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Oak and fir take carbon from the same air, and from the same
soil water and mineral salts, and nitrogen that is left there, per-
haps, by a co-operating microbe; but oak still remains oak, and fir
remains fir, and their seed will produce the same as the parent tree.

Allow me now to present to you a perhaps crude comparison.
The joiner at his bench gets hump-backed after years, the tailor's
and the cobbler's gait and gestures are recognized; their special
work has produced this. Specific activity, within bird and fish, oak
and fir, develops a special anatomy. But the impulses of animals
and plants are inherent and lasting, and endowed already in the
germ cell.

Life, indeed, is a chemical change; a preparing and receiving of
the potential energy called food and contact with active energy,
impressions of the senses and so on, with the result of a widening
metabolism and a final kratabolic excretion. But this chemical
chang^e is controlled by designing species, or to use the term of the
law of conservation of energy only such forms of energy and so
much of each are disengaged within the living cell as are in accord
with the design of species.

Within the living cell we observe something changeable, that
is energy changing its condition from rest or latency, or from one
form to another. Disengagement of energy means a change of its
condition, and this change from one to another gives us the con-
ception of cause and result. Therefore, we say, all physical phe-
nomena present a causative relation.

But there is also something unchangeable within every organ-
ism, something controlling all processes of nourishing and shaping
cells and tissues; it can not work or mould, because such an activity
would involve a changing. We cannot comprehend' it except by
comparison. The unchangeable has not causative relation. All
we know of it is, that changing energy is led under its influence dif-
ferently and in designs transmitted by procreation. These con-
trolled uses of the living are biological phenomena; but all specu-
lations beyond recognition of this control of physical phenomena
must be rigidly excluded from exact science.

Systematic botany and zoology have given us the term species



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144 INDIANA STATE MEDICAL SOCIETT.

and comparative anatomy and embryology dwell on different spe-
cies or respectively on different stages of the same species. Species
itself in an abstract conception. We see individuals, but the common
in individuals derived by reflexion is delineated by species. Yet
species in reality is the unchangeable in functions composing life.
Therefore, we transfer the unchangeable in forms to the unchange-
able in functions, shaping the forms. Consequently, species is iden-
tical with vitality in its relation to the outer world, and it means also
control in regard to its own life or functions. We have no other
definition of vitality, we comprehend it as we do the good, the beau-
tiful, ^the grand. (We perceive it on the way of comparing.) An-
alogy allows as valid conclusions as reasoning from cause to re-
sult. We understand Raphael and Mozart as well as Humboldt
and Faraday.

But I will go one step farther by showing the inconsistency of
the mechanical conception of nature. Modern physiology and
pathology are based on the cell theory. All vital functions are
transferred into cells; viz, receiving and transforming substance,
building up the organism, producing and procreating. There are
tissues, without proliferation, as bones whose new forma-
tion depends on the connective tissue of the periosteum.
We know several such mother-tissues. But there are also
metaplastic structures, having neither proliferation nor assimilation
as nails, hairs, red blood corpuscles, and the axis cylinders of the
nerves. These structures have no vital functions of their own, they
are as their mother-tissue made them, consequently they can not
become sick by themselves. The producers of hair and nails get
sick, and hair and nails show only the results of these sicknesses.
We may also not speak of diseases of the blood and nerves; blood,
for instance, may be contaminated, but not by itself, rather, like
a stream after a thunder-storm, by suffering organs around. There-
fore, we must naturally regard the functions of blood and nerves
as under physical laws exclusively; of the same character as excre-
tions and secretions, because they are extracellular and even mus-
cular contraction exhibit energies beyond cellular control. But
life in a normal and abnormal state pertains to cells and tissues with-
in certain limits; we recognize the cell-membrane by general con-
sent.



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HUMAN PHYSIOLOGY IN ITS RELATION TO BIOLOGY. 145

Now, our physiology teaches us about velocity of nerve im-
pulses, pressure of the blood in arteries; it explains digestion in the
stomach; all mere mechanical or chemical phenomena, but about
the work in brain-cells nothing is said; only recently autonomy of
the heart was acknowledged; the question, why the stomach does
not digest itself is evasively treated. Indeed, all vital actions remain
unexplained, because modern physiology dwells only on the phy-
sics and chemistry of the human body. But how may modern phy-
siologists pretend to say : " Life is mere chemical change and phy-
sics," and why may they call their disciplines science of life ? In
fact, matter and energy are only means and the stratum for the de-
velopment in the principle of life.

It was in 1858 Johannes Mueller died, the great physiologist,
well kno'wn for his high points of view in all his researches. Only
last year, thirty-six year^ after his death. Professor M. Vernorn in
his handbook on general physiology, the first work on this sub-
ject, has bestowed due respect to the memory of the father of the
science of life.

Mueller's successors parted in different directions of investiga-
tion, and became the founders of a mechanical and a chemical
school of physiology. It was a natural result, due to their methods,
that their problems concerned the physical phenomena only as
pointed out already. Physiology was not cellular any longer, but
extracellular, and consequently, vitality was not in question.

Medical practitioners and clinical teachers never discarded the
term of vitality, although they did not dare a distinct and clear
definition of it. Vitality was like an old household tool, nobody
knew whether it was a knife or saw, but everybody made use of
it as well as he could.

When Cohnheim from his mechanical standpoint logically re-
jected etiology from pathology, modern physiologists became
aware somewhat of their error.

We do not deny the necessity of fixing limits to exact science,
but as they were, they were drawn too narrow.

Embryology and comparative anatomy are the well-established
sciences of species, but science in physiology of differentiation, the
analogue of embryology and comparative physiology, are not taught
nor written about.

10



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146 INDIANA STATE MEDICAL SOdlETt.

Indeed, since bacteriology, which took its issue also from the
workshop of Lehmann and MuUer, ushered in various antitoxin
treatments, it became evident that Alma Mater was a neglectful
stepmother to the dearest of her children.

Without referring to authorities we have plenty of facts and
logics on our side to be justified in defining vitality as species in
action.

But it has become my duty now to demonstrate the vital con-
ception of nature we advocate.

If we take carefully some deposits from the soil of a swamp we
may observe sometimes on our slide little masses stretching to and
from and devouring and giving away particles. A close investi-
gation reveals, indeed, feeding, digesting, growing little masses,
endowed with all vital functions of higher differentiated organ-
isms. The cell is the simplest living unit, consisting of a nucleus
and protoplasm, ordinarily within a membrane. We know many
one-celled organisms, sometimes of a considerable size; by division
and separation new cells may be formed, but enclosed by a common,
slimy substance; a repetition of such a community may form layers
of an endoderm and exoderm, or layers transform into tissues and
organs; so that we may speak of animal persons, and even these
may form a still higher community, viz, an animal state, as ants
and bees.

This property of cell-communities developing in several degrees
and various forms is termed differentiation.

Cells constituting a complicated organism are still living units
although they have lost their power of independence ; their individu-
ality is merely ideal.

The laws of differentiation have the tendency to bring the sub-
stance of the body into contact with the outer world under most
favorable conditions. We observe as the result of differentiation a
diminshed variation of species, a more difficult yielding to influences
from without, but increasing temporary disorders within tissues and
organs. We did not find so far a variation of man, but frequent
and manifold diseases of organs exposed to unfavorable influences.
The human organism has a strong central power which may sacri-
fice much in parts in maintaining the whole.

In regard to the laws ruling phenomena in the human body we



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HUMAN PHYSIOLOGY IN ITS RELATION TO BIOLOGY. 147

can say what the mechanical school already teaches, that all pro-
cesses t)f digestion, respiration, perception, circulation, secretion
and motion are subject to the law of conservation of energy exclu-
sively. But changes we comprehend under the names of assimila-
tion, proliferation and production are not mere physical disengage-
ments of energy. We can not speak of combustion in the living
body; if chemical change within would be ordinary burning a more
intense heat would be produced as we readily observe. Chemical
change is controlled by species and led partly into other forms of
energy than heat. We know also that muscles and nerves waste
more substance than other tissues because a transformation of ener-
gy into mechanical or respectively into electric form as it is so pre-
eminently noticed in these tissues, means a loss of the correspond-
ing substance. Any transformation of energy can take place only
once on the same matter. Fuel heating the boiler must be renewed
if the same chemical change and heating should be continued. But
we do not know the changes leading to such transformations; we
must also concede that we have no positive proof of the electric
nature of nerve impulses; we only say, they are nothing else.

From a general point of view we may call food and air potential
energy, entering either directly or after much preparing circulation,
but taking part with Hit not sooner than from capillaries to-
ward abutting tissues. Disengaged energies, as light, mechanic
force in hearing and touching, chemical change in smelling and
tasting, heat and electricity in transformation are received either by
apparatus of senses, which with all probability are m-etaplastic struc-
tures without vital function or by nerve ends distributed over the
whole body. The irritation from without enters also to the depth of
the body to participate with vital changes.

Blood corpuscles and nerves may rightfully be called freight
and mail agents reaching all stations, but not taking part with fam-
ily life.

Under the light of such views it becomes evident that all physi-
cal phenomena within the organism must be strictly separated from
vital functions, and also that mechanical and chemical physiology
can not be judges in biological questions. Such questions pertain-
ing to life are omitted.



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148 INDIANA ^TATfi MEDICAL SOCIETY.

Concluding, I have to excuse myself for having assumed a crit-
ical standpoint in such an important matter. But medical practice
forces me daily to refer to vitality whenever I investigate as to cause,
course and outcome of a disease, or when I have to state the proba-
ble duration of life of an applicant for life insurance. On the other
side the thought was so near to pronounce species we observe in the
forms, as active also in building up the forms.

Certainly in diagnosing a disease we have to resort to a most
careful physical examination and only in questions of cause, course
and outcome of disease we must assume the higher standpoint of
vitality.



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SOME SANITARY QUESTIONS CONCERNING TURBER-

CULOSIS.



FRANK B. WYNN, A. M., M. D., INDIANAPOLIS.



Tuberculosis has long held sway as the most terrible scourge of
the human race; not as cholera or yellow fever, making a sudden
and terrifying onslaught upon a city to-day and leaving it depopu-
lated to-morrow, but slowly and surely at all times and among all
people accomplishing its fearful work. Familiarity with this disease
has robbed it of much of its terror. The laity do not appreciate the
frightful extent of its ravages. The figures of the census of 1890
startle the average mind when we read that 125,000 of our citizens die
annually of tubercular disease.

When Robert Koch discovered the true pathology of tubercu-
losis, as so well set forth by my esteemed colleague, the medical
world took new hope, both for the cure and prevention of this fearful
malady.

Accepting this bacillus of Koch] as the true cause of the disease,
let us inquire what are some of the common and preventable sources
of infection.

It is now admitted that bovine and human tuberculosis are iden-
tical, and transmissible from man to beast and vice versa. Gerlach
was first to show that bovine tuberculosis is not infrequently com-
municated to man. It is the most destructive and widely spread
disease among cattle.

That tuberculosis follows in the wake of civilization is no less
true of lower animals than of man. Wild beasts do not suffer from
the disease till sheltered in zoological gardens. In Europe about
twelve per cent, of cattle are said to have tuberculosis. Some herds
have been found in this country in which seventy-five per cent, were
affected. Examinations for tuberculosis in Massachusetts, Rhode



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150 INDIANA STATE MEDICAL SOCIETY.

Island, and other states of New England, show over seventy per cent,
affected. It is more frequent in milk than beef breeds, and twice
as common in cows as in steers. Frequency increases with advanc-
ing age.

The practical point to determine is, are the milk and meat of
tuberculous animals infectious? In the cow one of the most fre-
quent lesions is that of chronic mammary tuberculosis, character-
ized by diffuse, hard tunefaction of the mammae and more or less
induration of the udders. There is marked increase of fibrous con-
nective tissue elements. Nodes of varying size develop, which often
undergo ceaseous or calcareous transformation and ulceration. The
mammae present a knotty appearance and the degenerated nodules
are rich in bacillary accumulations. The milk of a cow with tuber-
culous udders is dangerous and should not be used. In such milk
the microscope reveals tubercle bacilli and inoculation experiments
with it upon guinea pigs and rabbits, communicate the disease. Such
is the conclusion of the Royal Commission, appointed by parliament,
which has spent five years carefully investigating this subject and
included no less a distinguished pathologist than Sims Woodhead.

In the August inspection of dairy herds in and about this city,
165 dairies were visited and 2,751 cows inspected. Seventy-seven
cows were found in bad physical condition. Seven were found with
ulcerated udders, evidently; tubercular in character. If the New
England per centage be taken as an average, we should expect to
find among the cows supplying our milk, 192 tubercular animals.
Of the seventy-seven in bad physical condition, a number manifested
symptoms of pulmonary tuberculosis. If the "tuberculin test" had
been applied, in all probability, a large majority would have been
found infected and unfit for milk production. The milk of one in
four tuberculous cows, according to Bangs, is infectious. As dairy-
men mix the milk, it is easily understood how the product from a
single animal, with ulcerated tuberculous nodules of the udder,
would contaminate the entire supply and prove a menace to con-
sumers.

The detection of tubercle bacilli in milk of tuberculous cows is
attended with considerable difficulty. The inoculation of lower ani-
mals with infectious milk gives more positive results. Bollinger, a



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SANITARY QUESTIONS CX)NCEBNING TUBERCULOSIS. 151

continental veterinarian of eminence, found the milk of eleven out
of twenty cows infectious by inoculation, while the bacilli were found
in but one sample. His experiments are corroborated by Freid-
berger, Vemeuil, and Arloing. It seems probable that in many
cases only the spores of tlie bacilli are present in the milk.

Recent investigations show that the milk of tuberculous cows
may be infectious, and the udders to all appearances perfectly sound.
Hiersherber inoculated rabbits with the milk from tuberculous cows
in which the udders were free from nodules. Fourteen cases devel-
oped. Professor Bang, of Copenhagen, after extensive investiga-
tions, reports that one-tenth of animals inoculated with milk from
tuberculoous cows with sound udders, became tuberculous. The
experiments of Drs. Ernst and Peters, of Massachusetts, lead them
to conclude that milk from cows with tuberculosis in any part of the
body may contain the virus.

It is easy enough to demonstrate the communicability of tuber-
culosis upon lower animals, through inoculation with infectious
milk. With man, such experiments are not practicable. Many
cases, however, seem to afford conclusive proof. Demme had four
infants die, due to intestinal tuberculosis. They had been fed upon un-
sterilized milk from a cow with marked tuberculous lesions. Olivier
reports thirteen cases of tuberculosis, chiefly intestinal, among girls
in a boarding school. The cases developed within three months,
and seven of them proved fatal. The fact that tuberculosis of the
intestines and mesentery occurs in children most frequently, is addi-
tional evidence that milk is the infective medium, since that consti-
tues their food. Cooking destroys the germs and renders tubercu-
lous milk safe. Its practical application in milk sterilizers for pri-
vate families and hospitals and the establishment of public steriliz-
ing depots for the poor, has resulted in great saving of infantile life
from intestinal tuberculosis.

The facts herein set forth are sufficient to emphasize the need
of thorough and systematic inspection of dairy herds and dairy barns
by competent persons. The department of health should be vested
with power by law and ordinance to license dairymen; to compel
proper sanitary arrangement in cow stables; to condemn tubercu-
lous cows and render compensation for the same and to apply the



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152 INDIANA STATE MEDICAL SOCIETY.

"tuberculin test" in cases in which there is doubt as to diagnosis.
In competent hands the "tuberculin test" is now known to be almost
infallible. Inspections should be of such frequency as to insure
compliance with requrements of the department.

The existence of tuberculosis in meat has long been known. The
sale of tuberculous meat was forbidden in Munich as early as 1730,
and later, in other German cities. It is recorded in the recent work
of Freidberger and Frohner that in 1677, twelve pupils in a Liepsic
school contracted intestinal tuberculosis from eating infected meat.
Sanitary laws of that day required the killing and destruction of
tuberculous animals. Recent statistical data from foreign cities,
where rigid inspection for tuberculosis of meat is made in slaughter
houses, show the following percentage : Baden, one-half per cent. ;
Munich, two-elevenths per cent. ; Berlin, four-fifths per cent. ; Paris,
six per cent. Doctors Woodhead and Martin fed the raw meat of
animals with tuberculous organs to pigs, guinea pigs and rabbits.
Five out of fourteen pigs, two out of thirteen rabbits, and twenty-
four out of one hundred and forty-five guinea pigs became tubercu-
lous.

Prussian law defines meat of tuberculous animals as unfit for
food when there is: generalized tuberculosis; that is when two or
more organs are infected, showing metastases through the general
blood current, when meat contains tubercules; and in advanced ema-
ciation, even if the tubercular lesions are localized. If the tubercu-
lar disease is clearly localized to one organ, the meat may be con-
sumed, provided the viscera are removed with care to avoid smearing
muscular tissues with tuberculous matter.

Tuberculosis is much less frequently communicated to man
through meat than through milk. This is owing to the fact that
meats are usually cooked. The experiments of Dr. Woodhead to
determine the influence of cooking upon tuberculous meat are of
interest. Ordinary boiling or roasting sterilizes the surface and
substance for some distance from the surface, but cannot be relied
upon to sterilize tuberculous material in the center of rolls of meat
of greater weight than three or four pounds.

To insure for the local markets of our American cities a whole-
some meat free from tuberculous matter, a more extensive adoption



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SANITARY QUESTIONS CONCERNING TUBERCULOSIS. 153

of the abattoir system in vogue on the continent is necessary. This
enables thorough inspection of the carcasses as they are slaughtered,
at a comparatively small expense. When slaughter houses are
scattered in different parts of the city's environs, as in this and most
other American cities, the proper inspection of carcasses for tubercu-
losis is impracticable, except at an expense greater than municipal
bodies are willing to incur. Under a false notion of economy, the
provision for meat, milk, and other food inspection in this city is
wholly inadequate. If all the slaughtering were done at one place
(the abattoir sysem) both better sanitary conditions could be main-
tained and the public could be assured of a wholesome meat, free
from tuberculous and other disease processes.

While there is no question as to the important role of meat and
milk of tuberculous animals as causative factors in the production of
the disease in man, without any doubt the most common medium of
infection is dried tubercular septum. The alvine discharges of those
suffering from intestinal tuberculosis is likewise rich in bacillary
material, and is a source of danger. Pus from cold abscesses, lym-
phatic glands and tubercular joints, contains bacilli and should be
destroyed without permitting to dry. Lupus and tubercular wart,
however, contain germs in such spare numbers that they may almost
be considered non-infectious. Cornet was first to show by his im-
portant work, the danger of inhaling the dried sputum of consump-
tives. Numerous investigations have proved that expired air con-
tains no tubercle bacilli. The sine qua non of dessinmination is des-
sication. This applies to tubercular products of whatever sort.
Dried and pulverized sputum finds ready access to the lungs by inhal-
ation. Considering the reckless frequency with which consump-
tives discharge expectorated matter upon carpets, walls, floors, side-
walks, etc., where it dries and mingles with the dust of the atmos-
phere, to be breathed by healthy persons, the wonder is that all do
not become infected. In this connection. Flick's study of the mor-
tality from tuberculosis in Philadelphia from 1861 to 1891, is of
interest. No decrease in the death rate from this disease occurred
until the doctrine of its contagiousness began to be taught. From
1881 to 1891 an average yearly decrease of 784 deaths was recorded.

Granting the contagious nature of tuberculosis, what measures



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154 INDIANA STATE MEDICAL SOCIETY.



of public hygiene would be wise and humane ? What action should
be taken by public health authorities to prevent its spread? Wishing
to ascertain what practical measures had been adopted by public
health bodies in other cities, to prevent the spread. of tuberculosis, the
following questions were propounded to the chief health officer in
each city:

1. Has an attempt been made to eradicate tuberculous cows from
the dairy herds supplying milk to your city ? Has tuberculin been
used as a diagnostic test ?

2. Is inspection for tuberculosis made of carcasses of animals
slaughtered for your local markets?



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