Relation of Pathology to Therapeutics

We are not in a position to discuss the relations of this science of Pathology, which treats of the phenomena of the diseased organism, to the science of Therapeutics, which proposes to cure disease….

(1 Read before the Homoeopathic Medica Society of the State of New York, May, 1863.)

THE questions of the Relation of Pathology to Therapeutics is one of exceeding importance, if for no other reason than this: that, by a very large portion of the medical profession, it is commonly held that the whole science of Therapeutics is based, in its general principles and in its special applications, upon the science and the facts of Pathology.

Before beginning the discussion of this subjects, it is necessary to define the terms used in stating the question, as well as certain kindred terms.

The study of the tissues and organs of which the healthy human body is composed constitutes the science of Physiological Anatomy. It may be pursued upon the living or the dead body, provided the death resulted from violence and not from disease.

The tissues and organs of the healthy body are so fashioned as to perform, each, a special work. This act of performing its special work is called the function of an organ. An organ can act only during the life of the individual. Functions, therefore, can be predicated only of living organs. The study of the performance of their special work by the aggregation of organs which make up the body constitutes the science of Physiology.

Physiological Anatomy, then, is the science of the tissues and organs of the healthy body; Physiology is the science of the functions of the healthy, living organism.

When any or all of the tissues or organs of the body have suffered modifications of substance or of structure in consequence of disease, the study of these material changes, which are the results of disease, constitutes the science of Pathological Anatomy. This may be studied upon the living or the dead diseased organism.

When, in consequence of the action of a morbific agent, any or all of the organs of the body perform their special work in an abnormal manner; in other words, when the function of any of the organs of the body is perverted, the study of these changes and perversions of function constitutes the science of Pathology, which, like Physiology, can be studied only in the living organism.

Pathological Anatomy, then, is the science of the morbid tissues and organs of the diseased body. Pathology is the science of the abnormal functions of the diseased living body.

Diseased tissues and organs being modifications of healthy tissues and organs, it is clearly necessary to understand Physiological Anatomy before we can understand Pathological Anatomy. Just as necessary is it, for the same reason, to understand Physiology before we can master Pathology. Indeed the latter might be said to exist only by comparison with the former.

If this be true of the details of these sciences, it is no less true of their essential nature and philosophy. If one would gain correct notion of the subject, scope, limits and relations of the science of Pathology, he must first have a just and exact idea of those of Physiology. To the latter, therefore, I propose to devote a few words.

Dr. Carpenter defines the objects of Physiology to be the study of “the phenomenon which normally present themselves during the existence of living beings”, or, in another place, “the phenomena of health or normal life.”

Its object, then, is not, as it has been sometimes loosely stated, life itself, but the phenomena which depend upon and result from normal life. The science of Physiology brings these phenomena into systematic form, classifies and compares them, analyzes secondary and complex phenomena into their simple elements, and seeks the ultimate phenomenon in which the real elementary manifestations of simple life is made, uncomplicated by secondary or related chemical or mechanical phenomena.

Virchow says, “The chief point is to obtain a recognition of the fact that the cell is really the ultimate morphological element in which there is any manifestation of life, and that we must not transfer the seat of real vital action to any point beyond the cell.” (1 Cell. Path., Eng. ed., 3)

Dr. Carpenter says, “The cell lives for itself and by itself, and is dependent upon nothing but a due supply of nutriment and a proper temperature for the continuance of its growth, and for the due performance of its functions until its term of life expires. Its chief endowment seems to be that of attracting or drawing to itself some of the various substances which are contained in the nutritive fluid in relation with it. This fluid is a mixture of a great number of components; and different sets of cells appear destined severally to appropriate these. As far as is yet known, however, the composition of the cell-wall is everywhere the same, being that of Protein.”

DR. J.H. Bennett says, “Nutrition is now considered to depend upon an inherent vital property peculiar to the tissues themselves, which exercise a force at the same time attractive and selective. By its agency each tissue and gland attracts from the blood that amount of matter which is necessary to maintain it in bulk, and at the same time selects from it the peculiar substance necessary for itself and for the secretion it is destined to produce.”

According, then, to the most advanced writers on this subject, we are to regard the organism as a complex which is capable of being analyzed into an aggregation of cells, of homogeneous structure, but each of which is endowed with a peculiar inherent vital power of “attraction and selection,” which we recognize only in its results and which constitutes the only “real action of life” that we are capable of observing. In the words of Virchow, “Every animal presents itself as a sum of vital unities, every one of which manifests all the characteristics of life.”

Life, then, really consists in the exercise by each cell of its inherent peculiar attractive and selective power. Physiology concerns herself with the results of this exercise. A cell by virtue of its inherent power abstracts from the nutrient fluid a substance which is to serve to nourish the organ to which the cell belongs, or to furnish the secretion of that organ. If the former, then the future history of that organ, its development, its functions and its interstitial decline and dissolution and the fate of its debris belong to the secondary and complex phenomena to which Physiology devotes herself. With these phenomena, life has no exclusive connection save in the primary exertion by the cell-wall of its “inherent attractive and selective power.”

Physiologists with great propriety attempt to explain by mechanical, chemical and electrical laws the secondary phenomena of the organism, the relations of different tissues and secretions to each other and their natural reactions. But they make no attempt to explain the action of the cell-wall which is the ultimate and essential phenomenon of life. They accept this as an ultimate fact, they recognize of power peculiar to the wall of each variety of cell and different from that of any other cell, and they deal with the results of the exercise of this power.

Physiology having been defined as the science of the phenomena of normal life, Pathology has been declared by the same writer (DR. Carpenter), to be the science of the phenomena of “disease or abnormal life.”

If the mutual reaction of two secretions be different in any individual case from that which is observed in the healthy organism, one or other of the secretions must be of an abnormal character. This must have resulted from an abnormal exercise by the sell-wall of that inherent selective power, by virtue of which the secretion was made. The essential and ultimate act of disease is found, like that of life, to consist in some abnormal exercise by the cell-wall of its inherent vital power. As we recognize the existence of this power in the healthy cell only through its action and its result, viz., the function of secretion and the substance secreted, so we recognize disease, which is an abnormal exercise of this power, only through its result, viz., an abnormal secretion.

“Not infrequently,” says Dr. Bennett, “this attractive and selective power in the tissues is deranged, producing increase or diminution in growth or secretion, general or partial. Not unfrequently the selective power appears to be lost, and the attractive power much increased,” etc., etc. From this alteration of these forces, diseased conditions of these fluids and tissues result. The secondary and complex phenomena resulting from the reaction of abnormal tissues are analyzed by Pathology and referred to this elementary deviation in the selective and attractive forces of the cell-wall. But the nature and intimate cause of this alteration, which is, however, the essence of disease, Pathology does not attempt to explain or apprehend, knowing it only by its effects.

As, therefore, Physiology concerns herself with the result of life, so does Pathology take cognizance of the results of disease. For it must be repeated that as the functions of healthy organs and the tissues of the healthy body which are respectively the subjects of Anatomy and Physiology are not life, but only results of life, so the abnormal functions and the altered tissues of the diseased body, which are respectively the subjects of the science of Pathology and Pathological Anatomy are not disease itself, but only the results of disease.

Carroll Dunham
Dr. Carroll Dunham M.D. (1828-1877)
Dr. Dunham graduated from Columbia University with Honours in 1847. In 1850 he received M.D. degree at the College of Physicians and Surgeons of New York. While in Dublin, he received a dissecting wound that nearly killed him, but with the aid of homoeopathy he cured himself with Lachesis. He visited various homoeopathic hospitals in Europe and then went to Munster where he stayed with Dr. Boenninghausen and studied the methods of that great master. His works include 'Lectures on Materia Medica' and 'Homoeopathy - Science of Therapeutics'.