There can be no question but that protection from cold and judicious attention to the health generally, by suitable exercise and diet, has a powerful tendency to prevent that overloaded condition of the blood to which I believe acute pneumonia to be chiefly due; still I have no doubt but that the most active preventive measure that can be adopted is keeping up the respiratory capacity to the full requirements of the system, a precaution which is specially necessary to ease-loving and high-living gentlemen who are past the prime of life. I am of the opinion that if such persons would cultivate their breathing powers by the simple means here recommended, their liability to pneumonia would be notably reduced.
THE TRUE FIRST STAGE OF CONSUMPTION.
The progress of tubercular consumption has been divided by pathologists into three stages. The first stage being that in which a deposit of tubercular matter occurs in the lung tissue, the second is entered on when the tubercles soften, and the third when they have melted down, been expectorated, and cavities have formed. But the real beginning of this most insidious and justly dreaded disease not infrequently antedates for a long time, often for several years, the deposit of any tubercular matter. During all this time an expert examiner can detect the slight but very significant changes already taking place in the pulmonary organs. Physicians determine the condition of the lungs chiefly through the sounds elicited by percussion of the chest walls by the end of the middle finger, or a small rubber hammer adapted to the purpose, and by those produced by the respired air rushing in to and out of the bronchial tubes and air vesicles. The percussion sounds yielded by the chest during what has been aptly called the pre-tubercular stage do not differ from those elicited in health, because it is only when some morbid matter exists in the lungs that the percussion note is altered, therefore negative results only are obtained in the real first stage by this mode of examination. But important information can be obtained by interrogating the sounds due to the inspired air rushing into and distending the air vesicles. When the lungs are perfectly healthy, these are breezy and almost musical. During the pre-tubercular stage they become drier and harsher; qualities of evil omen that continue to increase as time passes, if properly directed means be not adopted to correct the evil; but so far none of the symptoms that indicate the slightest deposit of tubercle can be detected, but the breathing capacity of such persons is never up to the full requirements of the system. The reader is referred to the table already given, which exhibits the decline of the breathing capacity of persons suffering from consumption in its several stages. When the disease has made such decided progress that tubercles are already deposited in the lungs in sufficient quantity to give rise to the physical signs by which their presence is proved, this carefully compiled table shows that the diminution of the vital capacity already amounts to one-third of that considered by Dr. Hutchinson to be necessary to the maintenance of health.