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It is evident that the more complex is the organism undergoing adaptive changes, the longer will be the time spent in the formative, or unstable, or pathological condition.
Each of the cells of which the body is composed lives a life which is to a certain degree an independent one. It is true that they do depend upon one another, almost absolutely, so far as the maintenance of life is concerned, but it is also true that there is a certain individuality in the life processes of the various cells of the body; that they live, each in its own life; eat, each its own food; eliminate katabolic products, each of its own kind, and perform each its own duties. They react to their own environment, each for itself, though this environment is composed of the other cells of the body, and the fluids formed by them. Thus, the body acts as a unit, because the cells affect the environment of one another. Of all cells, the neurons affect the other cells in the most conspicuous manner.
When any cell group of the body is subjected to the influence of abnormal conditions its metabolism undergoes certain changes, characteristic both of the cells themselves and of the nature and force of the abnormal influences. Every cell group gives its own characteristic reply to changes in its environment, both normal and abnormal. The connective tissues abnormally stimulated thicken and harden; the nerve cells act extravagantly, wear and die; epithelial cells multiply, and only become broken down in answer to the presence of insuperable obstacles to further metabolism. Muscle cells multiply with increased function; nerve cells never multiply after differentiation is well begun, long before birth. Many structures atrophy with disuse, but others may maintain a non-functional existence for years; in the case of the embryonic nerve cells, they may live undeveloped for a life time. In all these instances the principle holds true, that the reply which the cells of the body give to abnormal changes in their environment does not long remain that which is characteristic of their normal metabolism.
After a period of reactions to an abnormal development, the cells of the body do not at once regain their normal activity. There must needs be a second transition period, usually very much shorter than the first, during which the cells again accommodate themselves to environal changes. In some cases, recovery is much more tedious than the onset of the apparent disorder, but the period of apparent disorder is not always equal to the period of reaction to the abnormal environment. The habit of health retains at least a potential influence upon metabolism, even during long periods of disease.
The return to the normal function often seems perfect, but there is much more rarely a perfect, or even very nearly perfect, return to the normal structure. The cell usually retains in its structure the history of its unhappy experience. In this respect, the cells of the whole body share with the highly differentiated neurons the phenomenon of memory. This principle holds true also for many very complex organisms, and for species of organisms. Plants and animals undergo certain changes as a result of domestication. If they escape from captivity and again lead a wild life, they regain many of their ancestral traits, but they never lose the acquired characteristics. The history of their captivity remains ineffaceably written in their bodies and in their habits. This is true among mankind also. The Indian who, having been educated, returns to his ancient habits, is never the aboriginal person. The degenerate in civilized communities is never the savage. Atavism is never complete; recovery is probably never absolutely complete.
These facts have an important bearing upon the prognosis in any case. If the patient has been suffering from a given disease for a long time, it is almost certainly true that the metabolism of the cells of the injured organ have made some steps toward adaptation to the abnormal condition, and that recovery will be complicated by the embarrassment of the cells in another adaptive process. The question will often arise as to whether it is wiser to subject the cells to this second adaptation, or whether it is wiser to let them alone in their new estate, and to facilitate the compensatory changes, by securing the best of food, air, nerve supply and elimination to the injured structures. There is no doubt that in dealing with old people, especially, the latter method is usually wisest. They have no time to spend in rearranging their physiology. They are to be made comfortable and as happy as possible. The number of years required to make a person old is not to be stated in this connection. There are some cases among young people where the reaction of the body to an abnormal environment is so fixed that any effort at correction is unwise. The kyphosis of Pott’s disease is a very common example of the deformity which is permanent and incurable, and not productive of serious visceral disturbance. On the other hand, it must be remembered that the human body is one of tremendous complexity, and that a whole life time is not enough to secure any essential changes in metabolism. Adaptation more nearly normal than efforts at adjustment could be are not rare, abut perfect adaptation to an abnormal environment is an accomplishment requiring many times one life time. It must be remembered also that during the time in which the cells are in process of adjustment they endure the abnormal metabolism characteristic of the period of change. They are more intensely affected by external changes than are normal cells, more easily invaded by bacteria, more easily wearied, and enjoy less of the “habit of health” than normal cells. Some instances of the persistency of the habit of disease may be mentioned.
After abnormal food is taken, vomiting may occur, which often persists after the stomach has been thoroughly emptied. This vomiting may become a factor in perpetuating a diseased condition. If anyone eats too much sweets or starches the excess of sugar is eliminated from the blood by the kidneys. If the habit of eating too much sugar be continued for any length of time, the physiological glycosuria becomes a pathological one, and sugar continues to be excreted even after the carbohydrates have been eliminated from the diet altogether. This is a form of the persistence of a habit of abnormal function, for it must be granted that the presence of sugar in the blood in so great a quantity as to cause its elimination by the kidneys is itself an abnormal condition.
When sensory nerves are a long time subjected to abnormal pressure, as by tight shoes, or clothing, or by abnormally contracted muscles, they cease to seem painful. The removal of the pressure upon them, the relaxation of the abnormally contracted muscles, with the concomitant return to the normal conditions of blood supply and drainage, is frequently followed by much pain. Because of the habit of disease, the occurrence of the pain may be deferred for some time, and the careful physician may be able to evade much of the pain by making the recovery rather slow. The persistence of pain is a very common occurrence. This is due to the lowering of the liminal value of the neurons concerned. If the neuron systems which carry sensations of pain are frequently stimulated, the continued passage of sensory impulses over them lowers their liminal value until even normal impulses arouse sensations of pain in consciousness. This reaction is essentially physiological. The lowering of the liminal value of neurons which are frequently stimulated is a very important factor in perpetuating the habit of health, in preserving memories, in making possible such education as we know, and in adding to the value and strength of life in many other ways. But this factor in normal neuron metabolism becomes a means of perpetuating the consciousness of pain long after the cause of suffering has been eliminated. After the cause of the suffering has been eliminated, and the structure of the body becomes normal, the return to the normal neuron metabolism can not be very long delayed. The habit of pain is self-limiting, but it must always be considered in determining prognosis and therapeutics.
After a long illness which had been dealt with according to the strenuous methods of our grandfathers, recovery was very long and difficult. Even yet, though the most severe methods have been superseded, recovery from the therapeutic methods seems to require more time and more discomfort than recovery from the unaided disease. This is due, in part, to the fact that therapeutic procedures which are not wisely determined work rather injury than good, in part to the toxic action of the drugs employed upon the depuretic organs, and in part to the acquired habit of drugs. The cells of the body, in reacting to the abnormal condition which was the original cause of the disease suffered certain changes in their metabolism. The doctor of ancient days added to this already complicated problem other abnormal factors,--various drugs, heat in an abnormal degree, impertinent stimulation of many kinds, -- and the cells were compelled to adjust their metabolism to these factors also. The patients usually recovered, if they were young and robust. They were of the type that endures and survives hardships. During their enforced idleness, the overworked tissues became rested, disorders due to trauma were apt to heal in spite of meddlesome attention, bones subject to slight subluxations regained their normal relations when the muscles attached to them became relaxed, the bacterial diseases were usually self-limited anyway, and so recovery usually occurred in spite of the most absurd and harmful methods of therapeutics.
After the subsidence of the symptoms due to the diseased conditions, the effects of the therapeutics were still to be overcome. The cells of the body had become partially adapted to the presence of stimulating drugs, the excessive heat, the close, dark room, and they had now to readjust themselves to the environment which was normal to them before the onset of the diseased condition. This second adaptation was forced upon the cells at a time when the blood was poor, their reserve forces were depleted, and the whole body was more or less permeated with both the toxins of the disease and the poisons used to combat the disease. It is not at all surprising that the accidents of convalescence were so often fatal, nor that morphinism, alcoholism, and other drug habits so frequently followed severe illnesses.
In dealing with disease by osteopathic methods, the complications of recovery are very slight. The efforts of osteopathic therapeutics are to secure and to maintain, as far as possible, the conditions normal to the cells, and not to produce additional causes of confusion. If this be successfully done, long and tedious convalescence is usually avoided. The exceptions to this are found in the cases of chronic diseases which have been treated by abnormal methods for a long time, and in other cases associated with long and severe exhaustion. In all cases, recovery is not complicated by the necessity for a readjustment to the lack of abnormal stimulants. As a matter of clinic experience, those patients whose recovery has not been complicated by any marked interference with the nature of the reply which the cell groups make to their environment are those whose recovery is most speedy, most comfortable, and least hampered by unexpected complications.
Sequelae of any of the acute diseases, in any text book of medical practice. Decide which of the sequelae are probably due to the disease in itself, and which are due to the therapeutic methods employed. |