Pathologist

“ Although pathology, therefore, as a branch of medical science, is necessarily founded on physiology, questions may nevertheless arise regarding the true character of a structure or organ, to which occasionally the pathologist may be able to return a more satisfactory and decisive reply than the physiologist—these two branches of medical knowledge being thus found mutually to advance and illustrate each other. ”

“ The experiments of the pharmacologist in the investigation of the action of drugs can be and are carried out under anæsthesia in the same way as those of the physiologist. But the experiments of the pathologist, which consist in conveying germs and other disease products to animals, come under a different heading. One does not deny that if the animal takes the disease, suffering is produced. ”

“ This universal and acknowledged rule is Pathology, the science which unfolds and exhibits the nature and character of disease, and "dictates the maxims of rational practice." It is the foundation and only base of rational medicine, which proceeds on the assumption that the nature and character of disease is fully known and appreciated. This knowledge is not only rational, but indispensable, in order to understand and apply the principles which ought to govern in the medication and cure of disease. ”

“ But that which it behoves the physician to see, not, indeed, with his bodily eye, but with clear, intellectual vision, is a process, and the chain of causation involved in that process. Disease, as we have seen, is a perturbation of the normal activities of a living body, and it is, and must remain, unintelligible, so long as we are ignorant of the nature of these normal activities. In other words, there could be no real science of pathology until the science of physiology had reached a degree of perfection unattained, and indeed unattainable, until quite recent times. ”

“ Undoubtedly one of the most important steps which medicine has made in its development, is the recognition of the difference between disease itself and those symptoms which may be caused as the result of such disease. We shall find that in most, if not in all, of the older writers on medicine, the treatment of the physician was directed towards the alleviation of those prominent symptoms, which, then not so much looked upon as symptoms, were only recognized as the main cause of the attack. ”

“ The very notion of Diagnosis in our modern sense of the word depends upon Morbid Anatomy. The older physicians seldom attempted to determine the seat of an ailment. [8] Disease was looked upon not as a condition depending upon disordered physiological functions, but as something external, attacking a previously healthy person, disturbing, and, if not expelled by art, finally destroying him; while any structural changes which were found after death were regarded rather as the effects than the causes of the symptoms during life. ”

“ We have to dissect nature; which, for practice, is better than to abstract it.” “To clinical medicine the body becomes a pathological museum. In every part we recognise certain proclivities to morbid action; and the purpose of our study is to trace these tendencies to their source on the one hand, and to their effects on the other.” “The effects of disease may be for a third or fourth generation, but the laws of health are for a thousand.” “Happily, at this day, hygiene has gained strength enough to maintain an independent position in science. ”

“ For physiology is the study of natural conditions, and must first be studied by physicians, inasmuch as what is normal is healthy, and the rule for its own rightness, as well as for every abnormal deviation therefrom. But when deviations from health, or any abnormal conditions are defined by the light of healthy structures, then pathology, the science of disease, becomes intelligible. Then also from a knowledge of pathology the practice and art of healing, and numberless new methods of treatment, will naturally spring. ”

“ It is a common proverb, that one extreme often follows another. It is sometimes so in medicine. As soon as physicians had let go the absurd idea that diseases were the work of demons, had given up their useless mysticisms, and begun to look upon disease as the effect of natural causes—when Anatomy, Physiology and Pathology had helped to explain morbid phenomena, and rational means had come to be employed, practitioners commenced a course of active treatment and went to work with all their might to cure all diseases by positive medication. ”

“ At a period when pathological research is lending its aid in investigating the appearances of disease in every part of the body, and many nice distinctions in diagnosis are aimed at, which are better calculated for nosological than practical purposes, it seems to me not a little extraordinary, that so few have cultivated that most important branch of medicine, the study of the diseases of children. ”

“ But I claim for the modern physician a knowledge and a power far beyond that of alleviating symptoms: viz., a true knowledge of the lesion which causes the symptoms, and the power of conducting the disease to a rapid favourable termination, notwithstanding what appears to the inexperienced or uninformed the most alarming and fatal phenomena. He is enabled to watch with accuracy by means of his stethoscope the removal of the consolidation of the lung, to favour the resolution of the exudation, and to assist the excretion of the absorbed products from the economy. ”

“ Not only in everyday practice in certain lines is a knowledge of this technique necessary for diagnostic purposes, but the true physician should so hold himself toward every problem of diagnosis which presents itself to him, that with every opportunity, he will, through excision, curettage or autopsy, make use of his technical skill to further his knowledge of disease, and to aid his science toward a solution of its great problems. ”

“ Such a diagnosis would ruin a modern physician. The modern physician tells his patient that he is ill because every drop of his blood is swarming with a million microbes; and the patient believes him abjectly and instantly. ”

“ When the physician discovers certain signs or symptoms which constitute the diagnosis of any disease, he regards those signs as the effects of a disease already in existence, and treats the patient accordingly. ”

“ Pathology, the science of disease, and therapeutics, the [463] rational science of healing, are grounded now on the safe methods of physics and chemistry and a thorough knowledge of the human organism. Disease is no longer regarded as a special entity that comes on the body like an evil spirit or mysterious organism, but is conceived as a baneful disturbance of its normal activity. Pathology is only a branch of physiology; it studies the changes that take place in the tissues and cells under abnormal and dangerous conditions. ”

“ No sharp line of demarkation can be drawn between the two classes of phenomena. No one can say where anatomical variations end and tumors begin, nor where modification of function, which may at first promote health, passes into disease. All that can be said is, that whatever change of structure or function is hurtful belongs to pathology. Hence it is obvious that pathology is a branch of biology; it is the morphology, the physiology, the distribution, the etiology of abnormal life. ”

“ When the physician is confronted by a new form of disease for which no remedy has been discovered, he must know its cause and origin, or his practice will be mere guess-work. Anybody can discover the evident causes—heat, cold, over-eating. These things the least instructed physician will probably know. It is the knowledge of hidden causes which makes the superior man. He who aspires to be instructed must know what we now call physiology—why we breathe, why we eat, what happens to the food which we swallow, why the arteries pulsate, why we sleep, etc. ”

“ Every malady is accompanied by its characteristic indications, some of which are diagnostic, i.e., they particularize the affection and distinguish it from all others.
Medical diagnosis is both a science and an art; a science when the causes and symptoms of a disease are understood, and an art when this knowledge can be applied to determine its location and exact nature. Science presents the general principles of practice; art detects among the characteristic symptoms the differential signs, and applies the remedy. ”

“ It can hardly be but that the modes of investigating disease ordinarily followed, labour under some radical errors or defects, else the researches of ages, pursued, as they have been, with exemplary diligence, and, in many splendid instances, by minds of the first order of intellect, must, ere this, have rendered our knowledge of the nature and treatment of disease more certain and more complete. ”

“ As there are, in fact, no two human organism exactly alike, so also is there divergence, more or less, in each individual case, in disease; and however apparently similar the symptoms may be, the knowledge and experience of a physician becomes necessary in order to determine correctly what the ailment is and how general principles should be applied in each particular case. ”

“ In private and even dispensary [Pg 46] practice, where the subjects were of a better physical and moral nature, we often saw the disease subside, and health return, after less attention to administer medical aid, or to supply other wants, than was exhibited at the hospital. We are, notwithstanding, sanguine enough to anticipate useful results from our attentive study of the symptoms of the disease, in connexion with that of the post mortem examinations, and to consider ourselves as in possession of lights to guide us with more certainty than before. ”

“ This state of things has been occasioned by the circumstance that medical practitioners have often been more given to the formation of theories upon the nature of disease and the mode of its treatment, than to that careful observation and patient accumulation of facts, by which, in other sciences, the phenomena of nature have been unravelled. ”

“ No doubt both clinical study and pathological observation have not only helped practical medicine onward, but they have also greatly contributed to the progress of physiology itself. In fact, I find it impossible to separate exact clinical and pathological work from scientific research of a purely physiological nature. Is not all treatment more or less experiment? ”

“ Besides, it is often very difficult, if not impossible, to determine the true character of a disease by its early symptoms; so that much skill and experience are often required to make a correct diagnosis. But when the case is fully made out, no good physician thinks of treating it with one or more specifics. Such remedies are improper for physicians, and always dangerous in the hands of the common people, as many sad examples prove. ”

“ To battle with the occult forces which play so important a part in determining the course or consequences of disease, it is absolutely essential that the physician should know all that is possible to be known of the patient’s history, and of the history of the patient’s family. ”

“ DISEASE HAS CERTAIN UNMISTAKABLE SIGNS,
or symptoms, and, by reason of this fact, we have been enabled to originate and perfect a system of determining with the greatest accuracy the nature of chronic diseases without seeing and personally examining our patients. In recognizing diseases without a personal examination of the patient, we claim to possess no miraculous powers. We obtain our knowledge of the patient's disease by the practical application of well-established principles of modern science to the practice of medicine. ”

“ But the great objection is, that books, however well adapted to explain the theory of medicine, are of little practical use in making us acquainted with disease as it occurs in nature. The ordinary symptoms of any morbid state, as described in books, are rarely if ever met with in any individual. ”

“ The tendency of the accomplished specialist in medicine is to refer all physical trouble to the ill conduct of the organ he presides over. He can often trace every disease to want of width in the nostrils, to a defective eye, to a sensitive throat, to shut-up pores, to an irritated stomach, to auricular defect. ”

“ Our starting-point in this, as in all departments of biological study, must be the biological unit, and it is to the alterations to which this is subject, under varying conditions of nutrition and stimulation, that the science of pathology must apply itself. Man can never be the only object of appeal in this inquiry. The human organism is far too complex to enable us to understand the true significance of diseased processes. ”

“ Arriving now at the surgery of this Age, we find that matters were more chaotic than in other departments of medicine, and for reasons which are easily given and appreciated. While, ordinarily, external diseases are more easily discerned than internal, and while in a corresponding degree they can be more satisfactorily treated; while, in other words, external pathology has ordinarily taken precedence of internal in professional as in lay minds, this view seems to have been inverted for a time during the Middle Ages. ”

“ The biological healing system, based on the laws of nature and the acknowledgment of the fact that no two cases of disease are exactly alike, requires much broader knowledge and much deeper insight on the part of the physician than did the old-school of medicine with its search for symptoms of special diseases and its occult prescriptions. ”