A system of practical medicine. By American authors. Vol. 1 : $b Pathology and general diseases
History
A system of practical medicine. By American authors. Vol. 1 : $b Pathology and general diseases
Medicine -- Practice
Recognizing pathology as simply morbid physiology--that is, the study
of the body and its functions in states of disorder from morbid
conditions--how these morbid conditions are produced is the complex
question to be answered by Etiology.
Nor is this question (or series of questions) by any means only of
speculative or theoretical importance. It is, indeed, eminently
practical. What a difference, for example, there must be in the
diagnosis, prognosis, and treatment of an attack of inflammation of
the eye, in accordance with its causation by ordinary conditional
influences (taking cold), by a particle of steel imbedded in the
cornea, or by syphilis! How great the difference between the wound
made by the teeth of an animal, in one case with, and in another
without, the presence of rabies in its system! Take the instance of
what we call fever: at a certain stage it is almost the same in half a
dozen diseases. By the causation, when known, of this common congeries
of symptoms we judge of the essential nature of the malady, and so of
its proper treatment.
It is a maxim in philosophy that every event or effect must have at
least two causes. In medical etiology we often find many causes
conspiring to produce one effect. These may be, and commonly have
been, grouped together under two heads; as, 1, predisposing, and 2,
exciting, causes. But under each of these may come a number of
agencies contributing toward the production or modification of
disease. Thus, of predisposing causes we may enumerate inherited
constitution, habits of life, previous attacks of disease, atmosphere,
and other immediate surroundings. Exciting causes--say, of an attack
of apoplexy--may be, in the same case, mental shock, a stooping
posture, an over-heated room, etc. One disease is very often the next
preceding cause of another. So we speak of the great class of sequelæ
of acute or subacute disorders; as, ophthalmia after measles, deafness
following scarlet fever, or blindness small-pox, abscesses following
typhoid fever, paralysis diphtheria, etc. But this kind of causation
is extremely common also in chronic affections. What a train of
organic troubles, of kidneys, heart, arteries, brain, and other parts,
attend the affection to which we give the name of Bright's disease!
How complex the sequence often of valvular disease of the heart,
itself in many instances the effect of rheumatic fever, with {126}
endocarditis as a local manifestation of that disorder! Hardly any
discovery in pathology (or pathogeny, the generation of diseases) of
the last half century has been more remarkable and fruitful than that
of thrombosis and embolism, with their serious and not rarely fatal
consequences, through obstruction of the blood-supply to different
organs.
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