Physician and patient

by Worthington Hooker

1. The sympathy which exists between the different organs of the body.

The fact that when one organ is disordered in any way other organs sympathize, or suffer with it, is familiar to every one. This sympathy destroys the simplicity of disease, in two ways. In the first place, it produces many symptoms at a distance from the organ affected. Pain, for example, is often far away from the disease which causes it. The pain in the right shoulder from disease of the liver, in the knee from disease of the hip joint, and in the head from disordered stomach, are familiar instances. Convulsions, in the great majority of cases, especially in children, are a mere symptom developed by the sympathy of the brain and nervous system with disease in some other organ—for example, a disordered stomach, the irritation of teething, &c. Now if sympathy renders disease complex, by developing such marked symptoms as those we have mentioned, at a distance from the affected organ, much more will it do this by the numerous less observable, and less definite symptoms, attendant upon our various bodily maladies.

In the second place, sympathy destroys the simplicity of disease, not only by exciting symptoms in organs at a distance from the part affected, but also by creating actual disease in those organs. A single example will suffice. The child, whose brain sympathizes with the disease in its stomach, may have inflammation after a time fastened upon its brain in consequence of this sympathy, the symptoms at first being obscure, but at length clear and unequivocal.

The influence of sympathy in modifying disease occasions constantly much perplexity in the mind of the physician. He often finds it difficult, and sometimes impossible, to decide whether an organ, which he sees to be affected, is really diseased, or is merely sympathizing with some other organ.

The simplicity of disease is thus destroyed by sympathy, even when all the organs, except the one which is attacked, are in a healthy state at the time of the attack. And when they are already in an unhealthy, unnatural condition from previous disease, the complication is rendered still greater. Chronic[2] cases especially are often so complex from this cause, that it requires the most discriminating acumen to unravel their history, and make out the starting point of the disease. Often it is impossible to discover any such starting point; and sometimes there is none, but there are several different diseases in different organs, all affecting each other through sympathy, and presenting together a confused and changing medley of symptoms. In such cases, the manifestations of diseased action are at one time most prominent in one organ, and at another time in another. These variations in the phase of the disease are often so unaccountable, as to seem capricious, and they always embarrass the physician, as he attempts to determine the effect of his remedies, and to proportion them to the importance of the symptoms, as they show themselves in the various organs. It would sometimes almost seem, that a tricksy little spirit were playing its pranks among the organs, now here and now there, eluding his search, and escaping his grasp.

In some cases, disease will leave the organ in which it seems to be obstinately fixed, and appear in full force in some other organ, which has been up to that time only sympathetically affected. This is more apt to occur in children, because the sympathies are more lively in them than they are in adults. Such changes, taking place often without any obvious cause, and so suddenly, and sometimes, we may add, so secretly, you can readily see, must tend to make our knowledge of disease, and of the effect of remedies, confused and uncertain.

2. The influence of unseen or secret causes, is another source of uncertainty in medicine.

The fact, that some causes, whose nature and extent cannot be appreciated, are at work modifying disease, and the effects of remedies, constantly forces itself upon the attention of the practitioner. The causes of disease, and of the changes that occur during its progress, are much more concealed from our view than is generally supposed. Patients are fond of fixing upon something to which they can attribute their sickness; but in the great majority of cases, the conclusion which they adopt with so much confidence is a mere supposition, and does not rest upon any substantial proofs. Even in the case of a common cold, you will find that the reasons given for believing that this or that cause produced it, often will not bear a strict examination, according to the acknowledged rules of evidence. Ordinarily some exposure is looked upon as being without a doubt the cause, when it may have been only one of the causes, or may even have had no agency at all in producing the result.

Some of the causes of disease, though, from their definite and invariable results, we may be perfectly aware of their presence, are yet of an occult nature, escaping all the tests devised to detect them. For instance, the miasm, as it is termed, which is the cause of intermittent fever, has never yet been detected in the atmosphere, by the application of any chemical test. And yet, no result in the wide range of disease is more definite and palpable than that which this miasm produces. And so secretly does it make its impression, that the disease sometimes lies dormant for a long period, even for weeks and months—the system all the while showing no signs of its presence. I once had a case of intermittent fever, which was not developed till a year had elapsed from the time of the patient’s exposure to the cause.

The nature and mode of operation of the causes of many diseases are involved in mystery, and are subjects of discussion and dispute among medical men. The formidable, and often fatal malady, that results from a wound received in dissection, is attributed by some to a poison evolved in the decomposition of the body; while others suppose that it arises from the irritation of the wound simply, circumstances concurring to increase the irritation in one case, while it is left to subside in others. It is agreed, on all hands, that the contingencies on which the disease depends are not ascertained; and they are so often absent, that the cases in which the malady does actually occur bear a very small proportion to the whole number of instances in which such a wound is received.