Homeostasis: Its Dislocations and Perturbations

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HOMEOSTASIS: ITS DISLOCATIONS AND PERTURBATIONS DICKINSON W. RICHARDS, M.D.* Homeostasis, a concept which describes admirably the physiological mechanisms that protect and restore the normal, does not encompass the destructive forces ofdisease. This was the basic premise ofan argument in which I endeavored to examine this general subject a few years ago. In that paper I reviewed the historical background ofhomeostasis, concentrating chiefly on its essential origin from Claude Bernard's fixité du milieu intérieur; then pointed out in further detail how homeostasis fails in disease, especially chronic disease; and, finally, by way of contrast, described a group of pathological conditions whose essential nature is an excess response, an apparent homeostatic effort which in correcting onedifficultyproduces others muchworse. To this inordinate, unbalancing, excess response I gave the name "hyperexis." Toward the end of that paper I suggested that in the large realm of pathology there were undoubtedly other categories, ofthe same generality as hyperexis, which might be similarly described. In this paper I resume the argument at this point and attempt a broader survey ofthe biological trends which are found in disease. In brief, the following descriptive terms are proposed: the excess response , "hyperexis"; the deficient response, "ellepsis;" the inappropriate response, "akairia." Following this, I have still one more, in which a rather large segment of experience is looked at in a fashion somewhat apart from our usual systems of biological knowledge. I am calling it the concept ofdisorder and suggest for it the name "taraxis." * Department of Medicine, Columbia University College of Physicians and Surgeons. This paper was read at a meeting of the Practitioner's Society, New York City, December 13, 1957. The writer wishes to express his gratitude to Alfred R. Bellinger for providing the many Greek words fromwhich the terms in this paper werechosenand for much helpful criticism and discussion. 238 Dickinson W. Richards · Homeostasis Perspectives in Biology and Medicine · Winter i960 I.Homeostasis While everyone knows the general meaning ofthe term "homeostasis," it may be well to give a few precise quotations, to be sure that we keep clearly in mind what it is we are talking about. In The Wisdom ofthe Body, Walter Cannon says: The coordinated physiological processes which maintain most of die steady states in the organism are so complex and so peculiar to living beings—involving, as they may, die brain andnerves, theheart, lungs, kidneys, and spleen, allworking cooperatively —diat I have suggested a special designation for diese states, homeostasis. The word does not imply somediing set and immobile, a stagnation. It means a condition—a condition which may vary, but which is relatively constant. This is, ofcourse, only a restatement, and an incomplete one at that, of Claude Bernard's concept of the constancy of the internal environment as set forth some sixty-five years earlier. It is curious that in his book Cannon never gives due acknowledgment to his great predecessor. Barcroft and Henderson did much better. At the risk ofrepeating what is perhaps already known by heart, I will quote again one of Claude Bernard's classic passages: The organism is only a living machine constructed in such a fashion diat, on die one hand, diere is full communication between the external environment and the milieu intérieur, and on the odier, diat diere are protective functions of organic elements holding living materials in reserve and maintaining widiout interruption humidity, heat, and odier conditions indispensable to vital activity. Sickness and deadi are only a dislocation or perturbation ofthat mechanism. Note especially this last sentence—which is, in fact, my text. II.The Excess Response, Hyperexis In order to recapture more fully the attitude of my previous paper, I will review briefly the idea ofhyperexis. As noted in the statement just quoted, it was clear enough to Claude Bernard that the milieu intérieur is not maintained in disease. Such was not the case, however, with Cannon. Like most of the physiologists of his day, especially the English and the American, he was much more interested in the adaptive, the successfully adaptive, mechanisms of the "normal" organism than with their dislocations and perturbations in disease. In The Wisdom ofthe Body there is but litde emphasis upon disease ofany...

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