Pathology

“ 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. ”

“ 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. ”

“ 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. ”

“ This, one of the most difficult problems of pathology, is being attacked by many able workers, who are all striving from different standpoints to elucidate the nature of these new formations, which spring from the normal tissues in which they develop and which they destroy. ”

“ 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. ”

“ It seems to me that we live at a period, when morbid anatomy should take a higher stand. This science is not only that of organic derangements, that take place slowly, as the principles or consequences of chronic diseases,60 it consists in the examination of all the alterations our organs can undergo, at any period in which we may observe their diseases. With the exception of certain kinds of fevers and nervous affections, every thing in pathology is within the province of this science. ”

“ 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. ”

“ The Hippocratic writings constitute a systematic and comprehensive presentation of medical and surgical observations, doctrines and practise. Especial attention was given to prognosis, dietetics and meteorological conditions as causes 'of disease; and the beginning was presented of the humoral pathology, which for ages dominated medicine. ”

“ Experimental Pathology and Pathological Physiology are branches of pathology and physiology which, combining the methods of both these sciences with those of chemistry, attempt, by the study of abnormal conditions experimentally produced, to explain the disturbance in function consequent upon cell or tissue injury or disturbances in physiological or chemical equilibrium. ”

“ Henceforward, as it appears to me, the connection of medicine with the biological sciences is clearly defined. Pure pathology is that branch of biology which defines the particular perturbation of cell-life, or of the coördinating machinery, or of both, on which the phenomena of disease depend. ”

“ Where no fetters are placed on the economic life, the healthy organism, in time, overcomes these local inflammations, as we may designate, by an expression taken from pathology, the influx of an abnormal number of cells of a certain sort to a place not intended for them. ”

“ The eloquence of facts appeals to the scientific mind nowadays much more than the assertion of crude and unproven principles. The complexity and mystery of action inherent in living matter have probably been accountable for much of the vague philosophy of disease in the past, and have furnished one reason at least why pathology has been so long in asserting its independence as a science. ”

“ A Text-Book of Pathology. By Alfred Stengel, M. D., Professor of Clinical Medicine in the University of Pennsylvania. Octavo volume of 979 pages, with 400 text-illustrations, many in colors, and 7 full-page colored plates. Cloth, $5.00 net; Sheep or Half Morocco, $6.50 net.
WITH 400 TEXT-CUTS, MANY IN COLORS, AND 7 COLORED PLATES
In this work the practical application of pathologic facts to clinical medicine is considered more fully than is customary in works on pathology. ”

“ The second part is devoted to the account of special diseases, which are classified as "Disorders of Secretion," "Hyperæmias," "Inflammations," "Hæmorrhages," "Hypertrophies," "Atrophies," "New Growths," "Neuroses," and "Parasites." In connection with each disease are given its synonyms, a general description in a sentence, its symptoms, diagnosis, etiology, pathology, prognosis, treatment, and, when proper, illustrations. ”

“ Nearly a generation has elapsed since its publication, and it would he strange if, in the rapid progress of inquiry, its pathology on some subjects had not become rather antiquated, and its therapeusis also arraigned, if not partially discarded. ”

“ A very useful addition is an Appendix treating of the technic of pathologic methods, giving briefly the most important methods at present in use for the study of pathology, including, however, only those methods capable of giving satisfactory results. ”

“ Anomalies, defects, erosions, ulcers, evidences of trauma, inflammations, abscesses, tubercles, gummata, neoplasms, parasites, and all forms of pathologic changes, local or general, must be accurately located and described. The changes [Pg 40] peculiar to certain diseases and infections must always be borne in mind during the examination of any organ in which such conditions are likely to be found. The relationship of lesions in different parts of the body must be recognized. Localized lesions must be described according to position, size, form, color, consistence, etc. ”

“ Pathologic material is examined in the fresh state when it is desired to make a diagnosis in the shortest time possible, or when the processes of fixation and hardening produce such alterations in the morphology and chemic constitution of the cells that these features can be recognized only in the unfixed, fresh state. ”

“ The chief sources of pathologic material are the autopsy, surgical operation, diagnostic excision and curetting, the spontaneous discharge of diseased tissue, and the experimental production of pathologic conditions in animals. ”

“ The work is primarily a dictionary of practical medicine for the use of practitioners. It includes naturally all the diseases that come more particularly within the province of the physician as distinguished from that of the surgeon; but in the numerous articles on general pathology, general therapeutics, hygiene, medical jurisprudence, diseases peculiar to women and children, and subjects on the border-land of medicine and surgery, it includes all but the most technical parts of surgery also. ”

“ Cases are found where the patient, possibly on the public platform or at a social gathering, is seized with a consciousness of the malady so suddenly as to render medical assistance futile. Surgical Cases It is impossible to mention more than a few of the most typical cases of diseases of this sort. ”

“ For, Pathology is rapidly becoming the basis of sensational literature, and in art, as in politics, there is a great future for monsters. ”

“ Once grant the above definition of disease, and even the most trivial aberrations from the normal must be regarded as diseased conditions, quite irrespective of whether, when structural, they interfere with the function of the part or not. ”

“ 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. ”

“ 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. ”

“ Most pathologists would consider this to be of the nature of inflammation—and I believe justly.
There is indeed much difficulty in pronouncing upon the nature of minuter changes of structure detected in the internal parts of the body after death. We are obliged to arrive at conclusions by help of analogies drawn from morbid processes, which we have watched in their progress during life, upon the external surfaces; for during life we have the functions and sensibilities of the part to aid us in forming a right judgment concerning its disease. ”

“ On the one hand, a physiologist is bound to accept that the disease was originally developed as a consequence of an anatomical alteration of a certain organ or nerve-cell or fibre; and on the other he is bound to consider that the same disease or consequence develops itself in a young one which has no such circumstances of anatomical alteration of a certain organ or nerve-cell or fibre—at least detectable by any means of investigation at present employed. ”

“ Evidence is accumulating which may end in the explanation and perhaps in the prevention of the direst of human woes—cancer itself, though at present inquiry is being directed rather to intrinsic than to extrinsic causes.
When, leaving the infections, we look for evidence of progress in our knowledge of more or less local diseases, we may begin with the nervous system. It is in this department, from its abstruseness and complexity, that we should expect the advance of anatomy and physiology—normal and morbid—to be most delayed. If we consult the medical works Neurology. ”

“ Thanks to the intimate alliance of morphology with medicine, the natural history of disease has, at the present day, attained a high degree of perfection. Accurate regional anatomy has rendered practicable the exploration of the most hidden parts of the organism, and the determination, during life, of morbid changes in them; anatomical and histological post-mortem investigations have supplied physicians with a clear basis upon which to rest the classification, of diseases, and with unerring tests of the accuracy or inaccuracy of their diagnoses. ”

“ 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. ”

“ Disease, although reduced to its last analysis under this system, is never so simple that it can be determined as the degeneration of one tissue exclusively. The unity of the body, the close connection of the various tissues, and the gradual transition from one into another, make it impossible to draw the lines as sharply and distinctly as between chemical elements. For the sake of classification we make the degeneration of a certain tissue the distinguishing element between various forms of disease. ”

“ What is the cause of disease? The question does not apply to any one particular form of disease or class of diseases, but to disease generally, as a concrete term meaning any disorder which may manifest itself by individual disturbances in the body; for such disturbance is but a variation in quantity or quality of one general disturbance, a variation in the mechanism that controls the work of keeping the existing cells in proper condition and replacing those cells which are constantly being destroyed. It is a variation in the process of regeneration, which we term life. ”

“ It has been judiciously remarked that pathological facts, or, to speak in common language, diseases in their different forms and degrees afford in the case of physiological investigation the most valuable equivalent to experimentation properly so called; inasmuch as they often exhibit to us a definite disturbance in some one organ or organic function, the remaining organs and functions being, in the first instance at least, unaffected. ”