of the local physicians. I knew that if I did not 
 cure her I would also come in for a tongue-lashing. Although 
 people regarded me as a "specialist in nervous diseases" (from 
 the fact that I had been connected with Insane hospitals for sev- 
 
 1 This is a subject that I discussed before the Section on Nervous and Mental Diseases of the 
 American Medical Association, 1905. 
 
NERVOUS PROSTRATION. 215 
 
 eral years), I had so little confidence that I could benefit her, not 
 to speak of curing, that I did not accept her as a patient at all. 
 One may at times give some good advice or attention and a pre- 
 scription and then tell the applicant not to return; in that way 
 the individual may leave without "hard feelings." One may es- 
 cape a tongue-lashing although one runs the risk of being re- 
 garded as "no better than the rest," for a prescription for medi- 
 cine likely would not benefit much. How can medicine cure a 
 reaction due to an unsanitary environment? 
 
 I recall another somewhat similar case coming a year or so 
 later where I named a prohibitive fee to get rid of the woman. 
 She said she would consider the matter but never returned. Sub- 
 sequently she referred several well-to-do people through whom I 
 learned that she considered me "a good doctor but too expensive 
 for poor people." Need it be added that the poor woman who 
 must clerk in a store, constantly exposed to infection, can not live 
 up to pure air advice, while a well-to-do housewife living in a clean 
 suburban home may readily follow such advice and be benefited? 
 The physician meets all sorts of people; from agreeable to dis- 
 agreeable, from those fully able and willing to follow advice to 
 those of the opposite kind; which will he choose? 
 
 But there is another side to this story. Many of the old 
 chronics are neglected. They are not studied and because of this 
 there can be no good advice. Many of these old chronics are dust 
 victims, something I did not at first know. Moreover I had little 
 patience with a certain class of people, those that are commonly 
 called imaginary ill or hysteric or "nothing the matter." 
 
 Why do people come to the doctor at all? Is not something 
 the matter ? If a physician can not find a lesion, something wrong, 
 is he justified in speaking of imaginary ills? If the patient says 
 he has a headache or has a pain in the chest, the physician must 
 take his word for it; he may be wholly unable to ascertain the 
 truth. Similarly with people who have all sorts of symptoms 
 which are beyond the ken of the physician. The complaints of 
 some neurastheniacs are legion and yet there may be nothing defi- 
 
216 DUSTY AIR AND ILL HEALTH. 
 
 nite od which one can put his finger and, like the surgeon, say, 
 Here is the difficulty. When a physician does take an interest in 
 some of these neglected people and gets their confidence and gets 
 them interested in observing themselves and their surroundings, 
 such patients become a mine of information. They may lose their 
 irritability and become the doctor's best friends. Many lie awake 
 at night worrying about their symptoms ; they imagine all sorts of 
 things. When they once properly understand they cease to worry, 
 and that of itself has a good influence on sleeplessness. 
 
 Many people lie awake a large part of the night. Why? The 
 conditions under which a neurastheniac is sleepless is itself an in- 
 teresting problem. Not to go into details here it may be said that 
 as a rule neurastheniacs are able to sleep under good air conditions. 
 
 Among my early male patients was a farmer approaching mid- 
 dle age. I regarded him as a neurastheniac — the term then served 
 as a sort of catch-all, all obscure nervous or mental cases were re- 
 ferred to it. His own relatives regarded him as "imaginary ill" 
 and as being a worthless, good-for-nothing fellow. That the man 
 was a dust victim wholly unadapted to town life (which he had 
 tried repeatedly but always went back to the farm) I did not real- 
 ize until long after he left me. 
 
 A physician is often at a loss to know how far to go in report- 
 ing cases. People leading uneventful lives may not furnish "case 
 reports" or biographies worth giving. On the other hand people 
 with eventful lives are usually those standing out in a community, 
 and if one characterizes them too closely they are readily identi- 
 fied. Then too one hesitates to write about people who in the 
 course of years have become good friends. Often before there was 
 a mutually satisfactory relationship of physician and patient there 
 may have been a number of disagreeable incidents. Neurasthe- 
 niacs often have sharp tongues. Such remarks of course also apply 
 to ' ' disagreeable dyspeptics. ' ' 
 
 (It may be worth mentioning that this manuscript has been 
 passed around among several professional friends and that some 
 quickly recognized some of the cases mentioned, indeed some had 
 
NERVOUS PROSTRATION. 217 
 
 been called in consultation, but I feel confident that none of these 
 physicians will reveal names. Furthermore none asked regarding 
 the names of individuals who were wholly strange to them, that 
 is, where they did not suspect having met the individuals. In a 
 general way it may be said physicians are interested in "cases," 
 not in individuals. They care nothing for names. In case reports 
 in medical journals names are never given.) 
 
 Clerks in stores are scarcely considered brain workers and yet 
 when they give out, when health fails, some physicians speak of 
 nervous prostration. According to my observations, it would be 
 more proper to speak of overwork, and "overwork" here can be 
 used in a dual sense : First, on account of long hours, when clerks 
 begin early and work until late at night. All recognize that long 
 hours may produce ill health, but in this community stores are 
 closed at six in the evening, one can scarcely speak of overwork 
 on this account. Second, one can speak of overwork of the de- 
 fences of the body in trying to get rid of infection. This is par- 
 ticularly true of crowded stores where little or no attention is paid 
 to ventilation. 
 
 The clerk who is subject to colds and catarrh is not apt to re- 
 tain his position long. If there is much loss of time on account of 
 dyspepsia he may likewise not remain long. The clerk who is able 
 to withstand unsanitary conditions may in time be promoted to 
 a responsible position, and then there may be more or less ' ' worry 
 and tire of the brain," and then a physician can more or less 
 truthfully speak of nervous exhaustion or nervous prostration, or 
 neurasthenia. And yet in many cases there is a better explana- 
 tion, dust infection. I shall briefly mention the history of a young 
 woman clerk who wasi with me for over five years, long enough to 
 make a fairly full study of her case. Her history must be con- 
 sidered as "The short and simple annals of the poor." 
 
 This young woman had much ill health while in school. She 
 had to begin work early. On account of her health her widowed 
 mother thought it would be best to have an indoor occupation, so 
 she would not be exposed to the cold and rain and snow. She 
 
218 DUSTY AIR AND ILL HEALTH. 
 
 found a position in a large store, one that I know not only has 
 poor ventilation hut is not kept clean, and that meant to inhale 
 dusty air all day long. In school she had frequent, colds and now 
 she had not only colds hut also catarrh, but not sufficient to com- 
 pel her to give up work. She soon came to the conclusion that 
 everybody had catarrh, because all the people about her had it. 
 In time the alimentary tract became deranged; she complained of 
 dyspepsia. After several years she was promoted and that meant 
 greater responsibility and now symptoms of so-called nervous pros- 
 tration appeared, including worry and sleeplessness at night. 
 About this time she came to me, after having consulted a number 
 of physicians. She had had various diagnoses, depending on how 
 she was complaining at the time or what symptoms were empha- 
 sized. On investigating I promptly came to the conclusion she 
 was a dust victim and was reacting to an unsanitary environment, 
 that instead of having had "all sorts of diseases" or at times sev- 
 eral at once, she had a "protean disease," namely Coniosis or 
 Dust Infection. I pointed out that the only cure was a change 
 of occupation, to live under better air conditions. As she had to 
 assist in supporting younger children, she did not see how she 
 could change. 
 
 There were a number of factors contributing to her ill health. 
 Being more or less sleepless during the night, she would fall asleep 
 toward morning and lie in bed as long as possible, eat a hurried 
 breakfast and take a car down toAvn, carrying a lunch with her. 
 The only water at the store was muddy hydrant water which she 
 did not use. As a consequence of a lack of fluid, there was con- 
 stipation. In the evening she would be so tired that instead of 
 walking home and getting the outdoor air, she took a crowded car. 
 Moreover on account of her chronic ill health she was stunted, 
 sallow, and had an old look. And yet she expected to be cured by 
 medicine alone. 
 
 She was what physicians call an "easy mark;" she could be 
 loaded down with different kinds of medicine with a charge for 
 each. But she was unwilling to follow advice — except that of 
 
NERVOUS PROSTRATION. 219 
 
 swallowing medicine. What is to be expected under such circum- 
 stances? I finally got her to get up earlier in the morning and 
 eat more slowly and walk down town; likewise to walk home in 
 the evening. But on the return of shorter days she had to abandon 
 these walks because the streets were poorly lighted, at times no 
 lights at all. The use of more fluid also helped. 
 
 She had little! to say about the use of patent medicines, indi- 
 rectly denied their use, but several years later, when I also pre- 
 scribed for her mother, I found she had been using all kinds and 
 that at times she used some containing alcohol, occasionally to such 
 an extent that she was under its influence. There is an old saying 
 about people drowning their sorrows in alcohol. That is practi- 
 cally what some patent medicine users do. 
 
 As already mentioned, the store was poorly ventilated. In fact, 
 one might say there was no ventilation, and the constant stream 
 of shoppers brought in a large amount of sidewalk filth. Condi- 
 tions were about as bad as they could be. She suffered and com- 
 plained greatly, and yet on the return of the open door season 
 with free ventilation she would improve and then would stop 
 "doctoring." On the return of cold weather there would be a 
 return of symptoms and she would come back to me. Finally 
 after five years she came to realize that her ill health was due to 
 her environment, and yet she did not change positions or occupa- 
 tion. She did not even complain to her employer about the bad 
 air conditions, knowing that if she did she likely would be dis- 
 charged. This naturally led to a discussion of the value of Unions 
 and of a combined effort and of the need for a community as a 
 whole to clean up, that the individual is powerless. The only sal- 
 vation of the individual under such conditions is to get away. 
 Often the matter of ill health and chronic ill health is a problem 
 for the community rather than for the individual; the physician 
 would have to prescribe for the sick community, especially where 
 our Triad of National Diseases prevails. 
 
 Cases of this kind are common and when the physician sees 
 the uselessness of attempting to cure he may in time become dis- 
 
220 DUSTY AIR AND ILL HEALTH. 
 
 gusted. If he gives any attention at all it will be only routine 
 attention, and individuals who get "only routine attention" in 
 time become bitter toward the medical profession. Naturally on 
 account of such prescribing some physicians in time degenerate 
 into mere symptom-prescribers and pill-peddlers. They give the 
 people what they want, not what they really need. 
 
 This patient remained with me for five years when she finally 
 drifted out of my hands. I had given her a good deal of time, 
 wholly out of proportion to her small fee, a fee that in her own 
 estimation took her out of the charity class, although to me still 
 a charity case. But I got data. That was my real reward. Per- 
 haps needless to say the longer an individual is kept under obser- 
 vation the more valuable notes become. But in the end there is, 
 i here must be, a termination of relationship. Why she ceased to 
 report I do not know. I am inclined to believe it was on account 
 of her mother's exposure of the fact that she used patent medi- 
 cine. 
 
 Although I had long felt like severing the relationship of phy- 
 sician and patient, because I was accomplishing so little and the 
 data I got were few and simple and mainly repetitions, yet I con- 
 tinued her in the hope that she would make a change and that I 
 could then see how her health would improve, in other words, that 
 instead of getting a lot of notes on "bad air influences" I would 
 get notes on ''good air influences." One year she said she was 
 considering the matter of marrying, but hesitated on account of 
 her health. I expressed my belief that if she got away from the 
 store and lived under good air conditions her health would greatly 
 improve. She did not marry however. 
 
 How will such an individual end? In general one can divide 
 dust victims into two groups, those with a low blood pressure and 
 with more or less deficiency of gastric secretions, and likely to 
 end in tuberculosis. At the other extreme are those with a tend- 
 ency to high blood pressure and over nutrition ; individuals of this 
 kind usually end with "heart or kidney disease." I shall refer 
 to this subject later. 
 
NERVOUS PROSTRATION. 221 
 
 The patient at one time said if I believed' that spitting, dirty 
 streets and the neglect of cleaning up generally had such an evil 
 influence on health it was my duty to call attention to these things 
 in the newspapers. Now I had been doing that very thing, until 
 quite recently. Shortly after I came here I wrote a brief paper 
 advocating an anti-spitting ordinance. This paper was published 
 in the Bulletin of the Indiana State Board of Health for August 
 1901. I got a lot of reprints in pamphlet form which I distributed, 
 at my own expense. Then I advocated it in the newspapers. Did 
 I get any thanks? No, only abuse. Subsequently I wrote many 
 papers, signed and unsigned, regarding the improvement of mu- 
 nicipal conditions, advocating pure air, pure water, clean streets, 
 sewers, abatement of the smoke nuisance, noises, etc., but after a 
 time one gets tired. Any one who objects, especially to unsanitary 
 conditions, is regarded as a kicker, and yet what many commun- 
 ities need is vigorous kickers. There is always some antagonism 
 created, especially among people who own considerable property 
 and who are opposed to municipal improvements on account of 
 expense. Many people are lot and land poor, they object to a 
 doctor who advocates improvements. The doctor who says noth- 
 ing and does nothing but strictly attend to his own business gets 
 along best in life. Some may even question why a physician should 
 write a book of this kind, which is largely a criticism of unsanitary 
 municipal conditions. 
 
 One of my manuscript critics when she realized how much ill 
 health this town has, how many physicians there are and how- 
 many drug stores with shelves loaded with patent medicines, and 
 with newspapers full of patent medicine advertisements, remarked 
 that the town must be full of ignorant doctors otherwise they would 
 cure the ills of the people. I might 1 offset this by the remark of 
 another who said the town must be full of ignorant people or they 
 would not tolerate such conditions. One can get all sorts of opin- 
 ions. One of my friends told me he had passed through the town 
 and stepped off the car to stretch his| legs at the railway station 
 near the heart of the city where the streets are paved and where 
 
222 DUSTY AIR AND ILL HEALTH. 
 
 tin' railroad company keeps things neat and clean. (One street 
 terminates at the station and has comparatively little traffic.) He 
 thought the town must he a "nice and clean one." Another friend 
 had also passed through but at another railroad station. He no- 
 ticed the dingy little station, with streets around it deep in mud. 
 His opinion was that it is a nasty and dirty town. A town may 
 have only one or two paved streets and if a visitor comes to town 
 he is sure to be taken over these streets. The only way to get a 
 proper idea of a community is to spend some time in it and go 
 all over it. 
 
 Since these notes were written, a "Doctor of Dead Towns" has 
 been here. He virtually prescribed for a sick community. He 
 was brought here by a local organization that wants to bring about 
 an improvement. He found much to criticise. His "tonic" pro- 
 duced some results. Although this town for years has had good 
 cement sidewalks, it was not until the late summer of 1910 that 
 any serious effort was made to get properly paved streets. The 
 people have at last awakened to their necessity. 
 
 European tourists who travel on through trains and stop only 
 in large cities get a very imperfect idea of our smaller cities and 
 towns. But they learn much of the condition of small villages as 
 they pass through them, how unkempt they are in comparison to 
 European villages. 
 
 I referred to the above patient as an "easy mark;" such peo- 
 ple do not take much time of a man who readily hands out a 
 bottle of medicine or a box of pills or tablets. They are ready to 
 give the man who promises to cure a trial. Some men claim to be 
 specialists for chronic cases, they may be perfectly willing to leave 
 the acute specific diseases, with a few exceptions, to the regular 
 profession, to the family physician. Such men catch the chronics 
 and are able to extract fees to an extent unknown to the conscien- 
 tious physician. 
 
 As I write I have before me a local paper containing a quarter 
 page advertisement of an advertising doctor. He tells of his won- 
 derful accomplishments in curing sick people. He is willing that 
 
NERVOUS PROSTRATION. 223 
 
 the local physicians should treat cases of nearly all specific dis- 
 eases, for he says: 
 
 "If you have the Measles, Typhoid Fever, Pneumonia, Smallpox, Scar- 
 let Fever or any other acute disease of that type, do not consult Dr. . 
 
 These are the diseases for your family doctor to treat; he gives that 
 class of diseases his full time and attention, and naturally is better pre- 
 pared to treat them. 
 
 But, on the other hand, if you suffer from some Deep Seated, Com- 
 plicated Chronic Disease of the Stomach, Bowels, Rectum, Kidneys, Blad- 
 der or other organs of the Genito Urinary Tract — THEN consult 
 Doctor . As the family physician spends all of his time in the treat- 
 ment of the Acute Diseases, so does Doctor spend all of his time 
 
 in the treatment of the Special and Chronic Diseases which come under 
 his specialty. That is why that any man or woman who will only stop 
 and give the matter a little honest thought will at once fully decide that 
 Doctor can give them MUCH BETTER and MORE EXPERT treat- 
 ment in the disease which he treats." 
 
 It is interesting to question people who have been to such men. 
 As just mentioned they know how to extract the money from the 
 pocket book, but as to curing chronic ill health dependent on un- 
 sanitary conditions, of the kind described in this volume, which 
 covers nine-tenths, or certainly three-fourths, of all cases, why 
 that is out of question. No reputable physician makes promises 
 to cure (simply promising to do his best) but some people want 
 promises and they go to the man who does promise. What such 
 people need is education, to know something about their bodies 
 and how they react under abnormal surroundings. Their ill health 
 is preventable by cleaning up generally, not by drugs nor by the 
 "wonderful new methods" of the " Fly-by-Night " who comes to 
 town, "Here to stay." A good physician does not need to adver- 
 tise in such a manner; his "cured" or benefited patients w T ill ad- 
 vertise him. The alliance of medicine men and newspapers is a 
 bad one. 
 
 The young woman under discussion was a user of patent med- 
 icines. Whether she used them while with me was difficult to de- 
 termine. As a rule I do not accept nor retain patients who are 
 not truthful, as far as such matters can be ascertained. I have 
 
224 DUSTY AIR AND ILL HEALTH. 
 
 had patients who told me that while taking "doctor's medicine" 
 they also took "patent medicine," unknown to the doctor, some 
 of whom never inquire ahout such matters. 
 
 Although there is much denunciation of the nostrum evil few 
 physicians explain to their patients the why and the wherefore. 
 When we critically examine into the matter we find that in a gen- 
 eral way patent medicines fall into three great groups, the in- 
 different, the anodyne or sedative, and the cathartic. Although 
 none can cure all may give relief. We all know that a cathartic 
 may help. A "harmless" patent medicine may even at times give 
 relief, as when an individual has been overdrugged, either by phy- 
 sicians or from the use of powerful patent medicines, by taking 
 one that gives nature a chance to assert herself, especially if taken 
 on the approach of the open door season. As a matter of fact 
 many of the patent medicines are "perfectly harmless." But a 
 medicine that is "harmless" is also powerless. A potent remedy 
 on the other hand improperly used is apt to harm. 
 
 Alcohol may be used to deaden sensibility to pain and to drown 
 sorrow; opium may be used for the same purpose and is more 
 effectual to "kill" pains and aches. These are old drugs that 
 enter largely into the composition of nostrums. More recently 
 coal tar preparations have come into use ; they also numb sensi- 
 bility and are cheaper. All are of the habit-forming kind, requir- 
 ing larger and larger doses, or the dose must be repeated more and 
 more frequently. The alcohol user is apt to end as a drunkard, 
 the user of opium becomes an opium or morphine fiend. "Dope 
 fiends" are becoming more and more common through the use of 
 cheap coal tar preparations. Many patent medicines readily in- 
 duce habits, people resort to them constantly and in increasing 
 doses ; in the end they only aggravate their ills. 
 
 Alcohol, opium, acetanilid and other drugs of a similar nature 
 can palliate symptoms, make the user feel better for a time, but 
 properly speaking they can not cure. The conscientious physician 
 is less and less inclined to promise a cure, only to do the best he 
 
NERVOUS PROSTRATION. 225 
 
 can. The patent medicine men on the other hand "guarantee" 1 
 their nostrums and promise cures without even seeing the indi- 
 vidual. 
 
 A nostrum that has no influence whatever if taken on the ap- 
 proach of spring may be credited with producing a "cure" be- 
 cause people, and especially dust victims, naturally get better on 
 the return of the open door season. Patent medicine adver- 
 tisements in newspapers flourish during the closed door season; 
 they practically disappear during the summer when infection 
 on streets and sidewalks is sterilized by the hot sun and when 
 there is free ventilation. The moment a community begins to 
 clean up patent medicine advertisements begin to diminish in 
 the newspapers. Newspapers that go into clean and sanitary 
 homesi contain few patent medicine advertisements. 
 
 How much explanation is needed to convince a man that clean- 
 ing up, change of occupation, or change of environment is the 
 proper remedy for his ills? How much time should a physician 
 devote to the individual who seems unteachable? 
 
 A middle-aged man came to me ; he had heard of some people 
 whom I had greatly benefited, "cured" he thought, but in reality 
 I only benefited them because they lived up to good air advice. 
 Women can do that better than men who must go down town to 
 work. He "felt sure" I could help him, but when I got his his- 
 tory I doubted it. 
 
 He came to live in town years ago, direct from the farm. Evi- 
 dently he was wholly unadapted to town life and coming in con- 
 tact with sickly people. At first he complained mainly of a de- 
 ranged alimentary tract and had all sorts of diagnoses, then nerv- 
 ous symptoms became more marked and the term "nervous dys- 
 pepsia" was perhaps the best one that could be applied. More 
 recently he was told he was neurasthenic, with of course all sorts 
 
 1 The Pure Food and Drug Act, has actually been of great advantage to many patent medicine 
 makers, in that they are able to add to the label, "Guaranteed under the Pure Food and Drug Act." 
 People ordinarily do not understand that that merely means the absence of certain ingredients, 
 especially the ones just mentioned, or stating their amount. 
 
 [15] 
 
226 DUSTY AIR AND ILL HEALTH. 
 
 of synonyms, including "nothing the matter," a diagnosis which 
 he hotly denied. 
 
 For years he had been taking patent medicine. "Why not? He 
 had obtained little help from the doctors and so came to the con- 
 clusion that it was all experiment and guesswork and he might 
 do that himself and at less expense. He took "all the patent med- 
 icines you ever heard of." 
 
 I gave him a lot of time, both in ruling out definite disease and 
 in advising him how to reduce symptoms to a minimum. He was a 
 dust victim, wholly out of harmony with his surroundings, but I 
 could not induce him to make a change. When I saw that he 
 expected at least some medicine I gave him a little, such as was 
 really indicated at times, as laxatives and headache tablets. In 
 time I found he placed less faith in my advice than in the medi- 
 cine and wanted medicine to take regularly, and then I began to 
 lose interest. Just then however he became distributor of samples 
 of all kinds, including patent medicines, and that gave an oppor- 
 tunity to try all sorts of nostrums, "free, gratis, for nothing." 
 I now encouraged him to continue to report ; I got all sorts of data 
 regarding patent medicines. I no longer disputed with him but 
 allowed him to believe we both were experimenting to find the 
 "right medicine." "When I finally got tired he had not yet found 
 the right one. 
 
 To make the story complete it should be added that the man 
 was so poor that he could not buy the kind of food needed, could 
 not take necessary rest nor buy sufficient fuel that would keep 
 the house warm without stopping up all cracks and crevices. 
 
 While revising these notes a patent medicine circular was left 
 at the door, entitled ' ' Short Stories, ' ' stories alternating with tes- 
 timonials. On page 9 occurs on item as follows: 
 
 FUNNY ADVICE BY FUNNY DOCTORS. 
 
 It is absurd to direct "good nourishing diet, rest, fresh air," etc., to a 
 poor man or woman who has hardly enough to keep body and soul together. 
 But this is thoughtlessly done every day. M. Brieux, the well-known 
 author of Les Avaries, the play in which the ravages of syphilis are 
 
NERVOUS PROSTRATION. 227 
 
 openly presented, discusses this subject in Le Matin. The following regime 
 was prescribed for a patient who applied for treatment : 
 
 1. Avoid fatigue, damp and cold. 2. Clothe very warmly ; wear 
 flannel next to skin. 3. Eat well ; underdone meat, 7 to 15 ounces a day, 
 to be taken scraped and pounded in cold buillon, or as balls in powdered 
 sugar. Raw or soft boiled eggs — four to six, if possible eight to ten a day. 
 Sardines in oil, two daily, butter, watercress, cooked and raw. A large 
 cup of cocoa with milk in the morning. Beer with the meals. 
 
 And to whom was this regime given? To a beggar peddler, covered 
 with filthy rags, who earned a few sous a day. — Selected. 
 
 If one were to comment on that one could say, Some doctors 
 are more than funny, they are foolish. They give advice utterly 
 impossible for poor people to follow. On the other hand, is it 
 good for poor people who can not afford the necessaries of life to 
 resort to patent medicine ? To what extent will that benefit them ? 
 The remedy is for the charity organization to seek out the poor 
 and give them adequate assistance. The man who is in danger of 
 starvation is not a case for a little medicine, nor does giving a 
 little food suffice; he requires a sufficiency. It would really be 
 better for some people to die outright than to die a lingering 
 death of weeks and months from starvation, attended by all sorts 
 of misery. The same is true in regard to the use of nostrums. 
 If people knew the hopelessness of taking nostrums and medicine 
 they might make some determined effort to get better. As it is 
 the patent medicine man allows them to live on in hope — and 
 finally die in despair. 
 
 When I first began the practice of medicine I did not inquire 
 what patients had been taking or who had been the previous phy- 
 sician ; I wanted to make my own diagnoses and prescribe accord- 
 ing to my own ideas. In the course of time I found that most 
 applicants had ill health, it is really the exceptional individual 
 who has a well-defined specific disease, and then I discovered that 
 it pays to find out what people have been taking and who has 
 been prescribing for them, for manifestly if an individual had had 
 symptoms indicative of malaria and had been dosed with quinine 
 it would be useless to give more quinine; or if a patient had been 
 
228 l>r$TY AIR AND Itt KEAtTtt. 
 
 told there was sluggishness of the liver and had been severely 
 purged a different mode of treatment might produce better re- 
 sults. Then too it pays to ask who the previous physicians were. 
 One can judge people by their physician, as one can judge them 
 by their clothes. The patient who has been drifting about among 
 cheap symptora-prescribers really never gets the best that Medi- 
 cine has to offer and the diagnoses of such men may not be worth 
 considering or repeating. 
 
 It also pays to ask whether an applicant, or new patient, has 
 been using patent medicine. It gives one an idea of his mental 
 status. The man or women who has had a high school course in 
 anatomy and physiology, in hygiene and sanitation, is not apt to 
 be a purchaser of patent medicine and does not constantly require 
 a-b-c explanations — why certain kinds of ill health are prevalent, 
 why ill health must be considered a reaction largely due to an 
 unsanitary environment and incurable by drugs or by outlandish 
 modes of treatment. 
 
 Poor and ignorant people and patent medicine go together. 
 That means especially poor people living under unsanitary sur- 
 roundings ; those living in isolation are usually healthy and have 
 little need for medicine. Intelligent people likely have a good 
 family physician who by timely advice prevents ill health and 
 disease. The man who has his nose on the grindstone and must 
 work as long as possible is to be pitied. He may be willing enough 
 to follow advice but is wholly unable to do so ; he wants a doctor 
 who is going to cure him by the use of medicine. He is not apt to 
 have as his physician a man who gives detailed advice. There are 
 people moreover who place patent medicines and the doctor's med- 
 icine on the same plane. They seem to think it is merely a ques- 
 tion of getting the "right medicine" and that if they keep on try- 
 ing they will find it. But at times even intelligent people, or what 
 must be regarded as such, use patent medicines, due mainly to the 
 way nostrums are brought before the public, how they are adver- 
 tised, or recommended by those who believe they have been ben- 
 efited. 
 
NERVOUS PROSTRATION. 229 
 
 Some people avoid patent medicines that are boldly advertised 
 as such but they may be "taken in" by the "reading notice." 
 Newspapers differ greatly in how they sell their advertising space. 
 Some are very careful regarding the character of the advertise- 
 ments they admit. Properly considered, "newspaper medicine" 
 as commonly understood is an anomaly. Why should the news- 
 papers, many of them, be in league with nostrum makers and 
 quacks of all kinds to defraud the public in offering impossible 
 cures, offering to cure what no reputable physician can cure or 
 under conditions that make a cure impossible? Many physicians 
 require their patients to go to bed; the nostrum maker may offer 
 or even "guarantee" to cure while a man is at work, a potent rea- 
 son to the poor man who must work as long as possible. Many 
 affections, or conditions of ill health, are wholly incurable in the 
 presence of the cause, the reaction will only cease when the cause 
 is absent. The Hay-fever victim has learned that neither patent 
 medicines nor doctors can cure. If he wants relief he must 
 "change climate." A man going to a new home may find it so 
 malarial that he has difficulty to live ; if he is wise he will get out. 
 Our own State in former years had a reputation that attracted 
 very few immigrants ; they passed on further west. A man moving 
 to a new city may or may not know that he is running the risk of 
 contracting typhoid fever on account of bad water supplies; he 
 may decide to leave or at least take the precaution to sterilize the 
 water. People who are prudent are apt to avoid such cities en- 
 tirely. If people realized to what extent ill health is dependent 
 on bad air conditions they would shun many dirty cities. 
 
 The number of patent medicine advertisements in a city's news- 
 papers gives some general idea regarding the presence or absence 
 of sanitation. People in health ordinarily pay no attention to 
 such advertisements, just as others fail to see the market reports 
 or read base ball news. Newspapers are written for all sorts of 
 people, everybody is likely to find something to interest him. If 
 there is too much that is disagreeable a man will likely not sub- 
 scribe at all. Some newspapers claim to be "The best family 
 
230 DUSTY AIR AND ILL HEALTH. 
 
 paper." They usually are the ones that contain a minimum of 
 patent medicine advertisements; they may refuse to insert adver- 
 tisements disguised as reading notices or use headings that mis- 
 lead. When a community is oversupplied with newspapers there 
 is apt to he keen competition. Some of the papers are continually 
 on the verge of bankruptcy, they are apt to accept all sorts of 
 questionable advertisements. We see a somewhat similar condi- 
 tion of affairs in the case of doctors; the community that is over- 
 supplied likely contains men who make all sorts of promises to 
 cure in order to get patients. 
 
 A clergyman who might be regarded as a neurastheniac came 
 to me. He noticed some mild symptoms that led him to think of 
 consulting a physician, when, at the psychological moment, his 
 eye met a "reading notice," a disguised advertisement of a patent 
 medicine that can be "mixed at home." At the bottom occurred 
 the statement. "The editor can endorse this prescription." The 
 prescription itself contained several well-known ingredients and 
 then the "joker," the name of the nostrum. The preacher 
 promptly sent around to the druggist and had this "prescription" 
 filled. Unfortunately druggists will fill prescriptions without the 
 physician's signature; formerly the druggist was the righthand 
 and co-worker of the physician; today he is mainly the agent of 
 the patent medicine men. He will even wrap the doctor's medi- 
 cine in a patent medicine circular. This preacher took the medi- 
 cine for some time but instead of getting better he got worse and 
 then he came to me. When I got his history and saw what he had 
 been taking (he showed me the bottle) I smiled and explained how 
 he had been taken in. He became very indignant that people are 
 fooled by advertisements gotten up like reading matter and that 
 an editor should endorse a nostrum. He asked, Is there no way 
 to stop it? 
 
 With a man of this kind one is apt to discuss things in detail. 
 I pointed out to him that in proportion as people became educated 
 and learned something about physiology and pathology and sani- 
 
NERVOUS PROSTRATION. 231 
 
 tation they know better, that in proportion as communities clean 
 up there is no need for nostrums that can not cure although they 
 may palliate or disguise symptoms. 
 
 All my patient needed was good air. In a clean community 
 likely he would have no symptoms whatever. 
 
 In a dusty city one is apt to find all sorts of advertisements 
 of cough cures, but is a "cough cure" really a remedy? Ought 
 there not really be a cleaning up and a doing away with the cause 
 of cough, especially of irritating dust? The same is true for ca- 
 tarrh ; people who have good air have no catarrh. It is also true 
 of a host of symptoms, many of which are designated as "dis- 
 eases" by the patent medicine men. Some patent medicine men 
 may give warnings not to use strong medicine, but to use their 
 mild medicine regularly, "every day." One may question whether 
 that is good advice. Many of the patent medicines are of the habit- 
 forming kind, the victim finds it almost impossible to stop them. 
 
 The above mentioned patient camel to me after his first experi- 
 ence with patent medicine. Some people come to a doctor with- 
 out having taken any patent medicine at all, but most of the old 
 chronics come after having tried many if not ' ' all they ever heard 
 of." Now suppose I had not spent a lot of time in making expla- 
 nations, that he had no disease but was only reacting to an unsan- 
 itary environment, is it not reasonable to conclude that he would 
 have made continued efforts to "get cured?" 
 
 I have had many patients tell me that at first they were op- 
 posed to taking patent medicines, but when they found the doc- 
 tors unable to cure or even give marked relief they "experi- 
 mented" in the hope that they would find something that would 
 help. They thought it all guess' work. The old explanation that 
 "people love mystery" did not appeal to them — to them doctor's 
 medicine or his Latin prescriptions were just as "mysterious" as 
 the patent medicines. It pays to tell such patients why they are 
 still uncured and why they are incurable by the use of medicines 
 of any kind and from any source. Whether a bottle of a doctor's 
 "favorite prescription" is handed out directly, or his prescription 
 
232 DUSTY AIR AND ILL HEALTH. 
 
 filled by a druggist, or whether a bottle is bought ready-made is 
 to many immaterial. 
 
 On the other hand I have had patients, exceptional ones to be 
 sure, who came for advice and not for medicine. If the matter is 
 not clearly explained to them (why they have ill health dependent 
 on their environment) one feels sure that in time they might also 
 try patent medicines. Why not? Advertisements confront them 
 on all sides. People who have been "cured," who assert such at 
 least, tell them of this and of that nostrum. When people get 
 desperate they will try anything tor get relief. 
 
 Some nostrum makers publish testimonials from "home peo- 
 ple," or "from people you know." Several years ago I cut out 
 a number of these published by a certain firm. With one or two 
 exceptions the people lived on back streets of neglected parts of 
 the city. I myself did not know a single one of the testifiers. I 
 took these testimonials to the medical society and asked the phy- 
 sicians if they knew the people. A few of the individuals men- 
 tioned were unknown to any of the physicians; some were known 
 to all, they had had experience with them. With two or three 
 exceptions all were known as deadbeats. Physicians considered 
 them people not worth while. There are various reasons why this 
 is so, as there are various reasons why such people will sign a 
 patent medicine testimonial. 
 
 A man complaining all winter may of course be benefited by 
 taking some nostrum at the proper time, especially on the return 
 of the open door season (seasonal influence). Some patent medi- 
 cines are really based on prescriptions of physicians; if taken at 
 the right time and under the right conditions they will benefit, but 
 that does not mean cure. The reason the doctor's medicine even 
 of a simple kind is usually efficacious is due to the fact that it is 
 given after more or less study of the patient. There are very few 
 medicines that are really curative, we need only think of quinine 
 and real malaria. There are any number of ailments that doctors 
 can not cure and that patent medicines can not cure. Nature does 
 the curing, medicine can only help, it may turn the balance in our 
 
NERVOUS PROSTRATION. 233 
 
 favor. Many states of ill health are wholly dependent on environ- 
 ment. The man who works in a dusty factory may cough inces- 
 santly. He may have severe asthma. Unless he changes his occu- 
 pation no medicine will cure him. The experienced hay-fever vic- 
 tim is apt to smile when promised a cure, even, hy a doctor. The 
 patent medicine people have practically abandoned advertising 
 cures for hay-fever; too few people "bite" to make it worth while. 
 
 Recently some nostrum makers have substituted the term "re- 
 lief" for "cure." This change is due to the operation of the Pure 
 Food and Drug Act. At times one sees advertisements in which 
 occur one or more testimonials from people who claim to have been 
 cured, while the heading of the advertisement may claim relief 
 only. Likely in time the testifier will discover that it was only 
 temporary relief, for probably with the return of the closed door 
 season he will again relapse, particularly if he is a dust victim. 
 
 Drugs and medicines and cures of all kinds are innumerable. 
 The shelves of the average drug store groan with them, and yet 
 the physician uses very few medicines, the true and the tried. 
 With Socrates, on passing through the toy shop, he can say, "How 
 many things are here which I do not need. ' ' 
 
 While writing these notes two incidents occurred which may 
 be worth recording. 
 
 At a meeting of a medical society a young physician had a 
 "cold;" he asked one of the older and more widely experienced 
 men, 
 
 "Doctor, when you have a cold what do you do for it?" 
 
 "I wear it off," was the gruff reply. 
 
 While at a drugstore the druggist, whom I know well, in a 
 hoarse whisper asked, referring to his own condition, "What do 
 you call it, aphonia?" I call it frog in the throat, I replied. 
 
 One of the two men in the store at the time inquired, "Do 
 you have any cure for a cold?" The druggist immediately an- 
 swered, "Yes, some good ones." The men were of a kind to ap- 
 preciate a joke on the druggist and so I loudly called back, "Do 
 you have any real good cold cures?" Of course he had to reply 
 
234 DUSTY AIR AND ILL HEALTH. 
 
 in the affirmative. Then I shouted back, "Why don't you try 
 some of them yourself?" 
 
 The druggist did not enjoy the joke. His cold cures were to 
 sell, not to try on himself. 
 
 For years I have been taking five daily newspapers, two from 
 our capital city and three local ones, not to speak of Sunday pa- 
 pers. The reason for taking so many is to study the patent med- 
 icine and quack advertisements. To what extent do different pa- 
 pers admit them to their columns and where do they draw the 
 line? Some apparently admit everything, others draw certain 
 lines. One paper may admit all sorts of patent medicine adver- 
 tisements but refuse the advertisements of the quack. One won- 
 ders to what extent a newspaper looks after the people's, the 
 reader's, interest, and to what extent it is purely selfish, acting 
 upon the principle, Let the buyer beware. Many of the monthlies 
 and weeklies are careful of the sort of advertisements they admit 
 to their pages, even newspapers are beginning to draw lines. But 
 so far newspapers that do not admit patent medicine advertise- 
 ments are exceptional. 
 
 Now in this volume I am attempting to show that many ills, 
 complaints and symptoms for which patent medicines are used are 
 incurable by drugs, because they are reactions. The only cure is 
 to get away from the cause. But medicines may palliate ; some 
 blunt sensibility and give relief from pain, but that does not mean 
 cure. If the people clearly understood this they would not con- 
 stantly be trying old patent medicines and all the new ones that 
 appear. But who is to teach them? 
 
 What occurs when the average individual in ill health goes to 
 the average doctor ? We all know what takes place : often while 
 the patient is telling his complaints the doctor is putting up some 
 medicine which he hands out with directions how to take, with 
 scarcely a word of good advice. Is it not true that the average 
 patient expects to be cured by the medicine, just as the user of 
 patent medicine expects to be cured? If one fails, he tries an- 
 other. Medicine is medicine. Many will ask, What is the differ- 
 
NERVOUS PROSTRATION. 235 
 
 ence between medicine sold over the druggist's counter and that 
 handed out by the doctor? Some doctors are merely competitors 
 of the druggist in selling medicine, in peddling pills. 
 
 Suppose a young doctor with high ideals comes to a community 
 where the people use doctor's medicines and patent medicines in- 
 discriminately, where they try one or the other, perhaps both at 
 the same time. How will he attempt to tell the people that their 
 ills are not curable by medicine? that he does not propose to give 
 drugs for ills that are incurable! If people understand that the 
 new doctor, a regular graduate, is not going to give them drugs, 
 will they call on him at all? If he would speak out he would lit- 
 erally be committing professional suicide. He would not get a 
 footing. He would not make a living. In order to teach the peo- 
 ple he must still give them what they want and gradually teach 
 them better. But the young doctor soon marries and then has a 
 family to support and that means he is less and less inclined to 
 give the people what they need, merely giving what they want, 
 and soon his practice does not differ from that of those about him. 
 He gives out medicine as freely as the rest — and then is it any 
 wonder that the people place him and his medicine on a level with 
 that of the patent medicine men? The doctor who does not do as 
 others is exceptional. 
 
 A newspaper has a duel function, it supplies its readers with 
 news and supplies the needs or wants of the buyer and seller. The 
 man who has something to sell uses the newspapers as the go- 
 between. The man who wants something will make his wants 
 known through advertisements. The patent medicine man has 
 something to sell; why should he not advertise his wares? 
 
 The doctor has something to sell, call it medicine or call it skill 
 or professional services, but instead of using the newspaper he 
 hangs out a sign. The doctor's sign often means "Medicine for 
 sale." (That applies in nine cases out of ten; the tenth man may 
 be wholly exceptional.) Because there are practitioners who do 
 not sell medicine or write prescriptions other doctors are "down 
 on them," just as they are down on the newspaper that advertises 
 
236 DUSTY AIR AND ILL HEALTH. 
 
 patent medicine and that takes the advertiser's part. This state 
 of affairs will likely continue until the people themselves make a 
 change. 
 
 Addendum : On p. 209 I asked, Who makes the best family 
 physician? Old patients are constantly giving me their opinion. 
 A friend in a distant town on reading this manuscript told me of 
 a young man, the son of a doctor, who went through a very un- 
 sanitary high school with flying colors. He was undecided what 
 to do and for a year had an outdoor job and then concluded to go 
 to medical college. He did not lose a day on account of ill health, 
 although the medical college was located in the heart of a large 
 and dirty city. Shortly before graduating while home on a short 
 vacation he told of the kind of work he was going to do after get- 
 ting his medical degree. He was going to treat "sick people," 
 with strong emphasis on sick; he did not want "old ladies" nor 
 "old chronics" who are constantly complaining, "who think they 
 are sick. ' ' He thought that kind of people needed faith and mind 
 cures, they did not need a regular physician. "Thus spoke inex- 
 perienced youth." 
 
 Here again my comment is: How unfortunate that medical 
 colleges do not teach about common ills and the influence of en- 
 vironment. How can a young doctor in robust health, who has 
 had no instruction, and no practical experience, understand the 
 kind of cases that he meets on getting out into the world ? If such 
 a young doctor meets an old chronic who takes an interest in him 
 he may be told a few things about chronic ills. Even the old 
 "granny" may give him a few ideas that she has learned through 
 bitter experience. Having learned more or less about the sciences 
 on which Medicine rests, he of course will learn much more quickly 
 than people who have not such a foundation. As already men- 
 tioned, such a young physician may have very high ideals but in 
 time, unless he has some guiding principle for treating ill health, 
 he degenerates into a mere routinist or symptom-prescriber like 
 those all about him. 
 
NERVOUS PROSTRATION. 237 
 
 In affections and states of ill health due to had air the proper 
 remedy is to clean up, to get away from dirt. If a community 
 will not clean up, the individual had best go to one that does. The 
 florist knows what will happen to his plants when he fails to keep 
 them clean and from being overcrowded; a sudden blight will 
 carry them off. The farmer knows that his domestic animals when 
 closely housed become sickly and die. Among human beings living 
 under unsanitary surroundings there may be much ill health, many 
 symptoms, but it is well defined disease that kills. Many symp- 
 toms can be palliated. A cough may be ' ' cured by a cough cure ; ' ' 
 there are all sorts of remedies to "kill a pain," but the cause of 
 the cough and of the pain may be operative just as before. The 
 absence of symptoms merely gives the individual a false sense of 
 security. If he knew what the cough or the pain signified he 
 would not resort to such treatment. Many drugs blunt the nerv- 
 ous system; they numb pains and aches. We know how a man 
 who suffers bodily and mentally will drink to excess, drown his 
 pain and sorrow in alcohol, and how others will take opium, per- 
 haps in the form of hypodermic injections. There are a number 
 of drugs that can be used for this purpose; if one is not used, 
 another will be. Alcohol, opium, cocaine and acetanilid can largely 
 replace one another. If those in misery are denied the use of one, 
 they are apt to resort to another. I have repeatedly met people 
 who had been benefited, who felt better, by the use of certain nos- 
 trums (particularly of the kind that blunt sensibilities) but dis- 
 continued their use for fear of forming "the habit." The num- 
 ber of patent medicines that are used habitually is remarkable. 
 
 The subject of the relationship of patent medicines to the ab- 
 sence of cleanliness is a large one; likewise that of the influence 
 of the mind on ill health and disease, as manifested by the various 
 faith and mind cures. "When we study reputed cures we find that 
 many are intimately bound up with a change of seasons and change 
 of surroundings. 
 
 Many persons unqualifiedly praise or condemn certain things. 
 Physicians almost invariably condemn the patent medicine men 
 
238 DUSTY ATR AND ILL HEALTH. 
 
 and modes of treatment which they do not or perhaps can not 
 countenance. People often want to know the reason why. 
 
 When we begin to inquire why patent medicines and fads of 
 all kinds that aim to cure ills are so common in our country we 
 may find it due to the way in which people live and are exposed 
 to ill health producing conditions. One of these factors I have 
 attempted to point out in this book. I feel confident that if people 
 cleaned up generally, had clean towns, clean streets and clean 
 homes (and that means also clean food, clean water and clean air, 
 clean clothing), there would be vastly less ill health and disease 
 than there is at present. Some one has truly said that chronic 
 ills are mostly of our own making, and that means they are largely 
 preventable. 
 
 Sanitarians have observed that as soon as a city gets a pure 
 water supply salubrity greatly improves; there is less disease and 
 ill health that primarily is not dependent on the use of bad water. 
 One might say people live up to their good water supply; that 
 they are less tolerant of dirt elsewhere. It is difficult to teach the 
 value of good clean air to those who drink dirty water and live on 
 dirty and dusty streets; one almost comes to the conclusion that 
 the first step in getting clean air is to get clean water. 
 
 I recall years ago reading of a city man, a clerk, who received 
 as a Christmas present from an aunt a fine marble statue. He 
 had expected something more useful. When the statue was put 
 on the center table, the table seemed out of harmony; a fine new 
 center table had to be bought to do it justice. Then it was noticed 
 that the table was out of harmony with the other furniture in the 
 parlor and that meant to get new furniture. Then they noticed 
 that the carpet and wall paper were out of harmony. The refur- 
 nished parlor was in such marked contrast with the other rooms 
 that in time the house was completely refurnished, even to the 
 kitchen. Then the inside of the house was in such marked contrast 
 to the outside that more improvements were demanded. The im- 
 provements extended to the lawn and to the street and alley. Then 
 the neighbors noticed how their own homes were out of harmony 
 
NERVOUS PROSTRATION. 239 
 
 and they began to improve. The marble statue became the means 
 of renovating a whole neighborhood. 
 
 Clubs of all kinds flourish today. How many are devoted to 
 a study of the legends of early days? How many devote them- 
 selves to the heathen in foreign lands? How many study their 
 own community, its wants and needs? 
 
 In this country the majority rules. We can have protection or 
 free trade, prohibition or license. Men, and women too, warmly 
 take sides. But what sort of citizen is apt to take the side of dirt 
 and dust and ill health and misery? Club women can do much, 
 the women generally can do much, for in what does keeping a city 
 clean differ from keeping a house clean? 
 
 One of my old patients who has had much experience with 
 court house conditions in looking over this manuscript expressed 
 her dissatisfaction that I did not have more to say about court 
 house air and city hall air and the dust factor in politics — how 
 men who do not smoke and chew and spit take little interest in 
 politics and how the women are disgusted with politics and de- 
 mand a hand in electing officials. Now this is a subject on which 
 I have collected a lot of data but it would take time to go over all. 
 Likely the argument would run along this line, I am not neces- 
 sarily speaking of local conditions. 
 
 "Slates" are usually discussed and made up in places where 
 air conditions are very bad, only too often in saloons. Individuals 
 designated as "best citizens" usually do not take part. At the 
 primaries air conditions are usually bad and the "best citizen" 
 too often remains away, especially if he is influenced by bad air. 
 In his absence ward politicians control matters and nominate can- 
 didates, "slates go through." Only too often candidates are poli- 
 ticians who can live under bad air conditions, often bull-necked 
 apoplectic individuals (who however usually die prematurely on 
 account of some cardio-vascular affection) or, on the other hand, 
 men who do not react to bad air but who are as clay in the hands 
 of the bosses. Now in the early days political meetings proper 
 were held in the open but today "stump speeches" are made in- 
 
240 DUSTY AIR AtfD ILL HEALTH. 
 
 doors and usually under very bad air conditions, so bad that "best 
 citizens" stay away. If the women attended likely there would 
 be less tobacco chewing and smoking. The typical politician as we 
 know him is not concerned with the welfare of the city and to dis- 
 tract attention from local problems he injects State and National 
 politics into city affairs and befogs local issues. When the best 
 citizen comes to vote he finds very little difference between the 
 candidates of the two great political parties; he does not care 
 whether he votes or not. But there are men who do vote, some 
 are paid for doing so. "Writing to the newspapers" after the 
 election does no good. 
 
 Remarks about city politics and politicians also apply to county, 
 State and Nation. Is it not true that only too often the man who 
 is elected is of the kind who always has a cigar in the mouth and 
 puts his feet on the table? What is to be expected from him in 
 the matter of cleanliness? Is it any wonder that the women are 
 disgusted and demand the right to vote and that many States are 
 giving them this right ? In other States men are beginning to vote 
 for candidates other than those of the two great political parties ; 
 just now socialist candidates are receiving many votes. Socialism 
 in its best sense seeks the common good. If the socialists live up 
 to their ideals their party has a great future before it, especially 
 in the management of our cities. 
 
 Socialism does not mean anarchy. The typical anarchist as 
 described in the newspapers resembles the hero of the blood and 
 thunder stories. Anarchists usually meet in the back room of 
 some saloon under horribly bad air conditions. They react and the 
 reaction manifests itself mentally, sometimes reaching the point 
 of insanity. The best remedy for anarchism is cleanliness, a fact 
 which socialists seem to recognize. 
 
 (Writing as I have does not necessarily mean that I am a so- 
 cialist; as a matter of fact I am largely a believer in individual- 
 ism. But when it comes to the matter of cleaning up, in making 
 cities sanitary, I believe the individual is helpless ; it takes a com- 
 bined effort. Theoretically we believe that all men are born free 
 
NERVOUS PROSTRATION. 241 
 
 and equal, but practically speaking no one believes it. It is im- 
 possible for all to live on the same plane. As an evolutionist I 
 believe that many individuals are out of harmony with their en- 
 vironment and with the spirit of the times. As a physician T 
 believe that the man who does not give attention to symptoms of 
 ill health is not of a type to survive under complex life conditions.) 
 
 The other day one of my old patients hailed me on the street, 
 "Did Mr. X come to you?" naming a court-house official. No, he 
 did not. "Well, I recommended you to him and he said he would 
 come. He has been complaining of a sore throat and catarrh for 
 some time, and has been doctoring. I told him not to waste any 
 time but come to you. You may look for him at any time. ' ' He 
 made a few remarks on what a nice sort of man Mr. X is, and 
 indicated that I should do my best, which I promised to do — but 
 I did not thank him for referring the man to me. 
 
 Now although my old patient knows more or less about dust 
 influences I do not know whether he suspected that official to be a 
 dust victim. Assuming that he is, in what does "doing my best" 
 consist? Should I tell him that he is not adapted to the air of the 
 court-house, that he is a farmer and not a politician and that he 
 ought to live on the farm? Is he "sick enough" to follow good 
 air advice or will he deem me a crank and try some other doctor 
 who will give him lots of medicine? Judging the man in the light 
 of other cases, I do not want him as a patient. I have no time for 
 making long a-b-c explanations, and unless one does explain so a 
 man understands he will not follow good advice. But unless I do 
 have a "talk" with him how will I be able to get the facts in the 
 case? He may not be a dust victim at all — and in that case I 
 likely would not mention him among cases. If he comes to me 
 after "my book" is out I can give him a copy and save a lot of 
 time. 
 
 Is it necessary to add that "nice men" are put on all tickets — 
 to offset the men who are anything but nice — no political boss 
 would think of making up a ticket wholly of his own kind. 
 
 The honest farmer or citizen who is elected to office and must 
 
 [161 
 
242 DUSTY AIE AND ILL HEALTH. 
 
 spend his time under bad air conditions is to be pitied. If there 
 were a determined effort to have good air at the courthouse, say 
 by electing a woman or two who would not tolerate the smoker 
 and chewer and spitter, perhaps there would soon be a radical 
 difference. 
 
 Case Report : Mrs. — called up at a time when my name no 
 longer appeared in the telephone directory as a physician, asking 
 if I still accepted new patients. She had been referred by one of 
 my old patients, and the very fact that she had been referred was 
 to me good evidence that, in all probability, she was a dust vic- 
 tim. Her language indicated that she was above the average in 
 intelligence. She lived in a good section of town. Being childless 
 and in fairly good circumstances meant that she likely would be 
 able to live up to good air advice. I asked her to come in and we 
 would talk over matters. 
 
 The woman gave a long history of "not feeling well." Said 
 she was not really sick but at the same time was not well, there 
 was always something wrong, yet she was never bedfast but often 
 housefast. She had tried many physicians and even specialists in 
 a large city. She clearly realized the seasonal influence, that she 
 got better in the summer and relapsed in the fall. She was in- 
 clined to self-pity, that she could not do as others. Moreover there 
 was a history of tuberculosis in one side of her family and she had 
 a constant fear of consumption. 
 
 She was fond of flower gardening and on the approach of cold 
 weather took in a number of plants to winter over. This gave me 
 a clew regarding explanations. I proposed a systematic examina- 
 tion and keeping a record, with health supervision, to which she 
 agreed. The fact that I found nothing radically wrong of course 
 was pleasing but when she asked, Then what is the matter? de- 
 tailed explanations were necessary. I told her I believed she was 
 a dust victim and that if she kept herself under observation and 
 reported occasionally she could soon verify it, which she did in 
 the course of time. 
 
NERVOUS PROSTRATION. 243 
 
 She wanted to know how to reduce acute attacks to a minimum, 
 and if possible lay in a stock of health that would tide her over 
 the late winter months when she invariably ran down, during the 
 last few years at times reaching low ebb. The explanation of 
 raising plants and taking them into the house on the approach of 
 cold weather enabled her to understand. Unless one knows just 
 what to do the plants will sicken, even die ; one must learn how 
 to take care of them. Similarly people must learn how to take care 
 of children under unsanitary surroundings or they will perish. 
 Likewise the individual must know what to do for himself — among 
 other things avoiding five cent shows where air conditions are very 
 bad or long shopping tours, such as people make who have lots 
 of time but who buy little, shopping being a sort of recreation. 
 She protested that these things did not affect her, but her diary 
 soon convinced her that she "felt good" in proportion as she 
 avoided crowds and bad air. 
 
 This patient was one of those individuals or cases that are a 
 bugbear to the honest physician ; he does not know what to do and 
 is apt to try all sorts of remedies and modes of treatment. When 
 such a patient has made the rounds of doctors and specialists she 
 is likely to be hypercritical and to question. Unless the physician 
 is willing to answer questions he may find the individual very dis- 
 agreeable, and still more so if no good results follow his treatment. 
 
 Although I promptly diagnosed dust infection and regarded 
 her as a dust victim, yet for some time I was doubtful to what 
 type she belonged. I finally came to the conclusion she was one 
 of those nervous individuals who ultimately develop membranous 
 catarrh of the intestines. Practically all her symptoms must be 
 regarded as warnings, rarely is any one sufficiently severe to de- 
 mand an active remedy. There was more or less complaint of 
 constipation and yet all she needed, besides good air, was several 
 glasses of water a day. Occasionally after an acute exposure 
 there was an acute neuralgic condition of one side of the face, for 
 which she received a prescription. Although in the past she had 
 
244 DUSTY AIR AXD ILL HEALTH. 
 
 taken a lot of medicine and had come to lose faith in drugs, yet 
 she was willing to take medicine, even wanted it. 
 
 She complained that physicians had not been frank with her, 
 had not freely discussed her symptoms and apparently held back 
 information from her and on this account she believed she was 
 worse off than she really was. She feared tuberculosis. Then 
 again she expressed her belief that doctors were constantly experi- 
 menting on her, trying new medicines. The most common diag- 
 nosis was malaria; I advised her to keep a record of her tempera- 
 ture twice a day; she was surprised to find that this frequently 
 was subnormal and that the complaint of chilliness came on after 
 there was an acute exposure to bad air. Because the diagnosis of 
 malaria had been such a frequent one, she clung to this longest. 
 If physicians regarded her complaints as "imaginary" they did 
 not tell her so — that is a diagnosis most commonly made only in 
 the case of poor people. 
 
 There was a complication, a serious one, that held her back — 
 a catarrhal husband constantly exposed to bad air who brought 
 infection to an otherwise clean home. It was equally important 
 to advise and prescribe for him. 
 
 Disease, III Health, Symptoms. How shall one explain the 
 condition of an individual who has ill health rather than well- 
 defined disease, who reacts to his environment, and to what extent 
 shall one speak of prevention, of avoiding the causes that produce 
 symptoms? Explanations depend largely upon the individual. 
 Sometimes the explanations run along the following lines: 
 
 When a man goes up a high mountain he reacts, there is op- 
 pressed breathing, he feels as if he would suffocate, he feels faint. 
 Some speak of the reaction as mountain sickness. Shall we call it 
 a disease — "mountain disease?" 
 
 When a man goes into a dense smoky air he reacts, he feels as 
 if he would suffocate ; he coughs and sneezes, his eyes water, mucus 
 forms in the air passages — shall we say he has "smoke disease?" 
 
NERVOUS PROSTRATION. 245 
 
 When a man falls into the water he reacts, how greatly depends. 
 He may get water into his mouth, he may he paralyzed from fear, 
 he may be in great danger from drowning — shall we say he has a 
 disease? Is the act of drowning a "disease?" Today some peo- 
 ple seem to regard everything as a "disease." 
 
 What sort of aid would we give a man reacting to a rarified 
 atmosphere, to one reacting to smoky air, to the one who falls into 
 the water? To what extent do we consider a man in danger and 
 make efforts to succor him ? What sort of ' ' symptoms" do we con- 
 sider indicative of danger? 
 
 Perhaps the answer largely depends upon our own experiences. 
 If we are able to swim we may expect the man who fell into the 
 water to swim out or at least keep his head above water until help 
 arrives— his vigorous kicking is not to be regarded as a symptom 
 of drowning but as an effort to save his life. We are likely to 
 watch him, throw him a life preserver, if not jump in to his aid, 
 if help is needed. The man who can not swim would be foolish 
 to attempt a rescue by jumping in and the man who throws a 
 heavy life preserver and hits the swimmer on the head only does 
 harm. 
 
 Is the man inhaling smoke in danger? What are danger sig- 
 nals, what are dangerous symptoms? To what extent is a rarified 
 atmosphere dangerous? Would a physician treat such a case 
 "symptomatically" or would he merely advise keeping quiet and 
 as soon as possible transfer the individual to a lower altitude? 
 
 When a man is attacked by some wild beast he is apt to make 
 a vigorous defense. Should we call the reaction a disease, and 
 should we regard his efforts to save himself as symptoms indicat- 
 ive of danger, or do they show that the man is successfully fight- 
 ing off the enemy ? Is it not true that danger appears or increases 
 as a man fights less vigorously, as he gets faint, exhausted, when 
 the reaction, i.e. "symptoms," is less marked? 
 
 When a man is attacked by myriads of microbes his body re- 
 acts, there is an active fight. To what extent shall we aid the man 
 
246 DUSTY AIR AND ILL HEALTH. 
 
 attacked? Do we know what he needs? Fever is an index of the 
 heat of battle — are we aiding a man if we give him something to 
 "reduce the fever?" 
 
 A long time ago a cynic defined a physician as a man who pours 
 drugs about which he knows little into a body about which he 
 knows less. But physicians in the course of time have learned a 
 lot about the human body and about drugs, including their worth- 
 lessness to cure and their value in palliating symptoms as well as 
 in discriminating between symptoms — those that threaten life and 
 those that merely indicate that the body is reacting vigorously in 
 "throwing off the disease," in getting rid of infection. 
 
 Many physicians use simple remedies and get results — they 
 know just when to use them to turn the balance in our favor. 
 When a physician is sick he does not prescribe for himself; he 
 keeps in mind the old saying, A man who prescribes for himself 
 has a fool for a patient. Lawyers have a similar saying. But in 
 the case of symptoms not due to the presence of real disease he 
 likely has discovered what will help him and he may not be above 
 taking his own medicine. If the people knew how little medicine 
 a physician takes and how little he gives his relatives and friends 
 and his old patients they would carefully consider the indiscrim- 
 inate use of drugs. 
 
 To what extent are drugs of value in dust infection? Such a 
 question opens up a wide field for discussion. Here I will merely 
 say drugs may help but can not be considered in the light of 
 ' ' cures. ' ' 
 
 Among my early patients was a servant girl with sore hands, 
 the skin was scaly, cracked and occasionally suppurated. She had 
 used all sorts of salves, ointments and lotions. I told her the most 
 important thing to do was to keep her hands out of water. But 
 how was she to do that; she had to work? Could I write her a 
 prescription? I did write her one for a greasy mixture, explain- 
 ing that it would be effective only if the hands were kept dry. T 
 did not see her again for several years and then I learned that she 
 continued to have sore hands for a long time because she had to 
 
NERVOUS PROSTRATION. 247 
 
 put them in water more or less. After getting married when she 
 "could take it easy" she was able to live up to keep-your-hands- 
 out-of-water advice and then her hands soon got well. 
 
 Another early patient was a man who worked with moist ce- 
 ment, he had sore hands that he vainly tried to heal by the use 
 of medicines. I advised a change of occupation. I did not see him 
 again for nearly ten years, when one day he greeted me on the 
 street. At first I failed to recognize him, he was thin, sallow and 
 hollow-eyed, with suffering written on his face. I learned that he 
 had gone to a large city soon after he had consulted me, his hands 
 improved at once — but gradually his chest began to ache and 
 finally he came to the conclusion that the dusty city air did not 
 agree with him ; it choked him and made him cough. As a matter 
 of fact ten years of city life had exhausted him. Is it necessary 
 to say that the man in addition to advice to keep his hands away 
 from irritants should also have had good air advice, to keep his 
 nose out of bad air? 
 
 Frequently I have occasion to advise hay-fever victims, and 
 if they get any prescription it is one that may palliate; the "cure" 
 consists in change of air. Old hay-fever victims have fully learned 
 this lesson, they smile at those seeking a "cure" by the use of 
 drugs. 
 
 The man who wants to avoid the effects of rarified mountain 
 air, of smoky air, will keep away — just as the dust victim will 
 keep away from dusty air. 
 
 Should a Patient be Told the Truth? The patient had 
 questioned whether she was being told the truth by physicians; 
 that led to a lengthy discussion. I explained to her that in case 
 I had found tuberculosis the question of telling the truth would 
 have assumed a different aspect than where there is no well-defined 
 disease; that had tuberculosis been present I likely would first 
 have discussed the matter with her husband, but since she is only 
 a dust victim I had at once discussed conditions or findings with 
 her. There was no need at all for concealing the truth, she ought 
 to know the truth. "The truth shall make you free." 
 
248 DUSTY AIR AND ILL HEALTH. 
 
 But, a physician told me, by speaking of dust influences pa- 
 tients, especially the active minded, may imagine effects after an 
 exposure, symptoms may be purely imaginary. The best reply I 
 can make to such a remark is: Study your own cases, withhold 
 the information that the patient is a dust victim as long as you 
 desire, until satisfied that dust influences are real or "purely 
 imaginary." I have satisfied myself over and over that they are 
 real. 
 
 Such patients will naturally ask one's opinion of other physi- 
 cians. Here is dangerous ground, for patients will "talk" and 
 one may get an undesirable reputation among fellow-practitioners. 
 Under such conditions the physician had best get the patient's 
 view and avoid expressing his own. It certainly would not be 
 proper in a volume of this kind to give any derogatory opinions 
 against physicians who honestly try to help their patients and are 
 working in the best light they have. But what shall be said of 
 the doctor who has so little esprit de corps, so little pride in his 
 profession, that he does not belong to his county medical society 
 where things of common interest are discussed and where physi- 
 cians learn to know each other and their abilities and capabilities? 
 Is it the physician's duty to expose such men, men who readily 
 promise to cure what no conscientious physician can cure? Here 
 I end as I began, should a patient be told the truth ? 
 
 Experimenting and Being Experimented Upon. The pa- 
 tient's remarks of being experimented upon should also be con- 
 sidered. The subject is one that could be discussed at great length. 
 One would have to go back to the early days when physicians had 
 practically no knowledge of the workings of the human body, when 
 they tried all sorts of things in the hope of "driving out" disease. 
 Then we must consider the fact that in proportion as men have 
 few facts they are apt to spin elaborate theories. Properly speak- 
 ing there was no medical science until about three hundred years 
 ago when with the revival of learning the experimental method in 
 science arose. Up to that time the circulation of the blood was 
 not even known. Today the experimental method has reached a 
 
NERVOUS PROSTRATION. 249 
 
 wonderful development. There are even journals devoted to "ex- 
 perimental medicine." 
 
 But medical men who experiment are comparatively few. They 
 are usually college and hospital men. The average physician is 
 not an experimenter, properly speaking, just the opposite. He 
 even hesitates to try new remedies unless they are backed by au- 
 thorities. But there are not lacking physicians, especially those 
 who lack a grounding in the sciences on which medicine rests, who 
 are ready to try anything and everything in the hope of curing, 
 without perhaps a proper conception of what they are attempting 
 to cure. Some physicians give "alteratives" but they have a 
 very hazy idea of what they really are trying to alter. Similarly 
 they give tonics without understanding the needs of the body. I 
 am reminded of a recent occurrence. 
 
 A friendly druggist gave me a sample package of a "laying 
 tonic" for hens. The package says, "It insures egg laying with- 
 out forcing, is absolutely harmless and promotes health. Try it 
 at our expense; enough for six hens for twenty-one days." A 
 poultry book accompanied the sample, which told how to build a 
 properly lighted, drained and well ventilated chicken house, in 
 fact, giving much good advice regarding the care of chickens. 
 Here are the directions given for using the sample of "laying 
 tonic": 
 
 "First separate six fowls for the test. Put 1 level teaspoonful into 
 1 pint of mash feed. Besides this, feed dry grains liberally twice a day 
 in a 6-inch deep litter, so that fowls will work for it. Keep oyster shell, 
 grit, beef scrap and pure water constantly before them. 
 
 "A good mash can be made as follows : For cold weather — October 
 to late spring — feed mash first thing in the morning. Two parts cut alfalfa 
 or clover, two parts mixed feed or wheat bran, two parts cornmeal, one 
 part green cut bone or beef scrap, one part table scraps. Add a little 
 salt. Add boiling water in sufficient quantity to moisten every portion 
 without making it sloppy or sticky. Cool somewhat before feeding." 
 
 Is any one who separates six fowls and follows these directions 
 experimenting ? One of the first rules for experimenting is to vary 
 only one factor at a time, otherwise one can not draw proper con- 
 clusions. 
 
250 DUSTY ATR AND ILL HEALTH. 
 
 Suppose a man is not feeling well, that he "needed a tonic," 
 and that the doctor gave him a prescription, with elaborate direc- 
 tions how to take. Now every physician knows that what people 
 need is an abundance of good food and proper housing — the 
 "tonic" has little or nothing to do with it. But some people are 
 so obtuse that they do not understand these things, and when they 
 feel better the medicine is given the credit. 
 
 I occasionally see chickens cooped up, with a little runway, 
 perhaps composed of cinders, with nothing green in sight. Twice 
 a day some corn is thrown in. It is an utter impossibility for any 
 "laying tonic'' to make them lay. I similarly know people who 
 are in want of food and fire, indeed of proper housing, and yet 
 when they come complaining to a physician they may be given a 
 tonic. If such people do not get well after trying different tonics 
 and different medicines can they properly accuse the doctors of 
 experimenting? Why doctors merely hand out a little medicine 
 instead of properly investigating and pointing out things is another 
 question. Shall we say that if people expect little of the doctors 
 they get little? If a patient insists on a tonic she will likely get 
 one. 
 
 There is another side to the question of experimenting. The 
 physician in private practice can not afford to have the reputation 
 of experimenting on his patients. Just how often a physician can 
 "change the medicine" without getting the reputation of being an 
 experimenter, is of course an open question. But aside from giving 
 medicine anything out of the usual is apt to be regarded in the 
 light of an experiment and if the patient does not clearly under- 
 stand the why and the wherefore he is apt to regard himself as an 
 experimenter. 
 
 But frequently patients themselves want to experiment, or 
 rather they want "experimental evidence" that they are not dust 
 victims. I tell such a patient that after all the assumption that 
 he is a dust victim may not be true, that one goes largely by an- 
 alogy, judging one by another, and that if he wants to experiment, 
 why there is nothing to prevent him. I do not advise dust victims 
 
NERVOUS PROSTRATION. 251 
 
 to experiment by wilfully exposing themselves, hut if they want 
 to do so I ask them to enter the experiment on their record and 
 tell me about it. The dust victim soon finds that it does not pay 
 to experiment, that there are enough unavoidable exposures to 
 show him that dust infection is a reality. 
 
 In connection with the last mentioned patient fears and phobias 
 should also be mentioned. 
 
 Fears and Phobias. Individuals who are classed as neuras- 
 theniacs, especially those who have active minds, are subject to 
 all sorts of fears, at times to phobias. Fear is inborn and may be 
 said to have a good foundation, phobias are excessive fears often 
 lacking substantial ground. Phobias may shade off into insanity. 
 Fear is an instinct; in proportion as we fear and avoid dangers 
 we are apt to survive. Fear shades off into worry, especially where 
 the individual does not reason about causes. Take, for instance, 
 the neurastheniac who complains of pains in the chest and fears 
 tuberculosis. He may lie awake at night and worry. This is es- 
 pecially true in those who have had a death in the family or among 
 relatives from tuberculosis. The same is true again of individuals 
 who have a pain, perhaps a recurrent pain, in the region of the 
 stomach. They fear cancer of the stomach, just as another may 
 be led to fear heart disease or kidney disease. Now as a rule the 
 pains and aches of the neurastheniac are due to environmental in- 
 fluences rather than to disease or the beginnings of disease, and 
 when the matter is properly explained (especially if the individual 
 is a dust victim) they dismiss the subject and no longer lie awake 
 at night wondering what it all means. 
 
 Dust Fear. When I first realized the possibility of infected 
 dust I developed a "dust fear," but in the course of years I came 
 to the conclusion that the very fact that I was alive showed that 
 after all one's fears may be largely groundless. As one develops 
 a good air conscience one naturally avoids places where the air is 
 suspected and under good air conditions dust fear may not come 
 into consciousness at all. 
 
252 DUSTY AIR AND ILL HEALTH. 
 
 When I first began to discuss these things I now and then met 
 individuals who developed a similar dust fear, or to give it a tech- 
 nical name, Conophobia, I can now see that often it was my fault 
 that this happened, that I did not fully explain. In attempting 
 to show the dangers of dust one should also explain that the very 
 fact that the individual is still alive shows that he has escaped all 
 sorts of dangers and now that he is warned he will likely suffer 
 less than in the past. To be forewarned is to be forearmed. 
 
 To cultivate a healthy fear of dust and to acquire a good air 
 conscience and avoid worrying are worth while. It may even be 
 desirable to make a radical change of one's surroundings. As a 
 matter of fact every now and then some of my "best patients" 
 leave the community, following my advice to get better air. 
 
 In discussing this subject one of my patients related an experi- 
 ence that shows the genesis of fear and his attempts to get rid of 
 worry. When Mr. — reached the age of puberty he began to go 
 to the barber. He went for several years; occasionally there was 
 a little scratch or a cut on the face or a pimple would appear, but 
 he never paid attention to them. Then one day a little cut was 
 followed by barber's itch and he had a serious time in getting rid 
 of it. After that he was apprehensive of every little scratch or 
 pimple. He was in constant dread of barber's itch. About that 
 time safety razors came on the market and he promptly got one 
 and shaved himself. Then all fear of barber's itch vanished, ex- 
 cept, for a short time each month when he went to the barber to 
 have his hair cut and get shaved. Then he again carefully watched 
 his face and always looked for the worst. Finally he decided to 
 shave himself even at the time of the monthly hair cutting. 
 
 Hospital Physicians and Physicians in Private Practice. 
 For several years I was physician among the insane, and that 
 means among other things that one does not have to look after the 
 financial side of the practice of medicine, and it means, too, that 
 one can give an individual much time and attention wholly with- 
 out any thought of getting any returns. Occasionally some of my 
 
NERVOUS PROSTRATION. 253 
 
 old hospital patients come in for advice, perhaps under the im- 
 pression that I still have lots of time and will discuss things in 
 detail. 
 
 I recall a young man, one of my former hospital patients, who 
 consulted me regarding the question of getting married and start- 
 ing a store in a small county-seat. He complained of the scant 
 attention his home physician gave him (he came from a distant 
 county) and remarked on the difference between hospital physi- 
 cians and those "on the outside," that the latter had little time 
 or took little time for discussion, and that some spoke dogmatically, 
 as though there were only one side to a question. I had to point 
 out that strictly speaking his "case" was scarcely one for the 
 ordinary physician, that the general practitioner was concerned 
 with ills, with ' ' treating the sick ' ' and that ■ many are so busy 
 doing this that they have no time to discuss such problems. 
 
 The man who has once been in an insane hospital and then 
 thinks of getting married may be confronted with all sorts of 
 questions, especially in the small village where everybody knows 
 everybody else and where people are suspicious of a man "re- 
 lapsing, ' ' of becoming insane again, although the chances of doing 
 so may be very remote. 
 
 This young man had a mate in view but had never sounded 
 her regarding her views of marrying a man who had been in an 
 insane hospital, he was too conscientious to attempt concealment. 
 
 Now I myself was very busy at the time and I too was "on the 
 outside. ' ' I was no longer a hospital physician with lots of time to 
 discuss topics of remote interest to me. To what extent does one 
 express himself dogmatically under such conditions? 
 
 But there was one aspect of the question that was of interest 
 to me. The man had a rural ancestry and had always lived on 
 the farm. When he tried town life he reacted, mentally, and then 
 was sent to the insane hospital. If he now went to live in town 
 would he fail again? This was a question to which I was willing 
 to give time. I strongly advised against leaving the farm, and in 
 the light of what is said in this volume the reasons must be clear. 
 
254 DUSTY ATE AND ILL HEALTH. 
 
 At the same time I told him if he did go to live in town in spite 
 of my advice to keep me informed — I was after data, of course. 
 What the ultimate outcome was I do not know. 
 
 I charged the young man a small fee (two dollars, one-fifth of 
 what he told me he had expected to pay), and he again spoke of 
 the difference between hospital doctors and those on the outside — 
 he evidently still regarded me as a "hospital doctor," although I 
 was in private practice. I pointed out how men chose hospital 
 positions. Some went on account of the practical experience, a few 
 followed it as a career. (Most men get tired in a year or two on 
 account of the monotony — one knows for months and for years in 
 advance what sort of cases come before him, monotony palls.) 
 Some went on account of the opportunity to save enough so they 
 can "stand it for a time" while waiting for patients in private 
 practice. (I belonged mainly to this group.) Some men disgusted 
 with the private practice of medicine preferred to have a salaried 
 position and have no concern about the matter of fees at all. 
 
 He had never thought of these things — nor have many others. 
 The "outside physicians" must more or less constantly consider 
 the bread and butter aspect of the practice of medicine. Is it any 
 wonder that the general practitioner gives some people scant at- 
 tention? And is it any wonder that many refuse to enter into 
 movements looking to municipal or civic improvements? Matters 
 of purely civic importance are only too often made matters of 
 politics and people take sides — and get abuse. Many physicians 
 do not care to do anything that does not naturally fall within 
 their professional spheres — and to some that sphere is a very nar- 
 row one. 
 
 Every now and then we read about the "wonderful advance 
 of medicine" or of sanitary science. We are told what the gov- 
 ernment has done in Panama, in Cuba, and in the Philippines, 
 how it has altered unsanitary surroundings and reduced the death 
 rate. And then some people wonder why the government does not 
 interest itself in people nearer home. 
 
 When one considers to what extent the insane in our State 
 
NERVOUS PROSTRATION. 255 
 
 institutions are made comfortable and ill health is prevented, one 
 begins to realize how much a community could do, especially for 
 the poor who are a constant foci of infection to others. 
 
 Medical Supervision. Health Supervision. One of my old 
 patients years ago while living under city conditions had much ill 
 health but while employed about an insane hospital had good 
 health. On going back to city life his health again failed; when 
 he came to me he thought his time was up. The one factor that 
 he had to consider was the air factor. Country life soon set him 
 up and then he again got employment at the insane hospital and 
 here at the same time he was under medical supervision, that is 
 he was daily seen by the hospital physicians who gave him timely 
 attention. As a consequence his health is now better than it had 
 been for many years; one may say he has taken a new lease on 
 life. 
 
 If there is one thing that is given careful attention at that 
 hospital it is air conditions, as I know from many years' close ob- 
 servation, and on this account the common ailments, so prevalent 
 in the nearby town during the closed door season, are practically 
 absent. 
 
 The subject of health supervision will be considered in con- 
 nection with cardio-vascular cases to be cited later. I may here 
 say that for some time I have been giving special attention to such 
 cases particularly from the standpoint of health supervision, of 
 preventing ill health or symptoms of ill health, and shall I say 
 symptoms of old age? The term refers to changes in the heart 
 and blood vessels. 
 
 Choosing a title for this volume has been a puzzle. Since this 
 volume is intended for people in ill health, the title should show 
 this, and yet it should not be one that is repellant or that limits 
 the field too closely, and on the other hand it should not be so 
 broad as to deceive the man who really is not concerned in the 
 subject of ill health. 
 
256 DUSTY AIR AND ILL HEALTH. 
 
 I have in mind a volume that recently appeared, "Old Age 
 Deferred." It is really a volume that appeals to a limited num- 
 ber of physicians, and yet the title, as well as parts of the book, 
 appeals to nearly everybody. But after all the one great factor 
 that our people, in contrast to European people, have to guard 
 against is practically not mentioned at all. This is the factor I 
 am trying to bring out in this volume. 
 
 People in chronic ill health often live on to old age, but it is a 
 life of more or less constant misery. I am trying to tell, particu- 
 larly the "old chronics," how to reduce symptoms, pains and 
 aches of all kinds, to a minimum. Moreover I am not concerned 
 with complicated directions that only a rich man can follow, but 
 with simple advice which practically any one can follow, but of 
 course only fully by those who are really able to take care of 
 themselves, with all that that implies. 
 
 We hear of the formation of Century Clubs — among men. 
 Many men are willing, indeed anxious, to live a hundred years, 
 but we do not hear of women giving expression to such a thought. 
 They would rather not live so long but lead a full life, a life with 
 a minimum of ill health. They would rather live a full life than 
 a long life. Many people who reach old age do not enjoy life, 
 and, most important, do not make life pleasant for those about 
 them. Would it not be best for the men also to seek a full life 
 rather than a long life? "Old Age Deferred." That title ap- 
 peals to every one. Old age is something we like to ward off. 
 After all it may not be measured by years. Some men are old 
 at forty, others are young at seventy, well expressed by the old 
 saying, A man is as old as his arteries, in fact, he is as old as his 
 weakest organ — it may be the thyroid gland or it may be the 
 "nuciform gland"? I have no desire to criticise that volume 
 but I do wish to say that many are misled by the title. It is not 
 a popular volume and indeed is of value only to physicians and 
 not even to every physician. It is a translation of a German book, 
 written by a physician who practices at a fashionable German 
 health resort, one patronized only by rich people, those who can 
 
NERVOUS 1PROSTTUTTON. 257 
 
 afford the best that Medicine has to give. Although the influence 
 of "good air" is repeatedly mentioned, to say emphatically that 
 everybody should live on the edge of town or have his own park 
 or bit of woodland must be regarded as a ridiculous solution. How 
 many people can live up to such advice? And that brings us 
 back to the old question. What is good air? What is its opposite? 
 
 Moreover a poor man can not afford to have a physician look 
 him over at short intervals and give timely advice, he must do the 
 best he can under limited circumstances. And yet if he properly 
 understands the subject he can accomplish much in reducing his 
 symptoms of ill health to a minimum; he will always find physi- 
 cians at home, acquainted with local conditions, who will help him. 
 
 I end as I began, choosing a title for this volume has been a 
 puzzle. 
 
 U71 
 
VII. 
 
 CARDIO-VASCULAR AFFECTIONS 
 
 OR HEART AND KIDNEY CASES. 
 
 In the eases so far mentioned the physician can not accurately 
 if at all predict the outcome. The individual, the patient, may die 
 early or he may long outlive the physician who perhaps predicted 
 an early death on insufficient grounds. There may be, and usually 
 are, many factors to be considered. Prudent people who take care 
 of themselves and heed warnings, that is symptoms, are apt to live 
 on and on, perhaps die of "old age" (this however usually means 
 some "terminal infection"). Others go ahead and take no time to 
 rest or to give nature a chance to overcome infection or attacks of 
 ill health; some disease appears and terminates life. There is much 
 truth in the old saying, Acquire an incurable disease and live long, 
 only we must know what that means. Usually there is no disease 
 at all, only ill health not arising to the dignity of disease. It is 
 usuall}' old chronics who live long, the robust go to pieces quickly 
 and prematurely, especially under unsanitary city conditions. 
 
 In general one may divide individuals into three great groups 
 according to the blood pressure, those with a low pressure, those 
 with a medium pressure, those with a high pressure. The average 
 individual in health has a medium pressure ; if the physician wants 
 to study him he must look him up. People with low pressure tend 
 to end especially in such diseases as consumption and catarrhal 
 pneumonia. Low blood pressure however is not incompatible with 
 long life, if care is taken to keep away from infection, to live 
 under good surroundings and heed symptoms or warnings. High 
 blood pressure on the other hand tends to so-called cardio-vascular 
 affections, especially heart and kidney diseases, in apoplexies, par- 
 alyses and Bright 's disease. It is in high pressure cases that the 
 physician can often pretty accurately predict the outcome. 
 
 The increase in recent years of heart and kidney diseases has 
 
 (268) 
 
C AUDIO- VASCULAR AFFECTIONS. 259 
 
 become quite noticeable. But we must consider that many other 
 diseases have greatly diminished. Some of the formerly great epi- 
 demic diseases no longer occur at all among us ; they are kept 
 away. While writing these notes cholera is being kept out of our 
 country. In the end of course all must die, if not from one cause 
 or disease then from another, and yet when all factors are con- 
 sidered the increase in heart and kidney diseases stands out, no- 
 ticeably among people who are young in years. One may naturally 
 expect a giving out of parts of the body, of blood vessels, for 
 instance, in old people, but one would not expect this in those who 
 are still comparatively young. Acute specific disease may of 
 course attack persons of any age and carry them off, but as a rule 
 apoplexy and paralyses and Bright 's disease are not classed among 
 the acute specific diseases ; they are ordinarily not considered as 
 having any connection with "germs." 
 
 Symptoms are commonly divided, as stated above, into sub- 
 jective and objective, those that we ourselves feel and those that 
 we can see in others. We may have a headache or feel nauseated, 
 but unless we tell another of it he would not know it. We must 
 take a man's word for the things, symptoms, we can not see; such 
 symptoms are subjective. Cough and vomiting on the other hand 
 are objective symptoms, or signs. 
 
 At times a man will say he feels feverish, and yet the ther- 
 mometer may fail to show any elevation of temperature, he feels 
 so only. A man may complain of being sick and yet the most 
 skilled physician may fail to find any evidence of disease. There 
 may be only a transitory reaction. 
 
 Again a man may say he has the "best of health." He applies 
 for life insurance; he may pass a good examination — until the 
 urine is examined and the blood pressure is taken, then he may be 
 rejected promptly. He may be wholly unaware that he has al- 
 bumin in the urine or that he has a high blood pressure and that 
 there is danger of a sudden termination of his life. Unless such 
 a man is examined by a competent physician he may not learn 
 about his condition at all. 
 
260 DUSTY AIR AND ILL HEALTH. 
 
 Does the presence of albumin in the urine constitute a disease 
 or is it merely a symptom or an indication of disordered function- 
 ing*/ The same question may be asked regarding a high blood 
 pressure. Various causes may bring on such symptoms and yet 
 the physician may hesitate to speak of disease. Often it is a mat- 
 ter of quantity. A trace of albumin or a slight elevation of pres- 
 sure may be disregarded as not signifying anything; much albumin 
 or a very high blood pressure indicates danger. When does health 
 shade off into ill health and into disease and finally into death? 
 To what extent do data enable us to predict? Prediction is the 
 test of science. 
 
 All sorts of people, patients, come before the physician. All 
 complain in some way or other. Why should they come to him 
 unless there is something the matter? Unfortunately the doctor 
 has no instrument to test the presence of pain and its intensity, 
 he must take the patient's word for it, just as the patient must 
 take the doctor's word for it that albumin and a high blood pres- 
 sure are present; exceptionally he may demonstrate their pres- 
 ence, as to the man who has had high school or college labora- 
 tory work. Some patients find it difficult to convince the doctor 
 that there is something the matter; they will not believe the doc- 
 tor who tells them that it is all imaginary — just as the doctor finds 
 it difficult to impress some men that there is something the matter, 
 as when he examines a supposedly healthy man for life insurance 
 and finds albumin and a high blood pressure. 
 
 Some people are constantly running after the doctor for all 
 sorts of trivial complaints, often mere symptoms of discomfort, and 
 so in the end the doctor may tell his patient to ignore slight com- 
 plaints, that there is nothing the matter, meaning ' ' nothing organic 
 the matter." At the other extreme again are people who refuse 
 to consult the physician at all, although there may be something 
 radically wrong, the man, as just mentioned, with albumin and a 
 high blood pressure, perhaps in imminent danger of death from 
 "heart disease" or "kidney diseases," either one or both combined. 
 
 There are all kinds of symptoms of perverted or abnormal 
 
CARDIOVASCULAR AFFECTIONS. 261 
 
 functioning of the organs of the body. When we feel perfectly 
 well or healthy there are no symptoms, we do not speak of "symp- 
 toms of good health," only symptoms of ill health or disease. 
 Some people always complain, some never. Some people readily 
 talk about their ailments, others think it beneath their dignity to 
 complain. Some people when they first come to a new physician get 
 much attention but in time they may be told their ills are "im- 
 aginary," and then they go elsewhere. 
 
 There is an old saying that chronic diseases are mainly of our 
 own making; it goes back to the days when the opposite was be- 
 lieved of acute diseases, that these were sent by Providence or 
 were unavoidable. But since the causes of many diseases and con- 
 ditions of ill health have been discovered, such sayings lose much 
 of their force. Many acute diseases and especially epidemic dis- 
 eases are wholly preventable, especially by a combined effort; the 
 individual alone may be powerless. We need only think of cholera 
 and yellow fever and the plague. On the other hand some "chronic 
 diseases" are as unavoidable as they are unpreventable ; they are 
 incident to the human body, sooner or later disturbed functioning 
 will appear, and in the end all must die. 
 
 Many chronic diseases are due to a man's occupation. Some 
 
 occupations are classed as dangerous, tending to shorten a man's 
 
 life on account of diseases. Knife grinder's rot and phossy jaw 
 
 are handy names. A man may know better than to take up a risky 
 
 occupation and to continue at it, but as a matter of fact we all 
 
 know that some continue after being told by the physician that to 
 
 continue is to commit suicide. The poor man with a family may 
 
 know better but what can he do away from his trade? He is apt 
 
 to work on as long as possible. Plato long ago said: 
 
 "When a carpenter is ill ... . he expects to receive a draught 
 from his doctor, that will expel the disease hy vomiting or purging, or 
 else to get rid of it by cauterizing, or a surgical operation; but if any one 
 were to prescribe to him a long course of diet, and to order bandages for 
 his head, with other treatment to correspond, he would soon tell such a 
 medical adviser that he had no time to be ill, and that it was not worth 
 his while to live in this way, devoting his mind to his malady, and 
 neglecting his proper occupation; and then wishing the physician a good 
 
262 DUSTY AIR AND ILL HEALTH. 
 
 morning, he would enter upon his usual course of life and either regain 
 his health and live in the performance of his business; or, should his con- 
 stitution prove unable to bear up, death puts an end to his troubles." 1 
 
 We also hear of the rich man, perhaps the captain of industry, 
 who has been told he is committing suicide by "working under 
 high pressure." Heart and kidney diseases are considered as 
 "high pressure diseases" par excellence. A man may know that 
 his occupation, "making lots of money," is killing him but in 
 spite of his physician's best advice he will persist. Some want to 
 continue a year or a. few years longer and then retire, but they 
 die before the time is up, or they are so worn out when they do 
 retire that death soon overtakes them. 
 
 Country boys are constantly flocking to cities. Some succeed, 
 many fail. We are apt to hear of the successes but not of the fail- 
 ures. The boy who is unable to "bear the pressure," to "stand 
 the racket," is apt to return home disabled, perhaps by tubercu- 
 losis or some other disease incident to the massing together of hu- 
 manity under conditions not conducive to health and longevity. 
 Perhaps one in a hundred succeeds in bearing life in the large 
 city. When the successful man visits his old home we hear much 
 about him, how well-fed and healthy he looks; his example leads 
 many boys and young men to try city life also. The physician 
 knows that people can not be judged by their appearances and 
 that many who seem in robust health die suddenly and prematurely. 
 
 One almost comes to the conclusion that poor people who can 
 not "keep up pressure" die from tuberculosis and similar wasting 
 diseases, while rich people die from heart and kidney diseases. 
 Such a general statement of course needs qualifying but it seems 
 true in considering the past family history, whether the ancestry 
 is urban or rural or to what extent weeding out on account of 
 unsanitary city conditions has occurred. 
 
 Physicians have a saying that a man is as old as his arteries, 
 meaning the extent to which his arteries have thickened or har- 
 
 1 What the workman should know is that the physician has no "cure" for many ills and that there 
 is no healing herb growing in the garden or woods. He must learn that many ills are of his own making, 
 if they are not due to personal neglect they may be due to the neglect of his employer or of the com- 
 munity as a whole. Here we see the advantage of Unionism, in asking or demanding sanitary reforms. 
 
CARDIOVASCULAR AFFECTIONS. 263 
 
 dened, either through disease or from internal pressure on account 
 of a strenuous life or on account of living under unsanitary con- 
 ditions. Such a saying may of course also be applied to the con- 
 dition of a man's lungs, to what extent they have been destroyed 
 or put out of use on account of clogging up. 
 
 We read of aged Indians and old out-of-door people having 
 arteries "soft as a child's." All physicians know that the lungs 
 of a country man are pink and those of a resident of a smoky and 
 dirty city are black as coal. The city resident may early begin to 
 have hard arteries "to stand the pressure," just as his lungs be- 
 come black on account of the large amount of carbon particles 
 and dust of all kind inhaled. The anemic consumptive dies pre- 
 maturely, just as the robust short necked apoplectic man is apt to 
 die prematurely, if not from apoplexy then from Bright 's disease. 
 
 At times families show a tendency to die from some diseases, 
 or group of diseases, there seems to be some "hereditary tend- 
 ency." Some people expect to die as their father or mother died. 
 Again, at times people will say, "Why we never had such a dis- 
 ease in the family," as tuberculosis, meaning they do not believe 
 they have such a disease or that they will die from it, because 
 "It is not in the family." 
 
 But often the influence of environment is greater than that of 
 heredity so-called. People may die from tuberculosis, because ex- 
 posed to it as none of their ancestors had been. Life in a city is 
 radically different from life in the thinly settled country, in the 
 former the active cause of consumption (tubercle bacilli) is all 
 about, in the other it may be wholly absent. 
 
 In the Introductory I referred to the influence of heredity and 
 of environment, telling of an Indian and a white man who applied 
 for life insurance and how the white man lived on and on although 
 he had been rejected. The usual explanation is that the Indian is 
 not accustomed to a life of civilization, to a life under more or less 
 pressure. We similarly speak of white people who are not adapted 
 to the "high pressure of city life." The Outlook for September 
 1G, 1911, says: "The death rate among the Indians of the United 
 
264 DUSTY AIR AND ILL HEALTH. 
 
 States is two and a half times as great as among the whites . . ." 
 But we should keep in mind that the Indian is still living in the 
 open. One wonders what his death rate would be under city life. 
 
 When we question what is meant by "high pressure" we are 
 apt to get all sorts of indefinite replies (except from those who 
 have studied blood pressure in arteries). The "strenuous life," 
 the struggle for riches, the desire for fame, etc., are expressions 
 that by many are considered synonymous with "high pressure." 
 But we may at once ask, Under what conditions? 
 
 What is meant by high pressure life and where is such life 
 carried on? What distinguishes the high pressure man from the 
 low pressure man? We all have some ideas on the subject. It is 
 generally agreed that the high pressure man lives in the large city 
 where competition to make a living and get riches is keen or fierce. 
 The farmer leading a quiet uneventful life is not apt to be accused 
 of leading a high pressure life. A man's surroundings have much 
 influence. 
 
 The subject is a vast one and all sorts of replies may be made 
 to the query of what constitutes high pressure life. In a subse- 
 quent volume I shall confine myself to one phase of it — high pres- 
 sure as shown in the blood vessels. This may be measured by 
 proper instruments, just as the pressure of a boiler can be meas- 
 ured. Perhaps we are justified in saying that some men like some 
 boilers are working under high pressure and are in constant dan- 
 ger of blowing up. Some blow up early. One can go a step further 
 and say that men like boilers all come to an end, some rust out, 
 some blow up. Some blow up under comparatively low pressure, 
 often well rusted. 
 
 High blood pressure effects as a rule begin to show themselves 
 toward middle life. For one thing those who tended to perish 
 from low pressure affections, notably tuberculosis, perished early. 
 The child of high pressure parents is apt to live through an at- 
 mosphere that tends to destroy others through tuberculosis, he is 
 the survivor of the fittest. Strong respiratory mucous membranes 
 that can stand heavy city air laden with soot and cinders and acids 
 
CARDIOVASCULAR AFFECTIONS. 265 
 
 due to the combustion of coal as well as diseases of all kinds; a 
 strong digestion able to keep up HC1; a strong nervous system 
 that can work many hours a day without breaking down ; similarly 
 a circulatory system that can keep up pressure and keep the blood 
 coursing through the vessels, all these are necessary to reach at 
 least middle life in the large and dirty city. 
 
 Nowadays comparatively few die from accidents or in wars. 
 People die in bed rather than "with their boots on." In older 
 times it was different and in savage times wholly different. 
 
 A very interesting question to the physician is how do city 
 people with a long-lived country ancestry end? Are they likely 
 to live long? 
 
 Why do some families tend to die from diseases attended by 
 low blood pressure, others by a high blood pressure ? At what age 
 do members of such families fail? The death of a small child or 
 of an old man or woman may mean little to a community. The 
 death of a middle-aged man with a large family of children may 
 mean much. To what extent is the community responsible for the 
 death of the head of a family and responsible for the care of his 
 children ? These and similar questions are receiving more and more 
 attention. 
 
 I have referred to this subject very briefly because I intend to 
 take it up in detail later. Here I merely wish to bring out the 
 point that a dust victim may be apparently very robust, that he 
 may not at all fail through tuberculosis or catarrhal pneumonia 
 or through loss of strength, but that car dio -vascular failure may 
 come on suddenly. 
 
 In the original outline for this volume it was planned at this 
 place to cite a number of illustrative cardio-vascular case reports, 
 beginning with early ones that were misunderstood, just as dys- 
 peptics and neurasthenics had been misunderstood. But case re- 
 ports are of such variety and there are so many little things that 
 should be mentioned that I finally came to the conclusion to devote 
 a separate volume to them, especially since the subject of health 
 
266 DUSTY AIR AND ILL HEALTH. 
 
 supervision must be considered in some detail. Here I shall men- 
 tion only one eardio-vascular case on account of the discussion of 
 symptoms, that symptoms may be considered as warnings to be 
 heeded, perhaps as blessings in disguise. 
 
 Mrs. — . Middle-aged well-to-do housewife. (We have not yet 
 reached a stage where we can mention a patient's, or the family's, 
 income to enable the reader to get some idea of an individual's 
 ability to fully live up to medical advice — in the light of this vol- 
 ume, to good air advice, with all that that implies.) She came to 
 me complaining of a train of symptoms, especially nervous symp- 
 toms, that at once directed my attention to the possibility of cardio- 
 vascular disturbances. I found a high blood pressure, as expected. 
 I soon came to the conclusion she was a dust victim and that the 
 high pressure was dependent on exposure to bad air. At the very 
 first interview I told her of my observations on similar cases; by 
 watching air conditions she likely could verify my ideas. She was 
 willing to observe and keep a record. In the course of a few 
 months the idea that her high blood pressure was due to dust in- 
 fluences was fully verified. 
 
 This patient reported at first weekly, then bi-weekly, and finally 
 once a month. During these consultations a number of topics were 
 discussed, and because she was philosophical, some topics were 
 taken up that are ordinarily not considered at all. 
 
 With such a patient one can consider health supervision in 
 detail, how much or how little is to be expected from it. One can 
 discuss details that one would scarcely think of taking up with 
 the individual whose whole life is a constant struggle for existence 
 and to whom sickness and inability to work spell disaster. 
 
 Here and there in this volume I referred to discussions I had 
 with patients in whom there was no marked organic change, who 
 under good air conditions would likely go on for years. But there 
 is another class of patients, cardio- vascular cases, the kind just 
 mentioned, in whom on account of high blood pressure there may 
 be a more or less marked change, especially a thickening of the 
 blood vessels to resist pressure. How long such an individual will 
 
CARDIO-VASCULAK AFFECTIONS. 267 
 
 last is a problem. It may be a matter of a short time only, but 
 with prudence he may last for years even though one feels that 
 the span of life is very uncertain. To what extent shall conditions 
 be freely discussed with an individual of this kind? Here we must 
 at once distinguish between those who are philosophical, who look 
 things squarely in the face, and the opposite, those who if they 
 knew the real condition of affairs would "fly to pieces." (Shall 
 we speak of a third group, the religious, who believe they are in 
 God's hands and take no care of the morrow? Some of them call 
 on the physician at the eleventh hour when little or nothing can 
 be done. Shall we add that the world is advancing and that even 
 the fatalistic Turk is outgrowing old time beliefs?) 
 
 As a general statement it may be said that the intellectual and 
 those in easy circumstances who need not worry on account of finan- 
 cial conditions belong to the former class, while the ignorant and 
 those in straitened circumstances as a rule belong to the latter 
 — people not apt to read this volume. 
 
 In order to teach the average patient the physician must appeal 
 to his intelligence and past experiences and use suitable illustra- 
 tions. Some learn with difficulty, some are apparently unteachable. 
 On the other hand is the exceptional individual, shall we say he 
 belongs to the class who are readers? (Out of the many local li- 
 brary users the vast majority are only novel readers). He is the 
 individual with whom one can discuss things frankly, things that 
 one does not discuss with the average individual who comes to the 
 doctor's shop. It is necessary to refer to this matter in order that 
 the remaining portion of this volume will be properly understood. 
 Often one hesitates to speak freely about some topics for fear of 
 being misunderstood. Needless to say in making verbal explana- 
 tions one always feels his way, statements can be immediately mod- 
 ified, objections answered and adverse criticism that one gets by 
 rushing into print avoided. 
 
 The following topics have been discussed with comparatively 
 few patients and that means opinions are subject to revision and 
 correction, many are topics upon which opinions differ widely. 
 
268 DUSTY AIR AND ILL HEALTH. 
 
 Living in Isolation. The above patient had learned in the 
 course of time that she had least ill health, or disagreeable symp- 
 toms, by living in isolation, by rarely going into crowds. Because 
 she rarely went into crowds, she was regarded as peculiar, a fact 
 which she realized but said she did not care. She looked the pic- 
 ture of health ; when she did attempt to explain her condition and 
 ill health she was not understood. She preferred to live in isola- 
 tion and be misunderstood rather than go out and make misunder- 
 stood explanations. Not knowing where the real danger lay she 
 went to extremes and yet in spite of being "exceedingly careful" 
 she had more or less ill health. After her attention was directed 
 to the dust factor she knew how to guard herself properly and at 
 the same time she realized that there was less need of isolation, 
 her only requirement to have good health is good air. 
 
 She is literary, fond of reading and discussing literature, but 
 opportunities to take part in discussions are limited. I have re- 
 peatedly met individuals of this kind and several times I have 
 advocated the formation of a "High Pressure Club," that is, for 
 people of kindred ailments and kindred minds to meet now and 
 then, under suitable air conditions, of course, to discuss topics of 
 mutual interest. But there are too few in a small community 
 whose minds are really kindred and so nothing came of the project. 
 
 Patients of this kind as a rule are interested in reading the 
 biographies of literary people who had chronic ill health. They 
 readily understand the air factor, likewise why such individuals 
 may have needed the contact of kindred minds, perhaps only to 
 be found in large cities, while health conditions demanded retire- 
 ment to the pure air of the country, as in the case of the Carlyles, 
 who mentally required city life but physically country air. Sam- 
 uel Johnson says : 
 
 "There is indeed no need of research and refinement to dis- 
 cover that men must generally select their companions from their 
 own state of life, since there are not many minds furnished for 
 great variety of conversation, or adapted to multiplicity of intel- 
 lectual entertainments." 
 
CARDIOVASCULAR AFFECTIONS. 269 
 
 To What Extent Shall One Advise a Life of Seclusion? 
 Every physician knows that patients if put on a certain track often 
 go to extremes, something which one may greatly regret. The indi- 
 vidual who has a tendency to lead a secluded life may become 
 practically a hermit. On the other hand, to advise a life of more 
 or less seclusion to one who is fond of society may mean the prompt 
 termination of the relationship of physician and patient. For in- 
 stance, a middle-aged woman, very fond of society, came to me com- 
 plaining greatly. I concluded she was a dust victim with a high 
 blood pressure. There may also have been kidney disturbance but 
 she objected to any examination to give certainty. She wanted to 
 know if I could not simply give her some medicine or some good 
 advice. I promptly advised her along the line of pure air require- 
 ments. "When she fully understood what this meant, to go out less 
 into society and into crowds of all kinds, she suddenly exclaimed, 
 "Don't you have any social aspirations yourself to realize what 
 your advice to me means?" What shall one say in reply? This 
 woman was mentally the opposite from the one just mentioned; 
 a free discussion was entirely out of the question. I merely said 
 that a physician could simply advise; the patient would have to 
 decide whether to follow the advice or not. Had she been a relative 
 or a good friend, I should have insisted that my advice be followed. 
 When she found I had no curative medicine and that in order to 
 feel better she would have to cut down on social affairs, she did 
 not become my patient at all. 
 
 Going to Church or Not. If a physician is satisfied that going 
 to church has a bad influence on states of health, should he advise 
 the patient to remain away? 
 
 Now we all know that a certain class of individuals place re- 
 ligion above everything; some who are born into a certain religion 
 think they can not get along without it, and if the physician were 
 to tell them not to go to church they likely would promptly change 
 doctors. This is especially sad in the case of old people who be- 
 lieve they must go down town to church almost every day and on 
 
270 DUSTY AIR AND ILL HEALTH. 
 
 this account are in constant ill health and misery. There are Very 
 few individuals with whom one can discuss this question freely. 
 
 It should be kept in mind that in a small community all sorts 
 of people meet in the same church. The very cleanly and those 
 the opposite come together. Those coming from clean suburbs and 
 those from what amount to slum districts meet. One can point out 
 these tilings and how in large cities churches will be found in the 
 clean suburbs, attended only by cleanly people, where air condi- 
 tions are unobjectionable. If a patient is very religious one can 
 advise a removal to a community where churches are kept clean 
 and well ventilated, and where the importance of sanitation is un- 
 derstood. Here is a pertinent clipping from the Western Christian 
 Advocate of May 12, 1909 : 
 
 "THE DOORKEEPER IN THE HOUSE OF THE LORD. 
 
 "Some one, somewhere, some time ought to establish a college of jan- 
 itors. The ignorance of the average janitor as to problems of sanitation 
 in public buildings, the regulation of beat, and particularly of proper 
 ventilation, is immeasurable. Church trustees generally hire the lowest 
 bidder to take care of the church, open and close the doors, sweep and 
 dust, and make the fires. The functionary is ignorant of the most ele- 
 mentary principles regarding fresh air, and in fact seems to have an an- 
 tipatby to it; it hinders getting the auditorium quickly heated. It never 
 occurs to him to effect a change of atmosphere after one congregation bas 
 used up all the ozone. Not infrequently ancient things in the basement 
 send up through the registers hot air charged with staleness and musti- 
 ness. If the wind blows through the church-rooms once a week it is a 
 liberal allowance. 
 
 Frequently a congregation breathing devitalized air, even when most 
 interested, shows signs of drowsiness and stupidity after the first quarter 
 of an hour. It affects the preacher, too, who feels that he's speaking in 
 a kind of vacuum. His lungs are soon exhausted of their vitality. It's 
 an immense pity that so often the whole service of worship — the comfort 
 and profit of the people — the sermon upon which much care and labor has 
 been expended — should be utterly spoiled by the stupidity of some in- 
 competent janitor who gets the church too hot or too cold, too stuffy or 
 too draughty. Architects should pay more attention to the beating and 
 ventilation of churches of even small cost, and church trustees ought to 
 pay enough for the services to "the sexton" to secure men of some knowl- 
 edge, experience, and judgment." 
 
CARDIOVASCULAR AFFECTIONS. 271 
 
 Such a "fresh air" article should direct the attention of church 
 people to the importance of selecting good janitors. 
 
 From general remarks I might briefly refer to a specific case: 
 One day as I passed one of our large new churches on the street 
 car, the colored janitor was standing in the doorway, arms akimbo, 
 and just then spat a large mouthful of tobacco juice on the fiber 
 doormat before him. (In the nearby High School I have seen the 
 janitor spit into the hot air register — and I am told that at least 
 one of the teachers did the same.) Is it necessary to say that no 
 clean community would for a moment tolerate such conditions and 
 that an enlightened congregation would be very careful in selecting 
 a janitor? Negroes in whom the weeding out process has been 
 going on only a short time and who have a high death rate from 
 tuberculosis are least desirable as janitors. 
 
 Advising a Patient to Move. Cities vary greatly in cleanli- 
 ness and especially in respect to the spitting habit. Some of my 
 patients who complain greatly here do very well under a different 
 environment. Shall a physician advise them to move? Those an- 
 swering from a selfish standpoint will likely say No, for constantly 
 to send away good patients leaves one with a lot of poor ones un- 
 able to get away. But when one considers the patient's welfare, 
 puts oneself in his place, the matter assumes a different aspect. 
 
 As already mentioned, our streets are either covered with dust 
 or mud and the down town sidewalks with spittle and floors of 
 public buildings are not clean. It is difficult, almost impossible, 
 to escape dust infection. Practically the only solution is to remove 
 to a clean community. There are few unbiased individuals with 
 whom one can freely discuss this question of moving, of leaving 
 one's home town and friends. The physician who speaks frankly 
 is likely to acquire the reputation of being opposed to a community, 
 of being a "knocker." 
 
 Keeping a Daily Record I have already referred to this in 
 the case of ordinary patients. The question assumes a somewhat 
 
212 DUSTY AIR AND ILL HEALTH. 
 
 different aspect with the educated, those who lead a mental life in 
 addition to merely vegetating. In the one class a diary or a record 
 may be very simple, in the other it may be complex. Some people, 
 patients, are afflicted with insomnia ; they lie awake at nights think- 
 ing all sorts of thoughts. Should there be a mention of these 
 thoughts in a daily record, should patients be told to make an 
 attempt to find out why certain thoughts come up? 
 
 At times the patient here under discussion would have a train 
 of thoughts and an almost irresistible impulse to get up and write 
 them out Her previous physicians had told her to resist, not to 
 get up, that it would only aggravate her insomnia. I advised the 
 opposite course, both because the thoughts or ideas might be val- 
 uable and if not written down the remembrance might be wholly 
 lost the next morning, and because the mind would perhaps be at 
 ease after these insistent thoughts were written down. I advised 
 that when there was an active train of thought either to get up or 
 to write in bed, telling of my own experience in having accustomed 
 myself to writing in the dark. My observations lead me to con- 
 clude that when this is done sleep usually follows. It seems some 
 individuals will lie awake at night with a train of thoughts con- 
 stantly going through the mind, while the moment these thoughts 
 are put down on paper the mind is at rest and sleep returns. The 
 number of patients with whom one can discuss such a "Seelen- 
 leben" is very limited indeed. 
 
 Mental Influences. Neglecting Symptoms. Individuals 
 vary greatly in regard to imagining things. Some with active 
 minds are constantly thinking about things, even dream about 
 them, while others apparently do not think or dream at all. The 
 appearance of certain symptoms may cause a good deal of worry, 
 merely by imagining all sorts of things. We dread what we do 
 not understand. I have already referred to a patient lying awake 
 at night. Shall we advise neglecting symptoms or shall we tell 
 the patient to attempt to determine under what conditions this 
 active thinking or active imagining occurs? But even the most 
 active minded individuals have times when they feel dull and think- 
 
CARDIO-VASCULAR AFFECTIONS, 273 
 
 ing is an effort. Perhaps here too one may make an effort to find 
 the reason. 
 
 Euthanasia. In the family history of this patient "gradual 
 death" has been the rule, that is, there has been much lingering 
 sickness and much suffering before death finally occurred. One 
 day she told me she dreaded dying that way, she would prefer to 
 die suddenly. This naturally led to a discussion of the usual fate 
 of a high pressure victim by apoplexy, although there may be 
 repeated apoplexies and much paralytic disturbance before there 
 is a "stroke" sufficiently severe to kill. Early strokes may simply 
 disable, perhaps be followed by much misery, while those coming 
 in later years are apt to kill quickly. If the individual can live 
 in a manner to keep off early strokes there will likely be euthan- 
 asia, in fact he may die of some other affection than the familial 
 one. 
 
 This is not a pleasant subject to discuss, yet if an individual 
 wants discussion to get light, to whom will she likely apply? To 
 whom if not a physician ? 
 
 This subject naturally led to a discussion of views among phy- 
 sicians regarding euthanasia, a topic that is ordinarily tabooed. 
 We both came to the conclusion that a physician should be careful 
 how he talks about this subject, that a physician's function relates 
 to the prolonging of life and palliating suffering in the incurable. 
 
 But not all want a sudden and painless death; the religion of 
 some is opposed to this idea of sudden death, some pray against 
 sudden death, they want time for extreme unction. On the other 
 hand a preacher told me, "Be prepared to die at any time." 
 
 Herbert Spencer while doing newspaper work in the heart of 
 
 London and putting in his spare time on his first book, relates in 
 
 his autobiography: 
 
 "The offspring of the mind, like the offspring of the body, are apt to 
 become objects of engrossing interest to which all other objects are sub- 
 ordinated. A striking illustration of this was furnished by me early in 
 1849, as I was taking my morning walk in St. James's Park. The weather 
 was frosty; and, having a bad cold, I was coughing violently. Abrasion 
 of a small superficial bloodvessel produced some appearances which I, 
 
 (18) 
 
274 DUSTY AIR AND ILL HEALTH. 
 
 little the better it seems for such medical knowledge as I possessed, ab- 
 surdly Interpreted into spitting of blood, and at once inferred tbat I was 
 doomed. As I walked on in saddened mood, my first thought was — "It will 
 be a pity if I can't finisb my book first." p. 406, Vol. I. 
 
 Herbert Spencer soon realized that bad air did not agree with 
 him and he moved to the clean suburbs and spent much time in 
 the open — and in the end died of "old age," aged eighty-three 
 years. 
 
 Discussion of Symptoms. Symptoms have been briefly dis- 
 cussed in Chapter V. But there is another side to the question, 
 one that can be discussed with only a. few, with the philosophical. 
 This is the beneficence of symptoms. Ordinarily it is assumed that 
 symptoms (and indeed ill health and disease) are great evils, but 
 arguments can be advanced in opposition, that symptoms are bless- 
 ings in disguise. 
 
 It should be kept in mind that in cardio-vascular cases one can 
 make rather sharp distinctions between subjective and objective 
 symptoms, those which the patient experiences and which the phy- 
 sician must take on faith, and those symptoms or signs that may 
 not be recognizable by the patient himself, at least seldom are, but 
 which can readily be determined by the physician. For instance, 
 all statements referring to pain have to be taken by the physician 
 for what they are worth, he has no instrument to determine the 
 presence of pain or to estimate its intensity. On the other hand 
 variations in blood pressure, variations in the action of the heart, 
 variations of urinary constituents and the appearance of abnormal 
 substances may be wholly unknown to the patient and unrecog- 
 nizable by him. Ordinarily a physician does not go into details 
 regarding objective symptoms, or "laboratory findings," because 
 few patients understand them, but he may to good advantage dis- 
 cuss subjective symptoms, and, in the case of the philosophical, 
 show that the popular conception is not a good one, that as a rule 
 symptoms are blessings in disguise; that they are warnings from 
 nature to be heeded. The subject is a vast one; one can not do it 
 justice in a brief discussion. 
 
CARDIOVASCULAR AFFECTIONS. 275 
 
 Symptoms of III Health. Symptoms of Disease. It may be 
 said that diseases are due to definite pathogenic or disease-pro- 
 ducing causes, and on the other hand that common ill health is 
 usually due to an abnormal environment, or to variable causes. 
 Nature tells us through symptoms that something is wrong; by 
 heeding the warnings and avoiding abnormal conditions symptoms 
 will likely subside. 
 
 Language and letters enable us to express our ideas to others, 
 both must be learned. Some ideas can be expressed by the illiter- 
 ate, we need only think of the cry of a small child. But what a 
 vast difference between the illiterate man and the educated chronic 
 in telling about symptoms! 
 
 People vary greatly. On the one hand we find people who "go 
 all to pieces" on the appearance of ill health and disease; on the 
 other hand are those who are philosophical and remain calm. Time 
 of course makes great changes, and the at first impatient may be- 
 come patient and philosophical. The man sick for the first time 
 wants to be cured at once; the old chronic merely asks for relief, 
 to reduce symptoms to a minimum. 
 
 "With some individuals there is no discussing symptoms, all 
 they want is medicine that will cure. With some a physician must 
 almost speak of symptoms as entities, as something to be "driven 
 out," perhaps by a very disagreeable smelling or tasting medicine. 
 To the few one can point out that many symptoms are due to an 
 unsanitary environment (in dust victims) and that removal from 
 the cause may be all that is necessary for symptoms to disappear. 
 With an exceptional patient, the philosophical, as just mentioned, 
 one can even discuss symptoms as beneficent processes, sent by Na- 
 ture to warn us, or to enable her to repair damages. 
 
 With that rare individual who has some knowledge of Evolu- 
 tion the subject can be discussed from an evolutionary standpoint, 
 of the survival of the fittest, and how Nature has weeded out those 
 who do not heed warnings, and how the process is still going on 
 today. 
 
276 DUSTY ATR AND ILL HEALTH. 
 
 SYMPTOMS OF ILL HEALTH AS WARNINGS FROM 
 
 NATURE. 
 
 In enumerating symptoms it is always a question how they 
 should be given, in alphabetical order or in the order of their im- 
 portance, and whether common or technical names should be used. 
 
 Anorexia. This is the technical term for loss of appetite, and 
 whether this term is used or "Appetite, loss of," it would still 
 head the list in alphabetical order, as it would also according to 
 its importance, coming only after Pain. 
 
 Loss of appetite is very common, both in ill health and in dis- 
 ease. AVhen a man is sick Nature takes away his appetite, and 
 that means the stomach is getting a rest and the patient has to 
 rest; and in the mean time Nature is repairing the damage, or 
 fighting off the disease. The worst form of treatment is to insist 
 on the invalid eating. (I am of course not speaking of the excep- 
 tional case where feeding may be required.) 
 
 At times we hear individuals say after an attack of typhoid 
 fever, "after that I never felt better in my life." This means for 
 one thing that he had been resting and fasting. Dr. Tanner fasted 
 forty days, and so we need not fear starvation from a few days' 
 fast. 
 
 Asthenia, which literally means lacking strength, is due to a 
 great variety of causes. It may be due to anemia, a deficiency of 
 blood, either in quantity or in quality. If much blood is lost from 
 a wound or an injury we all know that by keeping quiet in time 
 nature replaces the loss. If loss of strength as well as anemia is 
 due to lack of food, proper food will restore normal conditions. 
 Bad air may occasion an anemia that produces a great loss of 
 strength. In fact the individual may get so weak that he must 
 remain at home. There are all sorts of tonics but the best one after 
 all is exercise in the open air. and in proportion as an individual 
 does stay away from bad air conditions he gets better. The man 
 who is wise will staj r away entirely, or he will change his occupa- 
 tion or remove from an unsanitary environment. Many in ill 
 
CARDIO- VASCULAR AFFECTIONS. 277 
 
 health must get worse before they get better, before heeding Na- 
 ture's warnings. 
 
 Breath, Getting out of (Dyspnea). This is a very common 
 symptom, especially among those not accustomed to exercise. When 
 they do exercise beyond the extent to which they are accustomed 
 the body rebels, Nature takes away the breath and the individual 
 must desist. It is a wise provision of Nature, otherwise a weak 
 heart might quickly go to pieces. But many individuals who are 
 weak need exercise. They should start in gradually and the whole 
 body, including the heart, will react and get strong, and then they 
 are able to do considerable exercising without getting out of breath. 
 
 If the individual who is short of breath persists in exertion he 
 is likely to faint and that will make him. desist. Shall we say that 
 that is an additional way Nature has of enforcing her warnings? 
 
 Cough. This has already been sufficiently referred to under 
 Colds and Catarrh, as being a provision of Nature to bring up for- 
 eign substances, especially dust. If a certain cause brings on cough, 
 the proper treatment is to avoid that cause and not to use a cough 
 cure, which may simply numb the nerves of sensibility and thereby 
 aggravate in the end. 
 
 Chilling. Chilling is due to various causes, as previously men- 
 tioned. In cold weather it is a warning to keep out of the cold, 
 or to dress warmer. To chill after a cold bath means to avoid 
 cold baths. To chill after exposure to bad air means to avoid the 
 cause. 
 
 Constipation. It may seem odd to mention constipation in 
 connection with conservative or beneficent processes, and yet it has 
 been claimed that a less amount of fluid makes the feces less a 
 culture medium for injurious bacteria, that it is a provision of 
 nature to help the body. Be that as it may, I find over and over 
 in dust victims that constipation is to be regarded simply as a 
 warning and if the warning is heeded and the environment is 
 changed, the constipation subsides naturally. 
 
278 DUSTY AIR AND ILL HEALTH. 
 
 Emaciation. This may be dependent on a great variety of 
 causes. Loss of flesh goes hand in hand with illness, and that means 
 to rest, and often when an individual rests Nature is given a chance 
 to correct the difficulty on which emaciation depends. If emacia- 
 tion is dependent on food, as among the poor, the proper remedy 
 is an abundance of nutritive food, not a little medicine, which often 
 simply benumbs sensibility. If loss in weight is dependent on con- 
 tinued infection, with the body at a disadvantage, the proper rem- 
 edy is to get awaj 7 - from the source of infection. If it is dependent 
 on bad air the remedy is clear. If emaciation is dependent on the 
 presence of pernicious disease, then the Lord help you — you are 
 past the aid of man. We should try to avoid pernicious diseases 
 in time. Much is preventable. 
 
 Fatigue. Fatigue spells rest from work, from whatever pro- 
 duces the feeling of fatigue or of being tired out. A man who is 
 fatigued from hard manual labor requires rest; that is a truism 
 recognized by everybody. A society woman who is "overworked" 
 may also require rest. To the latter many things are a real task 
 that to others may be a pleasure, as making calls or going to par- 
 ties; the poor who make these at long intervals enjoy them, while 
 one who does this constantly may find it a burden. Fatigue may 
 go to the point of loss of ambition, that is a warning that many 
 heed, and then Nature is apt to restore the balance. It would seem 
 some cases of fatigue, 1 so-called nervous prostration, are simply 
 cases in which the defences of the body against infection are over- 
 worked, merely getting into good air causes the symptoms to sub- 
 side. 
 
 Fever. This may be said to be Nature 's way of telling us what 
 is going on during infection. Its height can be measured by the 
 thermometer. Fever may really be a conservative process and phy- 
 sicians are careful how depressants are given, drugs that "break 
 the fever." A mild fever may not be heeded by an individual, 
 but when it is high he will likelv decide to take to his bed. Rest 
 
 1 1 am here not making fine distinctions between termi. 
 
CARDIO-VASCULAR AFFECTIONS. 279 
 
 in bed is one of the best medicines, but unfortunately many are 
 opposed to it, or were so in former days when the sick room was 
 closed up tightly and darkened, wholly unlike the modern sick 
 room in a hospital. 
 
 Hyperacidity of the Stomach. This may be simply a pro- 
 vision of Nature to fight off infection ; if it disappears in good air 
 the remedy to a sensible man should be clear — get out. It may be 
 added that the causes of hyperacidity as of high blood pressure are 
 poorly understood and there are all sorts of theories and endless 
 discussion. 
 
 High Blood Pressure. Is this too to be regarded as a con- 
 servative process? Does it help the individual for a time? Often 
 it goes to extremes and ends fatally. If a high pressure subsides 
 by a change in environment, should the physician discuss the sub- 
 ject fully with his patient and advise him to make a change? (This 
 was done in the case of the present patient — by living up to the 
 pure air requirements her high pressure with a train of symptoms 
 promptly subsided.) 
 
 Insomnia. There are many causes that produce sleeplessness, 
 many of them dependent on environment. The countryman is un- 
 able to sleep near a boiler shop ; the city man is kept awake by the 
 crowing rooster. The natural time to sleep is at night when things 
 are quiet, and for countless ages man has slept under such condi- 
 tions; those who "turn night into day" are reversing the order of 
 Nature. If a man persists with night work after being warned that 
 is his lookout — he can take sleeping potions if he wants them. If 
 sleeplessness subsides by changing the mode of life, that is the 
 proper thing to do; similarly if others find they are able to sleep 
 under good air conditions they should make a change. 
 
 Mucus Formation. An excessive mucus formation is common 
 in simple catarrh, so frequent in people who inhale irritating mat- 
 ter. The mucus is sent out to protect the delicate membranes and 
 to entangle the irritating matter; when enough has accumulated 
 
280 DUSTY AIR AND ILL HEALTH. 
 
 it is spat out. This subject has been treated under Colds and 
 Catarrh. Unfortunately some individuals with cardio-vascular dis- 
 turbance have no mucus formation and do not spit ; everything 
 inhaled seems to remain in the body. Mucus formation is most 
 common in the throat. It is also common in the stomach. If a 
 certain cause is known to produce it, the proper treatment is to 
 avoid the cause. If that is not done the simple mucus formation 
 is usually followed by pus; when this has gone to the point of 
 corroding a blood vessel and there is a spitting of blood, the warn- 
 ing is heeded, but unfortunately often too late. 
 
 Pain. There is scarcely a letter of the alphabet under which 
 a number of remarks on symptoms can not be made, but this is not 
 the place to attempt a systematic enumeration. The subject of 
 pain itself could be considered in many pages. Pain above all 
 other symptoms is beneficent (with exceptions, of course). We see 
 this in the case of a broken bone. "With the least movement there 
 is intense pain, that means to keep quiet ; in proportion as there 
 is immovability the broken bone knits together and is perhaps as 
 serviceable as ever. When the stomach is inflamed or injured or 
 irritated, there is pain when food is put into it; that means to 
 keep food out until the damage is repaired. The sick dog goes in 
 hiding and refuses to eat. 
 
 There are many different kinds of pain, different names. There 
 is a "pain of the nerves," so-called neuralgia. This is sometimes 
 said to be a "cry of the nerves for pure blood," often it is only a 
 call for pure air. The pain may disappear along with any defi- 
 ciency in the blood or "impure blood." Then there is a form of 
 pain known as "rheumatic," but this may not at all mean real 
 rheumatism. I feel convinced that much of the common rheumatic 
 pain is simply a reaction to bad air conditions ; the warnings should 
 be heeded. When pain is very severe it usually is heeded. 
 
 A pain in the back does not ordinarily mean Bright 's disease 
 but may mean dust infection. Some individuals have acute pains 
 at the site of an old injury, as during an acute attack of dust in- 
 fection. Such a pain may be a veritable barometer and the indi- 
 
CAKDIO-VASCULAR AFFECTIONS. 281 
 
 cations should be properly read. Some pain is of course purely 
 psychical, perhaps the result of misdeeds and the fear of being 
 discovered; here there may be a clear relationship of cause and 
 effect and of the remedy. 
 
 Skin Symptoms. Symptoms connected with the skin occur in 
 variety. The face may be a good index of "bodily conditions and 
 states of health," yet some dust victims "look healthy" and get 
 no sympathy — so they suffer in silence. 
 
 Dryness of the skin is common in those with chronic ill health 
 and on the other hand in many acute diseases excessive perspira- 
 tion is common. Perspiration comes on from various causes, as 
 undue exertion, either bodily or mental. In the man unaccustomed 
 to physical exercise any undue exertion may turn to heat and per- 
 spiration; gradual exercise, increased from day to day, prevents 
 this. In the palms of the hands blisters form readily on hard man- 
 ual application, as after rowing; the soft skin is not adapted and 
 rebels. By going about it gradually, exercising a little every day, 
 the skin adapts itself, it becomes hardened and calloused. Muscles 
 at first flabby soon become hardened and solid. These are adapta- 
 tions. 
 
 The question of "becoming hardened" to bad air conditions is 
 an interesting one. We all have heard how the Indian is "hard- 
 ened" so that his whole body is like the white man's face, "all 
 face" — and yet the Indian does not thrive under the conditions 
 under which the white man lives in cities. Parents who attempt 
 to "harden" their children by little clothing and by exposure to 
 cold and giving cold baths may unconsciously enough be going on 
 the theory of "cure or kill." Those able to stand such a "hard- 
 ening process" may be nothing more than the survivals of the 
 fittest, the unfit perish — better dress children warmly and avoid 
 undue exposure. 
 
 In dust victims flushing, a sense of heat in the face, is very 
 common. I tell my patients it should be regarded as a warning 
 to stay away from crowded places where the air is bad. Many dust 
 victims have an eruption of the skin, pimples. One may personify 
 
282 DUSTY AIR AND ILL HEALTH. 
 
 Nature and say that is the way she teaches an individual to remain 
 in seclusion. A dust victim under good air conditions may find 
 that his face will soon clear up. This is a good argument for those 
 who are fond of dances or theaters; their complexion clears up 
 when they live in good air. 
 
 Sallowness may be regarded as a warning, as a conservative 
 process. People when told they "look bad" are apt to make some 
 sort of an effort to better their complexions, and that usually means 
 their health. 
 
 When I was a boy of about twelve I had a chum who every 
 Saturday afternoon blacked the family shoes. Occasionally I 
 would help him, so he could play with me. One day he said, "If 
 this shoe had a white spot on it that nobody could get off, I could 
 get it off." How? "I would black over it." 
 
 That is the way some people change their complexion, they 
 paint it over. Some "complexion cures" merely form a coating 
 over the skin, and that too is the method of many a symptom- 
 prescribing doctor who apparently causes a symptom to disappear. 
 
 To the very scientific diagnostician of diseases, pain, as a symp- 
 tom, is of the utmost importance, in general we may say all others 
 are of secondary importance. On the other hand to the general 
 practitioner of medicine (not to speak of the specialist, the derma- 
 tologist) the skin is of the greatest importance, because its appear- 
 ance, in large measure determines people to consult a physician. 
 Many will come only when they look bad, and when they are not 
 benefited by advice, or medicine, resort to advertised "cures" of 
 all kinds — complexion cures, pimple cures, eczema cures, dandruff 
 cures, baldness, etc. 
 
 Some people, women particularly, may ignore symptoms, even 
 marked pain — but a bad complexion is likely to be heeded. A 
 "bad complexion" may be considered a warning that something is 
 wrong in the body, the skin merely reflecting it. Symptoms are 
 variously classifiable. Some manifest themselves locally, others 
 generally or in some distant organ. Formerly we heard much of 
 reflexes. 
 
CARDIO- VASCULAR AFFECTIONS. 28 .'j 
 
 Some symptoms are modifiable, others not, they will cither be 
 present or absent. In many diseases there are characteristic symp- 
 toms with a variable number of secondary or minor ones, often 
 largely dependent on environment. The tone or appearance of the 
 skin may be an index of the general health. The man or child with 
 a "bad. color" or "sickly appearance" may go to the country, 
 seashore or mountains, and in a short time return home with a 
 different-looking skin, perhaps tanned, and then we may hear of 
 a "healthy color." Such observations are of course only "skin 
 deep." Our school children during the closed door season acquire 
 sickly, sallow complexions, not to speak of actually becoming dis- 
 abled. It is remarkable how they improve during the summer 
 vacation — and how they relapse the next fall or winter. Why do 
 not parents inquire into the causes or reasons? 
 
 The hair and teeth in their development are derived from the 
 skin, as any embryologist will explain. The evolutionist might 
 make any number of remarks on changes in skin, hair and teeth 
 incident to civilization, getting away from the simple life. 
 
 The loss of teeth, of hair, and the loss of contractility of the 
 blood vessels in the skin are incident to our altered mode of living. 
 Soft food and a mouth full of bacteria are detrimental to teeth. 
 Tight headcovering, compressing blood vessels and excluding light 
 and air, and using comb and brush full of germs of all kinds (men 
 in barber shops) are all factors in baldness. Primitive people do 
 not know of premature baldness. "Warm clothing and living in 
 warm houses means a less active cutaneous circulation. In many 
 indoor dwellers the skin seems to have lost this important func- 
 tion to a large degree — a fatal defect in cardio-vascular cases ; the 
 altered skin can not aid the failing kidneys. 
 
 Gray hair is a sign of advancing age. To pull out the first 
 gray hairs does not retard the process of growing old, no more 
 than dyeing the hair; neither does painting the skin help. But a 
 good set of artificial teeth has been a boon to many a person in 
 enabling him to properly masticate his food (often too well, leading 
 him to overeat). 
 
284 DUSTY AIR AND ILL HEALTH. 
 
 Tinnitus. Buzzing in the ears is a symptom due to a variety 
 of causes, a very common one being an excessive use of quinine, so 
 freely taken by many. To avoid the cause means to avoid the 
 effect. Quinine is rarely indicated and should be token only when 
 prescribed by a physician ; when it disagrees he can likely give a 
 substitute. People use quinine for colds when the proper remedy 
 is good air. 
 
 Buzzing in the ears is very common in city people ; many as- 
 cribe it to noise, but more commonly it is due to dust. Tinnitus 
 may be regarded as a veritable dinning into our ears to get out of 
 an unsanitary environment. Many of my patients have found 
 it so. 
 
 Only the other day I met one of my old patients who was 
 greatly annoyed by a buzzing in one of his ears during the closed 
 door season. He spent last winter in Florida, led an outdoor life 
 and did not notice any buzzing at all until he returned. He has 
 now practically decided to spend his winters in a warmer climate. 
 
 Vomiting. This goes hand in hand with the first symptom 
 mentioned, loss of appetite. If the stomach is irritated or de- 
 ranged, Nature takes away the appetite. If a foolish man per- 
 sists in forcing food down, it is vomited up, just as irritants gen- 
 erally are vomited up. The early morning vomiting has already 
 been referred to as frequently being connected with the spitting 
 up of dust-laden mucus. It usually disappears promptly on hav- 
 ing good air in the sleeping room at night, or if need be also good 
 air in the day time. 
 
 "Weak Heart/' Here I am not attempting to make a sys- 
 tematic enumeration of symptoms, of which there are a large num- 
 ber, but one must at least refer to "weak heart" as a supposed 
 symptom of heart disease. Some people, patients, are told, "You 
 must be exceedingly careful, you have a weak heart," We may 
 ask, Why? Why do people have weak hearts? Or shall we ask 
 a patient who says he has a "weak heart," How do you know? 
 
 Some people have weak arms and legs. Reason, lack of exer- 
 
CARDIO-VASCTTLAR AFFECTIONS. 285 
 
 cise. Some people have weak or feeble intellects. Some are born 
 so but more often the reason is failure to exercise the brain. Some 
 people have "weak hearts" because they fail to exercise and give 
 the heart muscles some work to do. Muscular tissue when not used 
 becomes flabby. The heart is a muscular organ, often it is the last 
 organ to fail. 
 
 But every physician knows that the advice to take physical ex- 
 ercise must be given cautiously. At the one extreme are those to 
 whom we can readily say, What you need is exercise, lots of it. 
 At the other extreme are those who must be advised very cau- 
 tiously, where the heart muscle has degenerated to such an extent 
 that vigorous exercise is apt to be fatal at once, embodied in the 
 saying, Do not run after a street car. This also applies to the man 
 with a high blood pressure to whom sudden exercise may be fatal. 
 Between these extremes there are all sorts of eases where the phy- 
 sician must carefully discriminate. On the one hand there is dan- 
 ger of overestimating and on the other hand of underestimating 
 conditions and requirements. A supposed weak heart may really 
 be a strong one and the opposite may be true. 
 
 In some individuals (those with hypertension) the heart may 
 be exhausting itself in working against an excessively high blood 
 pressure — comparable to using a force pump when an easy work- 
 ing pump only is required. The strain of keeping the blood in 
 circulation may be all the heart can do; physical exercise, work, 
 may promptly bring on dyspnea and that means to desist. But 
 the high pressure individual may find that he can breathe well in 
 good air — and that may be the solution for his difficulties, if he will 
 only heed the warnings. 
 
 Worry. And what shall be said of worry? One of the pet 
 symptoms of the patent medicine man, of the symptom-prescriber 
 and of the faith and mind curist is worry. 
 
 Worry is an old word; it goes back to times when life was 
 simple, then worry meant to choke or suffocate. It was applied 
 to an actual struggle, a taking hold of the throat. But in the 
 course of time the term was applied to a mental state or condition 
 
286 DUSTY AIR AND ILL HEALTH. 
 
 without perhaps a basis in fact. Today most of our worries are 
 "in the mind." 
 
 People living the simple life have few worries; those leading 
 the strenuous life under complex surroundings, as in our crowded 
 industrial cities, have many worries, beginning with worry to make 
 ends meet. But there are people who have such a desperate strug- 
 gle for existence that they have no time to worry, at least they do 
 not worry to the extent of those having ample time, and perhaps 
 also a vivid imagination, and, shall we add, no proper conception 
 of the relationship of cause and effect. 
 
 I do not continually tell my patients not to worry, for if they 
 feel better they naturally cease to worry. Worry is often depend- 
 ent on environment, it is often only a symptom of ill health. In 
 many cases change of environment is the remedy. 
 
 Properly considered worry is a beneficent symptom. Worry 
 should lead the w r orried one to look for causes — and then apply 
 the proper remedy. 
 
 Symptoms vs. Affections. To draw a line between symptoms 
 and affections is difficult, because symptoms shade off into affect- 
 ions or disorders, into minor maladies and of course into diseases. 
 For instance, a loss of appetite may change into a something more 
 than a mere symptom, just as the lack of blood may mean more 
 than a mere symptom, and as a high blood pressure may in time 
 be followed by a condition known as an arterio-sclerosis. A per- 
 sistent irritation of the air passages may result in bronchitis, just 
 as a persistent purulent catarrhal process may be followed by the 
 production of much scar tissue with a permanently altered lining 
 of the air passages or of the stomach. Repeated dyspeptic attacks 
 may eventually terminate in a well-defined disorder, in a perma- 
 nent impairment of the digestive function. It would seem that 
 most of the common affections or minor maladies of civilized life 
 are dependent on environmental influences, especially air condi- 
 tions, and that means that they are largely preventable. 
 
 Common affections like common symptoms may also be looked 
 
CARDIOVASCULAR AFFECTIONS. 287 
 
 upon, especially in their early stages, as conservative processes, 
 teaching man to do one thing and to avoid another. 
 
 Diseases vs. Affections vs. Symptoms. Some symptoms have 
 a variety of causes, just as many affections have a variety of causes. 
 On the other hand, diseases, that is, specific diseases, may he due 
 to one definite cause. We need only think of such diseases as 
 typhoid fever, tuberculosis, malaria, etc. In the absence of the 
 specific cause there is no disease. By eradicating the cause a 
 country can be kept free from such diseases. In early days, be- 
 fore the rise of sanitation, there were many diseases now known 
 only by name. Cleaning up, making cities sanitary, has caused their 
 disappearance. The sanitarian emphatically insists, Let us clean 
 up. Today when we are threatened with certain diseases, notably 
 cholera, our cities immediately get busy cleaning up. They know 
 that in proportion as they do clean up, they will escape. They no 
 longer ascribe a "visitation" to Providence and those who say Let 
 us pray are becoming fewer and fewer. A city may continue to 
 use bad water, but the moment cholera or typhoid fever in epi- 
 demic form appears an effort is made to get a better water supply. 
 Perhaps after all many of the great epidemic diseases are blessings 
 in disguise, they teach us to clean up. 
 
 Unfortunately some diseases have gotten a good hold and are 
 taken as a matter of course, notably tuberculosis, and no proper 
 attempts toward eradicating the disease are made. Cleaning up 
 and giving the people good air would cause tuberculosis largely to 
 disappear, along with a host of affections scarcely rising to the dig- 
 nity of disease. Many diseases have come in and flourish just like 
 weeds, simply because we have neglected them. 
 
 Aches and pains, ill health and disease are very common under 
 crowded and unsanity city conditions. Should symptoms be 
 heeded? Should they be looked upon as evils, or as warnings from 
 nature? The philosophical likely heed them and in so doing live 
 on and on. Those who do not heed them perish prematurely. The 
 heedless form a type that is not apt to survive. On the other hand 
 
288 DUSTY AIR AND TLL HEALTH. 
 
 it is a well-known fact that chronics often outlive their physicians. 
 The reason may not he far to seek : the chronic is constantly warned 
 by his pains and aches; he never goes to extremes. If he finds a 
 certain cause produces a certain effect, he avoids that cause. What 
 many chronics need, as I have attempted to show in my case re- 
 ports, is good air. 
 
 This view may be considered a philosophical one. It shows the 
 importance of cleaning up. Such a view is diametrically opposed 
 to the teachings of the faith curists who say symptoms and disease 
 are imaginary. 
 
 The patent medicine man will also disagree. He looks upon 
 symptoms differently; to him a loss of appetite means the taking 
 of his "tonic" to create an appetite and "eat anything you want." 
 To him backache spells Bright 's disease and he advises the indi- 
 vidual to dope himself with his nostrum. Cough is something to 
 be "cured." Pain is a something to be "killed." And thus the 
 poor and ignorant who get their medical knowledge from the pat- 
 ent medicine advertisements get the worst of it. The evolutionist 
 may console himself with the thought that in time all these indi- 
 viduals will be killed off — for the betterment of the race. Intelli- 
 gence and prudence pay. 
 
 From the standpoint of the evolutionist it would also appear 
 that those w T ho react to their environment are of the type that will 
 prevail. One can reason from analogies among animals, those of 
 new countries or islands that do not fear man are destroyed; in 
 proportion as they do fear him and avoid him the species is per- 
 petuated. Many species of animals have been exterminated in 
 recent years simply because they did not fear man enough. Sim- 
 ilarly men who fear disease, and symptoms, and flee from them, or 
 still better through knowledge prevent their occurrences, are of a 
 type to survive. 
 
 Perhaps after all there are compensations. Sensitive people 
 can not do as those who do not react to their environment; they 
 have pains and aches, they are warned, and if the warning is 
 heeded, they live on and on. 
 
vm. 
 
 SPECIFIC DISEASES. 
 
 This volume does not aim to discuss specific diseases ; all that is 
 attempted here is to show how persons in chronic ill health may learn 
 how to reduce ill health to a minimum, assuming that they are influenced 
 by dusty air conditions. In order that the subject may be better under- 
 stood, it is necessary to make a few references to specific diseases. 
 
 One can draw analogies between diseases and plants, as practically 
 all our specific diseases like our worst weeds are introduced. Among 
 our worst weeds are a few that are natives, but just how many diseases 
 flourished before the white man came to our country is a matter that will 
 never be known, because there were no competent observers among the 
 first comers. Only a few diseases can be mentioned and commented upon. 
 
 Milk Sickness This undoubtedly native disease was formerly very 
 common and fatal. It is practically extinct in our State, although a case 
 now and then occurs. 1 The cause is found in certain localities, usually 
 damp shady places, often fenced off to keep out stock. If cows get 
 in they may contract the disease, known as "Trembles," and transmit it 
 to man, presumably through the milk — hence the name Milk Sickness. 
 Cutting down the forest and letting in the sunlight seems to be all that 
 is necessary to cause the disease to disappear, just as many of our native 
 plants disappear under the same conditions. 
 
 Malaria. Whether malaria existed in our country before the white 
 man came is a problem, perhaps not; most likely it was introduced. 
 Malaria is due to a definite cause, a small ameba that lives in the red blood 
 cells and destroys them. It requires for its transmission a certain kind of 
 mosquito (Anopheles). The mosquito before it can transmit the disease 
 must have bitten some one who has malaria. It can not transmit the dis- 
 ease without first getting it. It breeds in wet places; drainage causes the 
 breeding places to disappear. The use of quinine causes the disease to dis- 
 appear in man, and that means mosquitoes can not infect themselves. 
 Moreover since the use of screens has become so common mosquitoes are 
 kept out of houses. Hence by draining, by the free use of quinine (we 
 know how people are constantly dosing themselves with it), and by the use 
 
 1 1 am especially interested in this disease and its active cause. Every now and then I hear of 
 cases, both of trembles in animals and milk sickness in man, but usually too late to make -any investi- 
 gation regarding the active cause, that means especially to make bacterial cultures. 
 
 Milk sickness is of especial interest to physicians of the Ohio Valley, where the disease formerly 
 was common, because Eastern physicians who had never seen cases denied its very existence. 
 
 [19] (289) 
 
290 DUSTY AIR AND ILL HEALTH. 
 
 Of screens, malaria has been reduced in its prevalence to such an extent 
 that it most Unlay be classed Ideally ;is a rare disease. 
 
 .Malaria has been repeatedly referred to in this volume, because it is 
 so commonly confounded with dust infection. Some physicians realize 
 that some Of their patients do not have true malaria, they speak of "false 
 malaria." a name often synonoiuous with dust infection. "A touch of 
 malaria" is also frequently hoard. 
 
 True malaria is by some writers held to have been the cause of the 
 decline of Greek and Roman civilization. One almost feels Inclined to 
 take the view that the "False Malaria" which nourishes in cities and 
 towns today is a powerful factor in present day race suicide. 
 
 Yellow Fever. This is a tropical disease, also transmitted by a 
 mosquito, one with striped legs (Stegomyia). This mosquito occurs in 
 the Southern States and may occasionally be found as far north as the 
 Ohio River. Until a few years ago it was not known how the disease 
 is spread and all sorts of precautionary measures were taken during an 
 epidemic, including "shot gun quarantine." Three or four years ago sev- 
 eral Yellow Fever victims passed through this town on the railroad ; they 
 occasioned no alarm whatever. To know how a disease is transmitted 
 means to be able to guard ourselves and avoid needless precautions and 
 useless alarms. 
 
 Cholera. Asiatic cholera has repeatedly come to us from tropical 
 countries where it is endemic, that is, where it always occurs. It is now 
 kept out by watching immigrants at the seacoasts, as at this writing. The 
 disease, due to a definite micro-organism, is transmitted by getting into 
 the drinking water ; it is also spread by flies carrying fecal matter from 
 the sick. Cities that have good drinking water and sewers and are cleanly 
 generally have practically nothing to fear from cholera. The former 
 "cholera fear" has practically disappeared. 
 
 Leprosy. A few years ago the newspapers had much to say regarding 
 leprosy and the danger of its gaining a foothold. It would seem, however, 
 that leprosy is a disease that has pretty well run its course among north- 
 ern white people. Formerly it was very common in Europe and leper 
 hospitals were to be found everywhere. Today it is a rare disease, and 
 yet the occurrence of a case causes alarm. It is characteristic of the 
 human mind to become alarmed at possible dangers but to neglect real ones. 
 Thousands die from the ravages of a bacillus that is closely related to the 
 lepra bacillus, namely the tubercle bacillus, and yet people take the 
 presence of consumption as a matter of course. 
 
 Smallpox. Smallpox is another disease that formerly was very com- 
 mon but which now is rare and has lost its terrors. Some European 
 countries are very strict in requiring vaccination and as a result smallpox 
 is practically unknown. But there are countries less strict and smallpox 
 
SPECIFIC DISEASES. 291 
 
 prevails accordingly, pocked faces are quite common. Smallpox was one 
 of the first diseases introduced into our country. It was very fatal to the 
 Indians who had never heen accustomed to it. One can understand how 
 a few out of the hundreds who perish may leave offspring that is more or 
 less resistent and that with repeated exposure of the offspring finally a 
 strain will be produced that is more or less resistent, just as in the case 
 of rust proof oats. The story of rust proof oats is an interesting one. 
 The ordinary farmer when he sees his oat field suddenly blighted plows it 
 under. But a number of years ago one man more shrewd than the rest 
 noticed that a few stalks survived. By cultivating the seed from this 
 plant through successive generations he finally produced the "rust-proof 
 oat." In the case of man there is another factor that must be considered, 
 the admixture of more or less immune blood. Pure blood Indians are be- 
 coming more and more rare. 
 
 Measles. Measles is a very common disease of childhood. It has been 
 among us so long that it only exceptionally attacks an adult. It is so 
 mild a disease that many parents neglect to call the physician at all. 
 Indeed in the country children get well without anything whatever being 
 done. But when the disease attacks people who have never had it, as the 
 Esquimos of the far north, or islanders in the South Seas, whole tribes 
 may become extinct. Such people must undergo the process of adapta- 
 tion. In this connection it may be mentioned that the natives of the 
 West Coast of Africa are in about the same position in regard to malaria 
 as we are to measles; adults are immune. 
 
 As a rule school children are free from "contagious diseases" during 
 the summer but the moment they are massed in school houses certain dis- 
 eases appear, notably measles, scarlet fever and diphtheria. Where chil- 
 dren are massed closely as in schools such diseases readily spread. One 
 of the most important functions of the physician is to make a proper 
 diagnosis. 
 
 Scarlet Fever. This in many respects resembles measles but is re- 
 garded as a degree more severe and the child that is neglected is apt to 
 perish. But it makes a vast difference under what conditions scarlet fever, 
 measles, and other diseases, including typhoid fever and consumption, are 
 contracted, and where the victim lives. In the city with all sorts of infec- 
 tion about and the body constantly engaged in fighting off infection, these 
 diseases may be quite severe, while they may be mild in the isolated coun- 
 try where in spite of improper nursing and the use of ordinary diet people 
 recover. Indeed even the consumptive when sent out from the city in 
 time tends to get well. 
 
 Influenza, known also as La grippe, is a specific disease due to a 
 definite cause (a small bacillus) whose clinical manifestations greatly re- 
 semble those of "colds," in fact to such an extent that during and after 
 the prevalence of an epidemic a large number of cases are indiscriminately 
 
292 DUSTY AIR AND ILL HEALTH. 
 
 dubbed "grip," especially by physicians who do not discriminate. Grip 
 ordinarily is syiuuionious with "colds." Influenza has appeared at intervals 
 of years and attacked almost everybody. The pandemic of 1S89-90 was 
 especially severe. But manifestations vary in different individuals. Most 
 commonly there is an irritation of the respiratory mucus membranes with 
 evidences of colds and catarrh and usually there is marked nervous de- 
 pression. In some the digestive tract is greatly deranged. In others nerv- 
 ous symptoms predominate. One may speak of types. 
 
 The severity of the disease is largely dependent on air conditions, 
 mild under good air and severe under bad air. Pat made an observation 
 that is verified by many: "Influenza is a funny disease, you're sick so 
 long after you get well," meaning that there are after affects. But we 
 should keep in mind that Pat usually lives under bad air conditions, in 
 the city, and that the farmer in isolation may have an entirely different 
 story. Children at home before and after school age may suffer slightly 
 while those going to school and inhaling bad air may suffer severely. 
 In the country the disease is often so mild that a physician is not called. 
 ^Yhen Influenza reaches a people who have never had it or have not had 
 it for a long time it may be a serious disease, killing many, as mentioned 
 in the case of measles. The same is true of other diseases to which people 
 are not accustomed. 
 
 Some diseases come to us periodically, but not finding life conditions 
 favorable again disappear. Some diseases are actively combatted and kept 
 down, as mentioned under cholera. There is another disease that flour- 
 ishes in overcrowded communities where sanitation is neglected that should 
 be mentioned, namely the Plague. This has several times come near get- 
 ting a foothold in California. 
 
 The Plague. The Plague is a disease par excellence that flourishes 
 with overcrowding and neglect of sanitation. An extract from Woodruff's 
 "Expansion of Races" shows how the scientific student of diseases looks 
 upon some diseases. It emphasizes the importance of cleanliness and pre- 
 vention of overcrowding, not only of cities but of the country as a 
 whole. 
 
 "PLAGUE AND DIRT." 
 
 "The plague of India is a direct result of overcrowding of indescrib- 
 ably filthy people. In Calcutta, as many as 144,000 live in one square 
 mile (London has 36,000 per square mile), 250 living where there are 
 accommodations for only fifty, or less ; huts seven feet square accommo- 
 date five or more. The germ has such ideal conditions for spreading from 
 rats that it can not be eradicated. The native is so dirty in his habits 
 that .... the British have finally given up all hope of forcing 
 sanitation upon the Hindu. Even when the reported deaths of plague 
 amounted to nearly 30,000 a week, they were forced to allow the native 
 to contract the disease. The strange new methods of cleanliness were 
 repugnant to him and often ran counter to his religion. 
 
SPECIFIC DISEASES. 293 
 
 "According to a writer in L'lllustration (Paris), it is now generally 
 admitted that there is overpopulation in India, and that the present 
 mortality from plague is a beneficial blood-letting. The deaths in 1906 
 were so numerous that the Government stopped reporting them. In 1901 
 the number of victims was 275,000; in 1902, 580,000; in 1903, 850,000; 
 in 1904, 1,025,000— and the estimate for 1905 was over 2,000,000, and 1907 
 totaled even more." (p. 69.) 
 
 We are further told about its repeated ravages in Europe, how at 
 times it may have killed off one-quarter of the entire population, and how 
 by the eighteenth century Europe had arrived at a stage of cleanliness 
 where its ravages became less and less. 
 
 ". . . . Plague is really a disease of rats transmitted by fleas, and 
 these ancient epidemics show bad sanitation of crowds, for rats never 
 flourish except in such conditions." (p. 70.) 
 
 In the light of such descriptions comments on the ravages of our 
 specific diseases seem tame, but we do have some diseases that are almost 
 as fatal as the plague of India. We need only think of Tuberculosis, a 
 disease that flourishes among the poor living under crowded and underfed 
 conditions, but unfortunately en account of the spitting habit it also finds 
 victims among people who live under different life conditions. 
 
 Tuberculosis. Tuberculosis is a disease that has long afflicted Euro- 
 peans and their descendants and for ages has been killing off the sus- 
 ceptible, until now the average individual is fairly immune, unless condi- 
 tions are very bad. It is severe in families where there was no constant 
 exposure and where weeding out has not been going on. It is of course 
 more active under crowded, congested conditions than in the open country, 
 not only on account of constant exposure but also on account of the weak- 
 ening of the body under general unsanitary conditions. If people lived 
 under good air conditions, tuberculosis would be a rare disease, afflicting 
 only those who are especially sensitive, and perhaps largely maintain 
 itself by attacking the feeble. Tuberculosis pure and simple in an indi- 
 vidual living under good air conditions has few symptoms, so few that the 
 disease in its early stages may escape recognition. A case that is well 
 developed can be diagnosed by almost any one. In proportion as indi- 
 viduals live under bad air there are many symptoms. It is an old disease, 
 well described by the ancient Greeks. 
 
 Tuberculosis or Consumption like many weeds has come to us from 
 the old world and like them does not thrive in clean communities. Just 
 as neglected farms and waste places are the natural homes for weeds, 
 from whence the seed are spread, so neglected communities and the slums 
 of cities are natural homes of tuberculosis. There is a State law that 
 compels the cutting of weeds, largely neglected however except by the 
 railways, but we are only beginning to realize that the breeding places 
 for consumption must also be cleaned up. Tuberculosis is a disease that 
 has gained such a foothold among us that its presence is taken as a 
 
294 DUSTY AIR AND ILL HEALTH. 
 
 matter of course; we are scarcely alarmed when a neighbor next door 
 dies, while a case of leprosy or cholera in an adjoining county or state 
 alarms many. 
 
 What must we do to get rid of tuberculosis? There are two general 
 lines of procedure. First, to clean up, to make the conditions for the 
 existence of tuberculosis unfavorable, to clean up slums and communities 
 and buildings generally, and give the people good air. Consumption can 
 be banished, just as malaria has been banished and as typhoid fever in 
 large cities has been banished. The afflicted should be sent out where 
 they can get good air; if not too far advanced they are apt to recover. 
 Tuberculosis is really a protest against bad air conditions, just as typhoid 
 fever is a protest against bad water. Looked at evolutionally, one would 
 be inclined to say that it serves a community right to have consumption 
 and typhoid fever and malaria. The people themselves are to blame and 
 nature is weeding out among them as she has in times past. 
 
 A second method of getting rid of Tuberculosis is by the use of anti- 
 toxins. This is a subject of exceeding interest to the scientific physician, 
 but unfortunately he only too often neglects the simpler method, cleaning 
 up. Tuberculosis is important to the student of ill health, he must con- 
 stantly rule out its presence in dust victims, many of whom end through 
 the ravages of the tubercle bacillus, and, as already mentioned, more 
 particularly those who have a low blood pressure. Old densely crowded 
 countries with exhausted soils must constantly contend with starvation ; 
 underfed people are numerous. Today in our country conditions are 
 gradually reaching a similar stage and the weeding out through tubercu- 
 losis will go on for a long time. 1 
 
 Diphtheria. This may be cited as an example of the anti-toxin treat- 
 ment of specific diseases, both in preventing and curing the disease through 
 the use of its own poison, its anti-toxin, just as smallpox may be cited 
 as a disease preventable (but scarcely curable unless resorted to very 
 promptly) by the use of vaccination. 
 
 1 Case Report. One of my earliest patients was a young farmer whose ancestors were rura 
 Europeans. Under bad air conditions the man became afflicted. There was present cough, fever, 
 free expectoration (full of tubercle bacilli) and night sweating, not to speak of other symptoms. He 
 was promptly advised regarding the influence of "bad air" and the importance of remaining in good 
 air. His symptoms gradually subsided and tubercle bacilli disappeared in the course of months. 
 For two years he apparently was well. Then there was another infection; this too subsided in a year 
 or two. He was now more careful. He remained in apparently good health for several years until 
 one day in midwinter he had some business at the court-house of his county-seat. That meant to be 
 exposed to bad air all day. He reacted very promptly: there was a marked "cold," followed by a 
 catarrh, which "hung on." When he returned he had symptoms of tuberculosis. On examining the 
 sputum tubercle bacilli were found, this settled the diagnosis. The infection this time was so severe 
 that he did not recover. While the active tubercular process was going on, he came to recognize 
 clearly that symptoms were dependent on exposure to bad air, and needless to say, he was very careful 
 not to expose himself, but of course it is almost impossible wholly to avoid doing so. Such a case 
 shows the marked difference between country and city cases, the latter often being harassed by a 
 variety of symptoms. 
 
SPECIFIC DISEASES. 295 
 
 Typhoid Fever. This is another disease that was early brought to 
 our country. It is closely related to typhus fever with which it was long 
 confused. Recently another related disease was separated, paratyphoid 
 fever. Thus finer and finer distinctions are being made. What seemed 
 to be cases of the same disease may be found to be something entirely 
 different. The treatment of different diseases may of course differ 
 radically. 
 
 Typhoid fever is essentially a water-born disease. The active cause 
 gets into streams and into wells ; it is also carried by flies, as in the case 
 of cholera. It took cities a long time to learn that typhoid fever can be 
 prevented by the use of pure water. Many cities have gone to great 
 expense to get good water from a distance or else resort to filtration on a 
 large scale. This is a matter where the community as a whole must take 
 hold ; the individual is practically powerless. Household filters are worse 
 than useless. Typhoid fever is more common in small towns than in 
 large cities. Many a vacationist on returning to the city brings back 
 typhoid fever. The prudent man is more and more making inquiries 
 before starting on his vacation; he knows that many diseases are pre- 
 ventable; he will not willingly or knowingly go to a malarial country or 
 to a region where yellow fever or cholera occurs, nor will he go to a 
 community where typhoid fever prevails. 
 
 Just now we hear more or less of vaccination against typhoid fever, 
 the special scourge of soldiers in camp. Under changing camp life, it is 
 simpler to vaccinate than to take constant precautions in getting water 
 free from typhoid germs, but such an argument does not apply to people 
 of the city; there people are fixed to their homes and not constantly mov- 
 ing about and there water furnished should be pure. The importance of 
 a pure water supply is well known. Backward communities are still too 
 common. 
 
 Typhoid fever is a disease due to a definite micro-organism, or germ, 
 with a variable number of symptoms. The textbooks mention a large list 
 but it should be kept in mind that the textbooks as a rule are written by 
 city men, based on city cases, especially on city hospital cases, and that 
 means in turn people who live under bad ai'r conditions. The mortality 
 rate in cities and in city hospitals is high. In the country the disease 
 generally runs a mild course and in spite of poor nursing and improper 
 food patients tend to get well. 1 Under good air many of the acconipany- 
 
 1 The following from my paper on Atypical Cases and Dust Infection (American Medicine, Oct. 1, 
 1904) may be pertinent: 
 
 In some cases the inhalation of dust simply acts as a modifier of the symptoms of disease. The 
 behavior of a typhoid fever case in a city with a dusty atmosphere differs from that of one in the 
 country with a pure air — the constant slight efforts of coughing and clearing the throat may be wholly 
 absent in the latter case, and respiratory diseases, like bronchitis, laryngitis, pneumonia, pleurisy, 
 tuberculosis, etc., are less apt to carry the patient off. Indeed, it would seem that among the first 
 things to do in the treatment of typhoid fever (as well as of other exhausting diseases) would be to 
 place the patient in a good atmosphere. 
 
296 DUSTY AIR AND ILL HEALTH. 
 
 ing symptoms are wholly absent and the country doctor is often in doubt 
 whether he is really dealing with typhoid fever. 1 It is only within recent 
 years that a test has been devised that will enable him to determine 
 definitely. The test is made by the use of a few drops of blood. 
 
 An observant old country doctor located in a small village surrounded 
 by intelligent farmers told me he has less and less to do each year with 
 "filth diseases" and ill health depending on unsanitary surroundings. His 
 explanation was simple: The people are learning to clean up generally. 
 Many get "'Farmer's Bulletins*' of all kinds in which they are told how to 
 take care of their animals, not to speak of crops ; they have learned that, 
 it pays to look after things — and they apply the knowledge to themselves. 
 What is good for beast is also good for man. 
 
 Pneumonia. Lobar pneumonia or "real pneumonia" is popularly rec- 
 cognized as a disease that usually follows a "cold ;" professionally it is 
 considered a disease that seeks out robust men ; it has been designated as 
 the Captain of Death. In some cities it outranks all other causes of 
 death ; it is widely prevalent during the closed door season. 
 
 The popular belief that pneumonia follows a cold is frequently men- 
 tioned by the patent medicine men. "Beware of a cold," they say — and 
 at the same time they advise taking their nostrums "to cure a cold and 
 prevent pneumonia." 2 
 
 Pneumonia is a rare disease under good air conditions and is readily 
 "amenable to treatment," with a low death rate. Some country doctors 
 say they have little difficulty in successfully treating their cases and in 
 shortening the disease, which the city doctors deny. If we consider the 
 difference in environment one may see why there are such divergent views. 
 
 Pneumonia does not occur in a new country until it is introduced, no 
 more than other "germ diseases." The "pneumococcus" is a very minute 
 plant, a bacterium, that can be grown artificially in test tubes, just as 
 large plants can be grown in the greenhouse or in the garden. Introduced 
 diseases like introduced plants thrive only if the conditions are favorable : 
 if not they perish. 
 
 Pneumonia flourishes where people are massed under bad air, one may 
 speak of hotbeds of disease. We may say that the prevalence of pneu- 
 monia is a good index of unsanitary air conditions, just as typhoid fever 
 is an index of unsanitary water. 
 
 In this volume the writer is telling about things "here at home." It 
 is not his intention to tell about things in distant countries. One is re- 
 
 1 Our newspapers frequently speak of people being "threatened with typhoid fever," and yet in 
 a day or two they may be about as usual. The question then arises, What really was the matter? 
 According to my experience such "threatened" cases are often acute attacks of dust infection. 
 
 3 Having twice had this disease myself, once in childhood and once since a physician, I have 
 naturally been inquiring under what conditions it occurs, and that means at the same time how to prevent 
 it. Here again the matter of good air and cleaning up crops out very strongly. 
 
 While physician among the insane I was struck by the rarity of pneumonia among the hospital 
 inmates. The reason is simple: great cleanliness and an abundance of good air day and night. 
 
SPECIFIC DISEASES. 297 
 
 minded of Samuel Johnson : "Nay don't give us India. That puts me In 
 mind of Montesquieu, who is really a fellow of genius too in many re- 
 spects; whenever he wants to support a strange opinion, he quotes you 
 the practice of Japan, or of some other distant country, of which he 
 
 knows nothing " But the following clipping from a newspaper 
 
 article of several years ago relates to our own country. It shows how 
 pneumonia was brought to a previously "healthy country" and how on 
 account of favorable conditions it readily increased and found many vic- 
 tims. The lack of an abundance of water to clean up properly is an im- 
 portant factor. The closing paragraph is very suggestive ; the conditions 
 under which men sleep tell the story. If those men had clean tents to 
 live in the mortality rate would quickly subside. 
 
 DEATH IS SUDDEN; WEALTH IS QUICK. 
 
 Pneumonia Becomes the Scourage of the Nevada Gold Hunters. 
 
 DEATHS EIGHTY A MONTH. 
 
 Goldfield the Gathering Place of Thousands of Adventurers. 
 
 Goldfield, Nev., January 5. — There's a terrible little fellow who seems 
 to have been appointed by the spirits of the desert to keep ward and 
 watch over the golden treasure buried in the barren hills of bleak Ne- 
 vada. He is the Pneumococcus. The treasure hunters are slowly besting 
 him, but the little demon is exacting a heavy payment for the gold they 
 take away. 
 
 Pneumonia is the scourge of Goldfield. Deaths in the mining camp 
 run from 60 to 100 a month. Call it an average of 80 and you have a 
 yearly death rate of 6 per cent. A very large majority of these deaths are 
 due to pneumonia, a few to typhoid. 
 
 The outside world hears little of it save when some well-known man 
 passes away, such as ex-Governor Hunt of Idaho, who succumbed here to 
 the scourge of the camp. Most of the victims are homeless and friendless 
 adventurers. No fuss is made over them. They are simply taken out and 
 buried in the most God-forsaken cemetery in all the world. 
 
 In most of the victims life goes out like a snuffed candle. So swiftly 
 death rides on the wings of Pneumococcus that they call it black pneu- 
 monia down here. But it's only old-fashioned pneumonia working the 
 more swiftly that it has such fertile soil in which to plant its seed. It 
 is intensive farming, Death the farmer. 
 
 The hardships of this coalless, overcrowded mining camp weaken 
 constitutions so that when disease comes it meets little resistance. In 
 four saloons late last night a correspondent counted sixty-eight men asleep 
 
'298 DUSTY AIR AND ILL HEALTH. 
 
 on the floor. Some were drunk and some were merely exhausted with toil 
 and had no other place where they could sleep. 
 
 Out of the kindness of their hearts the bartenders let them sleep 
 where they lay. Occasionally a man with a mop would approach one of 
 the sleepers and i>oke him into seini-wakefuluess. 
 
 "Hey, Bill." he would say, "roll over till I mop beneath ye." 
 
 The sleeper would obey orders, returning to slumber the next instant, 
 while the mop continued its work under the next man and the whirr of 
 the roulette ball, the popping of many corks and the volleys of profanity 
 in many tongues blended for the slumberer's lullaby. It is men of this 
 sort that are dying like sheep in Goldfield. They are shipping two or 
 three of them out on every train, others they bury in nameless graves; 
 the hospital is full and the undertaker cheerful. 
 
 The newcomer wonders why there is a graveyard so near the middle 
 of the town. This the story of how it happened, related by one of the 
 oldest inhabitants of the Goldfield settlement : 
 
 "When I first blew in here nobody had ever cashed in. A few days 
 later some fellow croaked. He'd no money, no friends, no name that any- 
 body knew of. 
 
 "So a few of us thought it was up to us to plant him. I was on the 
 committee to pick out a cemetery site. We found a place out on the 
 desert about a mile from town. Then we gave a man $5 to dig the grave. 
 
 "Jake Murnan was the fellow we picked for the job. Jake was drunk 
 and broke. He hated to let his jag die, so a fivespot looked big to him. 
 
 "I took him out and showed him the place and Jake came back to 
 get a shovel and a pick. On the way back he comes on a hole, six by eight 
 feet, that some prospector had made and, being some tired, he figures that 
 this is just as sightly a place for a grave as the one we picked out. So 
 he digs it right there in that prospector's excavation. 
 
 "When we come to bury the stranger we sees Jake has made a break, 
 but we was too busy to bother about it. So we plants him right there. 
 
 "Course, the next one was put right next to him, and so it grew up 
 into a fine young cemetery- Pretty soon we gets 200 bodies planted there. 
 
 "So we calls a halt and starts another cemetery further out. But 
 Jake is responsible for the first one." 
 
 GOLDFIELD IS INDIFFERENT. 
 
 But it's little Goldfield cares for the man who falls. They are rush- 
 ing in every day to take his place. There's gold out there in the desert 
 and the lucky ones will get it. If you live, you live; if you die, you die, 
 says fatalistic Goldfield. 
 
 If a man were to recount all the tales he hears down hear of men 
 who go to bed paupers and wake up worth tens of thousands he would be 
 set down as the possessor of a singularly active imagination. But a great 
 many of these yarns are true and capable of demonstration. For example : 
 
SPECIFIC DISEASES. 299 
 
 [Next comes a column of such examples, of men who quickly became 
 rich and some who again quickly became poor. The article closes as fol- 
 lows:] 
 
 Society Note: The many friends of Tex Rickard will be interested to 
 hear that he intends having his Northern saloon swept out next week. — 
 
 Indianapolis Star, January 0, 1907. 
 
 Syphilis, or the Pox, was until recently rarely mentioned in polite; 
 literature or referred to vaguely as "blood poisoning." It is a disease that 
 is transmitted almost exclusively through contact, the parasites travelling 
 from one individual to another, especially through abraded mucous mem- 
 branes — the abolition of the common drinking cup aims to avoid infection 
 through lips and mouth. 
 
 This disease formerly ravaged fearfully and still does, but today "it 
 kills only poor people who are friendless" — it is considered a disgrace to 
 die from it. Often it is innocently contracted, especially by children. 
 
 Those who see few cases underestimate and those who see many 
 overestimate the prevalence of this disease. In the practice of the family 
 doctor, particularly in small communities, there is a complicating factor — 
 patients conceal the presence of the disease and go elsewhere to be treated, 
 perhaps to a quack who loudly advertises his ability to cure "blood poison" 
 in a short time. 
 
 Syphilis is one of the diseases that needs the widest publicity but 
 which up to date has received anything but that. 
 
 Another disease that should be mentioned is gonorrhea. To what ex- 
 tent does it prevail? According to some physicians it is not at all com- 
 mon, according to others it is very common. Why this discrepancy of 
 opinion? Here is the explanation of one of our observing physicians: 
 
 The country doctor, unlike the city doctor, does not write about his 
 cases — he talks about them. Many people know he talks and when they 
 have certain unmentionable diseases do not go to him but go to the city 
 doctor. Some of the latter specialize or at least give special attention to 
 such cases, "they do not give their patients away." Because the city doc- 
 tor gets many such cases he is inclined to believe the world is full of the 
 disease — just as the country doctor who sees few cases has an opposite 
 opinion. This being so, the truth lies somewhere between extremes. 
 
 There is no need to run over a larger list of specific diseases, many 
 of which are dependent on the neglect of cleanliness, we need only think 
 of lousiness and the itch and many skin diseases that are transmitted 
 among neglected children, or of diseases among domestic animals due to 
 neglect and transmissible to man, such as worms of many kinds, including 
 tapeworms and trichina. In some instances the cause is so large that any 
 one can see it, in others so minute that only the highest power of the 
 microscope reveals it. High school courses in elementary biology and bac- 
 
300 DUSTY ArR AND ILL HEALTH. 
 
 teriology and sanitation can not be too common, and the importance of 
 the influence of environment and of Cleanliness can not be over-emphasized. 
 
 Diseases in the average civilized community are transmitted mainly 
 through aiT, through contact, through food, through insects and through 
 water. Air should be mentioned first, for we breathe it every minute of 
 our lives. Cities, as already mentioned, aim to get good water supplies, 
 likewise good food; there are all sorts of laws and ordinances covering the 
 matter of good and bad food. As to insects we know that many common 
 household pests are absent from clean homes. When Mrs. Carlyle re- 
 moved to London the first thing she did was to look for bedbugs. Today 
 we have advanced so far that we "swat the fly" and other common house- 
 hold pests. Some insects like some weeds flourish only in neglected homes 
 and communities. 
 
 Although in recent years the importance of good air, both in prevent- 
 ing and curing consumption, has become well known, yet the role of bad 
 air in common affections is scarcely realized. Catarrh, dyspepsia, and 
 nervous prostration flourish in communities where air conditions are neg- 
 lected. These affections, one can not speak of them as definite diseases, 
 flourish like common weeds. They are readily eradicable by a combined 
 effort. 
 
 When a new country is first settled the old weeds of civilization arc 
 absent : they come in gradually. When the Kankakee swamps were 
 drained and crops planted, farming was easy the first year; there were 
 no weeds to contend with, but in a year or two they began to come in and 
 after a few years they were so common that farming now is mainly a 
 battle against weeds. It requires a combined effort among farmers to 
 keep them at a minimum. The rented farm, like the rented home, is apt 
 to fall into neglect; it will ripen seed enough to infest or infect the whole 
 country around. In crowded tenements life is a constant battling against 
 ill health and sickness and disease. One scarcely realizes to what extent 
 poverty itself is dependent on chronic ill health. 
 
 WEEDS AND DISEASES. 
 
 The analogy of the introduction and spread of weeds and of 
 diseases is very interesting to me, because long before I became a 
 physician I had become interested in the appearance of new weeds. 
 I have kept track of new- arrivals, particularly along rivers and 
 railways and in waste places. New plants are brought in in various 
 ways. In order to know what is new one of course must know what 
 is old. In time I found plants that had not been reported by 
 others; such are said to be "new to the State." The botanist 
 
SPECIFIC DISEASES. 301 
 
 Usually gathers plants while travelling, and then he begins to re- 
 alize that many of the weeds of other countries are likely to appear 
 in his own home. I have seen many weeds appear in this State 
 that are foreigners, they are just as foreign as the White Man or 
 Negro or Chinese, as foreign as the specific diseases just mentioned, 
 but many soon become thoroughly acclimated or naturalized. 1 
 
 When I became a physician I had a very natural desire to have 
 a specimen of every disease found in the State, the " specimen" to 
 consist either of a bit of tissue or the active cause (a microbe or 
 parasite of some kind), a photograph or merely "notes on cases," 
 in other words case reports. In the course of time I found a few 
 diseases that had not been reported previously, they were new to 
 the State. 
 
 The student of natural history and especially of botany soon 
 learns that species vary, that there are no sharp dividing lines. 
 The student of medicine too soon learns that there are no hard and 
 fast lines in the case of many diseases and particularly in condi- 
 tions of ill health. 
 
 When I first began to botanize I asked friends who went away 
 to send or bring me plants; many promised but few did so, and 
 then often it was just a flower and not a "specimen" such as a 
 botanist would collect. One may be wholly unable to identify an 
 imperfect specimen. One soon avoids asking friends to collect un- 
 less they happen to be experienced, and that is also true of "case 
 reports." 
 
 1 A botanist may go mijea out of his way in order to study a new weed, and after properly identi- 
 fying it he may make an effort to destroy a patch; but after a plant has become common he scarcely 
 notices it and any effort to eradicate it would prove futile. The task of ridding a locality of weeds 
 belongs to the community, a fact recognized by our State laws, which require the annual cutting of 
 weeds. 
 
 The physician interested in the advent of new diseases may likewise make great efforts to study 
 the first cases but after a disease becomes common he may become indifferent. Disease eradication 
 must also be done by the community. 
 
IX. 
 
 BIOGRAPHY AND ILL HEALTH. 
 
 While in college I was in a class in Evolution. One term we 
 read the Life and Letters of Charles Darwin, which had just ap- 
 peared. I had already decided to become a physician and naturally 
 1 noticed references to ill health. There were many references, and 
 I wondered what it all meant. But the subject of ill health is not 
 a college study and nothing was said about it in class. That was 
 really the first time 1 noticed how the subject of ill health crops 
 out in biographies and in letters. 
 
 A few years later while physician in a hospital for insane I be- 
 came interested in letters written by the insane. I encouraged 
 patients to write, indeed I aimed to get a specimen of the writing 
 of every patient (several hundred) under my care. Those who had 
 no friends I encouraged to write to me ; a few wrote regularly every 
 Sunday. In the course of years I accumulated a collection of hun- 
 dreds of letters. 1 tried to get autobiographies, but with few ex- 
 ceptions failed. The reason is simple: Men who are sent to state 
 institutions are not likely to be writers. But I did obtain several. 
 One was long enough to make a fair sized book. The man was a 
 fluent writer and his frankness reminded one of old time biogra- 
 phies ; he spoke about his life as sane men nowadays are not apt to 
 speak. 
 
 Since I have made a special study of ill health, particularly of 
 old chronics, I have been interested in getting biographies and in 
 comparing such accounts with printed biographies of people who 
 have had much ill health, as in the case of Darwin just referred to. 
 To what extent can one compare and draw conclusions? To what 
 extent can one interpret the "Lives" of the dead by the lives of 
 the living? Again, to what extent can the living profit by the 
 
 (302) 
 
BIOGRAPHY AND ILL HEALTH. 303 
 
 "Lives" of the dead? In all probability the best students of the 
 biographies of people who had much ill health are people who them- 
 selves have ill health. 
 
 Autobiographies. A number of my patients have given me 
 autobiographical accounts, but it should be kept in mind that in a 
 small community there are few people who are writers or who lead 
 eventful lives and one may hesitate to cite them at all. 
 
 In a general way it may be said that patients can be divided 
 into two groups, those who work with their hands and those who 
 work with their brains. Now poor people as a rule work as long 
 as they possibly can, until actually disabled by disease. They have 
 no time to rest, to give nature a chance to correct the impending 
 difficulty. They may not even listen to advice regarding proper 
 food, proper housing and proper ventilation. Many are as willing 
 to take medicine as they are unwilling, because unable, to follow 
 good advice. Some take medicine from anybody, including the 
 patent medicine men. In contrast to this class are those who in 
 the old world are known as the "better class," but with us there 
 are no sharp lines. 
 
 It is not difficult to get data regarding the influence of bad air, 
 they are mainly of the simple annals of the poor. But it is difficult 
 to get continuous data regarding the influence of good air. If a 
 physician insists on his good air advice being followed some men 
 will change doctors rather than their occupation. That means few 
 pure air biographies of men. 
 
 On the other hand are the women. Those living in the suburbs 
 may not be compelled to go down town daily and expose themselves 
 to bad air. They are better able to live up to good air advice. For 
 this reason most of my autobiographies and biographies are from 
 women, a fact which the reader may have noticed from case reports 
 already cited. 
 
 Today I am inclined to ask every new applicant for a brief 
 autobiography, one saves much time thereby. Moreover the appli- 
 cant for professional services is enabled to collect his thoughts and 
 to present them systematically and to the point. One soon finds 
 
304 DUSTY AIR AND ILL HEALTtt. 
 
 that some long-winded patients are not worth while but the very 
 fact that an individual is willing to write out such an account 
 makes him worth while. 
 
 When I Avrote my paper on Dust, A Neglected Factor in 111 
 Health I included one case report which was autobiographic, as 
 follows : 
 
 Case of Mr. C, as written by himself, May 16, 3904 : 
 
 "Age at this writing, 24 years. 
 
 "Family : All long-lived — no tuberculosis as far as can be traced. 
 Mother and mother's family both subject to colds and nose, throat and 
 stomach troubles. Mother always extremely nervous and exhausted after 
 such attacks. This condition also occurs in subject. 
 
 "First appearance of complaint : Up to about five years of age no in- 
 flammations or cold troubles of any kind. Then a great susceptibility, 
 always beginning in respiratory organs and canal, and ending in disturbed 
 stomach — and muscular exhaustion. End in prolonged cough. 
 
 "Conditions when in school and the vacation periods : Up to the time 
 of starting to school no evidence of these symptoms ; after that colds very 
 frequent — growing less frequent and ceasing during summer months of 
 vacation. Several vacations spent in country, where no disturbances oc- 
 curred. Recurrence of disturbances upon continuing school sessions. 
 
 "At 18 years leaves school. Office work : At 18 leaves school and 
 takes office position. At first this position was not confining and allowed 
 of one-half time in open air, during which time no great disturbances oc- 
 curred. Then work became more confining and finally inside exclusively. 
 Cold conditions became aggravated immediately. After about two years 
 of this work subject was compelled to quit work entirely for over eighteeu 
 months, during which subject suffered from continued colds, excessive 
 nervousness and general weakness. This condition was owing partly to 
 confinement and partly to overwork. About three months of the last part 
 of this eighteen months of enforced idleness were passed in the country. 
 Those three months were more beneficial than anything else toward im- 
 proving condition. 
 
 "Occupation since 18 : Both indoor clerical work and outside work — 
 no manual work. Habits sedentary, body sluggish. General condition 
 pretty good until increased application to inside work — then condition be- 
 came worse. Overwork and confinement to quarters in which practically 
 no ventilation was possible finally produced same condition as before — 
 continued and frequent colds, followed by stomach disorders and nervous 
 exhaustion. 
 
BIOGRAPHY AND ILL HEALTH. 305 
 
 OBSERVATIONS. 
 
 "1. Office in which subject was occupied (was) below level ground, 
 with no facilities for ventilation ; consequently dust and spittle deposited 
 or blown into the room was held, and the air was never more than a slight 
 per cent. pure. Whenever subject's work confined him to this place con- 
 dition became rapidly worse. 
 
 "2. Dust : It was observed that on clear, sunny days condition very 
 much improved, but two or three days of dusty weather again produced 
 first nose and throat and bronchial irritations, and then stomach disorder, 
 accompanying or following the cold condition ; that disorder followed on 
 exposure to blowing dust or indoor confinement with impure air. When 
 at home subject experienced no such disagreeable sensations as in the 
 down-town districts and districts where impure air was the irritant. 
 
 "3. Railway trains : Two very severe colds can be traced directly to 
 confinement for three hours or less in railway coach — in both cases all 
 windows were closed and cars full of people — some of whom spat upon the 
 floor frequently. 
 
 "4. It has been observed that overheating in impure air will always 
 produce cold condition. 
 
 "5. Conditions always worse after attending public gatherings, meet- 
 ings, etc., especially where the majority of the people assembled are men. 
 At one political meeting especially, where expectoration was unusually 
 frequent, inflammation began before subject even left the room. 
 
 "6. Subject was formerly told by physicians that the nervous ex- 
 haustion was produced entirely by overwork, but it has been observed that 
 this nervous condition invariably accompanies a cold or respiratory or 
 alimentary inflammation. 
 
 "7. During the sweeping and after the sweeping in the office where 
 dust has been deposited for some time a condition of cold occurs, but not 
 invariably." 
 
 The above notes were copied on the machine just as they were 
 handed in. 
 
 I hope some day this man will write a detailed account of his 
 life, especially dwelling on his observations since writing this brief 
 account. He has learned to live within his limitations and to re- 
 duce ill health to a minimum. 
 
 In this volume when speaking of environmental influences one 
 has largely in mind the average man or average "case" or patient. 
 At either end are extremes. That environmental influences or 
 causes that produce symptoms, ill health or disease, should mani- 
 fest themselves differently in the "idle rich" and again differently 
 
 [201 
 
306 DUSTY AIR AND ILL HEALTH. 
 
 in those who are desperately poor, must be self-evident. And that 
 the very active brain worker should have symptoms scarcely known 
 to the dull witted manual laborer must also be evident. 
 
 Physical vs. Mental Life. In general it may be said that 
 the individual leads two kinds of lives, a physical and a mental; 
 in some one, in some the other predominates. Some people have 
 such a desperate struggle to make a living that they have little time 
 to think. Such lives would naturally form dull biographies. 
 
 Everybody of course thinks more or less. Some individuals 
 now and then have a "rush of thoughts." In some the mind is so 
 active that it continues at night in dreams. An interesting ques- 
 tion is: Under what conditions is the mind unusually active, or, 
 under what conditions is it not active? Of the individual whose 
 mind is usually active one may ask, Under what conditions is it not 
 active ? While of the person whose mind is occasionally very active 
 we may ask, Under what conditions does this occur? 
 
 To what extent does environment influence an individual's phy- 
 sical and mental life? I have tried to show in this volume how it 
 influences health and ill health and how one factor stands out, Dust. 
 
 CASE REPORTS AT SECOND HAND. 
 
 The physician constantly hears of people afflicted with certain 
 diseases or of people in ill health. His patients will tell him of 
 this and of that individual but the data may be so imperfect that 
 he is unable to make a diagnosis. The physician, unlike the botan- 
 ist, can not go out and collect specimens; he must wait until the 
 "specimen of disease," the afflicted individual applies to him. We 
 say the patient selects the physician, not the physician the patient. 
 
 Although one may be inclined to discredit the statements of 
 patients concerning the disease or ill health of others, yet when 
 the ill health is apparently similar one may attach considerable 
 importance to statements. We reason from analogy. If a physi- 
 cian has "old experienced chronics" who are good observers he 
 
BIOGRAPHY AND ILL HEALTH. 307 
 
 may be inclined to accept their statements as true, and yet such 
 case reports are "second hand," and that is what I have been try- 
 ing to avoid in citing cases. Hence the frequent occurrence of the 
 pronoun I, for I am writing of my own cases. 
 
 Many of my "experienced patients" who are well informed 
 on the subject of dust influences will tell me about people whom 
 they have observed, perhaps friends whom they frequently see and 
 whose ill health they will interpret in the light of their own. Old 
 patients often want to send people to me but I may not see my 
 way clear to accept them, or on the other hand the invalid or com- 
 plaining one may not deem it desirable to come to me. 
 
 One of my patients, a middle-aged woman, the wife of a rail- 
 roader, had been noticing how the air of passenger trains, espe- 
 cially of smoking cars, affects passenger conductors. Now it should 
 be understood that well managed railroad companies are careful 
 how they advance their men. They engage a large number of men 
 for the lower positions and out of them they successively advance 
 those they deem desirable or competent. Men begin as brakemen 
 or firemen and may advance successively to the very highest po- 
 sitions. Now a man, say a young country man, may have good 
 health as long as he is a brakeman on a freight train, he is leading 
 an outdoor life, but he may complain greatly when transferred to 
 a passenger train. The man with constant colds and catarrh and 
 weeping nose and eyes is not apt to be advanced to the position of 
 passenger conductor. On the other hand a passenger conductor 
 may complain greatly of dust infection that does not manifest it- 
 self by such symptoms. The disturbance may manifest itself by 
 a deranged alimentary tract and since this may present no visible 
 signs the company retains the man, may even advance him. A 
 man with dyspepsia may be able to do the work of a passenger 
 conductor but when he is advanced to a still higher position where 
 the work is largely mental he may complain of nervous symptoms. 
 He may suffer from what is called nervous prostration. In the 
 lower positions it is easy to supply a substitute when a man is dis- 
 abled but with the higher positions this may be difficult, so a man 
 
308 DUSTY AIR AND ILL HEALTH. 
 
 may fall back into a lower position. It is only the survival of the 
 fittest who are able to and do till the higher positions. 
 
 Now my old patient at first had had much ill health and con- 
 sultations were taken up with a discussion of her own conditions 
 and symptoms, but in time as there was less complaint there was 
 developed a habit of discussing her friends. She was loyal to her 
 friends and she would talk over some that she wanted to come to 
 me. Some I saw my way clear to accept. At one time her loyalty 
 to a friend was greater than to me and she brought the woman and 
 I had to prescribe and advise whether I wanted to or not. At an- 
 other time she was very anxious that I accept as a patient a man 
 who had recently been promoted to be a passenger conductor, for 
 years he had been a freight conductor. Immediately he began to 
 complain. Evidently he was wholly unadapted to air conditions 
 found on small passenger trains where the spitter is so conspicuous. 
 I told her I was willing to accept him as a patient, but when the 
 man himself found that I would likely advise a "change of occu- 
 pation," as going back to the outdoor life of the freight train, he 
 concluded not to come. He had been waiting for years and years 
 for this promotion and the idea of relinquishing it was not to be 
 thought of. Instead he would try some other physician, one who 
 would attempt to cure by the use of medicine alone. 
 
 Now I never saw this man and yet I could give quite a full 
 history from data obtained through my patient, in weekly or 
 monthly installments. We were both interested in the man. The 
 story as I obtained it from my patient was to me like studying an 
 individual through his biography. The man finally died. I feel 
 confident that had he lived up to good air advice he might have 
 lived on indefinitely instead of dying prematurely and leaving a 
 family of immature children. Cases like that are tragedies. 
 
 Although my patient was above the average in intelligence and 
 was a good observer, yet she was not much of a reader. I tried to 
 interest her in reading biographies of people who had ill health. 
 My reasons were not wholly altruistic, although she would profit 
 
BIOGRAPHY AND ILL HEALTH. 309 
 
 by such reading I myself would profit by getting the references to 
 ill health. 
 
 One of ray well-informed patients was travelling on an inter- 
 urban car. At a small town two men took seats directly behind her 
 and from remarks about the weather and generalities soon began to 
 talk about health matters. One man evidently was a well-to-do 
 farmer and the other was a county surveyor, judging by the con- 
 versation they had about road improvements. The farmer compli- 
 mented the surveyor on his success in getting good roads built ; the 
 surveyor attributed this to the fact that he was always ready to 
 talk with people, even spending evenings at his office at the court 
 house. He tried to bring men who opposed each other together to 
 exchange views, making his office a meeting, or shall one say a 
 loafing? place. From discussion about roads and weather, they 
 talked of their health and then the surveyor's voice had a still more 
 doleful sound to my patient ; he complained greatly ; said he could 
 not understand why he runs down at the beginning of every year, 
 that during the last few years he ran down worse than ever. My 
 patient gathered from the tone of his voice even more than from 
 his words that the man was much "run down" and after telling 
 of the remedies and doctors he had tried, it was evident that he 
 was very much discouraged. The farmer suggested that he accom- 
 pany him to California, that he was going merely to spend the 
 winter. The surveyor wished he could, he feared he might later 
 on be compelled to. For the last few years February and March 
 had been his worst months ; he felt that if he could hold out during 
 these months he would get along again, but he was starting in so 
 early this year with his aches and pains, nothing much the matter 
 but "just have no appetite and don't feel like bestirring myself;" 
 he feared he would not hold out. He told how well he felt during 
 the summer when out looking after the construction of roads, 
 spending little time in the court house. 
 
 My patient "understood the case at once," too much confine- 
 ment about the court house and too much inhalation of court house 
 
3]0 DUSTY AIR AND ILL HEALTH. 
 
 air! She almost felt it her duty to turn around and speak to the 
 man, but yet that was not proper, she did not know him at all, and 
 besides she knew she could not make herself understood; some 
 things can not be explained briefly. When the men were leaving 
 the car, she did turn around to tret a good look at the sick man; 
 he was anemic, very pale and languid. My patient said if my book 
 had been out she would have told the man of it, that it would give 
 him the explanation of his ill health — I am just vain enough to 
 think that this book will fulfill my patient's expectations. 
 
 Cases or " histories of ill health" of course occur in infinite 
 variety. It is hoped that in this volume a sufficient number and 
 variety of cases have been cited to direct the reader's attention to 
 a neglected factor in ill health and that he will find at least one 
 case that approximates his own, enabling him to make a compar- 
 ative study. 
 
 The reader should keep in mind that my cases are "selected 
 cases. ' ' They are picked out from a large number. There may be 
 other factors operative but here I have emphasized only one, the 
 factor that is commonly neglected. The reader who wants case 
 reports that are written impartially, with no theory to uphold, 
 might be referred to the biographies of people who had much ill 
 health, where references are incidental. 
 
 During the last few years I have been reading many biographies 
 of people who had more or less chronic ill health, mainly to de- 
 termine to what extent air conditions or dust influences crop out. 
 One frequently gets on the wrong track and may do a lot of read- 
 ing only to find in the end that there is nothing in it. Some biog- 
 raphies contain so little mention of ill health that one almost thinks 
 a mention of it was not worth while, if not a disgrace. There may 
 be so few references to the matter of health and ill health that a 
 biography is not worth while to the student of ill health. On the 
 other hand there may be many references. Where there are sev- 
 eral volumes (as in the case of Darwin) one must read carefully 
 not to miss any. Then again often little things are mentioned that 
 
BIOGRAPHY AND ILL HEALTH. 311 
 
 at first sight seem to have no relationship to ill health but which 
 may really be of importance. 
 
 Now individuals who have or had much ill health are apt to be 
 better readers or students of biographies of people who had much 
 ill health than those who are in robust health, and it may become 
 highly profitable to the physician to interest them and to discuss 
 details. The physician in the small community where there are 
 few literary people, not to mention poor library facilities, greatly 
 appreciates such assistance. 
 
 Another interesting topic is to get the details of individuals 
 who report themselves cured by outlandish modes in weekly or 
 monthly journals. Some cases as they stand are reflections on, if 
 not an indictment of, the medical profession, and yet when one 
 gets details it may be anything but that. For instance, a retired 
 preacher in bad health after trying the doctors and trying sana- 
 torium treatment in vain adopted the faith cure, he was cured by 
 faith, so he said, in a letter to a religious weekly. It was not diffi- 
 cult to get details and then T found the following conditions: 
 
 The old man had been living in a large city ; he had been com- 
 plaining more or less and finally was forced to give up. Physi- 
 cians did not help him much and so when feeling unusually bad, 
 in midwinter, he went to a large sanatorium, that meant to be still 
 confined indoors. Then at "darkest before dawn" he decided to 
 take up a faith cure, not by changing his religion but by relying 
 on its power to cure the sick. He went back to his old country 
 home, a very clean little town on the high banks of a river, and 
 here under good air conditions he recovered. When I got the de- 
 tails I at once saw that it was not a faith cure at all, it was a na- 
 ture cure. One can predict what will happen when such a man 
 goes back into his old environment ; the student of ill health thinks 
 of subsequent events. 
 
 Every now and then some patient calls my attention to such 
 "case reports." Substituting the name of some drug or "new 
 
312 DUSTY AIR AND ILL HEALTH. 
 
 remedy" for imponderable faith or prayer, one sees similar case 
 reports in medical journals; dust influences may readily be read 
 between the lines. But the individual, the patient, who was cured 
 by change of place or by change in time may relapse. The man 
 who is cured by going to a small town may relapse on going back 
 to the city ; the man who was cured by a new remedy in the spring 
 may relapse on the return of the closed door season. After study- 
 ing a number of cases I came to the conclusion that "Odd as such 
 an expression may sound, I am almost tempted to say that I could 
 take the same patients and 'make them sick' on the exploited rem- 
 edy — simply by beginning treatment in the summer and ending 
 in the winter months." (A Study of Reprints and Clinical Re- 
 ports on Proprietary Medicines. Amer. Med. June 10, 1905.) 
 
BIOGRAPHY AND ILL HEALTH. 313 
 
 BIOGRAPHY AND THE INFLUENCE OF ENVIRONMENT. 
 
 As just mentioned there are many references to ill health in 
 the Life and Letters of Charles Darwin. To what extent can we 
 interpret the nature of a man's ill health from his biography in 
 the light of living people who seem to have similar ill health ? On 
 the other hand, to what extent can the living profit by the "Lives" 
 of the dead? This is a subject that I have brought up several 
 times before learned societies. 1 The subject is a large one and I 
 can only refer to it here very briefly. 
 
 Biographies differ greatly according to the sort of life a man 
 led, whether eventful or not. Uneventful lives furnish dull biog- 
 raphies. The fact that a man was a statesman, a literary -man, a 
 soldier, a musician or a scientist naturally colors the biography. 
 Then the abilities and limitations of the man who writes the biog- 
 raphy must be considered. As a rule the biographer's vocation is 
 similar to that of the individual about whom he writes. The Life 
 of a musician is most apt to be written by a man who is a musician 
 or has a good knowledge of music; the Life of the soldier by a 
 military man. The Life of a scientist, a life of interest perhaps to 
 only a scientist, is apt to be written by a scientist ; the same may be 
 said of a medical man. One expects the Life of a literary man to 
 be written by a literary man and contain much book-chat. 
 
 Now everybody is likely to have more or less ill health and 
 sickness. Some escape in youth, to suffer much toward the end. 
 To what extent these things are mentioned in biographies is an in- 
 teresting question. Some biographies have practically no mention ; 
 others are full of references to ill health. A biographer who has 
 robust health may wholly fail to make mention of ill health, while 
 on the other hand the biographer who himself has more or less ill 
 health may make frequent mention. (Practically speaking, there 
 are no biographies that deal with a man's ill health as books now 
 
 1 The Chronic 111 Health of Darwin, Huxley, Spencer, and George Eliot, Indiana Academy of 
 Science, 1905. 
 
 Benjamin Franklin's Observations on Colds and 111 Health, Cass County (Ind.) Medical Society, 
 1906. 
 
 Biography and the Influence of Environment, Indiana Academy of Science, 1908. 
 
 The Chronic 111 Health of Charles Darwin, Amer. Ass'n Advct. Science, Boston, 1909. 
 
 Charles Dickens and Sanitation. Cass Co. (Ind.) Med. So. Feb., 1912. 
 
314 DUSTY AIR AND ILL HEALTH. 
 
 deal with his statesmanship, military exploits, his books, his con- 
 tributions to science, etc. At least I know of none ; I am speaking 
 of ill health dependent on the influence of environment. It must 
 be evident that, a ''medical biography" which brings in a mass of 
 facts relating to some definite disease may not be of great value to 
 the student of common ill health, particularly if the writer is 
 biased. ) 
 
 The student of dust influences must of course constantly keep 
 in mind the occupation of the individual about whom he is read- 
 ing and the environment under which he lived. We all have an 
 idea under what conditions a statesman spends his life and all have 
 an idea of the surroundings of the literary man. But merely to 
 say that an individual is a statesman or a literary man is not suffi- 
 cient. We must, for instance, sharply distinguish between poets 
 and novelists and historians. All may be regarded as "book- 
 worms, ' ' men who consult books more or less freely. The historian 
 must dig out his data from old dusty and musty tomes. He may 
 or must visit the country and the scenes he is about to describe, 
 but the life out of doors is apt to be short compared to the time 
 spent, in dusty libraries. A novelist may spin a story offhand, a 
 problem novelist may have to read much, or he may spend much 
 time among people getting firsthand information ; after getting his 
 data, he may go into seclusion to write. Tn general similar remarks 
 apply to the poet. A poet like Milton, whose works are full of 
 classical allusions, must have read much ; on the other hand, Words- 
 worth's writings are about things he saw in the country: We speak 
 of certain poets as city poets, they describe crowded streets ; others 
 as poets of the country, they tell of the simple life, of the open 
 sky and fresh air. Offhand one would be inclined to assume that 
 the latter are long-lived. 
 
 Indiana Biographies. There are few Indianians whose lives 
 have been written up in detail and references to ill health are 
 mainly incidental. Where there was much ill health some mention 
 can not be avoided. It is to be hoped that some one who has ac- 
 cess to data will write a biography taking up in detail the ill 
 
BIOGRAPHY AND ILL HEALTH. 315 
 
 health, say of Governor 0. P. Morton. There is already an ex- 
 cellent general biography but there are not enough details to en- 
 able the student of ill health to arrive at satisfactory conclusions. 
 
 Governor Morton was a country boy who on going to the city held 
 out very well at first but in time symptoms of ill health appeared. 
 He spent much time in the State House; gradually symptoms as- 
 cribable to environmental influences began to appear. Moreover 
 making political speeches in crowded halls where spitters abound 
 is a hazardous occupation. There is mention that "his father was 
 a paralytic in his latter years and an aunt had been similarly 
 stricken." When Governor Morton became paralyzed in the lower 
 extremities he believed his hour had come. Evidently he had a 
 high blood pressure. His physicians prescribed absolute rest, but 
 as soon as he had partially recovered he was back at work. Evi- 
 dences of the paralysis remained and finally he went to Paris to 
 consult a famous specialist, but he apparently got more benefit 
 from the rest and the outing (he returned by way of Switzerland) 
 than from the medical treatment, a mode of treatment that is now 
 considered barbarous. 
 
 After being governor he became a senator and that again meant 
 indoor life in crowds. At times of an election he made public 
 speeches. There were ups and downs. One can clearly see how a 
 prolonged rest benefited him and how severe exposure to bad air 
 aggravated. He died, evidently on account of a high blood pres- 
 sure, still comparatively young. 
 
 New England Biographies. The most popular and generally 
 accessible biography of Americans are those of New England lit- 
 erary people. (Those who question such a statement will naturally 
 ask what sort of library facilities a man has.) In some biographies 
 environmental influences can be traced fairly well. New England 
 biographies moreover have an advantage from the fact that there 
 was more or less visiting and correspondence and one gets many 
 cross references. Thus there may be mention of an acute attack 
 of ill health but no clew regarding antecedents, the clew being 
 found in some other biography. It is interesting to trace out fac- 
 
31 6 DUSTY AIR AND ILL HEALTH. 
 
 tors concerned in ill health, but it requires much time and good 
 library facilities or a long purse to buy all biographies — It is not 
 advisable for dust victims to use old library books. 
 
 Louise M. Alcott was a story writer more or less dependent on 
 moods. We must make distinctions between getting the plot of a 
 story and the best conditions for writing it. It would be interest- 
 ing to know why writers are dependent on moods, why they can 
 write well one day or one week and not at all the next, or in one 
 place and not in another. Under what conditions does a writer 
 complain of being unable to write ? When a man is unable to work 
 we say he is sick. What shall be said of the literary man unable 
 to work? Shall we say he too is sick, mentally ill? 
 
 From the biography of Louisa M. Alcott (Cheney) it appears 
 that she had good health up to the time she became a nurse at 
 Washington, on the outbreak of the Civil War. Here under hor- 
 ribly bad air conditions she was stricken with an acute fever and 
 lost her immunity to bad air. She complained of various symp- 
 toms, including at times an inability to write. Periodically she 
 would break down and go to Europe. She would begin to feel 
 better on board ship and felt well while in Europe, but we find 
 her complaining of her old ills as soon as she returned home. City 
 and country exercised an influence. One can clearly see that her 
 ill health was dependent on environmental influences. Naturally 
 she made the rounds of the doctors. At one time she expressed 
 her belief that after having had nine doctors she had found the 
 right one, but there was no cure for her. She died prematurely. 
 A number of my patients have read her biography and all believe 
 she must have been a dust victim. 
 
 J. G. Whittier is commonly regarded as a poet although he 
 wrote much prose, especially in his younger days. For years he 
 was connected with newspapers. He was a country boy, not 
 adapted to city life, a fact which he himself soon discovered and 
 then sought isolation. In addition to his other difficulties he had 
 defective vision, a common affliction in dust victims on account of 
 
BIOGRAPHY AND ILL HEALTH. 317 
 
 the nearness of the eyes to the nose and air passages, where infec- 
 tion is constantly passing. Whittier's ill health has heen explained 
 as being due to "eyestrain" but we must go further and inquire 
 why eyestrain is so common in certain individuals and under cer- 
 tain surroundings. We may come to the conclusion that eyestrain 
 is one of the penalties of living under unsanitary surroundings. 
 
 W. H. Prescott. Prescott was a historian; he had to obtain 
 his data from books, especially from old books and old manu- 
 scripts. His ill health began early and throughout his life there 
 was much of it. At times he would suffer severely and then again 
 largely escape, depending on the surroundings or conditions under 
 which he lived. 
 
 Here I shall not attempt to go into details. I am merely mak- 
 ing general mention in the hope of directing the reader's attention 
 to some biographies that he may read with profit. 
 
 English Biographies. In general it may be said that English 
 biographies are more satisfactory to the student of ill health than 
 our own, for several reasons : First, English writers as a rule live 
 in London (West End) and frequently visit each other and that 
 means there are many cross references. Second, because London- 
 ers are alive to the question of good air and change of air and 
 change of climate. Now it should be kept in mind that the west 
 end of London is comparatively thinly built up, it has many large 
 parks. The wind usually comes from across Windsor Forest and 
 the open country. The exceptional East Wind brings the smoke 
 and dust from the heart of the city, particularly from the East 
 Side where the poor are densely massed, and then there is apt to 
 be complaint, especially by those who are very susceptible to dust 
 influences. Mrs. Browning, for instance, frequently complained 
 of the East Wind. 
 
 Mrs. E. B. Browning was country bred and had much ill health 
 while in London but her health at once improved on living under 
 good air conditions in Italy. In w r armer countries people live more 
 out of doors than in cold northern ones. Now and then she vis- 
 
318 DU8TY AIR AND ILL HEALTH. 
 
 ited her old home but would at once complain and usually shorten 
 her visits. She blamed the climate, not knowing what the real fac- 
 tors were and that much of her ill health was preventable and 
 that she could have lived in rural England perhaps just as well 
 as in Italy had she known her limitations. She frequently men- 
 tioned the Tramontana while living in Florence. This is a wind 
 coming from the Apennines; it also is an east wind. One would 
 assume that a mountain wind brings health but we should not for- 
 get that when it reaches the city it brings the filth of the city on 
 to people who live in the opposite end. 
 
 Thomas Carlyle was a country Scotchman living in London. 
 He had life-long ill health. He is commonly regarded as a dys- 
 peptic and hypochondriac, but if we carefully study his biography, 
 including cross references in other biographies, we may arrive at 
 the conclusion that he was a dust victim. The same remarks apply 
 to his wife, who also came from rural Scotland. She realized that 
 although her health was bad in London she had good health on 
 visiting her old home in the country. But in the country she had 
 nobody to talk to. She preferred to live in the city where she met 
 people; she preferred congenial people and poor health to good 
 health in the country but no one to talk to. She was not excep- 
 tional. The physician constantly meets people, especially women, 
 who say they would rather be dead than move or remove to the 
 country. 
 
 One hardly expects a man of Carlyle 's cast of mind to talk 
 about his ailments, and yet his biography and his letters are full 
 of references to his chronic ill health. 
 
 George Eliot was one of the foremost women writers; her 
 novels are based on a study of human nature. She had frequent 
 discussions with Herbert Spencer, England's foremost philosopher. 
 One might think the subject of common ill health and the detailing 
 of symptoms were beneath her dignity and yet her biography, that 
 is the letters printed in her biography, are full of such references. 
 The explanation is perhaps simple : Many of her letters are to old 
 
BIOGRAPHY AND ILL HEALTH. 319 
 
 friends, people who moved on an entirely different plane. There 
 were few points of contact, but there is one that is almost universal ; 
 just as people in health speak of the weather, those in ill health 
 speak of their complaints. Her friends wrote about their ills and 
 she did the same. Her letters give a fair account of her health 
 and her symptoms and of course more or less of conditions under 
 which she lived. Although letters are given in chronological order, 
 yet the data may not be in the same order, for a letter may refer 
 to events of months or even to years ago. Such references should 
 be properly placed. George Eliot's biography is perhaps one of 
 the simplest and most satisfactory to the student of ill health 
 
 Charles Darwin. In the case of George Eliot there is really 
 only one volume of biography, that by her husband. Although 
 there are several other volumes treating of her life and personality, 
 they contain very little information of value to the student of ill 
 health; they can scarcely be considered as supplementary and the 
 general reader can dispense with them. In the case of Darwin 
 there are four volumes, two appeared years after the others. There 
 is of course an immense literature relating to Darwinism. George 
 Eliot's biography is chronological; Darwin's biography on the 
 other hand is largely topical, that is letters relating to certain 
 topics are brought together. To bring all the data in chronological 
 order is quite a task, how large I did not realize until I came to 
 copy out the references to ill health and environmental influences 
 for a paper at the time of his hundredth anniversary. Darwin 
 was a marked dust victim, but, from the fact that he had much 
 ill health while living in the isolated country, his complaints seem 
 rather puzzling, until one considers that he got whole cartloads 
 of old books from the city, and that when too ill to be about he 
 would look them over reclining on a couch ; that meant literally to 
 get ' ' filled up on city dust." He mentions abstracting whole 
 series of Transactions of learned societies. He realized that books 
 were dusty and that one gets dirty handling them, indeed he wrote 
 a paper on the importance of having cut edges and gilt tops. But 
 that his ill health was dependent on dust influences he did not at 
 
320 DUSTY AIR AND ILL HEALTH. 
 
 all realize. His life history is a very interesting one to the student 
 of chronic ill health. 
 
 Darwin had much faith in hydropathy and frequently went to 
 a water cure establishment. With all his knowledge about animate 
 nature he evidently did not properly understand the relationship 
 of cause and effect, he did not study nor understand the factors 
 that produce ill health or restore health. Scientists as a rule have 
 a great knowledge along certain lines only, along others they may 
 possess the knowledge of the average man or that which they have 
 perhaps imbibed at home from ignorant parents. But in the case 
 of Darwin we should not forget that he was the son and grandson 
 of physicians, and that his knowledge regarding matters relating 
 to health and ill health and disease was far above the average. In- 
 deed, he went to medical college for a time; his father wanted him 
 to be a physician, but the practice of medicine had little attraction 
 for him, as for many another man of a scientific cast of mind, Hux- 
 ley, for instance. The humdrum life of the average practitioner 
 of medicine does not appeal to such men; moreover, they are usu- 
 ally not believers in the free use of drugs. At that time so-called 
 laboratory work was unknown, if we except dissections. Darwin 
 himself revolutionized the study of medicine, which is really a 
 branch of biology. 
 
 Among my scientific friends are several men who have medical 
 degrees but who soon became dissatisfied with the practice of med- 
 icine and instead took up teaching ; to be in competition with a lot 
 of symptom-prescribers was distasteful. More than one has told 
 me that the study of ill health and perhaps disease in the light of 
 environmental influences appealed to him. Indeed, one man al- 
 most decided to take up practice again, after a "little brushing 
 up," but when I explained to him the difficulties one encounters, 
 especially how one must swallow his pride in dealing with disagree- 
 able people and always be on the lookout to earn enough to make 
 a living, he abandoned the idea. 
 
 Medicine is too often considered in the light of a science, and 
 the physician as a scientist. The science of medicine is of course 
 
BIOGRAPHY AND ILL HEALTH. 321 
 
 based on many sciences. The practice of medicine however is an 
 art based on other arts. We need only consider the art of pleas- 
 ing people, such as the "disagreeable dyspeptic" and the "sharp- 
 tongued neurotic." The man who practices purely as a scientist 
 and the man who practices without a knowledge of science are both 
 out of their element. 
 
 The biographies of three Englishmen who visited our country 
 are of especial interest, those of Charles Dickens, Thomas II . Hux- 
 ley, and Herbert Spencer. All three men were dust victims and 
 suffered more or less severely while here. They suffered in pro- 
 portion as they were exposed to "crowd poison." The explanation 
 is perhaps not far to seek but to explain it briefly is a difficult 
 matter. 
 
 Charles Dickens was the son of a poor government clerk and 
 at first had a hard struggle for existence. Perhaps this is the rea- 
 son he was always in sympathy with the poor. He was early ap- 
 prenticed to a shoe-blacking manufacturer at starvation wages and 
 was habitually in want of sufficient and proper food. After addi- 
 tional schooling he learned stenography and became a court re- 
 porter and finally a newspaper reporter. Then he began to write 
 fiction. The "Pickwick Papers" at once made him famous, and 
 his days of poverty were at an end. "David Copperfield" is said 
 to be mainly autobiographical. At the age of thirty he made a 
 visit to our country, no doubt to broaden his horizon. His ' • Amer- 
 ican Notes ' ' and parts of his ' ' Martin Chuzzlewit ' ' were the result 
 of this trip. 
 
 Charles Dickens made two visits to our country, one in 1842, 
 as a young man, and one twenty-five years later, at the age of 
 fifty-five. If I were to characterize these two trips, according to 
 his American Notes and according to Forster's biography, and the 
 volume of letters, I would say that the first trip is remarkable on 
 account of the many references to our national tobacco chewing 
 and spitting habit, and the second on account of the numerous 
 references to ill health ; he was constantly on the point of breaking 
 down, and indeed shortened his tour to get back home. His read- 
 
 [211 
 
322 DUSTY AIR AND ILL HEALTH. 
 
 ing tours had serious consequences ; they undoubtedly hastened his 
 death. 
 
 When Dickens first came to us he expected to find a free country, 
 .1 free people. He expected more real liberty than in England. 
 In this he was disappointed. He found that many people were held 
 in slavery (the negroes), and that others were subdued by public 
 opinion (or shall we say newspaper opinion?) ; that many did not 
 dare to speak out openly — a fact impressed upon us today: Boost, 
 Don't Knock. He saw that we were too contented with ourselves 
 and made no radical effort to better conditions. 
 
 On his first tour Dickens was litlle confined indoors, in fact he 
 travelled mainly during the open door season, and chiefly by stage 
 coach and canal and river boat, and, being a vigorous young man 
 fond of outdoor exercise, he escaped ill health ; at least there is no 
 mention in his biography. 
 
 Dickens's second American tour is of interest to the physician, 
 to the student of common ill health, on account of the many refer- 
 ences to ill health ; they occur on almost every page. 
 
 In the very beginning he was attacked by colds and "American 
 Catarrh. ' ' The latter is eminently an indoor affection, transmitted 
 from one to another through the medium of pulverized catarrhal 
 sputum. The biography and letters speak of overwork but really 
 there was less work and less worry than there had been in England. 
 Everything was planned and arranged for him ; he merely appeared 
 on the stage for an hour and a half or two hours and then his work 
 was over. But there was overwork. The defences of the body in 
 getting rid of infection were overworked. He was constantly in- 
 haling infected dust and reacted acutely, frequently being on the 
 point of breaking down. The spitters no doubt were absent from 
 his audience but they had been there the evening before. 
 Then too we must consider the handkerchiefs that are shaken out, 
 particularly in saluting such a man. One can see that besides be- 
 ing afflicted with American Catarrh, Dickens also had American 
 Dyspepsia and was always on the verge of American Nervous Pros- 
 tration. 
 
BIOGRAPHY AND ILL HEALTH. 323 
 
 Dickens had planned to come as far west as Chicago hut did 
 not get further than Buffalo. Had he come, for instance, into the 
 heart of the spitter's country he likely would have shared the fate 
 of his son. who recently died shortly after a visit to the Middle 
 West, where he lectured before a large audience in a poorly ven- 
 tilated hall. 1 Charles Dickens shortened his visit for fear of a 
 total collapse. He felt that the only way to get rid of his Ameri- 
 can Catarrh, and other ills or symptoms, was to leave the country. 
 In this he was not disappointed, for he tells of his catarrh begin- 
 ning to leave soon after getting out on the ocean. Any one can 
 understand that ocean air means good air. 
 
 Dickens had early noticed the influence of environment, and 
 when things did not go well with him he took a long walk into the 
 country. One of his biographers mentioned the fact that Dickens 
 had a theory that, "To every portion of the day given to labor 
 should correspond an equal number of hours spent in walking." 
 He mentioned that his best loved w r alks were on the cliffs and across 
 the downs by the sea and that he had remarkable powers of endur- 
 ance as a pedestrian. We see this theory more or less applied in 
 his writings, where if things do not go right he takes his characters 
 out into the open air. 
 
 Unfortunately on his second tour he did not live up to his 
 theory, he did not offset hours in bad air by hours in good air. 
 Shall we say that infective matter or toxic products accumulated 
 at a greater rate than the defences of the body could get rid of 
 them? 
 
 After a short rest in England, Dickens concluded to give one 
 more series of readings in his own country and then retire to his 
 
 1 A physician and noted lecturer living on the Atlantic Coast gave an address before the same 
 audience. He gave a fresh air lecture but overlooked one very important factor, the one I have been 
 trying to emphasize in this volume. The following from an Indianapolis paper looks like the irony 
 of fate: 
 
 "Dr. , the man who has been telling us through the magazines how to keep ourselves in 
 
 good health and enjoy life, is in such poor physical condition that his physician — doctors do not trust 
 themselves to prescribe for themselves — has ordered him to cancel his lecture engagements and take a 
 
 complete rest for six months. Dr. says the trouble is that he has overworked, but is he 
 
 sure that he has not been living up to his own rules too closely?" 
 
 I went to hear these lectures, and as a result carried away a "cold that hung on" for two weeks. 
 I went hoping to escape but got caught. I have no doubt that many others in that audience were 
 similarly caught. 
 
324 DUSTY AIR AND ILL HEALTH. 
 
 country home. One is reminded of the suburbanite who jumped 
 off his train before it came to a stop. He did this a hundred times 
 luit lie did it once too often. To the student of common ill health 
 and environmental influences it is clear that Dickens should not 
 have attempted to give another series of readings after his Ameri- 
 can tour; his health was too much shattered. In fact he did not 
 complete the final series. One feels that he died prematurely. He 
 evidently was a cardio-vascular dust victim, with a high blood 
 pressure. 
 
 There are any number of topics that one can work out from the 
 data contained in Dickens's biography and letters. A very interest- 
 ing one is his relationship to the medical profession. One would 
 assume that a man of such eminence would have the best physi- 
 cians of the community and country, and this in general was true ; 
 but unfortunately the medical men whom he consulted were sur- 
 geons rather than physicians. Today there is of course a greater 
 gulf between the two than at that time. When we think of a sur- 
 geon we think of surgical operations. The surgeon is not concerned 
 with ''mere ill health," its cause and prevention. But on the other 
 hand the physician of the best type, especially today, is always 
 seeking to prevent, not only disease but also common ill health. 
 He tells his patient what to do and what not to do. He even seeks 
 to avoid the need for surgical operations. Properly considered, 
 Dickens never got the square deal from the medical profession. 
 The medical men did not study him in the light of the influence 
 of environment. On carefully considering all the data as given 
 in his biography and letters, one arrives at the conclusion that 
 Dickens, until perhaps the very end, did not have any well-defined 
 disease. This thought bears repetition. It would seem that his 
 chronic ill health w r as merely an expression of unsanitary life con- 
 ditions, particularly bad air conditions. Practically all his symp- 
 toms must be considered in the light of warnings from nature to 
 desist, to get out into good air. Dickens like Huxley felt well phy- 
 sically almost as soon as he got out into the country — but country 
 life means isolation. 
 
BIOGRAPHY AND ILL HEALTH. 325 
 
 Dickens's influence on the masses was great. He was a sani- 
 tarian, but not of the trained, salaried kind ; he was a sanitarian by 
 instinct, so to speak. He saw unsanitary conditions that failed to 
 be recognized by the medical profession of his time — and only too 
 often by present day physicians. He was not a scientist; he was 
 a literary man. In writing about unsanitary conditions, especially 
 of the lives of the miserable poor, Dickens did not appeal- to the 
 reason ; his appeal was to the emotions. He wrote novels, fiction, 
 but, very important to note, his stories were not spun wholly out 
 of his brain; they are based on facts, on personal observations. 
 As a writer he depended for inspiration upon long walks about the 
 city, he knew London thoroughly. He got into all the back streets 
 and alleys and slums generally. He studied humanity as well as 
 the influence of environment at first hand. 
 
 The influence of Dickens as a sanitarian crops out especially in 
 the education of children. His influence was great. Among other 
 things he insisted upon large and well-ventilated school rooms. 
 And yet we say Dickens is a caricaturist and out of date! 
 
 That Dickens clearly saw the influence of environment is evi- 
 denced by the fact that his outdoor people, farmers, fishermen and 
 sailors, are strong, robust, ruddy faced people, while his indoor 
 people, city people, are thin, sallow, sickly, usually undersized, the 
 exceptions merely bringing out the contrast. 
 
 Dickens was eminently sane in his views regarding sanitation. 
 He fully realized the importance of cleaning up. Cleanliness is 
 the great remedy for poverty and for the "slum disease" and for 
 ill health dependent on unsanitary surroundings. His novels are 
 full of references. 
 
 It is to be regretted that Dickens did not live a few years longer 
 and write a novel dwelling particularly on the evil influence of 
 an unsanitary environment. He could have appealed to the masses 
 as a sanitarian by instinct. 
 
 We need a Dickens to describe unsanitary conditions in our 
 country, some one to tell us of the importance of cleaning up. As 
 matters stand, we rely too much upon authorities, often incompe- 
 
326 DUSTY AIR AND ILL HEALTH. 
 
 tent and negligent. As already mentioned under schools, parents 
 expect school authorities to do everything. Moreover the people 
 do not properly support Boards of Health. Unfortunately, these 
 are too often composed of physicians who are mere figure-heads. 
 The people should be represented more directly on Boards of 
 Health. There should be business men, manufacturers, teachers, 
 lawyers, perhaps even a preacher, on our Boards of Health, and 
 certainly a club woman interested in the matter of health and ill 
 health. The women can show the men how to clean up. Individ- 
 uals who are mere figureheads should be recalled. 
 
 Although Dickens had much to say regarding our national 
 chewing and spitting habit, he never traced the relationship of 
 our "Triad of National Diseases" to it. He did not even mention 
 that the tobacco chewer encourages others to spit, notably those 
 who are catarrhal or tubercular. If he had had only an inkling 
 he might have written a novel directing attention to pulverized 
 spittle as a cause of national ill health, impressing the people as 
 no scientific writer can. 
 
 Thomas H. Huxley. Huxley came to London as a young man. 
 He withstood bad air conditions quite well at first but in the course 
 of years complained more and more. He started out to be a physi- 
 cian but ultimately became a teacher of some of the sciences on 
 which Medicine rests, and that means he was constantly in contact 
 with the best medical men of London. The two volumes of Life 
 and Letters are full of references to ill health. As a matter of 
 fact his ill health must be regarded as a reaction to an unsanitary 
 environment, to bad air conditions. His physicians at times would 
 send him to the country, to Switzerland, and even to Egypt, and 
 his health would improve at once, but he would relapse on getting 
 back to the city. Of course he had all sorts of opinions from doc- 
 tors. Although Huxley did not know of dnst infection (he lived 
 before the days of bacteriology) yet he realized that air conditions 
 and crowds influenced him ; he learned many little things about 
 avoiding ill health. He was continually trying to find his limita- 
 tions. When he came to this country he was careful about avoid- 
 
BIOGRAPHY AND ILL HEALTH. 327 
 
 ing crowds. He gave only a few lectures to selected audiences; 
 had he done otherwise one feels he would have broken down. After 
 quitting London and residing on the seashore, he took a new lease 
 on life. He lived beyond the allotted "three score and ten." 
 
 It is interesting to note expressions used by Huxley in telling 
 about his bodily condition, about his ill health. Besides common 
 terms such as coughing, headache, nausea, and vomiting, he uses 
 such expressions as shaky voice; scarcely had a voice; morbid state 
 of mucous membranes ; a shot at bronchitis ; confounded stomach ; 
 hypochondriacal dyspepsia; intestinum colon plays a trick every 
 now and then; general nervous depression : blue devils (used re- 
 peatedly); curious nervous irritability; hypochondriacal depres- 
 sion; neuralgia or rheumatism or whatever it is. There is a long 
 list of such and similar expressions. 
 
 Herbert Spencer Avas likewise a dust victim but unlike Hux- 
 ley his work did not bring him in constant contact with the best 
 physicians, in fact he complains that some physicians whom he con- 
 sulted did him more harm than good. Like Huxley he was always 
 trying to find his limitations, under what conditions he could live 
 with the least ill health. He spent much time on vacations in the 
 country. Huxley tells how he was trying to find his juste milieu, 
 the conditions under which he could best exist ; Spencer speaks of 
 wanting a keeper, some one who will tell him what to do and what 
 not to do. 
 
 "When Spencer came to our country he was exceedingly care- 
 ful to avoid crowds. He was importuned to give public lectures 
 but refused, although the terms were flattering and he greatly 
 needed money to publish his books, since they appealed to a lim- 
 ited number of readers only. Spencer lived on to old age. He may 
 be cited as an example of the English saying, Acquire an incurable 
 disease and live long, always keeping in mind what "disease" 
 means. 
 
 A study of the life and writings of these three men is also of 
 interest on account of their views regarding education, "What 
 education is of most worth?" 
 
X. 
 
 PERILS AND A REMEDY. 
 
 We are constantly told of perils and chief perils that threaten 
 us, our cities and our country, if not the world as a whole, and 
 how mankind is on the verge of extinction. Those who unduly 
 magnify perils are called alarmists. Those who study certain top- 
 ics may see perils that wholly escape the observations (or shall we 
 say the "imagination"?) of others. Some articles in newspapers 
 and magazines make use think, others make us smile, depending 
 largely on the viewpoint. 
 
 In discussing the dust problem with patients a physician finds 
 all sorts of people, those who make light of the whole subject to 
 those who see the gravest danger and who wonder that they are 
 still alive or that man has not long ago disappeared from the face 
 of the earth. To the one class the physician must show that the 
 dust peril is a real peril, that it is in operation all about us, not 
 only in the production of ill health but in destroying life as well 
 as in the matter of "race suicide." On the other hand those who 
 are unduly alarmed must be told that the very fact that they are 
 alive is good evidence that the danger is not as great as they be- 
 lieve, think, or imagine. Although the susceptible are constantly 
 being killed off, there are any number of survivors that can live 
 under present day conditions, although perhaps complaining more 
 or less of ill health. One can point out that under sanitation many 
 diseases have practically disappeared, some are known only by 
 name, and that the average length of life has been greatly increased. 
 Just as there has been a diminution of diseases and ill health on ac- 
 count of getting good water, so there will be better health with 
 good air. 
 
 There are perils everywhere, by knowing about them we can 
 
 (328) 
 
PERILS AND A REMEDY. 329 
 
 largely guard ourselves. Our street car company recently put up 
 signs regarding the peril of stepping off backward. In issuing 
 these warnings the street car company aims to protect its passen- 
 gers and also itself, injuries are often wholly avoidable or prevent- 
 able. Many people are always getting off backward in all walks 
 of life. They are surrounded by all sorts of perils, they must be 
 told how to act. We hear much of publicity to-day. It is becom- 
 ing clearly recognized that when a peril is freely discussed we are 
 on the right road to lessen it. 
 
 Dr. Saleeby in his very sensible book, Health, Strength and 
 Happiness, says in the very beginning: 
 
 "Such books as this might be are amongst the chief makers of hypo- 
 chondriacs — people who make themselves ill by trying to keep well." 
 (p. 9.) 
 
 A few pages further on under the head of "The Need of Air" 
 
 he says: 
 
 "A full discussion of this question can not injure even the most sug- 
 gestible and hysterically-inclined woman. I really do not think that any 
 one can be too fussy about the need of pure air, though millions of people 
 are too fussy about the need for its exclusion. Such persons have, in 
 every case, made themselves susceptible to draughts, and can undo their 
 burdensome handiwork. Further, the man or woman who is fussy about 
 the need for fresh air is benefiting other people besides himself, and earns, 
 though he does not obtain, the thanks of all except the tubercle bacillus. 
 I hope this chapter will afford fresh power to his elbow." (p. 25.) 
 
 The Remedy. When an alarmist points out a peril he usually 
 also suggests a remedy, what we must do to be saved. To what 
 extent is dust a peril 1 Views are apt to vary widely. The marked 
 dust victim may over-emphasize it. The immune may make light 
 of it. Those who have never had their attention directed to the 
 subject are likely to consider the matter largely in the light of 
 their own susceptibility. The reader should not arrive at hasty 
 conclusions, now that his attention has been called to the matter 
 he should observe. 
 
 Of course everybody tries to avoid dust, many merely because 
 it is dirty, it soils the clothing, it is disagreeable, unpleasant. They 
 
330 DUSTY AIR AND ILL HEALTH. 
 
 regard it as a nuisance rather than as a menace to health. The 
 wise physician when he sees a dust cloud coming down the street 
 says, There is money in that for me — if the people only knew! 
 
 During the open door season, during summer, the doctor, the 
 general practitioner, has little to do but he knows the moment the 
 schools open and the children are massed together in unsanitary 
 school buildings he will begin to get busy and when the cooler 
 days come and people house themselves up he gets very busy. 
 Medical inspection of school children has been brought forward as 
 a remedy, as far as relates to school children. To inspect and to 
 report does not mean to prevent but that no doubt will be the next 
 step. Cleaning up is the remedy. The community as a whole 
 should be inspected and made clean. 
 
 Formerly cities were very unsanitary, as they are still in back- 
 ward communities. On account of the massing of humanity ills 
 and diseases of all kinds were rife, morbidity and mortality rates 
 were high. To understand this fully we must read about condi- 
 tions as they existed a hundred and more years ago. New coun- 
 tries largely go through the same cycle as the old ones. Adam 
 Smith wrote of the large number of children born to Scotch moth- 
 ers and how out of twelve or fifteen only one or two would survive. 
 At the same time Benjamin Franklin was telling of the large fam- 
 ilies in our own country. Since then conditions have radically 
 changed. Old European cities have cleaned up and have greatly 
 reduced their death rate ; cities are almost self-sustaining now, no 
 longer dependent on the constant influx of country blood. On the 
 other hand conditions in our own country have grown progres- 
 sively worse, as evidenced by small families and the cry of race 
 suicide. Although we are able to keep out many diseases such as 
 cholera and the plague, yet many of the old time diseases flourish 
 in our country, besides a host of maladies that manifest themselves 
 as ill health rather than well defined disease. 
 
 In early days there was no milk problem, but today this is a 
 serious one in large cities, and even in the small cities. To the man 
 who keeps a cow it is no problem at all. Milk becomes impure 
 
PERILS AND A REMEDY. 331 
 
 mainly on account of passing through many hands. Similarly the 
 water problem is a serious one to cities but is no problem to the 
 isolated farmer. 
 
 It is not alone human beings who suffer from massing, we see 
 the same thing among plants. There is increasing difficulty in 
 raising farm and garden crops. When the soil was still fertile and 
 pests and parasites of all kinds were absent, anybody could farm, 
 just as anybody could raise garden truck and fruits. Our National 
 Department of Agriculture and our State Experiment Stations 
 are engaged in telling the farmer and the horticulturist how to 
 succeed under adverse conditions — but so far little effort has been 
 made to tell him how to raise a family of strong and healthy chil- 
 dren. The farmer who lives in isolation is still able to produce a 
 large family of children but when he sends them to unsanitary 
 schools or to unsanitary cities there is heavy loss. City people are 
 reproducing themselves at so small a rate that there is a constant 
 cry of race suicide. 
 
 During the last few years we have heard much about Conser- 
 vation, chiefly about conserving our national resources, now that 
 some are almost exhausted. There is even a movement to "con- 
 serve national health." All sorts of efforts are made to prevent 
 the loss of human life. "We have railroad commissions that seek to 
 prevent accidents; the}' tell us how many hundreds of lives have 
 been saved. Cities appoint pure milk commissions and tell us how 
 many lives of infants are saved. Cities develop a pure water con- 
 science, people demand and get good water and then we are told 
 how many lives have been saved from typhoid fever. We have 
 pure food laws and ordinances of all kinds and statisticians are 
 inclined to speak of the number of lives saved. Physicians speak 
 of their efforts in saving lives, as for instance in building the Pan- 
 ama Canal. There are all sorts of efforts but we are only begin- 
 ning to realize the need for good air. This has manifested itself 
 so far mainly by smoke commissions, seeking to do away with the 
 "smoke evil." We are only beginning to understand the dust 
 evil. If the people knew to what extent dust is the cause of ill 
 
332 DUSTY AIR AND ILL HEALTH. 
 
 health and disease they would make radical efforts in dust pre- 
 vention and in cleaning: up. 
 
 The people simply do not realize the amount of ill health and 
 disease that is dependent on the dust evil. Although in our country 
 the amount of well-defined disease is being reduced the amount of 
 ill health is increasing, for various reasons, chiefly from the fact 
 that as sanitation reduces specific diseases people who ordinarily 
 would have perished live on and are subject to ill health that is 
 not sufficiently severe to kill. During the prevalence of an epi- 
 demic those who have a "lowered vitality," who have had more 
 or less ill health are largely weeded out. In proportion as such 
 diseases are kept in check people live on and on. Prudent people 
 of course guard themselves at all times. The man in chronic ill 
 health may be unusually careful. The well-to-do who can properly 
 do this live on and on while the poor man who must work perishes 
 early and only too often leaves a large family of small children. 
 If the community as a whole were interested in sanitation the poor 
 man would have a better chance of surviving, of reaching a greater 
 age. Naturally there are all sorts of remedies proposed, especially 
 superficial ones. While the sanitarian insists upon cleaning up, 
 there are still people who oppose such measures. There is a sect 
 of fanatics who deny that there is such a thing as disease, and 
 then there are those who while not denying disease believe in ig- 
 noring it, who try to delude themselves. The "New Thought Move- 
 ment" and faith cures have been put forth as remedies. But there 
 is nothing new about these ; such remedies are old, such views take 
 us back to primitive times. The physician of today believes that 
 most mental ills are dependent on physical conditions. The an- 
 cient Greek philosopher said, Know Thyself. The modern sani- 
 tarian advises. Know your city. The evolutionist tells us to study 
 our environment, that our health and ill health are largely depend- 
 ent upon it. Environmental influences may be regarded as the 
 influence of surroundings. 
 
 In speaking of the evils entailed by the lack of knowledge of sur- 
 roundings, Ward says: "Indeed, the greater part of all suffering is the 
 
PERILS AND A REMEDY. 333 
 
 it-suit, direct or remote, of such ignorance. Obviously, therefore, the first 
 great duty of man is to acquaint himself with his environment. This can 
 only be done by study. The phenomena that lie on the surface are of little 
 value. They mislead at every turn. Not only must the deep-lying facts, 
 difficult of access, be sought out with great labor and perseverance, but 
 they must be co-ordinated into laws capable of affording safe and reliable 
 guides to human operations. To do this requires a vast amount of patient 
 study. Only a little has yet been revealed of the more important truths 
 of nature, yet consider the amount of research which it has required ! 
 Nevertheless, only a few individuals have contributed anything at all to 
 the result. It is as yet only the simpler and more obvious relations 'be- 
 tween man and nature that have determined. In the domain of physical 
 forces and chemical substances he is able to exercise previsi'on in many 
 ways to secure advantages and avert evils, but in most of the higher fields 
 of \ital, mental, moral, and social phenomena, these relations are either 
 utterly ignored or but dimly suspected, so that his knowledge of them 
 avails him nothing. The great work before him, therefore, still is study." 
 (Lester F. Ward, Dynamic Sociology, Vol. II, p. 11.) 
 
 He further says : "But what constitutes the environment of the 
 civilized man? The character of the environment of animals and of savage 
 man is easy to perceive. It is the earth, the air, the rocks and waters, 
 the trees, grass, birds and animals, the last to include, in the case of the 
 savage, the men of his own tribe and of other tribes, and also civilized 
 races, in case any such ever come in contact with him. It is by learning 
 to know these things that he is enabled to protect and defend himself. 
 
 "But, looking to races somewhat more advanced than the crude savage, 
 we find, as frequently shown before, that their advancement has been due 
 to action on their part in taking advantage of certain deeper laws of 
 'nature, in making use of materials that savages fail to make use of, in 
 interpreting phenomena that savages do not correctly interpret, and, 
 through these means, in devising plaDS and inventing appliances for mul- 
 tiplying the products of nature and increasing the supply of physical, 
 social, and intellectual wants. And, when we have reached the highest 
 forms of social existence, we find that the only effective means by which 
 desire is gratified, progress achieved, and happiness attained, consist in 
 still deeper knowledge of the natural surroundings, in a still wider grasp 
 of laws and principles, in the correct interpretation of still more obscure 
 phenomena, and in the discovery and invention of still better means and 
 methods of securing remote ends. To know one's environment is to possess 
 the most real, the most practical, the most useful of all kinds of knowledge, 
 and, properly viewed, this . class of information constitutes the only true 
 knowledge." (Vol. II, p. 495.) 
 
 In discussing the expression "knowledge of the environment,"' Ward 
 comes to the conclusion that it is co-extensive and synonymous with the 
 word science. "Knowledge of man's environment is nothing more nor less 
 
334 DUSTY AIR AND ILL HEALTH. 
 
 than scientific knowledge; and. conversely, all scientific knowledge con- 
 sists in knowledge of the environment. . . . The only useful knowledge 
 is that which furnishes relations. Isolated facts, until employed for this 
 purpose, are not really employed at all. An object known only in itself 
 ran scarcely he said to be known. . . . Science is dynamic. Whatever 
 it touches is transformed. The only object in knowing is by means of it 
 to do something . . ." 
 
 Ward refers to the attenuation of knowledge and of getting away 
 from things, and how especially in the Middle Ages men were inclined to 
 neglect facts, and how science brings us back to facts and to nature. We 
 can readily see how students of environment and environmental influences 
 are not likely to be misled by the present fad of psychotherapy. Ward also 
 refers to much of our literature as being simply a jugglery of words, 
 pleasing to the ears, but of little value in keeping man acquainted with his 
 environment. 
 
 Perhaps few of us realize fully the importance of environmental in- 
 fluences, of how our life, our thoughts and actions, are dependent thereon. 
 No doubt many of us have at times wondered what our own life and the 
 life of others would be under different surroundings. 1 
 
 Today we hear much regarding a return to the simple life. 
 That is by some considered a cure for many ills, including race 
 suicide. What do we mean by the simple life? Does it mean a 
 return to earlier primitive conditions, to a stage, for instance, seen 
 in the southern mountains where people are healthy and live long ? 
 It is sometimes said that the southern mountaineers are a hun- 
 dred years behind in their civilization. Some countries are far be- 
 hind. How many would prefer "fifty years of Europe than a 
 cycle of Cathay"? How many after living the complex life of 
 today are really willing to return to simple conditions? Accord- 
 ing to my experience there are so few that they are scarcely worth 
 considering at all. There is of course much that can be simplified. 
 "Good taste" itself seeks the simple. We often hear the rich and 
 the new-rich compared; too many want to show their money by 
 gaudy display. 
 
 As civilization advances and life becomes more complex a re- 
 turn to primitive conditions is not a remedy. People outgrow 
 primitive ideas of religion, of government and State constitutions. 
 
 Even the physician outgrows the traditions of his profession. 
 
 Biography and the Influence of Environment, Ind. Acad. Science, 1908. 
 
PERILS AND A REMEDY. 335 
 
 The old time physician was a good Samaritan who bound up wounds 
 but the physician of today attempts to prevent the infliction of 
 wounds. The old time physician promptly handed out medicine 
 to those who came to him complaining; old tradition demands that 
 any one applying to a physician should be given aid or relief and 
 no questions asked regarding compensation. But times have 
 changed. Not so very long ago the physician did not ask for a fee 
 at all — he was supposed to be above that, he "expected a honor- 
 arium. ' ' The physician of today has gotten away from such ideas, 
 he believes the laborer worthy of his hire and asks for his fee or 
 sends in his bill for services rendered. The modern laboratory 
 doctor is not bound by old traditions. He investigates fully before 
 advising and prescribing, that means much time is given those ac- 
 cepted. He is apt to inquire in the very beginning what he will 
 get in return. As in all other walks of life, the man who has little 
 to give gets little. ' ' For he that hath, to him shall be given : and 
 he that hath not, from him shall be taken even that which he 
 hath." The physician of today is inclined to place the blame for 
 the prevalence of ill health and injuries of many kinds where it 
 properly belongs. The people are beginning to realize that many 
 injuries, as from railway accidents, are preventable; they are be- 
 ginning to realize that many deaths from impure water are pre- 
 ventable, cities supply themselves with good water. We are be- 
 ginning to understand that the ravages of tuberculosis are largely 
 preventable by good air. 
 
 It is perhaps useless to attempt to teach old people regarding 
 the importance of sanitation and hygiene, whose chief law is that 
 of cleanliness. But it is worth while to teach the young; they 
 learn readily and remember. The place above all others that should 
 be clean, where in fact the importance of cleanliness should be 
 taught, is the common school. From there the teachings are spread. 
 But in order that the children may be taught the teachers must 
 first be taught. Where shall the process of teaching the impor- 
 tance of cleanliness begin? Shall it be left to the authorities or 
 shall it be left to the people? Or do the people still expect the 
 
^36 DUST* AIR AND ILL HEALTH. 
 
 general practitioner of medicine to teach them? As a rule peo- 
 ple do not call upon the physician until they are sick; is the bed- 
 side a good place to teach the importance of sanitation? Who 
 makes the best Btreel commissioner to direct street cleaning, a man 
 or a woman) Who makes the best sanitarian, the physician in 
 private practice depending for his bread and butter on the mis- 
 fortunes of his fellow-citizens or the trained sanitarian paid by the 
 community, the man who has nothing to lose from the enemies he 
 makes? Is it necessary to add that the right of a man in ill health 
 to prescribe for himself or to employ some one to "doctor" him 
 will likely be conceded? The wise man will likely employ a skilled 
 physician to look after him. just as the wise community will em- 
 ploy a skilled sanitarian to look after the communal welfare. 
 
APPENDIX 
 
 [22] (337) 
 
INDEX 
 
 A-b-c explanations, 228. 
 
 "Abe Martin" and Pump Towns, 23. 
 
 Acetanilid, 224, 237. 
 
 Adaptation, 35, 50. 
 
 Adenoids, 85. 
 
 Advertising doctor, 222. 
 
 Advertisements, newspaper, 235. 
 
 Advising a patient to move, 271. 
 
 Agassiz, 165. 
 
 Age and arteries, 262. 
 
 Age and high blood pressure, 264. 
 
 Air, bad (a synonym), 65. 
 
 dust free, 129, 148. 
 
 good (synonym for clean), 
 
 night, 18. 
 
 open, 20, 28, 276, 323. 
 
 pure (synonym for clean), 
 
 of Places, 99, 146. 
 Albumin, 260. 
 Alcohol, 24, 224, 237. 
 Alcott, Louisa M., 316. 
 Alteratives, 249. 
 
 American Catarrh, 69, 103, 105, 175, 
 322, 323. 
 
 Diseases (see Triad of). 
 
 Dyspepsia, 175, 322. 
 
 Nervous Prostration, 322. 
 
 Notes, Dickens, 321. 
 
 spitting habit, 69, 321. 
 
 tours, Dickens, 321. 
 Analogies, plants and animals, 85. 
 
 animals and man, 288. 
 
 diseases and plants, 289. 
 
 weeds and diseases, 300. 
 Ancestors, rural or urban, 34, 122. 
 Anemia, 185, 276. 
 Anopheles (mosquito), 49, 53, 289. 
 Anophelesis, 49. 
 Anorexia (loss of appetite), 
 
 276, 186. 
 Antagonism to physicians, 214. 
 Anthracosis, 72. 
 "Anti" remedies, 130. 
 Anti-smoke laws, 69. 
 Anti-spitting ordinance, 148, 221. 
 Antitoxin and diphtheria, 294. 
 Antitoxin and tuberculosis, 294. 
 Appendicitis, 167. 
 Appetizers, 186. 
 Apoplexy, 258, 273, 76. 
 
 Arabs and odors, 92. 
 Arteries and age, 256, 262. 
 Arteries, soft and Indian, 263. 
 Arterio-sclerosis, 286. 
 Asthenia (lack of strength), 276. 
 Attic colds, 107. 
 Atypical cases, 172. 
 Autobiographies, 155, 303. 
 Autobiographic case report, 304. 
 Autobiography, 196. 
 Auto-intoxication, 168, 170. 
 Automobile colds, 107. 
 Autumnal catarrh, 65. 
 Average patient, 305. 
 
 Backache, 131, 145, 288. 
 Backward communities, 57, 330. 
 Bacteriology, 24, 29. 
 
 and explanations, 146. 
 Bacillus tuberculosis, 147. 
 Bad air influences, 220. 
 Baldness, premature, 282. 
 Barber's itch, 254. 
 Beard, Dr., and neurasthenia, 213. 
 Becoming hardened, 281. 
 "Being Done Good," Lent, 132, 183. 
 "Beneficent Dust," 68. 
 Best citizens and politics, 239. 
 
 family paper, 229. 
 
 family physician, 236. 
 
 patients, 252. 
 
 vs. worst people, 178. 
 "Best of health" and life insur- 
 ance, 259. 
 "Better class," 303. 
 "Beware of a cold," 296. 
 Bilious, 167. 
 Biliousness, 169. 
 Biography, 18, 93, 129. 
 
 and Environment, 313. 
 
 and 111 Health, 302. 
 Biology, problems, 183. 
 Bladder, irritable, 190. 
 Bleeding and purging, 59. 
 Blood count, 176. 
 
 poisoning, 131, 299. 
 
 pressure, 76, 198, 258, 279, 285. 
 
 purifiers, 101. 
 
 vessels, 283. 
 
 (23) 
 
 (341) 
 
342 
 
 DUSTY AIR AND ILL HEALTH. 
 
 Boards of Health, 111, 326. 
 Blue Monday, 10S. 
 Blues, the. 192, 212. 
 Boil the water, 22, 27. 
 Book, dust, 66. 
 
 dust colds, 107. 
 Books, old dusty, 316, 319. 
 
 German, 256. 
 Bookworms, 314. 
 "Boost, Don't Knock," 322. 
 "Break the fever," 278. 
 Breath, getting out of, 277. 
 Bright's Disease, 146, 25S. 
 
 and backache, 2S0, 288. 
 Bronchitis. 286. 
 Browning. Mrs. E. B., 317. 
 Bryant, William Cullen, and ma- 
 laria, 18. 
 Byssinosis, 72. 
 
 Cancer fear, 164. 
 
 of the stomach, 172. 
 Captain of death. 296. 
 
 of industry, 262. 
 Cardio-vaseular affections, 258. 
 
 Case Report, 266. 
 
 type, 76. 
 Carlyles, the. 26S, 300, 318. 
 Carpet colds, 108. 
 
 Case Reports, 84, 90, 93, 132, 133, 
 137, 139, 140, 144, 152, 153, 160, 
 161, 163, 175, 176, 178, 181. 197. 
 199, 200, 202, 204, 205, 206, 20S, 
 217, 225, 230, 242, 253. 266, 294, 
 304. 
 Case Reports at secondhand, 
 306, 309. 
 
 dry-as-dust, 93. 
 
 in journals, 311. 
 
 cancer, stomach, 172. 
 
 reprinted, 84, 90, 176. 304. 
 Case Notes at secondhand, 196. 
 Cases, "interesting," 41. 
 
 reporting, 216. 
 
 selected, 310. 
 
 successful and unsuccessful, 140. 
 
 typical and atypical, 172. 
 Catarrh, American, 69, 175. 
 
 infective and non-infective, 104. 
 Catarrhal diathesis, 104. 
 "Catching cold." 99, 113, 188. 
 "Catching disease," 30. 
 Cathartics, 167, 170. 1S9, 224. 
 Cathay vs. Europe, 334. 
 "Caught more cold," 117. 
 Century Clubs, 256. 
 
 Chalicosis, 72. 
 Change of air, 153. 
 
 of climate, 127. 
 Changes in climate, 15. 
 
 in Indiana, 45. 
 Charlatans, 135. 
 Chautauqua salute, 70. 
 Chemists and explanations, 146. 
 Chest, oppression in, 189. 
 Ohewer and spitter, 242. 
 Chewing tobacco, 69. 
 Chief perils. 44, 328. 
 Children, delicate, 133. 
 
 hardening, 281. 
 
 in isolation, 86. 
 
 newborn, 123. 
 
 school life, 123. 
 Chills and chilling, 186, 277. 
 Chinese cities, 14S. 
 Cholera, 290, 51, 259, 287. 
 
 fear, 290. 
 Christmas colds, 108. 
 Chronics and symptoms, 288. 
 Chronology and biography, 319. 
 Church, 52. 
 
 colds, 10S. 
 
 doorkeeper, 270. 
 
 going or not, 108, 269. 
 City cases, 160. 
 
 doctor, 16, 208. 
 
 dust, 63. 
 Cities, backward, 142. 
 
 fortified, 143. 
 
 and country blood, 330. 
 Civilization, 142. 
 
 diseases of, 130. 
 
 Greek and Roman, 290. 
 
 stages of, 62. 
 
 and malaria, 290. 
 Classifying colds, 106. 
 
 diseases, 55, 212. 
 
 dust victims, 73. 
 
 patients, 76. 
 
 people, 77. 
 Clean air, 238. 
 
 food, 19, 23, 238. 
 
 streets, 143, 238. 
 
 water, 23. 23S. 
 Clean Up, Clean Out, Keep Clean, 
 
 32. 167. 
 Cleaning up, 123, 219, 237, 2S7, 
 293, 330. 
 
 and women, 326. 
 
 and pat. med. ads, 225. 
 Cleanliness, surgical, 174. 
 Clergyman's sore throat, 206. 
 
INDEX. 
 
 343 
 
 Clerks in stores, 217. 
 Climate, 127. 
 
 changes in, 15. 
 
 "horrible," 138. 
 
 indoor, 33, 128. 
 
 "wonderful," 130. 
 Closed door season, 137, 170. 
 
 and pat. med. ads, 225. 
 Clothing, 283. 
 
 "healthiest color," 23. 
 
 red flannel, 23. 
 Clubs and Club women, 239. 
 Coal tar preparations, 224. 
 Cocaine, 237. 
 Cold cures. 233. 
 Colds, 74, 188. 
 
 attic, 107. 
 
 automobile, 107. 
 
 book dust, 107. 
 
 carpet, 108. 
 
 church, 108. 
 
 classifying, 106. 
 
 court-house, 109. 
 
 dance-hall, 109. 
 
 housecleaning, 110. 
 
 manifestations, 116. 
 
 railway, 110. 
 
 school, 111. 
 
 State Fair, 96. 
 
 tax payer's, 98. 
 
 that hang on, 99. 
 
 vacuum cleaner, 112. 
 
 and Ben. Franklin, 213. 
 catarrh, 103. 
 cold, 103. 
 exposure, 114. 
 indoor life, 105. 
 Colonizing, 33. 
 Common factor, 102. 
 Communal welfare, 336. 
 Communists, 24. 
 Compensations, 288. 
 Complexion, 185, 282. 
 
 cures, 282. 
 
 vs. pain, 282. 
 
 and good air, 282. 
 Concealed malaria, 18. 
 Conclusions, hasty, 329. 
 Conditions for catching colds, 113. 
 Confession of ignorance, 152, 
 
 174, 214. 
 Congenial people, 318. 
 Congestive chill, 188. 
 Coniosis, 72, 174, 218. 
 Conophobia (dust fear), 252. 
 Conservation movement, 331. 
 
 Conservative processes, 287. 
 Constipation, 166, 189, 277. 
 
 and pat. med. ads, 160. 
 Contagious diseases in schools, 291. 
 Contributing factors, 21 8. 
 Constriction of chest, 189. 
 Continuous data, 303. 
 Co-operation, 43. 
 Cough, 189, 277. 
 
 cures, 231, 237. 
 Country ancestry, 265. 
 
 boys and city, 262. 
 
 doctor, 172, 208. 
 
 doctor and medical journals, 78. 
 
 dust, 63. 
 
 grub, 32. 
 
 homes, 68. 
 
 practice, 157. 
 
 road dust, 63. 
 Court-house, 52, 294. 
 
 air. 309. 
 
 colds, 97, 109. 
 
 officials, 241. 
 
 and women, 239. 
 Crowd Poison, 65, 73, 92, 321. 
 "Cuckoo Parents," 111. 
 Culture media, 30. 
 Cure vs. relief, 233. 
 Cures, outlandish, 311. 
 Curing or killing, 141. 
 
 a cold, 233. 
 
 vs. benefiting, 92. 
 
 vs. relieving, 233. 
 "Cystitis," 190. 
 
 Daily record, 271, 180, 201. 
 
 Dance-hall colds, 109. 
 
 Darkest before dawn, 96, 97, 101, 311. 
 
 Data, continuous, 303. 
 
 Darwin, Charles, 302, 319. 
 
 Life and Letters, 313. 
 Dead finger symptoms, 190. 
 Death, gradual or sudden, 273. 
 Decline of life, 125. 
 Delicate people, 29. 
 Department of Agriculture, 60. 331. 
 Dickens, Charles, 69, 103. 
 
 "American Notes," 321. 
 
 biography, 321. 
 
 and sanitation, 313, 325. 
 
 and spitting, 321. 
 
 and walking, 323. 
 Diagnoses, 3S. 
 
 offhand, 15. 
 Diary, 272. (See also Daily 
 Record.) 
 
344 
 
 DUSTY AIB AND ILL HEALTH. 
 
 Diathesis, catarrhal, 104. 
 Differential diagnosis, 171. 
 Diphtheria, 294. 
 Dirt and plague, 292. 
 Dirty water vs. dirty streets, 23S. 
 Disagreeable dyspeptics, 216, 321. 
 Discussing symptoms, 185, 274. 
 Discussions, tabooed, 273. 
 
 useless, 1S5. 
 Disease, ill health, symptoms, 244. 
 
 symptoms, 275. 
 
 "catching," 30. 
 
 '•knocking out," 156, 
 
 names, 156. 
 
 proof, 51, 88. 
 
 vs. ill health, 42, 55. 
 
 vs. symptoms, 53. 
 
 and ill health, 53. 
 Diseases, acute, 261. 
 
 chronic, 261. 
 
 classifying, 55, 212. 
 
 collecting cases, 301. 
 
 industrial, 56. 
 
 in Indiana, 54. 
 
 naming, 168. 
 
 occupational, 56. 
 
 terminal, 35. 
 
 transmission, 300. 
 
 Triad of, 17, 76, 105, 167, 212, 
 219, 236. 
 
 of civilization, 59, 130. 
 
 vs. affections, 2S7. 
 
 vs. symptoms, 286. 
 
 and causes, 48, 53, 213. 
 
 and Jews, 56. 
 Disease-producing microbes, 25. 
 Dizziness, 195. 
 Doctor, advertising, 222. 
 
 best friends, 216. 
 
 citv, 16, 208. 
 
 country, 172, 20S. 
 
 of dead towns, 222. 
 
 making a living, 235. 
 
 robust, 29. 207, 236. 
 
 medicine, 232. 
 
 and criticism, 12. 
 
 and ideals, 235. 
 
 and meeting places, 149. 
 
 (see also under Physician.) 
 "Doctoring," 32, 60, 197, 219. 
 Dogmatic statements, 156. 
 Dogmatism, 253. 
 
 Domesticated animals and plants, 51. 
 "Do Not Spit," 70. 
 Dreams and dreaming, 87, 190, 306. 
 
 Dresses, trailing, 65, 176. 
 Drowning as a "disease," 245. 
 Drugs, 61. 
 
 Druggists, 15, 32, 57, 230. 
 Dry-as-dust Case Reports, 93. 
 Dry cough, 190. 
 1 ►ryness of skin, 281. 
 Dust, A Neglected Factor in 111 
 Health, 84, 95, 153, 176, 304. 
 
 as a factor, 306. 
 
 as a menace, 330. 
 
 as a nuisance, 330. 
 
 clouds, 330. 
 
 evil, 331. 
 
 fear, 251. 
 
 free air, 129, 149. 
 
 infection, 74, 84, 101, 106, 196, 218. 
 
 infection and age, 123. 
 
 modifying symptoms, 295. 
 
 "beneficent," 68. 
 
 book, 66. 
 
 city, 63. 
 
 country, 63. 
 
 dwellings, 67. 
 
 featherbed, 67. 
 
 glass, 64. 
 
 indoor, 66. 
 
 kinds, 62. 
 
 library, 66. 
 
 paved street, 64. 
 
 poison, 73. 
 
 pollen, 64, 128. 
 
 problem, 328. 
 
 spit, 65. 
 
 sterilized and unsterilized, 68. 
 
 theory, 132, 202. 
 
 and imagination, 248. 
 
 and storms, 162. 
 
 and sunlight, 27. 
 Dust Victims, 17, 63, 73. 
 
 classification, 73. 
 simple, 74. 
 rheumatic, 75. 
 dyspeptic, 75. 
 nervous, 76. 
 cardio-vascular, 76. 
 
 educated, 196. 
 
 symptoms, 183. 
 Dwellings, 67. 
 Dysmenorrhea, 121 
 Dyspepsia, 55, 75, 151, 190. 
 
 American, 175. 
 Dyspeptic Dust Victims, 75. 
 Dyspeptics, old. 80. 
 Dyspnea (difficult breathing), 277. 
 
INDEX. 
 
 345 
 
 Early records, 54. 
 
 Early settlers, 46, 54. 
 
 Ears, buzzing, 105. 
 
 East Wind, 317. 
 
 East Wind and Mrs. Browning, 317. 
 
 "Easy Marks," 218, 222. 
 
 Ecology, 45. 
 
 Eliot, George, 318. 
 
 Emaciation, 191, 278. 
 
 English biographies, 120, 317. 
 
 Englishmen, three visiting, 321. 
 
 Environment, 172. 
 
 alteration, 88. 
 
 influence, 42, 305, 332. 
 
 simple and complex, 157. 
 
 and heredity, 35, 120, 263. 
 
 and worry, 286. 
 "Equable temperature," school 
 
 room, 26. 
 Ethics, medical, 108. 
 Europe vs. Cathay, 334. 
 European weeds, 47. 
 Euthanasia, 273. 
 
 "Everybody has catarrh," 00, 103. 
 Evolution and discussions, 275. 
 "Examinations free," 108. 
 
 "thorough," 136. 
 "Exceedingly careful," 178. 
 "Exciting causes," 113. 
 Expectoration or spitting, 69. 
 Experienced chronics, 306. 
 
 patients, 68, 307. 
 Experimenting, 248. 
 
 on hens, 249. 
 Experimental evidence, 250. 
 
 medicine, 249. 
 Experiments by patients, 250. 
 
 and private practice, 250. 
 Explanations of ill health, 11. 
 
 a-b-c, 206, 228, 241. 
 
 "biliousness," 160. 
 
 common, 16S. 
 
 fashionable, 30. 
 
 "overwork," 25. 
 
 "It's dyspepsia," 37, 38. 
 
 "It's grip." 19. 
 
 "It's the liver," 37, 168. 
 
 "It's malaria," 19. 
 
 "It's the noise," 30. 
 
 "It's the stomach," 38. 
 
 "It's uric acid," 37. 
 
 "It's what I eat," 19. 
 
 or diagnoses, 38. 
 
 vs. facts, 149. 
 Exposure and colds, 114. 
 Eyestrain, 317. 
 
 Factor, seasonal, 101. 
 Facts vs. explanations, 140. 
 Faddists, 158. 
 Fads vs. cleaning up, 23S. 
 Faith cures, 311, 332. 
 
 curist, 288. 
 
 and mind cures, 132. 
 False malaria, 200. 
 Familial diseases, 273. 
 Family, adapted, 110. 
 
 histories, 117, 110, 121, 202. 
 
 history, good, 01. 
 "Family history negative," 118. 
 Family physician, best, 200. 
 
 and specialist, 16. 
 Farmer, old settler, 14. 
 
 retired, 162. 
 
 and dust, 68. 
 Farmers' Bulletins, 206. 
 Farming and weeds, 300. 
 Fasting, 276. 
 Fatigue, 278. 
 
 Favorite Prescriptions, 231. 
 Fear an instinct, 251. 
 
 and uses. 2SS. 
 Fears and Phobias, 251. 
 Featherbed dust, 67. 
 Fees and honorarium, 41, 133, 214. 
 
 254, 335. 
 Fellow-students, 78. 
 Fever as a symptom, 246, 278. 
 "Filled up on city dust," 310. 
 Filth diseases, 206. 
 Filth on streets and sidewalks, 117 
 Flatulency. 101. 
 Fleas and plague, 203. 
 Flies, 200, 205. 300. 
 Flushing, 101, 281. 
 Food. 20, 158, 164. 
 Foundlings, 122. 
 Franklin, Benj., 140, 330. 
 
 and colds, 213. 
 Frying food, 21. 
 Funny advice, 226. 
 
 Gall Stones, 167. 
 
 Gastritis, 154. 
 
 General run of cases, 12. 
 
 statements and exceptions, 12. 
 Germans, 175. 
 German books, 160, 256. 
 
 sanatoria, 120, 140. 
 
 specialist, 160. 
 Germ theory, 44. 
 "Germs are everywhere," 146. 
 
;ug 
 
 DUSTY AIR AND ILL HEALTH. 
 
 Germs and diseases, 259. 
 
 and dust, 27. 
 Getting the feel wet, 74. 
 Ghettoee, 122, 34. 
 Ginseng disease, ss . 
 (J lass. lCo. 
 
 dust. (i4. 
 Goldenrod, 4P. 
 Golden Weddings, 125. 
 Gonorrhea, 299. 
 Good air. 2.")C>. 
 
 Influences, 220. 
 
 family history, 91. 
 
 samaritan, physician. 335. 
 Going to church or not, 269. 
 Gout and gouty, 75. 
 Gray hair and age, 2S3. 
 Greens, 102. 
 Crip. 292. 
 
 as an explanation, 97. 
 "Guaranteed" nostrums, 225. 
 
 Pure Food and Drug Act. 225. 
 Guarantee to cure, 229. 
 Guesswork. 22<>. 
 
 Handkerchiefs, 70. 
 Hay-fever, 65, 104, 12S. 
 
 and climate. 229. 
 
 and cures, 247. 
 Habit-forming drugs, 237. 
 Headache. 184, 191. 
 Healing herbs, 262. 
 Heart, weak, 2S4. 
 
 and kidney cases, 258. 
 
 and kidney diseases, 220. 
 Health inspection, 61. 
 
 in city and country. 141. 
 
 supervision, 255, 61, 155, 197, 199. 
 "Healthy." 49. 
 
 color. 283. 
 
 the. 77. 
 Hereditary tendencies, 263. 
 Heredity vs. environment, 
 
 35. 120. 263. 
 High blood pressure. 220, 25S, 279, 
 
 and age, 264. 
 High pressure, 264. 
 
 club, 26S. 
 High school and air, 25, 204. 
 High standard in medical edu- 
 cation, 206. 
 Hindus, 292. 
 Hippocrates, 146, 210. 
 Historians, 314. 
 Histories of ill health. 310. 
 Honorarium, 41, 335. 
 
 llousocleaning, 110, 194. 
 
 colds. 110. 
 House parties, 155. 
 Houses, overheated. 25. 
 Hospital cases, 172. 
 
 physicians, 252. 
 Hunters and trappers, 50. 
 Huxley, T. H.. 826, 320. 
 Hydrochloric acid, 176, 265. 
 Hyperacidity of the stomach, 279. 
 Hypochondria, 76. 
 1 [ypodermics, 154. 
 Hysteria, 76. 212. 
 
 Idiosyncrasy, 73. 
 "Idle rich," 305. 
 
 Ill Health, explanations (see under 
 Explanations). 
 
 symptoms (see under Symptoms). 
 
 and biography, IS. 93. 302, 313. 
 
 and disease, 42. 49, 53, 287. 
 
 and Letters, 319. 
 Ills as reactions, 234. 
 "Imaginary" diseases and ills, 
 
 76, 174, 215, 244. 
 Immigrants, 46. 
 
 Immunes and Immunity, 209, 293. 
 Impure blood, 2S0. 
 
 milk, 330. 
 Influence of environment (see En- 
 vironment ) . 
 Influences, mental, 272. 
 Influenza, 291. 
 "Incurable disease" and long life, 
 
 25S, 327. 
 Indians, The, 45, 4S, 50, 54, 87, 147, 
 
 194. 263, 2S1, 291. 
 Indian medicine man, 59. 
 Indiana biographies, 314. 
 
 climate, 45. 
 
 State Medical Society, 59. 
 
 topography, 45. 
 Industrial diseases, 56. 
 Indoor climate, 33, 74, 96, 128. 
 
 dust, 66. 
 Inheritance, as an explanation, 35. 
 Insane Hospital practice, 252. 
 
 and pneumonia, 296. 
 Insomnia, 192, 279. 
 Intercostal neuralgia, 132. 
 "Interesting cases," 41. 
 Intestinal mucus, 168. 
 Intestines, Membi'anous Catarrh, 
 
 76, 174. 
 Irish, 175. 
 Isolation, 86, 268. 
 
INDEX. 
 
 347 
 
 "It's dyspepsia," 37. 
 
 "It's grip,'' 19. 
 
 "It's malaria," 19. 
 
 "It's the liver," 160, 107, 168, 185. 
 
 "It's the noise," 30. 
 
 "It's the stomach," 160. 
 
 "It's what I eat," 19, 159. 
 
 Janitors, 270. 
 Japanese and clothing, 24. 
 Jews, The, 34, 56, 122. 
 Johnson, Samuel, 268, 297. 
 Joint pains, 192. 
 
 Kankakee Swamps, 300. 
 
 Keeping a daily record, 271. 
 
 Keeping up pressure, 262. 
 
 "Kickers," 221. 
 
 Kidney and Heart cases, 258. 
 
 Kidney and Heart diseases, 220. 
 
 "Kill the pain," 237. 
 
 Kindred minds, 268. 
 
 Kinds of colds, 106. 
 
 Knife grinder's rot, 261. 
 
 "Knockers," 271. 
 
 "Knocking out rheumatism," 133. 
 
 Know Thyself, 332. 
 
 Know your city, 332. 
 
 Laboratories, 60. 
 Laboratory doctor, 335. 
 
 findings, 274. 
 Lack of ambition, 192. 
 La Grippe, 291. 
 Laissez faire, 98. 
 Laxatives, 166, 189. 
 Lead poisoning, 49. 
 "Leave everything to the doc- 
 tor," 112. 
 Length of life, 328. 
 Lent, "Being Done Good," 132, 183. 
 Leprosy, 290. 
 Lesions, 76. 
 Letters, George Eliot, 318. 
 
 and references to ill health, 319. 
 Let the buyer beware, 234. 
 Let us pray, 2S7. 
 Library dust, 66. 
 Libraries, 67, 314. 
 Life insurance, 260. 
 
 story, 36, 263. 
 Life and Letters, Darwin, 302. 
 
 Huxley, 326. 
 Limitations, Huxley, 13S, 326. 
 Literary men, 192, 314. 
 "Lives" of the dead, 302, 313. 
 
 Living in isolation, 268. 
 
 Local conditions and changes, 45. 
 
 Localized pain, 131. 
 
 Looking for the worst, 90. 
 
 Long life and old chronics, 91. 
 
 Loss in weight, 278. 
 
 Lot and land poor, 221. 
 
 Low blood pressure, 258. 
 
 "Lowered vitality," 332. 
 
 Lumbago, 72, 132. 
 
 "Lung trouble," 122. 
 
 Malaria, 49, 289. 
 a touch of, 18, 290. 
 as an explanation, IS. 
 concealed, 18. 
 false, 290. 
 and quinine, 201. 
 Man above forty years, 56. 
 Manifestations of colds, 116. 
 Marble statue, story, 238. 
 Measles, 291. 
 Medical biography, 314. 
 
 schools and colleges, 59, 79, 
 
 205, 210. 
 inspection, schools, 61, 87, 330. 
 profession and Dickens, 324. 
 science and the uncured, 118. 
 societies, 134. 
 supervision, 255. 
 Medicine, an evolution, 41. 
 art or science, 177, 248, 320. 
 Darwin's influence, 320. 
 men, 11, 59. 
 
 men and newspapers, 223. 
 Medicines "guaranteed to cure," 15. 
 the right ones, 228. 
 and mystery, 231. 
 Meeting places, 51. 
 and doctors, 149. 
 Membranous catarrh intes- 
 tines, 76, 174. 
 Mental influences. 272. 
 life, 306. 
 reaction, 253. 
 stimulation, 192. 
 symptoms, 192. 
 Mesology, 45. 
 
 Microbes, disease-producing, 25. 
 Milk problem, 330. 
 sickness, 289. 
 and bacteria, 147. 
 Milton, 314. 
 Minds, kindred, 268. 
 Mineral springs, 132, 160. 
 Missing factor, 102. 
 
348 
 
 DUSTY AIR AND ILL HEALTH. 
 
 Missionaries, 54. 
 Missionary spirit, 7S. 
 Misunderstood dyspeptics, 152. 
 
 patients. 174. 
 Modern flat dweller, 20. 
 Moliere, 57. 
 
 Moods and writing, 316. 
 Moribund, the, 78. 
 Mortality from typhoid fever. 295. 
 
 statistics. 31. 
 Morton. O. P., 315. 
 Mosquitoes, is. 40. 53, 2S9. 
 "Mountain disease." 244. 
 Mountaineers, 34. 50. 91, 200, 334. 
 Moving about, 33. 
 
 advising, 271. 
 Mucus formation. 76, 104. 195, 27!>. 
 
 and dust, 00. 
 Muscular pains, 193. 
 Mysterious attacks, 154. 
 
 cases, 174. 
 
 Names concealing ignorance, 113. 
 Naming diseases, 15S. 
 National Department of Health, 
 27, 60. 
 
 diseases (see Triad). 
 Nationalities, 46. 
 Natives (Indians), 45. 
 
 (whites). 46. 
 Natural vs. artificial food. 20. 
 Nature, personifying, 2S1. 
 Negroes and weeding out. 271. 
 Neglected factor, the, 102. 
 Neglecting symptoms. 272. 
 Nervous prostration, 212. 
 
 dust victims, 76. 
 Nervousness, 193. 
 Newspaper, 12. 
 
 clipping, 297. 
 
 medicine, 30, 220. 
 
 writing, 221, 240. 
 
 and advertisements, 234, 235. 
 
 and medicine men, 223. 
 Neuralgia, 2S0. 
 Neurasthenia, 39, 76, 212. 
 
 and Dr. Beard, 213. 
 Neuratheniacs and the doctors. 214. 
 Neurastheniacs, 214, 251. 
 Newborn, 123. 
 New-fangled diseases, 14. 
 New remedies and seasonal in- 
 fluences, 312. 
 Night air, IS. 
 
 thoughts, 272. 
 Nine-tenths and one-tenth, 12. 
 
 Nostrum evil, 224. 
 Nostrums, 132. 224, 288. 
 
 habit-forming, 224. 
 "Nothing the matter," 215. 
 "Nothing organic the matter," 200. 
 Novelists, 314. 
 Novel reader, S4. 
 Numbness, 100. 
 Nurses, trained, 211. 
 
 Objective symptoms, 250. 
 Occupation and ill health, 49. 
 
 and disease. 40. 
 Occupational diseases, 56. 
 Occupations, 33, 49, 51, 124, 261. 
 
 and meeting places, 51. 
 Odors and Arabs, 92. 
 Old age, 125. 
 
 and arteries, 256, 262. 
 
 and ill health, 256. 
 "Old Age Deferred," 255. 
 Old chronics, 12, SO, 82, 256. 
 
 and long life, 91. 
 Open air schools, 28. 
 
 and man. 20. 
 Open door season, 133, 163, 232, 330. 
 Opium, 224, 237. 
 Oppression of the chest, 189. 
 Outdoor life, 131. 
 Outgrowing ills, 201. 
 
 primitive ideas, 334. 
 Overcrowding, 32, 85, 94, 109, 
 
 237, 202. 
 Overeating, 155. 
 Overgrown villages, 143. 
 Overheated houses and rooms, 
 
 25, 116. 
 Overwork, 28, US, 212, 217, 
 
 278, 305, 322. 
 "Overwork" as an explana- 
 tion, 25, 217. 
 
 Pain, 2S0. 
 
 "killer," 136, 193. 
 
 psychical, 2S1. 
 
 vs. complexion, 2S2. 
 
 and fear, 251. 
 Pains and aches, 184, 251. 
 
 as warnings, 42. 
 Palpitation, 194. 
 Panama Canal, 331. 
 
 and sanitation, 254. 
 Papaws, 21, 73. 
 Paralysis, 76, 258. 
 Parasites, 48. 
 Paratyphoid fever, 295. 
 
INDEX. 
 
 349 
 
 Passenger conductors, 307. 
 
 trains and spitters, 308. 
 Patent medicine, 42, 104, 175, 219, 
 221, 224, 228, 231. 
 
 Advertisements, 32, 101, 150, 150, 
 166, 170, 220, 288. 
 
 "harmless," 224. 
 
 "jokers," 230. 
 
 man, 288. 
 
 prescriptions, 230. 
 
 testimonials, 232. 
 
 and cleaning up, 225, 237. 
 
 and closed door season, 170, 225. 
 
 and patients, 228. 
 
 and physician, 237. 
 Pathological museums, 87. 
 "Pathology of the living," 42. 
 Patients, average, 305. 
 
 advising to move, 271. 
 
 classifying, 76, 303. 
 
 experienced, 307. 
 
 philosophical, 267. 
 
 as bugbears, 243. 
 
 as fellow-students, 78. 
 
 and experiences, 177. 
 
 and experiments, 250. 
 
 and patent medicines, 228; 
 Peculiar cases, 1.64. 
 People, classifying, 77. 
 
 not worth while, 232. 
 
 wants and needs, 11. 
 "Perfect health," 100. 
 Perils, 44, 328. 
 
 and a remedy, 328. 
 Personal mention, 79, 115. 
 Pests and parasites, 47, 130. 
 Philippines, 254. 
 Philosophical, the, 267, 274. 
 Phobias, 251. 
 
 Physical vs. mental life, 306. 
 Physician (see also Doctor). 
 
 best family, 209. 
 
 good Samaritan, 335. 
 
 old time definition, 246. 
 
 placing the blame, 335. 
 
 promising to cure, 223. 
 
 robust, 207. 
 
 teaching sanitation, 336. 
 
 vs. surgeon, 324. 
 
 and acute diseases, 223. 
 
 and antagonism, 214. 
 
 and country life, 20S. 
 
 and esprit de corps, 248. 
 and ill health, 20S. 
 and patent medicine, 237. 
 and simple remedies, 246. 
 
 Pie, 19, 159. 
 Pill -peddlers, 220. 
 Pimples, 281. 
 Placing the blame, 335. 
 Plague, 292. 
 Plants and man, 85. 
 Plato, 207, 261. 
 Pleurisy, 132. 
 Pleurodynia, 132. 
 Pneumonia, 296. 
 an index, 29(5. 
 and the insane, 296. 
 at Goldfield, 297. 
 Poets, city, 314. 
 country, 314. 
 "Poisoned secretions," 104. 
 Political meetings, 73, 159. 
 Politics and politicians, 239, 241. 
 Pollen dust, 64, 128. 
 Pollenosis, 72. 
 Polo, 95. 
 
 Poolroom air, 126. 
 Poor people, 32, 125, 133, 137, 226, 
 
 261, 306. 
 Postmortem pathology, 42. 
 Prediction, the test of science, 260. 
 Predicting, 258. 
 Premature baldness, 283. 
 Prescott, W. H., 317. 
 
 Prescribing for oneself, 246. 
 for the community, 219. 
 
 Prevalent ill health, 42. 
 
 Preventable accidents and dis- 
 eases, 335. 
 
 Preventing ill health, 228. 
 
 Primitive man and open air, 20. 
 
 Professions (see Occupations and 
 Trades). 
 
 Prognosis, 199. 
 
 Promising to cure, 38. 
 
 "Protean disease," 218. 
 
 Providence and acute diseases, 261. 
 
 Prudent people, 44, 258. 
 
 Pseudo specialist, 135. 
 
 Psychasthenia, 112. 
 
 Psychotherapy, 334. 
 
 Ptomaines, 53. 
 
 Publishing paj)ers, 134. 
 
 Pullman coaches, 110. 
 
 Pump Towns and "Abe Martin," 23. 
 
 Pure Food and Drug Act, 225, 233. 
 
 Pure water conscience, 331. 
 
 Pure air and typhoid fever, 295. 
 
 Puzzling cases, 217. 
 
 Quinine, 201, 284, 289. 
 
350 
 
 DUSTY AIR AND ILL HEALTH. 
 
 Race suicide, 208. 328. 330. 
 
 and false malaria. 290. 
 Ragweed, 49, 65, 128. 
 Railroaders, 200. 307. 
 Railroad cases. 209. 
 Railway coaches, 110. 
 
 colds. 110. 
 
 stations, 222. 
 Railways and weeds, 293. 
 Rare vs. common diseases. 15. 
 Rats and plague. 293. 
 Reading notice. 229. 
 Record, daily. 150, 180, 201. 
 Real specialists, 135. 
 Relief \ s. cure, 233. 
 Remedy. The. 329. 
 Remedies superficial, 332. 
 Reporting cases. 210. 
 Reprints, 81. 
 Retired farmers. 102. 
 Rheumatic cases. 131, 114. 
 
 dust victims, 75. 
 
 sore throat, 145. 
 Rheumatism, 137. 
 
 "knocking out." 133. 
 Right, the. "to doctor." 336. 
 Robust countryman. 122. 
 
 doctor. 29, 207. 236. 
 
 teachers. 29. 
 
 the, and sudden death, 258. 
 Rose cold. 65. 
 Routine attention. 220. 
 Ruling out, 163, 171. 
 Rural ancestors. 34, 122. 
 
 life, 142. 
 Rush of thoughts, 306. 
 Rusts and blights. 47. 
 
 Saleeby, Dr., 329. 
 Sallowness, 2s2. 
 Sanitarian, 238, 336. 
 Sanitation, 143. 
 
 Dickens influence on, 325. 
 
 and Panama. 254. 
 Sanatoria. 132. 
 
 German. 129. 
 Sassafras, 102. 
 Scar tissue, S7. 
 Scarlet fever, 291. 
 Schools, 52, 124, 204, 291. 
 School children, 28, 77, 84, 330. 
 
 colds. 111. 
 
 life. 123. 
 
 medical inspection, 61, 87, 330. 
 
 open air, 28. 
 
 School room temperature, 26. 
 
 teacher, robust, 29. 
 Schools and cleanliness, 335. 
 
 and weeding out. 203. 
 Scientists and ill health. 320. 
 Scotch, 119. 
 Seasonal factor, 101. 
 
 influence, 232, 242. 
 
 influence and new remedies, 312. 
 Seclusion, advising, 269. 
 Secondhand notes, 196. 
 Seelenleben, 273. 
 
 Selected rases. 310. 
 Servant girls. 211. 
 Settlers, early. 4(i 
 Short and simple annals, 217. 
 Shopping, 130, 1 V 7. 
 
 as a recreal ion. 243. 
 Siderosis, 72. 
 Sidewalk spitting. 71. 
 Silicosis. 72. 
 Simple dust victims. 74. 
 
 Case Reports of S4, 90, 93. 
 
 life. the. 50. 54, 194, 334. 
 
 life and worry. 286. 
 
 the, vs. the complex, 13. 
 Skin, dryness, 190. 
 
 symptoms, 2S1. 
 Sleeplessness, 192. 
 Slums. S7. 
 
 Slum disease and cleanliness, 325. 
 Smallpox. 48, 290. 
 Smith. Adam, 119, 330. 
 Smog. 06. 
 
 cloud, 173. 
 Smoke. 66. 
 
 evil, 331 
 
 injuriousness, 66. 
 "Smoke disease," 244. 
 Smoke and smog, 66. 
 Smoking and mosquitoes, 18. 
 Social aspirations, 269. 
 Socialism. 240. 
 
 Socialism vs. individualism, 240. 
 Soil exhaustion, 142. 
 Specialists. CO. 134, 160. 
 
 German, 160. 
 
 and family physician, 16. 
 Specific diseases, 289. 
 
 diseases and causes, 53. 
 Specimens (plants and dis- 
 eases). 301. 
 Spencer, Herbert, 273, 327. 
 Spit dust, 65. 
 "Spit dust rheumatism," 145. 
 
INDEX. 
 
 351 
 
 Spitter's country, 323. 
 
 town, 80, 143. 
 Spitting, 28. 
 
 black, 70, 194. 
 
 habit, 69. 
 
 habit and Dickens, 321. 
 
 or expectoration, 69. 
 Spittle pulverized, 326. 
 Stages of civilization, 62. 
 Standards, high, 177. 
 Standpoints, 43. 
 State Fair colds, 96. 
 Statistics, mortality, 31. 
 Staub-freie Luft, 149. 
 Stegomyia (mosquito), 290. 
 Sterilized and unsterilized dust, 68. 
 Stevenson, Robert Louis, 118. 
 Stock of health, 243. 
 Stomach, hyperacidity, 279. 
 
 trouble, 122, 154. 
 Store keeper, 51. 
 Stores, unventilated, 153. 
 Storms, 201. 
 
 and dust, 162. 
 Street cleaning and women, 336. 
 Street lights, 219. 
 
 Streets, dirty and dusty, 64, 145, 238. 
 Strenuous life, 264. 
 Students of biography, 311. 
 Studying diseases and ill health, 57. 
 Study your own cases, 248. 
 Subjective symptoms, 259. 
 Subconscious cerebration, 192. 
 Suburbs, 143. 
 Sudden recoveries, 140. 
 Stump speeches, indoor, 239. 
 Suggestion, 193. 
 Sunday, a day of rest, 126. 
 Sunlight, 68. 
 
 and dust, 27. 
 Surgeon, 60. 
 
 and physician (see physician). 
 Surgical cleanliness, 174. 
 Survival of the best, 119. 
 
 of the fittest, 91, 94, 119, 122, 124, 
 264, 275. 
 Susceptibility, 27, 50. 
 
 unusual, 202. 
 Symptoms-complexes, 212. 
 
 names (Huxley), 327. 
 
 prescribers, 94, 158, 189, 220. 
 Symptoms, 172, 181, 1S3, 212. 
 
 common, 56. 
 
 detailing, 318. 
 
 discussing, 185. 
 
 discussion, 274. 
 
 Symptoms, "driving out," 275. 
 
 high blood pressure, 260. 
 
 mental, 192. 
 
 modifiable, 283. 
 
 neglecting, 11, 272. 
 
 objective, 274. 
 
 secondary, 283. 
 
 skin, 281. 
 
 subjective, 274. 
 
 subjective and objective, 259. 
 
 vague, 184. 
 
 as reactions, 245. 
 
 as warnings, 42, 184, 192, 275. 276, 
 287, 324. 
 
 in typhoid fever, 295. 
 
 of ill health, 185, 275. 
 
 of disease, 275. 
 
 vs. affections, 286. 
 
 vs. diseases, 287. 
 
 and dangers, 245. 
 Syndromes, 212. 
 Syphilis, 299. 
 
 Table, Evolution of Dust, 62. 
 
 Evolution of Physician, 58. 
 Tabooed topics, 273. 
 Tanner, Dr., and fasting, 276. 
 Tax Payer's cold, 98. 
 Teachers, robust, 29. 
 Teachers' Institutes, 109. 
 Teaching young and old, 335. 
 Teeth, artificial, 2S3. 
 Temnerate zone, 54. 
 Tenements, 300. 
 Terminal disease, 35. 
 
 infection, 25S. 
 Testimonials, 232. 
 Theaters, 52, 243, 282. 
 Theory, working, 40. 
 
 of dust infection, 133. 
 Thoughts, "rush of," 306. 
 
 train of, 272. 
 
 writing them down, 272. 
 Threatened with, 296. 
 
 pneumonia, 38. 
 
 consumption, 38. 
 Time lost and ill health, 125. 
 Tinnitus (buzzing of ears), 2S4. 19o 
 Tobacco chewing, 65, 69. 
 
 smoking, 18. 
 
 spittle, 65. 
 Tongue, coated, 1S6. 
 Tonics, 186, 249, 276. 
 
 for laying hens, 249. 
 Tonsillitis, 145. 
 Topography, Indiana, 45. 
 
352 
 
 DUSTY AIR AND ILL HEALTH. 
 
 Touch of malaria, a. 18. 1GS, 290. 
 Towns, unhealthy, 31. 
 Trades and professions, 204. 
 
 i See also Occupations.) 
 Tradition and physician, 335. 
 Trailing dresses. (">.*>, 155. 
 Tramontana (East Wind), 31S. 
 Traveling facilities, 129. 
 Trembles, 2S9. 
 Triad of National Diseases. 17. 7<i. 
 
 105. KIT. 212, 21!>. 320. 
 Trolley Cars, 70. 110. 
 Truth, telling. 199, 247. 
 Tuberculosis, 171, 293. 
 
 Case Report, 294. 
 
 as a protest. 2'.M. 
 
 and weeding out. 2!)4. 
 Typhoid fever. 295. 
 
 as an index, 296. 
 
 and backward communities, 295. 
 
 and bad water. 229. 
 Typical cases, 172. 
 
 Underwear. 178. 
 Unhealthy towns, 31. 
 
 trades. 149. 
 Unions, 137, 219, 262. 
 Urban aneestors. 34. 122. 
 
 life. 142. 
 Uric acid, 192. 
 
 acid in the blood, 39. 
 
 Vacations and typhoid fever. 2*.!5. 
 
 Vaccination. 290, 295. 
 
 "Vacuum cleaner colds, 112. 
 
 Varied diet, 158. 
 
 Varying manifestations of colds, 116. 
 
 Ventilation. 25, 52, 204. 
 
 Vertigo, 195. 
 
 Violent methods. 141. 
 
 Visitations, 287. 
 
 Vitality, lowered, 332. 
 
 Vomiting, 384. 
 
 Walking. 323. 
 Wants and needs. 11, 77. 
 War and weeding out, 94. 
 Wash and be clean, 23. 
 Water, 22, 27, 164. 
 
 clean. 23S. 
 
 muddy. 22, 218. 
 
 and salubrity. 238. 
 
 and typhoid fever, 27, 295. 
 Ward. Lester F., 333. 
 Warnings (see Symptoms). 
 Weak heart. 2S4. 
 Weeded-out families, 94. 
 Weeding out. 50, 142. 275, 2!)4. 
 
 on account of ill health and dis- 
 ease. 199. 
 
 and schools, 203. 
 Weeds and diseases, 54, 300. 
 Weight, loss of, 278. 
 Whit tier, J. G. ; 316. 
 Windstorms, 67, 101, 201. 
 Wind, East, 317. 
 Winter cough. 100. 
 Women and Case Reports, 303. 
 
 and cleaning up, 226. 
 
 and stx-eet cleaning, 336. 
 
 and voting, 240. 
 "Wonderful climate," 130. 
 "Wonderful new methods." 223. 
 Woodruff, Dr., 292. 
 Wordsworth, Wm., 314. 
 Working theory, 40. 
 
 under high pressure. 2<i2. 
 Worry. 216, 251. 285. 
 Writing to the newspapers, 240. 
 Writing and moods, 316. 
 
 in bed, 272. 
 "Wrong medicine," 101. 
 
 X-colds, 113. 
 
 Yellow fever, 290. 
 
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