January 23, 18S0-1 



SCIENCE. 



87 



lous matter will produce corresponding disease 

 in the intestine and other abdominal viscera. A 

 number of dogs, subjected for several weeks to 

 an atmosphere surcharged with particles of sputa, 

 became tuberculous, but the evidence is not con- 

 vincing. 



The possibility of tubercular inoculation has 

 been known for years. To Koch is due the credit 

 of discovering wherein the peculiar agency con- 

 sisted. 



The contagiousness of pulmonary consump- 

 tion has been believed for more than a century, 

 and still is accepted by many physicians. Dr. 

 Hermann Brehmer, upon whose extensive work 1 

 the present article is based, warmly contests these 

 views, and, it must be admitted, with ability. He, 

 in brief, endeavors to prove that pulmonary 

 chronic consumption is never produced by the 

 bacilli, and is neither contagious, nor. strictly 

 speaking, hereditary. As the director for more 

 than thirty years, of a private institution for the 

 treatment of consumptives, he has been able to 

 study nearly twelve thousand cases, chiefly drawn 

 from the better classes. Certainly conclusions 

 based upon such ample clinical material are en- 

 titled to our consideration. 



Though some adherents of the bacilli theory of 

 contagion have believed that these organisms are 

 directly hereditary, lying latent for a longer or 

 shorter period, to finally take on activity, yet 

 such a view seems wholly improbable, if not 

 absurd. Thus it is apparent, in what is considered 

 hereditary consumption, that that which is entailed 

 upon the offspring of consumptive parents is not 

 the disease itself, but merely the disposition to the 

 disease, — the consumptive habitus. If such a 

 predisposition exist, as it unquestionably does, 

 wherein does the true causation lie ? Not in the 

 bacilli, for they merely find a soil already prepared 

 for their reception, and isolation does not appear 

 to affect the chances of such predisposed persons 

 becoming diseased. A sound, healthy person 

 never becomes infected by the bacilli, at least 

 never in the form of chronic pulmonary consump- 

 tion, and the possibility in any other is not yet 

 proven. It is only those in whom a predisposition 

 exists — a consumptive habitus — who acquire the 

 disease. What, then, is the true causation of the 

 ordinary phthisis ? This the author endeavors to 

 show. 



He has shown from the researches of Rokitansky, 

 and his own, that the lungs of consumptives are 

 abnormally large, and the heart and abdominal 

 viscera are abnormally small. Thus the lungs do 



1 Die aetiologie der chronischen hingenschivindsucht, 

 vom standpunkt der klinischen erfahrung. Von Hermann 

 Brehmer, sen. Berlin, Hirschwald, 1885. 8°. 



not receive their due amount of nourishment, and 

 become the foci of disease, where the bacilli 

 readily and easily find a lodging-place. This view 

 may appear startling, yet it seems well sustained. 

 The flat-breasted person of consumptive tendency 

 has the lungs, not small, as is generally sup- 

 posed, but elongated and large : the heart not 

 merely atrophied, but actually lessened in capacity 

 and power. Thus the relation between the normal 

 heart and lung is about one to six : but in many 

 consumptives so great a discrepancy as one to 

 twelve may exist. The relation between the lungs 

 and heart may consist not only in the former being 

 too large, or the latter too small, but both may be 

 actually normal so far as size is concerned, and 

 the evil be found in abnormally small pulmonary 

 arteries. Not only does the heart show physical 

 incapacity, but it is functionally weakened, pal- 

 pitation always existing to a greater or less degree 

 in consumptives. Whatever may be the exact 

 relation between these organs, the result is invari- 

 ably the same, — deficient nutrition to the tissue 

 of the lungs. Rarely are the abdominal viscera 

 enlarged, and almost constantly it is found that 

 consumptives have never been hearty eaters. A 

 person with large breast, and its accompanying 

 small lungs, an enlarged and powerful heart, well- 

 developed abdominal viscera, and a hearty appetite, 

 rarely, if ever, becomes consumptive. 



Here, then, is the ultimate cause of the disease. 



— impaired nutrition. This impaired nutrition 

 may be the resultant of various antecedent causes. 

 First, and most important of all, is that due to 

 heredity or prenatal life. Instances are too numer- 

 ous to require argument, that acquired peculiar- 

 ities may be and are transmitted to offspring. 

 Impaired vitality, from whatever cause it may be 

 due, re-appears often in the child. When such 

 impaired vitality consists in the predisposing ab- 

 normal correlation of lungs, heart, and viscera, 

 the fuel is prepared that only needs the match to 

 start into active flame. The question here is of 

 the greatest moment, — Were the tubercle-bacillus 

 no longer in existence, would tuberculous disease 

 become extinct ? 



A predisposing cause of but little less impor- 

 tance is that of the exhausted vitality in the 

 mother, due to too frequently repeated gestation, 



— a cause that not only affects children of later 

 births, but retro-acts strongly upon the mother. 

 Thus it is that the later descendants of large and 

 numerous families are more disposed to ccnsump- 

 tion. Again : lack of nutrition in childhood, 

 whereby the healthy and normal development of 

 the alimentary and arterial systems is retarded, 

 produces a like disposition. 



Injuries to the lung, in some instances, have 



