The Elements of pathology

Disease is an abnormal condition of our life and body, which becomes apparent to the patient himself and to those about him by variously striking phenomena-the so-called symptoms of disease.

If we observe these symptoms attentively, noticing how they arise, develop and again disappear, we soon see that they seldom appear singly, but that a number of them are generally united, either at a certain spot in the body, or around a strongly-marked, so-called cardinal symptom. We distinguish groups of symptoms, viz.: those of Inflammation, of Fever, and many others.

In inflammation, we see in the inflamed part redness, pain, swelling, and increased warmth; in fever, the rise of bodily temperature is the cardinal symptom, which is accompanied by the minor symptoms of accelerated pulse and respiration, chills, loss of appetite, delirium and increase of uric acid and urates in the urine.

The number and variety of such groups of symptoms appear at first sight very great, but after a time we notice that the same ones reappear in the most dissimilar diseases; that, in short, typical groups of symptoms exist which are fundamentally connected.

The ordinary course of diseases is also somewhat typical. For almost all begin with a local affection, or produce one after a short time; inflammation sets in or a tumor forms. From this point local irritation spreads in two ways:

First. The anatomical changes take place, either by means of a certain continuous process, or by a more interrupted advance. Abnormal products are likely to form at the seat of disease, spread to the surrounding parts, be taken up by the lymph and blood vessels, and thus enter into the entire circulation of the body. These products occasion new groups of symp

toms, such as fever or metastases of disease to other parts of the body. The nerves of the diseased part also become irritated, and not only is the patient made painfully aware of their existence, but, through the agency of the central nervous system, all kinds of new symptomatic sensations are produced. Such are sympathetic affections and cramps, which at first glance seem to have little to do with the primary affection.

Second. The disturbance of the function of the diseased part must be considered as a means of spreading the local irritation. One for all, all for one-such is the great law of the division of labor, which governs the bodily organism as absolutely as it does, or should, the organism of the State. If now one part stops work, the whole body suffers in consequence. The importance of the work of the diseased part may be questioned, but all work has a certain value, and every cessation of it entails suffering upon at least a small number of adjacent parts. What happens then when the larger vital organs, the lungs, kidneys, heart and liver, partially interrupt, or imperfectly perform their work? The blood current moves more slowly, the blood loses its oxygen and becomes overloaded with carbonic oxide, uric acid and biliary products. New groups of typical symptoms then arise, such as cyanosis, dropsy, uræmia, jaundice and many others.

Thus every disease spreads. Even new local affections may in this way be generated. But if this is not the case, and no vital disturbance of function has taken place, the eventual disappearance of the primary local affection also obliterates its train of effects, and the body reverts gradually to its normal condition.

The question now arises: what is the cause of this typical uniformity, which shows itself as well in the combination of individual symptoms into groups, as in the succession of the latter in the ordinary course of disease? This might readily be answered by saying that these things exist in the nature of disease, and that minute investigation shows everywhere the workings of cause and effect, and renders all such questioning superfluous. Notwithstanding, I must confess that it now seems to me especially opportune to study the nature of disease in itself, and thereby to separate that which pertains to the cause of disease from that which is due to peculiarities of the diseased organism.

The present tendency is to refer all that is typical and

« Previous Continue »

Books