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PREVENTABLE DISEASES
BY
WOODS HUTCHINSON, A.M., M.D.
_Author of "Studies in Human and Comparative Pathology," "Instinct and
Health," etc., etc. Clinical Professor of Medicine, New York Polyclinic,
late Lecturer in Comparative Pathology, London Medical Graduates College
and University of Buffalo_
BOSTON AND NEW YORK HOUGHTON MIFFLIN COMPANY The Riverside Press
Cambridge
COPYRIGHT, 1907, 1908 AND 1909, BY THE CURTIS PUBLISHING COMPANY
COPYRIGHT, 1909, BY WOODS HUTCHINSON
ALL RIGHTS RESERVED
_Published November 1909_
FIFTH IMPRESSION
* * * * *
By Woods Hutchinson
THE CONQUEST OF CONSUMPTION. Illustrated.
12mo, $1.00 _net_. Postage extra.
PREVENTABLE DISEASES. 12mo, $1.50 _net_.
Postage 13 cents.
HOUGHTON MIFFLIN COMPANY
BOSTON AND NEW YORK
* * * * *
CONTENTS
I. The Body-Republic and its Defense 1
II. Our Legacy of Health: the Power of Heredity
in the Prevention of Disease 31
III. The Physiognomy of Disease: what a Doctor
can tell from Appearances 55
IV. Colds and how to catch Them 83
V. Adenoids, or Mouth-Breathing: their Cause
and their Consequences 103
VI. Tuberculosis, a Scotched Snake. I 123
VII. Tuberculosis, a Scotched Snake. II 140
VIII. The Unchecked Great Scourge: Pneumonia 174
IX. The Natural History of Typhoid Fever 198
X. Diphtheria: the Modern Moloch 222
XI. The Herods of Our Day: Scarlet Fever,
Measles, and Whooping-Cough 243
XII. Appendicitis, or Nature's Remnant Sale 267
XIII. Malaria: the Pestilence that walketh in Darkness;
the greatest Foe of the Pioneer 289
XIV. Rheumatism: what it Is, and particularly
what it Isn't 311
XV. Germ-Foes that follow the Knife, or Death
under the Finger-Nail 331
XVI. Cancer, or Treason in the Body-State 350
XVII. Headache: the most useful Pain in the World 367
XVIII. Nerves and Nervousness 387
XIX. Mental Influence in Disease, or how the Mind
affects the Body 411
Index 439
PREVENTABLE DISEASES
CHAPTER I
THE BODY-REPUBLIC AND ITS DEFENSE
The human body as a mechanism is far from perfect. It can be beaten or
surpassed at almost every point by some product of the machine-shop or
some animal. It does almost nothing perfectly or with absolute
precision. As Huxley most unexpectedly remarked a score of years ago,
"If a manufacturer of optical instruments were to hand us for laboratory
use an instrument so full of defects and imperfections as the human eye,
we should promptly decline to accept it and return it to him. But," as
he went on to say, "while the eye is inaccurate as a microscope,
imperfect as a telescope, crude as a photographic camera, it is all of
these in one." In other words, like the body, while it does nothing
accurately and perfectly, it does a dozen different things well enough
for practical purposes. It has the crowning merit, which overbalances
all these minor defects, of being able to adapt itself to almost every
conceivable change of circumstances.
This is the keynote of the surviving power of the human species. It is
not enough that the body should be prepared to do good work under
ordinary conditions, but it must be capable, if needs be, of meeting
extraordinary ones. It is not enough for the body to be able to take
care of itself, and preserve a fair degree of efficiency in health,
under what might be termed favorable or average circumstances, but it
must also be prepared to protect itself and regain its balance in
disease.
The human automobile in its million-year endurance-run has had to learn
to become self-repairing; and well has it learned its lesson. Not only,
in the language of the old saw, is there "a remedy for every evil under
the sun," but in at least eight cases out of ten that remedy will be
found within the body itself. Generations ago this self-balancing,
self-repairing power was recognized by the more thoughtful fathers in
medicine and even dignified by a name in their pompous Latinity--the
_vis medicatrix naturæ_, the healing power of nature.
In the new conception of disease, our drugs, our tonics, our
prescriptions and treatments, are simply means of rousing this force
into activity, assisting its operations, or removing obstacles in its
way. This remedial power does not imply any gift of prophecy on nature's
part, nor is it proof of design, or beneficent intention. It is rather
one of those blind reactions to certain stimuli, tending to restore the
balance of the organism, much as that interesting, new scientific toy,
the gyroscope car, will respond to pressure exerted or weight placed
upon one side by rising on that side, instead of tipping over. Let the
onslaught of disease be sufficiently violent and unexpected, and nature
will fail to respond in any way.
Moreover, we and our intelligences are a product of nature and a part
of her remedial powers. So there is nothing in the slightest degree
irrational or inconsistent in our attempting to assist in the process.
However, a great, broad, consoling and fundamental fact remains: that in
a vast majority of diseases which attack humanity, under ninety per cent
of the unfavorable influences which affect us, nature will effect a cure
if not too much interfered with. As the old proverb has it, "A man at
forty is either a fool or a physician"; and nature is a good deal over
forty and has never been accused of lacking intelligence.
In the first place, nature must have acquired a fair knowledge of
practical medicine, or at least a good working basis for it, from the
fact that the body, in the natural processes of growth and activity, is
perpetually manufacturing poisons for its own tissues.
In this age of sanitary reform, we are painfully aware that the most
frequent causes of human disease are the accumulations about us of the
waste products of our own kitchens, barns, and factories. The "bad air"
which we hear so frequently and justly denounced as a cause of disease,
is air which we have ourselves polluted. This same process has been
going on within the body for millions of years. No sooner did three or
four cells begin to cling together, to form an organism, a body, than
the waste products of the cells in the interior of the group began to
form a source of danger for the others. If some means of getting rid of
these could not be devised, the group would destroy itself, and the
experiment of coöperation, of colony-formation, of organization in fact,
would be a failure.
Hence, at a very early period we find the development of the rudiments
of systems of body-sewerage, providing for the escape of waste poisons
through the food-tube, through the kidneys, through the gills and lungs,
through the sweat glands of the skin. So that when the body is
confronted by actual disease, it has all ready to its hand a remarkably
effective and resourceful system of sanitary appliances--sewer-flushing,
garbage-burning, filtration. In fact, this is precisely what it does
when attacked by poisons from without: it neutralizes and eliminates
them by the same methods which it has been practicing for millions of
years against poisons from within.
Take, for instance, such a painfully familiar and unheroic episode as an
attack of colic. It makes little difference whether the attack is due to
the swallowing of some mineral poison, like lead or arsenic, or the
irritating juice of some poisonous plant or herb, or to the every-day
accident of including in the menu some article of diet which was
beginning to spoil or decay, and which contained the bacteria of
putrefaction or their poisonous products. The reaction of defense is
practically the same, varying only with the violence and the character
of the poison. If the dose of poisonous substances be unusually large or
virulent, nature may short-circuit the whole attack by causing the
outraged stomach to reject its contents. The power of "playing Jonah" is
a wonderful safety-valve.
If the poison be not sufficiently irritating thus to short-circuit its
own career, it may get on into the intestines before the body thoroughly
wakes up to its presence. This part of the food-tube being naturally
geared to discharge its contents downward, the simplest and easiest
thing is to turn in a hurry call and cut down the normal schedule from
hours to minutes, with the familiar result of an acute diarrh[oe]a.
Both vomiting and purging are defensive actions on nature's part,
remedies instead of diseases. Yet we are continually regarding and
treating them as if they were diseases in themselves. Nothing could be
more irrational than to stop a diarrh[oe]a before it has accomplished
its purpose. Intelligent physicians now assist it instead of trying to
check it in its early stages; and paradoxical as it may sound, laxatives
are often the best means of stopping it. It is only the excess of this
form of nature's house-cleaning which needs to be checked. Many of the
popular Colic Cures, Pain-Relievers, and "Summer Cordials" contain opium
which, while it relieves the pain and stops the discharge, simply locks
up in the system the very poisons which it was trying to get rid of.
Laxatives, intestinal antiseptics, and bowel irrigations have almost
taken the place of opiates in the treatment of these conditions in
modern medicine. We try to help nature instead of thwarting her.
Supposing that the poison be of more insidious form, a germ or a
ptomaine, for instance, which slips past these outer "firing-out"
defenses of the food-tube and arouses no suspicion of its presence until
it has been partially digested and absorbed into the blood. Again,
resourceful nature is ready with another line of defense. It was for a
long time a puzzle why every drop of the blood containing food and its
products absorbed from the alimentary food-canal had to be carried,
often by a most roundabout course, to and through the liver, before it
could reach any part of the general system. Here was the largest and
most striking organ in the body, and it was as puzzling as it was large.
We knew in some crude way that it "made blood," that it prepared the
food-products for use by the body-cells, and that it secreted the bile;
but this latter secretion had little real digestive value, and the other
changes seemed hardly important enough to demand that every drop of the
blood coming from the food-tube should pass through this custom-house.
Now, however, we know that in addition to its other actions, the liver
is a great poison-sponge or toxin-filter, for straining out of the blood
poisonous or injurious materials absorbed from the food, and converting
them into harmless substances. It is astonishing what a quantity of
these poisons, whether from the food or from germs swallowed with it,
the liver is capable of dealing with--destroying them, converting them,
and acting as an absolute barrier to their passage into the general
system. But sometimes it is overwhelmed by appalling odds; some of the
invaders slip through its lines into the general circulation, producing
headache, backache, fever, and a "dark-brown taste in the mouth"; and,
behold, we are bilious, and proceed to blame the poor liver. We used to
pour in remedies to "stir it up," to "work on it"--which was about as
rational as whipping a horse when he is down, instead of cutting his
harness or taking his load off. Nowadays we stop the supply of further
food-poisons by stopping eating, assist nature in sweeping out or
neutralizing the enemies that are still in the alimentary canal, flush
the body with pure water, put it at rest--and trust the liver.
Biliousness is a sign of an overworked liver. If it wasn't working at
all, we shouldn't be bilious: we should be dead, or in a state of
collapse.
Moral: Don't rush for some remedy with which to club into insensibility
every symptom of disease as soon as it puts in an appearance. Give
nature a little chance to show what she intends to do before attempting
to stop her by dosing yourself with some pain-reliever or colic cure.
Don't trust her too blindly, for the best of things may become bad in
extremes, and the body may become so panic-stricken as to keep on
throwing overboard, not merely the poisons, but its necessary daily
food, if the process be allowed to continue too long.
This is where the doctor comes in. This is the point at which it takes
brains to succeed in the treatment of disease--to decide just how far
nature knows what she is doing, even in her most violent expulsive
methods, and is to be helped; and just when she has lost her head, or
got into a bad habit, and must be thwarted. This much we feel sure of,
and it is one of the keynotes of the attitude of modern medicine, that a
large majority of the symptoms of disease are really nature's attempts
to cure it.
This is admirably shown in our modern treatment of fevers. These we now
know to be due to the infection of the body by more or less definitely
recognized disease-germs or organisms. Fever is a complicated process,
and we are still in the dark upon many points in regard to it, but we
are coming more and more firmly to the conclusion that most of its
symptoms are a part of, or at least incidents in, the fight of the body
against the invading army. The flushed and reddened skin is due to the
pumping of large quantities of blood through its mesh, in order that the
poisons may be got rid of through the perspiration. The rapid pulse
shows the vigor with which the heart is driving the blood around the
body, to have its poisons neutralized in the liver, burned up in the
lungs, poured out by the kidneys and the skin. The quickened breathing
is the putting on of more blast in the lung poison-crematory. It is
possible that even the rise of temperature has an injurious effect upon
the invading germs or assists the body in their destruction.
In the past we have blindly fought all of these symptoms. We shut our
patients up in stove-heated rooms with windows absolutely closed, for
fear that they would "catch cold." We took off the sheets and piled
blankets upon the bed, setting a special watch to see that the wretched
sufferer did not kick them off. We discouraged the drinking of water and
insisted on all drinks that were taken being hot or lukewarm. Nowadays
all this is changed. We throw all the windows wide-open, and even put
our patients out of doors to sleep in the open air, whether it be
typhoid, tuberculosis, or pneumonia; knowing that not only they will not
"catch cold," but that, as their hurried breathing indicates, they need
all the oxygen they can possibly get, to burn up the poison poured out
in the lungs and from the skin. We encourage the patient to drink all
the cool, pure water he will take, sometimes gallons in a day, knowing
that his thirst is an indication for flushing and flooding all the great
systems of the body sewers. Instead of smothering him in blankets, we
put him into cold packs, or put him to soak in cool water.
In short, we trust nature instead of defying her, coöperate with her in
place of fighting her,--and we have cut down the death-rate of most
fevers fifty to seventy-five per cent already. Plenty of pure, cool
water internally, externally, and eternally, rest, fresh air, and
careful feeding, are the best febrifuges and antipyretics known to
modern medicine. All others are frauds and simply smother a symptom
without relieving its cause, with the exception of quinine in malaria,
mercury, and the various antitoxins in their appropriate diseases, which
act directly upon the invading organism.
Underneath all this storm and stress of the fever paroxysm, nature is
quietly at work elaborating her antidote. In some marvelous fashion,
which we do not even yet fully understand, the cells of the body are
producing in ever-increasing quantities an _anti-body_, or _antitoxin_,
which will unite with the toxin or poison produced by the hostile germs
and render it entirely harmless. By a curious paradox of the process, it
does not kill the germs themselves. It may not even stop their further
multiplication. Indeed, it utilizes part of their products in the
formation of the antitoxin; but it domesticates them, as it were--turns
them from dangerous enemies into harmless guests.
The treaty between these germs and the body, however, is only of the
"most-favored-nation" class; for let these tamed and harmless friends of
the family escape and enter the body of another human being, and they
will attack it as virulently as ever.
Now, where and how did nature ever succeed in getting the rehearsal and
the practice necessary to build up such an extraordinary and complicated
system of defense as this? Take your microscope and look at a drop of
fluid from the mouth, the gums, the throat, the stomach, the bowels, and
you will find it simply swarming with bacteria, bacilli, and cocci, each
species of which numbers its billions. There are thirty-three species
which inhabit the mouth and gums alone! We are literally alive with
them; but most of them are absolutely harmless, and some of them
probably slightly helpful in the processes of digestion. In fevers and
infections the body merely applies to disease-germs the tricks which it
has learned in domesticating these millions of harmless vegetable
inhabitants.
Still more curious--there is a distinct parallel between the method in
which food-materials are split up and prepared for assimilation by the
body, and the method adopted in breaking up and neutralizing the toxins
of disease-germs. It is now known that poisons are formed in the process
of digesting and absorbing the simplest and most wholesome foods; and
the liver uses the skill which it has gained in dealing with these
"natural poisons" in disposing of the toxins of germs.
When a fever has run its course, as we now know nearly all infections
do, within periods ranging from three or four days to as many weeks, it
simply means that it has taken the liver and the other police-cells this
length of time to handle the rioters and turn them into peaceable and
law-abiding, even though not well-disposed citizens. In this process the
forces of law and order can be materially helped by skillful and
intelligent coöperation. But it takes brains to do it and avoid doing
more harm than good. It requires far more intelligence on the part of
the doctor, the nurse, or the mother, skillfully to help nature than it
did blindly to fight her.
This is what doctors and nurses are trained for nowadays, and they are
of use in the sick-room simply because they have devoted more time and
money to the study of these complicated processes than you have. Don't
imagine that calling in the doctor is going to interfere with the
natural course of the disease, or rob the patient of some chance he
might have had of recovering by himself. On the contrary, it will simply
give nature and the constitution of the patient a better chance in the
struggle, probably shorten it, and certainly make it less painful and
distressing.
If these symptoms of the summer fevers and fluxes are indicative of
nature's attempts to cure, those of the winter's coughs and colds are no
less clearly so. As we walk down the streets, we see staring at us in
large letters from a billboard, "_Stop that Cough! It is Killing you!_"
Yet few things could be more obvious to even the feeblest intelligence,
than that this "killing" cough is simply an attempt on the part of the
body to expel and get rid of irritating materials in the upper
air-passages. As long as your larynx and windpipe are inflamed or
tickled by disease-germs or other poisons, your body will do its best to
get rid of them by coughing, or, if they swarm on the mucous membrane of
the nose, by sneezing. To attempt to stop either coughing or sneezing
without removing the cause is as irrational as putting out a
switch-light without closing the switch. Though this, like other
remedial processes, may go to extremes and interfere with sleep, or
upset the stomach, within reasonable limits one of the best things to do
when you have a cold is to cough. When patients with severe
inflammations of the lungs become too weak or too deeply narcotized to
cough, then attacks of suffocation from the accumulation of mucus in the
air-tubes are likely to occur at any time. Young children who cannot
cough properly, not having got the mechanism properly organized as yet,
have much greater difficulty in keeping their bronchial tubes clear in
bronchitis or pneumonia than have grown-ups. Most colds are infectious,
like the fevers, and like them run their course, after which the cough
will subside along with the rest of the symptoms. But simply stopping
the cough won't hasten the recovery. Most popular "Cough-Cures" benumb
the upper throat and stop the tickling; smother the symptoms without
touching the cause. Many contain opium and thus load the system with two
poisons instead of one.
Lastly, in the realm of the nervous system, take that commonest of all
ills that afflict humanity--headache. Surely, this is not a curative
symptom or a blessing in disguise, or, if so, it is exceedingly well
disguised. And yet it unquestionably has a preventive purpose and
meaning. Pain, wherever found, is nature's abrupt command, "Halt!" her
imperative order to stop. When you have obeyed that command, you have
taken the most important single step towards the cure. _A headache
always means something_--overwork, under-ventilation, eye-strain,
underfeeding, infection. Some error is being committed, some bad
physical habit is being dropped into. There are a dozen different
remedies that will stop the pain, from opium and chloroform down to the
coal-tar remedies (phenacetin, acetanilid, etc.) and the bromides. But
not one of them "cures," in the sense of doing anything toward removing
the cause. In fact, on the contrary they make the situation worse by
enabling the sufferer to keep right on repeating the bad habit, deprived
of nature's warning of the harm that he is doing to himself. As the
penalties of this continued law-breaking pile up, he requires larger and
larger doses of the deadening drug, until finally he collapses, poisoned
either by his own fatigue-products or by the drugs which he has been
taking to deaden him against their effect.
In fine, follow nature's hints whenever she gives them: treat pain by
rest, infections by fresh air and cleanliness, the digestive
disturbances by avoiding their cause and helping the food-tube to flush
itself clean; keep the skin clean, the muscles hard, and the stomach
well filled--and you will avoid nine-tenths of the evils which threaten
the race.
The essence of disease consists, not in either the kind or the degree of
the process concerned, but only in its relations to the general balance
of activities of the organism, to its "resulting in discomfort,
inefficiency, or danger," as one of our best-known definitions has it.
Disease, then, is not absolute, but purely relative; there is no single
tissue-change, no group even of changes or of symptoms, of which we can
say, "This is essentially morbid, this is everywhere and at all times
disease."
Our attainment of any clear view of the essential nature of disease was
for a long time hindered, and is even still to some degree clogged, by
the standpoint from which we necessarily approached and still approach
it, not for the study of the disease itself, but for the relief of its
urgent symptoms. Disease presents itself as an enemy to attack, in the
concrete form of a patient to be cured; and our best efforts were for
centuries almost wasted in blind, and often irrational, attempts to
remove symptoms in the shortest possible time, with the most powerful
remedies at our disposal, often without any adequate knowledge whatever
of the nature of the underlying condition whose symptoms we were
combating, or any suspicion that these might be nature's means of
relief, or that "haply we should be found to fight against God." There
was sadly too much truth in Voltaire's bitter sneer, "Doctors pour drugs
of which they know little, into bodies of which they know less"; and I
fear the sting has not entirely gone out of it even in this day of
grace.
And yet, relative and non-essential as all our definitions now recognize
disease to be, it is far enough (God knows) from being a mere negative
abstraction, a colorless "error by defect." It has a ghastly
individuality and deadly concreteness,--nay, even a vindictive
aggressiveness, which have both fascinated and terrorized the
imagination of the race in all ages. From the days of "the angel of the
pestilence" to the coming of the famine and the fever as unbidden guests
into the tent of Minnehaha; from "the pestilence that walketh in
darkness" to the plague that still "stalks abroad" in even the prosaic
columns of our daily press, there has been an irresistible impression,
not merely of the positiveness, but even of the personality of disease.
And no clear appreciation can possibly be had of our modern and rational
conceptions of disease without at least a statement of the earlier
conceptions growing out of this personifying tendency. Absurd as it may
seem now, it was the legitimate ancestor of modern pathogeny, and still
holds well-nigh undisputed sway over the popular mind, and much more
than could be desired over that of the profession.
The earliest conception of disease of which we have any record is, of
course, the familiar Demon Theory. This is simply a mental magnification
of the painfully personal, and even vindictive, impression produced upon
the mind of the savage by the ravages of disease. And certainly we of
the profession would be the last to blame him for jumping to such a
conclusion. Who that has seen a fellow being quivering and chattering in
the chill-stage of a pernicious malarial seizure, or tossing and raving
in the delirium of fever, or threatening to rupture his muscles and
burst his eyes from their sockets in the convulsions of tetanus or
uræmia, can wonder for a moment that the impression instinctively arose
in the untutored mind of the Ojibwa that the sufferer was actually in
the grasp, and trying to escape from the clutch, of some malicious but
invisible power? And from this conception the treatment logically
followed. The spirits which possessed the patient, although invisible,
were supposed to be of like passions with ourselves, and to be affected
by very similar influences; hence dances, terrific noises, beatings and
shakings of the unfortunate victim, and the administration of bitter and
nauseous messes, with the hope of disgusting the demon with his
quarters, were the chief remedies resorted to. And while to-day such
conceptions and their resultant methods are simply grounds for laughter,
and we should probably resent the very suggestion that there was any
connection whatever between the Demon Theory and our present practice,
yet, unfortunately for our pride, the latter is not only the direct
lineal, historic descendant of the former, but bears still abundant
traces of its lowly origin. It will, of course, be admitted at once that
the ancestors of our profession, historically, the earliest physicians,
were the priest, the Shaman, and the conjurer, who even to this day in
certain tribes bear the suggestive name of "medicine men." Indeed, this
grotesque individual was neither priest nor physician, but the common
ancestor of both, and of the scientist as well. And, even if the history
of this actual ancestry were unknown, there are scores of curious
survivals in the medical practice of this century, even of to-day, which
testify to the powerful influence of this conception. The extraordinary
and disgraceful prevalence of bleeding scarcely fifty years ago, for
instance; the murderous doses of calomel and other violent purges; the
indiscriminate use of powerful emetics like tartar emetic and ipecac;
the universal practice of starving or "reducing" fevers by a diet of
slops, were all obvious survivals of the expulsion-of-the-demon theory
of treatment. Their chief virtue lay in their violence and
repulsiveness. Even to-day the tendency to regard mere bitterness or
distastefulness as a medicinal property in itself has not entirely died
out. This is the chief claim of quassia, gentian, calumbo, and the
"simple bitters" generally, to a place in our official lists of
remedies. Even the great mineral-water fad, which continues to flourish
so vigorously, owed its origin to the superstition that springs which
bubbled or seethed were inhabited by spirits (of which the "troubling of
the waters" in the Pool of Bethesda is a familiar illustration). The
bubble and (in both senses) "infernal" taste gave them their reputation,
the abundant use of pure spring water both internally and externally
works the cure, assisted by the mountain air of the "_Bad_," and we
sapiently ascribe the credit to the salts. Nine-tenths of our cells are
still submarine organisms, and water is our greatest panacea.
Then came the great "humoral" or "vital fluid" theory of disease which
ruled during the Middle Ages. According to this, all disease was due to
the undue predominance in the body of one of the four great vital
fluids,--the bile, the blood, the nervous "fluid," and the lymph,--and
must be treated by administering the remedy which will get rid of or
counteract the excess of the particular vital fluid in the system. The
principal traces of this belief are the superstition of the four
"temperaments," the _bilious_, the _sanguine_, the _nervous_, and the
_lymphatic_, and our pet term "biliousness," so useful in explaining any
obscure condition.
Last of all, in the fullness of time,--and an incredibly late fullness
it was,--under the great pioneer Virchow, who died less than a decade
ago, was developed the great cellular theory, a theory which has done
more to put disease upon a rational basis, to substitute logic for
fancy, and accurate reasoning for wild speculation, than almost any
discovery since the dawn of history. Its keynote simply is, that every
disturbance to which the body is liable can be ultimately traced to some
disturbance or disease of the vital activities of the individual cells
of which it is made up. The body is conceived of as a cell-state or
cell-republic, composed of innumerable plastid citizens, and its
government, both in health and disease, is emphatically a government "of
the cells, by the cells, for the cells." At first these cell-units were
regarded simply as geographic sections, as it were, sub-divisions of the
tissues, bearing much the same relation to the whole body as the bricks
of the wall do to the building, or, from a little broader view, as the
Hessians of a given regiment to the entire army. They were merely the
creatures of the organism as a whole, its servants who lived but to obey
its commands and carry out its purposes, directed in purely arbitrary
and despotic fashion by the lordly brain and nerve-ganglia, which again
are directed by the mind, and that again by a still higher power. In
fact, they were regarded as, so to speak, individuals without
personality, mere slaves and helots under the ganglion-oligarchy which
was controlled by the tyrant mind, and he but the mouthpiece of one of
the Olympians. But time has changed all that, and already the triumphs
of democracy have been as signal in biology as they have been in
politics, and far more rapid. The sturdy little citizen-cells have
steadily but surely fought their way to recognition as the controlling
power of the entire body-politic, have forced the ganglion-oligarchy to
admit that they are but delegates, and even the tyrant mind to concede
that he rules by their sufferance alone. His power is mainly a veto, and
even that may be overruled by the usual two-thirds vote.
In fact, if we dared to presume to criticise this magnificent theory of
disease, we would simply say that it is not "cellular" enough, that it
hardly as yet sufficiently recognizes the individuality, the
independence, the power of initiative, of the single constituent cell.
It is still a little too apt to assume, because a cell has donned a
uniform and fallen into line with thousands of its fellows to form a
tissue in most respects of somewhat lower rank than that originally
possessed by it in its free condition, that it has therefore surrendered
all of its rights and become a mere thing, a lever or a cog in the great
machine. Nothing could be further from the truth, and I firmly believe
that our clearest insight into and firmest grasp upon the problems of
pathology will come from a recognition of the fact that, no matter how
stereotyped, or toil-worn, or even degraded, the individual cells of any
tissue may have become, they still retain most of the rights and
privileges which they originally possessed in their free and untrammeled
am[oe]boid stage, just as in the industrial community of the world about
us. And, although their industry in behalf of and devotion to the
welfare of the entire organism is ever to be relied upon, and almost
pathetic in its intensity, yet it has its limits, and when these have
been transgressed they are as ready to "fight for their own hand,"
regardless of previous conventional allegiance, as ever were any of
their ancestors on seashore or rivulet-marge. And such rebellions are
our most terrible disease-processes, cancer and sarcoma. More than this:
while, perhaps, in the majority of cases the cell does yeoman service
for the benefit of the body, in consideration of the rations and fuel
issued to it by the latter, yet in many cases we have the curious, and
at first sight almost humiliating, position of the cell absorbing and
digesting whatever is brought to it, and only turning over the surplus
or waste to the body. It would almost seem as if our lordly _Ego_ was
living upon the waste-products, or leavings, of the cells lining its
food-tube.
Let us take a brief glance at the various specializations and trade
developments, which have taken place in the different groups of cells,
and see to what extent the profound modifications which many of them
have undergone are consistent with their individuality and independence,
and also whether such specialization can be paralleled by actually
separate and independent organisms existing in animal communities
outside of the body. First of all, because furthest from the type and
degraded to the lowest level, we find the great masses of tissue welded
together by lime-salts, which form the foundation masses, leverage-bars,
and protection plates for the higher tissues of the body. Here the
cells, in consideration of food, warmth, and protection guaranteed to
themselves and their heirs for ever by the body-state, have, as it were,
deliberately surrendered their rights of volition, of movement, and
higher liberties generally, and transformed themselves into masses of
inorganic material by soaking every thread of their tissues in
lime-salts and burying themselves in a marble tomb. Like Esau, they have
sold their birthright for a mess of "potash," or rather lime; and if
such a class or caste could be invented in the external industrial
community, the labor problem and the ever-occurring puzzle of the
unemployed would be much simplified. And yet, petrified and mummified as
they have become, they are still emphatically alive, and upon the
preservation of a fair degree of vigor in them depends entirely the
strength and resisting power of the mass in which they are embedded, and
of which they form scarcely a third. Destroy the vitality of its cells,
and the rock-like bone will waste away before the attack of the
body-fluids like soft sandstone under the elements. Shatter it, or twist
it out of place, and it will promptly repair itself, and to a remarkable
degree resume its original directions and proportions.
So little is this form of change inconsistent with the preservation of
individualism, that we actually find outside of the body an exactly
similar process, occurring in individual and independent animals, in the
familiar drama of coral-building. The coral polyp saturates itself with
the lime-salts of the sea-water, much as the bone-corpuscles with those
of the blood and lymph, and thus protects itself in life and becomes the
flying buttress of a continent in death.
In the familiar connective-tissue, or "binding-stuff," we find a process
similar in kind but differing in the degree, so to speak, of its
degradation.
The quivering responsiveness of the protoplasm of the am[oe]boid
ancestral cell has transformed itself into tough, stringy bands and webs
for the purpose of binding together the more delicate tissues of the
body. It has retained more of its rights and privileges, and
consequently possesses a greater amount of both biological and
pathological initiative. In many respects purely mechanical in its
function, fastening the muscles to the bones, the bones to each other,
giving toughness to the great skin-sheet, and swinging in hammock-like
mesh the precious brain-cell or potent liver-lobule, it still possesses
and exercises for the benefit of the body considerable powers of
discretion and aggressive vital action. Through its activity chiefly is
carried out that miracle of human physiology, the process of repair. By
the transformation of its protoplasm the surplus food-materials of the
times of plenty are stored away within its cell-wall against the time of
stress.
Whatever emergency may arise, nature, whatever other forces she may be
unable to send to the rescue, can always depend upon the
connective-tissues to meet it; and, of course, as everywhere the medal
of honor has its reverse side, their power for evil is as distinguished
as their power for good. From their ranks are recruited a whole army of
those secessions from and rebellions against the body at large--the
tumors, from the treacherous and deadly sarcoma, or "soft cancer," to
the harmless fatty tumor, as well as the tubercle, the gumma of
syphilis, the interstitial fibrosis of Bright's disease. They are the
sturdy farmers and ever ready "minute-men" of the cell-republic, and we
find their prototype and parallel in the external world, both in
material structure and degree of vitality, in the well-known sponge and
its colonies.
Next in order, and, in fact, really forming a branch of the last, we
find the great group of storage-tissues, the granaries or bankers of the
body-politic, distinguished primarily, like the capitalist class
elsewhere, by an inordinate appetite, not to say greed. They sweep into
their interior all the food-materials which are not absolutely necessary
for the performance of the vital function of the other cells. These they
form first into protoplasm, and then by a simple degenerative process it
is transformed, "boiled down" as it were, into a yellow hydrocarbon
which is capable of storage for practically an indefinite period. Not a
very exalted function, and yet one of great importance to the welfare of
the entire body, for, like the Jews of the Middle Ages, the fat-cells,
possessing an extraordinary appetite for and faculty of acquiring
surplus wealth in times of plenty, can easily be robbed of it and
literally sucked dry in times of scarcity by any other body-cell which
happens to need it, especially by the belligerent military class of
muscle-cells. In fever or famine, fat is the first element of our
body-mass to disappear; so that Proudhon would seem to have some
biological basis for his demand for the _per capita_ division of the
fortunes of millionaires. And yet, rid the fat-cell of the weight of his
sordid gains, gaunt him down, as it were, like a hound for the
wolf-trail, and he becomes at once an active and aggressive member of
the binding-stuff group, ready for the repair of a wound or the barring
out of a tubercle-bacillus.
And this form of specialization has also its parallel outside of the
body in one of the classes in a community of Mexican ants, whose most
distinguishing feature is an enormously distended [oe]sophagus, capable
of containing nearly double the weight of the entire remainder of the
body. They are neither soldiers nor laborers, but accompany the latter
in their honey-gathering excursions, and as the spoils are collected
they are literally packed full of the sweets by the workers. When
distended to their utmost capacity they fall apparently into a
semi-comatose condition, are carried into the ant-hill, and hung up by
the hind legs in a specially prepared chamber, in which (we trust)
enjoyable position and state they are left until their contents are
needed for the purposes of the community, when they are waked up,
compelled to disgorge, and resume their ordinary life activities until
the next season's honey-gathering begins. It scarcely need be pointed
out what an unspeakable boon to the easily discouraged and unlucky the
introduction of such a class as this into the human industrial community
would be, especially if this method of storage could be employed for
certain liquids.
Another most important class in the cell-community is the great group
of the blood-corpuscles, which in some respects appear to maintain their
independence and freedom to a greater degree than almost any other class
which can be found in the body. While nearly all other cells have become
packed or felted together so as to form a fixed and solid tissue, these
still remain entirely free and unattached. They float at large in the
blood-current, much as their original ancestor, the am[oe]ba, did in the
water of the stagnant ditch. And, curiously enough, the less numerous of
the two great classes, the white, or leucocytes, are in appearance,
structure, pseudopodic movements, and even method of engulfing food,
almost exact replicas of their most primitive ancestor.
There is absolutely no fixed means of communication between the
blood-corpuscles and the rest of the body, not even by the tiniest
branch of the great nerve-telegraph system, and yet they are the most
loyal and devoted class among all the citizens of the cell-republic.
They are called hither and thither partly by messenger-substances thrown
into the blood, known as _hormones_, partly by the "smell of the battle
afar off," the toxins of inflammation and infection as they pour through
the blood.
The red ones lose their nuclei, their individuality, in order to become
sponges, capable of saturating themselves with oxygen and carrying it to
the gasping tissues. The white are the great mounted police, the
sanitary patrol of the body. The moment that the alarm of injury is
sounded in a part, all the vessels leading to it dilate, and their
channels are crowded by swarms of the red and white hurrying to the
scene. The major part of the activity of the red cells can be accounted
for by the mechanism of the heart and blood-vessels. They are simply
thrown there by the handful and the shovelful, as it were, like so many
pebbles or bits of chalk.
But the behavior of the white cells goes far beyond this. We are almost
tempted to endow them with volition, though they are of course drawn or
driven by chemical and physical attractions, like iron-filings by a
magnet, or an acid by a base. Not only do all those normally circulating
in the blood flowing through the injured part promptly stop and begin to
scatter themselves through the underbrush and attack the foe at close
quarters, but, as has been shown by Cabot's studies in leucocytosis, the
moment that the red flag of fever is hoisted, or the inflammation alarm
is sounded, the leucocytes come rushing out from their feeding-grounds
in the tissue-interspaces, in the lymph-channels, in the great serous
cavities, and pour themselves into the blood-stream, like minute-men
leaving the plough and thronging the highways leading towards the
frontier fortress which has been attacked. Arrived at the spot, if there
be little of the pomp and pageantry of war in their movements, their
practical devotion and heroism are simply unsurpassed anywhere, even in
song and story. They never think of waiting for reinforcements or for
orders from headquarters. They know only one thing, and that is to
fight; and when the body has brought them to the spot, it has done all
that is needed, like the Turkish Government when once it has got its
sturdy peasantry upon the battlefield: they have not even the sense to
retreat. And whether they be present in tens, or in scores, or in
millions, each one hurls himself upon the toxin or bacillus which stands
directly in front of him. If he can destroy the bacillus and survive, so
much the better; but if not, he will simply overwhelm him by the weight
of his body-mass, and be swept on through the blood-stream into the
great body-sewers, with the still living bacillus literally buried in
his dead body. Like Arnold Winkelried, he will make his body a sheath
for a score of the enemy's spears, so that his fellows can rush in
through the gap that he has made. And it makes no difference whatever if
the first ten or hundred or thousand are instantly mowed down by the
bacillus or its deadly toxins, the rear ranks sweep forward without an
instant's hesitation, and pour on in a living torrent, like the Zulu
_impis_ at Rorke's Drift, until the bacilli are battered down by the
sheer impact of the bodies of their assailants, or smothered under the
pile of their corpses. When this has happened, in the language of the
old surgeon-philosophers, "suppuration is established," and the patient
is saved.
Or if, as often happens, an antitoxin is formed, which protects the
whole body, this is largely built out of substances set free from the
bodies of slain leucocytes. And the only thing that dims our vision to
the wonder and beauty of this drama, is that it happens every day, and
we term it prosaically "the process of repair," and expect it as a
matter of course. Every wound-healing is worthy of an epic, if we could
only look at it from the point of view of these citizens of our great
cell-republic. And if we were to ask the question, "Upon what does
their peculiar value to the body-politic depend?" we should find that it
was largely the extent to which they retained their ancestral
characteristics. They are born in the lymph-nodes, which are simply
little islands of tissue of embryonic type, preserved in the body
largely for the purpose of breeding this primitive type of cells. They
are literally the Indian police, the scavengers, the Hibernians, as it
were, of the entire body. They have the roving habits and fighting
instincts of the savage. They cruise about continually through the
waterways and marshes of the body, looking for trouble, and, like their
Hibernian descendants, wherever they see a head they hit it. They are
the incarnation of the fighting spirit of our ancestors, and if it were
not for their retention of this characteristic in so high a degree, many
classes of our fixed cells would not have been able to subside into such
burgher like habits.
Although even here, as we shall see, it is only a question of quickness
of response, for while the first bands of the enemy may be held at bay
by the leucocyte cavalry, and a light attack repelled by their
skirmish-line, yet when it comes to the heavy fighting of a
fever-invasion, it is the slow but substantial burgher-like fixed cells
of the body which form the real infantry masses of the campaign. And I
believe that upon the proportional relation between these primitive and
civilized cells of our body-politic will depend many of the singular
differences, not only in degree but also in kind, in the immunity
possessed by various individuals. While some surgeons and anatomists
will show a temperature from the merest scratch, and yet either never
develop any serious infection or display very high resisting power in
the later stages, others, again, will stand forty slight inoculations
with absolute impunity, and yet, when once the leucocyte-barrier is
broken down, will make apparently little resistance to a fatal systemic
infection. And this, of course, is only one of a score of ways in which
the leucocytes literally _pro patria moriuntur_. Our whole alimentary
canal is continually patrolled by their squadrons, poured into it by the
tonsils above and Peyer's patches below; if it were not for them we
should probably be poisoned by the products of our own digestive
processes.
If, then, the cells of the body-republic retain so much of their
independence and individuality in health, does it not seem highly
probable that they do also in disease? This is known to be the case
already in many morbid processes, and their number is being added to
every day. The normal activities of any cell carried to excess may
constitute disease, by disturbing the balance of the organism. Nay, most
disease-processes on careful examination are found to be at bottom
vital, often normal to the cells concerned in them. The great normal
divisions of labor are paralleled by the great processes of degeneration
into fat, fibrous tissue, and bone or chalk. A vital chemical change
which would be perfectly healthy in one tissue or organ, in another may
be fatal.
Ninety-nine times out of a hundred any group of cells acts loyally in
the interests of the body; once in a hundred some group acts against
them, and for its own, and disease is the result. There is a perpetual
struggle for survival going on between the different tissues and organs
of the body. Like all other free competition, as a rule, it inures
enormously to the benefit of the body-whole. Exceptionally, however, it
fails to do so, and behold disease. This struggle and turmoil is not
only necessary to life--it is life. Out of the varying chances of its
warfare is born that incessant ebb and flow of chemical change, that
inability to reach an equilibrium, which we term "vitality." The course
of life, like that of a flying express train, is not a perfectly
straight line, but an oscillating series of concentric curves. Without
these oscillations movement could not be. Exaggerate one of them unduly,
or fail to rectify it by a rebound oscillation, and you have disease.
Or it is like the children's game of shuttlecock. So long as the flying
shuttle keeps moving in its restless course to and fro, life is. A
single stop is death. The very same blow which, rightly placed, sends it
like an arrow to the safe centre of the opposing racket, if it fall
obliquely, or even with too great or too little force, drives it
perilously wide of its mark. It can recover the safe track only by a
sudden and often violent lunge of the opposing racket. The straight
course is life, the tangent disease, the saving lunge recovery.
One and the same force produces all.
In the millions of tiny blows dealt every minute in our body-battle,
what wonder if some go wide of the mark!