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Dr. Jennings was not the first to suggest the unity of disease, but he was undoubtedly the first to apply the principle of evolution to pathology. Since his day it has been the Hygienic position that there is a progressive evolution of pathology, beginning with its initial stages in infancy or early childhood and proceeding in unbroken continuity as a chain of united and interdependent sequences throughout the life of the individual, until its ending in apoplexy or cancer in middle life or thereafter.
A cold, said Tilden, "is the proximal symptom of a complex whose distal symptom is cancer, when not tuberculosis or some other fatal degenerating malady. The intermediate symptoms are the so-called acute diseases. Few people can withstand the ravages of the severe types of the interpolated so-called diseases, which are nothing more than crises of toxemia . . ." He pointed out that these crises in toxemia, which medical science has metamorphosed into special entitative and distinct individual diseases, are but the self-cleansing efforts of the body.
The persistance of pathological evolution results necessarily from persistent causation. It has been said that "God cannot make a two-year-old colt in a minute." Every growth requires time for its completion. It requires time to develop habits that influence life. Cancer, Bright's disease, apoplexy or other fatal malady, is in evolution for years. They are not of sudden development. Such factors as time, tolerance, resistance, habit and metabolic change determine the character of the symptomatic developments, although these grow, as previously stressed, out of a common basic cause. Pathologists have been so busy studying special pathology and describing the pathological fragments thus created, that they have not had time to watch the step by step and stage by stage evolution of the total pathological process.
Literally, the term pathology means a treatise on disease. It is defined as a science of disease. We are not here interested in the evolution of science, but in the evolution of disease. Evolution is a continuous development distinguished by each stage growing out of the one before and merging into the succeeding one. Commonly there is progression from simple beginnings to complex endings. The process is marked by continuity and variation.
In pathological evolution we witness a continuous growth of pathological development from simple to complex forms. Pathological evolution may be properly described as a cumulative evolution, accompanied by divergences that lead to several progressive modifications of the initial pathology. Only in a slight degree is pathological evolution orthogenic (in a straight line), but it may be in another sense, often parallel, even polytypical.
There is invariable order in the evolution of pathology. When their sequence and relationship are adequately understood, it will be seen that an unbroken line of pathological evolution reaches from its initial beginnings in infancy to the final ending in later life. Before we can understand this orderly development of abnormal changes in the structures and functions of the body, it is essential that we understand that there must first be a cause for all of these developments. Pathology is not an uncaused series of phenomena. Both the symptoms and the pathological developments must be considered as causally linked to preceding and succeeding steps in terms of chains of causes and effects. The continuity of pathological developments, once it has been adequately realized, will bring order out of the present chaos.
In each pathological development, one part is before and another part is after. When we lack a clear conception of causal relations, we fail to understand regular or invariable sequence--we are prone to attempt to explain these sequences by a superficial concomitance or accidental resemblance. So long as our attention is fixed upon merely adventitious elements in this chain of causation and we fail to recognize enervation and toxemia as basic cause, we will fail in all our efforts to remove cause.
We are asked: why must enervation precede toxemia? The answer is that, so long as nerve energy (functioning power) is adequate, excretion will keep the fluids and tissues sweet and clean and no toxemia can develop. Adequate functioning power is a sure guarantee of purity of blood. If elimination is not checked, toxemia will not evolve. This is in line with our previous statement that in every pathological development, one part is before and another part is after. The sequence is invariable. This is not to say that extraneous poisoning, such as drug poisoning, cannot occur in the absence of enervation; but this is not what is meant by toxemia, nor is such poisoning the cause of the diseases with which mankind suffers.
The popular notion that a man may be healthy one minute and sick the next, that we may dine with a healthy man at noon one day and attend his funeral the next--"sudden death" from heart disease,
cerebral hemorrhage, etc.--is based on the mistaken assumption that disease may suddenly evolve, that a serious pathological state may exist without previous preparation. In the special pathologies that have been created by the medical profession and that have received individuality and names and are regarded as entities, there is no background, no causal connection of the fully-evolved pathology with previous pathologies. One incident does not connect with another; one development does not lay the groundwork for the next. Of chronology there is but faint trace. Nowhere do we find a starting point. There is no effort to trace out what happened (developed) from time to time, from point to point, from stage to stage, in any pathological evolution.
Pathology must have a beginning somewhere and wherever this is, here is the place for us to start our studies. Studies of pathology that are carried on at necropsy are too late to have any significance for us.
In all cases of serious organic disease, such as Bright's disease, diabetes, heart disease, apoplexy, paralysis agitans, etc., etc., there have been premonitions without number, dating far back in the life of the patient, which would have enabled the patient to have prevented the evolution of the disease, had the premonitions been understood and heeded. I am convinced that detailed studies of the life and pathological history of a sufficient number of cases will enable us to predetermine the direction in which the pathological evolution is headed.
When toxemia and gastro-intestinal infection become established, the diseases of predisposition (diathesis) evolve. How do we discover that an individual has a tendency to the development of a particular disease? We discover it only when he has evolved the said disease. If a child frequently develops a sore throat, we say that he has a tendency to develop sore throat. How else would we know this? But these early crises and early stages of chronic disease would point in particular directions if we had a sufficient number of life histories of pathological evolutions to enable us to understand their meaning.
Between the first cold of infancy and death from cancer in middle life, there are intermediate complexes and symptoms galore--colds, coughs, sore throats, constipation, diarrhea, headache, tired feeling, grouchiness, apprehension, restlessness, sleeplessness, bad breath, coated tongue, languor, a sense of weariness over the eyes, depression of the whole body towards noon, commonly met with a stimulant, intolerable ennui, other aches and pains, and many so-called acute diseases, all of which are but crises in toxemia.
Catarrhal inflammation--a cold, gastritis, inflammation of the tonsils, etc.--are but crises in toxemia. Organic change is an ending resulting from repeated toxemic crises, causing functional irritation, inflammation, enlargement, enduration and degeneration, which may be tumor, cancer, tuberculosis and death from septicemia. Repeated for months and years, catarrhal inflammations end in chronic catarrh of the nasal passages, ulceration, hay fever and other so-called nasal diseases. Tonsillitis ends in chronic thickening and enlargement. Repeated crises in the stomach end in ulceration and cancer. Frequent diarrhea with intermittent constipation ends in chronic colitis, ulcerative colitis, polyps and cancer.
The first deviation from health is a gradually developing enervation resulting from enervating mental and physical habits. So long as enervation and checked secretion and excretion persist, there is a general inability of the organs of the body to function normally. The toxemic state slowly devitalizes the tissues over a period of years, resulting in delayed healing and degeneration of injured or devitalized parts. The varying symptom-complexes, starting with enervation and progressing to toxemia and impaired nutrition, with a gradual deterioration of the entire system, and ending finally in ulceration, enduration and fungation (cancer) is a long, drawn-out pathological evolution with a continuous degeneration of tissue. "The sum of the symptoms," wrote Tilden, "of all so-called diseases make up the symptomatology of toxemia.." Instead of these crises being the cause of the succeeding pathological states, they are constituents of the total pathology. One pathology is no more the cause of another pathology than speaking and answering cause conversation. They are parts of the course of pathology, not its cause.
The principle of unity and continuity has not been applied to pathological evolutions sufficiently long and too few men have devoted themselves to it for us to have traced out all the gradations of development, from its first indistinct and imperceptible rudiments, through all the multiplicity of developments to its final endings in pathology of such magnitude that life is no longer possible. Arising, as it were, out of enervation and toxemia as the pathological substratum, by infinitely minute degrees, stage after stage of pathology evolves and thus, onward and downward, are the lowest stages of pathology--the end points that result in death--arrived at. The organism gradually deteriorates under this continued and mounting toxic saturation and various organs show change.
It is not difficult to trace almost imperceptible gradations of pathology in the bodies of the sick until we arrive at the most advanced stages of pathological evolution. If, in our present state of knowledge, we are compelled to leap over many intermediate stages in pathological evolution and progress from one stage to another by observing largely the more distinct steps, the future will fill in the gaps and provide our successors with fuller knowledge than we now possess.
Evolutionary pathology, which belongs to the Hygienic System, rests squarely on the fact of a breach of the laws of being that govern the behavior of organisms in their relations to each other and to their environment. It involves the mal-observance of the fundamental laws that underlie the world of life and it can be shown in a thousand ways that disobedience to the laws of organic existence produces evil results. Violated law leads, in the first place, to an abnormal metabolism and thence by self-poisoning, to weakness, decline and premature death. Along the way there is the evolution of monstrosities and cancer.
Pathological developments in each individual case are in line with tendencies or diatheses. It is probable that the pathological tendencies of the individual always arise out of actual defects or disharmonies within the individual. Every deviation from normal relations in living structure is defect and deformity; in the vital functions it is disease. However much a so-called disease in one person may have in common with the "same" disease in another individual, because of a common source of disease and a common organ-functional complex, it is different by as much as the organisms differ. This is not to say, however, that there are no other factors that add to the differences between the two "diseases." Unfortunately, those hereditary weaknesses that constitute pre-dispositions are not to be dreaded merely as contributing factors in the production of disease, but also because of the obstacles which they throw in the way of permanent recovery.
We need only to know the conditions under which organic integration flourishes in order to understand the conditions under which integration languishes and is transformed into one or another form of disintegration. For want of nothing but knowledge of the right ways and the proper opportunity for development, present generations are not half developed, either in body or in mind; the young are marred and scarred saplings, whose later years will evince distortions of body and mind resulting from the injurious care and treatment of the earlier years.
Many things in the daily life of man will precipitate a crisis in the profoundly enervated and toxemic. If they are also infected with intestinal putrescence, the crisis may be a very severe one. Variegated as the symptom-complexes called diseases appear, variegated as the symptomatology of even one of these complexes may be, they all rest on the solid foundation of toxemia which has resulted from checked excretion growing out of enervation.
When any portion of the mucous membrane of the body is requisitioned to do vicarious duty for the normal organs of elimination, which have had their functions lowered by enervation, we have a so-called catarrhal disease. When, by practicing enervating habits of body and mind, the individual has established chronic catarrh of the intestinal, respiratory and genito-urinary tracts, he is in line for the development of a wide variety of symptom complexes, ranging from a cold through tonsillitis, pharyngitis, laryngitis and bronchitis to hay fever, asthma, polyps, pneumonia, bronchiectasis and tuberculosis, from gastritis through constipation and diarrhea, to simple colitis, ulcerative colitis, gastric ulcer, intestinal polyps and cancer; from metritis and leukorrhea or cystitis, through ovaritis, cervicitis, to uterine polyps and cancer; from simple urethritis through cystitis, nephritis, ulcers of the womb and bladder, to stones in the kidneys and cancer; from cholecystitis to simple hepatitis; through gall stones and jaundice to cancer of the gall bladder or liver. All chronic diseases evolve out of frequently repeated crises in toxemia--this is to say, out of acute diseases. Enervating habits, to which are added habitual overeating, wrong eating, drug habits and drug treatments, lead on and on, step by step, from simple toxemic crises to the most formidable diseases of the nosology. Unless the enervating habits are corrected the enervation increases, toxemia grows greater and a slow but progressive degeneration of the mucous membranes, blood vessels, heart, lymph and other organs of the body takes place.