These distinctions, it will be perceived, have a direct and most important bearing upon the science of Therapeutics, which has for its object the cure of disease.
The process by which the secretion of any fluid of the body is accomplished cannot be explained. It is an exertion of that peculiar vital power of which we have spoken as inherent in the cell-wall. The secretion of the gastric juice and of the bile, for example, is wholly inexplicable. But when, after being secreted, these or similar fluids are brought into contact with each other or with any foreign substance, whether within or without the body, the actions and reactions which ensue are explicable by chemical, mechanical or electrical laws, and these explanations constitute the object of Physiology. It is obvious that these phenomena may be of great complexity and that the explanations may require to state the conditions of several successive series of reactions, which intervene between the external fact or symptoms as viewed by the observer, and that ultimate action of the cell-wall which Virchow declares to be “the only real vital action of the living organism” or, on the other hand, the phenomena may be simple and the explanation may be complete by a simple and direct reference to the selective action of the cell-wall. Thus, for example, the fact of salivation, as noticed by an external observer, is made up of the discharge of the salivary secretion into the mouth. The explanation refers us at once to that selective power of the cell-wall of the salivary glands which extracts from the nutritive fluids the constituents of this peculiar secretion which, as such, is not found anywhere in the body except in the salivary ducts as the results of the process we have just described.
On the other hand, the fact of urination is made up, so far as the external observer is concerned, of the discharge of urine from the urethra and the emptying of the urinary bladder. The physiological investigation, however, shows the process to be quite complicated, and the explanation carries us through several series of phenomena, before we arrive at the ultimate fact. Thus, we trace the urine through its reservoir, the bladder, up the ureters to the tubuli of the kidneys, where it has probably received, if not the whole, at least a great portion of its watery constituents; and this contribution may require a further explanation by the mechanical laws of endosmosis and exosmosis whereby this constituent was separated from the blood. Not tracing this constituent further, for the present, by asking, as we should logically be required to do, how this substance came to be contained in definite quantity in the blood, we seek the other constituents of the urine and find the urea and possibly some other of them eliminated by the Malpighian bodies from the blood through the agency of the cell-wall. And yet even this can hardly be called the ultimate vital act, which will require to be sought by a still deeper analysis. For although the cells of the Malpighian bodies do separate the urea from the blood, yet they do not manufacture it from the constituents of that fluid. They find it there already formed, and an exhaustive analysis of the physiological fact of urination would require us to seek the origin of the urea in the blood. This would lead us to the study of the nutrition and decay of the nitrogenized tissues, and in the cell-walls of these we should first meet with that ultimate vital act, in which alone, of all the processes which urination involves, life, pure, simple and inexplicable, is concerned.
Physiology goes somewhat further than this analysis of the actual normal functions of the living organism. Under the name of Experimental Physiology she not only seeks to apply the test of synthesis to her analysis, but she endeavors to solve her problems by the substitution of analogous substances for some elements of the nutrient fluid, or for some of the secretions of the organism, and thus light is thrown not merely on the processes of the living organism, but also contributions are made to the derived science of Pathology.
Let us now take a similar view of the science of Pathology, which deals with abnormal functions as Physiology does with normal functions, and which might almost, by a license of speech, be called the science of Morbid Physiology.
The fact of morbid salivation is, to the observer of objective, occurrence, only a discharge of abnormal salivary fluid. The pathological explanation, like the physiological, leads us to the selection from the blood by the cell-wall of the glands of the substances out of which it fabricates the salivary fluid. If the blood be normal and yet the saliva be, as we have supposed, abnormal, then the mysterious power of the cell-wall must have been perverted, altered or impaired. This manifestation of life must have become a manifestation of abnormal life-which is disease. Here, then, in the seat of disease-just where we found the seat of life-in the inherent attractive and selective power of the cell-wall. This, then, is the nature of disease, a modification of that unknown and inscrutable power, life.
“Health,” says Carpenter, “or normal life”, “disease or abnormal life.”
“Not unfrequently,” says dR. Bennett, “this attractive and selective power in the tissues is deranged. Not unfrequently the selective power appears to be lost and the attractive power greatly increased, and thus,” after a few intermediate steps described, “the phenomena which we call inflammations ensue.”
To take, now, an example of a more complex series of phenomena, the fact of the evacuation of morbid urine, simple as it may appear to the observer of external phenomena only, yet leads us, in our search after the original act of “abnormal life” in which the morbid excretion had its origin, to examine first, whether the change was purely a chemical change, originated and effected while the urine was retained in its reservoir, the bladder-for if so, it differs little from a corresponding change which occurs daily in the “vase de nuit” secondly, whether the urine derived its morbid character from the admixture of morbid secretion, or effusion from the surface of the bladder, of the ureters, of the pelvis of the kidney, or from the tubuli; from each of which it might receive blood, or mucus, or pus, or, perhaps, liquor sanguinis alone holding fibrine in solution, or finally solid fibrinous casts; or, thirdly, whether the morbid change in the urine came from a loss, on the part of the cell-walls in the Malpighian bodies, of their inherent vital selective power, whereby they are enabled to separate from the blood those substances which it is their province in the healthy body to separate; or, finally, whether the blood no longer contains, as in a normal state it should do, those elements which it is the function of the kidney cells to eliminate which it is the function of the kidney cells to eliminate from it, in other words, whether the whole train of processes which eventuates at last in the evacuation of abnormal urine, may be traceable to an abnormal interstitial nutrition and destruction of the nitrogenized tissues; all these are questions which it is the legitimate and very useful business of Pathology to solve.
Now, be it observed, whether the cause be traced to abnormal action in the cell of bladder, ureter, kidney, or in that of the muscular or cerebral tissue, we arrive always at the fact that as the action of the cell-wall in the healthy body constitutes the only real vital action of the organism, the only unmixed manifestation of life; so the modified and abnormal action of the cell-wall in the diseased body constitutes the only real action of abnormal vitality in the organism-the only unmixed manifestation of disease.
It may be objected that no account has been taken in what we have said, of the action of the nervous system, to which, nevertheless, both in the case of morbid salivation and in that of morbid urine, the alteration in the salivary gland and in the kidney respectively may have been attributable. But this objection simply adds another step to the analysis. For every action of any part of the nervous system involves and expenditure of a portion of nervous substance, that is, a process of interstitial destruction and reconstruction, and this process is effected only through the attractive and selective power of the cell-wall of the nervous tissue. Thus are we brought again face to face with this inevitable mysterious power, the abnormal action of which constitutes Disease.
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.
It has been stated than a large portion of the medical profession hold that the science and practice of Therapeutics are based upon the science and facts of Pathology. It is held that the explanation of the phenomena of the morbid organism, which Pathology furnishes, give the key to the procedures which should be adopted for the restoration of the morbid organism to a healthy condition. If, for example, it be ascertained through the investigations which Pathology makes for us, that a certain series of morbid symptoms may be traced to an abnormal condition of the gastric fluid, a too great acidity, for example, “it is,” says Dr. Bennett, “the discovery and removal of such causes as this that constitute the chief indications of the scientific practitioners.” Let us see in what way Dr. Bennet proposes that this “removal” shall be accomplished. He says, supposing another case: “The capillary vessels become over-distended with blood, and the exudation of the liquor sanguinis to an unusual extent takes place, constituting inflammation. How is this to be treated? In the early stage, topical bleeding, if directly applied to the part, may diminish the congestion, and the application of cold will check the amount of exudation. But the exudations, having once coagulated outside of the vessels, acts as a foreign body, and the treatment must be directed to furthering the transformations which take place in it, and facilitating the absorption and excretion of effect matter. This is accomplished by the local application of heat and moisture, the internal use of neutral salts to dissolve the increase of fibrine in the blood, and the employment of diuretics and purgatives to assist its excretion by urine or stool”
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'.