Dusty air and ill health; a study of prevalent ill health and causes

Front matter

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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 diagnoses vary greatly. An old chronic is apt to get all sorts of diagnoses, 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 number of people, especially with "dust victims," with people who react to dusty air, and with people who have had much experience

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 monograph 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 headlines, 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 observations on first entering medical college in the fall of 1889. The author's first "Dust paper" wras written in 1893. Since the summer 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 connection 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 discussion of the dust evil or the dust problem, especially in relation to ill health. Dust is a neglected factor in ill health.

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. specialist. 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 explanation. School children. Need of a National Department of Health. Diseases 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 explanations of ill health. "It's the stomach," "It's dyspepsia," etc. "Threatened with" as an explanation. Old chronics and the physician. Newspaper medicine. Fashionable explanations : neurasthenia, uric acid, auto-intoxication. "Interesting cases." Physician and returns for efforts. Medicine a? an evolution. Symptoms as reactions. Pathology of the living. Breathing, drinking, eating. Perils.

I. Introductory

In the course of time a physician meets all sorts of people having 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 individual 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 medicines that appear, even faith or mind cures. Some believe in trying 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

— 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 exceptional 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 exceptional. Out of ten cases, or patients, nine may have traits, complaints, wants and desires in common, the tenth may differ radically. 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 demanding 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 unusually skilled physician, or, on the other hand, he may be a charlatan of the worst kind.

Somewhat similar remarks may be made regarding our newspapers: 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 ordinary 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 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 conclusions. If the doctor assumes that he knows it all and his patients know nothing there is not apt to be a lasting relationship of patient 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 comparatively 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 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 institutes, 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 referring 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 profuse 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 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 newspapers 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 catarrh. ' '

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 — instead 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 forget 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 consult 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 satisfactory 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

— just as some people go to the great German specialists who are also supposed to know more. In the case of our common ills, especially 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 conditions 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 "infected 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 explanation 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 mentioned 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.

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 "malarial," "concealed malaria," "a touch of malaria," if not "miasmatic." Real malaria (malarial fever) was formerly very common in Indiana and any case of illness was at once supposed to be malaria 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 people 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 disease. (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 doctors of his time explained all ill-defined eases by "It's malaria."

"It's malaria" was a common explanation in our State. It is still used to some extent but is falling1 into disuse, because real malaria has almost disappeared. People are beginning to understand that a certain kind of mosquito transmits the disease and that before the mosquito can transmit it it must have bitten somebody who has real malaria. Hence a suspected case of malaria without any other cases of malaria about, or occurring in midwinter 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 frequently 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 attacks 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 occasionally 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 conditions 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 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 subsists on plain substantial and nutritious food and that in the absence 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 traveller 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 weeding 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.

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 susceptible 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 unsanitary 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 discussing 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 individuals 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.