The physical conditions which underlie and cause variation in function, predisposition and susceptibility in the human organism are at the present time of all things most obscure and perplexing. Nothing in the entire field of human endeavor is so shadowy and elusive as the facts involved. Why under a given set of circumstances does one individual react in one way and another in an entirely different way? Why, for example, does a given treatment affect one in one way and another in a different way? Why does a given diet give full satisfaction to one while another, in the same family, will suffer from malnutrition?
Why does a “cold” always settle in the upper respiratory tract in one case, in the lower in another, and in the intestinal tract in a third? One person is predisposed in one way and another in a different way. One is susceptible to one thing, another to an entirely different thing. These are questions for which at the present time we have no sure and comprehensive answers. Conjectures, yes, but no real answers.
Moreover, the materia medica abounds in mysteries, enigmas and bewildering contradictions which no one has yet solved or explained; and many a physician and student has been driven to the point where the whole subject is condemned as a stupendous farce because of this. And in this unquestionably lies the explanation for the spirit of drug nihilism which is rampant in all schools of medicine, and the explanation why everybody wants to get into a speciality, particularly surgery, directly on leaving college.
And what is the answer to the problem? Is there one, or must the great boon of health and happiness forever remain a secret with the gods?
Will humanity forever be teased and tantalized by having this dangled before its eyes but just beyond its reach? If so, then the death knell has been sounded for the medical profession, and humanity must be reconciled to suffering and civilizations must continue to rise and fall, come and go, as they have in the past. There is then no sure hope of improved conditions.
But surely there is no man or woman so hopelessly pessimistic as willing to accept a negative answer. Surely no one is willing to declare that human ingenuity has reached its summit of achievements. There is none who denies that this is a universe of cause and effect. Then surely is no one who believes that anything just happened, that it had no cause; surely none who is in his right mind or who is above the grade of moron.
Hence it follows that if we are going to make any headway in our studies of the human organism, its variations, predispositions and susceptibilities, we must begin with the most common and obvious facts concerning it and its processes. We need at the start to definitely prove at least one fundamental fact and fully determine its laws and all that they involve; and, next, we must never lose sight of these laws for a single instant, and no matter where they lead we must be ready to follow. The possibilities which lie before us if we will do this may in a measure be appreciated if we will call to mind some of the marvelous achievements of the astronomers, achievements made possible with higher mathematics.
For example, the planet Neptune was definitely located in the heavens some time before it was seen and by a process of reasoning that began with the incident of an apple falling from the branch of a tree. A far cry from an apple to the largest planet in our solar system, yes, but they are directly connected. For many years astronomers had observed the peculiar movement of the planet Uranus when it reached a certain point in its orbit and long sought an explanation for the cause.
Two mathematicians and astronomers–one an Englishman, Adams, and the other a Frenchman, Leverrier–working independently, but basing their calculations on the same premise, namely, the law of gravity as established by Newton, reached the same conclusion, and about the same time. Their conclusions were, that this swerving out of the regular orbit was the result of the attraction of a larger and more powerful body at a definite point and distance beyond. Accepting this as possibly true, other astronomers pointed their telescopes in the direction indicated and in a short time located the planet which since has been called Neptune.
But how different are the methods of most of our so-called research workers and scientists in medicine. With them the more obvious the fact the less a place it has in their thinking. For instance, no fact is more firmly established than that organization is essential to function. It is so firmly established and so universally admitted to be true that no one ever stops to question it; no one ever assumes it necessary to elaborate or explain it; he would be “laughed out of court” if he did. Yet it is doubtful if any fact is more completely ignored in the thinking of these same research workers and would-be scientists. And this the medical profession has generally been guilty of doing.
The common fact of organization and all that is involved in its being and processes is quite as completely ignored as was the falling of apples by all except Newton. Suppose Adams and Leverrier had ignored the simple incident, and the law by which it occurred, and flown off to the heavens and there sought the answer to the mysterious movement of Uranus, is it likely they would have found it? That is probably what others had been doing and were doing. What besides evidence of disease– bacteria, pathology, symptoms–has any place in the laboratory experiments, in diagnosis, in short, in every attempt to solve the mystery of disease? What besides these does the urgently advised modern physical examination take into consideration? “What other evidence of health have we except the absence of these things?” This is the common attitude; and the amount of ignorance it embraces is quite beyond computation.
Suppose we take this proposition that organization is essential to function and deal with it logically, go step by step from the beginning right on. Let us see where it will lead us. Let us give it the place of the falling apple. If it is true, then its corollary, namely, that character of organization determines character of function, must also be true. If a certain thing cant be without the presence of another thing, then it is clear that the latter is in a very large measure influential in determining what the former is and does. If there can be no function without organization, then it cannot be difficult to see that what is done depends on the character and capacity of what is doing it.
With this preposition established and in mind, let us ask the question, do all humans come into the world identically organized and constituted?
We know they do not, and, moreover, we know that no two grow up under identical conditions, hence are differently influenced and stimulated during all subsequent years. Now, growth means increase in size and number of tissue cells, and development means differentiation and maturation of cells. That these things involve a complex process, susceptible of easy derangement, with defective results, is not difficult to understand. Growth of cells can in a large measure be hastened or retarded; and the same thing can be done with the processes of differentiation and maturation. Some articles of food will do one thing and some will do another. With medicines and other agencies vital processes can be controlled.
The external environment stimulates or retards these also, and does so most powerfully. In one instance the organism is played upon in one way and in another in a different way. What is stimulated in one may possibly be retarded in another, with the result that when both reach maturity they are profoundly different in structure, in constitution and in their functional processes and capacity for function. One will be predisposed in one way, another in a different way. One will be susceptible to certain things to which the other will be quite immune, or may even be very favorably affected by them.
Both will have the same number and general character of organs and tissues, but in all these there will be differences in composition and constitution more or less pronounced. This is what makes differences in individuals and races. This is what makes differences in function and reaction. This is what causes us to vary our treatment in disease, leads us to prescribe one kind of diet for one person and a different kind for another. AND THIS IS WHAT WE MUST UNDERSTAND BEFORE WE SHALL BE ABLE TO TREAT HUMANS INTELLIGENTLY WHETHER SICK OR WELL.
During the various stages of human life different cellular conditions prevail. This means different kinds of cellular activities. This is well recognized. But what is not so well recognized is that not infrequently cellular states belonging to one period are carried over into the next and even later periods. This results, according to our original preposition, namely, character of organization determines character of function, in infantile or immature character of function also being carried over, carried over to a period where it is no longer appropriate and adequate; hence predispositions and susceptibilities of varying kinds. The importance of this is being brought home to us in the study of Endocrinology.
Embryologic etiology is beginning to assume its rightful place in the study of medicine.
Where there is disproportion in development, a lack of balance, there is soil favorable to development of diseases. As Buchard stated: “It is the organism and not the microbe which makes the disease.” This thought was amplified by another noted French pathologist, Roger, when he wrote: “It is demonstrated today that anatomical alterations and clinical manifestations, in appearance identical, may develop under the dependence of different microbes; reciprocally the same microbe, according to conditions often difficult to determine, may determine maladies anatomically and chemically dissimilar.” All of which is to say that, before a morbid process can gain a foothold a certain aptitude must be present, and what this is determines the character of its expression.
And this aptitude is an attribute of the morphological state of the organism, and it has its origin in the phylogenetic and ontogenetic history of the individual. That is to say, what the organism has is the product of its heredity supplemented by that of its own creation during the process of growth and development; and what it has, as has been said, determines its functional capacities, its predispositions and susceptibilities.
This truth was clearly understood by Virchow when in 1877 he wrote:
“It is a fact, verified by experience, that those organs which in their development remain subnormal by defect of their mass offer a grave and more frequent inclination to disease; in other words, a predisposition which very often is interpreted as a simple weakness, but which in many cases is a real anatomical deficiency, visible and determinable in the tissue.” And then he continued, “I, at least, all consider i as contributing to the essentials of progress of the Science when we shall introduce the habit in the initiation of research concerning the cause of disease of single organs to consider as the first fundamental investigating their primitive constitution and putting in relation their affections with their structural quality”.
This expresses in terse yet comprehensive terms the view- point of the modern morphologist. What he strives for in every instance is a clear and full understanding of not only the character of the “primitive constitution” of single organs but of all the organs, being firmly convinced of the truth of the unity of action of the whole complex of organs, and next, puts “in relation” the totality of the symptom complex with the totality of the structural complex, remembering always that character of organization determines character of function; that predisposition, susceptibility and variation in function are attributes of particular conditions of structure, always immediately related to each other.