WILLIAM F. WAUGH, M. D.
CHICAGO, ILL.

THE blood-vessels and collateral channels of the circulation carry to every part of the human body, to every cell of the countless number that make up our frame, one common nutritive fluid. From this each cell takes up that which it needs, letting the rest pass by. But what does it need?

If the cell is exactly equilibrated, if it stands in need of nothing, it takes up nothing. But if any element for which the cell has use is present in less than normal quantity, the cell takes up enough of that element to restore physiologic equilibrium.

There is a selective power displayed here, for the cells each takes up substances differing according as their respective functions and constitutions differ. Accordingly we find the nerve-cell taking up phosphorus, the bone-cell lime, the muscle-cell iron, etc. One cell takes a substance for which it has need, passing by other substances which other cells need and take. Is each cell a distinct, conscious entity, and is the selection a voluntary one? Or is the whole process governed by a wonderful system of complex, interdependent automatism? There is here an enticing field for conjecture and card-house building, unrestrained by the trammels of real knowledge -the fancy may have full sway.

The substance thus absorbed from the circulating fluids by the cells are usually denominated foods. Foods may be defined as those substances required by the cells to support their structure and sustain their functions. The need may be for a molecule of fat, sugar, albumen, salt, acid, water, lime, soda, iodine, phosphorus, etc.

But the need is not necessarily for material always. It may be that there is a defect in tonicity in the cell, and the need is supplied by a molecule of strychnine; and in that case the cell takes up the latter exactly. as it did the other substances for which a need was experienced. Or, the need may be such as is met by a molecule of aconitine, or veratrine, or digitalin-the cell absorbs what will satisfy its needs as felt at the moment.

But, these are medicines!

I would like to have a definition of foods and one of medicines that would distinguish these. There is evidently no hard and fast lines between them-is there any line at all? Is iron a food or a medicine? lime? manganese? acetic acid? phosphorus? iodine potash? It has been suggested that a food is a substance the need for which is constant, while a medicine is needed occasionally to

some others, has a decided craving for a meal of sauer kraut about once in a winter; but would not care for it three days in succession (it is always on the second day, you know). The man who attempts to eat a quail a day for forty days soon finds that his need for quail is only occasional, not constant. Sauer kraut and quail, therefore, are not foods but medicines!

There is no definition that establishes an essential, or other than a scholastic, difference between foods and medicines.

We have seen that each cell takes what it needs, and leaves what other cells need and take. What is there impossible then in supposing that when we place several medicines, apparently antagonistic in their action, .together in the circulation, each cell may take the drug it requires to restore physiologic equilibrium, leaving the antagonisic agent unabsorbed for the cell that needs the latter? To deny the possibility of this would be to erect a dividing wall between the foods and the medicines which we have been unable to so separate.

We speak of antagonistic drugs, but in truth it is a question if there is a really and absolutely antagonistic couple in the materia medica. One drug may excite and another restrain a secretion, like the sweat; but it will be found that one stimulates the sudoriparous gland while the other restrains the flow of blood to the skin, or acts on some other structure to check the flow.

The importance of this discussion lies in the fact that when we come to study the phenomena of disease we find antagonistic conditions present in different parts of the body. Take as the most apt example the oftquoted case of hyperemia: The presence of an over-supply of blood in the capillaries of any part signifies a loss of the moral tone of its vessels, which admit the surplus blood by distending. This constitutes a vasomotor paresis. But as there is no reason to suppose that the entire quantity of blood in the body has been increased, this over-supply here must be compensated by an under-supply elsewhere; in other words, there are other vessels not normally full, their lumen diminished, their walls therefore abnormally strong as compared with their contents, the balance between the centrifugal and centripetal pressures lost-they are spastic-vasomotor spasm is present.

Strongly favoring this view is the fact that it fully and for the first time explains the good results following the application of the diametrically opposite principles in the treatment of the hyperemic maladies. How else can we explain the excellent results ob

tained in pneumonia by those who use the vasomotor constrictors, strychnine, digitalis and ergot, in maximal dosage: and the equally favorable results reported by equally credible witnesses from veratrum, venesection, antimony and aconite? Especially as either of these succeeds far better than the middlecourse people who do neither, but rely on rest and non-interference? According to ths view the one who relaxes the spastic vessels and allows the blood to flow out of the pyheremic tract, and the one who contracts the paretic capillaries and forces the superfluous blood out, equally meet the indication and afford relief.

Burggraeve went a step further, and recommended that both principles be applied at once, taking the view above suggested, that the paretic cells could take up a tonic like digitalin or strychnine, and the spastic cells a relaxant like aconitine or veratrine, at one and the same time. If this be correct, it is evident that be have here a more effective method of treating hyperemias than either principle as applied singly affords.

The a priori reasoning leading up to this conclusion is faultless-it remains to apply the supreme test of clinical trial. There is a mass of evidence on the affirmative side, and little if any on the negative. But it is fortunately a case in which every physician may himself be judge and jury; where none of us take any other man's dictum, for we may one and all put the theory to the test of practical clinical application.

Give together aconitine to relax spasm, and digitalin to contract atony; adding strychnine when the vital depression predominates or veratrine when the excitement of the circulation and respiration pass the desirable limits, and the elimination is notably defective; changing from one to the other of these adjuvants as the symptoms indicate, but clinging to the two first named. Give each to produce the desired effect, not by the rigid dosage of the books. Treat the patient and meet the conditions presenting instead of giving a set formula for the name of the malady.

For the convenience of those unfamiliar with the agents and methods here advised, the following suggestions are added:

Of amorphous aconitine, give half a milligram-gr. 1-134-every ten to sixty minutes to an adult, until the fall of the fever or of the pulse-rate, or the evidences of breaking up of the fever, indicate a sufficiency of the remedy; then give less frequently so as to sustain the desired effect.

Of Germanic digitalin so-called-really digitalin-give a milligram-gr. 1-67-every half hour till the heart is regulated, its

rhythm uniform, and the hyperemic vessels are restored to normal tone as well as may be ascertained with our present means of observation; then regulate the dosage to the needs as with aconitine.

When the evidences of vital depression are manifest, as in asthenic pneumonias, add strychnine arsenate, half a milligram, every ten to sixty minutes until the desired evi. dences of restored tone and reaction are manifest; then as before, regulate the succeeding doses according to the needs.

When the heart is tumultuous and the eliminants are clogged, as in sthenic pneumonias especially, add to the basal aconitine and digitalin the powerful and safe veratrine, half a milligram every half to one hour— much oftener in eclampsia-until the softer pulse, or slight nausea or laxation, evidence the full desirable action; then as before, less. frequently. It is quite possible that we one day find the veratrine indicated and the next day find the depression so predominating that we change to strychnine; and perhaps next day go back to veratrine.

The application of such a system demands of the physician a close and discriminating study of the phenomena developing in every case. There is no prescribing en masse, no stretching every patient on a procustean therapeutics. Is such a necessity really to be regarded as an objection to the method?

What bearing would the admission of this selective action have upon the question of the status of the cell. Is the cell an independent, conscious entity, governed by its own volition, or is its function wholly directed by chemotaxis?

Let us begin with the ameba, as it is found floating free in water. Transfer it to the slide of the microscope, aud we see it move, extrude its pseudopoda, etc.-an independent, complete being, its life processes and reproduction exerted by itself as a separate being and not as a part of or dependent on any other animal or organism whatever. Between this and the highest type of animal there is no place at which a line can be drawn, separating these governed by conscious volition, and and those which are not so governed, which dividing line is natural and evident, not arbitrary.

Place beside the ameba on the microscope slide a white blood cell; and see if the two can be distinguished. What can be said of the one that can not apply equally to the other? They are indistinguishable in every respect.

If we cannot draw our line between the ameba and the leucocyte, still less can we draw it between the latter when floating free in the water on the microscope slide, and

when floating in the blood serum. Change of environment does not constitute a reason for transfer from one primary class to another. For the same reason we find it difficult to make the dividing line between the leucocyte and the same cell when it has assumed a stationary position as part of an endothelial wall. Nor between that and the epithelial cell; nor that and the other cells of the body.

The hypothesis of chemotaxis seems to be generally accepted, as the preferable working one for the phenomena of cell action; but rather from an unwillingness to admit the alternative hypothesis of independent cell volution than from any special testimony. But of the two the latter seems to be at least the most convenient, since we find writers constantly employing its language to describe the conditions presenting. And this is the more significant in that it is usually done unconsciously.

THE RELATION OF MAN TO NATURE (A STUDY PROMPTED BY "TESTIMONIES OF THE SEPULCHRES").

ALBERT S. ASHMEAD, M. D.

NEW YORK.

TWELFTH PAPER.*

God, in short, according to the theistic doctrine virtually addresses each human being thus: "I have made you in order that you should be perfect, even as I, your Father, am perfect. My love for you, and my desire for your perfection are so vast, that you yourself individually, might be the only thing made by me, and the whole end of creation might be the welfare of your single soul. Moreover, My power and wisdom being equal to My infinite love for you, all the processes of Nature with which your existence is connected have been ordered by Me in the way best fitted to endow you with all the faculties and dispositions necessary for the kind of life that I require of you, and with the circumstances which will best enable you to bring them to full development."

Do

But what are the facts of this evolutionary process in reality when considered in relation to the individual human being? they show that the intelligent God of erolution possesses a character to entitle Him to use such language? The evidence afforded by the cruelties of Nature show that the controller of nature cannot be wholly benevolent.

*The first paper of this series appeared in the MEDICAL FORTNIGHTLY issue of April 25, 1905.

The realization of preconceived types of the human race could not be called benevolent to

human beings as such. For the majority would be failures. And even if the final result was order and beauty, the means employed by the Omnipotent Designer would be terrible. This was the argument of Romanes. If God, therefore, be omnipotent, why did he not arrange that all men should be spiritually perfect from the first, instead of requiring evolution to make them perfect?

Bishop Gore says: "If the world is scandalized by the slow development and slow spread of revealed truth, the church has an answer which is as complete as it is short and gentle. 'You are ignoring,' says the church to the world. 'the gradualness of the spirit's methods.' The apologists of Russian autocracy might, with just as much reason, answer those who condemned the recent massacres in St. Petersburg, by saying, 'You are ignoring the violence of the Little Father's methods.' The answer which the world makes to the church is this: We are not ignoring the gradualness of the spirit's methods at all. The gradualness of the methods is precisely which we criticise and arraign." In fact the church instead of refuting the critcism of Darwinian science against the moral methods of Nature, merely relates it in a more precise and more appalling form. The more fully it is admitted this deliberate purpose on the part of an Almighty God is revealed in the evolutionary process, and the more clearly it is realized that the birth and growth of Christianity is an example of the same process, the more hopeless becomes the task of reconciling that process with the conception of a Christian God as good, or with whom man has any concern at all.

Pascal wrote more truly than he himself knew when he said, "Whoever judges of the Jewish religion by its coarser forms, will misunderstand it." The spirit of this remark should be applied to all religions, to all peoples, to every individual. Pick out the best, around which all can rally, and altruistically save it by weeding out and away with the weeds as far as the law of evil will permit. At least have charity. Why agnosticism should, as Mr. Dickinson says, be devoid of enthusiasm of delight," I cannot conceive. Let us not sit crying for the moon, while "the wonder and wealth of the mine" lies unopened at our feet. There are indeed besides, other things of value in the universe besides happiness and joy, and these things are often forgotten by those who argue for suicidal pessimism on purely hedonistic grounds. But one part of virtue itself is the temperament by the strength of which a man accepts the inevitable. Temperament is a quality; a

constitution not an acquisition; the temperament that times experiences "high states of exaltation" will by operation of the law of its form experience states of deep (more or less, depression-reactions; or will commit in discretion, and be penalized. And the world. will call it Free Will.

Man from the first has been acquainted with agreeable and disagreeable sensations. The former he called "good," the latter "evil." And these names were extended to what caused these sensations, so that they came to cover ethical qualities, then abstract principles, which in time becaine deified and demonized respectively. In this way God and the Devil came into being. But the natural tendency to exaggerate the importance of that which we like over that which we dislike led to the creation of an absolute personal God pure goodness, a conception impossible to reconcile with the counter principle of evil. All attempts to resolve this contradiction has been futile. Milton imagined envy to have crept into the quiet breast of an unchanged. Others tell us that evil is a purifying process, which will cease when its work is done; but good and evil are coeternal and each necessary to the existence of the other. But evil is not necessary if God is omnipotent goodness! goodness! Some writers speak of "the divine nature in which God at first made us" as having been lost. This is mere assumption. And they say further that there is nothing "so sure as that God is love and is ever seeking to draw men out of their fall into oneness with himself. This is a most surprising statement. What a weak inefficient God! They say that war cultivates this mystery like that of music, the Grail, the love-feast and withal Olympus and Elysium of the industrial age. Where the gods walk, the dryads dance, fauns frolic and Persephone gathers her flowers. The lovers of the beautiful-alas for our modern folly are banned the guest in their crafts; but they may not snatch an hour at the keyboard or fiddle-bow and behold her floating before them in a haze of falling notesbecause it stirs the pulse of valor; merriment, for it may be the very soul of dance; religion by its deeper song of one kind with conscience, and the sacred emotions. must we overleap the conscious life, which neither number nor matter in any wise explains. While science points some promising lines of research and philosophy accentuates the certitudes of intuition in a day when ratiocination alone has respect.

But

Without the whisper of a sound the mind can set in motion a melody never heard; and once shapen, it seems a thing inevitable, organic, alive. But music like life is the inter

play of rest and unrest. From one key of size or sentence to another it is conceivable that the life may pass as naturally as the electric message through the air. To those, then, who dogmatically assert that there is no life save in this little ferment of oxygen and carbon, where into our senses are keyed and co-ordinated, it may safely be replied that, on the contrary, there may be life, sentiment and intelligent within and without us, as actual and assured as our own, we to and it to us as tennis aura thin air, unintelligible, unseen and unheard. The brain is indeed a cosmos like the universe; conscience makes the vortical stability of the conscious, life; the moral laws are the inward counterpart of those outward laws, which materialistic monism, a philosophy more aptly described as immoralisim (unmoralism) calls it mechanical process, in which we may discover no aim or purpose whatever, an eternal fluctuation with no trace of a moral order.

As Newman Howard says, "It was a great saying of a great modern scientist that the universe was (is) infinite in an infinite num

ber of ways. Then the polyhedral limitation may be limitations only of our intelligence. And in that case in all the successions of music of soul, so palpable and perfect to the inner sense, we may be spelling out new laws of a new being. It is a guess, a wild guess, perhaps; yet, whatever may be the undiscovered which squares the inequations of life, when we learn that music, the felt reflex of the soul's rightly regulated emotion, is also a mirror of the central universal laws, we may put aside the arid and hideous prospect of materialistic immoralism (unmoralism) and gain assurance in the swift certitudes of intuition, believing not without proof, that 'beauty is truth, truth beauty;' that is all ye know on earth and all ye need to know.'

Curiosty is not only a principle that leads to knowing, but a principle and process of growing.

To

Truth is a kind of reality characterized by the phenomena of growth and of becoming; it does not admit of ultimate definition. that right is no_characteristic striving of a class of men. It is a common aspiration. Only the stuff of thought is most intractable, formless, like some milky way waiting to be analyzed into distinct star-forms of definite ideas.

Is time an element in evolution? Some thinkers say that Time, and they say perhaps rightly, is an illusion. They have only to press this to extremes, and presently they will become unwilling to catch a train, or to ask what o'clock it is. not follow that

How paltry.' How paltry." It does because our life and that of

the animals are branches of one fundamental vitality, we are wrong in speaking of different races of men and discriminating them from quadrupeds, and fishes and birds. May it not even be just as variety of matter exists, so it is not unlikely that variety of spirit exists.

Truth cannot but be the breath of the nostrils of every genuine scientific man. That which is not true, that is that which contains no element of truth cannot but be bad and hideous. Herbert Spencer says: Debarred as we are, from everything beyond the relation, truth, raised to its highest form, can be for us nothing more than perfect agreement, throughout the whole range of our experience, between those representations of things which are distinguished as ideal, and those presentations of things which we distinguish as real. Man can drift like other animals and often does; but we can also obey our own volition. But how do we know that we have volition?"Our ancestors invented legends to account for our kinetic psychology, legends of apples and serpents and the like," says Sir Oliver Lodge. But the fact is there, however, it be accounted for. The truth embedded in that old Genesis legend is deep; it is the legend of man's awakening from a merely animal life to consciousness of good and evil, no longer obeying his primal instincts in a state of thoughtlessness and innocence a state in which deliberate vice was impossible." But the reasoning is very weak and unworthy of the writer, unless it is to be regarded as an admission that God is the cause of misery on earth.

The universe is in no way limited to our conceptions; it has a reality apart from them; nevertheless they themselves constitute a part of it, and can only take a clear and consistent character in so far as they correspond with something true and real. Whatever we can clearly and consistently conceive, that is ipso facto in a sense, already existent in the universe as a whole; and that, or something better, we shall find to be a dim forshadowing of a higher reality. This is the creed of Sir Oliver, and optimistic though it be, he says, it seems to me the only rational creed for a man of science, who, undeterred by any accusation of dualism, realizes strongly that our entire selves, our thought, conceptions, desires, as well as our perceptions and our acts are all "but parts of one stupendous whole, whose body Nature is, and God the soul."

This optimistic creed does not relieve God of accountability for all the terrible distresses on earth. He is the cause. Variety of spirit exists; ergo the spirit of evil exists. Truth

is a relative fact, whether the fact be good or evil. Truth as an ideal is never reached, is

always relative. The Eden allegory is to show that the ideal life was destroyed by the Creator-that is to say, is impossible under the law of God-of Nature; and that man "a passenger on the planet" was smashed by forces over which he had no power of resistance. It is absurd to say that he there awoke to a new sense, except that he was a victim of misplaced confidence. There are two forcesgood and evil, and man is a ball tossed between them.

The belief in miracles, in heaven, in an atonement-regarded popularly as the washing away of the stain left upon the world by past evil-are beliefs by which religion seeks to justify its conviction that of the world seen as a whole it can be truly said, "Behold it is very good." Whatever may be the ultimate truth about space and time, to the imagination at any rate these are indispensable forms. Catholicism produces in its adherents a certain aristocratic temper founded on fact, half on sentiment. The Catholic Church is built non sine numine, we may believe, on a long and intimate knowledge of human nature. Her sacraments, her ritual, her liturgy compass our life from birth to death with an atmosphere of blessing; her hands, like that of the spouse in the Canticles, drop with myrrh. Be her shortcomings what they may, she appeals strongly to the feelings and the imagination; separation from her involves too great a strain to be undergone with impunity. Were we called upon to plan a religion for ourselves we could no doubt, frame one on larger lines. But our lot is cast with that of our fellows; our position is inherited, not made.

As to the problem of evil. Christian theology is involved in a plain contradiction in ascribing evil to the will of a being, who is all-powerful, all-good, and all-wise. If people insist on asserting that "God is all," "God is good, "we must accept the conclusion that follows, namely, "there is no evil." Those who insist that God is all, must accept the devil as an aspect of God, or deny that God is purely good.

But

God, according to some, allows evil, in the sense in which a good father allows a headstrong son to learn from experience. here it is forgotten that the power of the human purest is limited by external conditions over which he has no control. If these same external conditions apply to God, then God is not all. This argument holds up to the light the goody goody rot, that has been long fed to the world. As to the atonement, we have as facts the express assertion of the sufferer, that the "Son of man, came to give His life a ransom for many, and the declaration of St. Peter, that Christ also suffered for