THE LIBRARY
OF
THE UNIVERSITY
OF CALIFORNIA
LOS ANGELES
EX LIBRIS
CLARENCE ADDISON DYKSTRA
J
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.
I 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.
PRINTED PRIVATELY
19U
Copyright 1912
br
Robert Messier
WM. B. iURFORD PHII
INDIANAPOLIS
ilifc
PREFACE
111 health is a topic that concerns all of us. If we do not have
ill health ourselves there are 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
want 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)
6 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" was 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-
cati'on. "Interesting cases." Physician and returns for efforts. Medicine
ar 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 AIB AND ILL HEALTH.
III. DUST AND DUST VICTIMS 62
The Evolution of Dust (table). Country Road Dust. Dust From
Paved Streets. Glass 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 ; Cardio- Vascular Type.
Classifying Patients. Classifying the People. Patieuts or Fellow-students.
Missionary Spirit. A Personal Mention.
A few Case Reports or Case Histories of Simple Dust Victims. Young
Fanner. 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. Housecleaning 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 011 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 Advertisements.
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?
Experi'menting 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 ANT> ILL HEALTH.
IX. BIOGRAPHY AND ILL 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. Whittier. 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
L
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)
with 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 ? Manif estly 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
lie 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 causesi
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
1NTRODUCTOBY. 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 ILL 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 best 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