Dr. Rudolph Virchow (1821-1902) wrote his major work, Cellular Pathologie, in 1858.
"Virtually all forms of tissue injury start with molecular or structural alterations in cells, a concept first put forth in the 19th century by Rudolph Virchow, known as the father of modern pathology. We therefore begin our consideration of pathology with the study of the origins, molecular mechanisms, and structural changes of cell injury." ([Emphasis in original] 4th edition, 1989, page 2)
Dr. Virchow derived his understanding of the cell from the work of Theodor Schwann. In his important but largely ignored 1916 book, Form and Function, E.S. Russell captures the essence of Schwann's theory: "Each cell was itself (for Schwann and Virchow) an organism, and its life and activities were to some extent independent of the lives and activities of all the other cells. The multicellular organism was a colony of unicellular organisms, and its life was the sum of the lives of its constituent elements."(page 180)
Dr. Claude Bernard is generally recognized as the leading physiologist of the 19th century. He, along with Virchow, is recognized as a "founding father" of allopathic medicine because he initiated the proposition that advances in medicine must be based upon animal experimentation.
However, Dr. Bernard strongly disagreed with the "Schwann-Virchow" theory of disease and proposed a paradigm in which disease was said to arise as a result of dysfunction within the milieu intérieur (internal environment). His paradigm has been virtually ignored by allopathic medicine. Of course, Louis Pasteur was also a major contributor to "modern" medicine. Dr. Pasteur agreed with Virchow early in his career, but shifted to Bernard's side of the debate toward career's end.
Dr. Bernard delivered a series of 21 lectures in 1860 at the College of France, which were translated into English and published in the 1861 editions of The Medical Times and Gazette, A Journal of Medical Science, Literature, Criticism, and News, published by John Churchill of London, England. This journal was widely distributed in the United States and is still available for review in the archives at UCLA. In the last lecture in this series, Bernard summarized and reiterated his basic theory.
Pierre Louis Gaucher-Peslhebe,DC, suggests in his book Chiropractic: Early Concepts in Their Historical Settings (1993) that D.D. Palmer got his idea about the importance of neural regulation from Dr. Bernard. Professor Joseph Keating, in his articles in Dynamic Chiropractic, has demonstrated that D.D. clearly knew what was going on within medicine and physiology during the latter part of the 19th century. It would behoove the reader to look at Bernard's actual words, available to D.D. Palmer as he defined the basic chiropractic principles:
| LECTURES DELIVERED AT
By M. CLAUDE BERNARD
LECTURE XXI GENERAL RECAPITULATION OF THE VIEWS EXPRESSED IN THIS COURSE
GENTLEMEN - The nervous system, as Blainville philosophically observed, creates a secret harmony between the different parts of the living frame, establishes a permanent connection between them, and renders them mutually dependent upon each other. The principal object of the preceding lectures has been to show that nature employs two great classes of nerves for the accomplishment of this purpose; there only exist two kinds of nervous fibres in the economy which are, so to speak, derived from each other, and unite in the central parts of the system to form one great apparatus, the only real difference between sensitive and motor nerves being the direction of the nervous currents which travel along this fibre; it would, in fact, be altogether impossible to conceive in any given animal one set of nerves as existing independently of the other; and the chemical phenomena which take place within the living body being, as we have shown, the result of the action exerted by a particular class of motor nerves upon the vessels, are inseparably connected with the other manifestations of nervous activity. The importance of the connection which exists between nerves and vessels has, we trust, been strongly impressed upon your minds; it is the key to all the local modifications which arise upon certain given points of the economy, the general circulation being left undisturbed, and the heart's action remaining the same as before. In short, the discovery of the vasomotor nerves is pregnant with deeply interesting results, both in physiology and medicine; it explains the angular phenomena of local circulation from which the great majority of morbid symptoms are derived. No disease ever fixes upon all the organs at once; but local effects give rise to general affections, and these in their turn create local disorders; but the knowledge of the general laws of circulation cannot evidently enable the physiologist to explain the congestive phenomena which almost invariably result from the action of morbid causes. As long as we content ourselves with taking into consideration the impulse given to the blood in the heart, and the resistance which the tissues oppose to its progress, we shall only be able to account for general results, which extend to the whole economy. There exist, therefore, in the eyes of the physiologist and medical philosopher, two circulations entirely distinct in their nature, and in the effects which arise from their changes; the first is the general circulation, which Harvey's immortal labours have brought to our knowledge; the second is the capillary circulation, which lies under the direct control of the nervous system, and acts separately upon each individual spot of the body. To this part of the vascular apparatus are the majority of the morbid symptoms, or physiological phenomena, to be referred when a single point is affected, the other parts of the economy remaining in their usual state. There exist, in fact, two kinds of capillary vessels; the first establish a direct communication between arteries and veins, and secure a passage for the blood which flows from one system into the other; the second being of smaller dimensions, lie in contact with the histological elements of the tissues, and enjoy a considerable influence upon them. On this portion of the vascular system is nervous power chiefly exerted. Another point to which your attention has been drawn is the mode of action through which these results are obtained; contractile elements are as usual placed at the disposal of the nervous system; it cannot, in fact, be rationally asserted that the nerves act directly upon the blood, and modify its chemical composition, or change the direction in which it flows. In the vessels, as in all other parts of the body, the action of nerves is connected with the muscular element; and microscopical anatomy confirms the data of physiology by showing muscular fibres to exist in the vessels. We are thus enable through the action of the sympathetic nerve to modify at our pleasure the nutritious and vital activity of all tissues in living animals; bones, muscles, glands, and other organs obey the power of the nervous system. There exists one tissue, however, in which this process appears still more extraordinary; we allude to the action of the nervous element upon itself. So complicated in fact is the disposition of the living process, such is the intricacy of vital phenomena, that homologous tissues sometimes modify each other. This reciprocal influence in the present case is easily explained; the numerous vessels which ramify in the brain and a spinal cord being, as in other regions, placed under the control of the ganglionic system, the influence of the sympathetic nerve extends to the very center of the nervous system. The experiments of Donders, which we alluded to on a previous occasion, have fully justified the opinions here expressed; the introduction of a thermometer into the skull proves that after the division of all the branches of the upper cervical ganglion, the cerebral substance itself participates in the effects of this operation; its temperature rises, its vascularity increases, and, as a consequence, the general sensibility of all the cerebrospinal nerves is considerably increased. An operation performed on a single point of the nervous system gives rise, therefore, to a general hyperaesthesia of the whole apparatus. Might not these observations lead to a more accurate knowledge of the cerebral functions, hitherto involved in such deep obscurity? The application of these views to pathology has been partly attempted in the preceding lectures; and we have endeavoured to show you the intimate connection which unites the nutritive process to the leading features of inflammation. Without attempting to give a definitive explanation of these facts, we feel justified in stating that the influence of the vasomotor nerves upon the phenomena of nutrition is proved beyond the possibility of a doubt. We have shown you that the division of the principal branches of this nerve gives rise to inflammatory symptoms in the corresponding organs, when the animal is deprived of food. The intimate nature of these properties of the nervous system cannot of course be satisfactorily explained; but you are fully aware that the primitive causes of all natural phenomena lie beyond the reach of human knowledge; and the obscurity in which this part of the subject is involved is not the exclusive privilege of nervous action; an impenetrable mystery hangs over the origin of all the powers which maintain life. In concluding this course, it remains for us to show the relations in which our principles stand to the doctrines which actually prevail in the medical sciences. The history of medicine embraces two distinct periods - that of empiricism, and that of scientific observation. Such is the case with all branches of human knowledge. We start from direct observation and gradually rise to the conception of a regular system of definite laws, embracing all the relations of cause and effect. The progress of physiology and medicine has been slower than that of other sciences, but they rapidly tend to acknowledge settled rules and general laws; and the experimental method alone is capable of leading us to the long-wished-for result. We do not pretend, therefore, to exhibit the science of disease in its definitive and perfect form; but we have endeavoured to impress upon your mind the fundamental principles which must in future guide the labours of all scientific observers. The only solid foundation on which the edifice of nosology can be raised is physiology; and in spite of the cavils of those who, after devoting the greater part of their lives to clinical observation, have been led to despise all other methods of acquiring knowledge, the artificial barriers which prejudice had raised between the two sister sciences are crumbling into dust. We shall therefore pursue the course of our experimental labours; and in the course of the next session we shall endeavour to elucidate by physiological operations the history of one of the great morbid series with which clinical observation has made us acquainted. |
Harmony and Tone
Bernard was a disciple of Magendie, the great 19th century physiologist. It seems likely that Bernard derived his concept of the importance of the "harmonious" relationship between the parts of the "living frame" from Magendie. It also appears likely that Magendie derived this concept in part from Chinese medicine. Magendie started practicing "electroacupunture" as early as 1835.1 Wherever it came from, the concept of "harmony/tone/balance" (and self-regulation) is critically important, and obviously a founding principle of chiropractic and acupuncture.
We must acknowledge, however, that Bernard did not speak of only the nervous system as a factor in the body's ability to self-regulate. He also pointed to the importance of the "local circulation." Indeed, that aspect has been a focus of attention for the osteopaths and also leading 20th- century physiologists. Guyton, in the most recent edition of his work, states:
"In the extracellular fluid are the ions and nutrients needed by the cells for maintenance of cellular life. Therefore, all cells live in essentially the same environment, the extracellular fluid, for which reason the extracellular fluid is called the internal environment of the body, or the milieu intérieur, a term introduced more than 100 years ago by the great 19th-century French physiologist Claude Bernard." ([Emphasis in original] Guyton, Hall, Textbook of Medical Physiology, 10th edition 2000, page 2)
Guyton does a disservice to the work of Bernard by ignoring Bernard's emphasis on the nervous system and the concept of "self-regulation." It is becoming clear that the "internal environment" is a very complex structure. It serves a far greater purpose than merely that of a transportation system. (Of course, it does transport and house nutrients; hormones; neuropeptides; immune cells; etc.) We will demonstrate in a future article that much more than mere chemistry and transportation is involved. For now, let's look at some developments relative to the concept of the body's innate capacity for self-regulation and at its capacity for harmonious interaction within the internal environment.2
Bennett's Functional Unit
Terrence Bennett was a chiropractor practicing in California at the time of the adoption of the Chiropractic Act of 1922. At an early date in his career he gave an expanded definition of the concept of "self-regulation" that is difficult to improve upon even at this time. After discussing the importance of the nervous system, Bennett added:
"...so the arteriole, the capillary, the tissue space, the cell, the lymph capillary, which also lies in this same area, and we have a functional unit which is common to all tissue in the body." (Emphasis added)3
It is important to note that Bennett includes the cell within the "functional unit." Dr. Alfred Pischinger, of the University of Vienna Medical School, came up with a similar concept in the 1940s, but he did not include the cell within his definition of the body's regulatory mechanism. The emerging evidence about the body's innate self-regulatory capacity, which we will address in a future article, makes it clear that organ cells should be considered as part of the "internal environment - self-regulation paradigm."
Pischinger's "Regulatory Matrix"
Dr. Pischinger was a histologist who began work on defining the components of the extracellular compartment as early as 1945. His work has become the basis for a whole field of what is called "functional medicine" in Europe. Pischinger called the extracellular compartment the extracellular matrix because of both its complexity, and because of the interactive relationships of its component parts. He went so far as to flatly state:
"Organic diseases originate in dysfunctions of this system (the 'matrix') and its connections throughout the organism."4
He does not, however, include the cell as part of the functional unit; in that regard, he falls short of Bennett's definition of the "functional unit." Bennett is closer to the truth, as will also be demonstrated in a future article.
Flexner and Virchow
We will assume that our readers have heard of the Flexner report of 1910 and its impact on medical education in the United States. What you might not be aware of is its direct impact on the issues related to disease causation, and the Virchow-Bernard-Palmer-Bennett debate, through its utilization in the accreditation process for "medical" schools and legislation related to "medical" practice. Simply put, the debate over theories of disease causation was usurped by Flexner, who was neither a biologist nor a physician.
Flexner, in his report, gives a detailed description of what he believes should be the basis for the study and practice of medicine. On page 65 of a special republished version of his report (1990), he establishes Virchow's theory as the only acceptable approach to the understanding of disease. Flexner's report served as the foundation for the establishment of the current "medical-drug cartel" and the legislative and judicial pronouncements supporting that complex. Obviously, the answer to theories of disease should be derived from clinical and laboratory investigations, not by, in effect, legislative/judicial/accreditation fiat.
Robbins Revisited
At the start of this article, we quoted Robbins' view of the concept of "cellular pathology" from 1989. A new concept was added in the 1994 edition of Robbins (page 2). The basic concept of pathology is now stated as follows:
"Virtually all forms of tissue injury start with molecular or structural alterations in cells, a concept first put forth in the 19th century by Rudolph Virchow, known as the father of modern pathology. We therefore begin our consideration of pathology with the study of the origins, molecular mechanisms, and structural changes of cell injury. Yet different cells in tissues constantly interact with each other, and an elaborate system of extracellular matrix is necessary for the integrity of organs. Cell-cell and cell-matrix interactions contribute significantly to the response to injury, leading collectively to tissue and organ injury, which are as important as cell injury in defining the morphologic and clinical pattern of disease." (Emphasis in original.)
The recognition of the importance of the "extracellular matrix" is a step forward, but something is still missing from this allopathic theory of disease causation. Notice that the "interactions" between the cell-cell and cell-matrix are presented as a one-way street. The matrix-cell interaction, or regulatory function, is simply ignored. We will demonstrate in our future articles that this is a critical error.
It is understandable that the allopathic community would have difficulty accepting the concept of the extracellular regulatory function, as it has been captives of Virchow's cellular theory of disease for so long. In addition, its preoccupation has been with chemistry and drug therapy. This has, until recently, been preoccupied with the cell wall and receptor cites. Of course, it has now gone "down" to the gene level. The allopathic community cannot be expected to fully appreciate the implication of what we are calling the "internal environment - self-regulation paradigm."
Palmer and the 21st Century
The "internal environment - self-regulation paradigm" must be developed and refined by those following the Bernard-Palmer-Bennett-Pischinger or acupuncture theories. The question for chiropractors then becomes whether they will "step up to the plate" and acknowledge that elements of such a paradigm cannot be fixed in stone, based upon late 19th and early 20th-century knowledge. Obviously, Bernard and the early founders of chiropractic were operating with a limited knowledge of histology, chemistry and physics, and within a changing philosophical/religious environment. Chiropractors, and more particularly the chiropractic colleges, cannot ignore the advances in scientific knowledge that have taken place since the founding of chiropractic.
The chiropractic principle that the body has an innate capacity for self-regulation is clearly supported by recent advances in our understanding of basic physiology. But the constituent elements and applications of this paradigm are in their infancy, compared to the paradigm that has been developed due to the funding available to the "medical-drug cartel." Chiropractors and other non-allopathic practitioners must incorporate new scientific knowledge as it arises.
Chiropractors, acupuncturists and others who have not been blindsided by the cellular theory of disease and by drug therapy, who are willing to work in an expanding knowledge base, need to speak up and demand equal treatment before the law, and equal access to the governmental research funding stream. Without such action, the full development of the concept of the "internal environment - self-regulation paradigm" will continue to play second fiddle to the allopathic model of warring against disease and nature.
In our next article, we will discuss some of the approaches to evaluation and treatment within the "internal environment - self regulation paradigm." In the article after that, we will detail some of the emerging scientific evidence supporting this paradigm. Thereafter, we will look again at the 19th century battles over the philosophical ramifications of the ideas of not only "self-regulation," but also "self-organization."
D.D. claimed that the "power that makes the body, heals the body." What does that mean? Was that an idea that was in play during the 19th century? What happened to that premise in mainstream biology and medicine? We leave you with these questions for now.
- Ho, Popp, and Warnke, Bioelectro-dynamics and Biocommunication, (1994), p. 7. By mid-nineteenth century, electro acupuncture had spread to Italy and Germany. Electroacupuncture was introduced into China from the West in 1958. (Id.)
- The issue goes deeper than just "self-regulation." It also raises the question of morphogenesis. We will return to the philosophical aspects of this subject in a subsequent article.
- Martin. Dynamics of correction of abnormal function. The Terrence J. Bennett Lectures (1977), p. 6.
- Heine (ed.). Matrix and matrix regulation. Basis for a Holistic Theory of Medicine (1991), p.21.
David Prescott, MA,JD,DC,FIAMA
Silverado, California
Hon. Edwin Grauke,JD,DC
Lakewood, Colorado