Preventable Diseases. Woods Hutchinson
fact, if we dared to presume to criticise this magnificent theory of disease, we would simply say that it is not "cellular" enough, that it hardly as yet sufficiently recognizes the individuality, the independence, the power of initiative, of the single constituent cell. It is still a little too apt to assume, because a cell has donned a uniform and fallen into line with thousands of its fellows to form a tissue in most respects of somewhat lower rank than that originally possessed by it in its free condition, that it has therefore surrendered all of its rights and become a mere thing, a lever or a cog in the great machine. Nothing could be further from the truth, and I firmly believe that our clearest insight into and firmest grasp upon the problems of pathology will come from a recognition of the fact that, no matter how stereotyped, or toil-worn, or even degraded, the individual cells of any tissue may have become, they still retain most of the rights and privileges which they originally possessed in their free and untrammeled amœboid stage, just as in the industrial community of the world about us. And, although their industry in behalf of and devotion to the welfare of the entire organism is ever to be relied upon, and almost pathetic in its intensity, yet it has its limits, and when these have been transgressed they are as ready to "fight for their own hand," regardless of previous conventional allegiance, as ever were any of their ancestors on seashore or rivulet-marge. And such rebellions are our most terrible disease-processes, cancer and sarcoma. More than this: while, perhaps, in the majority of cases the cell does yeoman service for the benefit of the body, in consideration of the rations and fuel issued to it by the latter, yet in many cases we have the curious, and at first sight almost humiliating, position of the cell absorbing and digesting whatever is brought to it, and only turning over the surplus or waste to the body. It would almost seem as if our lordly Ego was living upon the waste-products, or leavings, of the cells lining its food-tube.
Let us take a brief glance at the various specializations and trade developments, which have taken place in the different groups of cells, and see to what extent the profound modifications which many of them have undergone are consistent with their individuality and independence, and also whether such specialization can be paralleled by actually separate and independent organisms existing in animal communities outside of the body. First of all, because furthest from the type and degraded to the lowest level, we find the great masses of tissue welded together by lime-salts, which form the foundation masses, leverage-bars, and protection plates for the higher tissues of the body. Here the cells, in consideration of food, warmth, and protection guaranteed to themselves and their heirs for ever by the body-state, have, as it were, deliberately surrendered their rights of volition, of movement, and higher liberties generally, and transformed themselves into masses of inorganic material by soaking every thread of their tissues in lime-salts and burying themselves in a marble tomb. Like Esau, they have sold their birthright for a mess of "potash," or rather lime; and if such a class or caste could be invented in the external industrial community, the labor problem and the ever-occurring puzzle of the unemployed would be much simplified. And yet, petrified and mummified as they have become, they are still emphatically alive, and upon the preservation of a fair degree of vigor in them depends entirely the strength and resisting power of the mass in which they are embedded, and of which they form scarcely a third. Destroy the vitality of its cells, and the rock-like bone will waste away before the attack of the body-fluids like soft sandstone under the elements. Shatter it, or twist it out of place, and it will promptly repair itself, and to a remarkable degree resume its original directions and proportions.
So little is this form of change inconsistent with the preservation of individualism, that we actually find outside of the body an exactly similar process, occurring in individual and independent animals, in the familiar drama of coral-building. The coral polyp saturates itself with the lime-salts of the sea-water, much as the bone-corpuscles with those of the blood and lymph, and thus protects itself in life and becomes the flying buttress of a continent in death.
In the familiar connective-tissue, or "binding-stuff," we find a process similar in kind but differing in the degree, so to speak, of its degradation.
The quivering responsiveness of the protoplasm of the amœboid ancestral cell has transformed itself into tough, stringy bands and webs for the purpose of binding together the more delicate tissues of the body. It has retained more of its rights and privileges, and consequently possesses a greater amount of both biological and pathological initiative. In many respects purely mechanical in its function, fastening the muscles to the bones, the bones to each other, giving toughness to the great skin-sheet, and swinging in hammock-like mesh the precious brain-cell or potent liver-lobule, it still possesses and exercises for the benefit of the body considerable powers of discretion and aggressive vital action. Through its activity chiefly is carried out that miracle of human physiology, the process of repair. By the transformation of its protoplasm the surplus food-materials of the times of plenty are stored away within its cell-wall against the time of stress.
Whatever emergency may arise, nature, whatever other forces she may be unable to send to the rescue, can always depend upon the connective-tissues to meet it; and, of course, as everywhere the medal of honor has its reverse side, their power for evil is as distinguished as their power for good. From their ranks are recruited a whole army of those secessions from and rebellions against the body at large—the tumors, from the treacherous and deadly sarcoma, or "soft cancer," to the harmless fatty tumor, as well as the tubercle, the gumma of syphilis, the interstitial fibrosis of Bright's disease. They are the sturdy farmers and ever ready "minute-men" of the cell-republic, and we find their prototype and parallel in the external world, both in material structure and degree of vitality, in the well-known sponge and its colonies.
Next in order, and, in fact, really forming a branch of the last, we find the great group of storage-tissues, the granaries or bankers of the body-politic, distinguished primarily, like the capitalist class elsewhere, by an inordinate appetite, not to say greed. They sweep into their interior all the food-materials which are not absolutely necessary for the performance of the vital function of the other cells. These they form first into protoplasm, and then by a simple degenerative process it is transformed, "boiled down" as it were, into a yellow hydrocarbon which is capable of storage for practically an indefinite period. Not a very exalted function, and yet one of great importance to the welfare of the entire body, for, like the Jews of the Middle Ages, the fat-cells, possessing an extraordinary appetite for and faculty of acquiring surplus wealth in times of plenty, can easily be robbed of it and literally sucked dry in times of scarcity by any other body-cell which happens to need it, especially by the belligerent military class of muscle-cells. In fever or famine, fat is the first element of our body-mass to disappear; so that Proudhon would seem to have some biological basis for his demand for the per capita division of the fortunes of millionaires. And yet, rid the fat-cell of the weight of his sordid gains, gaunt him down, as it were, like a hound for the wolf-trail, and he becomes at once an active and aggressive member of the binding-stuff group, ready for the repair of a wound or the barring out of a tubercle-bacillus.
And this form of specialization has also its parallel outside of the body in one of the classes in a community of Mexican ants, whose most distinguishing feature is an enormously distended œsophagus, capable of containing nearly double the weight of the entire remainder of the body. They are neither soldiers nor laborers, but accompany the latter in their honey-gathering excursions, and as the spoils are collected they are literally packed full of the sweets by the workers. When distended to their utmost capacity they fall apparently into a semi-comatose condition, are carried into the ant-hill, and hung up by the hind legs in a specially prepared chamber, in which (we trust) enjoyable position and state they are left until their contents are needed for the purposes of the community, when they are waked up, compelled to disgorge, and resume their ordinary life activities until the next season's honey-gathering begins. It scarcely need be pointed out what an unspeakable boon to the easily discouraged and unlucky the introduction of such a class as this into the human industrial community would be, especially if this method of storage could be employed for certain liquids.
Another most important class in the cell-community is the great group of the blood-corpuscles, which in some respects appear to maintain their independence and freedom to a greater degree than almost any other class which can be found in the body. While nearly all other cells have become packed or felted together so as to form a fixed and solid tissue, these still remain entirely