WITH INJURIOUS INFLUENCES.

303

typed in the site first chosen, which is almost always (where we can distinguish the two structures) not so much in the actual tissue of the organ as in that which connects it together, what we term the cellular tissue.

This is remarkable in the lungs; where tubercular deposits are first seated, not in the essential structures of the organs, but in those by which they are joined together. All those various depositions which are called tumours, generally begin and are very frequently entirely confined to the cellular tissue, and although there is in some malignant forms a disposition to locate themselves in organs, there is a very curious tendency towards such as may have already fulfilled their purposes in the animal economy.

We might multiply these illustrations to a tedious extent. We might show, for example, in the eye how curiously the greatest number of diseases in that organ are placed in structures least dangerous to the organ, and even when the organ is spoiled, so to speak, how much more frequently this is in relation to its function as an optical instrument, than to the structure which forms the link with the

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GENERAL CONSEQUENCES.

brain, as an organ of sensation. I must, however, refer* those who wish to see more of the subject to the work in which it is more fully discussed, under the term the "Law of Inflammation," which is a bad phrase, as imperfectly expressing the law; but as the greatest evils it exposes occur in cases of Inflammation, and as it shows the essential nature of that process to be entirely distinct from the characters which had usually been ascribed to it, every one of which may be absent so that expression was somewhat hastily given to the generalization which seemed best to express a great practical fact.

:

To return to the bearing of all this on Abernethy's views, and in relation to organs primarily or secondarily affected. In obedience to the conservative law, to which I have above alluded, defective function in one organ is usually accompanied by increased action in some other; and thus it happens that the symptoms are almost always in one organ, whilst the cause, or originally injurious influence,

* "Medicine and Surgery one Inductive Science," London, 1838. Highley.

OF SECONDARILY AFFECTED ORGANS. 305

has acted on another. The general reader will of course understand that we are not speaking of direct mechanical injury to an organ. Now all the most recondite diseases of the kidney are already acknowledged by many to be seated in a secondarily affected organ. Still the practice is in too many instances a strange mixture of that which is in accordance with the true views, and much that is in opposition to it; because it often includes that which is certain more or less to disturb the organ which it should be the object to relieve.

In the same manner, the lungs and heart are continually disordered and ultimately diseased from causes which primarily act on the liver; and I have seen such a case treated with cod liver oil and bitter ales, with a result which could not but be disastrous. The liver sends an enormous quantity of blood to the heart and lungs, from which it ought to have extracted a certain quantity of carbon, (bile); if this be not done, the heart and lungs are oppressed both by the quantity and the quality

VOL. I.

X

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IMPORTANCE OF PRIMARY ORGANS

of the blood sent to them. If nothing happens in either of the various sites I have mentioned, the blood must be got rid of, and it is so. In many cases a vessel gives way-or blood is poured out from a vessel-or the blood is employed in building up the structures of disease; but then the symptoms are frequently altogether in the chest, and not a sign of anything wrong in the liver..

I cannot go on with the multitudinous illustrations of these principles. The law is to determine injurious influences to the surface. Deposition in the cellular tissue of the lung is bad enough, but it is better, that is, less certainly fatal there than in the respiratory tubes, and that is the explanation of it.

But now comes the practical point; how is the primary organ to be got at, because that is the way to carry out the removal of the impediments to the sanative processes of nature, which in many cases no mere general treatment can accomplish. This is to be found by an examination into the real history of the case, and adding the further test of a real and careful observation of the various secretions.

AND OF DISCRIMINATION.

307

By going back to the former life of the patient, we shall seldom fail to discover the various influences to which he has been subjected, and the organs to which they have been originally addressed. Having made up our minds from our previous knowledge of injurious influences, on what organ they will most probably have acted, we now test this not merely by inquiry after symptoms, and it may be not by symptoms at all; but by careful observation of the actual work of the suspected organ; in this way we almost certainly discover the real offender, in other words the organ primarily affected. This is of immense importance; for we confidently affirm that one single beneficial impression made on it will do more in a short time-nay, in some rare instances, in a single day-than years of routine treatment, that has been nevertheless of good general tendency.

In treating it, i. e., the primary organ, however, great discrimination is necessary. If it be already organically affected, that treatment which would be, under other circumstances