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the blood, and consequently also of the most important textures and organs of the frame; and that it is this early stage of threatening derangement which is most within the reach of, and which most calls for, the exercise of the physician's controlling power. On the other hand, it is the various methods by which disease-germs are preserved and perpetuated when they have once been generated in the bodies of people affected by specific blood-contamination ; the means by which they are raised in mischievous power and virulence as they are in the act of dissemination ; and the contrivances by which they may be caught the instant they issue from their source in diseased organisms and destroyed before they can further pursue their baneful career, which it belongs properly to the governing department of the State to deal with by well-considered sanitary regulations. It is certain that disease-germs continue to live for long periods of time in the natural secretions and moist exudations of living bodies; often almost hybernating for a season, and then reawakening into renewed activity when favourable conditions for their growth and multiplication occur. The contagion of the cattle-plague unquestionably lurks in this way in the milk of the cow. Many kinds of disease-germs even retain their potential vitality in water, and some, which have been thrown out from the diseased body in a subdued state of activity for evil, are roused by external conditions and accidental influences into most deadly' energy and power. This certainly occurs with the germs of some kinds of infectious fever. But the most remarkable illustration of the fact has just been furnished by Dr. Burdon Sanderson in a direct experiment. He has taken purulent matter from an abscess in the spleen, and in the first instance innoculated the peritoneal cavity of a guinea-pig, and shown that the animal suffers no material harm from the innoculation. He has then inserted other portions of the same matter in the peritoneal cavity of a dog, and after forty-eight hours has taken fluid from that cavity and used it for again innoculating another dog; and deadly disease, closely resembling the worst collapse of cholera and malignant fever, is then found to be produced within six hours. The comparatively harmless matter is seen to be converted into a most virulent and energetic poison by the influence of an inflamed living organ exerted upon it during a couple of days. In seven distinct experiments Dr. 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 harmlessness, 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 healthy human blood, and only come into efficient activity when the blood loses its well-adjusted balance and full perfection. It is also a consideration of the utmost practical moment that most of the diseasegerms 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
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 organised 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 wherever 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 de novo from healthy bioplasm by the mere influence of extraneous circumstances, and that infectious diseases may again and again break out with a fresh 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 contagious disease are actually derived, or attempting to decide definitely whether they come from the very minute bioplasts' (aggregations of bioplasm), 'or from ordinary white blood-corpuscles, or mucus, or epithelial, or other particles, I think I am justified in advancing the doctrine that the germs originate in man's organism, and that they have descended from the normal bioplasm of the body.
'A carefal 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 ones deteriorate and disappear. The new forms may be closely allied to already existing forms and to forms 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 justify 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 growing into wider acceptance in the physiological mind, is, that whenever a bioplastic constituent of the living body is transformed into what is termed a diseasegerm—that is, into the material cause of the transmission of diseased action to otherwise healthy organisation, 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 organisation 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 is formed as a result of some inflammatory disorganisation 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 life-plasm of infinite minuteness, but of proportionally exalted energy ; and he believes that in some of the most grave and deadly forms of peritoneal inflammation, which are unquestionably communicated by substantial contact and material transmission, he has seen the process of organio 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 furnishes 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, diphtheria, 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; 22.84 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 recognised 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 Consump* tion. The book bears a very modest 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 Medicine in University College, that lymph, pus, and tubercle differed only in the degree of their vitalisation, and that they are 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, the corpuscular aggregations of bioplasm, which are used in the construction of the textures of the most important organs of the body, have not the power of free vital movement and plasticity which they ought to possess, and that they are, instead, hard, indolent, and dry. The bioplasm, or life-substance, becomes what Dr. Williams happily terms 'phthinoplasm,' that is bioplasm ’in a state of premature waste and decay. It will be observed how aptly the term “phthinoplasm, or wasting-plasm,' 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 older pathologists.
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 blooddeterioration 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,