[Reprinted from THE CLIMATOLOGIST, February, 1892.]n 
OBSERVATION AND EXPERIMENT IN PHTHISIS. 
A Reply to Professor Tyndall. 
By THOMAS J. MAYS, M.D., 
PHILADELPHIA. 
The September number of The Fortnightly Review contains 
an article by Professor John Tyndall " On the Origin, Propaga- 
tion, and Prevention of Phthisis," which, being written in that 
gentleman's usual lucid and impressive style, must carry convic- 
tion of its apparent truthfulness wherever it is read. To one, 
however, who is fully conversant with this controversy, which 
has been agitating the medical profession for the last ten years, it 
is clear that this article deals only with a small part of this great 
question, and that its premises are as erroneous as its conclusions 
are mischievous and harmful. The singular fallacy of the rea- 
soning which has been expended here is the assumption that when 
a disease has been shown to be communicable to the lower animals 
through inoculation that it must also be contagious, or infectious 
in fhe human family. Inoculation merely teaches that a disease 
may be transmitted, but whether the disease originates in this 
manner in practical life is quite another question, as will be seen 
from the evidence which will be offered hereafter. 
The burden of the paper is devoted to showing the value of 
" Dr. Cornet's great investigation" in its bearing on the origin 
and prevention of phthisis. The question whether the bacilli are 
ubiquitous or not is immaterial, so long as we admit (which is 
not disputed by Cornet) that they are most abundant in the en- 
vironment of consumptives; and we shall therefore pass on and 
examine the second research of Dr. Cornet, reviewed by Dr. 
Tyndall, viz., that on "The Mortality of the Nursing Orders" in 
the Catholic convents and monasteries of Prussia, and in which 
he demonstrates that phthisis causes 62.88 per cent, of all the 
deaths among.the nursing members of these institutions, but 
without any reason infers that they acquire the disease by nursing 2 
consumptives. Ever since this communication was made public 
it has served as ammunition to bolster up the contagion theory 
of phthisis, and what does it really show ? Does it show any- 
thing new? No, for it is common professional knowledge that 
this disease prevails very largely among those who lead indoor 
and inactive lives, precisely such a life as is followed by these 
nurses. Indeed Dr. Baer's statistics show ( Ueber das vorkommen 
von Phthisis in den Gefangenen, 1884) that the death-rate from 
phthisis among German prisoners is even greater-ranging from. 
64 to 90.9 per cent. Does Dr. Cornet's work prove the con- 
tagious nature of phthisis? No, for Dr. Baer's statistics also 
point out that prisoners who suffer solitary confinement, and who 
have, of course, no personal contact with any outside sources of 
the disease, are more prone to phthisis by 20 per cent, than those 
wTho are allowed to associate with each other. Another pressing 
question needs an answer before Dr. Cornet's inquiry can carry 
any weight whatever. Not all the inmates of these convents and 
monasteries are. engaged in nursing, but some devote their lives 
to teaching and to other work. Now why did he not make a 
comparative examination of the death-rate of those who are en- 
gaged in nursing and of those who teach, and so demonstrate 
whether those exposed (nurses) are more liable to this disease than 
those not so exposed (teachers, etc.) ? 
Moreover, I have shown {Philadelphia Medical and Surgical 
Reporter, September 27, 1890) that the relative death-rate of 
American firemen from consumption (i. e., when their death-rate is 
compared with that of the ordinary adult population from this 
disease, which is about 27.29 per cent.) is 53.09 per cent., only 
about 10 per cent, less than that which occurs among the Catholic 
nurses, and which are believed by Dr. Cornet to have contracted 
the disease from those whom they were nursing. Does this 
show that contagion plays any considerable part in the production 
of phthisis ? Hardly, for here we have a class of men who lead 
an outdoor life, and who do not come in contact with tubercle 
bacilli, or with the expectoration of consumptives, except by 
chance; and who, irrespective of their occupation, are not sur- 
rounded by any influence prejudicial to their health ; and yet, in 
spite of all these conditions, even after, so far as this is possible, 3 
all the personal and family factors which are known to induce 
the disease are eliminated by a rigid medical examination, con- 
sumption causes nearly 26 per cent, more of their deaths than 
it does among the ordinary adult population. Why does this 
high mortality exist among firemen ? It is because anything 
which has the power to sap, and exhaust the vigor and vitality 
of the constitution, also has the capacity to produce phthisis, re- 
gardless of the absence or presence of exposure to the bacillus 
tuberculosis. There is, perhaps, no class of men who are more 
open to enervating and depressing physical influences, or who 
suffer greater deprivations of rest and sleep than our firemen. 
The sudden transition from a warm room to active duty on a cold 
winter's night; the daring, the excessive and almost superhuman 
exertion demanded in battling with the flames; the extreme oscil- 
lations of temperature to which their bodies are subjected- 
bathed in perspiration at one moment and drenched and chilled 
by an icy stream of water the next; the necessity during emer- 
gencies of wearing and even sleeping in wet clothing from one 
fire to another, are burdens which no human constitution can long 
successfully withstand, and are unquestionably some of the most 
prominent causes which undermine the health of these self-sacri- 
ficing men. 
There is an abundance of other testimony which points against 
the contagious nature of phthisis in spite of the fact that there 
are many who profess to have seen well-defined evidence of con- 
tagion. I never yet saw a case of this kind reported which on 
thorough examination did not turn out to be a case of mis- 
placed confidence, so far as positiveness is concerned. Probability 
exists sometimes, but this does not constitute positive proof. 
This is not surprising, for it is not a question which is susceptible 
of decision by an appeal to specific individual instances, either for 
or against contagion; but is, as Dr. Oldendorff has recently ex- 
pressed it before the Society for Internal Medicine, in Berlin, a 
question which must be decided by statistics; and these, as we 
shall see, give no uncertain tones in response. 
Notwithstanding the assertion of Dr. Tyndall that "no investi- 
gation has proved that the mortality among physicians by phthisis 
does not far exceed the average" (p. 304), I am prepared to show 4 
that their mortality is far smaller than the average, and that among 
those who are especially exposed to the bacillary poison their death- 
rate from this disease is almost nil. The statistics of the Bromp- 
tom Hospital for consumption, in London, show that during a 
period of thirty-six years not a single clearly authenticated case 
of consumption arose within its walls among its 29 physicians and 
assistant physicians, its 150 clinical assistants, and its 101 nurses, 
of which there existed a health record. The statistics of Fried- 
richshain Hospital, in Berlin, lately gathered by Dr. Furlinger, 
show that during a period of sixteen years out of 83 physicians 
there were 2, out of 798 nurses there were 4, who became con- 
sumptive. This certainly points to an exceedingly small death- 
rate, and when we reflect that life insurance companies accept 
physicians as preferred risks, and view the transaction through 
a hard, cold-cash basis, it is needless to spin any fanciful theory 
concerning the necessary mortality of these men from consump- 
tion in consequence of their daily exposure to this disease. 
These statistics in regard to the non-contagiousness of phthisis 
are also confirmed by Dr. Detweiler, who declares that during the 
fourteen years of the active existence of his hospital for consump- 
tion, at Falkenstein, in Germany, not a single case of contagion 
occurred among the attendants, although a large number of con- 
sumptives were treated during that time, and some of the nurses 
had been in constant contact with very ill patients for seven years. 
The same is also shown by the influence of the consumption 
hospital of Gbrbersdorf, in Germany, on the death-rate from con- 
sumption among the inhabitants of that town. Dr. Brehmer, who 
had been in charge of that institution for twenty years, says that 
since 1854 more than ten thousand consumptives resided in his 
hospital, who daily walked the streets of that town and com- 
mingled with its inhabitants. The latter were, therefore, con- 
tinuously breathing an atmosphere more or less laden with 
tubercle bacilli, emanating from the dried expectorations of 
these consumptive visitors; yet, in spite of these favorable con- 
ditions for contagion, the mortality from consumption among the 
Gorbersdorf native population is 50 per cent, less since than it 
was before the establishment of his hospital. 
Dr. Haupt, of Soden, recently gave some very interesting 5 
figures which bear strongly on this question. Soden is a beauti- 
ful watering-resort for consumptive and other invalids at the foot 
of the Taunus Mountains, in Germany. He says that among 
the inhabitants of Soden there are 101 individuals who let lodg- 
ings to consumptive visitors during the summer months. These 
patients are nursed and cared for chiefly by the inmates of the 
families-the work of making the patients' beds, cleaning their 
rooms, beating the carpets, removing the expectorations, etc., 
being performed by female servants. During the winter months 
the rooms are reoccupied by the members of the landlords' 
families. Here then is a most fertile field for consumption to 
communicate itself from the sick to the well, if this disease pos- 
sesses all the virulent contagious properties which are ascribed to 
it by our enthusiastic but ill-starred friends; yet Dr. Haupt states 
that from 1855 to 1888-a period of thirty-three years-10 of 
the 238 members of such families died from consumption. In 
six of these cases, however, consumption was hereditary, and the 
cause of death in the remaining four -was traceable to colds 
and other external causes. Of the 415 servant girls who were 
employed, 5 died from consumption ; but in no instance, so far 
as is known, was the disease traceable to contagion. 
Dr. Langerhans, who practised medicine for nine years in 
Madeira, an island which is visited every winter season by about 
400 consumptives, states that these invalids are lodged, boarded, 
and in great part nursed by English colonists, varying from 210 
to 250 in number, who live in about 100 houses. The rooms 
which are occupied by consumptives in the winter are reoccupied 
during the summer, thus insuring the closest intermingling of 
the well with the sick; but the health-records, which have been 
accurately kept since 1836, show that only four of the English 
colonists died from consumption, and that one of these suffered 
from the disease before he came on the island. These figures 
are especially interesting in view of the sentimental fear that the 
healthfulness of mountain and of other resorts becomes impaired 
by the infectiousness of the exhalations and expectorations coming 
from consumptives who go there for relief. 
Similar negative testimony is obtained from the statistics of 
the non-contagiousness of consumption between husband and 
* 6 
wife. Dr. Schnyder, of Switzerland, gives a record of 844 cases 
of consumption occurring among married people. In 445 of 
these the husband only, and in 367 the wife only, was consump- 
tive ; while in 32 both the husband and wife were affected. He 
does not believe, however, that one of the 32 cases originated 
through contagion, for he has knowledge that 4 of these came to 
him fresh from the matrimonial altar afflicted with the beginning 
of the disease, and he thinks that young people occasionally 
marry whose health is in a similar condition. The late Dr. 
Flint gives a record of 670 cases of consumption affecting hus- 
bands and wives, and among these there were only 5 in which a 
suspicion of contagion arose; but it is certain, he says, that these 
cases can also be accounted for as coincidents in a disease so 
prevalent as consumption. M. Leudet shows, too, that out of 
112 widows and widowers whose consorts died of consumption, 
only 7 (4 women and 3 men) became consumptives. 
Now, if all these data mean anything, they assert positively 
that consumption or phthisis does not arise by being transmitted 
from person to person through contagion. The pursuit of ex- 
perimental investigation which Dr. Tyndall affirms will root out 
" this terrible scourge of tuberculosis" has absolutely done nothing 
to unravel the origin or propagation of phthisis, as we meet it in 
every walk of human life. All that it has done is to show that 
the disease may be transplanted by inoculation after it has been 
called into existence by other causes. The great difficulty has 
always been a neglect to distinguish between the origin and the 
transplantation of consumption. These two phenomena are act- 
ually treated as if they were one and the same thing, yet there 
is about as much difference between the original genesis of a new 
form of life, whether normal or abnormal, and the artificial 
transplantation of the same, as there is between sunlight and 
moonlight. 
This is well shown in skin-grafting. Particles of skin are 
planted on denuded bodily surfaces and become thoroughly in- 
corporated and form new skin, yet this artificial procedure gives 
us no knowledge of the origin and mode of genesis of the skin 
that is transplanted. Nor does vaccination give us the remotest 
idea of the source of the cow-pox virus. A vegetable graft is 7 
also capable of communicating the peculiar properties of the 
fruit, color of leaves, or of the tree or plant from which it is 
taken, to the whole tree or plant on which it is grafted. Dr. 
Darwin (Animals and Plants, etc., vol. i. p. 474), after relating 
a number of cases in which grafting or budding infused the pecu- 
liar characteristics of plants and trees into the stocks which re- 
ceived the grafts, concludes that the process may be regarded as 
the inoculation of a disease. Now the experimentalist who holds 
that because grafts possess the power of transmitting their prop- 
erties to the plant-stock, and that therefore all the diversified 
wealth of vegetable form and beauty is the product of inocula- 
tion by grafting, is about as wise as he who assumes that because 
pulmonary consumption may be produced by artificial inocula- 
tion, nature pursues a similar course in producing this disease. 
Let us imagine for a moment that the data which I have pre- 
sented here are mythical, that all the hostility to the contagionists 
emanates from what Dr. Tyndall passionately defines as " a num- 
ber of loud-tongued sentimentalists, who, in view of the researches 
they oppose, and the fatal effects of their opposition, might be 
fairly described as a crew of well-meaning homicides/' and that 
at the present time it was agreed to enforce the contagion theory, 
with all its cruel possibilities, to the bitter end, what possible 
benefit could any one expect from such a procedure, in the light 
of the history we have on this point? We should precisely repeat 
the experiment which was tested in Naples-from 1782 to about 
1850-with the most disastrous results. At that time the Nea- 
politans believed too that phthisis was contagious, and they en- 
acted and enforced the most rigorous laws that have ever been 
introduced for the suppression of any disease. For the neglect 
of reporting a case, a physician was fined one hundred and eighty 
dollars, with banishment for ten years. In every case the ceilings, 
walls, floors, doors, and windows of the rooms in which consump- 
tives died were torn out and burned, and new ones were substi- 
tuted. The bedding and furniture shared the same fate, and 
such dwellings were not inhabitable for one year. In consequence 
of these stringent laws, the family with phthisis in its midst was 
shunned and driven to want, and the patient was separated from 
the well and was regarded as a public pest. Houses in which 8 
consumptives died came into disrepute, and many of their owners 
were turned into beggars. The sick were neglected and left to 
die inhumanly, away from their families and friends. The in- 
tolerance of this heroic treatment becomes more evident when we 
learn that it had no influence whatever in diminishing the death- 
rate from phthisis in Naples and in other localities where it was 
administered. 
These facts will also have to be met by those who claim that 
phthisis is a contagious disease. It is useless to plead that a 
knowledge of the bacillus gives us more power to prevent this 
disease now than it did then without such knowledge. The au- 
thorities of Naples were as firm in their conviction that this dis- 
ease was contagious as the most enthusiastic bacillus-theorist is, 
and they carried out their ideas of prevention with the utmost 
exactness. Indeed, the requirements of the modern contagionists 
for stamping out phthisis seem more like the vaporings of a child's 
brain than the outcome of sober reflection, wlien compared with 
the strenuous efforts which the unfortunate and deluded Neapoli- 
tans put forth to crush out this disease. It was not enough for 
them that consumptives should cease to spit in handkerchiefs, on 
floors, ground and pavements, and use spittoons instead, and that 
they should prevent their expectoration from becoming dry, and 
diffuse the bacilli through the air; but these people were at once 
separated from the well, and in all probability neither they, their 
expectoration, nor their bacilli, ever came in contact with the out- 
side world again. Yet, in face of all the enormous amount of 
injury which was inflicted by these measures, there was not the 
least stay in the death-rate from this disease, for statistics show 
that this was as high, and probably higher, than in cities where 
segregation never received any consideration. 
In view of these developments, does it not seem a strange sa- 
tire on history to find men who are again anxious to repeat the 
follies and foibles of a century ago ? 
I think I have shown that the work of Dr. Cornet, in common 
with all the experimentation which has been devoted to showing 
the contagious nature of phthisis, is not only a wretched failure, 
but perpetrates a terrible iniquity on those who are afflicted with 
this disease, and wastes the time and energies of the people by 9 
misguiding them in regard to the true origin, propagation, and 
prevention of phthisis; and I am safe in predicting that he who 
persists in hugging this contagion delusion will live to reap 
" from the hopes which around him he sows, a harvest of barren 
regrets." 
(For references on this subject, see Dr. J. Uffelmann, Berliner 
Klin. Wochenschrift, 1883, s. 369; Dr. Valentin, Voyage Medi- 
cal en Italie, etc., 1822; Dr. Sim, Medical Times and Gazette, 
1860, vol. i. p. 363; Professor de Renzi, Storia della medicines 
Italie, p. 512; Phthisis in Italy, British and Foreign Medico- 
Chirurgiccd Review, vol. xlv. p. 112.) Published the 15th of each Month. 
THE 
CLIMATOLOGIST. 
A MONTHLY JOURNAL OF MEDICINE, 
DEVOTED TO THE 
Relation of Climate, Mineral Springs, Diet, Preventive 
Medicine, Race, Occupation, Life Insurance, 
and Sanitary Science to Disease. 
, 
Edited by 
JOHN M. KEATING, M.D., 
FREDERICK A. PACKARD, M.D., CHARLES F. GARDINER, M.D. 
ASSOCIATE EDITORS: 
VINCENT Y. BOWDITCH, M.D., Boston, Mass. FREDERICK I. KNIGHT, M.D., Boston, Mass. 
NORMAN BRIDGE, M.D., Los Angeles, Cal. ALFRED L. LOOMIS, M.D., New York City. 
PETER H. BRYCE, M.D., Toronto, Canada. HENRY M. LYMAN, M.D., Chicago, Ills. 
SAML. R. BURROUGHS, M.D., Raymond, Tex. FRANCIS MINOT, M.D., Boston, Mass. 
J. WELLINGTON BYERS, M.D., Charlotte, ,N C. WILLIAM OSLER, M.D., Baltimore, Md. 
J. M. DaCOSTA, M.D., Philadelphia, Pa. WILLIAM PEPPER, M.D., Philadelphia, Pa. 
CHARLES DENISON, M.D., Denver, Colo. BOARDMAN REED, M.D., Atlantic City, N. J. 
GEORGE DOCK, M.D., Galveston, Texas. J. REED, Jr., M.D.. Colorado Springs, Colo. 
WM. A. EDWARDS, M.D., San Diego, Cal. GEORGE H. ROHE, M.D., Baltimore, Md. 
J. T. ESKRIDGE, M.D., Denver, Colo. KARL VON RUCK, M.D., Asheville, N. C. 
SAMUEL A. FISK, M.D., Denver, Colo. FREDK. C. SHATTUCK, M.D., Boston, Mass. 
F. FREMONT-SMITH, M.D., St. Augustine, Fla. S. E. SOLLY, M.D., Colorado Springs, Colo. 
W. H. GEDDINGS, M.D., Aiken, S. C. * G. B. THORNTON, M.D., Memphis, Tenn. 
JOHN TRAILL GREEN, M.D., Tucson, Arizona. E. L. TRUDEAU, M.D., Saranac Lake, N.Y. 
JOHN B. HAMILTON, M.D., Chicago, HL J. B. WALKER, M.D., Philadelphia, Pa. 
T. S. HOPKINS, M.D., Thomasville, Ga. J. P. WALL, M.D., Tampa, Florida. 
JAMES C. WILSON, M.D., Philadelphia, Pa. 
Yearly Subscription, $2,00. Single Numbers, 20 cts. 
W. B. SAUNDERS, Publisher, 
913 Walnut Street, 
Philadelphia, Pa.