Memoirs of John Abernethy / With a View of His Lectures, His Writings, and Character; with Additional Extracts from Original Documents, Now First Published

by George Macilwain

But of course there is a limit to this power in organs of taking on additional or compensating actions; and when this limit is exceeded, then those actions are instituted which we call Disease. The site is seldom found to be that of the original disturbance; and usually for a very plain reason—because there it would be more dangerous, or fatal. It would be scarcely less serious in many cases, even though placed on organs secondarily affected; and therefore it is more usually determined to the surface of the body; where, taking them simply in the order of their greatest number, or frequency, we find the first class of diseased appearances, and which strikingly impress the real nature of the law. They are the most numerous, most obviously dependent on general disturbance, and most conservative, as being least fatal. Diseases of the skin are those to which we allude, and which, in the characters I have mentioned, exceed all other diseases.

Again—the next surface is that involution of the skin which covers the eye, and which lines the mouth, throat, and the whole of the interior surface of the respiratory tubes and the digestive organs. Here again we find the next seat of greatest frequency, and the conservative tendency, to coincide. We need only refer to the comparative frequency of what are called colds, ordinary sore throat, and so forth; as contrasted with those more serious diseases which occur in the corresponding surfaces of the respiratory organs and alimentary canal. In tracing diseases onwards in the order of their number, we never lose sight of this conservative tendency. When organs become involved in disease, we find that, for once that the substance of the organ is so affected, the membrane covering it is affected a hundred, perhaps a thousand times. This is equally observable with respect to the brain, heart, lungs, digestive organs, and some other parts; and it is of great importance practically to know how readily affections are transferred from the lining of the alimentary canal and other parts to the membrane covering it, rather than to the intermediate texture of the organ; again impressing, though now in a dangerous type truly, the conservative tendency of the law.

Finally, then, we arrive at diseases of Organs; and here we see this conservative tendency still typed in the site first chosen, which is almost always (where we can distinguish the two structures) not so much in the actual tissue of the organ as in that which connects it together—what we term the cellular tissue.

This is remarkable in the lungs; where tubercular deposits are first seated; not in the essential structures of the organs, but in those by which they are joined together. All those various depositions also which are called tumours, generally begin in, and are frequently confined to, the cellular tissue; and even though there is, in certain malignant forms of tumour, a disposition to locate themselves in organs, there is a very curious tendency towards such, as may have already fulfilled their purposes in the animal economy.

We might multiply these illustrations to a tedious extent. We might show, for example, in the eye, how curiously the greatest number of diseases in that organ are placed in structures least dangerous to the organ; and even when the organ is spoiled, so to speak, how much more frequently this is in relation to its function as an optical instrument, than to the structure which forms the link with the brain, as an organ of sensation. I must, however, refer those who wish to see more of the subject, to the work[³³] in which it is more fully discussed, under the term, "The Law of Inflammation," which is a bad phrase, as imperfectly expressing the law; but as the greatest evils it exposes occur in cases of Inflammation, and as it shows the essential nature of that process to be entirely distinct from the characters which had been usually ascribed to it, every one of which may be absent so that expression was somewhat hastily given to the generalization which seemed best to express a great practical fact.

To return to the bearing of all this on Abernethy's views, and in relation to organs primarily or secondarily affected. In obedience to the conservative law to which I have above alluded, defective function in one organ is usually accompanied by increased action in some other; and thus it happens that the symptoms are almost always in one organ, whilst the cause, or originally injurious influence, has acted on another. The general reader will, of course, understand that we are not speaking of direct mechanical injury to an organ. Now all the most recondite diseases of the kidney are already acknowledged by many to be seated in a secondarily affected organ. Still the practice is, in too many instances, a strange mixture of that which is in accordance with the true view, more or less marred by much that is in opposition to it; because it often includes that which is certain more or less to disturb the organ which it should be the object to tranquillize or relieve.

In the same manner, the lungs and heart are continually disordered, and ultimately diseased, from causes which primarily act on the liver; and I have seen such a case treated with cod-liver oil and bitter ales, with a result which could not but be disastrous. The liver sends an enormous quantity of blood to the heart and lungs, from which it ought previously to have extracted a certain quantity of carbon (bile). If this be not done, the heart and lungs are oppressed both by the quantity and the quality of the blood sent to them. If nothing happen in either of the various sites I have mentioned, the blood must be got rid of; and it is so. In many cases, a vessel gives way; or blood is poured out from a vessel; or blood is employed in building up the structures of disease; but then the symptoms are frequently altogether in the chest, and not a sign of anything wrong in the liver.

I cannot go on with the multitudinous illustrations of these principles. The law is to determine injurious influences to the surface. Deposition in the cellular tissue of the lung is bad enough; but it is better—that is, less certainly fatal—there, than in the respiratory tubes: and that is the explanation.

But now comes the practical point. How is the primary organ to be got at? because that is the way to carry out the removal of the impediments to the sanative processes of nature, which, in many cases, no mere general treatment can accomplish. This is to be found by an examination into the whole (that is, the former as well as the more recent) history of the case, and adding the further test of a real and careful observation of all the secretions.

By going back to the former life of the patient, we shall seldom fail to discover the various influences to which he has been subjected, and the organs to which they have been originally addressed. Having made up our minds, from our previous knowledge of injurious influences, on what organ they will most probably have acted, we now test this, not merely by inquiry after symptoms—and it may be not by symptoms at all—but by careful observation of the actual work of the suspected organ. In this way we almost certainly discover the real offender; in other words, the organ primarily affected. This is of immense importance; for we confidently affirm that one single beneficial impression made on it will do more in a short time—nay, in some rare instances, in a single day—than years of routine treatment, that has been, nevertheless, of good general tendency.