medical essays-第46节
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hy 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。
This single illustration covers a wider ground than the special function to which it belongs。 We are learning that the chemistry of the body must be studied； not simply by its ingesta and egesta； but that there is a long intermediate series of changes which must be investigated in their own light； under their own special conditions。 The expression 〃sum of vital unities〃 applies to the chemical actions； as well as to other actions localized in special parts； and when the distinguished chemists whom I have just cited entitle their work a treatise on the immediate principles of the body； they only indicate the nature of that profound and subtile analysis which must take the place of all hasty generalizations founded on a comparison of the food with residual products。
I will only call your attention to the fact； that the exceptional phenomenon of the laboratory is the prevailing law of the organism。 Nutrition itself is but one great catalytic proces
