CHAPTER I - Causes of Disease

    Normal and Abnormal. - In order to use the word abnormal, with reference to the structure and function of living tissues, we must have knowledge of the normal.  Normal is a word having, apparently, as many interpretations as the word "beauty," i. e. standards to which these words are applied differ, even as the individuals who use them.  In order that we make clear what we conceive as normal and abnormal conditions, it is necessary to call attention to variations in structure and function, which should be recognized as not being far enough removed from typical conditions to indicate the existence of a need for corrective interference.

    The Ideal Normal. - Our first steps in the acquirement of a medical education are practically all concerned with study of the normal.  We dissect bodies which have been changed by disease and therefore we come in contact with abnormality.  To counteract this we study descriptive anatomy and idealize our real knowledge which was obtained by dissection.  Ofttimes our ideal has such attributes of perfection that nothing ever comes up to standard and hence appears to us to be defective.  This hypercritical attitude leads to exaggeration of the interpretation put upon symptoms and hence leads to misdirected efforts at correction.

    Variations in Structure and Function. - We need therefore, first of all, a fairly good knowledge of the variations in structure and function which may be recognized as considerable departures from type, but still not abnormal in the sense we use that term when speaking of disease.  No tissue in the body is unyielding and hence will adapt itself to even a very moderate force, if that force is long continued.  This is well illustrated by the great changes which can be produced in the alignment of the teeth under corrective bracing.

    Adaptation. - The changes in structure, which are frequently recognized, may be evidence of adaptation, i. e. they are the final result of the body’s effort to maintain its existence at the highest point of efficiency of which it is capable.  With this thought ever in our minds we may safely observe the character of structures and draw many more just conclusions as to the existence of normal or abnormal conditions.

    Normal Health. - People usually seek the services of a physician because they suffer some degree of discomfort.  True it is that some seek a cosmetic effect, but this may hardly be seriously considered.  Normal health means a condition wherein we are unconscious of bodily distress and are able to do what is ordinarily counted as our share of work.  This state of bodily comfort, under the ordinary stress of labor, is not necessarily based upon symmetry of structural development, i. e. absolute conformity to our ideal of structural perfection.

    Comfort and Efficiency. - Normality from the cradle to the grave seems to be a personal equation, i. e. bodily comfort under the stress of moderate physical and mental exertion.  Increase of physical or mental exertion either, through adaptation, produces increased capacity, or, through failure of adaptation, produces destructive changes.  Comfort and efficiency are the real attributes of normality.  If these are present in average degree there is little likelihood of a physician being consulted.

    Variation of the Normal. - The normal of any individual varies at different periods of life and following accidents or severe illnesses.  The physician is frequently consulted with the hope that the normal of later years might be raised to the degree consciously possessed at a former time, or in the hope of being restored to the normal which existed previous to an accident or severe illness.  The new normals which constitute the result of repair after injury and illness do not measure up to the previous standard in most cases.  Consciousness of a decrease in efficiency leads many people to the hope of securing all increase by some specific means.

    Distress and Inefficiency. - The physician is constantly dealing with two classes of patients, those who suffer bodily distress, and those who are conscious of bodily inefficiency, in some degree, and hence suffer mental distress.  It is alluring to sufferers of either class to think there is a specific removable cause of their distresses, hence any form of treatment, aiming to specifically attack the cause, has a captivating character.

    Difference in Belief as to Causes. - All forms of treatment are, at least in fancy, based on the desire to remove the cause of the ailment.  The reason there is such wide discrepancy in methods is because of differences in belief as to causes.  In other words, if all forms of disease were thoroughly understood, i. e. as to cause as well as manifestations, there would very quickly develop an agreed form of treatment.  It appears so, but there is another factor to consider.  The same disease, due to the same cause, does not manifest itself the same in every individual, therefore the same means used to remove the cause does not bring the same reaction in every individual.  This has led to a multiplicity of methods even where the cause is known.  It is certainly a great gain to have but one unknown quantity, the vitality of the patient, instead of the two that previously existed, i. e. the cause of the illness and the vitality of the patient.  This desire to have but one unknown quantity has frequently led to the development of medical dogmas based on a belief in the existence of certain causes of disease.  'The germ theory and the lesion theory are good present day examples.  Both the germs and the lesions are so universally found that both form convenient foundations for dogmatizing.

    Interpretation of Phenomena of Disease. - Although these studies are directly concerned with the phenomena of lesions there is no desire on our part to exalt any group of phenomena out of its comparative value with any other group.  It is hoped that by presenting, as well as we are able, the lesion theory of disease, we may be able to show paths of convergence leading to a better interpretation of disease phenomena and thus the truths which underlie the lesion theory will not become distorted into fantastic vagaries.  We do not wish to be understood as claiming for osteopathy the discovery of the cause of disease.  There are many causes, widely divergent in character.  Osteopathy brings to your attention a cause, frequently found and of sufficient definiteness to warrant concentrated attention.

    Favorable Reaction to Environment. - Since we are mechanisms of living tissues, our survival depends upon reacting favorably to environment.  We find the elements, air, light, heat and cold all affect us adversely at times.  They become destroyers of bodily comfort and efficiency when intensified.  Changes in atmospheric pressure, intensification of light, increased heat or cold, affect us seriously.

    Known Causes of Disease. - Chemical poisons, such as lead, arsenic, mercury, phosphorus, carbon monoxide and other gases, are causes of profound injury.  'The organic poisons, alcohol, opium, morphine, cocaine, food poisons, snake venoms, autointoxications, play no small part in causing bodily discomfort and inefficiency.  The vegetable organisms, fungi and bacteria claim abundant recognition as causes of disease.  Protozoa are properly listed as causes, for have we not the wonderful discoveries concerning malarial fever, sleeping sickness, amoebic dysentery and yellow fever; sufficient scientific achievements to startle the world.  The fluke, cestode and round worm infections have long been recognized causes of disease.  Add to the foregoing all those adverse conditions imposed by the nature of our crowded existence in cities, noise and unrest, surfeit and poverty, fatigue and worry, it is little to be wondered at that we find ourselves searching almost hysterically for some thing to aid us to survive it all.

    The Tenacity of Life. - It is marvelous how our bodies adapt themselves to all the vicissitudes of environment, survive the effects of inorganic and organic poisons, invasions of bacteria or protozoa, maintain existence in spite of deficient food and rest.  The tenacity of life in human tissues, the adaptations and compensations that are developed, are worthy the pen of some scientific genius who has the literary ability to make the layman have faith in natural law.

    Lesion-Disease Association. - With all these causes of disease we may well ask ourselves what relation the spinal or other joint lesion has.  It would be difficult to find any disease process that does not exhibit a spinal or other joint lesion, in the sense we osteopaths recognize.  This coincidence of disease and spinal, or other, joint lesion does not necessarily indicate a sequence of events starting in the lesion.  As scientists, rather than special pleaders for a theory, we want to know the significance of this association.  It is our aim to devote the pages following to an analysis of this lesion-disease association.  We aim to write helpfully, analyzing our failures that we may know our weaknesses, analyzing our successes so that we may make our solid principles more widely recognized.
 
    Remove the Cause of Disease. - No great amount of analysis of the various causes of disease is required before we realize that to "remove the cause" we must do something more than treat individual members of society.  There is a phase of medical practice which requires us to view the good of the community rather than any portion of it.  Some lives are sacrificed because we have no cure for the individual.  We cure the community, the race, by sacrificing the individual.  Public health requires what seems to be cruelty toward the individual from whose disease we must be protected.

    Preventive Medicine. - As fast as causes of certain diseases have been demonstrated, plans for prevention take precedence over treatment of the individuals who suffer from those diseases.  Thus a new class of physicians is developed, i. e. those trained to cope with the problems of preventive medicine rather than meet the exigencies of treating individual patients.  It is the necessarily aggressive advance of preventive medicine which arouses antagonism and social discord.  No one could successfully contend that all preventative methods, thus far enforced, are satisfactory.  Then, too, it is not possible to demonstrate quickly to all the members of a community the necessity for certain procedures.  Sacrifice of the individual, be it ever so slight, for the good of the whole, is not agreeable to the victim or his friends.  Altho we are developing methods primarily applicable to the individual rather than serving the aggressive purposes of preventive medicine, that which makes the individual an efficient member of society subserves public health.

    Symptoms. - Diseases manifest themselves by certain phenomena which are designated as symptoms.  Symptoms are abnormal degrees of normal reaction.  This is made evident by the fact that some symptoms represent sub- and others super-normal functioning.  The supernormal functioning represents a reaction, on the whole favorable to recovery, whereas the subnormal reaction is not favorable.  Since the symptoms represent phases of reaction or non-reaction in tissues, the effort put forth by the body, as a whole, to recover, is in proportion to the energy contained in its cells.  In a restricted sense the cause of disease is in the cells of the body.  They contain the stored energy, i. e ., potential energy.   When this potential energy is released by some force, or stimulus, we have kinetic energy.  Potential energy does not transfer itself spontaneously into kinetic energy without first being affected by some other force, which may be called a stimulus.  The, amount of potential energy converted into kinetic is not proportional to the amount of the stimulus used to initiate the process.  All stored energy, i. e., potential energy, requires a certain strength of stimulus to start the process of conversion into kinetic.  When this strength of stimulus is known, it is called the normal.  There are usually several kinds of stimuli, each one having a varying degree of intensity.  For example, the potential energy in a muscle fiber will be converted into kinetic energy as a result of mechanical, thermal, chemical or electrical stimuli.  Certain amounts of each of these stimuli are required to initiate the change in the form of energy.

    A Normal Stimulus. - The potential energy in a muscle fiber has a certain degree of resistance to stimuli.  A definite amount of any one of the four forms of stimuli named is necessary to cause the muscle fiber to contract.  This definite amount, which is capable of stimulating the muscle to an average contraction, is called the normal stimulus, and the action of the muscle is called the normal contraction.  If the muscle should contract more vigorously than usual in response to this normal stimulus, the resistance of the potential energy of the muscle fiber is below normal.  The strength of stimulus and discharge of energy may vary greatly in their proportions within normal limits, but there are well marked lines above or below which resistance is spoken of as above or below normal.

    A Change of Resistance. - When the resistance of the potential energy is below normal, a normal stimulus causes too great an effect, that is, too much potential energy is transferred into kinetic energy.  When the resistance of the potential energy is normal, and the stimulus above normal, there also results an excessive discharge of potential energy.  Therefore, excessive discharge results from lowered resistance, or increase of stimulus.  Resistance is a quality of the cell protoplasm.  The stimulus is an external force.  The cell depends on proper surroundings in order to maintain its resistance to external stimuli, such as bacteria.  The strength of bacteria may also be increased or decreased by the nature of their surroundings.

    Cause and Effect. - After potential energy has been changed into kinetic energy, this latter may generate more potential energy, and this also may be converted into kinetic.  Thus cause is converted into effect and effect into cause. This is an endless chain.  When such a process is beyond the normal, as in the body when varying symptoms present themselves, therapeutic efforts must be concentrated on some particular reflex in order to break the chain.

    Cell Relations. - The relations of a cell with its fellows, that is, its structural relations, are the basis upon which its resistance, in large measure, depends.  Therefore, anything which disarranges its normal relations will, in all probability, change its resistance to stimuli.  All therapeutic methods which aim at lessening the too rapid conversion of potential into kinetic energy, that is, increasing cell resistance, must see that correct structure is attained.

    Excessive Stimulation. - In cases where almost complete exhaustion of potential energy has resulted from lowered resistance and we find that even increased strength of stimulus fails to evoke a response, the same structural fault may exist.  We know that stimulation, when excessive, passes into inhibition.  Perhaps it is truer to state that overactivity of a cell leads to exhaustion of its potential energy.  The stage of exhaustion, in this sense, is consonant with inhibition.  As an example: In case of structural changes in the lower dorsal region, there may result a change in resistance in the secretary and contractile cells of the intestines, due to changed blood supply.  Diarrhea results for a time, followed by constipation.  At the beginning of the rapid conversion of potential into kinetic energy the muscles feel tense.  After the constipation, or period of exhaustion, sets in, they are flabby.

    Structural Defects. - Structural defects may result in lowered resistance in groups of cells.  They also act as stimuli to set free the potential energy in these cells.  In many cases we note only a predisposition to yield to weak stimuli.  This is the condition in individuals who are "fairly well," but cannot endure any of the normal stimuli in average amount.  They cannot exercise freely without a bad reaction.  A slightly heavier meal than usual, the excitement due to the presence of many people, arouses "symptoms."  Their physiological processes are easily perverted by normal stimuli because a structural defect, either directly or indirectly, has decreased cell resistance.  Cases of lowered resistance, supposed to be due to heredity, should be carefully examined for structural defects.  It is not improbable that many an ancestor is wrongly accused of transmitting a "predisposition."  While cell resistance remains below normal, all external stimuli, such as atmospheric changes and the presence of bacteria, even if in only normal amounts, may call forth "symptoms of disease."

    Cell Life Dependent on Circulation. - The individual cells of the body depend on the supply of nourishment brought to them by the circulating fluids of the body.  The protoplasm of the cells is a complex, chemical substance made up of an enormous number of complex molecules.  These molecules, on account of the looseness of combination of their atoms, require sufficient crude material brought to them to maintain the proper atomic tension.  Upon this tension is based the resistance to normal or abnormal stimuli.  The necessary food for cell protoplasm is brought to the cells by blood and lymph.  Since cell protoplasm is entirely dependent upon the circulating media, any disturbance of these media changes the metabolism of the cell, and hence a change in resistance results.  This resistance may be varied by failure on either the arterial or venous side of the general circulation, resulting in changed lymph circulation.  The constant removal of katabolic products is of as much importance as the constant renewal of material for anabolism.

    Intracellular Tension. - Intracellular tension, i. e., the cohesiveness of the atoms of each molecule, is dependent on lymphatic circulation; this upon arterial and venous circulation.  If there is abnormal variation in any of these circulatory fluids, there results a change in resistance of the cells.  Therefore, a normal stimulus mass may provoke to great a transference of potential into kinetic energy and thus initiate a chain of such transferences of one form of energy into another.  As a rule, the kinetic energy which results from the release of potential energy, in excessive amounts, acts as a stimulus to release still more potential energy and so on to the point of exhaustion of the supply of such stored energy.  This change is exemplified in the series of symptoms which appear in many diseases.  Each liberation of a new supply of energy gives rise to a new system.  If the potential energy resides in a gland, excessive secretion results; if in muscle, excessive contraction, etc.  The way in which the kinetic energy is manifested depends upon the manner in which its cause, i. e., potential energy, is stored.  The secretion or the contraction may act as a stimuli to liberate still more potential energy.

    Scientific Therapeutics. - Therapeutic methods become scientific just in proportion as they are based on the known structure and function of the tissues and the exact cause of the disturbed condition of the tissues, i. e., the disease.  The effort to develop scientific therapeutics has led to various ways of looking at the problem.   We have mentioned the fact that each case of illness is a problem with two unknown quantities, i. e., the cause of the illness and the reaction power, i. e., the resistance of the individual.  The cause, in many instances, may be sufficiently well known to govern the method of treatment, at least the treatment appears scientific if we think only of the cause.  The possible weak point in the plan of treatment is the fact that no consideration has been paid to the existence of the second unknown quantity, i. e., the resistance of the tissues to the disease as well as to the treatment.  The treatment of typhoid fever by intestinal antiseptics appears scientific because it appears to bring the cause of typhoid and the means of destroying it in proper relations The treatment has not proven successful because of the second unknown quantity and because that which is destructive to the cause is likewise destructive to the tissues.

    The Problem as a Whole. - The development of scientific therapeutics is evidently not easily accomplished, even when we know the cause of disease.  There are those who treat diseases and those who treat individuals, i. e., those who attack causes, with little regard for the reactions of the individual, and those who aim to support the reactions of the individual without any direct attack on the cause.  It is evident that neither method is altogether right, hence scientific medicine is ever striving to evolve a treatment suited to the problem as a whole.  Take for example the problem of ridding the body of an intestinal parasite, such as a tape worm.  Methods of treatment differ, altho based on a known cause and a known condition for elimination of the parasite.  There are many ways of making the parasite sick enough to loose its hold on the walls of the intestine.  The question is: Which way will be least disturbing to the host ?  The practice of osteopathy is full of such problems, the majority of them nowhere near as simple as the one used as an illustration.  The human body is disturbed by many specific causes, varying in destructive power, which bring forth series of symptoms, which, taken together, give us a picture of a certain disease.  To these causes all human beings react in approximately the same way.  The symptoms pass through varying degrees of intensity, run a characteristic course and disappear.  We recognize that the reaction power of the body has triumphed over the cause of the disease.  The fact that the majority of sick people get well under all sorts of treatment naturally leads us to believe that the body is able, in a majority of instances, to conquer the cause of the disease.  Recognition of the healing power of Nature leads to the development of two views as to how disease should be met.  There are those who distrust and decry all therapeutic methods.  Such are fond of pointing to past therapeutic failures and are, in fact, therapeutic nihilists.

    Natural Recovery. - It is not enough to recognize the fact of recovery.  We want to know how natural recovery takes place, then we may be able to assist, at least not hinder, the forces acting for recovery.  The study of structure and function of human tissues is the foundation for understanding how Nature cures.  We believe that osteopathy has brought, and is now bringing, very valuable additions to the sum of human knowledge as to how Nature cures.  It is building its portion of scientific therapeutics based upon a knowledge of causes and reactions.

    Extrinsic Causes of Disease. - The causes of disease previously mentioned, i. e., environmental conditions, poisons, parasites, etc., are all external influences, in the sense that they are not a part of normal tissue structures.  The causes noted especially in osteopathic diagnosis are a part of the structure of the body.  The structural relations are sufficiently altered to compel the body to react on its own structural imbalance.

    Inherent Recuperative Power. - Since it has inherent recuperative power to overcome the effects of external causes of disease, there is no doubt but that it usually survives localized structural lesions of this inherent character.  It adapts itself as well to internal structural conditions as to diseases produced by other causes.  We have noted the necessity of a normal molecular intracellular tension in order to maintain the efficiency of the cell, also the necessity for proper relations between the cells and the circulating fluids.  Any structural fault which interferes with this relationship compels the body to react to this fault either in a way to correct it, or, if it threatens the life of the whole body, get rid of it.  We see in these reactions just such phenomena as we exhibit in our social relations, i. e., a sick member of the community causes no great reaction in the body politic until his illness menaces the whole people.

    Disturbed Tissue Relations. - Osteopathy emphasizes the disturbances in tissue relations.  It sees in these both predisposing and exciting causes of disease; predisposing, in that tissue resistance to outside influences is weakened; exciting, in that, in many instances, the reactions take on the character of acute diseases.  Injuries are so very frequent that there is scarcely an individual who has not put the structural tissues to a severe test.  These strains, usually of sufficient severity to produce local distress and healing reactions, leave their influences, and if a long time for healing was required, perhaps influenced the general statics of the body.

    The Biological Relation of Function and Structure. - The author does not look upon the so called osteopathic lesion as being an evidence that structure determines function, biologically considered.  The structural lesion is an interruption of the biological concept that function fashions the structure.  This interruption disturbs function, but the biological law is sure to assert itself in the recuperative process.  Since "biology has no statics," living tissues are always being rebuilt to serve the function which brought them into being.  This ability to repair an injured tissue and make it serve the special function for which it was intended, is the foundation for adaptation and compensation, those phenomena which we see exhibited by the body in so many forms in its struggle to survive.

    The True Art of Healing. - If we can study these phenomena, understand what Nature is trying to do, assist accordingly, then we are indeed physicians.  "In no case can anything appear in the form of disease which was not previously present in the body as a predisposition; external forces are able merely to make this predisposition apparent.  When the physician, by thorough observation and investigation, knows the conditions that influence a given predisposition in a definite way, when he is scientifically trained and has a true conception of hygiene, and is at once physician and naturalist, then he is able to cure disease by use of the very same forces which serve to create or alter the human constitution.  In this simple sense there is a true art of healing."