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not unfrequently acts as the first step in the development of the disease, determining the commencement of the noxious deposit, and leading to its further 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 condition of the blood, the over plastic deposits issuing from the derangement pass into the state of pus-corpuscles which dissolve and destroy 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, tubercledeposit 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 progressive destruction, filling and choking up the affected parts with decaying material, and involving them in prolonged, and frequently in fatal disorder.
The degraded bioplasm (phthinoplasm 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. In the one case acute and rapidly progressing consumption ensues. In the other the consumption is of chronic character and slow 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 hand, an analogous development of consumption has been also produced by using with the same animals for the inoculation diseased matter that is not consumptive tubercle; and from this it has been argued that the production of tubercle is in all the instances due to the setting up of a low form of inflammation which causes 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 1846, 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 inoculated animal; and I therefore always recommend 'that 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 ana careful examination and discussion. Muoh 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.
VOL. CXXXVI. NO. CCLXXVII. K
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 he, 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 13'39 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 sagacity 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 the 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 ali other .' means put together.' The curative influence of the re.r :dy 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 well borne by the stomach; easily diffused by emulsion through the alimentary mass; readily absorbed by the lacteala, 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-corpuscles) and bioplasm of the blood, tissuecells, 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 offices. Dr. Williams states that, in a practice of twenty-five years, 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 scrofulous taint, the particular blood-state which leads to consumptive deposit and disorganisation, as a degradation of blood-plasm 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 maintenance of the blood-plasm and flesh-plasm 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 most 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 that 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 views 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 soulsj is contained within the unelastic bounds of one hundred and twenty thousand square miles of sea-girt territory. It has been the reproach of civilised communities that the centres of aggregation are the haunts and strongholds 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 civilised 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 fields 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 civilised progress, when the leaders of its intellectual life and thought have as clear an apprehension and as keen a perception for the teachings of physiological 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.
Art. VIII.— The Japanese in America. By Charles LanKan, American Secretary to the Japanese Legation in Washington. London: 1872.
A T opposite sides of the globe, separated from each other by the whole breadth of Europe and Asia, and fringing the great continent from which they are only parted by a narrow belt of sea, are two countries, each composed of a group of islands distinguished alike for the beauty of their scenery and the fertility of their soil, although not in the same parallels of latitude, for the Japanese islands lie between the 31° and 45° of North latitude, and the British between the 50° and 59°. The parallel of 40° North latitude, which cuts through the middle of Japan, also cuts through Sardinia, the Island of Minorca, and the centre of Spain and Portugal. Southern, not Northern Europe, therefore, might best claim affinity with Japan, its products and its people, if latitude were the sole guide to those marks of outward form and type which suggest or simulate natural relationship. Notwithstanding this