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Normal cells act in a normal manner. This is self-evident when it refers to the unicellular organism. The single cell must live if the conditions of its life requirements are met. The cells of the multicellular organisms are not of different order from those more humble neighbors. The cells of bodies so complex as our own live each its own life. It is not an absolutely independent life, it is true, but it is in a manner an individual life, and it is dependent upon the other cells of the body more because of their effect upon its environment than for any other reason. Each of these cells, if it has a normal structure and a normal environment, must live a normal life. There is no choice in the matter. The normal cell in a normal environment cannot fail to respond to the normal demands upon it in a perfectly normal manner.
This does not exclude death. It is part of the normal metabolism of the normal cell that its possibilities of maintaining its power of reply to its environment shall fail after a certain time, unless there is a certain recombination of its chromatic structure. This is true of every organism which contains within it the possibility of development. In the case of the lower animals and plants, this need for the recombination of the nuclear elements affects the whole organism. The paramoecium, for example, is able to divide by asexual division for about three hundred generations. When the animals seem to be about to die of old age, they are small and not voracioius, and they display evidences of failing nutrition. They die if the sexual division is not permitted. Among the higher plants and animals, the cells of the body are able to divide in an asexual manner for years; some of the cells of the human body are able to continue dividing for a life-time, as is the case with the epithelial cells of the skin. Other cells lose their reproductive powers long before birth, as is the case with the nerve cells. These cells, and all the other cells of the body save only the reproductive elements, lose their power of sexual division, and in this very differentiation become limited in their possibilities of life. Thus it appears that death is one inevitable factor in the history of all the cells of the body except the reproductive cells, and for an almost infinite number of these also. The death of individuals secures racial advancement. The unfit leave the world to the fit. Death makes progress no longer merely probable; it makes progress absolutely inevitable. It is the premature death which we wish to avoid, and the suffering that spoils lives. (Note A.) The
most complex body is made up of cells. These act normally if they
have normal structure and environment. The activity of an organ is
the sum of the activity of its cells. This activity is not whimsical,
-- the cells have no choice. They may be subject to injury, and their
normal function be impossible. They are often unable to act normally
because of starvation, or over work, or over rest.
If the stomach, for example, fails in its function, there is some efficient reason for its failure. Usually faulty habits of eating are the cause of almost any indigestion. In other instances, the fault lies in an abnormal nerve or blood supply to the stomach. In other instances, there is some structural condition which renders normal function impossible. Always, there is some efficient cause for every fault of every organ. The
heart is an organ which fails in its duties sometimes, but it never fails
without reason. This reason is not always apparent, but it so often is
evident that there has been a history of infectious fevers, or rheumatism,
or over strain, that it is beyond question that the normal heart never
fails under circumstances that even approach the normal.
It is in considering disorders of the nervous system that this principle is most often doubted. It is perhaps never doubted in connection with these other conditions as a matter of theory, though it seems very often denied in the matter of deciding upon therapeutic procedures. Let it be granted that the faulty action of any organ is evidence of fault either in the structure or the environment of that organ, and the whole theory of the abnormal methods of combating disease becomes manifestly absurd. In the case of nervous diseases, and especially the diseases which appear functional, there is great temptation to consider the nerve cell the offending organ. The next question which appears is the determination of the cause of the mal-function. The neurons arc as dependent upon normal food and oxygen supply as the other cells of the body.. They are as greatly subject to injury from the retention of their waste products as are other cells of the body. They are as easily subject to fatigue as are other cells of the body. They are more unstable than any other of the cells, and the effects of their malfunction are more wide spread. There is no part of the body which may not be injured by a malfunction of the neurons. For these reasons, disease of the nervous system seems a primary condition, when it occurs. It is not a primary condition except when the structure of the neurons is itself at fault as a result of an inherited condition or some accident. The neuron may inherit a structure which renders it weak and unable to endure more than the most ordinary burdens of life. These show the symptoms of approaching senility very early in life, or they fail utterly upon the onset of some unusual strain. These owe their lack of normal function to faulty structure. There is nothing for the physician to do in these cases except to give the disordered neurons the best possible opportunity for normal activity. These neurons, even with their faulty structure, may often be enabled to perform their functions in a fairly normal manner in an environment which is unusually well selected. There must be no over work for the abnormal neurons, nor must their normal food fail, nor must they be permitted to endure the presence of any toxins at any time. In the normal life alone, with no demands save the absolutely normal, may the defective neurons be enabled to act in a fairly normal manner through a life time,--and the life time is probably a short one.
This principle must be held to apply to the mental conditions which vary only slightly from the normal. These cases offer some of the most puzzling problems which present themselves to the physician. There are many who doubt the existence of any real disorder in these cases and therefore prescribe placebos. These act upon the imagination of the patient for a time, but recovery never occurs under such circumstances. There is usually no urgent visceral trouble; if there is any at all it is usually due to injudicious medication or dietetic fads. These people are not often fairly dealt with. They are not sick in the manner they suppose, usually, but they are not normal people. It may be that their education has been at fault, in that case it is the duty of the doctor to remember the original significance of his title, and see that his patient is placed under conditions which lead to more rational and wholesome habits. The normal brain is not gloomy and filled with baseless apprehensions. There is no place in the function of the normal metabolism for the occurence of such affectations of ill health as fill the minds of the hypochondriac and others of his stamp. The very fact that a patient thinks he is sick when he is not is proof that there is some disorder, either in the structure or the environment of the cortical neurons. It not infrequently happens that serious causes of malfunction are overlooked by a busy physician because the patient displays evidence of the whining, self-conscioius, self-pitying professional invalid. The appearance of these symptoms always suggests the malingerer or the hypochondriac, but it is manifestly unjust to suppose that there can therefore be no real disease. If the case of such a person is accepted, the study of the symptoms and the full investigation of the functions of all the organs of his body should be made as carefully as in any other case. In a large proportion of cases such a careful examination will display efficient causes for the malfunction. If these be recognized, the possibilities of a cure may be determined. The term “functional disorder” is becoming more and more rare, and it is the hope of every person interested in rational therapeutics to see it disappear from our literature altogether. Note A.—Plato’s description of euthanasia is worth quoting: “But when the roots of the triangles: (affinities of the atoms, in modern tongue) “are loosened by having undergone many conflicts with many things in the course of time, they are no longer able to cut or assimilate the food which enters, but are themselves easily divided by the bodies which come in from without. In this way every animal is overcome and decays, and this affection is called old age. And at last, when the bonds by which the triangles of the marrow are united no longer hold, and are parted by the strain of existence, they in turn loosen the bonds of the soul, and she, obtaining a natural release, flies away with joy. For that which takes place by nature is pleasant, but that which is contrary to nature is painful. And thus death, if caused by disease or produced by wounds, is painful and violent; but that sort of death which comes with old age and fulfills the debt of nature is the easiest of deaths and is accompanied with pleasure rather than with pain.” -- Diaglogues of Plato, translated by Jowett. |