Medical Essays, 1842-1882

Chapter 18

Chapter 184,025 wordsPublic domain

I have referred you to the proper authorities for the account of those improvements which about the year 1830 rendered the compound microscope an efficient and trustworthy instrument. It was now for the first time that a true general anatomy became possible. As early as 1816 Treviranus had attempted to resolve the tissues, of which Bichat had admitted no less than twenty-one, into their simple microscopic elements. How could such an attempt succeed, Henle well asks, at a time when the most extensively diffused of all the tissues, the areolar, was not at all understood? All that method could do had been accomplished by Bichat and his followers. It was for the optician to take the next step. The future of anatomy and physiology, as an enthusiastic micrologist of the time said, was in the hands of Messrs. Schieck and Pistor, famous opticians of Berlin.

In those earlier days of which I am speaking, all the points of minute anatomy were involved in obscurity. Some found globules everywhere, some fibres. Students disputed whether the conjunctiva extended over the cornea or not, and worried themselves over Gaultier de Claubry's stratified layers of the skin, or Breschet's blennogenous and chromatogenous organs. The dartos was a puzzle, the central spinal canal a myth, the decidua clothed in fable as much as the golden fleece. The structure of bone, now so beautifully made out,--even that of the teeth, in which old Leeuwenhoek, peeping with his octogenarian eyes through the minute lenses wrought with his own hands, had long ago seen the “pipes,” as he called them,--was hardly known at all. The minute structure of the viscera lay in the mists of an uncertain microscopic vision. The intimate recesses of the animal system were to the students of anatomy what the anterior of Africa long was to geographers, and the stories of microscopic explorers were as much sneered at as those of Bruce or Du Chailly, and with better reason.

Now what have we come to in our own day? In the first place, the minute structure of all the organs has been made out in the most satisfactory way. The special arrangements of the vessels and the ducts of all the glands, of the air-tubes and vesicles of the lungs, of the parts which make up the skin and other membranes, all the details of those complex parenchymatous organs which had confounded investigation so long, have been lifted out of the invisible into the sight of all observers. It is fair to mention here, that we owe a great deal to the art of minute injection, by which we are enabled to trace the smallest vessels in the midst of the tissues where they are distributed. This is an old artifice of anatomists. The famous Ruysch, who died a hundred and thirty years ago, showed that each of the viscera has its terminal vessels arranged in its own peculiar way; the same fact which you may see illustrated in Gerber's figures after the minute injections of Berres. I hope to show you many specimens of this kind in the microscope, the work of English and American hands. Professor Agassiz allows me also to make use of a very rich collection of injected preparations sent him by Professor Hyrtl, formerly of Prague, now of Vienna, for the proper exhibition of which I had a number of microscopes made expressly, by Mr. Grunow, during the past season. All this illustrates what has been done for the elucidation of the intimate details of formation of the organs.

But the great triumph of the microscope as applied to anatomy has been in the resolution of the organs and the tissues into their simple constituent anatomical elements. It has taken up general anatomy where Bichat left it. He had succeeded in reducing the structural language of nature to syllables, if you will permit me to use so bold an image. The microscopic observers who have come after him have analyzed these into letters, as we may call them,--the simple elements by the combination of which Nature spells out successively tissues, which are her syllables, organs which are her words, systems which are her chapters, and so goes on from the simple to the complex, until she binds up in one living whole that wondrous volume of power and wisdom which we call the human body.

The alphabet of the organization is so short and simple, that I will risk fatiguing your attention by repeating it, according to the plan I have long adopted.

A. Cells, either floating, as in the blood, or fixed, like those in the cancellated structure of bone, already referred to. Very commonly they have undergone a change of figure, most frequently a flattening which reduces them to scales, as in the epidermis and the epithelium.

B. Simple, translucent, homogeneous solid, such as is found at the back of the cornea, or forming the intercellular substance of cartilage.

C. The white fibrous element, consisting of very delicate, tenacious threads. This is the long staple textile substance of the body. It is to the organism what cotton is pretended to be to our Southern States. It pervades the whole animal fabric as areolar tissue, which is the universal packing and wrapping material. It forms the ligaments which bind the whole frame-work together. It furnishes the sinews, which are the channels of power. It enfolds every muscle. It wraps the brain in its hard, insensible folds, and the heart itself beats in a purse that is made of it.

D. The yellow elastic, fibrous element, the caoutchouc of the animal mechanism, which pulls things back into place, as the India-rubber band shuts the door we have opened.

E. The striped muscular fibre,--the red flesh, which shortens itself in obedience to the will, and thus produces all voluntary active motion.

F. The unstriped muscular fibre, more properly the fusiform-cell fibre, which carries on the involuntary internal movements.

G. The nerve-cylinder, a glassy tube, with a pith of some firmness, which conveys sensation to the brain and the principle which induces motion from it.

H. The nerve-corpuscle, the centre of nervous power.

I. The mucous tissue, as Virchow calls it, common in embryonic structures, seen in the vitreous humor of the adult.

To these add X, granules, of indeterminate shape and size, Y, for inorganic matters, such as the salts of bone and teeth, and Z, to stand as a symbol of the fluids, and you have the letters of what I have ventured to call the alphabet of the body.

But just as in language certain diphthongs and syllables are frequently recurring, so we have in the body certain secondary and tertiary combinations, which we meet more frequently than the solitary elements of which they are composed.

Thus A B, or a collection of cells united by simple structureless solid, is seen to be extensively employed in the body under the name of cartilage. Out of this the surfaces of the articulations and the springs of the breathing apparatus are formed. But when Nature came to the buffers of the spinal column (intervertebral disks) and the washers of the joints (semilunar fibrocartilages of the knee, etc.), she required more tenacity than common cartilage possessed. What did she do? What does man do in a similar case of need? I need hardly tell you. The mason lays his bricks in simple mortar. But the plasterer works some hair into the mortar which he is going to lay in large sheets on the walls. The children of Israel complained that they had no straw to make their bricks with, though portions of it may still be seen in the crumbling pyramid of Darshour, which they are said to have built. I visited the old house on Witch Hill in Salem a year or two ago, and there I found the walls coated with clay in which straw was abundantly mingled;--the old Judaizing witch-hangers copied the Israelites in a good many things. The Chinese and the Corsicans blend the fibres of amianthus in their pottery to give it tenacity. Now to return to Nature. To make her buffers and washers hold together in the shocks to which they would be subjected, she took common cartilage and mingled the white fibrous tissue with it, to serve the same purpose as the hair in the mortar, the straw in the bricks and in the plaster of the old wall, and the amianthus in the earthen vessels. Thus we have the combination A B C, or fibro-cartilage. Again, the bones were once only gristle or cartilage, A B. To give them solidity they were infiltrated with stone, in the form of salts of lime, an inorganic element, so that bone would be spelt out by the letters A, B, and Y.

If from these organic syllables we proceed to form organic words, we shall find that Nature employs three principal forms; namely, Vessels, Membranes, and Parenchyma, or visceral tissue. The most complex of them can be resolved into a combination of these few simple anatomical constituents.

Passing for a moment into the domain of PATHOLOGICAL ANATOMY, we find the same elements in morbid growths that we have met with in normal structures. The pus-corpuscle and the white blood-corpuscle can only be distinguished by tracing them to their origin. A frequent form of so-called malignant disease proves to be only a collection of altered epithelium-cells. Even cancer itself has no specific anatomical element, and the diagnosis of a cancerous tumor by the microscope, though tolerably sure under the eye of an expert, is based upon accidental, and not essential points,--the crowding together of the elements, the size of the cell-nuclei, and similar variable characters.

Let us turn to PHYSIOLOGY. The microscope, which has made a new science of the intimate structure of the organs, has at the same time cleared up many uncertainties concerning the mechanism of the special functions. Up to the time of the living generation of observers, Nature had kept over all her inner workshops the forbidding inscription, No Admittance! If any prying observer ventured to spy through his magnifying tubes into the mysteries of her glands and canals and fluids, she covered up her work in blinding mists and bewildering halos, as the deities of old concealed their favored heroes in the moment of danger.

Science has at length sifted the turbid light of her lenses, and blanched their delusive rainbows.

Anatomy studies the organism in space. Physiology studies it also in time. After the study of form and composition follows close that of action, and this leads us along back to the first moment of the germ, and forward to the resolution of the living frame into its lifeless elements. In this way Anatomy, or rather that branch of it which we call Histology, has become inseparably blended with the study of function. The connection between the science of life and that of intimate structure on the one hand, and composition on the other, is illustrated in the titles of two recent works of remarkable excellence,--“the Physiological Anatomy” of Todd and Bowman, and the “Physiological Chemistry” of Lehmann.

Let me briefly recapitulate a few of our acquisitions in Physiology, due in large measure to our new instruments and methods of research, and at the same time indicate the limits which form the permanent or the temporary boundaries of our knowledge. I will begin with the largest fact and with the most absolute and universally encountered limitation.

The “largest truth in Physiology” Mr. Paget considers to be “the development of ova through multiplication and division of their cells.” I would state it more broadly as the agency of the cell in all living processes. It seems at present necessary to abandon the original idea of Schwann, that we can observe the building up of a cell from the simple granules of a blastema, or formative fluid. The evidence points rather towards the axiom, Omnis cellula a cellula; that is, the germ of a new cell is always derived from a preexisting cell. The doctrine of Schwann, as I remarked long ago (1844), runs parallel with the nebular theory in astronomy, and they may yet stand or fall together.

As we have seen Nature anticipating the plasterer in fibro-cartilage, so we see her beforehand with the glassblower in her dealings with the cell. The artisan blows his vitreous bubbles, large or small, to be used afterwards as may be wanted. So Nature shapes her hyaline vesicles and modifies them to serve the needs of the part where they are found. The artisan whirls his rod, and his glass bubble becomes a flattened disk, with its bull's-eye for a nucleus. These lips of ours are all glazed with microscopic tiles formed of flattened cells, each one of them with its nucleus still as plain and relatively as prominent, to the eye of the microscopist, as the bull's-eye in the old-fashioned windowpane. Everywhere we find cells, modified or unchanged. They roll in inconceivable multitudes (five millions and more to the cubic millimetre, according to Vierordt) as blood-disks through our vessels. A close-fitting mail of flattened cells coats our surface with a panoply of imbricated scales (more than twelve thousand millions), as Harting has computed, as true a defence against our enemies as the buckler of the armadillo or the carapace of the tortoise against theirs. The same little protecting organs pave all the great highways of the interior system. Cells, again, preside over the chemical processes which elaborate the living fluids; they change their form to become the agents of voluntary and involuntary motion; the soul itself sits on a throne of nucleated cells, and flashes its mandates through skeins of glassy filaments which once were simple chains of vesicles. And, as if to reduce the problem of living force to its simplest expression, we see the yolk of a transparent egg dividing itself in whole or in part, and again dividing and subdividing, until it becomes a mass of cells, out of which the harmonious diversity of the organs arranges itself, worm or man, as God has willed from the beginning.

This differentiation having been effected, each several part assumes its special office, having a life of its own adjusted to that of other parts and the whole. “Just as a tree constitutes a mass arranged in a definite manner, in which, in every single part, in the leaves as in the root, in the trunk as in the blossom, cells are discovered to be the ultimate elements, so is it also with the forms of animal life. Every animal presents itself as a sum of vital unities, every one of which manifests all the characteristics of life.”

The mechanism is as clear, as unquestionable, as absolutely settled and universally accepted, as the order of movement of the heavenly bodies, which we compute backward to the days of the observatories on the plains of Shinar, and on the faith of which we regulate the movements of war and trade by the predictions of our ephemeris.

The mechanism, and that is all. We see the workman and the tools, but the skill that guides the work and the power that performs it are as invisible as ever. I fear that not every listener took the significance of those pregnant words in the passage I quoted from John Bell,--“thinking to discover its properties in its form.” We have discovered the working bee in this great hive of organization. We have detected the cell in the very act of forming itself from a nucleus, of transforming itself into various tissues, of selecting the elements of various secretions. But why one cell becomes nerve and another muscle, why one selects bile and another fat, we can no more pretend to tell, than why one grape sucks out of the soil the generous juice which princes hoard in their cellars, and another the wine which it takes three men to drink,--one to pour it down, another to swallow it, and a third to hold him while it is going down. Certain analogies between this selecting power and the phenomena of endosmosis in the elective affinities of chemistry we can find, but the problem of force remains here, as everywhere, unsolved and insolvable.

Do we gain anything by attempting to get rid of the idea of a special vital force because we find certain mutually convertible relations between forces in the body and out of it? I think not, any more than we should gain by getting rid of the idea and expression Magnetism because of its correlation with electricity. We may concede the unity of all forms of force, but we cannot overlook the fixed differences of its manifestations according to the conditions under which it acts. It is a mistake, however, to think the mystery is greater in an organized body than in any other. We see a stone fall or a crystal form, and there is nothing stranger left to wonder at, for we have seen the Infinite in action.

Just so far as we can recognize the ordinary modes of operation of the common forces of nature,--gravity, cohesion, elasticity, transudation, chemical action, and the rest,--we see the so-called vital acts in the light of a larger range of known facts and familiar analogies. Matteuecci's well-remembered lectures contain many and striking examples of the working of physical forces in physiological processes. Wherever rigid experiment carries us, we are safe in following this lead; but the moment we begin to theorize beyond our strict observation, we are in danger of falling into those mechanical follies which true science has long outgrown.

Recognizing the fact, then, that we have learned nothing but the machinery of life, and are no nearer to its essence, what is it that we have gained by this great discovery of the cell formation and function?

It would have been reward enough to learn the method Nature pursues for its own sake. If the sovereign Artificer lets us into his own laboratories and workshops, we need not ask more than the privilege of looking on at his work. We do not know where we now stand in the hierarchy of created intelligences. We were made a little lower than the angels. I speak it not irreverently; as the lower animals surpass man in some of their attributes, so it may be that not every angel's eye can see as broadly and as deeply into the material works of God as man himself, looking at the firmament through an equatorial of fifteen inches' aperture, and searching into the tissues with a twelfth of an inch objective.

But there are other positive gains of a more practical character. Thus we are no longer permitted to place the seat of the living actions in the extreme vessels, which are only the carriers from which each part takes what it wants by the divine right of the omnipotent nucleated cell. The organism has become, in the words already borrowed from Virchow, “a sum of vital unities.” The strictum and laxum, the increased and diminished action of the vessels, out of which medical theories and methods of treatment have grown up, have yielded to the doctrine of local cell-communities, belonging to this or that vascular district, from which they help themselves, as contractors are wont to do from the national treasury.

I cannot promise to do more than to select a few of the points of contact between our ignorance and our knowledge which present particular interest in the existing state of our physiological acquisitions. Some of them involve the microscopic discoveries of which I have been speaking, some belong to the domain of chemistry, and some have relations with other departments of physical science.

If we should begin with the digestive function, we should find that the long-agitated question of the nature of the acid of the gastric juice is becoming settled in favor of the lactic. But the whole solvent agency of the digestive fluid enters into the category of that exceptional mode of action already familiar to us in chemistry as catalysis. It is therefore doubly difficult of explanation; first, as being, like all reactions, a fact not to be accounted for except by the imaginative appeal to “affinity,” and secondly, as being one of those peculiar reactions provoked by an element which stands outside and looks on without compromising itself.

The doctrine of Mulder, so widely diffused in popular and scientific belief, of the existence of a common base of all albuminous substances, the so-called protein, has not stood the test of rigorous analysis. The division of food into azotized and non-azotized is no doubt important, but the attempt to show that the first only is plastic or nutritive, while the second is simply calorifacient, or heat-producing, fails entirely in the face of the facts revealed by the study of man in different climates, and of numerous experiments in the feeding of animals. I must return to this subject in connection with the respiratory function.

The sugar-making faculty of the liver is another “catalytic” mystery, as great as the rest of them, and no greater. Liver-tissue brings sugar out of the blood, or out of its own substance;--why?

Quia est in eo Virtus saccharitiva.

Just what becomes of the sugar beyond the fact of its disappearance before it can get into the general circulation and sweeten our tempers, it is hard to say.

The pancreatic fluid makes an emulsion of the fat contained in our food, but just how the fatty particles get into the villi we must leave Brucke and Kolliker to settle if they can.

No one has shown satisfactorily the process by which the blood-corpuscles are formed out of the lymph-corpuscles, nor what becomes of them. These two questions are like those famous household puzzles,--Where do the flies come from? and, Where do the pins go to?

There is a series of organs in the body which has long puzzled physiologists,--organs of glandular aspect, but having no ducts,--the spleen, the thyroid and thymus bodies, and the suprarenal capsules. We call them vascular glands, and we believe that they elaborate colored and uncolored blood-cells; but just what changes they effect, and just how they effect them, it has proved a very difficult matter to determine. So of the noted glandules which form Peyer's patches, their precise office, though seemingly like those of the lymphatic glands, cannot be positively assigned, so far as I know, at the present time. It is of obvious interest to learn it with reference to the pathology of typhoid fever. It will be remarked that the coincidence of their changes in this disease with enlargement of the spleen suggests the idea of a similarity of function in these two organs.

The theories of the production of animal heat, from the times of Black, Lavoisier, and Crawford to those of Liebig, are familiar to all who have paid any attention to physiological studies. The simplicity of Liebig's views, and the popular form in which they have been presented, have given them wide currency, and incorporated them in the common belief and language of our text-books. Direct oxidation or combustion of the carbon and hydrogen contained in the food, or in the tissues themselves; the division of alimentary substances into respiratory, or non-azotized, and azotized,--these doctrines are familiar even to the classes in our high-schools. But this simple statement is boldly questioned. Nothing proves that oxygen combines (in the system) with hydrogen and carbon in particular, rather than with sulphur and azote. Such is the well-grounded statement of Robin and Verdeil. “It is very probable that animal heat is entirely produced by the chemical actions which take place in the organism, but the phenomenon is too complex to admit of our calculating it according to the quality of oxygen consumed.” These last are the words of Regnault, as cited by Mr. Lewes, whose intelligent discussion of this and many of the most interesting physiological problems I strongly recommend to your attention.