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SPECIFIC ACTION OF THE ELEMENTS OF TISSUES. 129
nothing but the action of its individual elements (cells), an action which consists in their attracting matters from the passing current of blood, in their effecting within their cavity a transmutation of these substances, and returning them in this transmuted form either to the blood, or yielding them up to the bile-ducts in the shape of bile.
Now I demand for cellular pathology nothing more than that this view, which must be admitted to be true in the case of the large secreting organs, be extended also to the smaller organs and smaller elements ; and that, for example, an epidermis-cell, a lens-fibre or a cartilage-cell be, to a certain extent, admitted to possess the power of deriving from the vessels nearest to them (not always indeed directly, but often by transmission from a distance), in accordance with their several, special requirements, certain quantities of material; and again that, after they have taken this material up, they be held to be capable of subjecting it to further changes within themselves, and this in such a manner that they either derive therefrom new matter for their own development; or that the substances accumulate in their interior, without their reaping any immediate benefit from it; or finally that, after this imbibition of material, even decay may arise in their structure and their dissolution ensue. At all events it seems necessary to me that great prominence should be assigned to this specific action of the elements of tissues, in opposition to the specific action of the vessels, and that in studying local processes we should principally devote ourselves to the investigation of processes of this nature. *
It will now, I think, be most suitable for us next to enter a little more in detail upon the consideration of the facts which form the basis of the humoro-pathological system,—upon the study of the so-called nobler juices. If the blood be considered in its normal influence upon nutrition, the most important point is not its movement, nor the greater or less afflux of it, but its intimate composition. When the quantity of blood is great, but its composition does not correspond to the natural requirements of the parts, nutrition may suffer; when the quantity is small, nutrition may proceed in a comparatively very favourable manner, if every single particle of the blood contain its ingredients mixed in the most favourable proportions.
If the blood be considered as a whole in contradistinction to other parts, the most dangerous thing we can do is to assume what has at all times created the greatest confusion, namely, that we have in it to deal with a fluid in itself independent, but upon which the great mass of tissues more or less depend. The greater number of the humoro-pathological doctrines are based upon the supposition, that certain changes which have taken place in the blood are more or less persistent; and just in the very instance where these doctrines have practically exercised the greatest influence, in the theory, namely, of chronic dyscrasiae, it is usually conceived that the change is continuous, and that by inheritance peculiar alterations in the blood may be transmitted from generation to generation, and be perpetuated.
This is, I think, the fundamental mistake of the humoralists, the real hinge upon which their errors turn. Not that I doubt at all that a change in the composition of the blood may pertinaciously continue, or that it may propagate itself from generation to generation, but I do not believe that it can be propagated in the blood itself and there persist, and that the blood is the real seat of the dyscrasia.
My cellulo-pathological views differ from the humoropathological ones essentially in this, that I do not regard the blood as a permanent tissue, in itself independent, regenerating and propagating itself out of itself, but as in a state of constant dependence upon other parts. We need only apply the same conclusions which are universally
THE OUT OP DYSCRASIA. ITS LOCAL ORIGIN. 131
admitted to be true as regards the dependence of the blood upon the absorption of new nutritive matters from the stomach, to the tissues of the body themselves also. When the drunkard's dyscrasia is spoken of, nobody of course imagines that every one who has once been drunk labours under a permanent alcoholic dyscrasia, but the common opinion is, that, when continually fresh quantities of alcohol are ingested, continually fresh changes also declare themselves in the blood, so that its altered state must continue as long as the supply of fresh noxious matters takes place, or as, in consequence of a previous supply, individual organs remain in a diseased condition. If no more alcohol be ingested, if the organs which had been injured by the previous indulgence in it be restored to their normal condition, there is no doubt but that the dyscrasia will therewith terminate. This example, applied to the history of all the remaining dyscrasiae, elucidates in a very simple manner the proposition, that every dyscrasia is dependent upon a permanent supply of noxious ingredients from certain sources. As a continual ingestion of injurious articles of food is capable of producing a permanently faulty composition of the blood, in like manner persistent disease in a definite organ is able to furnish the blood with a continual supply of morbid materials.
The essential point, therefore, is to search for the local origins of the different dyscrasiae, to discover the definite tissues or organs from which this derangement in the constitution of the blood proceeds. Now I am quite willing to confess that it has not in many cases hitherto been possible to find out these tissues or organs. In many cases, however, success has been obtained, although it cannot be said in every instance in what way the blood has become changed. Thus we have that remarkable condition, which may very well be referred to a dyscrasia, the scorbutic condition, purpura, and the petechial dyscrasia. In vain will you look (
around for decisive information as to the nature of this dyscrasia, and as to the kind of change experienced by the blood when purpura or scurvy shew themselves. What has been found by one has been contradicted by another, and it has even been shewn that sometimes no change had taken place in the proportions of the grosser constituents of the blood. There remains in this case, therefore, a quid ignotum, and you will, I am sure, deem it excusable, if we are unable to say whence a dyscrasia proceeds, of which we are altogether unacquainted with the nature. However, the knowledge of the nature of the change in the blood does not involve an insight into the requisite conditions for the dyscrasia, and just as little is the reverse the case. In the case of the hagniorrhagic diathesis, also, it must at all events be regarded as an important step in advance, that we are in a number of instances able to point to a definite organ as its source, as, for example, to the spleen or liver. The chief point now is to determine what influence the spleen or the liver exercises upon the special composition of the blood. If we were acquainted with the nature of the changes effected in the blood by the influence of these organs, it might not perhaps be difficult from our knowledge of the diseased organ also at once to infer what kind of change the blood would experience. But it is nevertheless an important fact that we have got beyond the mere study of the changes in the blood, and have been able to ascertain that there are definite organs in which the dyscrasia has its root.
In conformity herewith we must conclude that, if there is a syphilitic djfccrasia in which a virulent substance circulates in the blood, this cannot be permanently present there, but that its existence must be due to the persistence of local depots (Heerde), whence new quantities of noxious matter are continually being introduced into the blood. By following this track we arrive at the conclusion which we have already mentioned, and which is of extreme
LOCAL ORIGIN OF DYSCRASIiE. 133
importance in a practical point of view, that, namely, every permanent change which takes place in the condition of the circulating juices, must be derived from definite points in the body, from individual organs or tissues; and this fact, moreover, is educed, that certain organs and tissues exercise a more marked influence upon the composition of the blood than others; that some bear a necessary relation to this fluid, others, only an accidental one.