complexion, thick hair, good digestion and nutrition, and high blood pressure. The man is prone to corpulence and premature signs of old age. Such persons are liable to arthritic affections of all kinds and to diseases of the heart and blood vessels, angina, fatty heart, aneurism, atheroma and apoplexy." Graham Brown enumerates then the signs of the nervous constitution in a similar way. Then follow the bilious, lymphatic, strumous, gouty and rheumatic constitutions.

You will readily notice the inconsistency of this classification turning from individual peculiarity to morbid changes. A "strumous," "gouty" or "rheumatic" condition is pathologic and a deviation from a certain normal constitution.

A recent classification of constitutions in regard to the predominance of an alkaline or acid reaction of the juices and secretions is of no practical value at all in diagnosis or therapy.

The Century Dictionary defines constitution in general as the assemblage and union of essential elements and characteristic parts of a body. Force is not distinctly set forth if applied to man. It is the same as if we describe feathers, feet and bill of a sparrow, and imagine we study ornithology. We are dwelling on the anatomy of birds and not on their life.

As we stated at the beginning, we mean a force that will "pull the patient through." Neither an anatomical nor a chemical description will answer the purpose. In reality, we have no satisfactory definition of constitution because the idea of force has thus far been left out.

We had a similar experience in the history of science in regard to the conception of work. Until horses were replaced by steam engines, the general understanding of work was that of equality to force. But when Watt and Boulton introduced their steam engines it was of interest to know how much work they could do compared with horse power. It was thought that the average horse makes about two and one-half miles in one hour and lifts at the same time 150 pounds over a roller. By calculation, the formula of a horsepower was found to be equal to a force that lifts 33,000 pounds one foot in a minute. It makes no difference whether a horse does that, or an engine, or whether

an engine does five, ten or one hundred times the amount of work.

We learned that work includes not only force expended in direct accomplishment, but that expended in overcoming all obstacles. The concept of work is modern, and was unknown to the Middle Ages.

But life is also work, and comprehends force directly spent and forces overcoming obstacles. The great question is placed before us: What is the force we observe in the work of life?

Every living body is its own builder and engineer; consequently the force must be within and inherent to the body unlike the driving force of an engine. The true concept of this force is a philosophical problem, whose solution requires a whole series of arguments. We take our arguments from experience, but with sharp critics of our perceptions.

When we investigate the phenomena we observe on the living body, as discrimination is necessary between those within cells and those which are the result of the influence organs and organisms have on the surroundings. There are many manifestations of force which must not be called vital processes. We cannot observe intracellular processes directly, but only the power of their results, which changes the world without and also causes an impression on our senses. Closely investigating the mechanism of the human body, we become convinced that both substance and irritation participate in vital processes not sooner than when entering cells. All phenomena in lymph vessels and blood vessels or sense apparatus must be rigidly declared extracellular.

There are forces active in digestion, circulation, respiration, in sense-impression and motion; they are physical forces. But there is a great difference between intracellular processes and physical events.

The duck on the water and the pike in the water feed on the same substances, under the same sunshine, in the same surroundings, but we observe that the same substances entering different organisms assume quite different forms, and this permanently through generations. We no

tice the same in oak and pine tree growing on the same soil. Though we feed a dog on beef or at other times on fish or on potatoes we cannot change the dogkind.

There must be something within something permanent, transmitted from parent to offspring, something constant in the development of the organism, something indivisible or individual in every organism. No organism can be divided, so that two living bodies will be the result. Excep- · tions are only apparent.

Now, the question arises: Are there vital forces causing the great difference of the phenomena within and without the cells? Or are they physical forces under the influence of a certain animistic element? Since the discovery of the law of conservation of energy the idea of vital forces or of vitality in the old sense has to be given up. Not since Wohler; if we make urea out of its elements we can conclude that life makes use of physical forces, but not more. But if we study the actions in the living body under the light of this law we take a decided step forward.

It is a principle of the law of the indestructibility of force that a transformation of energy into another certain form can take place only once, and that all substances partaking in the phenomenon become unfit for the same purpose. There is a loss of substance. The fuel under the kettle has to be renewed. We find the same principle in the living organism. Where there is a transformation of chemical change, as in nervous or muscular tissues into electroid or mechanical force, there is a loss of substance.

There is another principle that energy of higher intensity sets free energy of lesser intensity, and that energy has always a descending tendency in its disengagements. As for instance, the great heat of the spark causes a chemical decomposition of the gunpowder. We find this principle also in the living body. The great chemical affinity of the gastric juices attacks the ingesta, but not the gastric glands, because these glands maintain a still higher affinity through life. The fact that the stomach does not digest itself is easily explained by the general law of the descending disengagement.

There is still another principle that energy must be adequate to the energy to be disengaged. Great heat is an adequate force to gunpowder, light is not. Light is adequate to certain silver salts. photographers make use of it. This prin

Our

ciple is also observed in the household of all organisms. We find the apparatus of digestion and sense-impression busily engaged in selecting or preparing substances or free energy for the reception into the organism.

Thus we see that the laws of the forces within and without the cells are the same, and we say, consequently, the forces themselves are identical.

We come now to the conclusion that the forces within and without the cells and organs are the same, but that those within the cells are under the influence of an animistic element. The existence of this animistic element is proved by the following facts:

1. All organisms have in common a certain substance; that is albuminous matter.

1. The essential substance in all organisms, vegetable or animal, has four regular constituents, viz., carbon, hydrogen, oxygen and nitrogen. There are also a dozen elements more or less regularly present; but the four mentioned form the stock of the albumins or proteids. Carbohydrates may be added as the restorers of albumins and fats as the products of them. These are what we call the living substance. They are found in the living and dead organism, but most of them appear in a different form during life. We know that the chemical reaction changes from alkaline to acid in death and that some substances coagulate in death, causing, for instance, the "rigor mortis." Some others have the peculiarity to remain unchanged for a length of time if separated from contact of life. The same albumins in the living are very loosely constituted, and instantaneously ready to change. They must be very complicated combinations.

But not only in regard to chemical change we must concede a difference of the substance in life and death, but also in regard to warmth in many animals, and even in plants; some keep a standard of warmth independent of the surroundings.

Light is not disengaged in living organisms, at least there is no combustion causing light. In glow worms and phosphorescent microbes light is not produced from warmth, nor is it accompanied by excessive heat, as in the physical phenomenon.

Nerve irritation is said to be of an electric nature, but it is decidedly not an electric cur

rent.

But coming back to chemical change as the

predominant form of energy in life, we observe entering substances assume a conformity with the substance within; then with every irritation there is a reduction, that is, a splitting off of some groups of atoms and a replacing of water.

We combine all conforming processes in the term assimilation, and all reductions by dissimilation. They balance each other during life, but with an ascending tendency in growth and descending in atrophy and wasting. Life is a long series of conforming and reducing actions, with an ascending followed by a descending tendency. These procedures can be accelerated or retarded within certain degrees, but any other alteration or any defect in the series are of grave consequences, as we see in cases of poisoning or of atrophy of the pancreas or thyroid gland.

It is evident conformity of living substance cannot be the property of matter and energy, but the quality of another element.

2. All life pulsates in cells; muscular cells of the heart furnish the power of circulation, glandular cells secrete, cerebral cells are the place of perception, and so are the cells of leaves and cambium the little workshops of vegetable life. The cell is a unit in its function, but consists of a nucleus and protoplasm. Both are of a different chemical formation, and the nucleus, at least, has a distinct anatomical structure. There is a chemical antagonism established, and as both nucleus and protoplasm are of a different concentration, osmosis plays a great role in chemical interchange. Osmosis is the cause of membrane formation, which in return enhances chemical change.

Substance passing in the cell conforms with the substance therein; then a normal irritation causes a splitting off of a certain atom group in exchange of a molecule of water. This reaction is strictly regulated in accord with the nature of the cell; it may be mechanic force in the contraction of muscular fiber, or chemical in secreting cells, or electroid in nerve cells.

But the reduced substance taking in a molecule of water from the surroundings becomes also a factor in the formation of membranes, in the disposition of saccharines and fats, and in the excretion of waste matter. The reaction of the cells is, therefore, both formative, productive and excretive. Cells regulate and

sustain themselves.

Mass passes in and out, but organization remains. This organization cannot pertain to matter or energy, but to an element that is constant. This fact becomes so much more evident when we follow up the variation of cells, although from a common origin no class of cells can be transformed into another kind. 3. All herbs and animals are individual, that means, they cannot be divided without risking their lives.

But we have to conceive the term not from the external form and appearance, but from the internal organization. Thus low forms of life as "stentor" may be cut in twain, and, provided both halves contain parts of the nucleus and parts of the protoplasm, two individuals will live and sustain themselves. The

organization is not disturbed. A "siphonophore" can drop off a part of its concern to live an independent life, but the whole animal is rather a partition into organs than a unit of organs.

The organisms are either single-celled or they are an accumulation of equal cells forming a colony. Other organized bodies appear in the form of layers, still others repeat layers in form of organs. A repetition of organs to a higher unit is termed an animal person or plant person.

Thus we see every living body becomes an individual by its organization. But the principle organization is pre-existing and constant from beginning to end, and cannot, consequently, be found in matter or energy.

4. All organisms have the same mode of growth; "omnis cellula cellula."

To have a full understanding of evolution we must bear in mind that there is as well a psychical as a bodily unfolding which run parallel and condition each other.

We observe in our feeling, thinking and acting, in our concept of the good and of the beautiful that there is the same subjective cause within, the "apriori idea" of Kant, and an objective irritation from without, as in any physical or physiological phenomenon. This fact demonstrates the correlation of mind and body.

Indeed, the human soul is the unfolded animistic element, but not more.

Under the laws of individuality, interdependence and subordination, multiplication of cells assumes the character of a systemic variation, both in structure and function.

A germ cell, like any other cell, possesses a differentiated structure. After fecundation, a vivid accumulation of substance takes place. The contents have increased threefold, but the periphery only twofold, therefore the chance of irritation from without has relatively decreased for some parts. The nucleus, as the main sufferer, initiates a cell division. Thereby the disproportion within the mother cell is compensated partially in daughter cells. But as a result of a differentiated structure already existing in the mother cell, its parts react differently and cell division becomes unequal, not so much in size of the parts as in their chemical character. Thus we understand how differentiation of an organism and division of work begins in the germ cell, only to become more evident in progress.

As magnitude of an angle does not depend upon the length of the lines which form it, but merely upon their relative position, so the great variety of cells in the developed body is not the result of growth, but of the peculiarity of the mother cell.

Evolution is unfolding something occult that steadily controls growth and construction.

The growing and shaping has been, compared with a reversed emboxing. "Bonnet," no doubt, had the shaping element in view without substance. It describes fairly well the course of development. But neither the idea of preformed organs nor the emboitement, even in its animistic conception, hold good.

Evolution is rather a steadily controlled

growth setting its own limits in every direction.

5. All living organisms have the same mode of propagation, "omne vivum ex ovo."

The relation between parent and offspring is maintained from simple cell division and spore formation up to sexuality, both in the vegetable and animal kingdom.

There is a duality in every germ cell, namely, an individual growth and a conservation of species. Life is inherited, all qualities of species are transmitted and of the individual qualities those that have brought on an enduring change of functions.

It is said that Darwinism denies a vitalistic conception of life. Value and merits of this famous theory shall not be disputed in the least. But if we grant that natural selection is an important factor of variation and of formation of new species, we must concede to the surroundings a much greater power, because an enhanced fitness is the natural result of more favorable conditions preceding. But

a

third point has to be considered, viz., that both influences be lasting.

After all, does not the doctrine of formation of new species acknowledge that there is something permanent in procreation that constantly tries to repeat the same forms and functions, but fails under certain circumstances? Indeed, we ought to be surprised that there is not more change of life forms than we observe.

This ends the somewhat lengthy argumentation of the vitalistic conception of life.

Our conclusion is: Peculiarity of substance, formation of units, organization of these units, evolution and transmission are the essential properties of all living bodies. Each and all of them prove convincingly the existence of an animistic element which is indivisible in the organization, constant in evolution and permanent in inheritance.

You will ask me now: What is this animistic element?

In answering this question I have to go back to the general concepts of things. We say all visible bodies consist of inatter and energy. But when we try to describe or to define matter or energy we make use of the one to explain the other. Thus the Century Dictionary says: "Matter is substance that irritates our senses." But energy irritates not substance. Or if we say energy is motion we must concede that we cannot conceive motion without assuming something that is moved. Therefore we assert neither matter nor energy can be described or defined, neither matter nor energy are real things, but elements forming things.

I declare now the animistic element is of the rank with matter and energy. It cannot be described or defined. But it is, notwithstanding, noticeable in its union with matter and energy. We readily recognize the dog-kind in a strange animal.

I furthermore say the animistic element is unmathematical; it never appears as a half or double, but always as a whole. This element has also no causative relation. We cannot say: The seed is the cause of the tree, or the egg is the cause of the bird, or the father is the cause of the son. For these two qualities the animistic element is essentially different from force or energy.

Another question will be: What use can we make of something that cannot be described and defined?

We speak of a mathematical point, a mathematical line, a mathematical pendulum, but we cannot describe a mathematical point, line or pendulum. Nevertheless our mathematicians start from such points, lines and pendulums, and their calculations are correct. Thus we also start from indefinable matter, energy and animistic element, and our calculations will also be correct. Limits can be drawn toward something, not toward nothing.

We come to the last question: How does the animistic element influence physical forces within living cells?

Our biological researches are restricted to the preliminary and final acts of life, but they do not reach life itself. We have only an inferential knowledge of the intracellular processes. As soon as we single out a phenomenon from vital functions life ceases to be. Cellular substance in our hands is dead. We know of this substance that it consists of very large molecules. One or two atoms of iron or sulphur are attached to thousands of atoms of carbon, hydrogen, oxygen and nitrogen. But by conclusions from phenomena amenable to our examinations it is ascertained that the molecules in the living cells are still larger. There is a constant splitting off and new formation, and all change is controlled and led in one certain direction, in the direction given by the design of species.

Life is a cycle evolving and rounding up in itself and by itself; the individual life is a wave in the current of species. There is a control of forces both in quan

tity and quality. Controlled energy is the force we have to consider in our formula of work of life. Thus we come back to the point we started from.

Work includes force expended as well in direct accomplishment as by overcoming all obstacles. The direct accomplishment of a living organism is controlled and led in growth and procreation, which we collectively call co-operative work, and in nutrition and separations which is reciprocal. When we said a living body is its own builder and engineer we referred to its co-operative and reciprocal work. From this twofold work of the organism we judge its capability of overcoming obstacles as they are presented by food warmth, as well as by obnoxious surroundings in general.

The capability and strength depends, as we have proved, not so much on the quantity of substance at disposition, than on the control over it. Much substance may enter the cell and conform with the chemical quality therein. But all surplus will be either stored up or eliminated at once. Only a certain amount participates in the processes of life. All forces within cells are controlled as long as there is life. In death this control ceases.

The inherited or transmitted peculiarity of co-operative and reciprocal work is what we call species in the biological sense. But there are individual vacillations not so much in general, but in the growth, proliferation, nutrition and separation of groups of organs which constitute organisms of various fitness for the battle of life.

The individual peculiarity of co-operative and reciprocal work of life is termed constitution.

Constitution is a term of practical sciences, as of medicine or gymnastics; but with our new conception it has a footing in abstract science.

This address may be construed as a walk through the realm of biological science. It opens new views and is, in reality, a conception essentially different from that prevailing. And as such a walk becomes more interesting by the pursuit of an aim, I proposed a definition of constitution that would compare with our concept of medicine and ally it rationally to biological science.

TRACHEOTOMY FOR A FOREIGN BODY IN THE LARYNX.*

BY DR. J. C. SEXTON, RUSHVILLE, IND.

Foreign bodies in the air passages always present interesting features, and their removal is attended with so many risks that death after operative procedure is a very frequent occurrence.

The case I present to you to-day is of peculiar interest, because of the character of the foreign body, the questions involved in the choice of method of removal, as well as the often-advised measure of leaving the case to nature.

The foreign body here shown is a spiral spring that is to be found in the ordinary hand bicycle pump. It is one-half inch in length, five-sixteenths of an inch in diameter, has caliber of one-fourth inch in the clear, and is made of No. 5 piano spring steel wire.

The boy who met this accident is eight years old. While playing about with the spring in his mouth he drew it into the larynx, where it settled, snugly fitting in between the vocal cords.

There was no severe pain, nor the least obstruction to respiration. Aphonia was instant and absolute. The epiglottis could not close perfectly, and efforts at swallowing were always attended attended with paroxysms of violent coughing and threatened suffocation. Spasm of the throat would instantly be excited and last from ten to fifteen seconds, during which time the suffering would be intense. Dr. Bowen, of Occident, located the foreign body with the laryngoscopic mirror, and brought the patient to my office. I could readily view the object resting deeply in the larynx. Dr. Hackleman, whom we

*Reported to Rush County Medical Society, December 3, 1900.