The Abdominal and Pelvic Brain
Byron Robinson, M. D.
1907

  CHAPTER XXXII.

GENERAL PATHOLOGIC PHYSIOLOGY.

Hopeful men worship the rising, pessimists the setting, sun.

Bumping one's head against the universe makes brains.
 

    The subject of this paper is pathologic physiology.  The theme is the abnormal function of organs, or organs acting under pathologic conditions.  The field included lies between normal physiology and pathologic anatomy.  It is the zone of pathologic physiology or clinical pathology.  In general it is determined with facility whether the visceral functions are pursuing a normal or abnormal course.  In certain subjects, however, it is difficult to determine whether the functions are normal or abnormal.  Some subjects present unmistakable pathologic symptoms for years, e. g., constipation, diarrhea, renal secretion, sweating; however, such subjects, though not theoretically, they are practically well.  Pathologic physiology enables the physician to estimate between theoretical and practical functions.  Not infrequently the functions of a subject vary to such a degree that it is difficult to decide whether he is well or ill.  I know one subject who, between forty-five and sixty years of age, would periodically (several times annually) urinate some five quarts daily, otherwise he was practically well.  He died of an acute attack of diarrhea at seventy.
    To understand pathologic physiology one must possess a clear view of physiology.  It may be well to remember that the common function of the thoracic and abdominal visceral tracts are sensation, peristalsis, absorption, secretion.  Disease is a deviation from one or all these common functions.  Disease begins as abnormal function and progresses with its repetition.  The study of pathologic physiology constitutes the subject of abnormal function.  To the four common functions mentioned of the thoracic and abdominal visceral tracts we must add the three special functions of the tractus genitalis - viz., ovulation, menstruation, and gestation - which offer vast fields of pathologic physiology in daily practice.
    Pathologic physiology arises from defects in the living protoplasm (inferior anatomy and physiology) or from environments (bacteria).  The subject born with pathologic physiology (heredity, stigma) is unable to withstand the friction of normal life.  The subject may occupy such environments that injurious influences affect his protoplasm, such as excessive physical or mental exercise, heat, cold, bacteria.  The study of pathologic physiology dignifies the basic study of physiology; it impresses the student with the functions and the structure of viscera.  First and foremost, the physiology of an organ must be studied in order that its deviations may be comprehended.  The study of physiology of organs will assist in comprehending the factors which influence the functional deviations.  The subject of visceral peristalsis, rhythmical movements, the object of which is to propel visceral contents - urine, blood, ingesta, lymph, gestation products, secretions, carbonic acid gas - is of vast practical interest in the daily practice of medicine.  Viscera are continually being subject to peristaltic waves.  Peristalsis is dependent largely on visceral contents and blood supply.  Hence the sluggish bowels (deficient peristalsis) are improved by supplying constant fresh blood.  Fresh blood constantly streaming through the tractus intestinalis, urinarius, and genitalis initiates repeated peristaltic waves.  The gravid uterus is in constant myometrial waves from extra blood supply.  The tractus intestinalis, as the fresh blood streams into its territory, is subject to constantly repeating peristaltic waves.  In visceral peristalsis the quantity of blood bathing the automatic visceral ganglia plays a role.
    Since pathologic physiology is the zone between physiology and pathologic anatomy it is doubtless the incipient stage of future disease, pathologic anatomy.  For example, chlorosis appears to be a precursory stage, a stage of pathologic physiology, to splanchnoptosia; gravidity precedes splanchnoptosia.  The study of pathologic physiology cultivates accurate diagnosis in incipient stages of disease, enhancing opportunities for prophylactic measures.  Modern investigation has forced us to accentuate functional (incipient) aspect of disease.  It stimulates us to discover and recognize abnormality of function.  It is returning to physiology as basic study.  The discovery of an abnormal function may lead to the diagnosis of a contingent disease.  The disordered function in the irritable weakness of the nervous system presents inferior anatomy and physiology.
    Pathologic physiology attempts to instruct through disordered functions of the living subject.      Pathologic anatomy attempts to instruct through changed structure in the living and dead subject.  In practice, recognized disordered functions, or pathologic physiology, are manifest a hundred fold more than recognized pathologic anatomy.  The old physicians recognized pathologic physiology under another name, as clinical pathology, functional or sympathetic disease.  Among the first to discuss pathologic physiology from a scientific or systematic standpoint was Cohnheim, as found in his celebrated general pathology.  However, before me lies the third edition (1904) of Dr. Rudolph Krehl's book, the first edition of which (1898) presented a systematic treatise on pathologic physiology.  Practically Dr. Krehl's book is a pioneer work on pathologic physiology, systematizing the labors of Cohnheim and others, as well as making vast additions to the field himself.  Pathologic physiology is not a new subject, for physicians recognized its existence in the past.  Modern laboratory methods have demonstrated that the normal functions of individual organs vary within an extensive range.  The border line between physiology and pathologic physiology is manifest by symptoms of various characteristics.  Frequently organs will vary double their usual range, as the quantity of urine may be two or four pints daily, defecation may be once or twice daily, or every second day.  Perspiration may be doubled for a period.  We may observe the heart beat 120 per minute for weeks with no recognizable pathologic anatomy.
    Pathologic physiology is characterized by an abnormal course of the life of an organ or a series of organs.  In what does normal course of organs consist?  We may designate as normal living processes what is found in the vast majority of individuals, in man and animals, when the individuals are considered healthy.  It is granted that the function of an organ has normally an extensive range of healthy action.  For example, the quantity of uric acid in the urine of the genera of aves, carnivore, herbivore, and bimana is extremely variable.
    Perhaps man would not long survive producing a quantity of uric acid which birds habitually secrete.  Each genera and, perhaps, species, have a law for themselves as regards the function of organs, possessing extensive variation of organ functions, without being pathologic.  Pathologic physiology should be taught with more exactness in the colleges, so that the graduates may not be compelled to learn it at the expense of their patients.  Pathologic physiology should be comprehensively explained to students, as it enables them to secure a general view of organized viscera, as well as the vicarious action of individual viscera.  Besides it aids the practitioner to diagnosticate disease when no pathologic anatomy demonstrably exists.
    Pathologic physiology is the zone between physiology and pathologic anatomy, an indeterminate, extensive, and frequently rapidly varying zone.  It is well to bear in mind that I am discussing pathologic physiology as dominated by the sympathetic nerve (nervus vasomotorius).  I will present in this essay some views on the pathologic physiology of the viscera which I have taught for years in gynecological and abdominal courses.
    No richer field exists in medicine, in inductive research, or for productive scholarship than the establishing of evident cause and effect in pathologic physiology.  Pathologic physiology projects physiology into the field and function of philosophy.  Physiology is the most noble of medical studies.  Science collects facts while philosophy arranges and predicates laws from them.  The field and function of philosophy is to deal with all classes and departments of incomplete knowledge for the purpose of utilizing it for man - to prolong life, lessen suffering, and increase happiness.  Pathologic physiology will aid in the Partial reduction of medical practice to laboratory investigation, e. g., sentlty, local and general, is heralded by observable cellular change - development, differentiation and degeneration of its vital, physiologic, process.  The cell is accompanied by a cyclic series of changes from embryoism through differentiation to senescence, termed by Prof.  Minot, cytomorphosis. (1) The first stage or embryonic cell is peculiar to itself in its physiology and if prolonged by circumscribed inclusions may become malignantly degenerated in the adult. (2) The second stage of life's cells, that of differentiation, consists of two states: (a) cytostatic differentiation, or the production of a material of definite and stable composition, as connective tissue, intercellular osseous substance - connective tissue framework; (b) cytodynamic differentiation is the production of substance having a metabolic function - parenchyma. (3) The third stage of life's cell is that of degeneration - senescence.  Hence the laboratory investigator may yet discern the cause that determines cellular changes - embryonic, differentiation and degeneration (senescence), i. e., the pathologic physiology of life's cyclic cell and also that of disease.  The philosophy of physiology at once suggests that the vital processes of cells - embryologic, differentiative, degenerative - cannot be abolished, however, they can be advantageously modified.  The destiny of the cell is an aggregative mould into organs - for physiologic function.  The composite organs functionating as a unit make man - the animal.
    Physiology or function precedes and dominates structure.  Man - the animal - is the drama, the play.  It calls into being, function, the stage accoutrements, and dramatis personae which exist and have signification to subserve the drama.  The play selects and arranges the scenery, creates and determines the settings, lends coherence and sense to the sentence, furnishes inspiration and purpose to the actors.  Now, it may be true in the material presentation of the play that stage furniture is the first structure element manifest, it is however subordinate to the motive of the performance or play.  The stage material, furniture, is forgotten, lost in the functions of the play.  Man's body is the stage accoutrements and personae.  The drama, the play, is the physiology, the function.  Interpreted, this means that function determines structure, not structure function.  Progressive motion in animals has traumatized, frictionized, the proximal end (brain), enticing increasing blood supply (friction) and consequent increase of substance arises, i. e., bumping one's head against the universe develops the brain.  Lincoln's body, that is, his anatomy, his stage accoutrements are dead, however, Lincoln, master of men, his play, his physiology, his function progresses unabated.  John Brown's body, his physical stage accoutrements, is dead but his function of liberty moves on forever, even to the latest Russian cry for freedom.  The staging, the physical accoutrements, of Uncle Tom's Cabin have long disappeared.  However, the motive of the play, the function of the drama, which was the freeing of the black men, has also ceased as the object of the play had been accomplished.  The parallel between the field of music and biology or physiology is striking.  Pipes and strings are the anatomy of music, but music itself, the ultimate object, is not pipes and strings.  It consists of a pleasing succession of agreeable sounds - music is the physiology of the pipes and strings.  The pipes and strings - the anatomy - are made to functionate as a unit through physiology, which rules anatomy.  The several instruments must work in harmony - as a unit - to produce the object, which is the orchestra.  Sound is itself an element, unrelated, unclassified, having neither predicate nor attribute and cannot therefore be confused with music - which is the pleasing succession of agreeable sounds to the human sense and purposely designated for that object.  The only functional value of sound is to be a pleasant succession.
 
HYRTL'S EXSANGUINATED RENAL ZONE (H, H, H.) 

     Fig. 111.  Corrosion anatomy.  Left kidney.  H, H, H, is what I term Hyrtl's exsanguinated zone.  A, B, equatorial line of lateral longitudinal renal border.  D, dorsal vascular renal blade.  V, ventral vascular renal blade.  H, H, H, indicates the course of Hyrtl's exsanguinated renal zone or the elective line of renal cortical incision with minimum hemorrhage - located 1/2 inch dorsal to the lateral longitudinal renal border.  The quantity of sympathetic nerves required for the kidney may be estimated by the number of arteries in its two vascular blades.

    Physiology harmonizes different structures as music does pipes and strings into a functionating unit.  As the instruments in the orchestra must subserve the purpose of the musician - which is music - so the aggregative molds of cells - organs - in the body must subserve the dignified purpose of physiology, i. e., a functional unit which dominates, determines and precedes structure.  We concede to our materialistic friend the physical basis of life and that function is not purely psychic in character.  In the final analysis of structure or function we are dealing with the arrangement of matter, and that is structure.  To illustrate that function, physiology, dominates structure, anatomy, one need only study large, noninfected, pelvic peritoneal exudates.  Not long after pelvic peritoneal exudate arises blood vessels begin to appear in the mass, projecting their course through it, followed by lymph vessels and nerves as well as an endothelial covering, until the jelly-like unorganized mass is a living structural unit, a functionating organism.  In this case did not physiology dominate, determine, precede anatomy? - yes, physiology is the central motive power of life.  Darwin recognized this principle throughout his investigation of the origin of species.  Through physiology he claimed he could modify species by environments that in a few years they could be scarcely recognized.  By environmental influences he could modify through physiologic forces the traits or characteristics. Observe how the patent foramen ovale, modifies circulation - i. e., physiology produces the clubbed fingers.  Dr. Thomas G. Atkinson in the editorials of the Medical Standard for July and Oct., 1906, writes instructively and strikingly on pathologic physiology.  He claims that the influences which determine structure operate from the complex to the simple, e. g., the larger functions of the body peristalsis, circulation, cerebration - are the simplified specific expressions of the multiple, complex, impressions produced on the body in general by circumstances and environment and these consequently are the determining causes of cellular structure.  Physiology is the father of anatomy, of form, of characteristics, of hypertrophy.  A myoma in the uterine wall or an ovum on the endometrium are the causes of uterine hypertrophy - increased blood supply has multiplied the cellular elements of the uterus.  Physiology or direction of excessive blood to the uterus has determined the multiplication of cellular structure And thus the amphioxis and similar animals that superseded and repeated his structure bumped their heads against the world's physical forces, developing the four skull vertebra and multiplying their cerebral cells by enticing blood, due to the cerebral trauma.  The Japanese have long bodies and short legs because they do not use the legs sufficiently to secure blood.  Sitting on chairs would entice more blood for larger legs.  The lessons to be drawn from these views are that structure has no power to modify itself.  It is perverted function that alters structure - pathologic physiology is the father of it.  Again Dr. Atkinson claims that perverted function, pathologic physiology, operates from the complex to the simple.  Pathologic physiology finally terminates by registering itself as altered adjustment of cellular structure in accordance with the perverted function at issue.  Structural changes as a rule are the final responsive reaction of cell arrangement to pathologic physiology, having their origin in the complex relations between organism and environments and operating through the less and less complex physiologic systems of the body.  The skillful and scientific physician can discern the origin and course of pathologic physiology and apply the appropriate advice, drug or scalpel, first to correct the function and second to correct the structure.

The Chief Duty of a Physician is to Correct Function.

    As nine-tenths of illness is so-called medical and one-tenth so-called surgical, practically the sphere of a physician's influence is limited to the field of pathologic physiology, which lies between normal physiology and pathologic anatomy - the zone of pathologic physiology.
    The common functions of viscera (sensation, peristalsis, absorption, secretion) do not perform uniformity throughout the same visceral tract and hence demand special attention in physiology, e. g., secretion is more prominent in the proximal end (cerebrum) of the tractus intestinalis while absorption is more pronounced in the distal end (sympathetic).  These views should be borne in mind when observing pathologic physiology.  In excessive secretion there is not only an expenditure of energy but also a loss of material from the body.  Physiology deals with the sources of energy and the transformation of energy.  The practically wise physician seeks to trace through the deviating functions the source of erroneous energy.
    In the consideration of physiology or pathologic physiology the nervous system must be considered a presiding genius.  E. g., food within the duodenum incites both the liver and pancreas to secrete through a nervous mechanism for it appears that if bile and pancreatic juice become mixed in Vater's diverticulum or immediately on arrival within the duodenum, the power of the succus pancreaticus is doubled.  It is well to know for practical therapeutics (pathologic physiology) that adrenalin- a product of the adrenal medulla - circulating in the blood appears necessary for the excitation of any nervus vasomotorius.  The thyroid gland manufactures some substance - thyro-iodin - which aids in the proper growth of body tissues and also for the normal discharge of the cerebral functions.  The fetus during gestation secretes some substance which aids in enlarging the mammary gland.  The ovary secretes a substance which preserves sex and nervous characteristics.  Hence with increasing knowledge of physiology we may be able to isolate these substances - adrenalin, thyro-iodin, ovarian secretion, secretions of pregnancy which induce mammary hypertrophy, etc., etc. - and in their isolation place a list of therapeutic messengers at our command which will correct the pathologic physiology of bodily organs.  With broader knowledge of physiology present, therapeutic nihilism will be replaced by rational therapeutics which rest on physiology, the solid ground of nature.
    The results from the study of the four grand common functions of viscera (sensation, peristalsis, absorption, secretion) must be the rock and base of our authority in pathologic physiology.
    Irritable weakness of the nervous system presents inferior anatomy and physiology.  The subject of pathologic physiology will force us to study the stigmata of function.  It is noteworthy that before the days of legitimate specialism few practical stigmata were recognized.  At present every specialty has a chapter of abnormalities, of stigmata.  In fact, the study of abnormalities has proceeded to such a degree that a majority of individuals are docketed with telltale stigmata of some sort or kind.  The pathologic physiology or stigmata of individuals may with impressive instruction be termed "habitus, " by which prefix we may distinctly designate certain classes of subjects.  We have the habitus phthisicus, habitus nervosus, and the ensemble of certain symptoms may well be termed habitus splanchnoptoicus.  The habitus is an expression of inherited weakness, defect.  It presents the idea that inferior anatomy and inferior physiology has been transmitted to or acquired by the individual.  The tendency of modern study is to accentuate - the functional aspect of disease; hence it is this method of study that has taught that there is an abnormality of function.  The mind is a good source of pathologic physiology, as by concentrated thinking one can congest excessively an organ, e. g., genitals, brain.  There is frequently more in the physician's suggestions than in his medicine.
Rational Medicine alone will stand the test of science and time.  Rational medicine must be the medical amazon of truth, from which will be eliminated the false lateral issues, tangenital fads, distorted views of the unbalanced and the knave.  Rational medicine must be founded on the solid ground of Nature to stand forever.  Will the teachings and knowledge of pathologic physiology aid the physician to exactuate more rational practice?  The comprehension of pathologic physiology will extend, the physician's views of physiology, which should resume its original basic position in medicine.  The future of clinical medicine lies in the direction of pathologic physiology.  Rational medicine consists in the application of scientific laboratory methods to the ambulatory and bedside patient.  However, the laboratory seems to advance periodically, beyond clinical application.  In the field of science and investigation there is continually clashing of opinions, with statements and counter statements, with evidence and counter evidence, from which established rules of practice evolve.      The principles of science require during the progress of discoveries, revision, reconsideration, and recasting.
    The perfection of physiological, chemical, and pathologic knowledge, with consequently improved technique, will enable the clinician to advance on the citadel of disease rationally during the premature stage of pathologic physiology with more practical hope of success.  Cardiac irregularity, palpatation (which chiefly rests on vigorous muscle or myocardium) is generally pathological physiology, or abnormal disordered function (excessive, deficient or irregular peristalsis) and often a nervous manifestation only.  The function or the physiology of the cardiac ganglia (Remak's, Bidder's, Ludwig's, and Schmidt's) have become temporarily disordered, pathological, wild, irregular, yet no pathological anatomy can be detected.  It is well enough to attempt to be scientific in explanation to the student, that cause and effect are logical sequence, yet, also, to admit that we cannot detect the cause of cardiac palpitation in any existing pathological anatomy - it is pathological physiology, disordered functions, through nonrecognized channels.  Pathological physiology alone will explain the irritable bladder; the cystoscope does not reveal the pathological anatomy.  The vesical apparatus is acting unusually, it is assuming an abnormal course.  I have noted such bladders for years; they afflict the possessor by frequent evacuations, by loss of sleep, and broken rest.  Who will attempt to explain the surface anesthesias by pathological anatomy?  They are here today and there tomorrow.  Many a time and oft have I noted - the pharyngeal anesthesia in hysteria; in fact one can apply a uterine sound vigorously to the surface of the pharynx without inducing nausea or reflex muscular action.
    We have no more appropriate terms to apply to these phenomena than pathological physiology, disordered function.  In practice of medicine the student should be instructed in physiological principles and not that he is always to attempt to remove changed structures by his remedies or scalpel.  The practice of medicine is the practice of common sense.  We are to use means to an end.  For example, if a frog's heart recently removed is placed in a warm physiological salt solution, it will perform its peristalsis for a time and cease; now, I can renew its peristalsis by stimulation; the stimulant may be an icicle, electric current, a hot steel needle, or a current of water or air.  The chief duty of the profession is to aid in the resumption of normal functions, not merely attempt to discover some pathological anatomy or changed structure, for it would waste valuable time.  We should cultivate pathological physiology rather than surgery, as it will be the vast future therapeutical field for nine-tenths of illness, whereas surgery is of value in about one-tenth of illness.
    The mind is frequently the organ that needs the stimulant of which quacks, patent medicines, knaves and pretenders take advantage.  Pathological physiology recognizes the influence of mind over matter.  The sensible physician realizes that suggestions are a powerful aid to peristalsis, absorption, secretion and sensation, to the restoration of visceral function, and though the honorable physician may not make the bold, false assertions of the quack, he can suggest honest, legitimate aid and comfort to the patient.
    The honest physician is secret and reticent.  The quack is blatantly false.  Secrecy and reticence is better than falsehood.  The physician can and should be an honest man.  The physician comprehending pathologic physiology becomes master of suggestions for the patient's benefit.  The medical profession cannot afford to leave the influence of mind over matter, the field of suggestive therapeutics, to the quack and knave.  The world of knowledge is our parish.  To alleviate suffering and prolong life from rational demonstrations of science is our duty.  To treat the sick by any legitimate means is our privilege.
 
CORROSION ANATOMY 

     Fig. 112.  Left kidney, dorsal surface (D) dorsal vascular blade. - H, H, H, indicates Hyrtl's exsanguinated renal zone, or the elective line of incision, one-half inch dorsal to the lateral longitudinal renal border.  Observe that the elective line passes to or invades the ventral renal vascular blade at the proximal and distal poles.  Hyrtl's zone is irregular at the renal poles.  The dorsal vascular renal blade is the smaller.  Observe the quantity of nervus vasomotorius required to ensheath the renal arteries with close fenestrated, network of plexuses.

    Diagnosis. - The diagnosis of functional deviation or abnormal visceral action is the rock and base in pathological physiology.  This view indicates that the physician understands the physiology.  First and foremost is the diagnosis, i. e., what abnormal course are the functions assuming?  Disease is abnormal physiology, and the sooner physiological deviation is diagnosticated, the sooner may effective remedial agents be instituted.  To be useful to a patient, the incipient stage of diseases, i.e., premature pathologic physiology, must be detected in order to check the progress of the abnormal function before pathologic anatomy establishes itself.  We must accomplish the diagnosis by all known aid, medical technique, and laboratory methods.
 
HYRTLíS EXSANGUINATED RENAL ZONE 

     Fig. 113.  Corrosion anatomy, left kidney, ventral view (V) ventral renal vascular blade. - From man about forty-five years of age.  The ureter was injected with yellow wax.  The ramus dorsalis renalis was injected with celloidin colored with red sulphide of mercury.  The trunk of the arteria renalis, including the ramus ventralis renalis was injected with uncolored celloidin.  The tissues were corroded in HN03 for two weeks.  A. R., Arteria renalis sinistra. 2, ureteral pelvis. 3, proximal ureteral isthmus.  H, H, H, indicates Hyrtl's ensanguinated renal zone.  It may be noted on the ventral surface that the renal dorsal vascular blade overlaps or invades the ventral vascular blade at the proximal and distal renal poles.  Hyrtlís exsanquinated renal zone is not equatorial at the proximal or distal renal poles nor in the central portion of the kidney.  The elective line of renal incision to invade the ureteral pelvis with minimum hemorrhage is located ½ inch dorsal to the lateral longitudinal renal border in the central segment of the kidney and is about two inches in length.  The quantity of nervous vasomotorius may be estimated by the number of arteries and ducts present.

    Pathologic physiology will rest on laboratory methods for rational knowledge and practical application.  Laboratory methods are valuable assets to a physician because they will increase his business of rational application and success.  The physician's self-confidence, which arises from accurate knowledge, begets confidence in the patient, and this increases his power and clientele.  Laboratory methods increase the physician's efficiency, and this contributes to his professional attainments.  Laboratory methods are invaluable to the physician himself for his own rational view of any disease.  Practically, patients are willing to recompense a physician according to his a b i I i t y and attainments.   The day is not distant when the physician's power to diagnosticate disease will be measured by his laboratory methods, especially in the incipiency or in the stage of pathologic physiology.  The judgment of the physician will be heavily taxed as to prognosis.  Unfortunately some cases of splanchnoptosia appear with neurasthenia, as an integral part, or splanchnoptosia is imposed on the subject of hysteria.  Neurasthenia and hysteria, though not primary in splanchnoptotics, easily thrives among them.  It is an indication of  defective knowledge and judgment to attribute symptoms nephroptosia or gastroptosia that belong to general splanchnoptosia.
    Blood Volume.  -  Pathological physiology combines rational views of living organs, more than that merely based on pathological anatomy.  For example, when pathological physiology of the kidney is studied, the instructor must take rational and and comprehensive views of the renal viscus.  Pathological physiology of the kidney takes into account the condition of the kidney, the constituents of the blood and volume of blood that streams through the organ.  The discussion of these three subjects in regard to the kidney lends a comprehensive view to the student in making a diagnosis on the living subject, e. g., the functional capacity of a kidney is the rational test, not albumen and casts.  It is common to observe much variation in the quantity of urine, inexplainable, except by pathological physiology, for urinalysis offers none.  Pathological physiology teaches that the circulation of an organ is a fundamental factor in comprehending diseased conditions.  The teacher who does not comprehend varying phases of circulation of the female genitals in the different stages of pueritas (quiescent), pubertas (development), menstrual (functionating), gestation (functionating), puerperal (involution), climacterium (subsidence), and senescence (quiescent), makes a defective gynecological teacher.  No organs except the kidney, offer such an extensively varied base to illustrate pathological physiology of the tractus vascularis as the female genitals.
    The circulation of an organ quotes its value in the animal economy; it rates its function.  Each organ is supplied by arteries which have automatic visceral ganglia, which regulate, govern, the volume of blood which flows through them.  The automatic visceral ganglia tell the story why the volume of blood changes so much in different conditions of the organs when the parenchymatous cells of an organ functionate, as the liver during digestion, the uterus during gestation, the cerebrum during thinking (cerebration), the blood volume is increasingly directed to the organ through the automatic visceral ganglia, dilating the arteries.  Hyperacmia indicates the functionating brain, kidney, and genitals, and these organs occupy vast considerations in practice.  Pathological physiology indicates that great benefit is secured by controlling circulation, blood volume, by checking peristalsis through withholding food; controlling diet controls the blood constituents to a certain degree.  Bier's method of artificial congestion is employing pathological physiology (in the tractus vascularis) for the purpose of curing chronic inflammation.
    Treatment of Pathological Physiology. - The treatment of pathological physiology consists: 1. In the detection and removal of causes; 2, the rational regulation of visceral function, a, by fluids; b, by foods; 3, habitat; 4, avocation; 5, prophylaxis.
    1.  The Detection and Removal of Their Causes. - The detection of the cause in pathological physiology requires the best head and the finest analysis.  The detection of a rectal ulcer or fissure as the cause of innumerable reflexes is a credit to the diagnostician.  The recognition of damaging effects of praeputial adhesions is important.  The glans penis or clitoris is like an electric bell button, the pressing or irritation of which rings the whole organism into pathological physiology.  A cinder in the eye is a grand master of pathological physiology.  I have known the detection and removal of a bleeding, proximally located, rectal polypus to save a child's lif e and make a physician's reputation.  This little rectal polypus had bled and escaped being examined for a whole year by numerous consultants.  I know a gynecologist who did five operations on a woman's genitals for pain in the distal abdomen.  She became no better, but worse.  The cause of all her pain was discovered by a consultant, who found a marked spinal gibbus or kyphosis of tuberculous nature at the junction of the dorsal and lumbar vertebrae.  The reflected pain from kyphosis had dislocated the gynecologist's mind, to make a scapegoat of the genitals.  Frequently infected groin glands are associated with an infected corn on a toe.  A decayed tooth may cause earache.  I knew a woman of twenty-four years, experienced some eight months of crucial suffering from pathological physiology.  She was examined by one physician who said her ovaries should be removed, two others said that she must have her appendix extirpated, one physician diagnosticated neurosis, another indigegtion, finally a physician was employed who found she had a ureteral calculus and removed it after which she gained thirty pounds in eight weeks.  This an excellent example to demonstrate that, though pathological physiology allows ample time for diagnosis and prophylaxis, yet it requires the finest head with the finest skill of analysis to interpret the signification of abnormal visceral function.  Hepatic calculus may introduce pathological physiology into the tractus intestinalis and associated visceral tracts, but it requires experience, accumen, and skill to detect the cause of pathological physiology.
    2.  Rational Regulation of Visceral Function by Visceral Drainage. - Pathological physiology teaches the supreme importance of visceral drainage. of maintaining in normal attenuated solution bodily secretions.  It teaches the benefit of removing the debris of waste laden blood by means of fluids.  When the patient's blood and organs are saturated with waste laden material, he is unprepared to resist the attacks of disease; he is prepared for irritation, for reflexes or neurotic explosions.  With scientific views of pathological physiology, the correction of functional deviation with rational ideas of visceral drainage, the physician holds the key of prophylaxis against the formation of pancreatic, hepatic, and renal calculus.  With ample visceral drainage, with sufficient fluids taken at regular intervals for visceral functions, the pancreatic, biliary, and renal secretions would seldom precipitate their salts, and colloid material or cohesive ground substance of calculus would be so attenuated that calculus would not form.
    Viscera should functionate at a normal maximum for bodily safety and protection.  Pathological physiology takes into account of the composition of glandular secretion, as the pancreatic, hepatic, and renal, with the view that pancreatic, hepatic, and urinary salts, especially urates, should be maintained in attenuated solution by ample fluids, that no calculi may form.  A study of the remedies recommended as uric acid solvents or eliminators of uric acid reveals the data that are composed of two ingredients, viz.: (a) alkali, (b) water.  The plan is to alkalinize the blood current, and thus render the uric acid more soluble and promote its elimination.  The administration of an alkali to dissolve uric acid concretions is of limited value.  Alkalies and uric acid are solvent in vitro, but cannot accomplish the same in vivo.  The alkalies are ingested with the foods, making soluble urates.  After all, the ingestion of alkalies in food and fluid cannot alter materially the uric acid.  However, the chief virtue lies in the quantity of water ingested at regular intervals during the day.  The water is the chief efficacious ingredient in uric acid remedies.  The water increases the blood volume which in turn produces a powerful stream irrigating the tractus urinarius and maintaining the uric acid in attenuated
mechanical suspension.
 
     Fig. 114.  This illustration represents the lymph glands or nodes located in the course of the blood vessels.  The lymph nodes are highly supplied by the nervus vasomotorius.

    Pathological physiology indicates that the composition of the blood is essential to health, and that its salts should not be concentrated or abnormal in relation.  Pathological physiology accounts for the various reflexes and disordered functions from the irritation of waste laden blood and the damaged functions resulting from nephrolithiasis and cholelithiasis.  Pathological physiology dictates that the ample fluids at regular intervals, visceral drainage, is the great safeguard against waste laden blood; it is the prophylaxis against cholelithiasis, pancreatolithiasis, and nephrolithiasis.  By the time that pathological anatomy is demonstrable, damaging structural mischief is established, and not infrequently with a lifelong cicatrix.  The vast majority of palpitations of the heart cannot be explained on pathological anatomy, which has been the tendency of medical progress for the past decade.  The nervous system so intimately and profoundly connects the visceral system, so solidly and compactly anastomosis the viscera, that appropriate stimulation administered to one visceral tract tends to induce adjacent visceral tracts to normal functions and consequent ample visceral drainage, e. g., ample volume of fluid in the tractus vascularis enhances the volume and flow of the tractus lymphaticus, and the general glandular system increases its flow, notably the perspiration, from the tractus cutis.  Stimulation of the cutaneous surface by massage or salt rubs not only stimulates the cutaneous nerve periphery, but also the circulation and tractus perspiratorius.  Stimulation of the tractus muscularis by exercise stimulates and enhances the function of all visceral tracts.
    A.  Visceral Drainage by Fluids. - About eighty per cent of the body is fluids while about twenty per cent is solids.  All viscera functionate by means of a fluid medium.  Fluid forms the chief distributing or circulatory agency of the organism.  Liquid is essential for assimilation and metabolism.. Water forms the bulk of the softer tissue and is an important factor in the composition of the harder.  Fluid permeates or flows through all the bodily structures by osmosis or distinct vessels.  Water is a more important agency in relating the individual to environments than food or air.  It flows universally through the organism.  It enters mainly through the tractus intestinalis, and escapes through the mucous membranes, skin and the chief excretory ducts.  Water, as related to the skin and lungs in the form of liquid vapor, affords the most important factor in controlling the temperature necessary for organic existence.  Diet consists on the average of six parts liquid to one part dry material.  These data explain why Dr. Tanner and others could fast such a length of time on drinking water only.  I was a watcher of Dr. Tanner's fasting twenty-five years ago, and wondered at the ease and apparent comfort of his abstaining from food so many weeks.  Water is more essential for the growth and sustenance of the vital system than food.  The most effective diuretic is water.  One of the best laxatives is water.  One of the best and most natural stimulants to renal epithelium is sodium chloride (one half to one fourth normal salt solution).  The blood contains three-fifths of one per cent of sodium chloride.  Water is to the organism what oil is to machinery, it prevents friction.  For the purpose of stimulating normal visceral action (the great common visceral functions are peristalsis, absorption, sensation, secretion), I administer eight ounces of one-half to one-fourth normal salt solution six times daily, two hours apart. (Note-Sodium chloride is contra-indicated in parenchymatous nephritis.) Three pints (of one-half to onefourth normal salt solution efficiently influences the renal secretion for ample visceral drainage.  Renal drainage should be sufficient to maintain in mechanical suspension the free insoluble uric acid to prevent calculus formations.  Also it should be sufficient to form soluble urate combinations with sodium. potassium, and ammonium salts.
    B.  Visceral Drainage by Foods. - To drain the viscera by appropriate foods and fluids may sound paradoxical; however, the common functions of viscera - peristalsis, absorption, sensation, secretion - are initiated and maintained by fluid and food.  Rhythm is one of the grand physical manifestations.  The tubes of the body under spiral motion assume a spiral direction.  Food stimulates the tractus intestinalis through its sensitive mucosa to continual, rhythmical, spiral motion, and consequent absorption and secretion.  The sodium chloride is an especial stimulant to the epithelium of the tractus intestinalis.  To drain the tractus intestinalis, foods which result in an ample indigestible fecal residue are requisite to maintain the fundamental peristalsis or rhythm necessary for its life of absorption and secretion.  If the tractus intestinalis be stimulated to a maximum by sufficient appropriate food and fluid, adjacent visceral tracts from their intimate nervous connection (through the abdominal brain). will share and assume normal function (peristalsis, absorption, secretion, sensation).  Rational foods must contain appropriate salts whose basis may form combinations which are soluble. as sodium, potassium, and ammonium, combined with uric acid and urates to form soluble urates.
    The proper foods are: Cereals (oatmeal, wheat, rice, graham bread); vegetables (practically all vegetables, cooked); albuminoids (milk, eggs, buttermilk); meats (limited, as they produce excessive uric acid formations.  A mixed diet is therefore most rational.
    In order to stimulate the epithelium (sensation) of the tractus intestinalis, urinarius, and genitalis and the endothelium (sensation) of the tractus vascularis and lymphaticus with consequent increase of peristalsis, sensation, absorption, secretion, in the five visceral tracts I employ a part or multiple of an alkaline tablet of the following composition: 1, Cascara sagrada, one-fortieth grain; aloes, one-third grain; sodium bicarbonate, 1 grain; potassium bicarbonate, one-third grain; and magnesium sulphate, 2 grains.  This combination is used as follows: One-sixth to one tablet (or more as required to move the bowels freely once daily) is placed on the tongue and followed by eight ounces of water (better hot).  Also at 10 A.M., 3 P.M., and at bedtime one-sixth to one tablet is placed on the tongue and followed by a glassful of any fluid.  In the combined treatment one third of the sodium chloride tablet (containing eleven grains) and (one-sixth to three) alkaline tablets are placed on the tongue together before each meal and at 10 A.M., 3 PM., and bedtime, followed by a glass of fluid.  The six glasses of fluid may be water, coffee, tea, milk, buttermilk, cream, eggnog - in short, a nourishment.  This method of treatment furnishes alkaline bases (sodium, potassium, and ammonium) to combine with the free uric acid in the urine, producing perfectly soluble alkaline urates, and materially diminishing the insoluble free uric acid in the urine.  Also the alkaline laxative and sodium chloride tablet increase the peristalsis, absorption, secretion, sensation of the tractus intestinalis, urinarius, vascuiaris, lymphaticus, genitalis, which aids secretions and evacuation.
    I have termed the sodium chloride and alkaline laxative tablets the visceral drainage treatment.  The alkaline and sodium chloride tablet inducing maximum visceral function take the place of the so-called mineral waters.  I continue this dietetic treatment of fluids and foods for weeks, months, and the results are remarkably successful, especially in pathologic physiology of visceral tracts.  The urine becomes clarified like spring water and increased in quantity.  The tractus intestinalis becomes freely evacuated, regularly, daily.  The tractus vascularis maintains an active peristalsis and full volume.  The blood is relieved of waste laden and irritating material.  The tractus cutis eliminates freely, and the skin becomes normal.  The appetite increases.  The sleep improves.  The patient becomes hopeful; natural energy returns.  The sewers of the body are well drained and flushed to a maximum.
    3.  Habitat. - Habitat has chiefly relations to the environments of air, exercise, heat, cold, moisture.  In habitat one of the principle factors is air.  The functions of the lungs are sensation, peristalsis, absorption and secretion.  It is through the great function of respiration that the internal tissue becomes related to the external world.  The medium of exchange between the internal tissue and the external world is the blood.  The blood, an universal tissue, a common transporter of oxygen and carbonic acid gas, plays a vast role in the economy of organism.  The red blood corpuscles during their passage through the lung (external respiration), automatically appropriate the oxygen, and after their return (from internal respiration) through the tractus vascularis unburden acquired carbon dioxide into the expiring air.  The pathological physiology of respiration is a wide zone and especially in an incipient zone to that of pathological anatomy.  Its pathological physiology is frequently amenable to treatment.  The respiratory apparatus has methods of its own to correct its pathological physiology, as cilia, coughing and sneezing to evacuate harmful material, as mucus and foreign bodies.  The grand remedial agent for pathological physiology of the living is continuous, ample, fresh cold air.
    4.  Avocation.- The avocation should suit the individual conditions.  In numerous cases the labor is unsuitable for the subject.  The hours are too long, the work is excessive or severe for the strength.  The condition enhances pathological physiology, rather than cures.
    5.  Prophylaxis. - Prophylaxis of disease is the tendency of modern medicine.  Pathological physiology teaches the control of disease by means of diet, fluid, habitat, avocation.