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Columtiia ZHnibersJitjf 
 inttieCitpcifJtetagcirfe 
 
 CoUese of $jjj>gicians; anb ^urgeonsi 
 
 3^ef erence Mrarp 
 
THE ASSOCIATION 
 
 HUMAN AND BOVINE 
 TUBERCULOSIS, 
 
 By E. F. Brush, M. D., 
 
 MOUNT VERNON, NEW YORK, 
 
 Wynkoop Hallenbbck Crawford Co. 
 
 PRINTERS, 
 
 NEW YORK AND ALBANY, 
 
PREFACE. 
 
 The following pages are devoted to the repub- 
 lication of some old papers presented to the 
 medical profession during the past ten years. 
 The reprint from the medical journals, from 5,000 
 to 7,000 of each, have been exhausted (as they 
 were given away). Requests for some of the 
 articles are still coming in; hence, the reproduc- 
 tion in book form. There is no claim that these 
 magazine essays are of sufficient importance to 
 be preserved in a bound volume; but as the 
 subject-matter is one that is now attracting, as it 
 deserves, an increased public attention, it may 
 be that some of the arguments and alleged facts 
 here presented may be deemed worthy of con- 
 troversy, and thus lead to the truth, which has 
 been one of the desires of the author. 
 
 Mount Vernon, N. Y., April, 1898. 
 
BOVINE TUBERCULOSIS.* 
 
 After passing through the various controver- 
 sies regarding gray tubercle, yellow tubercle, 
 giant cells, scrofulosis, etc., at the present time 
 we find the question of tuberculosis narrowed 
 down to bacillary infection, and we are con- 
 fronted with the inquiry, '' Is bacillary tubercu- 
 losis conveyed to the human race from animals 
 affected with this disease? " 
 
 All civilized races on the face of the globe have 
 surrounded themselves with domestic animals. 
 We have the horse, the pig, the sheep, the goat, 
 the dog, the cow, and others. Of these we find 
 that the horse is entirely exem.pt from tubercu- 
 losis. The sheep, the goat and the dog are not 
 found in nature affected with this disease, and 
 they likewise resist artificial infection well; under 
 certain condition the pig takes on tuberculosis; 
 it is, in fact, from this animal that we get our 
 word scrofulosis. But, as we find them at the 
 present timie, they are not tubercular, because in 
 this animal in-and-in breeding, which favors the 
 
 ♦Read before the Medical Society of the State of New York, February 7, 
 1888. Reprinted from the New York " Medical Journal." 
 
6 Bovine Tuberculosis. 
 
 development of tuberculosis in all creatures 
 prone to this affection, is not profitable to the 
 breeder, as swine animals of close consanguinity 
 fail to have young as a rule, and, if they do, the 
 offspring dies soon after birth. Thus breeders 
 are careful to put sows to boars not at all related, 
 and we find the pig of the present day remarka- 
 bly exempt from scrofulosis. The only reliable 
 statistics to which I have access are some com^- 
 piled in Bavaria in 1879, According to these, 
 of 66,403 animals slaughtered for food, only two 
 swine v/ere found to be tubercular. When, how- 
 ever, we come to the bovine race, we find among 
 these domesticated anim.als alv/ays a certain per- 
 centage of them affected v/ith tuberculosis in its 
 various forms. In fact, this race and the human 
 are pre-eminently tubercular. In all the experi- 
 ments of the present day, whether inoculation or 
 cultivation, matter from either the human or the 
 bovine race is used; and the question pro and con 
 relating to the contagiousness of this disease lies 
 between these two races. Of all the domesticated 
 animals known, none is so intimately or closely 
 related to the human race as the cow. We are 
 veritable parasites on this animal. We milk her 
 as long as she will give milk, and we drink it; 
 then we kill her, eat her flesh, blood, and most 
 of the viscera; we skin her, and clothe ourselves 
 
Bovine Tuberculosis. 7 
 
 with her skin; we com1) our hair with her horns, 
 and fertilize our fields with her dung, while her 
 calf furnishes us with vaccine virus for the pre- 
 vention of small-pox. Strange it would be, in- 
 deed, if, under all these circumstances, we did 
 not acquire from her some malady; she has tu- 
 berculosis, and we have tuberculosis; certain it is 
 she does not acquire it from us. Artificial inocu- 
 lation of tubercular matter from the cow in very 
 many cases tubercularizes other animals, and, by 
 the success of many of these experiments, scien- 
 tific men have, many of them, been excited into 
 becoming alarmists, and have appeared before 
 the world in print with sweeping and starthng 
 assertions, but have failed to attract the attention 
 they deemed their alarms entitled to. 
 
 The question of the contagiousness of the 
 disease under consideration is an old one. Mor- 
 ton, writing 200 years ago on consumption, says: 
 " This disease is also propagated by infection, 
 for this distemper, as I have observed it by fre- 
 quent experience, like a contagious fever, doth 
 infect those that lie with a sick person with a 
 certain taint." Although this statement has been 
 reiterated, and many of us have become con- 
 vinced from our own experience, fewbelieve that 
 it is contagious among the human race. At a 
 recent meeting in England, when the question 
 
8 Bovine Tuberculosis. 
 
 was under discussion, Dr. Henry Bennett ex- 
 claimed: '' Such a theory is dangerous, because, 
 if it were true, the disease would be worse than 
 the plague, and each tubercular patient would 
 have to be treated as were the lepers of old." 
 This is a queer statement, and evinces in a cer- 
 tain degree human perversity. I do not know 
 vvhat there is about this disease which fails to 
 alarm the human race ; it is contagious, insidious, 
 deceitful and destructive. Men afflicted unto 
 death are seldom or never convinced that they 
 are dying. As illustrating this strange human 
 fallacy, we notice that at one time in Germany 
 the name for tuberculosis in cattle was Franzo- 
 scnkrankheit, the then popular namic for syphilis, 
 and hence for a long time the flesh of animals 
 thus diseased was not eaten in that country; but 
 when they found that the disease was simply 
 tuberculosis — an affection that kills a far greater 
 number than the other disease — they fell to eat- 
 ing the meat again, just as we do. 
 
 Virchow says: '' Man is far m.ore susceptible 
 to the diseases of animals than the latter are to 
 similar diseases from man." Now, if Virchow is 
 right, and he generally is, the question arises, 
 Why are not more of the human race tubercular, 
 as we find a certain percentage of ah cows that 
 furnish milk and meat to the human race are 
 
Bovine Tuberculosis. 9 
 
 tubercular? Fleming reckons that 5 per cent, 
 of all the bovines in England are infected. Wc 
 have no complete statistics on this matter. 
 
 I have been told by inspectors of the Bureau 
 of Animal Industry that a much larger percent- 
 age of our cows are affected. Indeed, among 
 the thoroughbred Jerseys in the northern States 
 20 per cent, are affected, as I have been told by 
 Professor R. A. McLean, the chief of this dis- 
 trict from the bureau. Now, with this large per- 
 centage of tubercular cows, and assuming that 
 it is a fact that tuberculosis is communicated 
 from the bovine to the human race, and consid- 
 ering our close relationship to the animal, why 
 are not more of the human race killed by this 
 disease? 
 
 The total number of cows in the United States 
 for the year 1887 was 14,522,083 — that is, one 
 cow to every four and three-tenths (4.3) persons. 
 There exists, according to Lynt, a true parallel 
 betvv^een bovine and human phthisis; the curves 
 of double mortalit}^ are the same for different 
 districts in the Duchy of Baden. Now this must 
 mean that a larger proportion of the bovine race 
 dies from phthisis than of the human race, be- 
 cause of the difference in the length of life be- 
 tween the races. We have no statistics of this 
 kind in the United States, but Professor R. A. 
 
lo Bovine Tuberculosis. 
 
 McLean, the authority before referred to, tells 
 me that where cows are affected by tuberculosis 
 in great numbers, the death-rate from phthisis is 
 correspondingly large in the human race in the 
 same districts. This is his observation from his 
 large experience among diseased cattle. 
 
 Now let us see what the conditions of the two 
 races are, howthey differ, and how this difference 
 modifies the disease under consideration. With- 
 out going into detail in comparing the two, you 
 will find, after due comparison, the most marked 
 difference to be that of the normal temperature 
 of the tw^o races, and this difference you will at 
 once concede is of more effect in relation to the 
 disease than any of the other conditions. Many 
 years ago I made an attempt to discover the true 
 normal temperature of the cow by thermometric 
 observations of large herds in the field, and be- 
 came completely puzzled at the lack of uniform- 
 ity and the very high average. I then searched 
 my books for some authority on the subject, and 
 found a lamentable ignoring of the whole ques- 
 tion in many works relating to bovine pathology. 
 The only allusion I could find was in Steele's 
 work, which, while excellent in some other re- 
 spects, simply quotes bovine temperature from 
 Armatage, and this quotation was in turn a quo- 
 tation from an English book out of print, the 
 
Bovine Tuberculosis. ii 
 
 name of whose author was not given. These 
 quoted temperatures (100.9° ^- ^^ 101.9° F.) are 
 much lower than the resuUs of my observations, 
 and the differences I observed in the range were 
 far greater. I have found cows in apparently 
 perfect health with a temperature of 103.5° ^y 
 and ranging from that down to 101.2° F. From 
 my own observations among cows and the expe- 
 rience as given in books, I find that all the ani- 
 mals endowed with hairy and woolly coats, but 
 without well-developed sudorific glands — that 
 is, that do not sweat readily — do not maintain 
 a uniformity of temperature. The difference be- 
 tween a quiescent condition and one of activity 
 is several degrees without affecting the health. 
 But all these animals have a higher range ot 
 temperature than the human species. Thus we 
 find in the published tables the following figures: 
 Cows and oxen during confinement, 100.8° F. ; 
 during work and liberty, 101.8°; calves and stirks 
 during confinement, 100.9°; during work and 
 liberty, 101.8°; sheepduring confinement, 102.5°; 
 at liberty, 104.5°; lambs at liberty, 104.9°; pigs 
 in confinement, 101.6°; at liberty, 103.2°; dogs in 
 confinement, 99.3°; at liberty, 101.9°; and horses 
 in confinement, 99.2°; atworkand hberty, 100.3°; 
 rabbits, 103°; guinea-pigs, 102°; the common 
 fowl, 106.7°. 
 
12 Bovine Tuberculosis. 
 
 Now, if you compare this table with all the 
 recent inoculation experiments on bovine tuber- 
 culosis, you will find that the success of such ex- 
 periments is in direct ratio with the tempera- 
 tures — that is, commencing with the lower tem- 
 perature, that of the dog, we find the resistance 
 lessening as we go up the scale till we come to 
 the common fowl, with the highest temperature, 
 where there is no resistance whatever. Feeding 
 Vvdth tubercular matter is ahvays positive with 
 this bird. 
 
 We can noAv see why the human race is not 
 more extensively affected with tuberculosis, 
 which, in my candid opinion, is all derived from 
 the bovine race. A germ cultivated in the cow 
 is a tropical growth, because her average tem- 
 perature is between ioi° and 103° F. The hu- 
 man race, by this mode of illustration, represents 
 the temperate zone. Coffee v/ill not grov/ in 
 Connecticut unless 3^ou put it in a hot-house. 
 Ringer, in his valuable little m.onograph on -the 
 tem.perature of the body as a means of diagnosis 
 and prognosis in phthisis, states that in acute 
 cases the temperature of the human body rises 
 daily to a high point — 103° to 105°. Further, 
 a patient in previous good health is seized with 
 pretty copious and repeated haemoptysis; there 
 are no physical signs, and beyond a cough and 
 
Bovine Tuberculosis. 13 
 
 an elevated temperature of 102° or 103° F. there 
 is no evidence of phthisis. These symptoms are, 
 however, sufficient to declare the nature of the 
 case. Thus you will see that the temperature, as 
 cited here by Ringer, is about the normal tem- 
 perature of the bovine race. Ringer further 
 says: " Thus, in all cases observed in which the 
 deposition of tubercle was going on there was a 
 continual elevation of the temperature, while in 
 those cases in which the deposition had ceased 
 the temperature was normal." To quote further 
 from Ringer, whose testimony is valuable on this 
 point: " Thus we meet with cases of phthisis ac- 
 companied with elevation of temperature during 
 several weeks before we get physical signs indi- 
 cative of the deposition of tubercle." Now, al- 
 though Ringer does not draw such a conclusion 
 from this fact, the interpretation is plain to me 
 that from some cause or other the temperature 
 was increased to the right degree to start the 
 growth of the bacillus tuberculosis, which, when 
 well started, like all other ferments, had the 
 power of keeping up the temperature by its own 
 activity. That is, the temperature has been in- 
 creased to the proper degree to permit of the 
 growth of the bacillus, and the deposition of 
 tubercle is simply the result of the multiplicity of 
 bacilli creating for themselves places of congre- 
 
14 Bovine Tuberculosis. 
 
 gatioii. At least, I take it that this is the true 
 relation of the germ to the tubercle. The germ 
 does not kill directly, but an aggregation of the 
 bacilli surrounded by the new growth is the tu- 
 bercle, and when the tubercle is formed the germ 
 has finished its activity; and, if this new forma- 
 tion becomes organized or certified, death does 
 not result, but if the tubercle, that has been 
 formed simply as a resting-place for the bacillus, 
 breaks down, death results from sepsis. 
 
 These facts relating to temperature also illus- 
 trate localized deposits of tubercle from trauma- 
 tism. Thus, a human body in which the bacilli 
 are already present, but not growing for lack of 
 temperature, finds it proper conditions where the 
 temperature is raised by reason of the injury, as 
 traumatisms always produce local inflammatory 
 action. If this theory is accepted, the argument 
 regarding the scrofulous origin of joint diseases 
 becomes superfluous; both parties, in fact, have 
 been right. In further proof that a high tempera- 
 ture is necessary for the growth of the bacillus 
 tuberculosis, the late Dr. Flint, in his valuable 
 Vv^ork on practice, says: " I do not hesitate to 
 express the belief that in a certain proportion of 
 cases alcohol exerts a curative influence in pul- 
 monary phthisis." WunderHch, in his valuable 
 book on '' Medical Thermometry," writes: '' In 
 
Bovine Tuberculosis. 15 
 
 febrile conditions the effect of alcohol is to lower 
 the temperature." He also says: " Habitual 
 drinkers have, as a rule, under parallel circum- 
 stances, a lower temperature than other persons." 
 
 Not only does temperature play an active part 
 in the creation of tuberculosis as a disease, but 
 we find that in cultivations outside of the body 
 it requires a nicer adjustment of temperature 
 than any of the other germs. 
 
 In regard to the role played by the temperature 
 in the disease under consideration, we have a 
 very interesting experiment of Toussaint's. He 
 extracted some juice from the lung of a tuber- 
 cular cow; some of this virus he injected into a 
 pig and two rabbits; then he heated in a water- 
 bath part of the same virus to a 130° and 137° F. 
 for ten minutes, and injected the virus into four 
 hogs and four rabbits. He says general infec- 
 tion occurred very rapidly in all these animals. 
 Curious to state, the rabbits that had been inocu- 
 lated with the heated liquid died before the 
 others. 
 
 The only cited experiment that I can find 
 where tuberculosis was conveyed directly from 
 the bovine to the human race I clipped from the 
 Nev^ York " Medical Record " some years ago: 
 ''Two Greek physicians inoculated a patient who 
 was dying of gangrene of the leg with tubercular 
 
i6 Bovine Tuberculosis. 
 
 matter from a cow. They state that the patient's 
 lungs were healthy prior to the inoculation, and 
 at the autopsy there were well-marked tubercular 
 deposits in the lungs." If this is an authenticated 
 case, which, of course, I cannot affirm, there was 
 undoubtedly the proper temperature for the 
 growth of the germs, and hence the success of 
 the experiment. 
 
 My occupation brings me into close contact 
 with dairy cattle, and I have therefore been com- 
 pelled to devote my attention to the subject of 
 the diseases afflicting dairy stock. That there is 
 a large number of dairy cows afflicted with tuber- 
 culosis I can affirm; that there has never been an 
 attempt to exterminate this disease is a fact of 
 which I am also cognizant. Last year the Fed- 
 eral government appropriated half a milHon dol- 
 lars to stamp out zymotic pleuro-pneumonia. 
 This disease does not affect the human race, as 
 no other animal except the bovine has ever been 
 known to suiTer from it. It affects the pockets 
 of the cattle-dealers grievously; but the health of 
 the general public is not threatened by it, while 
 bovine tuberculosis, which the government in- 
 spector finds coincident with a high death-rate in 
 human phthisis, is left uncontrolled. Cattle- 
 breeders everywhere have unrestrictedly fol- 
 lowed the homicidal practice of in-and-in breed- 
 
Bovine Tuberculosis. 17 
 
 ing of dairy stock. This method of i3reeding we 
 all know favors the development of the disease, 
 and the development of this disease in the bovine 
 race simply means more phthisis in the human 
 race. One simple fact that strengthens my be- 
 lief that human bacillary tuberculosis is all de- 
 rived from the bovine species is, that where this 
 animal does not exist, pulmonary consumption 
 is unknown. The Kirghis on the steppes of 
 Russia, who have no cows, have domesticated 
 the horse, using its milk, meat and skin, and a 
 case of pulmonary tuberculosis has never been 
 known to exist among the tribe. The Esqui- 
 maux has no cows, neither has he pulmonary 
 phthisis, and I think it can be laid down as a fact 
 that where the dairy cow is unknown pulmionary 
 consumption does not prevail. 
 
 Among the numerous statistics giving the oc- 
 cupation of those persons who die of bacillary 
 phthisis, I do not find the occupation of a farmer 
 included; my own observations in farming dis- 
 tricts convince me that large numbers of these 
 people die of lung tuberculosis. That these 
 people are in greater danger of infection from 
 milk from tubercular cows is evident from the 
 fact that they very often drink the milk " warm 
 from the cow," while the city consumer almost 
 2 
 
i8 Bovine Tuberculosis. 
 
 ahvays gets his milk after it has been chilled, and 
 ail the cultivation experiments go to prove that 
 this germ will not grow at a temperature of less 
 than 87° F. The reason why these farmers' 
 deaths are not included in statistics is due to 
 their remoteness from the great centers where 
 the statistics are collected. 
 
 The cow has redeemed us from one dreadful 
 scourge, small-pox. I am, however, inclined to 
 think a greater scourge is continued to us by 
 the same animal. It is the deceitfulness and in- 
 sidiousness of this disease that lure us into a 
 quiet state. Bacillary infection is not rapidly 
 fatal as a rule; the infection received into the sys- 
 tem of a human being lies in wait for a proper con- 
 dition of its host before it can assert its sway, and, 
 if the opportunity never occurs in the individual 
 originally infected, the infection is continued to 
 the offspring, and the wasting bacillus finds its 
 opportunity some time. Men never know when 
 they receive the infection that results in a fatal 
 attack of pulmonary phthisis. 
 
 We long ago acknowledged our inability to 
 check this scourge when it has once got its in- 
 sidious grip on a human creature. Certain cases 
 do end in recovery, but under circumstances that 
 thus far we have been unable to comprehend; 
 we have no known methods of successful treat- 
 
Bovine Tuberculosis. 19 
 
 ment. Let us then, as medical men, turn our 
 attention to prophylactics. 
 
 There is no good reason why we cannot be 
 instrumental in passing laws to regulate the 
 breeding of dairy-stock. The disease is well 
 marked; therefore, there would be little difhculty 
 in selecting animals afflicted and excluding them 
 from the dairy and butchers' shops, and in indi- 
 cating to our legislators the necessity of passing 
 laws to prevent the breeding together of tuber- 
 cular animals, or the in-and-in breeding of any of 
 the bovine species. Let us treat this disease, es- 
 pecially among the cows, as leprosy was treated 
 of old, and then vvC shall be saved from the pain- 
 ful necessity of treating the human race in like 
 manner, for I am convinced that, if we stamp out 
 tuberculosis in the bovine race, a few genera- 
 tions v/ill eliminate it from the human family. 
 
 Since the presentation of my paper, I have re- 
 ceived numerous inquiries respecting the diag- 
 nosis of tuberculosis in the cow. One country 
 practitioner says he never saw a milch cow with 
 tuberculosis, and could not understand how the 
 disease could be so prevalent and yet not be 
 more apparent. 
 
 Tuberculosis is emphatically a bovine disease; 
 this race can be tubercular from birth to old age, 
 and yet no't die from this disease. It is only when 
 
20 Bovine Tuberculosis. 
 
 the surroundings, lack of care, and other bad 
 hveienic conditions lower the resistance that 
 caseation of the tubercular mass takes place, and 
 the animal dies from sepsis. 
 
 The diagnosis of tuberculosis in the cow is 
 just as simple as in the human famxily. We 
 recognize in this latter the general appearance of 
 an individual with a phthisical habit, or scrofu- 
 lous; and in the same manner, after becoming 
 familiar with the disease in the cow, one recog- 
 nizes a suspicious appearance, which requires to 
 be verified by percussion and auscultation. 
 
 The prominent sign of a suspicion of tubercu- 
 losis in the cow is an enlargement of the inguinal 
 gland. Coincidently with the deposition of tu- 
 bercular matter in other locations there is a 
 marked tendency of the lymphatic glands to 
 become focuses of infection. These glands are 
 usually infected in groups, those of the larynx, 
 pharynx, trachea, lung and heart, the abdominal 
 and the inguinal. It is the enlargement of this 
 last-named gland, which can be so plainly ob- 
 served even by a casual examination, that indi- 
 cates a tubercular condition. I never have seen 
 a tuberculous cow without an enlarged inguinal 
 'gland. Of course, this gland may become en- 
 larged from other causes; but just as we feel for 
 an enlargement of the post-cervical glands in a 
 
Bovine Tuberculosis. 
 
 21 
 
 supposed case of syphilis, so the enlargement of 
 the inguinal glands in the cow must be looked 
 for, and they are just as strong a diagnostic indi- 
 cation of tuberculosis in the bovine race as the 
 post-cervical glandular enlargement is of syphilis 
 in the human race. 
 
 
 The first illustration is one that I have had 
 engraved from a photograph, and shows this en- 
 largement. You will notice a prominence just 
 in front of the letter A, on the animal's thigh. 
 The history of this case may be interesting as 
 illustrating the diagnostic value of this glandu- 
 lar appearance. Last winter, a doctor, a friend 
 of mine, was showing me a number of photo- 
 graphs of famous cattle, among which was the 
 one from which this engraving is taken. The 
 
22 Bovine Tuberculosis. 
 
 general appearance of this bull, together with 
 the prominent appearance of the inguinal gland, 
 at once attracted my attention, and I said '' This 
 is a tuberculous animal." The possessor of the 
 picture smiled at my suspicion; nevertheless, he 
 lent me the picture, as I told him I knew the pur- 
 chaser of this bull, and therefore could learn 
 from him all about the animal. A few days later 
 I met the gentleman who had had charge of the 
 herd to which the bull belonged, and obtauied 
 from him the following statement: The bull v/as 
 bought in France for a very large sum of money, 
 because he was so closely inbred as to have a 
 larger percentage of the famous Cobm_assie blood 
 than any other animial living at that time. He 
 vv^as used for a short time in the herd for which 
 he was purchased, and then was sold at auction, 
 bringing a price numbered in the thousands of 
 dollars. He was sent West, where his purchaser 
 lived, and he, in order to get back his money, 
 allowed the bull to serve a large number of cows 
 shortly after his journey. Then the bull caught 
 cold and died. No suspicion of tuberculosis was 
 ever entertained, although the narrator of the 
 foregoing history replied, in reference to one 
 of my remarks: '' It always seemed to me a very 
 funny circumstance that a bull, used to ordinary 
 stabling, and its accompanying draughts, should 
 
Bovine Tuberculosis. 23 
 
 catch cold in July, in haying-time, and die from 
 such a cold." 
 
 The second illustration is from a photograph 
 of the chief bull of my herd, a Holstein, bred by 
 William M. Singerly, of Philadelphia. In his 
 breeding, there is not a single repetition of an 
 animal as far back as his pedigree goes in the 
 " Holstein Herd Book; " none of his progenitors 
 were at all related. You will observe how much 
 
 larger, stronger and rugged his appearance is 
 than that of the tuberculous Jersey. The differ- 
 ence in the formation of the chest and shoulders 
 is well marked, and, as the engraving shows, 
 there are no indications whatever of glandular 
 enlargements. I introduce these engravings to 
 illustrate two distinct types — first, an inbred 
 tuberculous animal, and secondly, a rationally 
 bred, healthy, robust animal. 
 
[Reprinted from The New York Medical Journal, June 15, 1889.] 
 
 THE RELATIONSHIP EXISTING BE- 
 TWEEN HUMAN AND BOVINE 
 TUBERCULOSIS.* 
 
 A strangely interesting phase of the study of 
 phthisis is that presented by the disease in hving 
 beings. In the human race the afflicted are gen- 
 erally the most attractive members of society. 
 Scrofulous females are usually among the most 
 beautiful people we meet, with their transparent 
 complexion and large languid eyes, while the 
 scrofulous males are either intensely intellectual 
 or correspondingly erotic. The same rule holds 
 good in the bovine race; the small inbred tuber- 
 cular Jersey is in appearance the most attractive 
 of any of the cow tribe, while even the common 
 scrub cow that is tubercular has a certain beauty 
 that distinguishes her from her miore robust sis- 
 ters. I know a famous animal painter who will 
 always unconsciously select from a herd of cows 
 the scrofulous one for his study whenever he 
 makes a study of a single animal from a herd. 
 
 *Read before the New York Academy of Medicine, April 18, 1889. 
 
 25 
 
26 Human and Bovine Tuberculosis. 
 
 This is not the only strange feature of the dis- 
 ease. No one seems to be afraid of it. For vears 
 men of undoubted scientific abihty have been 
 proclaiming to the world the still hardly recog- 
 nized fact that bacillar}^ phthisis is contagious, 
 but the human family take little heed. Further- 
 more, the individual, sorely afflicted, beyond hu- 
 man aid, and shortly to die, is not convinced of 
 the fact, but, with the same strange fatality that 
 surrounds the disease in all its phases, the con- 
 sumptive it still hopeful and imagines he is get- 
 ting better even while he is dying. 
 
 This insidious and delusive disease is not the 
 result of civilization, as many suppose. Barbar- 
 ous and uncivilized races are afflicted as severely 
 as many of the most advanced civilized races. 
 Neither geographical position nor clim.atic con- 
 ditions are a factor in the distribution of pulmon- 
 ary phthisis, notwithstanding that our best Avork- 
 ers in the study of the disease attempt at times to 
 account for its prevalence in certain localities by 
 reason of temperature or other cHmatic condi- 
 tions. Nevertheless, every knovn part of the 
 elobe, with a few isolated areas excluded, is a 
 habitat of the disease. After several years of 
 close study of the affection, and consulting all 
 accessible statistics and the habits of the people 
 where the disease prevails, the only constant as- 
 
Human and Bovine Tuberculosis. 27 
 
 sociated factor is found, in my opinion, in the in- 
 bred Ijovine species, without any regrard to the 
 social position of a community, its geographical 
 habitation, terrestrial or atmospheric condition. 
 If a community is closely associated with inbred 
 dairy cattle, tuberculosis nrevails. 
 
 This position which I take is susceptible of 
 strong proof. 
 
 In establishing my proof I will first draw your 
 attention to some barbarous races of Africa. 
 Speaking of the natives of South Africa, P. L. 
 Simmonds, in his book on " Animal Products," 
 sa3^s: ''This people delight in horned cattle of 
 the bovine species," " the natives are great milk 
 drinkers," " these barbarous people suck the 
 blood from the jugular vein of the hving bul- 
 lock," and also " churn together blood and milk 
 for a drink." Professor Low, in his " History of 
 the Ox," tells us: " In the vast regions of south- 
 ern Africa, peopled by trii)es of warriors and 
 herdsmen, cattle abound and multiply, and form 
 the wealth of little communities. The Hotten- 
 tots, while yet they had a countrv they could call 
 their owm, were rich in this kind of possession." 
 In Hirsch's book on the " Geographical Distribu- 
 tion of Phthisis " we find the following: " In 
 Cape Colony phthisis is oftenest met with among 
 the Hottentots inhabiting the plains near the 
 
28 Human and Bovine Tuberculosis, 
 
 coast." In proof of the fact that these African 
 cattle are inbred, we have the writings of Ander- 
 son, quoted by Darwin as follows: '' The Dama- 
 ras take great delight in having w^hole droves of 
 cattle of the same color, and take great pride in 
 their oxen in proportion to the size of their horns. 
 The Namaquas have a perfect mania for a uni- 
 form team, and almost all the people of southern 
 Africa value their cattle next to their women, and 
 take great pride in possessing animals that look 
 high-bred." Darwin, from whose '' Animals and 
 Plants under Domestication " we take this quo- 
 tation, adds in his own words: "As numerous 
 breeds are generally found only in long-civilized 
 countries, it may be w^ell to show that in some 
 countries inhabited by barbarous races, who are 
 frequently at war with each other, and therefore 
 have little free communication, several distinct 
 breeds of cattle now exist, or formerly existed, 
 at the Cape of Good Hope. Lignat observed in 
 1720 three kinds; at the present day (1868) vari- 
 ous travelers have noticed the difference of the 
 breeds in southern Africa. Sir Andrew Smith 
 several years ago remarked to me that the cattle 
 possessed by the different tribes of Kaffirs, 
 though living near each other under the same 
 latitude and in the same kind of country, yet 
 
Human and Bovine Tuberculosis. 29 
 
 differed, and he expressed much surprise at the 
 fact." * 
 
 These facts relating to the cattle-breeding pro- 
 pensities of the negroes account for the state- 
 ments of Daniell, that " phthisis is widely preva- 
 lent and very malignant among the negroes of 
 the west coast of Africa." In the interior plat- 
 eaus of southern Africa phthisis, hov/ever, hardly 
 ever occurs. This immunity can be accounted 
 for by the presence of the tsetse fly. This fly in- 
 habits well-defined regions in central Africa, and 
 where it exists, cattle, horses, and dop"s can not 
 live.f 
 
 Let us now take the civilized inhabitants of a 
 colder clim.e, and we find that in Denmark, one 
 of the noted dairy countries, there are 1,470,078 
 cows to 2, 033,959 inhabitants, or one cow to 
 I 5-14 inhabitant. The mortality from phthisis 
 in that county ranges from three in a thousand, 
 to 2 . 1 in a thousand. Now Iceland, an island 
 belonging to the King of Denmark, where the 
 climatic conditions are nearly the same, has 
 20,000 cows to 80,000 inhabitants. There are no 
 definite statistics about this, but, taking the most 
 
 *Guiol says that consumption is not uncommon among the colored races, 
 particularly the Kaffirs. Guiol, "Archives gin. de medecine," November, 
 1882, p. 329. 
 
 t Wallace, "The Geographical Distribution of Animals," 1876, vol. i, 
 p. 945- 
 
30 Human and Bovine Tuberculosis. 
 
 trustworthy accounts of the island as a guide, this 
 is about the condition of affairs. The people of 
 Denmark are well-to-do, and can use for them- 
 selves more of their dairy productions, while the 
 poor Icelander pays his rent with his dairy pro- 
 duct. With the exception of milk, the Icelander 
 uses very little from his herd for food. In several 
 accounts of travelers in that country giving a de- 
 scription of the entertainment extended to them, 
 I never find beef in a single instance, while in the 
 winter nearly all the milk used is obtained from 
 the sheep. Owing to the short hay crops, the 
 cows are fed in winter on dried fish, and conse- 
 quently the cattle will not give milk on the same 
 low diet as the sheep do. With all these modify- 
 ing influences, and only one cow to four individ- 
 uals, the rarity of phthisis in the island can be 
 accounted for, if my theory is correct. That the 
 disease is rare v/e know from the v/ritings of Sch- 
 leisner, who says: '' Accordino- to the unani- 
 mous testimony of practitioners on the island, 
 consumption does indeed occur there, although 
 remarkably seldom. In my own practice I have 
 m.ost carefully examined every patient who com- 
 plained of even the slightest trouble in the chest, 
 and out of 327 persons suffering from chronic 
 diseases of the organs of respiration, I found only 
 three with phthisis." Evans says that '' this 
 
Human and Bovine Tuberculosis. 31 
 
 statement is borne out by the more recent writ- 
 ings on the state of heahh in Iceland, by Learecl, 
 Hjaltlin, and Finsen. It would appear that it is 
 not with any national peculiarity that we have 
 here to do, from the fact that Icelanders who 
 migrate to Denmark fall into consumption not 
 infrequently." "^ 
 
 Now let us look into the afifairs of a Httle island 
 in the Atlantic Ocean as they existed 68 years 
 ago. It will be remembered that in my former 
 paper on this subject I made the statem.ent that 
 asses and goats were not tubercular animals. 
 The following is quoted from " A Description of 
 the Island of Saint Michael," by John W. Web- 
 ster, M. D., 1821: "Every family in Saint 
 Michael has one or more asses, which are the 
 principal beasts of burden in common use, sub- 
 sisting on the coarsest kind of food; the females 
 afford considerable milk, which is sold to sick 
 persons. Although the island is so well stocked 
 with black cattle, sheep, and goats as to allow 
 considerable exportation, few of these belong to 
 the peasanty. Cows are mostly attached to the 
 estates, and the peasant who hires a farm, in 
 addition to a certain quantity of work to be per- 
 formed for his landlord, is required to take charge 
 
 ♦Hirsch, " Handbook of Geographical and Historical Pathology," 1886, 
 vol. iii, p. 177, 
 
^2 Human and Bovine Tuberculosis. 
 
 of these, and convey the milk, butter, and cheese 
 to town, where they are sold for the benefit of 
 the morgado, and the poor peasant receives no 
 other recompense for his trouble than some slight 
 abatement in his rent. The milk is carried to 
 tov/n in skins, on the backs of asses, but, from 
 the agitation it undergoes, on its arrival most of 
 the families in the city prefer using the milk of 
 the goats, herds of which are kept in the vicinity, 
 and daily driven into tow^n and miilked at the door 
 of the customicrs." Dr. Webster adds: "Al- 
 though the climate of St. Michael can not be 
 safely recommended to a consumptive patient, 
 it is, nevertheless, rare to see the disease in a na- 
 tive." Dr. Webster would not have been aston- 
 ished at this condition of affairs had he realized 
 the truth that phthisis is a disease acquired from 
 the bovine race, for it is a fact that the only peo- 
 ple on the face of the globe who enjoy an abso- 
 lute immunity from phthisis are those who are 
 not in possession of the domestic cov/. Take, for 
 instance, the Kirghiz on the steopes of Russia; 
 these people consume large quantities of mare's 
 milk and eat the flesh of horses and sheep; but 
 they have no cows. According to Dr. Neftel and 
 other authority, a case of phthisis among these 
 people was never known. ^ Likewise, the Es- 
 
 ♦ Maj'dell, quoted by Williams. 
 
Human and Bovine Tuberculosis. 33 
 
 quimanx also enjoy immunitv, because they have 
 domesticated the reindeer, not the cow. 
 - But this allusion to the Esquimaux does not 
 apply to those who inhabit Greenland and. that 
 part of the Danish dominions in the Artie region. 
 There are Esquimaux that knoAv not the cow and 
 there are Esquimaux who have domesticated the 
 cow. So there are authorities that state that the 
 Esquimaux are exempt from phthisis, and other 
 authorities equally as positively state that '' con- 
 sumption is common " ^ among them. Thus, in 
 the government list of mortality for the province 
 of Julianshaab, '' forty-six persons died (out of 
 a population of 4,115, Esquimaux and mixed 
 breeds) of diseases of the chest, which include 
 phthisis, pneumonia, bronchitis, pleuritis, etc." t 
 This prevalence of tuberculosis is perfectly ex- 
 plained by the facts given in Dr. Hayes's book, 
 " The Land of Desolation." i He writes in his 
 visit to Julianshaab: " Around the lake were ex- 
 tensive pasture grounds, upon which were brows- 
 ing a herd of cows ... At this I was not a little sur- 
 prised, for, although I knew that in former times 
 cattle had been reared here in great numbers, I 
 had received the impression that at the present 
 
 * Williams, "Influence of Climate in Pulmonary Consumption," p. 17. 
 
 t Ibid., p. 16. 
 
 X Dr. Hayes, " Land of Desolation," p. 36. 
 
 3 
 
34 Human and Bovine Tuberculosis. 
 
 time they would not thrive. Mr. Arthur in- 
 formed me there was no difficulty in raising them, 
 except the very important one of forage for the 
 winter, for at Julianshaab the grass never grows 
 high enough for hay; further up the fjord, how- 
 ever, it is abundant. But since the hay must all 
 be brought in boats, it was both a tedious and 
 expensive operation to gather it. Yet he man- 
 aged to keep three cows, the governor had an 
 equal number, the doctor had two, others had 
 each one; and, indeed, all the well-to-do people 
 in the village — Danes, half-breeds, and the better 
 class of Greenlanders — had a daily supply of milk 
 the year round." Therefore, according to this 
 testimony, the average of dairy cattle in this com- 
 munity is higher than in many better-known lo- 
 calities, and the prevalence of phthisis is not at all 
 surprising. 
 
 Now let us look at a locality which once en- 
 joyed immunity but now is notoriously a place 
 for consumption. Wallace, in his work on " The 
 Geographical Distribution of Animals," tells us 
 that Australia was the poorest zoological region 
 on the globe. A story is told by Simmonds as 
 follows, which illustrates the scarcity of animals 
 in this region: " Mr. Oldfield, who has seen so 
 much of the aborigines of Australia, informs me 
 that they are all very glad to get a dog, and several 
 
Human and Bovine Tuberculosis. 35 
 
 instances have been known of the father kilUng 
 his own infant in order that the mother might 
 suckle the much-prized puppy." The only ani- 
 mals that existed in this island before its invasion 
 by Europeans were, according to Wallace, a few 
 marsupials. Previous to 1788 no ruminants ex- 
 isted in /Vustraha. In that year 1,030 convicts 
 and sailors v^ere landed; they had with them as 
 public stock one bull, four covvS, one calf, one 
 stallion, three mares, and three colts. In 1790 
 provisions gave out, and they were obliged to 
 kill all the live stock they possessed. In 1796 two 
 bulls and three cows of the Cape of Good Hope 
 breed were introduced, but they escaped and fled 
 into the interior, where they were lost for several 
 years. During this year several attempts were 
 made to introduce European cattle, but they all 
 died on the passage. In 1807 the Government 
 had a herd of cattle in the colony, and cows were 
 worth $400 a piece. In 1821, the government 
 becoming- convinced of the great advantages of 
 Australia as a grazing country, emigrants were 
 allowed a grant of from 500 to 2,000 acres of 
 grazing land, and rations from the King's stores 
 vrere also allowed to each settler; a certain num- 
 ber of convict servants were likewise apportioned 
 to them. They were also allowed a certain num- 
 ber of cattle from the government herd, and a 
 
36 Human and Bovine Tuberculosis. 
 
 loan of money to be repaid in seven years. This 
 was the beginning of the cattle raising in Au- 
 stralia. It proved so successful that in 1826 the 
 Australian /\gricultural Company commenced its 
 operations, which was the origin of the " sJiecp 
 and cattle manias and, as the historian puts it, 
 '' the priest forsook his altar and became a herds- 
 man of cattle." A drought, beginning in 1827, 
 and lasting: for three vears, cured the mania. But 
 within a year after the drought, cattle became so 
 plentiful that the meat of the best quality was 
 sold at a cent and a half a pound. In 1833, good 
 cattle could be bought for $4 or $5 a head. At 
 the present time, or according to the last con- 
 sular reports, there are 3,000,000 inhabitants and 
 8,000,000 cattle — nearly three animals to each in- 
 dividual. This great increase will be seen by the 
 foregoing to have taken place w^ithin 60 years. 
 Australia enjoyed a reputation for immunity from 
 consumption, and the favorable influence of its 
 climate on the course of the malady, but, as 
 Hirsch says, '' this has of late been shown to be a 
 mistake. In Victoria." he continues. '' where the 
 disease, it is true, has been a good deal more com- 
 mon only in recent years, the mortality from 
 phthisis in 1866, was 6 per cent, of the mortaUty 
 from all causes, while in Melbourne itself, the 
 death-rate rose between 1865 and 1869 from 2 . 22 
 
Human and Bovine Tuberculosis. 37 
 
 to 2 . 52 to a thousand of the population. In New 
 Zealand phthisis has made frightful ravages 
 among the Maoris, and has been one of the chief 
 causes of the gradual extinction of that race." 
 In my opinion, the death-rate from phthisis will 
 keep on increasing in that locality if the breeding 
 of cattle is not properly regulated by law. We 
 know from other historical facts that cattle can 
 be raised without this great danger, because 
 Hirsch and others tell us that in the Hebrides,''' 
 the Highlands of Scotland, iand North Wales 
 consumption is remarkably rare. The rarity of 
 the disease in these localities is accounted for by 
 Darwin's observation while he was studying the 
 conditions of cattle under domestication. He 
 says: " So with the mountain cattle of North 
 Wales and the Hebrides it has been found that 
 they could not withstand being crossed with the 
 larger and more delicate lowland breeds. Our 
 improved heavy breeds of cattle could not have 
 been formed on mountainous pastures." Now, 
 any one who has paid much attention to the his- 
 tory of cattle breeding knows that the improved 
 races, as we understand them, are the result of 
 the closest inbreeding. The rarity of the disease 
 in mountainous countries also explains the fol- 
 lowing quotation from Hirsch: " Few countries 
 
 * MacCormac, "Brit. Med. Jour ," 1868, ii, p. 571. 
 
38 Human and Bovine Tuberculosis. 
 
 of Europe enjoy, on the whole, so favorable con- 
 ditions as Switzerland in respect to the infre- 
 quency of consumption, the figures for the entire 
 country, according to Muller, being i . 86 in a 
 thousand. In studying, however, the statistics 
 of the different cantons, we find the mortality 
 ranging from 3 . 57 to only 0.81. We know that 
 there are localities in this mountainous country 
 where Darwin's oL)ser\'ations respecting moun- 
 tain ]}reeds would explain this condition of facts. 
 The number of cattle in Switzerland is 1,210,849, 
 and the population, 2,906,750, or one animal to 
 2 4-29 inhabitants. Of course, too, there are re- 
 gions of Switzerland where only the goat can 
 range. We find from the official returns'^ of 1866, 
 that there were 375,482 of these animals in that 
 country, and we know, from the reports of trav- 
 elers, y that the milk from the goat is used exclu- 
 sively in some localities. 
 
 Having considered the conditions of some bar- 
 barous and some civilized communities, let us 
 now look at the semi-civilized tribes of Madagas- 
 car. Both Hirsch and Evans, 1 quoting Grenet, 
 say that in this island consumiption is as common 
 as it is in any part of Europe, and rapidly fatal. 
 We have no statistics of the numbers of the popu- 
 
 * Siramonds, "Animal Products," p. 56. 
 
 t Prime, *' Letters from Switzerland," p. 44. 
 
 X Hirsch, op. cii., vol. iii, p. 186. 
 
Human and Bovine Tuberculosis. 39 
 
 lation or of the cattle, but all the writers who 
 have visited the country speak of the enormous 
 herds of cattle, and say that the principal diet of 
 the natives is meat, milk, and rice. The principal 
 occupation of the Malagasy is the raising of cat- 
 tle, thousands of which are shipped to the other 
 islands in the Indian Ocean. In fact, the Island 
 of Mauritius, with its mixed inhabitants, depends 
 entirely on Madagascar for its meat supply. The 
 Rev. William Ellis, describing his trip from Tam- 
 atave on the coast to the capital, a distance of 
 about 300 miles, tells of the natives presenting 
 him, at the end of every few miles' journey, with 
 a bullock, while the Queen herself, as a token of 
 friendship, presented him with eleven. He also 
 adds that the natives never skin their animals, 
 but cut them up and eat the hide as well as the 
 meat. 
 
 We have well-authenticated statements re- 
 specting another semi-civilized race, the natives 
 of Great Kabylia, who, according to Hirsch and 
 Evans and other authorities,* enjoy an almost 
 absolute immunity from phthisis. According to 
 the best authorities I could consult as to the his- 
 tory of the people, there is no evidence of the 
 presence of the bovine tribe among them, but 
 
 * Armand, " M^d. et hygiene des pays chauds,' ' Paris, 1853, p. 375. Bor- 
 theraud, "M^d. et. hyg. des Arabes," Paris, 1855. 
 
40 Human and Bovine Tuberculosis. 
 
 they possess large flocks of sheep and goats, and 
 each family has usually one bufialo ox to do the 
 plowing.'^ As these are a peculiar people, with 
 peculiar ideas and peculiar habits, not calculated 
 to encourage visits from European invalids, they 
 retain their immunity from phthisis to the pres- 
 ent day. But not so with their neighbors, the 
 Algerians. This country, having been occupied 
 for over half a century by the French, has been 
 therefore rendered suf^ciently civilized to offer 
 an asylum for European invalids. When first oc- 
 cupied by the French, the country was exempt 
 from phthisis, and, of course, the publication of 
 this fact drew to it many consumptive invalids. 
 The dairy cow was unknown in Algiers before 
 the French conquest. There were innumerable 
 herds of buffalo, indeed; but the French in vain 
 offered a premium of fifty francs a head for the 
 importation of dairy stock.f Up to 1854 they 
 w^ere unsuccessful, all these attempts proving fu- 
 tile. In the latest statistics from that country we 
 find the largest proportion of deaths from phthisis 
 among the European civil residents. t 
 
 Dr. Scoresby Jackson makes the following re- 
 mark about Algiers: "It is not necessary to 
 
 • Daumas, "La Grande Kabylie." Morell, "Algeria," 1854. 
 
 t Morell, " Algeria," p. 477. 
 
 $ Jackson, " Medical Climatology," p. 138. 
 
Human and Bovine Tuberculosis. 41 
 
 prove the absence of pulmonary consumption 
 from the natives of a country in order to demon- 
 strate the beneficial influence of its cHmate upon 
 those so affected from other countries. It would 
 be difficult to find such a place, . . . but Algiers, 
 at all events, approximates such a condition." 
 
 There are many other countries furnishing sta- 
 tistics of death-rate from phthisis where the dis- 
 ease is not indigenous but due to importation. I 
 think this can be said of Greece. According to 
 Roser''' and Olympios, the disease is very rare in 
 that country, and Edmond About, in his book 
 on '' Greece and the Grecians," tells us that " the 
 town of Athens possesses only five or six cows; 
 no other milk is drank than that of the sheep; 
 their butter alone is eaten. They eat meat but 
 once a year. The entire population eats meat at 
 Easter for the whole year, f and this meat is 
 lamb, t 
 
 In studying the relations existing between the 
 human and the bovine races I find that religion 
 plays a prominent part. Thus, in India, with the 
 Mohammedan, Brahmin, and Buddhist religions, 
 but where, as a rule, dairy cattle have not been 
 
 *Roser, " Ueber einige Krankheit. des Orients," p. 79. Olympios, 
 " Corresp. bayerischer Aerzte," p. i8t. 
 t Edmond About, "Greece and the Grecians," p. 33. 
 X Ibid.^ p. 102. 
 
42 Human and Bovine Tuberculosis. 
 
 domesticated, there was undoubtedly an absence 
 of phthisis before the English occupation. Hence, 
 to-day we find all statements regarding the pres- 
 ence of tuberculosis uncertain. Thus Hirsch''' 
 says: " So also in India the prevalence of 
 phthisis can not be given in figures. It is, on the 
 whole, rarer in that part of the vv'orld than in the 
 temperate zone of the Eastern Hemisphere, but 
 by no means so rare as the earlier observers sup- 
 posed from their imperfect means of diagnosis.'' 
 Now, here is that expression of the feeling of 
 doubt and uncertainty which we find in many 
 works relating to this elusive disease. A man 
 of scientific ability goes to a country and fiends no 
 phthisis among the inhabitants. After some 
 years, under circumstances that change the habits 
 of the people, he begins to find phthisis, and 
 therefore imagines he was mistaken in his first 
 observations. We find this taking place in Au- 
 stralia, Algiers and Greenland. In India this va- 
 cillating expression of doubt is easily accounted 
 for. When the English first occupied the coun- 
 try, the only cow they had was the small Hindoo 
 variety, not related to our dairy cow, and this 
 animal was and is an object of veneration, and 
 the milk used in the country was derived from 
 
 * Hirsch, op. cit.^ vol.iii, p. 185. 
 
Human and Bovine Tuberculosis. 43 
 
 the buffalo. All the Buddhists and many of the 
 Brahmin castes abstain from the use of meat in 
 any form. Ansell, an early writer, says: " It 
 appears that tuberculosis is correspondingly non- 
 existent in certain localities in India." Now, 
 there is a constant change always taking place 
 in such a country as India. Prejudices are dying 
 out, and many of the people have undoubtedly 
 adopted the habits of their conquerors. The 
 English dairy cow is slov\dy but surely finding her 
 way into India, or, as Mair, a deputy coroner of 
 Madras, says: " Beef is not at all times procur- 
 able, but is generally sold about once a v/eek in 
 every station where there is a sufficient number 
 of Europeans to render the slaughter of an ani- 
 mal w^orth the butcher's while, for little beef is 
 used among the natives. Occasionally the 
 slaughter of a fine English stall-'fed cow is adver- 
 tised. In some districts the sale of beef is pro- 
 hibited by law, out of respect for caste prejudices. 
 Butter is an article difficult to procure of good 
 quality, except on the hills, wdiere it is sold by 
 European settlers, who make dairy keeping con- 
 tribute to their support. The native tendency is 
 to palm off buff'alo butter for that made of cow's 
 milk." There is little doubt that when the Eng- 
 lish dairy system becomes well established in In- 
 dia, the statistics of phthisis will be uniform and 
 
44 Human and Bovine Tuberculosis. 
 
 undoubtful. Of course, the Buddhists and the 
 Brahmins will be the last to adopt the dairy cow 
 as a food producer. 
 
 Geographical and climatic conditions have 
 little, then, to do with the prevalence of tubercu- 
 losis. There are undoubtedly conditions of cli- 
 mate, habitation, etc., that favor the development 
 of the disease, if the contagium is present; and 
 the contagion, I think, is always derived pri- 
 marily from the dairy cow. The Kirghiz inhabit- 
 ing the steppes of Russia, lOO feet below the sea- 
 level, with a rigorous clime, intensely cold win- 
 ters and warm summers, badly housed and fed 
 during the long months of cold weather, no dairy 
 cows, and an entire absence of phthisis. Take, 
 as nearly as we can get, a diametrically opposite 
 geographical and climatic condition, and we find 
 Quito, the highest city in the world, situated lo,- 
 Goo feet above the sea-level, located at the equa- 
 tor. " No torrid heat enervates the inhabitant of 
 this favored spot, no icy breeze sends him shiver- 
 ing to the fire." " The mean annual temperature 
 is 58°, the extremes 45° and 70° Fahr.""^ Now, 
 we have quite positive and authoritative state- 
 ments regarding this city. Professor James Or- 
 ton, of Vassar College, who made a scientific ex- 
 
 * Orton, " Andes and Amazon," p. 92. 
 
Human and Bovine Tuberculosis. 45 
 
 pedition to the equatorial Andes in 1867, under 
 the auspices of the Smithsonian Institution, says, 
 at Quito, " suddenly we are looking down into 
 the valley of Chimbo; there are herds of cattle 
 and fields of grain, yet we shall not find a quart 
 of milk or a loaf of bread for sale. Thousands of 
 cattle are raised on the Paramos, but almost 
 wholly for beef. A disHke to milk (observed by 
 Humboldt), or at least an absence of its use be- 
 fore the arrival of Europeans, was, generally 
 speaking, a feature common to all natives of the 
 new continent. Some cheese, mostly unpressed 
 curd, and a Httle butter, are made, but in the pa- 
 triarchal style; only one American churn is in 
 operation (in Quito, with a population of 80,000). 
 The people insist on first boiling the milk, and 
 then stirring it with a spoon ; custom is omnipo- 
 tent here, and its effect is hereditary." Professor 
 Orton further says: '' Consumption is unknown 
 in the city." The testimony is unanimous that 
 phthisis does not exist in Quito, but on the plains 
 in Ecuador, according to Dr. Archibald Smith, 
 who practiced there for 25 years, '' the disease is 
 not uncommon." 
 
 Professor Orton, after leaving Quito and 
 traveling toward the Amazon, makes the follow- 
 ing observation, which clearly indicates that the 
 dairy cow exists in other parts of this country: 
 
46 Human and Bovine Tuberculosis. 
 
 " The following day we advanced five miles to 
 Tablon, an Indian hamlet on the mountain-side. 
 There we waited over night, and this was the 
 only spot in South America where we found milk 
 to our stomachs' content." 
 
 Without going into further details respecting 
 separate communities, let us consider the statis- 
 tics of Europe, and there v/e find that the preval- 
 ence of phthisis is regulated by the ratio of the 
 bovine to the human race. Thus, in Ireland, 
 Vv'here the cattle number 4,570,000, nearly an 
 equal proportion to that of the inhabitants, ac- 
 cording to Dr. Wylde, phthisis is by far the most 
 fatal affection to which the inhabitants of that 
 country are subject. Denmark, with about the 
 same ratio of cattle to inhabitants, sustains about 
 the same rate from consumption. In Portugal, 
 where there are six inhabitants to one bovine ani- 
 mal, consumption attracts so little attention that 
 fevv^ notices can be found relating to the disease 
 in that country. In Italy, the distribution of 
 cattle being one to six inhabitants, the mortality 
 from phthisis varies greatly in different parts of 
 the country, reaching the exceedingly low rate of 
 0.86 in a thousand in the Basilicata. In Egypt, 
 where the ratio is one animal to nearly thirty in- 
 habitants, Pruner tells us " that the disease be- 
 comes less in exact proportion as we proceed 
 
Human and Bovine Tuberculosis. 47 
 
 southward from the shore of the Mediterranean. 
 In Central and Upper Egypt it is decidedly un- 
 common."* 
 
 Thus the statistics go on, and where the excep- 
 tions arise, the cause is always evident in the con- 
 ditions that influence the breeds of cattle. Tak- 
 ing into consideration all the foregoing facts, 
 there can be little doubt that the inbred species 
 of the bovine race is the prime aetiological factor 
 of phthisis in the human race. They not only 
 nurse the germ and prevent its extinction, but 
 sow it in the human race continually and abund- 
 antly; without their aid the germ would die, for 
 of all the germs known none have so hard a 
 struggle for existence in the human kind as the 
 bacillus of tubercle, when we consider the com- 
 paratively few of the human race who are 
 afflicted, and the immense number who are ex- 
 posed to the infection and escape it. 
 
 Up to the present writing the cow is the only 
 known animal that has transmitted tuberculosis 
 to her offspring in inheritance, and even here we 
 have only one case. I am fully aware that this 
 statement will meet with considerable opposition, 
 as many of our best workers are of opinion that 
 bacillary phthisis is hereditary in the human race. 
 
 • Hirsch.p. 192. 
 
48 Human and Bovine Tuberculosis. 
 
 But I have concluded that this is merely a theory, 
 because, after diligent search, I have failed to find 
 a well-authenticated case on record of a human 
 foetus at term showing evidence of tuberculosis. 
 We have, however, on record in the " Fortsch- 
 ritte der Medizin," No. 7, vol. iii, 1885, a case 
 given by Johne of congenital tuberculosis in a 
 foetal calf of eight months, and in Crookshank's 
 '' Manual of Bacteriology " (plate 18) is a stained 
 illustration of the bacilli from this undoubted 
 case. Just in the line of this hereditary tendency 
 let me narrate an experiment of my own. Last 
 summer I took the entire lungs and all the largely 
 involved lymphatic glands from a cow dead from 
 acute miliary tuberculosis, and, confining five lay- 
 ing hens and a cock, fed them exclusively on this 
 matter till it was all consumed. I found after 
 eight days one of the hens, which I killed, had 
 tubercular afTection of the laryngeal glands; I 
 took twenty-six of the last e^^^s laid by these 
 hens and put them under two setting hens in an- 
 other part of the farm. Twenty- three of these 
 eggs developed foetal chicks, but not a single one 
 lived to come out of the shell. Two or three days 
 after the period of incubation had expired, the 
 hens themselves broke the eggs, but every chick 
 was dead. I took some of the ep-p-s that I had 
 not used for setting to the Carnegie laboratory, 
 
Human and Bovine Tuberculosis. 49 
 
 and Dr. Grauer searched diligently for the bacil- 
 lus tuberculosis, but failed to find any. He found, 
 however, the presence of the germ in the lym- 
 phatic glands of the hen I had killed; he now has 
 some of the chicks, but I have received no report 
 from him as to their condition. Of the four re- 
 maining hens and cock, some one stole the latter 
 when he was apparently quite ill, three of the hens 
 died extremely emaciated, notwithstanding that 
 they had abundance of good food after they had 
 finished the tuberculized matter, and the remain- 
 ing hen was killed by the burning of the building 
 in which she was confined. This experiment 
 needs confirmation by further experimentation. 
 I had no idea that the eggs would not mature, 
 or I should have placed with them under the same 
 hens, eggs from healthy birds; there w^as no ap- 
 preciable cause in the surroundings or other con- 
 ditions to prevent the hatching except the before- 
 mentioned tubercular condition of the layers. I 
 shall repeat this experiment, using eggs from 
 healthy birds with those from tuberculous layers. 
 Without knowing that the fact is so, I have 
 been looking up statistics of zoological gardens, 
 and find that tuberculous animals fail to breed 
 w^hile in confinement. Of course we have no 
 means of knowing how they behave themselves 
 in their wild state, but I feel pretty safe in as- 
 4 
 
50 Human and Bovine Tuberculosis. 
 
 serting that no one ever found a wild animal with 
 tuberculosis. Darwin's statement while writing 
 on inheritance — " that, unfortunately, it matters 
 not, as far as inheritance is concerned, how in- 
 jurious a quality or structure may be if compat- 
 ible with life " — only applies to the human race 
 and animals which the human race is instrumen- 
 tal in breeding. To such animals, bred by the 
 human race, Darwin applies the term artificial. 
 We all knovv^ that in cattle one that is injured or 
 unable to follow the herd is killed by the herd, 
 and 1)ulls in their wild state only maintain their 
 supremacy by their vigor. The moment the head 
 of a herd suffers from age or disease he is put 
 away by the next strongest, and thus the vigor 
 of the herd is preserved by this law of the survival 
 of the fittest. 
 
 Man can not generate new forms, but he can 
 so control and interfere with nature's processes 
 as to modify the original design. Inbred cattle 
 are selected, sheltered, and pampered, as they 
 would be unable to withstand the rigorous condi- 
 tions of the wild state; they propagate earlier and 
 are larger milkers and more efficient beef pro- 
 ducers, and their meat is more delicate and tender 
 than that of the wild animal. All this is achieved 
 by man at the expense of his own health. 
 
[Reprinted from "The New York Medical Journal," March 8, 1890.] 
 
 ON THE COINCIDENT GEOGRAPHICAL 
 DISTRIBUTION OF TUBERCULO- 
 SIS AND DAIRY CATTLE.* 
 
 If it can be shown by reputable authorities 
 that the geographical distribution of inbred dairy 
 cattle is coincident with the geographical dis- 
 tribution of human tuberculosis, there is a rea- 
 sonable presumption that these phenomena 
 stand to each other in the relation of cause and 
 effect. I am well aware that the doctrine, 
 started by Wells, that malarial, diseases are an- 
 tagonistic to pulmonary consumption, appeared 
 so plausible on its first announcement that sev- 
 eral other scientific men adopted the theory, and 
 even at the recent congress for the study of tu- 
 berculosis, held in Paris, the doctrine was again 
 advanced by De Brun, of Beyrout, and sustained 
 by Picot, of Egypt, after it had been entirely 
 abandoned by such men as Hirsch and others, 
 who, Hke him, had made the whole inhabitable 
 earth their field of observation. This theory, 
 like many another weak theory, was based on 
 
 * Read before the Medical Society of the State of New York at its eighty- 
 fourth annual meeting. 
 
 SI 
 
52 Distribution of Tuberculosis. 
 
 observations confined to a limited area and a 
 limited length of time. To avoid this error, it 
 has been my endeavor to extend my observa- 
 tions to every known inhabited portion of the 
 globe, and to all periods of time, recent or re- 
 mote; for it is impossible to study a disease Hke 
 tuberculosis without a proper understanding of 
 all the changes that have taken or are taking 
 place in each country, because tuberculosis is 
 slower and more uncertain in its development 
 than the other common contagious or infectious 
 diseases. One of the greatest disturbing ele- 
 ments I have found in the study of the geograph- 
 ical distribution of tubercular consumption is in 
 the medical reports of the British army and navy, 
 because, in countries enjoying an immunity from 
 this disease previous to the invasion of these 
 forces, many of the invaders, after the invasion, 
 suffer from an attack, and often die from pulmo- 
 nary consumption which they had acquired be- 
 fore leaving their native land; and consequently 
 the statistics show deaths from pulmonary 
 phthisis in the country, and thus rob it of its 
 reputation for immunity, notwithstanding the 
 fact that the natives themselves retain their ex- 
 emption. This fact may be alleged as a refuta- 
 tion of the popular theory of the day — that cli- 
 matic conditions stand in a causative relation to 
 
Distribution of Tuberculosis. 53 
 
 tubercular consumption, for many advocates of 
 this theory imagine (consistently, if the theory 
 were correct) that where climatic conditions 
 form an aetiological factor, all residents of a 
 country enjoying imimunity by reason of its cli- 
 mate would be exempt. This is not so. Only those 
 who are not infected are exemipt; consequently 
 we must look for some source of infection. Un- 
 doubtedly climatic and hygienic conditions 
 favor the development of the disease in a human 
 subject exposed to infection, and, therefore, the 
 first and greatest question for us to answer, if we 
 can, is, Whence comes the contagion? Is it in- 
 digenous in any of our domestic animals? No 
 one denies, when a humian subject suffers from 
 an attack of glanders, that the disease was ac- 
 quired from a horse; neither do we question the 
 derivation of an attack of hydrophobia in a 
 humian subject; and we know that many other 
 diseases are directly derived from some of our 
 domestic animals. Now, if we were to take a 
 single country like our own, and find that just 
 in proportion as dairy cattle abound in a given 
 community so does tuberculosis prevail, this 
 might be a mere coincidence; but if we take the 
 entire world and find the same existing connec- 
 tion between the tv/o, these accumulated coin- 
 cidences amount to a presumption that the con- 
 
54 Distribution of Tuberculosis. 
 
 nection is that of cause and effect. It seems to 
 me very easy to settle the question whether the 
 dairy cow does derive the contagion from us, as 
 some thoughtlessly allege, or no. The only pos- 
 sible way in which a cow could acquire the con- 
 tagion would be from its attendant, and surely, 
 even if that attendant were affected, the only 
 thing the cow could derive the disease from 
 would be his breath or his sputa, and this in the 
 proportion of one man to fifteen or twenty 
 animals; the attendants, too, may or may not 
 be affected, while in every dairy the percentage 
 of animals affected by tuberculosis is from five 
 to twenty-five per cent. Now, the danger the 
 other way is straight and plain, because the 
 human subject absorbs the entire animal, drink- 
 ing its secretion while this lasts, and finally eat- 
 ing the animal up. Further, we find communi- 
 ties without pulmonary tuberculosis who have 
 not dairy cattle, and we find, also, communities 
 that have been exempt previous to the introduc- 
 tion of dairy cattle. 
 
 Here let me say that I wish, above all things, 
 to avoid any appearance of having enlisted in the 
 army of " alarmists." If the presence of tuber- 
 culosis were simply a danger that could not be 
 avoided, and were to be threatening the entire 
 human race, as many would have us believe, it 
 
Distribution of Tuberculosis. 55 
 
 would be better to let the question alone entirely. 
 There are many people, both professional and 
 lay, who cannot take a calm view of a danger; 
 they must either approach it blindfold or else 
 must rush from it with screaming terror that 
 alarms every one within their hearing. Thus, 
 we see at the present day sanitarians and health 
 authorities urging the isolation of the unfortu- 
 nate consumptive, the destruction of his clothing 
 and everything connected with him, seemingly 
 assuming that the human race itself develops the 
 venom that is destroying it, like the scorpion 
 that stings itself to death. I do not attempt to 
 deny that it is possible for one human subject to 
 convey the infection to another, but I think this 
 danger very remote in comparison with the prime 
 danger of bovine infection. If we take countries 
 like Algiers and Egypt — where the tubercular 
 bovine is still absent, but the human consumptive 
 present, and the native population still exempt — 
 we surel}^ see that the danger of contagion from 
 human to human is not imminent; while, on the 
 other hand, if we take countries like Madeira, 
 Australia and the Sandwich Islands, we find very 
 plainly that the introduction of inbred dairy cat- 
 tle tuberculanzes the natives. I do not mean to 
 imply that every one who drinks milk from tu- 
 bercular cows will become tubercular, for, if this 
 
56 Distribution of Tuberculosis. 
 
 were a fact, instead of the deaths from pulmonary 
 consumption forming one-seventh of the whole 
 mortality, the great majority of civilized races 
 would have become extinguished by the disease. 
 I have know^n many cases of children and adults 
 taking for 3''ears the milk of tubercular cows and 
 yet exhibiting no symptoms of tubercular infec- 
 tion. We must ahvays remember that some 
 other systematic condition is necessary as well 
 as the germ for the development of this disease; 
 scrofulosis, temperature, certain hygienic or cli- 
 matic conditions that tend to lower resistance, 
 are all factors in the causation of a susceptibility 
 to infection. This susceptibility, arising from 
 any or all of the causes enumerated, may 
 be present in some individuals in a commu- 
 nity, and, unless the inbred dairy cow is 
 a producer of food for that community, 
 these cases, be they more or less numerous, 
 will not suffer from tubercular consumption. 
 There are localities with a rigorous climate, re- 
 sulting from their altitude, where dairy cattle 
 cannot be closely inbred, because inbred cattle 
 could not stand the severity of the climate, and 
 they are not, by reason of their breeding, tuber- 
 cular. Such animals are not deemed by the 
 modern breeder as the best dairy animals, for, 
 requiring, by reason of their vigor and robust- 
 
Distribution of Tuberculosis. 57 
 
 ness, more of the food that they consume for 
 their own nutrition, they have less of this food 
 available for making milk. In the Highlands of 
 Scotland and the Hebrides, where these crea- 
 tures abound, the countries are not known as 
 dairy countries, neither are they tubercular. It 
 is significant that in the great dairy countries, 
 such as England, Ireland and Denmark — in fact, 
 wherever the dairy is one of the national indus- 
 tries — the prevalence of tubercular consumption 
 is a settled fact, which requires no further con- 
 sideration on our part. In those countries, how- 
 ever, where there is no settled dairy industry, 
 and the habits of the people, are opposed to the 
 care of dairy cattle, the prevalence of phthisis is 
 rare or entirely absent. It is only in these coun- 
 tries that a doubt exists as to the extent to which 
 phthisis occurs. 
 
 Now let us look at China. Here is a nation 
 peculiar, to our notions. The reigning dynasty 
 and high officials are of Tartar blood; the bulk 
 of the people are pure Chinese. Andrew Wilson, 
 who made a trip through China and Thibet, and 
 published his book in 1875, says: " It is very 
 extraordinary that .... the Chinese should so 
 entirely eschew the use of milk in every shape; 
 at Lassa the pure Chinese do not take any milk, 
 and the reason they gave for not doing so was 
 
58 Distribution of Tuberculosis. 
 
 that milk made people stupid. The Chinese may 
 have got this idea from the fact that the Tartars, 
 who are necessarily milk drinkers and eaters of 
 dried ivAlk and buttermilk, are a a- ery stupid peo- 
 ple."* Pumpelly, who traveled extensively in 
 China under the auspices of the government, 
 says: "Great as is the variety of food in the Chinese 
 cuisine, some things are missed by the traveler — 
 such as bread, butter, and milk. A little milk is 
 sold."t The same v.Titer adds, respecting the 
 city of Pekin: " During the winter months this 
 city has no rival in the world in the abundance 
 and varietv of the o;-ame and domestic meats with 
 which its market is stocked. It receives large 
 quantities of good beef from Mongolia."! I have 
 abundance of testimony to the same effect, as 
 many travelers have written relating to this coun- 
 try. Of course, there is nothing in this that in- 
 dicates how their cattle were bred, or how much 
 milk they consumed, but this and all other testi- 
 mony emphatically indicates that the pure 
 Chinese, of which the poorer classes are entirely 
 made up, do not drink milk, while the Tartars 
 the ruling and militar}- class, do get milk and 
 beef; and I can show from reputable medical 
 
 * The Abode of Snow, New York, 1875, P- i97- 
 
 t Across America and Asia, Nev/ York, 1870, p. 302. 
 
 * Across America and Asia, p. 274. 
 
Distribution of Tuberculosis. 59 
 
 authority in China that, of these two classes, 
 the former are the non-tubercular when 
 the disease shows itself in that country. Thus 
 Dr. Wang, a Chinese physician educated in Edin- 
 burgh, where he had undoubtedly been taught 
 that climatic, hygienic, and dietetic conditions 
 were the causes of pulmonary consumption, 
 writes concerning diseases of the chest in China 
 as follows: " The rarity of consumption among 
 the country people and the greater exemption 
 from it of the laborinp- class in the citv, notwith- 
 standing that they are badly housed and badly 
 fed, must be attributed to their exercise in the 
 open air. . . . Still, I cannot quite understand 
 why phthisis is not more prevalent than it is 
 among them, especially the country poor, whose 
 food often seems not more than half sufficient to 
 support life." In regard to Canton, Dr. Wang 
 says: " Phthisis is tolerably prevalent, but by no 
 means so common as in Europe and America."* 
 Of course. Canton cannot be looked at like the 
 rest of China, for seaport towns are af^icted with 
 imported cases, even vvdien the disease is not in- 
 digenous. Dr. Jamisonf says: '' The testimony 
 of all foreign practitioners in China wdio have 
 written on the subject is unanimous as to the 
 
 * Dobell's Reports, voL iii, 1877, pp. 33, 34. 
 t Ibid., vol, i, 1875, p 283. 
 
6o Distribution of Tuberculosis. 
 
 rarit}^ of phthisis originating here among foreign- 
 ers; every instance of chronic phthisis which has 
 come under my care has been imported." Thus 
 the statistics of this city cannot be inckided in 
 the history of the disease in China. We see, 
 then, that among the poorer class puhnonary 
 consum.ption is absent or rare, while among the 
 better class of Tartar Chinese, phthisis is not an 
 uncommon disease. Thus Surgeon-General 
 Gordon dwells on " the frequent occurrence of 
 phthisis among the better classes at Tien-tsin. 
 especially among women." "^ Here, of course, are 
 the classes that get the milk and the meat. It 
 is very interesting to read the reports of medical 
 men regarding phthisis in China, and the differ- 
 ent reasons by which they endeavor to explain 
 its rarity. Mr. Porter Smith says: " Supposing 
 phthisis to be rare, it cannot be attributed to the 
 absence of a special tuberculiar diathesis among 
 the Chinese; " and Dr. Reid, after enumerating 
 the supposed causes of phthisis, says: '' If con- 
 sumption did not follow as a consequence of all 
 this, we should have a result different from vdiat 
 has been observed in other parts of the world 
 where like predisposing causes are found, .... 
 or that some other conditions exist that modify 
 
 ♦Dobell's Reports. 
 
Distribution of Tuberculosis. 6i 
 
 or neutralize them." The before-quoted Dr. 
 Jamison says that bronchial catarrh is exceed- 
 ingly common and often simulates phthisis. 
 
 Here, then, we have a country with two classes 
 one milk-drinkers and the other non-milk- 
 drinkers — and medical authorities have not been 
 al^le to assign an acceptable reason for the preva- 
 lence of phthisis in one class and not in the other, 
 where the commonly received predisposing 
 causes exist to the greatest extent. 
 
 Let us now direct our attention to regions 
 where cattle abound, but not as inbred dairy 
 stock, and where, consequently, milk is not an 
 article of diet. Such is South A.merica. " In 
 Colombia the practice of milking cows was laid 
 aside owing to the great extent of the farms and 
 other circumstances. In a few generations, M. 
 Rollin says, the natural structure of parts, and 
 withal the natural state of the functions, has been 
 restored. The secretion of milk in the cows of 
 this country is only an occasional phenomenon 
 and contemporary with the actual presence of the 
 calf. If the calf dies, the milk ceases to flow."* 
 Holden,t in his interesting book on this country, 
 says that butter is unknown, milk only occasion- 
 ally used and only extracted from the cows when 
 
 * Prichard, Nat. Hist, of Man, London, 1843, P- 34- 
 + Holden, New Granada, New Yotk ^^^ 
 
62 Distribution of Tuberculosis. 
 
 they have their calves with them, and ahvays 
 boiled. This author also adds, in his chapter on 
 diseases in this country: " There is little or no 
 consumption. I do not recollect of a single case." 
 As to the Argentine Republic, Consul Baker, of 
 the United States, writes in the Western Dairy 
 Journal, '' It may seem paradoxical, yet it is true, 
 that, while the Argentine Republic contains 
 12,000,000 of horned cattle, it produces neither 
 butter nor cheese; such a thing as a dairy farm 
 is unknown; such a thing as butter-making, in 
 the true sense of the word, is a myth; such a thing 
 as a cheese factory, if we except a cheap curd pro- 
 duced in Goya, has never been attempted. In 
 this immediate neighborhood you may or may 
 not find milk enough for your coffee, but else- 
 where no one, with rare exceptions, keeps a milch 
 cow; butter, if used at all, has, until very recently, 
 been brought from Italy; of late, unsalted butter, 
 the work of Spanish Basques, near Buenos Ayres, 
 
 has l}een finding its way to market Not 
 
 long ago I visited a ranch stocked with 15.000 
 cattle, and we did not have a mouthful of butter 
 for our bread, while our coffee was seasoned with 
 condensed milk from Illinois." AVe find, from the 
 writings of Mantegazza on the health of this 
 country, quoted by Hirsch, that there has been, 
 within the last fifty or sixty years, a diffusion of 
 
Distribution of Tuberculosis. 63 
 
 phthisis along the coast of this repubHc, princi- 
 pally among the negroes and mulattoes; but in 
 the interior and mountainous parts there is an 
 exemption. Of course, in the case of phthisis 
 along the coast, unless the imported cases are 
 separated from the indigenous cases, the value of 
 this evidence has no weight in our argument. It 
 might be noticed that ithe invasion of phthisis 
 on the coast coincides very nearly with the inde- 
 pendence of the country and the accompanying 
 admission of foreigners, while in the interior, 
 where the natives are more numerous, immunitv 
 from the disease prevails. 
 
 I have in a previous paper cited the facts rela- 
 ting to Ecuador, and the remarkable result that 
 the natives, where they do not use milk, are ex- 
 empt from pulmonary tuberculosis. I have also 
 in a previous paper alluded to the absence of 
 phthisis in Egypt, where the indigenous inhab- 
 itants did not make use of the milk of inbred 
 dairy cattle. The conclusions I arrived at at that 
 time were derived from my reading of the ac- 
 counts of that country given b}^ various travelers; 
 and since then I have written to Dr. J. A. S. 
 Grant, Bey, who has favored me with the follow- 
 ing communication, dated September 3, 1889: 
 '' With respect to Egypt, we are almost exempt 
 from tuberculosis unless among the black people 
 
64 Distribution of Tuberculosis. 
 
 and foreigners. The Copts and Arabs are re- 
 markably free from phthisis puhnonalis. I think 
 buffalo milk is the only staple of that kind sup- 
 plied to the villages, but I knovr that in the large 
 towns there are European cows." This shows 
 plainl}^ that the natives do not breed dairy cattle 
 and are exempt from puhPionary tuberculosis, 
 vrhile in the towns it is probable that the Euro- 
 pean cows mentioned in the bey's letter supply 
 the milk to the foreigners. 
 
 Like Egypt, all the rest of northern Africa 
 seems to be exempt from tuberculosis. Thus re- 
 garding Morocco, a country to v hich I have not 
 before alluded and which was thoroughly ex- 
 plored by Dr. Rohlfs in 1861, wdio adopted the 
 habits and manners of the natives, acting" as a 
 physician both among the people and in the 
 army, he writes in his book: " Diseases of the 
 lungs are scarcely known in Morocco,""^ and in 
 enumerating the prevailing" diseases he omits 
 pulmonary consumption or phthisis entirely from 
 the Hst; and he also says: ''the animals of the 
 Draa oasis are fine and similar to those in Mo- 
 rocco, such as the horse, ass, mule, and goat; 
 cattle are not common. The sheep in the Ter- 
 nate provinces are woolless."t He speaks only 
 of sheep's milk as used for food in the country. 
 
 * Rohlfs, Adventures in Morocco, London, 1874, p. 83. 
 t Ibid.^ p. 348. 
 
Distribution of Tuberculosis. 65 
 
 Taking a square of ten degrees of longitude 
 and latitude, making the geographical portions 
 nearly rdentical, we have in this square Morocco, 
 Portugal, and Spain. Now, these latter countries 
 were mostly in the possession of the Moors for 
 centuries, and although they are classed among 
 the civilized races, there are many remains of 
 Moorish customs and culture still surviving. 
 They are an agricultural people, and the dairy 
 business is one of the agricultural pursuits.* 
 According to Brandt, quoted by Hirsch, con- 
 sumption is prevalent in this country. This 
 condition of affairs applies also to Spain, as these 
 two countries are usually classed together. Now, 
 it must be granted that the geographical differ- 
 ences between these countries and Morocco are 
 not sufficient to account for the prevalence of 
 pulmonary consumption in the one and its ab- 
 sence in the other, the presence of dairy cattle in 
 one and not in the other is probably the most 
 marked and significant difference. This differ- 
 ence will be found everywhere in the world where 
 cattle are bred for the sole purpose of producing 
 milk or early matured beef. 
 
 I am very firm in my conviction that cattle 
 can be bred in such a manner that they will be 
 — 4 
 
 * Oswald Crawford, Portugal, Old and New, New York*, p. 155. 
 
66 Distribution of Tuberculosis. 
 
 neither scrofulous, nor tuberculous, and in these 
 respects not dangerous to the human race. After 
 due deliberation and serious study, both as a phy- 
 sician and as a cattle breeder, I am firmly of the 
 opinion that the blessings conferred upon us by 
 the bovine tribe far outweighs the burden of the 
 disease which they have entailed on us. When I 
 read of countries that have no tuberculous food- 
 producers, and consequently enjoying a total im- 
 munity from this disease, I remember at the same 
 time that they suffer from still more grievous 
 afflictions, both from the lack of the food fur- 
 nished us and from the presence of disease in 
 some form derived from their ow^n cattle. If it 
 were impossible to improve our own domestic 
 cattle in regard to their own and our health, I 
 should, I repeat, be in favor of letting the matter 
 rest as it is. Deeming it, however, quite possible 
 to breed our animals without any scrofulous 
 taint, and, in lieu of the burden of disease, assume 
 the burden of a heavier financial expense, I earn- 
 estly urge a reform. 
 
 The foremost cattle breeders have aimed at 
 producing an artificial animal, capable, when 
 bred for beef, of early maturity and early fecun- 
 dity; and, when bred for the dairy, all other con- 
 siderations were made subsidiary to an abundant 
 flow of milk. It would appear to these men ab- 
 
Distribution of Tuberculosis. (^y 
 
 ject foolishness to breed an animal for strength, 
 health, and robustness with a smaller yield of 
 milk. They would not deem it an improvement 
 to breed an animal that did not mature early, 
 and whose dam would not produce a calf till she 
 was three years old. But only by this method 
 can we stamp out tuberculosis in our beef and 
 dairy animals, and I am convinced that legislative 
 action will be necessary to keep the breeders in 
 this line, for it is one of the hardest things in the 
 world to upset a recognized commercial system. 
 Thus the question is focused: " Are we willing 
 to pay more for beef and dairy products, and 
 throw off the incumbrance of disease, or let the 
 matter remain as it is — an abundant supply of 
 cheap milk and cheap beef? " 
 
[Reprinted from " The New York Medical Journal," June 28, i8qo.] 
 
 CONSANGUINEOUS BREEDING IN ITS 
 
 RELATIONS TO SCROFULA AND 
 
 TUBERCULOSIS.* 
 
 In the propagation of young, the union of 
 two distinct sexes is an essential requirement for 
 the higher order of animals, and Mr. Herbert 
 Spencer accounts for the formation of two sexes 
 by the assumption that thus only can consan- 
 guineous unions be avoided. If it had been bet- 
 ter that animals should be produced from one in- 
 dividual and thus continuing to represent that 
 individual and that individual alone, man 
 and the higher orders of animals would have 
 been created hermaphrodite or parthenoge- 
 netic. But in the great plan of nature we 
 see, besides the different sexes, different 
 groups of permanent varieties of the species, 
 and breeds are the result of the mingling of 
 these varieties in different proportions. Thus, 
 in the human race, to avoid the repetition of a 
 single individual, not only are there distinct 
 
 • Read before the Society of Medical Jurisprudence and State Medicine, 
 March 10, iSgo. 
 
 69 
 
yo Scrofula and Tuberculosis. 
 
 sexes, but also distinct groups of the same spe- 
 cies capable of mixing and reproducing their 
 kind, and many of the races now existing are un- 
 doubtedly made up by mixture of two or more of 
 the permanent varieties. The dominant race of 
 to-day, the white race, shows distinctly that they 
 are not derived exclusively from any one per- 
 manent variety, but must have been formed by 
 the mingling of two or more of the permanent 
 varieties, as evidenced by the existence in the 
 sam.e race of such different types as the blonde 
 and the brunette, and of different temperaments, 
 and the commingling of all these types in every 
 conceivable gradation, as dark hair with light 
 eyes, and light hair with dark eyes, red hair, and 
 all kinds of varieties cropping out in the same 
 family of children. 
 
 It seems to me that all those who have studied 
 the subject of consanguinity have sight of this 
 tact — that two individuals consanguineously re- 
 lated represent not only the immediate parents, 
 but a certain mixture of the permanent varieties 
 of their species. Thus some of the domestic ani- 
 mals that we know contain only two permanent 
 varieties in the species, and it is from a mingling 
 of these varieties that the breeds are made; and 
 the permanency of these breeds depends on the 
 amount of mixture of these varieties in each 
 
Scrofula and Tuberculosis. 71 
 
 breed, as when one of these elements is bred out 
 or attenuated, then the breed becomes scrofu- 
 lous, sterile, and in every way deteriorated by the 
 close consanguinity of one variety. And thus 
 we find that animals more prone to scrofula, re- 
 sulting from consanguinity, are those of the least 
 number of distinct groups to the species; hence, 
 in a few generations, if the mingling of the varie- 
 ties has not been equal, one of them is bred out 
 or attenuated to such an extent as to be almost 
 entirely lost. Of course animals that produce 
 many young at one gestation will show this de- 
 teriorating process sooner than a uniparous ani- 
 mal, because the debilitating effect of gestation 
 must be greater. Thus the pig, a muciparous 
 animal with two groups to the species, develops 
 the scrofulous habit more readily than any of the 
 other domestic animals. Next in order come 
 the bovine tribe, a uniparious race, with two 
 groups known at present, with a probability of 
 other groups that have become extinct. These 
 animals develop the scrofulous habit from in- 
 and-in breeding, but not in so few generations 
 as the pig does. According to this argument, 
 the development of the scrofulous habit in man 
 from close interbreeding would be remote, be- 
 cause there have been many permanent varieties 
 of the human family; but there are in the human 
 
"^2 Scrofula and Tuberculosis. 
 
 family many other deteriorating influences at 
 work; alcoholism, syphilis, debauchery of all 
 kinds have stamped their imipress on the off- 
 spring, which is characterized sometimes only by 
 the scrofulous habit and intensified by consan- 
 guinity. 
 
 Questions relating to consanguinity and scrof- 
 ulosis have received an immense amount of atten- 
 tion and all kinds of conclusions have been 
 reached; but, from the fact that scrofula is so 
 slow sometimes in showing its results, except in 
 the pig, in breeds that have resulted from the 
 commingling of the groups of one species, even 
 when the scrofulous habit has been thus devel- 
 oped, the positive diseases that follov/ this con- 
 dition are not alw^ays developed, or developed 
 at times only slowly, and so remote from the 
 original primary causes that these causes are lost 
 sight of. Tracing up the course of some of our 
 specific contagious fevers, we are able to see the 
 connection between the primary cause and the 
 specific, and, these being so close together, we 
 are always able to grasp the whole train of cause 
 and effect. In scrofulosis, effects do not follow 
 causes in the same number of cases where cir- 
 cumstances tend to develop the cause, as in the 
 specific fevers, because scrofula is always a con- 
 genital condition and is not itself a disease, but 
 
Scrofula and Tuberculosis. 73 
 
 a'susceptibility to morbid conditions that are so 
 uncertain and insidious that consequently the 
 study of this condition is always misleading when 
 small groups or limited areas constitute the field 
 of observation. It is only in large masses of facts 
 with numbers of Hving beings whose origin, 
 pedigree, modes of breeding, and all other con- 
 comitant facts are taken together, that we can 
 reach a clear solution of the connection between 
 consanguineous unions and their train of dis- 
 eases. Thus I have ascertained, taking the whole 
 world as the field of observation, that human 
 tuberculosis exists only in those communities 
 closely associated with the inbred bovine species. 
 This observation does not, of course, exclude the 
 now acknowledged fact that bacillary phthisis 
 can be conveyed from one human subject to 
 another by contagion, because this is a part of the 
 fact that the original contagion was derived from 
 the bovine species; thus, where the inbred tuber- 
 cular cattle are unknown, bacillary phthisis is 
 also unknown. 
 
 I do not desire to discuss any of the questions 
 relating to race problems, but, from several years 
 of close study of the methods of cattle-breeding 
 and their diseases, and of their intimate relation- 
 ship to mankind, I am convinced that the bovine 
 race is scrofulous, the result of close consanguin- 
 
74 Scrofula and Tuberculosis. 
 
 ity, and tubercular from their scrofulous habit, and 
 this fact is almost too well known to need the 
 addition of any one's testimony, as a great ma- 
 jority of those who have studied the subject are 
 agreed on this point. But I am thoroughly con- 
 vinced, as I have said before, that the inbred 
 bovines, by reason of their scrofulous habit and 
 consequent susceptibility to tubercular disease, 
 convey to the human race bacillary phthisis; that 
 this danger can be avoided, and, to point out 
 methods of protecting the human race from this 
 source of infection, I w^ould adduce the following 
 argument: 
 
 As I stated in the beginning of this paper that 
 the pig was more prone to evil results from con- 
 sanguineous union than any of the other domestic 
 animals, and that these evil results follow more 
 closely the primary cause and, therefore, can be 
 more easily traced, and the fundamental princi- 
 ples of the argument more simply and clearly 
 demonstrated, I will commence with a few illus- 
 trations, gleaned from the best authorities on 
 questions of breeding, respecting that animal. 
 
 This species can be divided into two groups, 
 or permanent varieties — namely, the Sus indicus 
 and the Siis scrofa — and all the different breeds 
 are made up of these two difTerent groups of the 
 pig family. So distinct are these two varieties 
 
Scrofula and Tuberculosis. 75. 
 
 that Nathusius (quoted by Darwin) says that he 
 can trace the infusion of one-thirty-second or 
 one-sixty-fourth part of the blood of one of these 
 groups into that of the other, in the bony forma- 
 tion. Darwin himself says: "With respect to 
 pigs there is more unanimity among breeders on 
 the evil effects of close interbreeding than per- 
 haps with regard to any other large animal. Mr. 
 Druce, a great and successful breeder of the im- 
 proved Oxfordshires (a crossed race), writes: 
 ' Without a change of boars of a different tribe, 
 but of the same breed, constitution cannot be 
 preserved.' Lord Western was the first im- 
 porter of a Neapolitan boar and sow; ' from this 
 pair he bred in and in until the breed was in 
 danger of becoming extinct, a sure result (as Mr. 
 Sidney remarks) of in-and-in breeding.' " Mr. 
 Darv/in further relates that a Mr. Wright, a well- 
 known breeder, bred a family of pigs in-and-in 
 for seven generations; the number of pigs was 
 reduced at each gestation, and of the offspring 
 thus produced many were idiotic, without sense 
 even to suck, and, when attempting to move 
 could not walk straight, till finally one sow was 
 the sole offspring. She was the handsomest of 
 the entire seven generations, but would not be- 
 come pregnant by her sire, while to a stranger in 
 blood she bred at the first trial. " Nathusius 
 
^6 Scrofula and Tuberculosis. 
 
 gives an analogous and even more striking case. 
 He imported from England a pregnant sow of 
 the large Yorkshire breed, and bred the product 
 closely in-and-in for three generations; the result 
 was unfavorable, as the young were weak in con- 
 stitution, with impaired fertility. One of the 
 latest sows, which he esteemed a good animal, 
 produced, when paired with her own uncle (who 
 V\^as known to be productive with sows of other 
 breeds), a litter of six, and a second time a litter 
 of only five weak young pigs. Then he paired 
 this sow with a boar of a small black breed, 
 which he had likewise imported from England. 
 This boar, when matched with sows of his own 
 breed, produced from seven to nine young pigs; 
 now, the sow of the large breed, which was so 
 unproductive when paired with her own uncle, 
 yielded to the small black boar in the first litter 
 twenty-one, and in the second Htter eighteen 
 young pigs, so that in one year she produced 
 thirty-nine fine young animals. Colonel Le 
 Conteur Avrites me that from possessing a fine 
 breed of pigs he bred them very closely, twice 
 pairing brothers and sisters, but nearly all the 
 young had fits and died suddenly."* 
 
 All the above is taken from Darwin, who, of 
 
 ♦ Darwin, Animals and Plants under Domestication, Vol. i, p. loi. 
 
Scrofula and Tuberculosis. 'jj 
 
 course, only quotes from the works of others; 
 but the facts as stated are well known, and no 
 successful breeder to-day practices close consan- 
 guineous unions in breeding his pigs. It would 
 be very easy to compute the possibility of breed- 
 ing out an infusion of one of the varieties where 
 it existed only in the proportion of a third to the 
 other varieties, with this close interbreeding, and 
 it is also easy to understand how a cross with 
 another breed or another family of the same 
 breed would change the combination of the 
 minglings of the two varieties. 
 
 That pigs are scrofulous from this close union 
 is well known. The word scrofula is derived 
 from the name of one of these groups, the Sus 
 scrofa, and the name undoubtedly indicated the 
 well-known fact that close consanguineous 
 unions of these animals produced a constitu- 
 tional condition resembling in all respects, at 
 least as near as an animal can, human scrofulous 
 diathesis; and, furthermore, the common people 
 have noticed this resemblance and termed scrof- 
 ulosis " swine evil." The reason why these ani- 
 mals show the evil results of in-and-in breeding 
 more plainly and quickly than some other of the 
 classes of domestic animals, arises from the fact 
 that there are only two groups of the species, and 
 hence there is less possibility of modification than 
 
yS Scrofula and Tuberculosis. 
 
 in the species with a larger number of permanent 
 varieties. Thus, I beHeve if a species of animal 
 existed that was unique — that is, with no varie- 
 ties — consanguineous breedings would be pro- 
 ductive of more early evil effects than it is even 
 in the pig, and probably some of the races that 
 have become extinct were races that were so 
 situated as to miake it impossible to receive an 
 infusion of blood from some of the other per- 
 manent varieties of these species. 
 
 Now, as a contrast, to the pig, let us take the 
 horse and the sheep. Neither of these animals 
 is scrofulous, and in-and-in breeding can be car- 
 ried on with them without the same apparent 
 tendency to deterioration; neither are these ani- 
 mals subject to tubercular infection, with very 
 rare exceptions. The breeds of domestic sheep 
 are made up from eight or more permanent va- 
 rieties; it is therefore easy to see how many ad- 
 mixtures of different bloods can be infused 
 together to make the different breeds. There- 
 fore the possibility of working out all the com- 
 binations by consanguineous unions would take 
 a great length of time; and the same rule applies 
 to the horse in his insusceptibility to scrofula and 
 tuberculosis; but there are many other conditions 
 associated with the horse under domicstication 
 that, of course, belong to the domain of heredity. 
 
Scrofula and Tuberculosis. 79 
 
 such as spavin, ring-bone, exhaustion from over- 
 work and severe strain, stomach derangements, 
 etc., and these make the in-and-in breeding of 
 horses somxctimes unprofitable. Still consan- 
 guineous unions in the case of this animal are 
 never productive of scrofula and its attendant 
 train of disease. 
 
 All the foregoing facts, deductions and sug- 
 gestions will help us in our study of the main 
 question. That question is, can we prevent the 
 development of scrofula and tuberculosis in the 
 dairy cow and thus eliminate this disease from 
 the human family? There is no other animal in 
 creation that is so closely and intimately associ- 
 ated with some communities of the human race 
 as the domestic cow. Her milk is one of the 
 most absolute necessities for the nursery and the 
 table in every household; every part of her flesh 
 and the large viscereal organs are consumed as 
 human food; her blood is consumed by some 
 communities. All civilized races of the present 
 day acknowledge the utility of vaccine virus for 
 the prevention of small-pox, and this virus is 
 transmitted through the system of her calf before 
 it can serve as a protective virus for the human 
 system. Her hoofs and horns are transformed 
 into the gelatin which constitutes one of the deli- 
 cacies of the table and sick-room, her hair enters 
 
8o Scrofula and Tuberculosis. 
 
 into the composition of the plasters on our walls, 
 and with her hide we cover our feet. This animal 
 has been bred to a two-fold purpose — namely, to 
 furnish us with milk and with beef; in breeding 
 the dairy cow^ every other point has been lost 
 sight of except the main function of a milk- 
 producer. The well-known scrofulous forms in 
 animals and the human kind are, unfortunately, 
 the largest milk-yielders. Therefore, in some of 
 the noted milking breeds the form sought after 
 by breeders is that which will correspond with 
 the delineation of the characteristic form of 
 scrofulosis given by Miller,"^ as follows: "The 
 complexion is fair, and frequently beautiful, as 
 well as the features; the form, though delicate, is 
 often graceful; the skin is thin and of fine tex- 
 ture ^ * * the pupils are unusually spacious; 
 the eyeballs are not only large but prominent; 
 the eyelashes are long and graceful." Now let us 
 contrast this description of human scrofula with 
 Dr. L. H. Twaddell's description of a noted dairy 
 cow. " The Jersey cow is of medium size; her 
 peculiar deer-Hke aspect distinguishes her 
 "■'' * "^ her head is long and slender, the muzzle 
 fine, the nose is black, and the large, dreamy 
 eyes encircled with a black band * * * the 
 limbs of the Jersey are very slender and fine; her 
 
 * Principles of Surgery, p. 53. 
 
Scrofula and Tuberculosis. ^i 
 
 neck is slender and rather long; " and Colonel 
 George E. Waring, Jr., says he knows of no fault 
 in the milking cow greater than a thick skin. 
 Thus we have in the scrofulous human subject a 
 beautiful form, a thin skin, large eyes, and the 
 same characteristics as those found in the best 
 milking form of the dairy cow. Scrofulous fe- 
 males in the human race usually secrete an abun- 
 dance of mjlk, although they are not deemed the 
 best nurses. Even Donne alludes to this fact 
 and cites in his work on mothers and infants the 
 case of a nurse that suckled the children of one 
 of the most noted Paris physicians, and was 
 recommended by him to other noted famiUes, 
 who, when examined by Donne himself, was 
 found to be in a scrofulous condition. Of course, 
 she must have given an abundance of milk to be 
 thus recommended. I know, too, from my own 
 experience, that scrofulous females, as a rule, 
 secrete a larger quantity of milk than healthier 
 ones. Although the scrofulous female with her 
 abundance of milk would not be recommended 
 as a wet-nurse, the beautiful scrofulous dairy cow 
 is never declared contraband. 
 
 Let us now examine the pedigree and breed- 
 ing of the dairy cow and see why this animal is 
 scrofulous. The domestic breeds of the bovine 
 tribe are made up from two permanent varieties 
 6 
 
82 Scrofula and Tuberculosis. 
 
 of the species — namely, the Bos longifrons and 
 Bos primigeniiis ; these two varieties are dis- 
 tinctly identified, one as the large, the other as 
 the smaller form, and the most noted dairy 
 breeds belong to the smaller with very little of 
 the larger breed intermingled, while the beef 
 breeds belong to the larger form with more or 
 less infusion of the smaller to make the distinc- 
 tive breeds. Let us take one of the most noted 
 dairy breeds we have — the Jerseys. These ani- 
 mals have been bred on the Channel Islands for 
 several generations, without ever having received 
 a cross from other breeds, and they were the 
 only breed on the island of Jersey. These ani- 
 mals have now been distributed by exportation 
 among breeders in various parts of the world, 
 but the noted herds are still inbred in the closest 
 possible manner. 
 
 I have several tabulated pedigrees of Ameri- 
 can-bred Jerseys, and will cite that of '* Iduna." 
 Through six generations the male parent, " St. 
 Helier," himself an intensely inbred bull, has 
 been the sire twenty-five times in her genealogy 
 — that is, impregnating his own female progeny 
 through twenty-five lines in descent. Animals 
 produced by this method are truly delicate and 
 beautiful, and usually good milkers, and in other 
 points fulfill Miller's description of the human 
 
Scrofula and Tuberculosis. 83 
 
 scrofulous female. Now, scrofula is not always 
 tuberculosis, but I believe that scrofula precedes 
 tubercular infection. In this connection the fol- 
 lowing quotation from Hazard's book on the 
 Jersey, Alderney, and Guernsey cow may be of 
 interest: " Accordingly some good milkers, and 
 particularly old cows in which vital activity is 
 constantly decreasing and systematic reaction 
 becoming progressively more and more difficult 
 acquire a sickly appearance; the defective lymph 
 is deposited in the form of tubercular matter so 
 constantly found in the chest of old cows, the 
 animals become phthisical, the organs of pro- 
 creation become unhealthy; Vv^ith m^ore or less 
 constant irritation of the ovaries, the cow be- 
 comes barren. With this irritation there is a 
 periodic check to the secretion of milk; neverthe- 
 less, a very considerable flow still continues." 
 
 There is little need for me to add that this milk 
 sometimes finds its way to the nursery of a 
 scrofulous infant. Now, no one denies that these 
 intensely inbred Jerseys are notoriously tubercu- 
 lar; they are nearly all scrofulous, and it is notori- 
 ous that this breed is subjected to the most in- 
 tense consanguinity; and Walley, the well-known 
 v/riter on bovine diseases, says in his book, The 
 Four Bovine Scourges: " The breeds of animals 
 that in my experience are most subject to tuber- 
 
84 Scrofula and Tuberculosis. 
 
 cle are Alderneys, Guernseys (the latter in much 
 less degree than the former), and short-horns 
 among home cattle, and among foreign cattle the 
 Danish." Now, we know all these breeds enu- 
 merated by Walley belong to the most closely 
 inbred dairy and beef stock; among beef cattle 
 the short-horns are the most intensely inbred. 
 As a rule, these beef cattle do not show the same 
 distinctive processes of the tubercular infection 
 because they are not submitted to the drain of 
 continual lactation as are the dairy breeds, and, 
 moreover, are well fed and cared for, and 
 butchered when they are between three and four 
 years of age; hence they only show their true 
 condition when opened by the butcher. Further- 
 more, to show that this scrofulous and tubercular 
 condition is the direct result of consanguineous 
 breeding, we will take a breed of cattle that en- 
 joys an immunity from tuberculosis. Walley, the 
 author above quoted, says: '' The polled Aber- 
 deenshires seem to be particularly exempt." Mr. 
 Clement Stephens, chief veterinary inspector for 
 Northumberland, states: " There is another and 
 more valuable advantage these cattle possess — 
 namely, their remarkable freedom from tubercu- 
 lar diseases. Of course I cannot assert that it has 
 never been in this breed of cattle (the Aberdeen), 
 but this I can say: That, although I have had 
 
Scrofula and Tuberculosis. 85 
 
 special opportunities for research, and have ex- 
 amined great numbers of cattle, both alive and 
 post mortem, I have never yet seen a trace of it 
 in this breed." Now, these cattle are not of an 
 inbred breed. The rigorous climate of their na- 
 tive land and the lack of housing they receive 
 make it impossible for the thin-skinned inbred 
 animal to exist under these circumstances. The 
 following is quoted from the Breeder's Gazette 
 with reference to these animals: " The necessity 
 of keeping a house over his head has prevented 
 the Aberdeenshire breeder from following the 
 caprice of fashion; the blue-bloodqd breed for 
 which there used to be a kindness in som.e direc- 
 tions is dreaded beyond everything; the very 
 blueness of his blood makes him dangerous." 
 From the same source I quote the following from 
 a correspondent who had seen these cattle and 
 examined their thick coating of hair and protect- 
 ing skin; and comparing them with the short- 
 horns, he says: " But I now firmly beUeve that 
 every one of those animals that have that pecu- 
 liar soft handle (feehng of the skin) that I was 
 taught by my brother in the short-horn world to 
 so much admire, is tuberculosis in one or other of 
 its stages. Up to the time that an animal is in 
 the last stages of this fell disease I feel its hand- 
 ling would delight many of the best short-horn 
 
86 Scrofula and Tuberculosis. 
 
 judges. We have bred too many of the short- 
 horns to death." The great breeder of the polled 
 Angus and the great authority on the breed, Mr. 
 William McCombie, writes thus in his work on 
 Cattle and Cattle-breeding: '' To continue for 
 any length of time to breed in-and-in is not only 
 against my experience, but I believe against na- 
 ture." I have also searched through the records 
 of this breed and works relating to it, and I find 
 none of them giving evidence of close inbreeding. 
 We have thus the two-ends of the cattle-breeding 
 question — one, a small, intensely inbred and 
 pampered breed, the predominating dairy cow, 
 a true scrofulous animxal and numerously affected 
 by tubercle; the other, a large, hardy cross-bred 
 animal, with all evidence pointing to a total im- 
 munity from tuberculosis. 
 
 Now, I have seen it stated man)^ times that 
 cattle that are tuberculous become infected from 
 their attendants spitting and coughing around 
 the stable. If this were at all an aetiological 
 factor, we should find no breed of domestic cattle 
 exempt, because they are exposed to the same or 
 nearly the same class of associates with about the 
 same degree of intimacy, and it w^ould be very 
 strange if one man to ten or twenty cows, even if 
 he were phthisical, should be able to infect lo or 
 
Scrofula and Tuberculosis. 87 
 
 15 per cent, of them by his coughing and spitting, 
 and they not affect him while he is drinking their 
 milk, eating their flesh, and inhaling their breath. 
 This is really not a part of the subject under dis- 
 cussion; I simply introduce it here while discuss- 
 ing these two breeds — the tubercular and non- 
 tubercular. 
 
 I think there can be no doubt whatever that 
 the in-and-in breeding of animals, with two or 
 three permanent varieties only to the species, 
 does produce a constitutional weakness, to say 
 the least, that is not capable of resisting bacillary 
 tubercular infection. Tuberculosis itself is rarely 
 an inherited disease in the bovine tribe, where 
 this disease is indigenous. I have myself exam- 
 ined many foetal calves, v/hose mothers were 
 dead from acute miliary tuberculosis, without 
 ever finding the gross evidences of tubercular in- 
 fection; so I think it safe to say that the rule is 
 that the disease is not transmitted by inheritance, 
 and consequently the best way to eliminate a dis- 
 ease of this kind, which we know must be pre- 
 ceded by a hereditary constitutional dyscrasia, is 
 to breed animals, as we surely can do with our 
 domestic cow, so that they will not inherit this 
 scrofulous habit. 
 
 Of course, as I have said before, these two 
 
88 Scrofula and Tuberculosis. 
 
 questions of consanguinity and scrofulosis are 
 difficult to stud}^ and cannot receive their true 
 interpretation from any few isolated cases or 
 small groups of facts, and the only positive deter- 
 mination that we can arrive at is derived from 
 the study of all the dairy breeds. In them we 
 see that those which are habitually inbred are 
 scrofulous, as a rule. I am aware that almost any 
 one can adduce simple isolated cases showing 
 that an inbred animal is not scrofulous or tuber- 
 cular; but when the facts stands this way, that 
 when all the scrofulous and tubercular animals 
 occur among the inbred varieties, and not at all 
 among those that are not inbred, the deduction 
 to be drawn is obvious; and it is just this com- 
 bination of facts that makes the study of consan- 
 guinity, scrofulosis, and tuberculosis so elusive. 
 All the inbred anim.als are not scrofulosed, and all 
 those that are scrofulosed are not tubercular; and 
 thus, when we take the one breed that is notori- 
 ously tubercular, v/e find the facts pro and con, as 
 to the transmission of scrofulosis and the invasion 
 of tuberculosis are of equal weight, or, if any- 
 thing, the preponderance of evidence would be 
 against the deteriorating influence of consangu- 
 inity; but when we have the breed that is exempt 
 from these conditions, and observe that the only 
 
Scrofula and Tuberculosis. 89 
 
 difference is that it is not inbred, then we account 
 for the presence of less or more tuberculosis by 
 the disturbing influence of consanguinity. And 
 so with the study of tuberculosis beyond these 
 questions of breeding. We find, to all intents 
 and purposes, people surrounded by the same in- 
 fluences and exposed to the same degree of con- 
 tagion and infection and only a small percentage 
 acquire the disease. We have no doubt about 
 many other of the contagious and infectious dis- 
 eases, because effect and cause can be grasped at 
 one time, and a majority of persons subjected to 
 the same exposure in the same circumstances be- 
 come infected. And, so, then, we have to study 
 this disease — tuberculosis — in the same manner 
 in which we have to study consanguinity — that 
 is, by taking whole communities or nations, as it 
 were, and if we find in one country immunity 
 from tuberculosis in the human race and no 
 tubercular cattle associated with it, and in an- 
 other community, notoriously tubercular, drink- 
 ing milk and eating meat from domestic inbred 
 animals, then we have the large aggregation of 
 fact that points to but one solution. 
 
 Now, there can be no doubt in the minds of 
 intelligent men as to the methods necessary to 
 render the dairy and beef products safer for hu- 
 
go Scrofula and Tuberculosis. i 
 
 man food. The only conflicting element to what 
 is an obvious and necessary reform would be that 
 inexorable law of compensation. The present 
 methods of breeding our best milk and beef pro- 
 ducers have undoubtedly lowered the price of 
 both these commodities, and with this lowering 
 of price we have entailed on us the tax of disease. 
 If, then, wx wish to avoid this burden and breed 
 our milk and beef animals with health as the ulti- 
 mate aim, milk, at least, will be a far dearer com- 
 modity than it is at the present time, and so the 
 question will be narrowed down to the simple 
 one whether we shall pay eight or twenty cents 
 a quart for milk. I am only aware that it is a very 
 diflQcult matter to make a reform in the methods 
 of cattle breeding that have been carried on for 
 so many generations, and done very often by men 
 who imagined that they were conferring great 
 benefits on the human race. It will only be by 
 constant agitation, and by a constant arraying of 
 facts, as I have suggested, from large areas and 
 long periods, without ever allowing this import- 
 ant question to be narrowed down to individual 
 or isolated cases, as such comparisons of a limited 
 number of facts have always led to hasty, con- 
 fused, and unsatisfactory conclusions when ap- 
 plied to such questions as those of consanguinity, 
 scrofulosis, and tuberculosis. 
 
Scrofula and Tuberculosis. 91 
 
 If a sweeping reform is ever made, as I am 
 convinced it should be, it will only be effected 
 through legislative action, for I am convinced 
 from my experience that our lives are not long- 
 enough to turn some of the cattle breeders from 
 the error of improving, as they deem it, our dairy 
 cows and some of the beef breeds of cattle. 
 
[Reprinted from " The New York Medical Journal," December 20, i8go.] 
 
 THE MIMICRY OF ANIMAL TUBERCU- 
 LOSIS IN VEGETABLE FORMS.* 
 
 At one time I become deeply interested in 
 reading the travels of Livingstone and other 
 brave and noted explorers of Africa, and, while 
 my mind was full of the wonders and mysteries 
 of the Dark Continent, I met a gentleman who 
 informed me that he had resided many years in 
 Africa. I tried to obtain from him information 
 which I had been in search of. I spoke of the 
 geographical problems to be solved and the diffi- 
 culties to be surmounted in civilizing that enor- 
 mous continent, and the whole burden of his 
 comments was that Africa was a great country 
 and would be easily civilized and all obstacles 
 overcome if it was only properly drained. Now, 
 this man's residence in Africa had been confined 
 to the west coast, where the notorious swampy 
 and malarious districts lie, and, because he had 
 not traveled farther or interested himself in the 
 travels of others, he imagined that all Africa was 
 
 ♦ Read before the New York State Medical Association at its Seventh 
 Annual Meeting. 
 
 93 
 
94 Mimicry of Animal Tuberculosis. 
 
 like that portion of the country which he did 
 know would be the better for draining. 
 
 We should all naturally be surprised at the nar- 
 nowness of this man's views, who imagined that 
 an immense continent with snow^-capped moun- 
 tains and rainless deserts of vast extent could be 
 judged from the narrow^ limits of a malarious 
 swamp, where he had resided for a few years; but, 
 on reflection, the idea could not but occur to me 
 that we medical men, in our studies of the Dark 
 Continent of disease, were often as narrow in our 
 views as this man was in his views of Africa. For 
 instance, a very few years ago Koch discovered in 
 a tubercle numerous bacilli, and straightway w^e 
 fancy that the tubercle would be harmless if it 
 were only drained of its bacillus, and we put our- 
 selves to work with hot air, rectal injections, 
 medicated inhalations, etc., imagining all the 
 time that we could subdue this terrible and mys- 
 terious disease and settle all the difficult questions 
 of pathology connected therewith by simply 
 eliminating from the economy the bacillus of 
 Koch. The bacterial region is emphatically now 
 our place of residence; we w^ade through the 
 swamps of pus, blood, and morbid tissues, push- 
 ing aside all other forms and vital processes, after 
 the beckoning specter of a bacillus, and, when we 
 find it, flatter ourselves that we have reached the 
 
Mimicry of Animal Tuberculosts. 95 
 
 goal and discovered all that is necessary to con- 
 quer a disease associated with this small organ- 
 ism. We hardly inquire how it gained its posi- 
 tion, w^hat its functions are other than what we 
 imagine as being concerned in the causation of 
 disease, but accept it as the spirit and soul and 
 prime factor in the cause of pulmonary tubercu- 
 losis. Happily, the tendency now is to break be- 
 yond the bounds of this narrow bigotry; hence I 
 think that a study of some of the vegetable forms 
 that closely mimic animal tuberculosis will help 
 us in our march beyond the narrow swamp 
 through which we are still struggling. 
 
 One of the vegetable diseases which mimic 
 very closely tuberculous animal processes is seen 
 in the nut-gall. The nut-galls are truly tubercu- 
 lar processes affecting the breathing apparatus 
 (leaves) and the nutritive channels (roots) of 
 plants. These galls are among the most puzzling 
 of natural phenomena. It is actually known that 
 the Cynips, or gall-fly, a small insect of the hy- 
 menopterous order, punctures the leaf of a plant 
 or tree, and there deposits an egg, injecting at 
 the same time a very minute drop — the animal 
 itself is only one-tenth of an inch in length — of 
 what is described by entomologists as a poison, 
 but which is, beyond doubt, a digestive ferment. 
 This fluid, injected by the insect into the cavity 
 
\^6 Mimicry of Animal Tuberculosis. 
 
 that holds the ^gg, affects the nutritive process of 
 the plant in such a preponderating manner that 
 it allows the tgg to rest in the cavity without the 
 irritating results of the intrusion of a foreign 
 body, and the extraordinary nutrition caused by 
 the ferment goes on to form the tubercular mass 
 knov\^n as a gall. 
 
 Far more interesting and more closely analo- 
 gous to animal tuberculosis is the disease attack- 
 ing the grape-vine caused by the insect called 
 Phylloxera. Can anything in plant-life more 
 closely resemble a human tubercular lung than a 
 leaf of a grape-vine with the galls of Phylloxera f 
 '' In August, 1835, Luiz de Andrade Corvo pre- 
 sented a paper to the ^Academy of Sciences in 
 which he asserted that the vine disease ascribed 
 to Phylloxera vastatrix w^as really due to a bacil- 
 lus, or rather, according to his description, to a 
 bacterium, w^hich is always found in the tubercles 
 of the radicles and in the tissues of the vine which 
 are affected by this disease, termed by him tuber- 
 culosis. They are also found in the body of the 
 insect, which thus becomes simply the agent of 
 contagion." * 
 
 Now, has not this author narrowed his views 
 down to the bigotry of bacilli-worship? The 
 
 * Microbes, Ferments, and Molds. By E L. Trore-sart. D. Applctoa 
 & Co., New York, 1S86. 
 
Mimicry of Animal Tuberculosis. 97 
 
 presence of a bacterium in this disease of plant- 
 life is only one of many phases of a morbid pro- 
 cess. The bacillus he discovers here is merely the 
 nutritive ferment deposited by all gall insects, 
 and often, as we have already said, called a 
 poison. The Phylloxera vastatrix, like the Cynips 
 querciis, wounds the leaf, deposits its egg in the 
 wound, and besides, injects the bacterium which 
 is the nutritive ferment that produces the gall 
 v/hich characterizes the disease. The following 
 sketch of the natural history of the Phylloxera is 
 taken from John Henry Comstock's Introduction 
 to Entomology: " The grape Phylloxera hiber- 
 nates in the roots of the grape mostly as a young 
 larva of the first or sedentary, agam^ic, wingless 
 form. With the renewal of vine growth in the 
 spring this larva moults rapidly increases in size, 
 and soon commences laying eggs. These in due 
 time give birth to young, v/hich soon become 
 agamic, egg-laying mothers like the first, and, 
 like them, always remain wingless. Five or six 
 generations of these parthenogenetic, egg-bear- 
 ing, wingless mothers follow each other, when 
 (about the middle of June in the latitude of St. 
 Louis) some of the individuals begin to acquire 
 v/ings. Thus is produced the second or migrat- 
 ing agamic, winged form. These issue from the 
 ground while yet in the pupa state; as soon as 
 7 
 
gS Mimicry of Animal Tuberculosis. 
 
 they have acquired wings they rise in the air and 
 spread to new vineyards, vrhere they lay their 
 eggs usually in the dovrn of the under sides of the 
 leaves. Each individual of this generation lays 
 from three to five, and some as many as eight 
 eggs. These eggs are of two sizes; the smaller, 
 which produce males, are about three-fourths of 
 the size of the larger, which produce females. 
 From these eggs are hatched in the course of a 
 fortnight the third or wingless sexual form. Tc 
 is a very remarkable fact that this form emerges 
 from the egg not as larva, but as fully developed 
 individuals. These sexual individuals are born 
 for no other purpose than the production of their 
 kind, and are without means of flight or taking 
 food. After pairing, the body of the female en- 
 larges somewhat, and she is soon delivered of a 
 solitary egg. The impregnated egg gives birth 
 to a young louse, which develops into the first 
 form, and thus recommences the cycle of 
 changes. It has been discovered that sometimes 
 the first form during the latter part of the season 
 lays a few eggs, which are of two sizes like those 
 of the second form, and also produces males and 
 females, which are precisely like those born of 
 the winged form, and, like them, produce the 
 solitary im.pregnated egg. Thus the fact is es- 
 tabUshed that even the winged form is not essen- 
 
Mimicry of Animal Tuberculosis. 99 
 
 tial to the perpetuation of the species. Occasion- 
 ally individuals abandon their normal under- 
 ground habit and form galls upon the leaves of 
 certain varieties of grape-vine. Owing to the 
 great injury this species has done to the vine- 
 yards of France, hundreds of memoirs have been 
 published regarding it. But as yet no satisfac- 
 tory means of destroying it has been discovered. 
 The difficulty hes in the fact that the insecticide 
 m.ust be one that can penetrate the ground to the 
 depth of three or four feet, reaching all the 
 fibrous roots infested by the insect. It must be 
 a substance that can be cheaply applied on a large 
 scale and that v/ill kill the insect without injury 
 to the vine. Where the vineyards are so situated 
 that they can be submerged with water for a 
 period of at least forty days during winter, the 
 insect can be drowned. It is found that vines 
 growing in very sandy soils resist the attacks of 
 the grape Phylloxera. This is supposed to be due 
 to the difficulty experienced by the insect in find- 
 ing passages through such soil." 
 
 Here we have the whole natural history of a 
 bacillary tubercular disease in plants. Notwith- 
 standing the fact that every phase of its life his- 
 tory is well understood and the diseased parts can 
 be seen and handled, yet its treatment is futile. 
 This teaches us the narrowness of our study of 
 
loo Mimicry of Animal Tuberculosis. 
 
 human tuberculosis when we imagine that Koch's 
 discovery of the bacillus placed us in a position 
 to treat this complicated disease. We do not 
 know the m.anner in which the bacillus gains the 
 position it occupies in the tubercular mass, or 
 why it sometimes attacks the lungs, and some- 
 times the glands, and sometimes the bones. Is 
 it conveyed to its position by a host? Nothing 
 we as yet knov/ indicates this supposition except 
 the analogy of vegetable parasites. It is not 
 found in the blood or in the mxuscular juices. The 
 Dresent exclusive devotion to the observation of 
 bacteria would almost preclude the detection of 
 host if one did exist. Crookshank, in an appen- 
 dix to his work on Bacteriology, says: "When 
 examining blood, the bacteriologist must be pre- 
 pared to meet the minute organisms, which at 
 the first glance under moderate amplification 
 may be mistaken for vibrionic or spiral forms of 
 bacteria. The organisms referred to belong not to 
 the vegetable but to the animal kingdom. They 
 may occur associated with disease; but they ap- 
 pear to be more commonly found in the blood of 
 apparently perfectly healthy animals." Thus the 
 fact is stated by good authority that parasitic 
 anim.als do exist in the blood. 
 
 This is not the only parasite to illustrate the 
 mimicry of animal and vegetable morbid forms. 
 
Mimicry of Animal Tuberculosis, ioi 
 
 There are myriads of parasites, and parasites on 
 parasites, in the descending scale to the minutest 
 forms. Thus all vital activity is kept in unison; 
 nothing is allowed to die; one Hving organism 
 ceases that others may continue, and the others 
 in turn are dissolved to continue other phases of 
 vital activity. The little germ that robs man of 
 his vitahty undoubtedly conveys that vitality to 
 some other living organism, thus forming a link 
 in the endless chain of organisms in action. 
 
 Another form of change not parasitic is sug- 
 gestively analogous to the bacillary tubercular 
 phenomena. The yeast plant is a germ, and un- 
 doubtedly Pasteur's noted researches on the life 
 history of this plant formicd the starting point for 
 the universal study of bacteriology to-day. No 
 thinking man could have followed his reasonings, 
 conclusions, and deductions without concluding 
 that all febrile conditions at least were the result 
 of the growth of germ-life, producing ptomaines, 
 extractives, etc. There are many phases of alco- 
 holic fermentation that mimic the morbid pro- 
 cesses of bacillary phthisis. 
 
 Thus we know that the presence of the tuber- 
 cular germ in the mouth or other parts of the 
 body is not always followed by tuberculosis. 
 Analogously we know that the presence of yeast 
 germs in a saccharine solution does not ahvays 
 
102 Mimicry of Animal Tuberculosis. 
 
 give rise to alcoholic fermentation. The solution 
 must contain less than 20 per cent, of the saccha- 
 rine material. Thus the specific gravity of the 
 solution is the controlling condition in the activ- 
 ity of the yeast plant. The same may be true of 
 the human body. It can easily be understood 
 that in the human body the specific gravity may 
 vary. Thus an exceedingly fat and juicy body 
 would be of lighter specific gravity than a closely- 
 knit, hard, muscular body, and undoubtedly the 
 specific gravity of the body has something to do 
 with the miorbid action of many of the germ 
 phases of disease. Nor is this all. Before Pas- 
 teur's enlightening investigations it Vv^as sup- 
 posed that the yeast germ was contained in the 
 atmospheric dust, but Pasteur proved conclu- 
 sively that this was not the case. He admitted 
 atmospheric air and its dust into sterilized tubes 
 of proper saccharine solutions for the growth of 
 the yeast, but the alcoholic fermentation v/as 
 never set up in solutions thus treated. Then the 
 question arose, Where did the yeast plant come 
 from? and further study revealed the fact that 
 all kinds of fruit contained on their surface a germ, 
 termed by En gel " apiculated ferment " (car- 
 pozyma.) This is a hibernating germ, and, un- 
 less the fruit is bruised and its containing sugar 
 in due proportion brought into contact, the 
 
Mimicry of Animal Tuberculosis. 103 
 
 g-erm will not grow or produce its special 
 changes. This plant does not in any way resem- 
 ble the ordinary yeast plant unless it is modified 
 by its growth in a fermenting fluid. May we not 
 then easily suppose that some germ-forms exist 
 normally in the animal tissues prone to tubercu- 
 lar diseases, and only develop into the forms in 
 which we find them when some anterior morbid 
 process has been developed? This idea is con- 
 cisely expressed in a paper read before the Nev/ 
 York Medical Association, March 17, 1890, by 
 Dr. James R. Leaming, a gentleman who has 
 grown old in the study of this disease. He says: 
 " I have seen no case of phthisis that could not 
 be accounted for satisfactorily without supposing 
 infection or contagion. I can say more. I have 
 seen no case of phthisis where there was a proba- 
 bility of primary infection with no other cause. 
 
 " The first physical evidence of dead atoms in 
 the system is their extension from the capillaries 
 into the pleural cavities, as damaged leucocytes 
 or ptomaines by physical diagnosis and this may 
 be done before the presence of the bacilli can be 
 detected in the sputa. The bacillus is consequent, 
 not causative; it is true that ptomaines are in the 
 blood before the expression of the leucocytes, but 
 as a rule, not in abundance sufficient to attract 
 the germs." 
 
104 Mimicry of Animal Tuberculosis. 
 
 This explanation of one phase in the develop- 
 ment of tubercular disease will coincide exactly 
 with the development of alcoholic fermentation 
 in the case of grapes. Thus on the surface or in 
 connection with the grape is a hibernating germ, 
 and this germ is never brought into activity un- 
 less the grape is bruised and forms a solution, 
 when the germ becomes active and changes the 
 sugar into alcohol and other products of fermen- 
 tation, wdiich mimic the formation of ptomaines 
 in the animal economy. 
 
 There are many other forms of vital processes 
 outside of the animal body that mimic its morbid 
 processes. All these forms are complicated, 
 many of them mysterious, and associated with an 
 interminable train of anterior and subsequent 
 evolutions to the germ activity. My object in 
 alluding to those enumerated is only to shovv' the 
 apparent fallacy of our imagining that because 
 we have discovered the presence of a minute 
 germ, w^e are also in possession of sufficient 
 knowledge of the morbid processes associated 
 with this germ to indicate a rational mode of 
 treating the disease wdiere the germ exists, with- 
 out knowing definitely how much other condi- 
 tions outside the germ have to do with the pro- 
 cess. It has ever been one of the characteristics 
 of scientific men to make sweeping and hasty de- 
 
Mimicry of Animal Tuberculosis. 105 
 
 ductions from the discovery of some one un- 
 doubted fact. I do not in any manner wish to 
 detract from the honor and brilHancy of Koch's 
 discovery, but I wish to protest against the tend- 
 ency of the medical mind to-day to hang every- 
 thing on the bacihus. For instance, if the bacillus 
 was the only cause of tuberculosis, it would have 
 to be viewed in the light of a foreign body within 
 the tissues, and we know that foreign bodies al- 
 ways set up inflammatory action and subsequent 
 suppuration, which is not always the history of 
 tubercular processes. These are sometimes or- 
 ganized or cretefied. There is a germ disease 
 where the morbid processes depend on the germ 
 and the germ alone, and an abscess is ahvays 
 form-cd by this germ (actinomycosis) and a clean- 
 ing out of the abscess and total eHmination of the 
 germ cures the morbid process. But I think the 
 presence of the tubercular bacilli must be viewed 
 in somewhat the same light as the nut-gall of 
 Phylloxera. In this the presence of the eggs is 
 not the cause of the tubercular growth, because 
 if the &gg alone were deposited in the leaf it 
 would act as a foreign body; it is the material that 
 is injected into the leaf at the same time as the 
 &gg is deposited which sets up such an action in 
 the nutritive processes of the leaf that the irrita- 
 tion of the egg is entirely overcome. 
 
io6 Mimicry of Animal Tuberculosis. 
 
 Without much stretch of the imagination we 
 can imagine the giant cell as occupying the posi- 
 tion in the tubercle of human phthisis that the 
 egg of the Cynips occupies in the nut-gall. Ac- 
 cording to this view, the bacillus would be the 
 nutritive material causing the growth of the 
 tubercle. These surmises and similes could be 
 carried on ad miinituni, but I think the mimicry 
 is suggestive enough to indicate to us that there 
 is vastly more to be known of human tuberculosis 
 than merely that a germ is present in a mass of 
 morbid material. 
 
ONE OF THE APPARENT REASONS 
 
 WHY MAN IS AFFLICTED WITH 
 
 TUBERCULOSIS.* 
 
 The human race is grievously afflicted with 
 tuberculosis, and it seems to be an old, old enemy 
 to man. There is no organ or structure in his 
 entire anatomy that is not subject to the invasion 
 of the minute forms which make in man's econ- 
 om.y, somewhere or anywhere, a tubercle for 
 their residence. There is no other disease 
 that is so capricious, so versatile, and so decep- 
 tive. It is unlike other diseases, because there is 
 no constant road in which it travels; it attacks 
 all ages and conditions under any and all appar- 
 ent circumstances. Often and again man will 
 imagine he has been able to make out the source 
 of this stream of death, and finds, after years of 
 study and research, other numerous sources that 
 are just as much entitled to the distinction as the 
 first discovery. For many years it was estab- 
 lished with apparent truthfulness that the disease 
 w^as a hereditary affection, but, when the dead- 
 house was entered and the foetus in the womb of 
 
 * Read before the American Social Science Association, August 31, 1893. 
 
 107 
 
io8 Tuberculosis. 
 
 the victim was inA^estigated, it was found that 
 with very rare exceptions, indeed, did the minute 
 organism which characterizes the disease ever 
 pass the gates of the placental circulation, and 
 so, to-day, it is not classed as a hereditary affec- 
 tion, but as an acquired disease. We are quite 
 confident at the present timic that true tubercu- 
 losis is the result of the presence and growth of 
 a small organism that invades the tissues and 
 makes for itself a local habitation, which we term 
 a tubercle from its resemblance to a tuberculous 
 plant. At first it is insinuating and almost if not 
 quite imperceptible, and, like Uriah Heep, very 
 humble, but, as the colony increases and its 
 abode enlarges, it begins to assert its presence, 
 sometimes by simply stimulating the activity of 
 the structure it invades, and later the entire 
 economy takes on an increased activity, bodily 
 temperature is increased, the blood circulation is 
 accelerated, nutritive processes are impaired, 
 waste exceeds repair, and the tuberculous abode 
 of his majesty, the bacillus, breaks down into 
 ruins, and the crumbling walls enter the river of 
 life, which thus becomes putrid, and sepsis over- 
 powers the victim. As to the little germ that 
 causes the calamity, we know not whence it 
 came nor whither it goeth after its dire work is 
 accomplished. 
 
Tuberculosis. 109 
 
 Man is not the only animal afflicted with tuber- 
 culosis. Undoubtedly, more deaths occur among 
 the members of the human race than among the 
 lower animals, but there are far more dairy cows 
 infected with tuberculosis, in proportion to their 
 number, than in the human family. There is one 
 very good reason why fewer deaths occur among 
 dairy animals than among mankind, and it was 
 this discovery, which I am about to relate, which 
 led me to the conclusion that the cow was the 
 mischief-maker. 
 
 The reason that the tuberculous cow is not 
 often killed by the tuberculous process is found 
 in her high natural bodily temperature. We 
 know pretty conclusively that the tubercle bacil- 
 lus requires for its growth and multiplication a 
 temperature above the normal human bodily 
 heat, and, curiously enough, the raised tempera- 
 ture of the human subject that is pathognomonic 
 of the growth of tuberculous masses is the nor- 
 mal bovine temperature. Consequently, tubercle 
 will grow in the cow without any disturbance of 
 her normal temperature, and the train of evil 
 consequences that follows the effects of increased 
 bodily heat does not occur in the cow from an 
 invasion of tuberculosis. Therefore, the process 
 goes on in the animal, and, unless other morbid 
 conditions supervene to increase the bovine tern- 
 
no Tuberculosis. 
 
 perature, the tubercle does not break down and 
 cause sepsis, which is ahvays the cause of death 
 where the primary disease is tuberculosis. When 
 the cow dies of acute miliary tuberculosis some 
 other than the existing tuberculous disease has 
 supervened to increase her temperature and in- 
 terfere with the normal condition of the tubercle. 
 And right here is another curious fact — namely, 
 that as some other condition than tuberculosis 
 must arise in the cow to cause the breaking down 
 of the tubercle when it exists, so, contrariwise, 
 some other morbid aitection than tuberculosis 
 must first increase the temperature in the human 
 subject before the tubercle bacillus can com- 
 mence his morbid antics. When the tubercle- 
 building has commenced by reason of a proper 
 high temperature, the growth of the tubercle and 
 the fermentative action of the multiplication of 
 the bacillus will of itself continue the required 
 heat, and this continued increased temperature 
 is suf^cient to lower nutrition and resistance, and 
 consequently the tubercle finally breaks down, in 
 man without the intervention of any other mor- 
 bid condition, as is required in the cow, to cause 
 the same septic condition that kills both. 
 
 Now let me enumerate some of the causes 
 alleged as accounting for the presence of tuber- 
 culosis in man, and you will see that all of these 
 
Tuberculosis. m 
 
 causes are at work with our dairy animals under 
 the present modes of breeding and feeding in 
 the so-called best milk breeds. 
 
 First we will consider breeding. Vigor and 
 robustness in the offspring are undoubtedly 
 maintained by the union of individuals not con- 
 sanguineously related. Consanguinity will 
 always attenuate the vigor of any breed of ani- 
 mals. Close in-and-in breeding decreases the 
 size, increases nervous intensity, promotes early 
 maturity, and lowers the resistance to disease by 
 reason of the delicacy of the muscular tissue. In 
 other words, to use an old-fashioned term, con- 
 sanguinity produces scrofula. Scrofula is a con- 
 dition which we all recognize as one which seems 
 to make the individual prone to phthisis. 
 
 ScrofulojLis females in the human race usually 
 secrete an abundance of milk, because in scrofula 
 there is an unusual tendency of glandular en- 
 largement and activity. As the mammary is the 
 highest type of glandular structure, it is 
 stimulated to increased action. A scrofulous 
 cow is usually the largest milker, and the closest 
 kind of consanguinity has been practiced by 
 cattle-breeders, with the object of producing a 
 scrofulous animal, not because she is scrofulous, 
 but because the particular form she represents 
 are the largest yielders of milk. We find, too. 
 
112 Tuberculosis. 
 
 that consanguineous breeding has been alleged 
 as one of the causes of tuberculosis in the human 
 race, where it never can be conducted with so 
 close and intimate blood relatives as in the dairy 
 animals. So here we have at work in the cow 
 one of the alleged causes of tuberculosis in man. 
 
 Next in regard to climate. The absence of 
 phthisis in high, dry, mountainous regions has 
 been accounted for by reason of the altitude and 
 absence of moisture in the atmosphere; but here 
 occurs a somewhat curious fact — namely, that 
 the cow dairy does not thrive in hrgh, dry, moun- 
 tainous districts, but in the low, swampy, moist 
 region, where the succulent and lush grasses 
 grow, is the place where the cow flourishes, and 
 it is in these regions also that tuberculosis 
 abounds in both the bovine and human subjects'. 
 
 No name has shed more light on the history 
 of phthisis than that of Laennec, who himself 
 died of a pulmonary phthisis, and he said that he 
 knew of no more certain cause of this disease 
 than profound or prolonged grief or melancholy. 
 In the dairy we often see the variety of 
 grief represented by " Rachel weeping for her 
 children." The maternal instinct is a strongly- 
 marked characteristic in the dairy cow, and, 
 as grief is one of the minor conditions which 
 
Tuberculosis. 113 
 
 favor the development of tuberculosis in man, 
 it must be allowed as a factor also in the case of 
 the cow. 
 
 There is no doubt that nutrition plays as im- 
 portant a role, aetiologically, in the development 
 of tuberculosis as any other single factor outside 
 of the actual presence of the bacillus. Defective 
 nutrition, either from lack of variety, insufficient 
 quantity, or interference with the nutritive func- 
 tions in any manner, all cause lowered resistance 
 to such an extent as to favor the invasion of 
 tubercular infection. This is true as relating to 
 the human race, and we must give it some weight 
 as a factor in the development of tuberculosis in 
 the lower animals. Owing largely to the cheap- 
 ness of milk, if the dairyman is to feed his animals 
 with the materials most favorable for nutrition, 
 food must be cheap and stimulating to glandular 
 structures. With rare exceptions do we ever 
 find the cow getting the whole grist of any of the 
 nutritious grains. The materials classified by 
 the dairyman as the best food for cows are the 
 refuse from hominy mills, starch factories, glu- 
 cose factories, breweries, distilleries, and, in fact, 
 every refuse that is left after working up the 
 nutritious cereals and getting the best out for the 
 nourishment, of some other animal. Even on 
 the farms the poorer varieties of hay and grasses 
 8 
 
114 Tuberculosis. 
 
 are always designated as cow food. So we have 
 here at work in the dairy animal another alleged 
 cause of tuberculosis in man. 
 
 Phthisis in the human subject is most fre- 
 quently associated with sedentary occupations. 
 Tailors, seamstresses and other hand workers 
 present more than the usual percentage of deaths 
 from this disease. The same is true of the vic- 
 tims of forced confinement from whatever cause. 
 Baer's statistics of prisons show among the in- 
 mates a mortality four times as great as outside. 
 While the average total mortality of phthisis is 
 15 per cent, of the total mortaHty of the world 
 at large, in prisons it amounts to 40 or 50 per 
 cent. The mortality of manufacturers is twice 
 as great as that of outside occupations, while the 
 cloisters of the Old World show a phthisis mor- 
 tality of 50 per cent. 
 
 During the winter months the cow is, as a 
 rule, subjected to close and prolonged confine- 
 ment in an ill-ventilated and foul stable, and if 
 confinement can be considered a factor in the 
 development of the disease in man, it must be 
 reckoned as a factor^with the dairy animal. Pro- 
 longed lactation is another cause of phthisis in 
 the human subject, but no woman is subjected to 
 so prolonged and continuous lactation as is re- 
 quired of the dairy animal. 
 
Tuberculosis. 115 
 
 From the time that she is two years of age or 
 under she is milked continuousl}^ with the ex- 
 ception of a few weeks before her parturition; 
 and not only is she milked, but she is pregnant 
 during the greater part of the time that she is 
 yielding her milk. And so we might go on to 
 enumerate other conditions that have been 
 accounted as causes of the disease in the human 
 subject, and we should find them all at work in 
 the dairy and some of them even intensified in 
 the case of the cow. Therefore is it to be won- 
 dered at that the cow^ is a tuberculous animal? 
 And if the disease is contagious and conveyed 
 from one animal to another, what other animal 
 associated withmiankind is more likely to convey 
 to him. this fell disease? Man is more closely 
 associated with the dairy cow than with any 
 other of his domestic animals. He drinks her 
 milk and eats her flesh, and if she harbors the 
 germ we can see that every condition in her life 
 and her peculiarly high normal temperature, the 
 degree of w^hich is precisely that required for the 
 propagation of this organism as we -understand 
 the life history of the tubercle bacillus, favors its 
 transmission. Is it unnatural to suppose that 
 man becomes infected from this animal? And 
 so one of the apparent reasons why man is af- 
 flicted with tuberculosis is found as a conse- 
 
Ii6 Tuberculosis. 
 
 quence of his grave errors in feeding and caring 
 for one of the most useful and numerous of his 
 domesticated animals. Furthermore, I am still 
 convinced of the fact that where the inbred scrof- 
 ulous cow exists, there tuberculosis in all its 
 forms prevails among the human race, and where 
 this animal is absent the inhabitants enjoy an 
 immunity. 
 
THE DANGER OF MILK FROM TUBER- 
 CULOUS COWS.^ 
 
 The domesticated bovine animal appears to 
 be, above all other animals, subject to tuberculo- 
 sis. This animal is capable of bearing the tuber- 
 culous processes in their natural state — that is, 
 without breaking- down and producing sepsis, 
 which is the cause of death in the disease known 
 variously as phthisis, consumption, and so forth. 
 In other words, a dairy cow will have fulfilled her 
 functions with profit to her owner, and only 
 when she reaches the butcher is it discovered 
 that tuberculous growths are present in various 
 parts of her body. No other animal that I know 
 can be tuberculous for so long a period without 
 exhibiting evidences of the disease, and hence 
 the diagnosis of this disease in the domestic cow 
 is often a very difficult matter. 
 
 The reason why the domestic cow bears the 
 tuberculous processes without their breaking 
 down is by reason of her natural bodily tempera- 
 
 * Read at the Annual Meeting of the New York State Medical Society, 
 
 1892. 
 
 117 
 
ii8 Milk from Tuberculous Cows. 
 
 ture, her normal average temperature being 
 T02j°. This I have ascertained from personal 
 observation on hundreds of apparently healthy 
 animals, extending over several years. This is 
 about the temperature that arises in the human 
 subject during the stage of active tuberculization, 
 and this high temperature in the human subject 
 is a prominent etiological factor in the constitu- 
 tional disturbance, eventuating in the breaking 
 down of the tubercle that leads to the sepsis 
 producing death. Now, this normal tempera- 
 ture of the covv' admits of the growth of the 
 tubercle without constitutional disturbance, and 
 consequently the animal's resistance is retained 
 and tuberculous processes attain enormous pro- 
 portions without affecting the general health or 
 usefulness of the anim.al. Therefore, in order 
 that a cov/ miay develop the tuberculosis that 
 kills, some other morbid agency (traumatism, 
 puerperal septicaemia, etc.) must supervene to 
 setup the breaking-down process in the tubercle. 
 When acute miliary tuberculosis takes place in 
 the cow, old tuberculous processes are always 
 found, and the temperature is then increased 
 only a degree and a half. Acute miliary tuber- 
 culosis in the cow^ is a comparatively rare disease, 
 and hence many dairymen, cattle-dealers, and 
 breeders imagine that tuberculosis is rare, or 
 
Milk from Tuberculous Cows. 119 
 
 more rare than is reported to exist in dairy cattle, 
 for this reason alone, or because so few cases die 
 in comparison with the number of animals 
 afifected. Therefore, these men do not see the 
 latent evidences of disease, their standard of per- 
 fect health in dairy animals being the ability of 
 the animal to perform its functions with profit 
 to its owner; and having no comparative stan- 
 dard of health, they regard the animal as sick 
 only when it refuses to yield milk or fatten for 
 the butcher. 
 
 Now, what is the danger of milk from tuber- 
 culous cows when used as human food? Of 
 course, an animal affected with acute miliary 
 tuberculosis that kills — and this is the only form 
 of tuberculosis that kills an animal — in this form 
 the milk-secretions are suppressed very soon 
 after the onset of the general infection; and, as 
 the disease is comparatively rare, milk from these 
 animals is not so common as the literature on the 
 subject would lead one to suppose, while the 
 chronic latent form of the disease is always more 
 or less present in the ordinary dairies that supply 
 milk for food; and it is very safe to assume that 
 everyone that drinks milk as it is furnished to 
 cities takes milk from animals affected with tu- 
 berculosis — the chronic form always, the acute 
 form occasionally. So the question, as it seems 
 
I20 Milk from Tuberculous Cows. 
 
 to me, should be, When is the human subject fit 
 to take the milk from tuberculous cows with im- 
 punity? for there can be little doubt but that in 
 a robust state of health the human being can 
 ingest with impunity the food from tuberculous 
 animals, and probably in many conditions of im- 
 paired health such food can be taken wdthout 
 apparent danger. Of course, tuberculosis can- 
 not be studied in the same light as other infec- 
 tious diseases, because the introduction of the 
 poison into the system to-day may require a year 
 or ten years before it is developed into a disease. 
 It is, therefore, almost utterly impossible for 
 anyone to say in a giA^en case where the infection 
 came from. In the studv of this disease, takinsf 
 isolated or individual cases, where apparent 
 cause and effect stood in close relationship, it is 
 simply a coincidence, and is highly misleading. 
 I have watched the medical literature on the sub- 
 ject very carefully for a number of years, and 
 there are a fevr cases cited where the evi- 
 dence pointed strongly to the domestic cow as 
 the direct source of the infection. In other 
 cases, in v\hich I have myself known children 
 brought up on the milk of tuberculous cows, no 
 evil has as yet resulted, and I have never been 
 able to associate any case of tuberculosis in the 
 human subject, infant or adult, directly with a 
 
Milk from Tuberculous Cows. 121 
 
 tuberculous cow. I know a girl to-day, thirteen 
 years old, whose food for two years after wean- 
 ing was mainly the milk of a tuberculous cow. 
 The cow, of course, was then affected with 
 chronic tuberculosis, and ultimately succumbed 
 to general infection. The milk was given to this 
 child directly from the cow, and warm, and the 
 child has always been remarkably healthy. 
 About two years ago a friend of mine wanted me 
 to see his cow and say what was the matter with 
 her. I found her suffering from acute pulmon- 
 ary tuberculosis of the miHary type. She was 
 killed, and we found old tuberculous processes 
 in the mesentery glands. These were not 
 broken down, but a large mass in the medias- 
 tinum was broken down, and seemed to be the 
 source from whence the general infection spread. 
 The laryngeal glands were also chronically en- 
 larged. This was a family cow, and furnished 
 three children of the household, aged respect- 
 ively from tv/o to seven years, with their daily 
 supply of milk. These children, all of remark- 
 ably robust health, are perfectly well to-day. 
 But this kind of negative testimony proves no 
 more than the positive testimony that has been 
 thus far accummlated. The disease must be 
 studied, not by isolated cases, but on a broad 
 field. There are some ludicrous instances in the 
 
122 Milk from Tuberculous Cows. 
 
 history of the disease illustrating the fallacy of 
 drawing deductions from circumscribed observa- 
 tions: '' In 1677 twelve students who had taken 
 their repast in the Consistorium of Leipsig, died. 
 At the inquest it was proved that the hotel- 
 keeper had given them, in addition to other food 
 of a bad description, the flesh of emaciated and 
 infected cows, w^hose viscera were covered with 
 a great number of vesicles, of tubercular nodules, 
 and of purulent tumors. Externally this flesh 
 did not offer any abnormal appearance." In the 
 light of our knowledge in the present day it is 
 safe to assume that, whatever else these students 
 may have died from, it was not simply the tuber- 
 culous meat that killed them. Nevertheless 
 this unfortunate accident stirred up an exagger- 
 ated public feehng on the continent of Europe, 
 and most countries passed stringent laws. Three 
 years after the Leipsig accident the German 
 States enacted very severe measures to prevent 
 the sale of meat from tuberculous cattle. 
 Butchers were afraid to have anything to do with 
 animals showing the least trace of the disease; 
 the carcasses, and even the instruments used in 
 slaughtering such cattle, were turned over to the 
 public executioner. These measures involved a 
 heavy loss to the cattlemen; and it was found 
 that the executioners did not destroy the dis- 
 
Milk from Tuberculous Cows. 123 
 
 eased carcasses, but consumed them in their own 
 families or sold them to others, and that no in- 
 jury resulted from the use of this flesh. Then the 
 pendulum began to swing in the opposite direc- 
 tion, and the medical men began to teach that 
 tuberculosis was not a contagious disease, and 
 that the flesh could be eaten with impunity. In 
 fact, the meat of tuberculous cows was publicly 
 advertised as of good quality. Zuierlioz, a doc- 
 tor of medicine and philosophy at Bruckenau, 
 took twenty-five pounds of flesh from a tuber- 
 culous ox and ate it, in order to show that such 
 meat was not injurious. This doctor also pre- 
 pared a broth made from the tuberculous 
 nodules of the ox, and drank it in the market- 
 place before a large number of people. Then 
 about this time the various governments began 
 to rescind the various stringent regulations, and 
 the prejudice against the use of such food ceased 
 to exist. Now, in our day, with the increased 
 knowledge we possess as to the etiology of the 
 disease, stimulating increased discussion and en- 
 larging the literature on the subject, the public 
 are in danger of adopting the same unreasoning 
 prejudice. I say '' unreasoning prejudice," not 
 because I underestimate the danger of the pres- 
 ence of tuberculous animals as food-producers, 
 but because the methods heretofore adopted are 
 
124 Milk from Tuberculous Cows. 
 
 inadequate and one-sided. I firmly believe that 
 all the tuberculosis that afflicts the human race 
 is derived from the domesticated bovine, be- 
 cause the only people on the face of the earth 
 who enjoy immunity from tuberculosis are those 
 who do not harbor domesticated tuberculous 
 animals. If this broad statement is true, what 
 does it signify? Can we control the disease by 
 condemning animals only when they come to 
 the butcher, and allowing the milk to be used 
 until he makes the diagnosis for us? If con- 
 sumption is a contagious disease, and the human 
 race stands in danger of the contagium coming 
 from their most useful food animals, would it 
 not be wise to regulate the breeding of such ani- 
 mals? There are bovines that are reported to 
 enjoy a total immunity from tuberculosis, and so 
 it is possible for us to produce a breed that will 
 not menace the human race. But until the vast 
 number of earnest workers who are moulding 
 medical and scientific opinion unite their forces 
 in this direction, and until we get an animal not 
 tuberculous, wx must use our best efforts to 
 avert the dangers that now threaten us. I do 
 not believe that anybody can tell at what stage 
 of tuberculosis in the cow the milk is safe or be- 
 coming dangerous. We have statistical facts 
 enough pointing to the morbid conditions in the 
 
Milk from Tuberculous Cows. 125 
 
 human subject creating a receptivity to the con- 
 taeiuni. We know that nearly 50 per cent, of 
 diabetic subjects are carried off by pulmonary 
 phthisis. Surely we should guard a patient with 
 this disease from the possibility of contagion; 
 also in all other conditions of emaciation and 
 lowered resistance in the adult. With children 
 1 have no doubt that the danger is far greater, 
 as their food is solely or chiefly milk. I sincerely 
 believe that a child in perfect health can take the 
 milk of a tuberculous cow with impunity; but a 
 child that is born with a feeble constitution, or 
 of tuberculous parent or parents, or suffering 
 from cachexia, or any of the wasting diseases, 
 should not be allowed to have milk from a tuber- 
 culous cow, no matter what stage of the disease 
 miay exist in the cow. As to sterilizing or boil- 
 ing the milk for these children, the process may 
 or may not eliminate the disease germs — and we 
 have pretty good evidence that boihng does not 
 — but we are certain that either process lowers 
 the nutritive value of a food already belov/ par 
 (if from a tuberculous cow) by reason of the dis- 
 eased condition of the animal itself. So in the 
 same cases where the milk of tuberculous ani- 
 mals is to be prohibited, the absolute necessity 
 of the highest type of food also necessitates the 
 exclusion of boiled or sterilized milk of any kind. 
 
126 Milk from Tuberculous Cows. 
 
 As all cows are not tuberculous, it is perfectly 
 feasible to select animals to supply infant food. 
 As, however, the chronic forms of tuberculosis in 
 the dairy cow are not easily recognized, the medi- 
 cal man knows little or nothing about the cow; 
 and, as the American veterinary schools have 
 paid less attention than the subject deserves, 
 there are few people who are able to detect the 
 earlier symptoms. The necessity for more 
 definite knowledge of the cow herself by all 
 practitioners is evident, so that when it becomes 
 necessary to prohibit the use of food that is apt 
 to kill, there should be more people able to de- 
 tect the morbific conditions at work in the food- 
 producing animal. We can safely assert that in 
 our time tuberculosis will not be entirely elim- 
 inated from the dairy cow. We are approaching 
 the period when it will be; meanwhile, therefore, 
 let us guard the susceptible, and aid in the ad- 
 vance toward the annihilation of one source of 
 danger to the human race. 
 
[Reprint from New York Medical Journal, August 14, 1897.] 
 
 WHAT MUST WE DO TO BE SAVED 
 FROM TUBERCULOSIS?* 
 
 You may remember the story of Paul and 
 Silas: During their missionary work in Thya- 
 tira they found a young woman possessed of a 
 spirit of divination; they removed from her this 
 spirit, and thus interfered with her masters, who 
 used her as a means of making m^oney. The 
 apostles were imprisone'd for interfering with a 
 commercial enterprise, and while they were in 
 prison an earthquake occurred that destroyed the 
 building, and by this means all the prisoners were 
 released. The jailer in his intense chagrin at the 
 escape of the prisoners, v/as about to commit 
 suicide when Paul cried out to him, '' Do thyself 
 no harm! " and he, knowing that Paul and Silas 
 possessed a knowledge of salvation, said to them, 
 " Sirs, what must I do to be saved? " 
 
 Now, in almost the same spirit of missionary 
 enterprise, we are trying to cast out an evil spirit 
 
 * Read before the Medical Society of the County of Westchester, N. Y., 
 
 May, 1897. 
 
 127 
 
128 What Must We Do to be Saved? 
 
 from a bovine female; this female represents a 
 great business interest, and many of the men who 
 own this female do not want us to interfere with 
 their com.mercial interests, but the people, like 
 the frightened jailer, are calling out to us, '' Sirs, 
 v^hat must we do to be saved? " I think it can 
 be safely said that many of us know that our 
 present condition is dangerous. Both by omis- 
 sion and commission we are far from saving 
 grace. The taint of consumption is in us and 
 also in our neat cattle, and in this respect there is 
 no health in us. Therefore the gospel question 
 naturally occurs, What must v;e do to be saved? 
 There is a coincident distribution of bacillary 
 tuberculosis in the human and bovine species. 
 This disease can be conveyed from one anim_al to 
 another. W^e eat and drink the meat and milk 
 of the dairy cow, and this animal only comes in 
 contact by association with a very sm.all propor- 
 tion of the humian race. In her food she takes 
 nothing that was part of us, while we drink her 
 milk as lonsf as she lives and then devour her 
 body. Each single animal is thus distributed as 
 food to hundreds of the human order. If the dis- 
 ease can be conveyed in food it requires no argu- 
 mient to point out which of these species, the hu- 
 m.an or bovine, is most dangerous to the other. 
 I have repeatedly stated what I still firmly be- 
 
What Must We Do to be Saved? 129 
 
 lieve, that all the tuberculosis afflicting the hu- 
 man race comes from the dairy cow either di- 
 rectly or remotely, but to avoid argument, it is 
 safe to say that if the dairy cow were not afifected 
 with tuberculosis there would be much less of this 
 affliction in the human race. So, to answer the 
 question, we can say, " Cure the bovine race," 
 and this can not be done with the political syringe 
 man. It can only be accomplished by rational 
 hygiene, proper breeding, feeding, and treatment, 
 and when the attempt is made to cure it in this 
 manner many of you will be saved as surely from 
 tuberculosis as Paul and Silas thought the fright- 
 ened jailer was saved from sin. 
 
 In looking back over marked episodes in the 
 history of the human race, one characteristic 
 stands out in bold relief, and that is the tendency 
 of the human famil3^ when some great discovery 
 is made, to go to either extreme and thus delay 
 the enjoyment of the discovered golden mean 
 that lies always between the two extremes. 
 
 The history of vaccination is an illustration; so 
 is the development of the common-sense cleanli- 
 ness into Listerism. In truth, virtue lies between 
 two extremes, and both of these extremes are 
 vices. Between foolhardiness and. cowardice 
 there is true courage; between the miser and the 
 spendthrift is the prudent man. Now, there lies 
 9 
 
I30 What Must We Do to be Saved? 
 
 before us the great and virtuous necessity to 
 eliminate from the bovine race the taint of tuber- 
 culosis. This virtuous necessity lies between two 
 extremes; one is to let matters alone, the other 
 is represented by the frantic efforts of State 
 boards to stamp out the disease by killing a few 
 of the animals afSicted, and not attempting to in- 
 terfere with the conditions that generate the dis- 
 ease. The present effort to stamp out tuberculo- 
 sis from the dairy cattle of this country is as ab- 
 surd as it would be to attempt to stay an epidemic 
 of typhoid fever by killing every one who con- 
 tracted the disease and paying no attention to the 
 source of contagion. I have watched carefully 
 for years the action of State authorities in their 
 attempts to eliminate tuberculosis from the dairy, 
 and I firmly believe that more positive injury has 
 been done by their extreme variance from the 
 proper course than would have resulted from 
 leaving the matter entirely alone. Let me give 
 you an illustration among the many I have ob- 
 served. I know one dairy that has been visited 
 twice by inspectors with syringe and lymph. 
 This stable has always been positively dirty, ill- 
 ventilated, with poverty and carelessness to make 
 all the other conditions just necessary to develop 
 tuberculosis in an improperly bred animal. The 
 inspectors have killed off their quota of animals 
 
What Must We Do to be Saved? 131 
 
 from this stable and, without hygienic, dietetic, 
 or any other improvement in the environment or 
 care, the owner was simply left poorer, and so 
 forced to buy a lower grade of cows, to fill his 
 denlike place with more tuberculosis. There 
 must be a cause for the large number of cows that 
 are afflicted with tuberculosis, and is it not ordin- 
 ary plain common-sense to assume that the place 
 to attack the disease is at its fountain head? We 
 all know that close confinement, poor food, pro- 
 longed lactation, early and prolific maternity, 
 consanguineous breeding, all or any of these con- 
 ditions favor the development of bacillary tuber- 
 culosis, and all these are the common conditions 
 of the dairy, with the addition of dirt and care- 
 lessness. The statute laws of this State and of 
 many others in the Union are sufficient, if hon- 
 estly and conscientiously enforced, to make a bet- 
 ter beginning in stamping out the disease than if 
 ten times the amount of money that had been 
 asked for by the different State boards of health 
 had been granted and put into the hands of the 
 politicians as pay for working the syringe, lymph, 
 and thermometer. 
 
 There is no branch of domestic science that has 
 been so studiously neglected as bovine pathology. 
 The term '' cow doctor " has always been used 
 among veterinarians as a designation of stupidity. 
 
132 What Must We Do to be Saved? 
 
 When I began the study of bovine medicine I 
 could not find anywhere in the world a text-book 
 giving the correct bovine temperature. The 
 veterinary colleges have kept equine, canine, and 
 even feline pathology up to the times, but the 
 cow in the college has received the same treat- 
 ment that she has on the farm, been put into the 
 basement to get what nothing else would take — 
 the refuse. 
 
 What we want is intelligent bovine veterin- 
 arians, men who do not require Koch's doubtful 
 lymph, but those who are possessed of a proper 
 knowledge of the hygienic conditions necessary 
 to insure the health of animals, and to discover 
 the existence of other diseases. Tuberculosis is 
 undoubtedly a devastating scourge to the human 
 race, and it comes largely if not entirely from the 
 bovine race. We can have dairy cows that are 
 not afflicted with it, but not by waiting till they 
 contract the disease, and then killing them. The 
 disease itself will do the killing if it is given time. 
 What w^e want is doctors who can prevent and 
 thus cure without killing, and such doctors can 
 save thousands of infants' lives by eliminating 
 from the dairy other diseases and conditions that 
 go w^th tuberculosis in our dairies, but that kill 
 quicker than tuberculosis. This can be largely 
 accomplished without any change in the present 
 
What Must We Do to be Saved? 133 
 
 laws: All that is required is honest and intelli- 
 gent bovine veterinarians. The spirit which at 
 present seems to animate some dairy inspectors 
 is revealed by the following letter which I quote 
 from the Medical Review of Reviews: 
 
 " Dr. J. M. O'Neil, of Buffalo, writes to the 
 editor of the Buifalo Medical Journal as follows: 
 Sir: I send the following account of some cases 
 which have been brought to my notice, exempli- 
 fying the manner in which the bacilli of tubercu- 
 losis may be conveyed through the agency of 
 milk. The details of the following cases have 
 been supplied to me by a veterinary inspector, 
 who was engaged in his duties in Cattaraugus 
 county, some sixty miles distant from Buffalo. 
 When there he was requested by a farmer to in- 
 spect and test his two herds of cows. He com- 
 plied with the request, and in the first herd, num- 
 bering eighty, he found eight to be infected with 
 tuberculosis, and in the remaining herd he found 
 twenty-five out of a total of thirty animals, in- 
 fected. A neighboring farmer then asked the in- 
 spector to test his herd. He did so and found 
 all healthy. The calves bred from some of the 
 cows were then tested, and it was discovered that 
 many were infected. The owner of the calves 
 gave as a very plausible reason for the infection the 
 fact that he was in the habit of buying skim milk 
 
134 What Must We Do to be Saved? 
 
 and buttermilk, with which to feed the calves, 
 from farmers living in the immediate district, and 
 among others from whom he procured this milk 
 was the farmer whose herd the veterinary inspec- 
 tor had tested and found several of the cows to 
 be suffering from tuberculosis. Of course, the 
 foregoing account only goes further to prove the 
 already well-known fact of the danger of spread- 
 ing contagion by milk ... In these particular 
 cases, however, the danger affects Buffalo rather 
 closely, for I also ascertained from the inspector 
 that milk from these diseased herds was daily 
 brought into Buffalo and sold on the streets by 
 peddlers. The names of the peddlers were, as a 
 matter of course, withheld from me." 
 
 If it were not sad it would be funny to see a 
 great State like New York paying dairy inspec- 
 tors to discover the source of m.ilk supply that 
 conveys tuberculosis to calves, and refusing to 
 give the physician the necessary information that 
 would enable him to guard his patients who were 
 in peril from the same source. But, then, this 
 inspector is not called on to kill the babies if they 
 contract the disease, but it means more work for 
 him if the disease is scattered among the herds of 
 cattle in his district. This ridiculous condition of 
 affairs will continue until honest common sense 
 indicates to our health authorities how to attack 
 
What Must We Do to be Saved? 135 
 
 the great danger emanating from the cow stables 
 all over the land. What is the whole foundation 
 of Listerism but cleanliness? If the surgeon of 
 years ago had been told that he was criminally 
 filthy when he carried his instruments in a beau- 
 tiful-looking, deep-piled, velvet-lined case, and, 
 after opening a malignant abscess or bubo, he 
 simply wiped his instrument, to make the blade 
 bright and prevent it rusting, he would have re- 
 sented the accusation as a malicious libel. But 
 to-day he could be convicted of criminal careless- 
 ness for the same thing by a due process of law. 
 Antisepsis is just plain, common-sense cleanli- 
 ness. Dirt has been defined as matter in the 
 wrong place. Growing plants thrive and flourish 
 in the presence of material that is foul and nox- 
 ious to grov\^ing animals. There is nothing dirty 
 or filthy when it is in the right place. Cow dung, 
 urine, and effete matter from the lungs and skin 
 will make healthy fodder for the animals that 
 eliminate it when the material is put in the right 
 place under proper conditions. But cow dung 
 plastered over the sides of the cow, or allowed to 
 accumulate in the living place with the animal 
 that drops it, standing constantly in the dung and 
 urine she herself makes, besides fouling the air, 
 gives rise to foot-foul and other painful afflictions 
 that are markedly debilitating; breathing over 
 
136 What Must We Do to be Saved? 
 
 and over again the same air must lead to pulmxon- 
 ary susceptibility to disease; feeding on the refuse 
 matter from distilleries, breweries, glucose and 
 starch factories must tend to nutritive ailments, 
 and all these common conditions of our dairies 
 generate a marked susceptibility to profound 
 constitutional diseases of which tuberculosis is 
 the chief. Many people who are not familiar 
 with the condition of a large number of our dairy 
 stables may imagine that there is some exaggera- 
 tion in the foregoing statements, but I have never 
 seen any one who, without previous knowledge 
 of the existing conditions, after having made an 
 inspection of a number of dairies furnishing milk 
 for food, has not returned v\^ithout a profound 
 disgust at the state of affairs. It is not uncom- 
 mon to find fifteen or twenty cows confined in a 
 damp basement where no effort is made to ob- 
 serve cleanliness, and every effort possible is 
 made to exclude external air during the cold 
 weather, and thus the cows are kept warm by 
 their own reeking breath, made doubly noxious 
 by the accumulating filth and the stench from the 
 refuse food. 
 
 The milk from these animals is received in ves- 
 sels seldom or never properly cleaned, and taken 
 to be bottled or canned into the dwelling-house, 
 where poverty and a natural tendency to shiftless- 
 
What Must We Do to be Saved? 137 
 
 ness make everything as dirty as it is possible to 
 be. I will guarantee to direct anybody to dairies 
 where the foregoing conditions prevail and the 
 milk is sold for infant feeding. Will any reason- 
 able man af^rm that the State is doing its whole 
 duty w4ien it sends an inspector to such a stable 
 to kill a few of the cows and do nothing more? 
 The following is the State law that applies to just 
 these cases, and is copied from the Revised Stat- 
 utes, vol. i, under the head of Dairy Products, 
 sec. 12: 
 
 " The Proper Care of Cozvs, and using Diseased 
 Milk in Making Articles of Food. — No person shall 
 keep cows for the productions of milk for market, 
 or for sale or exchange, or for manufacturing the 
 same or cream from the same into articles of food, 
 in a crowded or unhealthy condition, or feed the 
 cows on food that is unhealthy, or that produces 
 impure, unhealthy, diseased, or unwholesome 
 milk. No person shall manufacture from impure, 
 unhealthy, diseased, or unwholesome milk, or of 
 cream from the same, any article of food. Who- 
 ever violates the provisions of this section is 
 guilty of a misdemeanor, and shall be punished 
 by a fine of not less than twenty-five dollars nor 
 more than two hundred dollars, or by imprison- 
 ment of not less than one month nor more than 
 four months, or by both such fine and imprison- 
 
138 What Must We Do to be Saved? 
 
 ment for the first offense, and by four months' 
 imprisonment for each subsequent offense. 
 
 Would it be unreasonable to assert that the 
 enforcement of this section of the statute would 
 do more for the stamping out of tuberculosis 
 than all the efforts that have heretofore been 
 made by State authorities? I have kept pretty 
 close watch of the work being done in this State 
 by the authorities whose duty it is to enforce the 
 laws relating to dairies, and I have yet to see 
 where any one has ever been apprehended for a 
 violation of the above section, and I know that 
 this section of the law is frequently and largely 
 violated. The greatest number of prosecutions 
 has been against the oleomargarine dealers. 
 
 This may be proper commercially, but from 
 our point of view, as medical men, it would be of 
 greater benefit to the health of the State to let 
 the imitation butter alone and improve the health 
 of our cattle and the purity of the product de- 
 rived therefrom. 
 
 I have often been asked why I do not bring 
 proceedings against violaters of the law if I know 
 of such cases; but, as I myself keep cows and sell 
 milk, my motives, if I took such action, would be 
 liable to misconstruction. Now, to sum up, what 
 I would recommend, if my opinion were asked, 
 would be, first and foremost, to educate inspec- 
 
What Must We Do to be Saved? 139 
 
 tors to a thorough knowledge of the conditions 
 necessary to breed and feed and care for dairy 
 stock in such a manner that there would be the 
 least possible disease and danger; and then an 
 unbiased enforcement of the law as it exists to- 
 day, turning the commercial supervision into an- 
 other channel. In fact, the bureau of agriculture 
 of the State of New York takes good care to-day 
 of the commercial interests involved in the dairy 
 business. 
 
 For the immediate improvement of our milk 
 supply, I would recommend the formation, in 
 every community, of a society of dairy supervis- 
 ion; this society to be composed of doctors and 
 veterinarians, who will make rules to govern 
 dairies in their vicinity, and who will certify as to 
 the quality of milk supplied to the community by 
 dairy men who are willing to obey and positively 
 carry out the rules of the association. This to be 
 called " approved milk." Probably one of the 
 greatest obstacles to the proper conduct of a 
 dairy is the low price of milk, and if this associa- 
 tion of dairy supervision was properly conducted 
 the '' approved miilk " would command a better 
 price. When milk is produced, as it ought to be, 
 for the health of the community, it must bring a 
 larger price than it commands now. 
 
 When it is not possible or advisable to form 
 
140 What Must We Do to be Saved? 
 
 dairy supervisory associations, if our local boards 
 of health, instead of making health codes that are 
 never enforced, would inspect the dairies in their 
 vicinity and, where they found any that were 
 filthy and contained diseased cows, report this to 
 the dairy inspector of their district, and, if the in- 
 spector would not perform his duty properly, 
 proceed against him. In this manner the laws as 
 they exist now could be enforced, and thus the 
 dairy cow would become what she should be — a 
 useful and not a dangerous animal. 
 
COMMENTS. 
 
 Regarding the last paper in this latter book, it 
 may not be amiss to print a few comments. 
 Nearly every paper in the series has received 
 some sort of criticism or commendation, but 
 these recent communications will indicate 
 slightly just how the subject is attracting atten- 
 tion. 
 
 Philadelphia, Pa., Feb. 7, 1898. 
 
 E. F. Brush, M. D., 
 
 Mount Vernon, N. Y. 
 Dear Doctor. — Your article, '' What Must We 
 Do to be Saved from Tuberculosis? " a reprint of 
 which you kindly sent me, is truly science up to 
 date. I congratulate you on your good work. 
 With best wishes, 
 
 Sincerely yours, 
 
 J. J. TAYLOR. 
 
 Washington, D. C, January 4, 1898. 
 Dr. E. F. Brush, 
 
 Mount Vernon, N. Y. 
 Dear Sir. — Please accept my thanks for a copy 
 of your little pamphlet entitled '' What Must We 
 Do to be Saved from Tuberculosis," reprinted 
 from the New York Medical Journal of August 
 14, 1897. I have been much interested in the 
 paper, and if you can spare them, I will thank 
 your for two or three additional .copies for the 
 
142 Comments. 
 
 use of this office. The printed franks which I 
 enclose will bring the pamphlets by mail free of 
 postage. 
 
 Very truly yours, 
 
 HENRY E. ALVORD, 
 Chief of Dairy Division. 
 
 Port Jervis, N. Y., Jan. 5, 1898. 
 E. F. Brush, M. D., 
 
 Mount Vernon, N. Y. 
 
 Dear Sir. — I am in receipt of your address and 
 am delighted with it. It is the first gleam of 
 common sense that I have seen on the subject 
 coming from your profession, and I thoroughly 
 appreciate it. 1 should like to pubHsh it in our 
 columns, and if you do not object, I will do so. 
 For that purpose I would need another copy, 
 if you can spare one. 
 
 I congratulate you on the paper; it is full of 
 wisdom and it should go in the hands of the 
 State Board of Health and especially of the 
 Tuberculosis Commiission — that committee who 
 have done nothing but bleed the taxpayers and 
 breed a senseless scare. I am sincerely obliged to 
 you for the paper and remain, 
 
 Yours respectfully, 
 
 E. G. FOWLER. 
 
 Haughville, Ind., Feb. 15, 1898. 
 Mr. E. F. Brush, M. D., 
 
 Dear Sir. — I was reading a short piece in the 
 Dairy World, headed, " What Must We Do to 
 
Comments. 143 
 
 be Saved from Tuberculosis?" as a title of a 
 pamphlet, and as I am a dairyman, I would like 
 very much to read the little book. Inclosed 
 please find stamp for reply. 
 
 Yours truly, 
 
 A. E. FRAZEE. 
 
 [From the Albany, N. Y., Express, Dec. 28, 1897.] 
 
 THE TUBERCULOSIS QUESTION. 
 
 ''What Must We Do to be Saved From 
 Tuberculosis?" is the title of a paper read by Dr. 
 E. F. Brush, of Mount Vernon, before the Medi- 
 cal society of the county of Westchester, which 
 was published in the New York " Medical Jour- 
 nal " and has now been issued in pamphlet form 
 for general distribution. 
 
 Dr. Brush agrees with the State Board of 
 Health in its belief that the prevalence of tuber- 
 culosis in human beings in due largely to infec- 
 tion from milk and the meat of cows; but he as- 
 serts that the Board is not proceeding in the 
 right manner to eradicate tuberculosis among 
 cattle. He reasons justly that the kilHng of cat- 
 tle that are found to be infected can do compara- 
 tively httle toward the accomplishment of the 
 main purpose while the conditions that breed 
 tuberculosis are allowed to remain. In short, 
 he points out that the State Board of Health 
 does not strike at the root of the evil because it 
 does not adopt measures to prevent the develop- 
 ment of the disease. 
 
144 Comments. 
 
 Dr. Brush directs attention to the neglect 
 which bovine pathology has suffered. The vet- 
 erinary colleges have kept the study of equine, 
 canine and even feline pathology up to the times, 
 but the term " cow-doctor " is used among 
 veterinarians as " quack " is used among healers 
 of the human species. Intelligent cow^-doctors 
 are needed; men who have a proper knowledge 
 of the hygienic conditions necessary to insure 
 the health of cattle, who can prevent and elimi- 
 nate tuberculosis from the dairies without whole- 
 sale slaughter. 
 
 New York, Feb. 28, 1898. 
 
 When you can find nothing only the Bible to 
 use to advertise your milk, you are a sorry man, 
 and I will neither countenance your advertising 
 nor your milk in any way. 
 
 A. N. Y. M. D. 
 
 February 28, 1898. 
 My Dear Dr. Brush, 
 
 I have just read your reprint, " What Must 
 W^e Do to be Saved From Tuberculosis?" I 
 also read your article in the New York Medical 
 Journal. I feel that you should be encouraged 
 in your work. 
 
 Yours sincerely, 
 
 W. H. BATES. 
 
DUE DATE 
 

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