rants". Pulmonary hæmorrhage is in itself not a symptom of "tuberculosis," but it is made so by wrong treatment.
The foregoing practical considerations will enable the reader better to appreciate the theoretical observations which follow.
The lungs, like all mucous surfaces, secrete mucus even in their healthy state; this collects while we remain quiet, but is thrown out when we move. Every adult person clears his throat in the morning. One who has been sitting for a long time must cough when he goes out-of-doors. Bodily movement is the best "solvent" for a cough. When one's life is sedentary, mucus collects first of all in the apices of the lungs, and it is more difficultly broken up there by bodily movement, because the apices are the uppermost parts of the lung, and the impetus of the cough must drive the expectorated mucus around the corners of the lung. The apices are a veritable receptacle for mucus, which, if not removed, dries up, grows hard, and causes ulceration. In one hundred autopsies we find as many as ninety cases where the apices are more or less shrunken, scarred, and obstructed, and this without reference to the cause of death.
The apices, furthermore, are regular dust and gas traps, especially the right apex, which usually is the first to be affected by consumption, because the air-passage leading to it is wider and less crooked than that leading to the left apex. All impurities inhaled into the lungs, and especially all dust, first make their way to the apices, and there settle, unless they are kept in motion by bodily exercise. Elimination, too, is more difficult in the apices than in the inferior lobes. In coughing, the latter are aided by the abdominal pressure; while the apices, on the contrary, have to depend on their own contractility, which is weaker in proportion as they have been out of exercise, or as their cell-walls have grown together. Heavy clothing, which, like the yoke for carrying water, bears on the collar-bone, diminishes the power of respiration in the apices; a modern winter-overcoat weighs as much as eight or nine pounds. If, in addition to this, we have the usual two turns of a comforter around the neck, then the neck is bound fast, and we have all the conditions necessary for producing a diseased condition of the apices. Under such circumstances it would require considerable exertion in coughing to clear the apices. Hence the troublesome dry cough, which often ends in vomiting, yet does not loosen the mucus in the lungs. No benefit is to be got in such cases from lozenges, drops, extracts; the most that can be expected from such remedies is that they may moisten the throat rendered dry by the effort of coughing. But then they fill the stomach with phlegm. For small children such substances are an actual poison, producing sour stomach, diarrhœa, and fever.
Continued hard coughing in time injures the texture of the lungs, and leads, often with bloody expectoration, to decay of the apices, and, finally, to true pulmonary consumption, concerning the rational treatment of which we add a few words:
