WITH COMPLIMENTS 03J1 •TIEaC'E ATJTHOB- 
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By Z. O* MrrI. ilOY, if, I\ 
ZAMESVILLl, OH.IGc 
Rejrrtnt from Si. Louis Medical and cal Journal, 
r :go'vj: j, isao. On Some Points in the Pathological-Histology of So-called 
Phthisis Pulmonalis, or Consumption. By Z. Collins 
McElroy, M. I)., of Zanesville, Ohio. 
Repridted from the St. Louis Med. and Surg. Jour., August 20, 1880. 
Mortality reports of the past year show one-fifth of the total 
deaths in several large cities, is due to what is called “ consump- 
tion/’ And including pneumonia and bronchitis, one-fourth 
of the total mortality. As near as I can ascertain, in the ab- 
sence of any reliable statistics, that is about the ratio of mor- 
tality in our own city from consumption, pneumonia and bron- 
chitis. I do not think it will vary much from that anywhere in 
our count}'. Perhaps it is less in the Southern States, and 
greater in New England, but still not disturbing the average 
for the whole country. 
A study of the main condition, to-wit: consumption, must 
always be a subject of profound interest to physicians. 
My own understanding of what is consumption, is this : A 
waste of the body, at a higher than natural speed, without being 
balanced by repair. In the beginning, without noticeable local 
complications, but as it progresses, the failure of structure in the 
lungs becomes prominent, though the waste of all parts of the 
body keeps pace with that of the lungs. 
I do not propose to reproduce the symptomatology, as it would, 
it seems to me, be a waste of time, as it is contained in most text- 
books, and in various special monographs, much more complete 
and systematic than would be proper on this occasion. 
And for precisely like reasons, nothing will be said of post- 
mortem appearances with unassisted vision, and microscopic 
sections could only be interesting enlarged on screens. 
And for the further reasons, that nothing can be learned, 
not already known, by a study of the forms, colors and other 
physical features of structure in a condition of decay : For, with 
every more or less complete change, or modification of physi- 2 
ological forms of structure, there are modifications of, or total abo- 
lition of function. 
I am not an admirer of Key. Joseph Cook, nor a constant 
reader of his “ Monday Lectures.” It is very seldom I read one 
at all. But that delivered by him on the 20th of December last 
(1879), on the anatomy and functions of the brain, is excep- 
tionably fair in its resume of what is known on the subject. I 
mention this now only for a single object, which I think he has 
very happily formulated. It is thus stated : “Every function per- 
formed by a living body, has its correlate in structure.” These 
are not exactly his words, but they are, to my understanding, 
just a little more explicit. I have on various occasions pre- 
sented the same general truth in other words to our medical 
societies. 
My own formulation has been as follows: “Every function 
performed by a living body, has behind it special forms of struc- 
ture on which it depends.” Any change in any structure is. 
absolutely certain to be followed by a corresponding change of 
function. * j 
There is one point on which hinges the whole pathology of 
the condition of the bodies which we call consumption. It is a. 
histological point, and has not, up to this time, engaged the atten-' 
tion of experimenters, and obsevers. It is this : by what means, 
exactly, is food converted into organic structures during life ; Or, 
it may be stated thus : “ How does food become living tissue ?” 
If the answer is “by digestion and assimilation,” let me ask 
are we any wiser than before? What is digestion? What do 
physiologists mean by the term ? What do they mean by assim- 
ilation ? Is it by some orderly process which can be followed 
from beginning to end and understood? Or, is it by some hocus 
pocus, haphazard process, which cannot be followed or under- 
stood ? The former is my understanding. 
Confining our investigations to the complexities of animal— 
higher animal—life, it does not seem to me possible to get even 
a clue to it. But turning to the simpler forms of organic life in 
the vegetable kingdom, a clue can be obtained that will not be 
misleading. 
Study attentively the mode of reproduction in any of the 
more common forms of vegetable life around us. They are 
reproduced, and the means are not a secret, even to the most 
careless observer. IIow is grass, for instance, reproduced ? The 3 
proper reply is by a seed. And what is a seed, say of grass, wheat, 
corn, rye or oats ? It is the material in which the parent plant 
has stored up the material and force for a two-fold purpose, viz.: 
the necessary material and the requisite modes of force to form 
the structures of the new plant, up to that point in its growth 
and development, at which it can appropriate other and new 
material to its further evolution. 
Grass, or other vegetable forms of organic life, when the means 
for their multiplication and preservation have been perfected, 
that is, when the seed is ripe, so to speak, the parent plant is 
dead. The seed falls to the ground in the cases under consider- 
ation, amidst the debris of the decaying parent plant; and from 
the midst of this decaying mass, with favorable external con- 
ditions, comes forth the new life and the new plant or plants. 
Analogy, not always a safe guide, is not likely to lead us astray 
in this case, and will be sure to show the investigator that the 
same law holds good in the complex animal, as in the simple 
vegetable and may be formulated thus: 
“ Each special histological structure in a complex living 
being, in the act of physiological decay and the performance of 
function, stores up, in the requisite material, the force 
for its own reproduction from other and new material 
If the structures of a living being at all times did this per- 
fectly, and new material and necessary conditions were always 
present, and the processs of reproduction always perfect, man 
would be immortal; would live in a state of perpetual youth. 
This is so far from being the actual state of the case, that, after 
maturity, the years will leave their traces on all the structures, 
and it is by this gradual loss of perfect physiological structural 
forms that men grow old and pass away. Advancing age is the 
correlate of failing tissues. 
Eut it will be instructive to follow food, so far as it can be 
traced in its pathway to living tissue. All the food ever eaten 
by a living being, and I have man in my mind prominently in 
my present study—is germinal—that is, it is the material in 
which some previous existences have stored up the material and 
force for their own preservation and multiplication. And as we 
are not cannibals, none of us ever partake of food in which a 
being of our own kind has stored force for its own preservation. 
Chemically, the food eaten by human beings is divided into 
the carbonaceous and nitrogenous. Another classification is by 4 
proximate principles, viz.: starch, fat, sugar, albumen and fibrin, 
gelatin, etc. Associated with our food, as we get it, there is 
alwrays more or less woody fiber and other insoluble matters. 
The stomach may be regarded as a receptacle of food in which 
it, or so much of it as can be, is dissolved by the aid of acids, 
and organic principles, the most prominent of which is now 
understood to be pepsin. The office of pepsin is to dissolve heat 
coagulated albumens and fibrins. The acids of the stomach 
dissolve the starchy elements of food. Oils and fats are emulsi- 
fied. As rapidly as these several proximate principles are dis- 
solved, they are passed directly into the venous blood-vessels, 
and go forward to the liver. In the liver there is a mingling of 
old blood—blood from the venous capillaries—and the new 
material from the stomach. All that takes place there is not 
understood, but it is very certain that the starchy compounds 
are converted into glucose—grape sugar. 
The stumbling block in the way of physiological investiga- 
tion has been, and is now, the lacteals. Current physiology assigns 
to them the functions of “absorbing’' certain products of diges- 
tion of new material—food—by the stomach? Why so? The 
structure of the lacteals and lymphatics here and elsewhere are 
identical. jiLu Mum, h/ U' fyUA/Z'rtf- vJaA/ cnMr'*k 
The lymph in the lacteals, during so-called digestion, is in larger 
quantity and differs from lymph in the lymphatics elsewhere, 
only in the greater amount of fat emulsion. And why should 
not the lymph be greater in the so-called lacteals during diges- 
tion—that is, solution of new food in the stomach—than at any 
other time ? Does not increased functional duty include increased 
physiological decay of structure performing it? Surely this is 
so. Increased duty means increased decay of structure in the 
intestinal tract, including in this its whole extent. Then, if the 
structures store up the force in the necessary material for their 
own reproduction from new material, there would of necessity 
be a larger amount of lymph in the lacteals during their periods 
of functional activity, than in periods of functional repose. 
In truth, the function of the lymphatic system would seem to 
be to gather up the material in which the structures have stored 
up the force for their own repair and perpetuation from the 
general debris. The lymph, therefore, is the analogue of a 
vegetable seed. It performs in the living body precisely the 
functions of a vegetable seed in the vegetable kingdom. To 5 
L . 
adopt it to the performances of its function continuously during 
the life of any individual, it must be mingled with the necessary 
new and old material exactly as it is mingled in the human 
body. And, further, it must be exactly as it exists in the human 
body to perform this function. And that is, these several things, 
old material, new material and the lymph—the seed of the 
various structures from which it has been derived—must be 
mingled together just before coming in contact with the gaseous 
atmosphere, containing ozonized oxygen. 
The mechanical arrangement of these several parts may be 
varied, but the essential principle must be strictly adhered to, as 
it is throughout animated nature. 
The researches of Ivlien, in London, have demonstrated the 
identity in histological structure of the serous membranes and 
lymphatic ganglia and glands. 
But to return to the stomach. It will be seen that a truer 
physiology will not regard the lacteals as carriers of new ma- 
terial at all. All new material, after solution is effected in the 
stomach, is sent through the venous blood-vessel system to the 
liver direct. Here it is mingled with the old blood returning to 
the lungs from all the capillaries. 
When the changes effected by the liver, in both new and old 
material, are completed, it is sent forward to the right heart. 
Just before it drops into the right auricle, the thoracic ducts 
pour their contents into the stream, and it goes thence to the 
lungs. In the lungs, this stream—old blood, new material and 
lymph, or seed of the various structures—meets the gaseous 
atmosphere. Some of the changes occurring there are known, 
but probably much that does occur there is still to be made out. 
But whatever they have been, all identity of its constituents are 
lost, and the outgoing stream—arterial blood—is at once, like 
the contents of the egg, the material and force to reconstruct 
the wasting tissues in the arterioles and capillaries. It will be 
seen that whatever there is of digestion, if by that term it is 
meant to cover the changes necessary to convert food into living 
flesh, must of necessity take place in the lungs. 
The stomach may do its duty perfectly; the liver ditto; the 
lungs ditto; but if the structures have failed to provide for their 
own repair from new material, or the seed-gathering apparatus— 
the lymphatic system—fails in its duty, there must of necessity 
be a failure in the repair of momentarily wasting tissues, at least 6 
with full physiological capacity to perform function. The subse- 
quent chain of events would be waste of tissues—not alone in 
the lungs—without being balanced by repair from new material. 
And that, it seems to me, brings to light some of the hidden 
mysteries of the pathology of so-called phthisis pulmonalis, or 
consumption. 
Difficulties in the performance of the functions of the 
stomach end of the assimilative apparatus are well known as 
dyspeptic, and are much better understood than those at the 
other end, where food becomes living tissue. Dyspepsia has its 
phenomena in pain and uneasiness, but once the food gets past 
the stomach, it is converted, without further unpleasant symp- 
toms, into living flesh. The failures at the other, or capilliary 
extremity of the assimilative apparatus, have no symptoms of 
pain or uneasiness. The failure has another language, which 
has never been properly interpreted. So-called consumptives 
often have good appetites, good digestion, so-called, in stomach— 
that is, food is dissolved properly in the stomach, and is properly 
sent to the liver, but the waste of body goes on, notwithstanding. 
The defect is made known by the progressive waste of body 
unbalanced by repair from new material. 
One other fact in regard to consumption is about receiving 
its final proof—that is, its self-limited character. And the 
additional fact, that the progress of the changes in structure are 
often arrested, and remain in abeyance longer or shorter inter- 
vals, sometimes through life. 
These facts explain the so-called successfully treated cases, 
and the action of so-called remedies which get credit for doing 
that in which they, in reality, have taken no part. 
Thus viewing the pathological condition, in so-called cases of 
consumption, my expectations of more successful remedial meas- 
ures than any now known, it seem to me, are well founded. But it 
will not consist in any specific mixtures of drugs to cure the patient 
outright. But it will consist of at least common sense in life’s 
surroundings, and less haphazard exhibition of drugs. It seems 
to me that the blood of persons in good health, of not dissimilar 
age, and the same sex as the patient, will in some way not now 
understood, he emploj’ed to furnish the force that will perfect 
the final process of living flesh formation in the capillaries of 
those in whom this process is deficient, and for the want of a- 
better name we call consumptives. 7 
This same conception of what must and does actually take 
place in all living beings during life, when applied to other 
departments of pathology, fits equally well as in so-called con- 
sumption. I apprehend in it are comprehended every possible 
pathological condition; acute and chronic, abnormal, deformed, 
and monstrosities. For, if the processes of living tissue making 
from food are not interfered with by some superior force, there 
could not be any pathology. All life would be immortal and 
perfect in types and forms. 
August, 1880.