| TISSUE-SELECTION IN THE GENESIS OF DISEASE. |
By W. HENRY KESTEVEN, M. R. C. S.
IT has occurred to the writer that the adoption of the germ theory of disease necessarily involves the application of the theory of evolution, and that here may be found a means of accounting for the genesis of the various forms of disease. Germs are living matter; they must therefore be under the influence of those laws and forces which condition all living matter. The most important of these, or the one that most interests us in the present connection, is the law of natural selection; and it must be that germs, in common with other forms of life, are under the influence of this law in some shape. Natural selection is a general term which embraces all other modes of selection, or provision for the "survival of the fittest." Among these is sexual selection, and, taking a broad view, we may also include selection by man. In order, then, to the attainment of greater exactness, may we not give a name to that form of natural selection which has been potent in bringing about the variations in the characteristics of those germs to which the differences in the forms of disease are due? Such a term may be found, I would suggest, in "tissue-selection," as indicating the special means whereby the constitution of the germs has been modified. The actual origin of the bodies which have received the names of germs is not at present determinable, and to say that they do not originate de novo, in decaying matter or elsewhere, is only to reaffirm the axiom now pretty generally admitted, Omne vivum e vivo. The fact that meets us here is that these germs, call them bacilli, vibriones, bacteria, or what we will, are met with almost universally in the atmosphere that we breathe. It is with the "why and the wherefore" of their existence that we are concerned. In looking for this, it will be necessary to consider the facts of the life-history of these germs, and to try to discover how they have been and are influenced by their surrounding conditions. We find that the conditions favorable to the full vital activity of these germs are a moderate temperature, moisture, and a resting-place or nidus in some organic matter whose chemical constitution enables it to afford the pabulum necessary for the maintenance of their existence. On the other hand, the influences antagonistic to their well-being are excessive heat or cold, the action of certain chemical bodies, and a condition of dryness. The last is certainly prejudicial, as it seems to hinder their full vital activity. At the same time it can not be considered absolutely obnoxious, as it is the means which favors their locomotion in the atmosphere. Putting aside, for the mean while, the thermometric and atmospheric conditions, we shall see that the
