course, it is devoid of symptoms, latent; the tissue-changes going on do not make known their existence by pain or unpleasant sensations. Did space permit I might quote without limit from medical authorities to prove not only the occurrence, but the quite frequent occurrence, of organic changes of structure in their "latent form." The index of almost any text-book on "Pathology," or "Practice," will direct the reader to ample evidence on this point. I will, however, cite one or two well-known authors. Prof. George B. Wood, of Philadelphia, remarks[1] that "sometimes inflammation" (he must refer to sub-acute or chronic inflammation) "runs its accustomed course, so far as relates to its effects upon the textures in which it is seated, with scarcely any of those evidences by which its existence in the interior of the body is usually detected, such as pain, disordered function, and constitutional disturbance. Under such circumstances it is said to be latent, and often escapes detection."[2]
Prof. Austin Flint ("Practice of Medicine," pp. 307, 308) refers to cases of what he calls "spontaneous" or "idiopathic endocarditis" (organic modification of the lining membrane of the heart) "which present the physical signs and anatomical characters of the disease without the first symptom having been noticed either by the patient or his physician." The terms "latent pleurisy," "latent phthisis," "latent pneumonia," etc., are familiar to every pathologist. With regard to this latter disease I cannot refrain from inserting one other citation from the "Works of Dr. Thomas Addison" (see "New Sydenham Society's Publications," article "Pneumonia," p. 11). Dr. Addison remarks that Laennec referred to pneumonia without symptoms as of rare but occasional occurrence, and adds: "I am convinced that these reputed deviations and exceptions, regarded as obscure, are of extremely frequent occurrence; and that they are met with at every period of life, and in every variety of constitution; and that they are very far indeed from being limited to old persons, or to what have been called complicated cases.... Cases with symptoms are in truth themselves the exceptions in a pathological sense; and, although most frequently met with in practice, are in fact cases of complication." This most apt statement is replete with wisdom, and true to Nature. Truly, the simplest form of the disease, that in which the tissue-changes are gradual (chronic), and without symptoms (latent), is rarely met with in practice, because the pathological evolution has followed so closely its designed course undisturbed, that the physician is never
- ↑ "Practice of Medicine," vol. i., p. 38.
- ↑ Dr. Wood, in here using the term "inflammation," is still possessed with the old error (long ago set aside by the researches of Dr. Handfield Jones and others), that the growth of fibrous (connective) tissue (the supposed "effect of inflammation upon the textures in which it is seated"), is always due to inflammation. Really this abnormal growth of fibrous tissue is a "new formation," the result of an evolutionary process, and is found after death from inflammation only because it preceded the inflammatory process, and was by this latter brought to a fatal termination.
