Volume 1

The principles of pathology / by J. G. Adami and A. G. Nicholls.

  • Adami, J. George (John George), 1862-1926.
Date:
1910-11
Catalogue details

Licence: In copyright

Credit: The principles of pathology / by J. G. Adami and A. G. Nicholls. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

    30/1080 (page 22)
    he the causative aoent of furtlier morbid processes. Heart disease, tiiat is, does exist. Rheumatism does not iu itself induce congestiou of the lungs, liver, and viscera iu general, with (edema and ascites such as we see iu mitral stenosis. Those are due directly to the cardiopathy, to the narrowed condition of the mitral valve and the consecpient obstruc- tion to the onward flow of blood. Acute rheumatism is here the remote cause, the mitral stenosis the direct. The above syndrome of vascular disturbances constitutes a definite morbid process, obstructive heart disease. Or, to sum up: ]. Disease is a process or succession of disturbances induced by any agent which disturbs the normal activities of the organism as a whole, or of its constituent parts. 2. Such disease may have purely a local seat, modifying the function and activities of an individual organ or portion of an organ, or may coincidently affect several organs. 3. In the latter case it frecpiently happens that the brunt of the dis- turbance falls upon one organ or tissue, so that we are apt, mistakenly, to regard the affection of that organ as the primary disease. 4. The affection of an organ or part may be of such a degree as not .seriously to disturb the working of other parts of the organism; or, on the other hand, may be the direct cau.se of affections of other parts, and so is apt to be mistaken for the primary cause of disease, where, as a matter of fact, it is the secondary. The recognition of these distinctions in practical medicine is of the highest importance. He who, for examj)le, treats a case of obstructive heart disease as a primary condition and directs his efforts jnirely toward overcoming the disturbances due to cardiac inadecpiacy, may, it is true, bring about temporary alleviation of the condition, but only temporary. The primary cause may still be effective, be it the virus of acute rheu- matism or factors inducing raised blood pressure. That is the rational medicine which .seeks and di.scovers the ])rimary disturbing agent, and, counteracting this, gives the fullest opportuuity for the measures directed against the secondary effects to be permanently servicealde. It may not always be po.ssible to determine the nature of the primary cause. Again, the local affection may have led to irreparable tissue changes; so also serious lesions inducing characteristic trains of symptoms may show themselves as remote eflects long years after the acute incidence of the ])rimary disease {e. g., the nervous lesions causing locomotor ataxia may only develop twenty years after the primary .syphilitic infec- tion, and when the causative agents are no longer present in the system). All this has to be admitted, but does not in any .sen.se contradict the general principle. On the contrary, it expands it, indicating that it is the duty of the physician to determine more surely the primary causes of disease, to recognize at the earliest stage the effects of the same, and to institute treatment I)efore those effects have proceeded to the stage of setting up irreparable injury. Cellular Physiology and Cellular Pathology.—If, then, we take the posi- tion that for every structure and every function of the body, and for the