A treatise on general pathology and its relation to practical medicine

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Preface To First Edition

The science of Pathology, by the combined effort and continued research of its votaries, has emerged from the clouds of Hypothesis which enveloped it in embryo ; but this advancement has not produced a corresponding reformation in the Practice of Medicine. Why is this ? Pathology has been cultivated by comparatively few in the Profession. Too many plod their way in unwarrantable routine, or in the sin of Empiricism. By such, the development, changes, and career of the human organism, if at all observed, are viewed as the vagaries of Hypothesis, or referred to the absurd agency of Chance.

The design of this work is to present the outlines of General Pathology in its present advanced position as a Science, and its instructive bearing upon Practical Medicine.

I have designed brevity and perspicuity of language in the work, which is written currente calamo, expressing my own views in my own manner ; though, on some points of the subjects embraced, I have been materially aided by recent and eminent authorities. I have written almost the entire work in the present year, during the intervals of leisure afforded by an extensive practice. This may suffice

Vlll PREFACE.

if an apology for the style of the work be deemed necessary ; but for the principles advocated, no apology is offered nor indulgence asked.

I shall be the recipient of the most desired remuneration, and shall have attained my highest aim, if this Volume contribute, in any degree, to the amelioration of human suffering, and the promotion of the Profession to which I am ardently devoted. C. L. C.

December, 1866.

Preface

SECOND EDITION, REVISED.

Pathology is to many physicians obscure ; to me interesting ; to our profession important ; to our race beneficent.

After years of ardent study, careful investigation and active practice, I present this treatise to the profession as a venture, as it is written from a standpoint totally independent of the censorship of creeds, schools and traditions. It is a source of gratification that this humble essay has been approved by many profound thinkers and some leading schools.

The first edition, 2,500 volumes, having been exhausted, the demand for the book calls for a second edition.

The work has been carefully revised, new matter added, and is again offered to the profession as a concise treatise on general Pathology.

(ix)

THE PERSISTENCE OF ERROR.

Mr. President and Doctors: — I am not here to disparage you with unfriendly criticism nor to regale you with flattering unction. We are all here to work by the rule of addition — to cast together all we think we know, then eliminate all we do not know — what remains is the known quantity. Should this appear infinitesimal, it may be augmented and potentialized by this coming together.

Our profession demands the aid of the iconoclast. Into every field of thought error obtrudes with alluring blandishments. In the religious, error most abounds, and longest persists. The reason of this is obvious ; theology rests upon the fiat of deduction, rather than the scrutiny of induction. The religions are not beautiful systems of morals, veiled in allegory and illustrated by symbols, but antiquated traditions, founded on superstitions and enforced by dogmas ; their creeds claim for their codes divine sanction, and submissive faith without investigative reason marks the highest attainment of their votaries. No wonder, then, that in these, error does much abound.

With these prelusory remarks, let us now consider the profession of medicine in which I am sure we are all profoundly interested. In this we deal mainly with inductive reason, and in this, great minds have labored, great advances have been made, and great blessings have come to mankind. Our triumphs are too glorious for oblivion and too numerous to mention now. But this is our bright side.

* An address delivered before the Tri- county Medical Association, at Butler, Mo. , by the Author.

(ii)

We must confess some errors, and these we may profitably discuss here and now. We are not to consider the long list of absurd superstitions, never sanctioned by the profession, but believed by some people ; as carrying a potato in the pocket for rheumatism — or buckeye for piles, a comb in the bosom for mammary abscess, and so on almost ad infinitum. But I wish to notice some of the errors which the profession has indorsed, and even now practice. It is not wonderful that the profession has at times gone dashingly into error, for that is human ; but the strange thing is that wrong principles and practice on some things have so long persisted. Hippocrates taught that amputation could only be safely performed through dead tissues, and that notion prevailed and governed the practice of surgery for two thousand years, till the time of Pare. Insane and epileptic people were as long believed to be possessed of a devil till the time of Pinel. Doctors persistently believed that the arteries contained air for more than fifteen hundred years. Th e lamented Servetus, who was burned at Geneva as a heretic in 1553, was the first to trace the circulation of the blood from the heart to the lungs and back to the heart. To suppress science, Dr. Michael Servetus was burned, and all of his writings except two volumes.

Down to a time within the memory of some of you, and when I began the practice of medicine, thirty-three years ago, mercurial salivation and heroic blood-letting were endorsed as orthodox treatment in most forms of disease — then it was as usual for a doctor to carry a lance as it is now to carry a thermometer ; the former has long been laid aside, and the latter must be relegated to the hand of the quack ! Then fever patients were not permitted to taste cold water, the prescribed drink was tepid water, in which was the ubiquitous burnt crust — then ptyalism played havoc with multiplied thousands of confiding patients, especially in syphilis, and the ravages of mercury were thought to be the ravages of syphilis — and were worse.

THE PERSISTENCE OF ERROR. 13

The long use of the stethoscope is another example of the persistence of error. For forty years the medical profession, from the learned professor to the mere tyro and the cheeky charlatan, deftly plied that instrument and looked profoundly wise. Even as late as two years ago I saw the late Dr. Flint go through the delusive farce of using the stethoscope, pleximeter and mallet, in the presence of 500 doctors and medical students in Belle vue. Perhaps dotage and puerile love of show form his best apology, but I was impressed with the fact that the Flint practice, like the flint lock, has had its day, for the profession has finally stamped out, lived down and risen above these imposing delusions.

Old Sam. Thompson said, "Heat is life, and cold is death." In this the venerable steam doctor was about right. More recently, but with less genius, many doctors, especially juveniles in practice and drones in pathology, have become morbidly afraid their patients will get too warm. This heat craze has impregnated clinical medicine with bastard twins — the clinical thermometer and cold baths in typhoid fever. Tepid baths impregnated with salt and soap are indispensable in the treatment of the low grades of fever, but the immersion of such patients in cold water too often proved fatal, consequently one of the twins died, but the other is still dragging out an unprofitable existence, and is the vade mecum of various grades of doctors, including professors, novices and mountebanks. In their hands that little guessing tube is as the cane in the hand of the dude, the divining rod in the hand of the water-witch, or the wand in the hand of the magician. They insert the little tube into the mouth or axilla of their patient (of a horse would do as well), let it remain awhile; ad interim, they assume an air of deep solemnity and amazing profundhy. Then they take it out, examine it carefully, and guess how their patient is getting along. Wonder how long this delusion will persist ! Not always, nor long, for the people will soon come to look upon the tube as an emblem of weakness. Besides, I have great confidence in the conscientiousness, the learning and the honor of the better class of the profession.

A real doctor should be void of shams ; should be able to apply ripe culture and clinical experience to determine the conditions and indications presented . by the tongue, pulse, skin and many other such reliable avenues to verity and success.

Typhoid is a continued fever depending upon essential morbid elements in the blood, and is of low but varying grades. Do not err by calling each grade a kind. In the old or long settled portions of this country, fever is generally of a low grade, or typhoid type. Our old-fashioned bilious fever is passing — indeed, has passed — into typhoid. I have seen individual cases do this, but the general and gradual transition has kept pace with the plow until now typhoid is the prevailing type of fever. The disease is congestive, the temperature variable, warmth and coolness local and alternating, hence, thermal test impossible and absurd. The patient is better warm than cold.

The schools evidently err in plunging patients affected with sun-stroke or heat-stroke into cold baths or ice boxes. They would do better to immerse the body in tepid water, and apply ice to the head.

Another error is the prescribing of cod liver oil in phthisis. It is worse than worthless ; it would blunt the appetite and derange the stomach of a buzzard, and has hurried many patients to the grave. The new and novel, yea, ludicrous and futile mode of treating phthisis by inflating the bowels with sulphuretted hydrogen and carbonic acid gasses, is offensively absurd. If the first mentioned gas were curative, the flatus of that gas which is generated in the bowels and is very abundant in consumptives would work a natural cure. Humanity demands that doctors intent on display should be merciful and not stink their patients to death. Observation and experiments are the progenitors and promoters of science, but the essential element is truth, or verification.

THE PERSISTENCE OF ERROR. 15

M. Pasteur's inoculations for the prevention and cures of hydrophobia unfortunately failed to develop a fact or elucidate a truth ; the practice is now known to rest upon an error, and the Austrian hospital directors, after numerous experiments at Vienna, have suppressed such inoculations.

These are not all, but why do such errors persist from day to day, from year to year, and from generation to generation ? Too many are graduated into the profession without the requisite literary qualifications and peculiar intellectual endowments necessary to make doctors ; too many medical schools are in operation ; too many men are filling professors' chairs and conducting clinics, who are too illiterate and uncultured in general science to grapple with abstruse problems, differentiate clearly, or reason profoundly ; too many in such positions, especially in New York, are too young and inexperienced for teachers. I saw a professor in one of the New York clinics examine a child six weeks old and pronounced the disease incurable paralysis, caused by pressure of the brain during parturition. I privately suggested to the professor that the child's arm was luxated at the shoulder, and that proved to be all that was the matter. That professor is a specialist "good on the brain," in New York, too, the assumed Bag-Dad of medical learning ; hence, doctors are not to be weighed according to the size of the town in which they reside, nor even by their position; neither should verbose pomposity nor its equivalent dullness be taken for dignity nor wisdom. Unwarrantable assumption, incapacity to investigate, a desire to ape others, or greed of gain, too often mar our profession. We want more men in medicine, in religion and in politics, who have the brains to think and the bravery to tell the truth, whether it makes them heretics or heroes, martyrs or monarchs.

A TREATISE ON

GENERAL PATHOLOGY.

Chapter I. Relative View Of Organic And Inorganic Matter

The primitive and ultimate state of all matter is inorganic. Hence, the earth is the prolific mother of the countless myriads of living organisms that dot her broad periphery. Millions of human beings bask in her genial climes, and luxuriate in the variety and abundance of her productions — countless tribes of animals subsist upon her bounties, and traverse her ample domain — numerous nations of plants rise from her bosom, extend their stately boughs, and unfurl their tender leaflets to the gentle zephyrs, to furnish oxygen and food for their superiors in organization. Yet, each of these living organisms is composed of the material that constitutes the rivers and mountains. Each one is formed a model of its kind ; endowed with properties of matter and conditions of activity, and regulated by laws instituted by the Creator of the Universe. Each is as a parasite receiving directly or indirectly from the earth the supplies necessary for an ephemeral existence. Finally, each is perishable, and soon returns to the earth to form the inertia of the inorganic world. So that, physically, the intellectual man, the beautiful woman, the fleet antelope, the sly mouse, the stately oak, and the humble lichen, are alike formed of the earth's material — are alike pensioners upon her bounties — alike they have a common fate, dissolution — alike their elements are returned to the silent recesses of the inorganic world.

We may extend this general view of organic life b}^ presenting other interesting similitudes common to all living beings. Each individual organism, whether animal or vegetable, is derived from a primordial cell, which consists of a vesicle filled with nutritive fluid ; each is developed by nutrition, which is at first carried on in the single primitive organic cell; this cell produces its kind, and multiplies into successive congeries of cells, until an organism is formed. Each organism is supplied with a circulating nutritive fluid ; hence, the sap of plants and the white fluid of the mollusk answer to the red blood that nourishes man and the lower animals.

This general resemblance is again presented in the remarkable similitude between the life of an individual organism and the life of a species. Each species, as well as each individual, has its time of origin, its embryonic stage, and its time of decline. Some of the fossil forms of the early geological ages are the embryos of existing species of animals.

Leaving this general view of the resemblance between, and the characteristics common to all living organisms, organic life next presents to our view a series of individual beings, each possessing its own peculiar individuality, properties of matter, and conditions of activity. The organic series appears to arise from inorganic matter, as by natural proneness, and extends from the merest effort at organization to an organism most complete and wonderful- — from the cryptogamia to the mammalia — from the mushroom to the man — from the humblest moss to the most highly organized man.

Organization is not limited in development by the arbitrary classification of species. The classification of organic

CELL DEVELOPMENT. 19

bodies into species, is convenient as expressing a general idea of their degree of organization, but it is far from definitive. It is a common error to suppose that all of any species of plants or animals are equal in organization. There are various degrees of organization in the human species ; and so of all the species of the lower animals and plants.

Perhaps the most comprehensive view of the organic series is presented by supposing a ladder planted at the foot of Chimborazo and extending to the summit ; this may be made a scale representing the relative organization of all organic bodies. Commencing where life and matter meet, in the primordial cell of the cryptogamic plant, at the lowest round of the ladder, we ascend gradually through the vegetable kingdom, and its various botanical classifications, until we reach the zoophyte, which is the link that connects vegetable with animal organization. It is the round upon which the former ends and the latter begins.

Leaving these zoophytic corals and polyps, we continue the ascent through the zoological classifications of the animal kingdom. Here we find, successively, the mollusca, the articulata, and the mammalia. The highest species of the latter order are the human races; of these there are five. These races rise successively one above another, in point of organization, as species above species, the lowest but a little above the highest of the lower animals — the highest being, as a class, the most completely developed of all organic beings. It is important to observe the effect upon organic development of external influences, such as light, heat, mental impressions, etc. These influences will be considered in the succeeding chapter.

It is an important fact that every primordial cell presents the same precise appearance, whether animal or vegetable. If three of these cells be examined by the most experienced observer, no perceptible difference can be distinguished between them ; each will be a fac simile of the others. Yet, the results of their several developments may be far different — one may develop a man, another a frog, and the other a figtree. Thus, by a few variations in the creation and development of a diminutive cell, the living being is a reptile or a fowl, a plant or a lion, a leviathan or a man.

The primordial cell, then, is the point from which all living beings spring ; it is the point at which life and matter meet and are united — at which vegetable and animal life meet and embrace each other in the harmony of progressive development. It is the germ that gives life, form and activity to the organic universe — that models every creature after its kind — that gives hugeness to the elephant, fleetness to the reindeer, strength to the horse, eyes to the eagle, wings to the dove — that gives a limited degree of reason (not instinct) to the lower animals — that links man to all below him — that clothes him in the image of the beneficent Maker — endows him with the highest degree of reason— prepares him for the highest order of life.

The primal cell was doubtless formed from inorganic material ; but how was it thus formed ? Need we invoke the God of nature for a solution of this query ? Manifestly, inexorable law exemplifies nature, and no known power can change the laws of matter. Organic cells produce their kind; the form and nature of an organism is impressed upon the primordial cell by the power that produces it. These cells are eminently prolific; a single cell develops congeries in rapid succession, until an organism is formed. The resulting organism is indicated by the nature of the first cell and the influences attending its development. Each living being, from the humblest plant to the most complex human being, has its precise place in the universe established by these influences. Nature never makes a mistake — no lapsus naturse can occur; every development depends on the influencing circumstances. Hence, a child may be born with hare-lip, minus a limb, or it may be acephalous ; it would truly be an unnatural child, but its development in this form is a natural result of the attendant

ATTRIBUTES OF MAX. 21

influences. Nature "cuts no freaks," and is not at fault for these imperfect developments ; they are but evidences that the operations of nature are conducted upon a general plan — that development is liable to mutation from ever-varying circumstances. Development, like, nutrition, may be increased, diminished, or perverted.

Observe the rudimentary organs, in some animals, as the subcutaneous feet of some reptiles. Plants, too, present rudimentary organs and excess of development ; a flower is a transformed branch — the sepal, the petal and the stamen would have been leaves had circumstances been more conducive to their development. These facts present the important corollary that the different forms into which organic matter is grouped is neither the effect of Divine special interference nor the decree of chance, but it is the inevitable consequence of immutable physical law.

A comprehensive view of nature presents all the forms that surround us, both animate and inanimate, the earth, and all the hosts of worlds that circle the sun, as the product of an original idea, and the subjects of one prime law which is co-extensive with space and coeval with the universe. Then it is under these laws that the process of development is conducted ; and as it is diminished or perverted by adverse influences, it is promoted when the influences are conducive. Horticulturists promote the growth of plants, and improve the quality of fruits by careful culture. Animal development is augmented in a similar manner. Children inherit the dispositions and infirmities, and, coordinately, the resemblance and intellect, of their parents. A generation born of highly organized and intellectual parents, and brought up in cultivated social circles, would bring the millenium. Vast and wonderful are the capabilities of man. He is the epitome of nature, the acme of the organic universe, the noblest sentient organism. He is a material body, capable of most exalted reason and morals. He exercises an appreciative discrimination between right and wrong, between good and evil. He possesses a principle — a moral nature — a living monad, which impels him to seek the reward of virtue and to evade the punishment of vice. He is the architect of his own destiny. He posesses power to act and a will to direct his own actions, and he is responsible for the manner in which he does act ; but some of his actions are necessitated ; for these he is not responsible.

Man's moral nature, exalted as it is, is not his only ennobling attribute; he is capable of a degree of intellection, investigative reason, and methodical thought, which exalt him far above all organic beings. But for these faculties of man, the moral world would be a chaos — the earth would yet wear her primal dress — the ocean would forever defy navigation — our rivers had never been whitened with the sails of commerce — the earth would continue her circuit without her motion being observed or admired — the blood would course our veins, and nutrition and oxygenation would go on without being observed — steam would have forever moved on with, and existed in, the rushing billows — the lightning would have roamed untamed in the elements — the universal law that regulates life and matter, that controls the stars and holds the planets in their orbits, would have continued its ceaseless operations unrecognized and unadmired.

Insignificant indeed would be man without the guidance and power of exalting mind. Muscle is to brain as matter is to mind. Muscular contractions can but procure the daily bread ; mental power elevates individuals, communities, and nations. Physical power is brute force ; knowledge is power — real, effective, and supreme.

The noblest intellect and the highest virtue are united in man — sentient and moral, intellectual and responsible man. He alone is biped and bimanus. He alone possesses a perfect vertebral column. He alone supplicates the shrine of science — investigates the laws to which he is subject, both physical and mental — moves erect — is lord of earth — having

ATTRIBUTES OF MAN. 23

no peer, he moves the paragon of the organic world. Though he comes into the world the most helpless of all animals, his feeble arm chains the mighty lion ; and the horse, the ox, and the elephant, move at his bidding. Armed with the front of Jove, the power of intellect, the light of reason, and the torch of discovery, he scans the universe — makes all below him subservient to his will. He disarms thunder, and sends the lightning on errands, along the wire path. The earth rejoices in his presence, allures his taste with viands, and perfumes him with her fragrance. Morpheus guards his slumbers. Distant worlds send luminous beams to relieve the monotony of his nocturnal soliloquies.

Chapter II Conditions Of Form And Activity Of Matter

Man is not exempt from the laws of matter. It would be inexcusable error to suppose that the form of even inorganic matter is the result of chance. The irregularities of the earth's surface depend upon laws as purely physical as those which hold the planets in their orbits. The mountains' lofty peaks and descending slopes are marked by the ravages of time, and by the physical impress of the number of beating storms they have withstood. The desert - of Sahara tells of the burning rays of an equatorial sun — the sands of the beach and the rock of Gibraltar are marked by the everrecurring ocean wave.

Rising to the organic universe, we find the same inexorable law prevailing throughout; it modifies the form and regulates the activity of all organic bodies. Plants do not spring up indigenously as under the irregularities of Todd's fabled chance world, but their growth and distribution are influenced by light and heat derived from the rays of the sun ; also, by the quality of the soil and the amount of carbonic acid gas in the atmosphere. That these influences direct the growth and variety of plants is abundantly demonstrated. If we travel from the equator toward either pole, we find each hemisphere belted with zones precisely corresponding in the nature and variety of their vegetable productions. Corresponding zones of vegetable growth are observed in ascending from the base to the summit of a mountain of sufficient altitude to present the same variations of temperature and climate as the different latitudes of the earth's surface.

Light, heat and moisture are essential conditions of vegetable growth. A seed would never germinate in the absence of these conditions ; but if it be introduced into a soil where there is sufficient warmth and moisture, it will germinate ; the young plant, being fed and nurtured by the nutriment stored up in the germinal seed, will rise above the ground before this supply is exhausted, but it cannot long survive without the presence of light ; there will be tardy and imperfect development owing to lesion of nutrition ; instead of being green the plant will be colorless, in consequence of the absence of chlorophyl, which is imparted to plants only through the agency of light.

Moisture promotes the growth of plants by supplying their roots with carbonic acid gas, which diminishes the amount that the leaves are required to take in from the atmosphere. Rain facilitates the development of plants by allowing them to appropriate to their own tissues the saline constituents of the soil in which they grow.

Besides these physical conditions, it is important to observe the variable influences produced upon plants by the various chemical constituents of the soil. The tobacco-plant requires a large amount of nitrate of potash ; the lime-plant requires abundance of lime earth. High dry lands contain largely of oxygen ; low damp lands abound in hydrogen and nitrogen ; and consequently in ammonia.

From the foregoing considerations, it is conclusive that the various forms of inorganic bodies are directed by the universal law of cause and effect ; and that though there exists in the germs from which vegetable organisms spring an inherent predisposition to develop into certain definite forms, yet their activity and degree of development are dependent upon numerous conditions, which are so many operations of physical law ; so that vegetable and inorganic forms are alike determined by the binding force of philosophical laws. 3

Further, what is true of these is also true of the animal organism, including man. Medical men, though leading the way in scientific research, were slow to discover that all matter is governed by one stupendous law. It is in conformance with this law that the universe is governed ; that the world "wags" as it does; that material bodies have form, affinity, attraction and gravitation ; that organic as well as inorganic bodies possess these properties; that the sap nourishes the tender leaflet ; that the blood courses the veins and ramifies the minutest capillaries ; that organic activity is maintained at a standard of health ; that disease originates and produces death, and that it subsides either with or without the aid of medicine.

It is unfortunate for science that most of the obscure phenomena of organic activity were so long considered as "vital power," which was understood to be the result of divine fate, or the fiat of some god in Pagan mythology.

The animal mechanism now claims our special attention. It is designed for activity on a huge scale, and is constructed in precise adaptation to the nature of the influences that put it in motion and continue its action. Besides, each animal is constructed in perfect adaptation to its mode of life ; hence, the fish has fins, the fowl has wings, the ruminant animals are provided with facilities for easy locomotion or transition to enable them to go in search of food. Man is favored above all, with legs to walk, hands to labor, and a brain to exercise a high order of reason. The lower animals, too, are capable of a degree of reason, in direct proportion to the amount and quality of their cerebral matter. That the lower animals possess this capability, has been denied by almost all writers on metaphysics ; but it is affirmed by observing the docility of the horse, the dog, and the elephant ; and it is asserted by the great fundamental law of cause and effect, of structure and activity, of mind and matter.