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six hours. The comparatively harmless matter is seen to be converted into a mosl virulent and energetic poisou by the influence of an inflamed living organ exertec upon it during a couple of days. In seven distinct experiments Ur. Sanderson found identically the same results. In every case the dog made subject to the secondary innoculation was dying in collapse and with terrific spasms at the expiration of six hours. It is also beyond dispute that the contagion of cholera when received into water and exposed for a few hours to the hot sun, acquires intensely concentrated virulence, and that this condition of mischievous exaltation is only continued for a brief interval, perhaps such as two or three days, and that the distinct states, first of exalted morbific power, and then of comparative Imrmlessness, of the infection, are marked by the development in the water of different types of microscopic life, which can be at once distinguished from each other, and may therefore be taken as. the distinctive symbols, on the one hand of imminent danger, and on the other of comparative safety.
It is a very remarkable and obviously an important and practical fact that many of the most deadly forms of infectiongerms, which can remain alive and hurtfully influential in liquids extraneous to the living body, and which can even be rendered more banefully energetic in such extraneous menstrua, are nevertheless inert and powerless in hfalthy human blood, and only come into efficient activity when the blood loses its well-adjusted balance and full perfection. It is al>o a consideration of the utmost practical moment that most of the disease-germs can be at once and summarily destroyed by special antagonistic agencies, if caught and acted upon as they pass out from the source of their production. Indeed, the most energetic and most actively multiplying corpuscular aggregations of life-plasm are so much the more readily and easily destroyed by antagonistic agencies of this class for the very reason that constitutes their energetic vitality —namely, the absence of investment of formed material around them. The various substances which are termed disinfectants, and which are designedly employed for the destruction of embryo disease-germs, are mostly reagents that are endowed with very considerable powers of reduction and chemical affinity, and that operate all the more certainly when they have to deal with naked and unprotected masses, such as these little organized germs of mischief are held to be.
It may thus be accepted as a fact pretty well established by the investigations of physiological science that disease-germs, potential for infectious work, are living bodies in the sense in which the colourless blood corpuscles are so; that is, that they are capable of being generated in the blood, and fed there out of its ordinary and normal constituents; and also of reproducing and multiplying themselves, and of carrying on this process of reproduction even when they pass from one living body to another. There is, indeed, a distinct school of physiologists with whom these leading facts weigh with such impressive force that they incline to assert that whereover infectious disease of any kind appears, there must have been its own specific germs already existent to produce its development. Dr. Beale's investigations, on the other hand, seem to have led him to the more comprehensive, and what we almost venture to term the more philosophic' doctrine that disease-germs of whatever kind, can at any time be generated <ie novo from healthy bioplasm by the mere influence of extraneous circumstances, and that infectious diseases may again and again break out with a fresb. and independent start when specific organic and material conditions obtain. Towards the conclusion of his monograph on '• Disease-germs," he says in reference to this point: —
"Without therefore venturing to state positively from what particular kinds of germinal or living matter of the body the germs of con:agious disease are actuilly derived, or attemptng to deei'le definitely whether they come from :he very minute bioplasts" (aggregations of biopl.-ism), " or from ordinary white blood-corpuscles, or mucus, or epithelial, or other partiles, [ think I am justified in advancing the loctriue that the gemis originate iu man's organism, and that they have descended from the normal bioplasm of the body.
•' A carwful study of the course and symptoms of the various fevers, which have been prevalent at different periods leads to the suggestion of the probability that from time to time new germs are produced, and that old oneg deteriorate and disappear. The new forms may be closely allied to already existing forms and to forme which have existed previously, but nevertheless the results occasioned by their development are so peculiar that we cannot but suppose they are occasioned by a poison of a special kind. It is even possible to discern differences between cases of the same type of contagious fever, which are sufficient to justifv us in arranging them as species of a genus or as varieties of a species."
The notion, then, which seems to be
gradually making way among physiologists and growin<» into wider acceptance in tlie physiological mind, is, that whenever a bioplastic constituent of the living body is transformed into what is termed a disease-germ — that is. into the material cause of the transmission of diseased action to otherwise healthy organization, the power of inherent individual vitality is quickened and raised, but that the form of the resulting organic aggregation is degraded and lowered. Living portions of the organization which, under the proper provisions of the health-rule, should concern themselves with the deliberate and orderly perfecting of their own construction for the accomplishment of some specific purpose, take in a mad way to multiplying a restless, unduly energetic, and disorderly progeny, which in no case attain to the intended state of perfection, and waste their vitality in mere reproduction of the lower structural form. Generation after generation of fresh aggregations of living plastic substance is formed, each successive generation degrading in constructive skill, but quickening in mere reproductive activity more and more, and acquiring, in connexion with the change, the habit, so to speak, of preying upon and destroying the material substance which, under happier circumstances, it would have supported and renewed. This obviously is the exact description of what occurs when purulent matter informed as a result of some inflammatory disorganization of healthy texture. The healthy coherent life-plasm is loosened and dissolved into incoherent pus-corpuscles which rapidly multiply brood after brood. In some other kinds of transformation and disintegration of texture resulting from disease, as for instance in what are known as cancerous affections, the corpuscular aggregations reproduced in the process of the transformation hang more or less together in a continuous mass, as generation after generation is added to the morbid growth, instead of being scattered loosely asunder as they are formed. Dr. Beale is of opinion that in infectious fevers a similar perversion of vital and generative force is carried into yet farther development, the final products of the progressive degradation being aggregations of perfected lifeplasm of infinite minuteness, but of proportionally exalted energy; and he believes that, in some of the most grave and deadly forms of peritonaea! inflammation, which are unquestionably communicated by substantial contact and material transmission, he has seen the process of organic
degradation of the white blood-corpuscle actually occur, under the observation of the microscope, as it has been here described.
But there is another group of diseases which furuishes yet more telling proof of the influence of blood-degradation as an immediate cause of life-destroying disorder — namely, the group which is known under the generic term Consumption. This group is of scarcely inferior importance in a social and economic sense to the group of Infectious Fevers. It kills yearly in England and Wales nearly half as many people as all the great variety of infectious disorders taken together, including in the list typhus, scarlatina, measles, small-pox, cholera, diptheria, and whooping-cough. For every 111,000 people who are carried away by infectious diseases, out of 488.000 who, in round numbers, die annually in England and Wales, 53.000 are carried away by consumption; 22-8i per cent, of the current death-rate is due to infectious diseases, and 12-5 per cent, to consumption. Infectious and consumptive diseases together claim 36 per cent, of those who die, and one death in every eight is due to consumption.
That consumption, in every form, is substantially a result of the living textures built up from the elaborated material contained in the blood being of low and depraved character, instead of having the finish of high perfection, is beyond dispute. The fact has been recognized for some considerable time, but it has, perhaps, never before been so clearly demonstrated and explained as now in a small volume recently printed by Dr. Charles J. B. Williams, and entitled " The Nature, Varieties, and Treatment of Pulmonary Consumption." The book bears a very mod| est aspect, and is of small dimensions, but 'it is the crowning labour of a life-long work of nearly half a century. Dr. Williams began his investigations in this special branch of research under the guidance of Laennec, Andral, and Chomel. Thirty-two years ago he was teaching from the chair of the Professor of MediI cine in University College, that lymph, I pus, and tubercle differed only in the dej gree of their vitalization, and that they are I essentially the same principle and may be continually seen passing into each other. He now, with the strength which comes from a half century of close observation and study, re-affirms this statement, and supports it by an elaborate reference to the grounds of his own conviction. He holds that in consumptive disease, tne
corpuscular aggregations of bioplasm, which are used in the construction of the textures of the most important organs of the body, have not thejjower of free vital movement and plasticity which they ought to posses?, and that they are, instead, hard, indolent, and dry. The bioplasm, or lifesubstance, becomes what Dr. Williams happily terms "phthinoplasm," that is '• bioplasm " in a state of premature waste and deciiy. It will be observed how aptly I the term "phthinoplasm," or "wastingplasm," expresses the state of the plastic textures of the body in the disease which is known as •'phthisis," the "wasting disease." In consumption the textures which have been built up" from the blood decay even while they live. The " phthinoplasm" of Dr. Williams is, of course, identical with the tubercle of oldi;r pathologist*.
Dr. Williams infers from a large series of considerations, which he discusses carefully and completely in the pages of his book, that the great primary cause of the particular blood-deterioration which engenders tubercle and leads to consumption, is the depressing and degrading influence of impure air, deficient and improper nourishment, and other debilitating and exhausting agencies. Accidental inflammation, especially of the respiratory organs, which are of necessity very amenable and open to the power of atmospheric chill in inclement seasons, not unfrequently acts as the first step in the development of the disease, determining the commencement of the noxious deposit, and leading to its farther dissemination and growth. But inflammation alone cannot produce the result unless the depraved blood-condition is there. The depraved blood-condition, on the other hand, can lead to rapid consumption without any kind of inflammatory complication. When inflammation occurs in the unconsumptive j condition of the blood, the over plastic deposits issuing from the derangement pass into the state of pus-corpuscles which dissolve and distroy the clogged textures, but at the same time clear them away, and relieve the oppressed part of the embarrassment. But when inflammation occurs in the consumptive condition of blood, tubercle-deposit is formed out of the deranged plasma, instead of purulent matter, and the deposit continues to clog instead of tending to clear away, and so carries with it the habit of further and progress-] ive destruction, filling and choking up the j affected parts with decaying material, and involving them in prolonged, and frequently in fatal disorder.
The degraded bioplasm (phthinopln^m or tubercle), when consumption sets in, is sometimes widely diffused in the form of thousands of minute masses like millet seeds, and sometimes closely packed in definite spots, and hedged round by firm membrane which tends to shut up the deposit and to hinder its dispersion. lu the one case acute and rapidly progressing consumption ensues. In the other the consumption is of the chronic character and glow progress.
Considerable attention has been given by Dr. Williams, and his son Dr. Theodore Williams, to the question of whether consumption is contagious, in the sense in which infectious fevers are so. Some seven years ago a distinguished physiologist induced consumption in guinea pigs and rabbits by inserting consumptive tubercle beneath the skin through punctures made for the purpose. In these experiments true tubercle was found in the lungs' liver, and in other glandular organs, after a few months. Similar experiments have since been made, and with the same result, in France. Germany, and England, and physiologists of the Germ-Contagion school have claimed the results as proofs of the contagiousness of the disease. On the other baud, an analogous development of consumption has been also produced by using with the same animals for the iunoculation diseased matter that is not consumptive tubercle; and from this it has been argued that the production of tubercle is in all the initances due to the setting up of a low form of inflammation which cau es degradation of blood-plasm, and not to the contagious communication of tubercle from body to body. Dr. Theodore Williams, who is steadily following in the track that has been marked out by his father's investigations, and who is formally associated with him in the production of this volume, and has taken especial pains with the statistical part, very pertinently remarks that if consumption were really contagious in the proper acceptance of that term, the fact would have been abundantly proved in the case of the Hospital for Consumption at Brompton, by the extension of the disease there to attendants; whereas, as an actual fact, it is found that the occurrence of consumption in persons connected with the hospital and its administration since its foundation in 1816, has been remarkably rare, and the deaths very few, in proportion vastly below the number of cases of infectious fever found in the staff of any of our fever hospitals, or indeed of any of the large general hospitals of the Metropolis. Dr. Williams himself concurs in his son's inference that consumption is not contagious like scarlatina, small-pox, or typhus; but he adds, " both reason and experience indicate that a noxious influence may pass from a patient in advanced consumption to a healthy person in close communication, and may produce the same disease, just as foul matter or putrid flesh will produce tubercles in an innoculated animal; and I therefore always reccommend that all such patients should sleep alone," and that special care should be taken to effect perfect ventilation. The non-contagiousness of consumption is, of course, the result which would be anticipated from the inert, dry, hardened character of the degraded texture. It is the soft, active, restless forms of bioplastic degeneration, and not the hard, indolent, and already half-dead conditions present in tubercle, that do the work of infectious dissemination.
The deductions which Dr. Williams has been led to give expression to in this volume are the results of a very large experience. He states in his preface that he has notes of more than 25,000 cases of the disorder, which have been under his observation and treatment in a course of something more than thirty years, and that he has selected from these cases one thousand, which are representative and typical, for more refined and careful examination and discussion. Much of the valuable remarks that he has drawn from this discussion, and printed in the pages of his book, are of too technical a character to be noticed in an article addressed to a circle of general readers. But there are some of his deductions that are of the widest application and interest.
When Dr. Williams commenced his investigations in this particular field of research, and when Laennec and Louis were still the great authorities on the subject, the duration of consumptive disease was held to be, on the average, two years. From Dr. Williams' selected cases it appears that the duration of the disease is now eight years. Of the one thousand cases selected for discussion 198 have ended fatally, while 802 relate to the history of persons still alive. Of the 802 living cases 34, or 4-5 per cent., have been apparently cured; 280 cases, or 38 per cent., have been benefited by medical and regiminal treatment; 102 cases, or 13'30 per cent., have remained for some time stationary; and 321 cases, or 43-53 per cent., are on the downward road, despite all that can be done for them by the physician's saga
LIVING JL.GK. VOL. XXVI. 1248
, city and art. Only 65 of the thousand selected cases prove to be unavailable for the objects of this classification.
The reason for the auspicious change in the duration of the disease, Dr. Williams remarks, is unquestionably the better understanding of the cause of the disorder, and the consequent improvement of its treatment by the physician. His testimony upon this point is very interesting and clear. He says that during the first ten years of his experience tha beneficial results of treatment were small, and limited to the influence upon incipient cases of a sea-voyage and residence in mild climates. In the next ten years of his experience a marked advance was obvious, and attributable to the employment of a more liberal diet and the use of the iodide of potassium and of vegetable tonics as medicines. But in the last ten years the improvement was very considerable and marked, and in the main due to the general use of cod-liver oil in consumptive cases. His own words in regard to this royal medicine for consumption are : — "I have no hesitation in stating my conviction that cod-liver oil has done more for the consumptive than all other means put together." The curative influence of the remedy he believes to be chiefly due to its power of dissolving and removing the depraved deposit; but he is convinced that it also acts as an eminently nutritious principle, increasing the amount of healthy plasma and diminishing the fibrinous constituents in the blood. He says of it: —
"It is an oily matter w»ll borne by the stomach; easily dittused by emulsion through the alimentary mass; readily absorbed by the lacteals, in which it contributes to form a rich molecular base in the chyle; apt to saponify with the basic salts of the blood; and, when diffused with this fluid through the capillaries of the body, capable of penetrating to all the textures and of exercising its solvent and softening action on the solid fats of old deposits, whilst it affords a rich pabulum for the sarcophytes (colourless blood-oorpu8c!«s) and bioplasm of the blood, tisaue-oell, and lymphatics."
The chief necessity, in regard to the remedial employment of cod-liver oil, seems to be that it shall be taken perseveringly and steadily for long periods of time, and that it shall be used immediately after a meal, so that it may mingle itself at once with the digesting food and take part in its sustaining office*. Dr. Williams states that, in a practice of twenty-five yean), he has had occasion to prescribe cod-liver oil for between twenty and thirty thousand patients, and that of these 95 per cent. have been able to continue its use for the requisite time without material difficulty, and 90 per cent, have more or less benefited from its employment.
Dr. Williams speaks very graphically of the lymphatic system as the " seed-bed of the flesh-germs—the lymph-corpuscles and "blood-corpuscles," and regards the I scrofulous taint, the particular blood-state which leads to consumptive deposit and disorganization, as a degradation of bloodplasm originating in that lymphatic system seed-bed. All measures of treatment and management, for those who are threatened with the consumptive taint in any form, resolve themselves: First, into the maintainance of the blood-plasm and fleshplasm in their most vigorous and healthy condition; and secondly, into the careful avoidance or immediate arrest of inflammatory attacks on the respiratory organs, which are more prone to become the seat of the phthinoplastic deposit. The book treats very fully and clearly of the various expedients by which both ends may be most efficiently secured; and it does that in so simple and untechnical a way tliat its pages may be advantageously consulted by everyone who has a personal ground for interest in the information there conveyed. The more technical parts of the book, which deal with the various pathological details of the subject, and with the illustrations that have been found in special cases, are also of the highest value, as the gleanings of close and philosophic observation in a field of large experience; but they are addressed to a different circle of readers.
The main value of such monographs as those which it is the object of this article to.bring into notice is the unconscious influence they exert in the creation of an.intelligent public opinion upon a subject that is of great practical moment. No intellectual reform is more needed, and more ardently to be desired, than that every responsible head of a family in the social community should have clear vlaws upon such matters as have here been dealt with. The problem of sanitary regulation by the State, which is already beginning to assert itself in somewhat loud tones, must grow into ever-increasing importance and urgency where a still multiplying population, already numbering thirty millions of souls is contained within the unelastic bounds of one hundred and twenty thousand square miles of sea-girt territory. It has been the reproach of civilized communities that the centres of aggregation are the haunts and strong
holds of evil influences which leave the wild places of Nature more desirable homes for man than cities and towns. But it is the privilege of civilized communities that their great centres of aggregation may, by the application of knowledge and cultured intelligence, be made in every sense better homes for man, and more advantageous field* both for the exercise of the human faculties and the enjoyment of human existence, than the unimproved face of the wilderness. There will no longer be hesitation as to the means by which this desirable object may be most surely advanced in a land which aspires to be in the van of civilized progress, when the leaders of its intellectual life and thought have aS clear an apprehension and as keen a perception for the teachings of phy.-iological and physical science as they have for political and social relations and questions. The ultimate solution of the great public health problem rests with the enlightenment of the public mind regarding the broad issues upon which hang health and disease, and life and death.
From Saint Pauls. OFF THE SKELLIGS.
BY .IBAN IKOELOW.
After this I had Valentine and his Greek to myself all the rest of the morning, and, after luncheon, April having treated us to one of her ever-fresh varieties, and given us a warm, still, and very sunny day, we sallied forth in a body to a certain fir copse, where we meant to sit for awhile, Aunt Christie bring! nat some books with her, and Tom also. We reached a screen of larches, and came through it to a place where the underwood had been cut away, and the large trees left. A good many felled trunks lay on the ground, with clumps of primroses about them, and oa the slope of a ridge grew whole nations of anemones and wild hyacinths.
We sat down on the ridge, just in front of the screen of firs. The long, deep dell was all bare to the light, for the chestnuts and poplar-trees had not yet unfolded their crumpled leaves, and the sun was pouring down his rays on the heads of the flowers. I do not know that a partly felled wood is a particularly lovely place in general, but that unsullied sky was delightful, so was the sudden warmth and the thick shelter behind us, and I liked to see the shy English birds flitting about and piping, and then peeping round corners at us.