Spencers Pathology of the Lung 2 Part Set
COPD is considered to be a chronic inflammatory process throughout the airway and lung parenchyme, allowing definition of two phenotypes involving primarily parenchymal disease emphysema and primarily airway disease Nakano et al ; Hoffman et al These two pathologies frequently coexist in a diseased lung. Pathological changes of the large airway include enlarged mucus-secreting glands and an increase in the number of goblet cells with mucus hypersecretion Pauwels et al In the peripheral airways, chronic inflammation leads to repeated cycles of injury and repair of the airway wall Pauwels et al , and the repair process results in structural remodeling of the airway wall Pauwels et al Quantitative measurement of the airway by HRCT is a promising method for evaluation of the inflammatory condition of the airway in COPD, and recent studies have shown that HRCT can be used to divide COPD patients into groups with predominant lower lung attenuation or thickening and narrowing of the airway, although many subjects have both abnormalities Nakano et al Hoffman et al Figure Thickening of the bronchial wall in cases of pulmonary emphysema.
High resolution computed tomography showing thickening of the bronchial wall and narrowing of the lumen arrows. Although not completely established, some patients with pulmonary emphysema in the upper lung field are reported to have simultaneous pulmonary fibrosis in the lower lung field Wiggins et al ; Cottin et al ; Lundblad et al ; Grubstein et al ; Mura et al Figure Cottin and colleagues performed a retrospective analysis of 61 patients with emphysema of the upper zones and diffuse parenchymal lung disease with fibrosis of the lower zones of the lung on chest CT.
These patients were characterized by subnormal spirometry, severe impairment of gas exchange, a high prevalence of pulmonary hypertension, and poor survival. The patients were almost exclusively male and all were current or ex-smokers. The pathophysiology of combined pulmonary fibrosis and pulmonary emphysema CPFE is unknown, but it is speculated that both emphysema and fibrosis may be related to a common environmental trigger or a genetic susceptibility factor. Combined pulmonary fibrosis and pulmonary emphysema CPFE in a year-old male who was a heavy smoker: High resolution computed tomography images.
In the upper lung field a , a prominent bullous change is apparent. In the middle lung field b , tiny air cysts arrows with ground-glass opacity are present in addition to the bullous changes. In the lower lung field c , distributed tiny air cysts with definable walls and ground-glass opacity are apparent. These features are consistent with interstitial fibrosis rather than pulmonary emphysema. Bullous lung is a risk factor for bronchogenic carcinoma, with a 32 times higher risk of developing bronchogenic carcinoma in patients with BLD compared with those without BLD Stoloff et al Radiological diagnosis of bronchogenic carcinoma is based on the shape, density, and interface with surrounding lung parenchyma.
However, these morphologies in bronchogenic carcinoma can be changed by underlying emphysematous changes, including influences on the extent of the tumor and the tumor — lung interface. In the normal lung field, bronchogenic carcinoma tends to grow globally, but this is not always true if the tumor occurs with pulmonary emphysema.
Since tumors tend to grow along the intervening normal lung, bizarre shapes are often observed. Some cases have findings that are similar to those of post-inflammatory fibrotic changes because the tumor extends along the emphysematous lesion, resulting in a thickened band-like structure Figure Nodular form of the bronchiolar alveolar carcinoma has an ill-defined border because tumor cells in the periphery grow along the alveolar wall with preserving alveolar air space.
However, the interface can be well defined if the dilated air space is neighboring to it. On CT, attention should be paid in the interpretation for mass or nodule in the wall of the bulla because they frequently lack the characteristic appearance of bronchogenic carcinoma. Occurrence of bronchogenic carcinoma with emphysema in a year-old male. High resolution computed tomography A subpleural band-like structure is observed with adjacent emphysematous changes arrow.
Postinflammatory fibrotic tissue was suspected, but malignancy could not be confidently excluded and thoracotomy was performed. Contact radiograph of a specimen showing that the tumor grew along the surface of the emphysematous space arrows. The pathological diagnosis was well-differentiated adenocarcinoma. Computed tomography appearances of bronchogenic carcinoma associated with bullous lung disease. J Comput Assist Tomogr , — HRCT plays an important role for analyzing pathologies of pulmonary emphysema not only in its morphological aspect but also in the assessment of severity.
National Center for Biotechnology Information , U. Author information Copyright and License information Disclaimer. All rights reserved. This article has been cited by other articles in PMC. Keywords: pulmonary emphysema, HRCT, radiologic-pathologic correlation, pulmonary fibrosis, bronchus, lung cancer. Introduction Chronic obstructive pulmonary disease COPD is a disease characterized by airflow limitation that is not fully reversible Pauwels et al Anatomy of the secondary pulmonary lobule An understanding of the normal anatomy of the peripheral lung is required when interpreting CT images of pulmonary emphysema.
Open in a separate window. Figure 1. Figure 2. Figure 3. Abbreviation: PV, pulmonary vein. Figure 4. Figure 5. Visualization of peripheral lung structure by HRCT In general, HRCT can be used to visualize an airway with a diameter larger than 2 mm, which corresponds to sub-subsegmental bronchi Murata et al Figure 6. Figure 7. Figure 8. Centriacinar emphysema Centriacinar emphysema is the commonest type of pulmonary emphysema and is characterized by an enlargement of the centriacinar airspace, with the effect mainly occurring in proximal respiratory bronchioles, leaving normal distal alveolar ducts and sacs Leopold and Gough Figure 9.
Figure Abbreviation: ILS: interlobular septum. Panacinar emphysema Panacinar emphysema is characterized by a uniform dilatation of the air space from the respiratory bronchioles to the alveoli, resulting in evenly distributed emphysematous changes within secondary lobules acini Thurlbeck Distal acinar or paraseptal emphysema Distal acinar or paraseptal emphysema is characterized as an enlarged airspace at the periphery of acini Thurlbeck Aging lung The lung undergoes a set of morphological and functional changes with aging.
Imaging topics related to pulmonary emphysema Phenotyping of COPD and imaging COPD is considered to be a chronic inflammatory process throughout the airway and lung parenchyme, allowing definition of two phenotypes involving primarily parenchymal disease emphysema and primarily airway disease Nakano et al ; Hoffman et al Combined pulmonary fibrosis and pulmonary emphysema Although not completely established, some patients with pulmonary emphysema in the upper lung field are reported to have simultaneous pulmonary fibrosis in the lower lung field Wiggins et al ; Cottin et al ; Lundblad et al ; Grubstein et al ; Mura et al Figure Bronchogenic carcinoma associated with bullous lung disease Bullous lung is a risk factor for bronchogenic carcinoma, with a 32 times higher risk of developing bronchogenic carcinoma in patients with BLD compared with those without BLD Stoloff et al Conclusion HRCT plays an important role for analyzing pathologies of pulmonary emphysema not only in its morphological aspect but also in the assessment of severity.
Topography of aging and emphysematous lungs.
Am Rev Respir Dis. Definitions and classification of chronic bronchitis, asthma, and pulmonary emphysema. Collagen and elastin in human pulmonary emphysema. Disease of the airways in chronic obstructive pulmonary disease. Eur Respir J Suppl. Combined pulmonary fibrosis and emphysema: a distinct underrecognised entity. Eur Respir J. Studies in alphaantitrypsin deficiency.
Acta Medica Scandinavica. Morphometry of small airways in smokers and its relationship to emphysema type and hyperresponsiveness. Smad3 signaling involved in pulmonary fibrosis and emphysema. Proc Am Thorac Soc. Concomitant upper-lobe bullous emphysema, lower-lobe interstitial fibrosis and pulmonary hypertension in heavy smokers: report of eight cases and review of the literature. Respir Med. An immune basis for lung parenchymal destruction in chronic obstructive pulmonary disease and emphysema. PLoS Med. Cross-sectional physiology of the lung. Chronic pulmonary emphysema: anatomy and pathogenesis.
Am J Med. State of the Art. A structural and functional assessment of the lung via multidetector-row computed tomography: phenotyping chronic obstructive pulmonary disease. Diffuse lung disease: pathologic basis for the high-resolution computed tomography findings. J Thorac Imaging. Radiologic-pathologic correlations of small lung nodules with special reference to peribronchiolar nodules. Collagen content of alveolar wall tissue in emphysematous and non-emphysematous lungs.
The centrilobular form of hypertrophic emphysema and its relation to chronic bronchitis. Computed tomography in the etiologic assessment of idiopathic spontaneous pneumothorax. Tumor necrosis factor-alpha overexpression in lung disease: a single cause behind a complex phenotype. Regarding Science as a gradually increasing sphere, we may say that every addition to its surface does not bring it into wider contact with surrounding nescience.
There must ever remain therefore two antithetical modes of mental action. Throughout all future time, as now, the human mind may occupy itself, not only with ascertained phenomena and their relations, but also with that unascertained something which phenomena and their relations imply. Hence if knowledge cannot monopolize consciousness — if it must always continue possible for the mind to dwell upon that which transcends knowledge, then there can never cease to be a place for something of the nature of Religion; since Religion under all its forms is distinguished from everything else in this, that its subject matter passes the sphere of the intellect.
Thus, however untenable may be the existing religious creeds, however gross the absurdities associated with them, however irrational the arguments set forth in their defence, we must not ignore the verity which in all likelihood lies hidden within them. In the existence of a religious sentiment, whatever be its origin, we have a second evidence of great significance.
And as in that nescience which must ever remain the antithesis to science, there is a sphere for the exercise of this sentiment, we find a third general fact of like implication. We may be sure, therefore, that religions, even though no one of them be actually true, are yet all adumbrations of a truth. As, to the religious, it will seem absurd to set forth any justification for Religion, so, to the scientific, it will seem absurd to defend Science. Yet to do the last is certainly as needful as to do the first. If there exist some who, in contempt for its follies and disgust at its corruptions, have contracted towards Religion a repugnance which makes them overlook the fundamental truth contained in it; so, there are others offended to such a degree by the destructive criticisms men of science make on the religious tenets they hold essential, that they have acquired a strong prejudice against Science at large.
What is Science? To see the absurdity of the prejudice against it, we need only remark that Science is simply a higher development of common knowledge; and that if Science is repudiated, all knowledge must be repudiated along with it. The extremest bigot will not suspect any harm in the observation that the Sun rises earlier and sets later in summer than in winter. Well, Astronomy is an organized body of kindred observations, made with greater nicety, extended to a larger number of objects, and so analyzed as to disclose the real arrangements of the heavens and to dispel our false conceptions of them.
That iron will rust in water, that wood will burn, that long kept viands become putrid, the most timid sectarian will teach without alarm, as things useful to be known. But these are chemical truths: Chemistry is a systematized collection of such facts, ascertained with precision, and so classified and generalized as to enable us to say with certainty, concerning each simple or compound substance, what change will occur in it under given conditions.
And thus is it with all the sciences. They severally germinate out of the experiences of daily life. Nowhere is it possible to draw a line and say — here Science begins. And as it is the function of common observation to serve for the guidance of conduct; so, too, is the guidance of conduct the office of the most recondite and abstract results of Science.
Through the countless industrial processes and the various modes of locomotion it has given to us, Physics regulates more completely our social life than does his acquaintance with the properties of surrounding bodies regulate the life of the savage. All Science is prevision; and all prevision ultimately helps us in greater or less degree to achieve the good and avoid the bad.
Thus being one in origin and function, the simplest forms of cognition and the most complex must be dealt with alike. We are bound in consistency to receive the widest knowledge our faculties can reach, or to reject along with it that narrow knowledge possessed by all. To ask the question which more immediately concerns our argument — whether Science is substantially true? And it is because they are conscious how undeniably valid are most of its propositions, that the theological party regard Science with so much secret alarm. They know that during the five thousand years of its growth, some of its larger divisions — mathematics, physics, astronomy — have been subject to the rigorous criticism of successive generations, and have notwithstanding become ever more firmly established.
They know that, unlike many of their own doctrines, which were once universally received but have age by age been more widely doubted, the doctrines of Science, at first confined to a few scattered inquirers, have been slowly growing into general acceptance, and are now in great part admitted as beyond dispute.
They know that scientific men throughout the world subject one another's results to searching examination; and that error is mercilessly exposed and rejected as soon as discovered. And, finally they know that still more conclusive evidence is furnished by the daily verification of scientific predictions, and by the never-ceasing triumphs of those arts which Science guides. To regard with alienation that which has such high credentials is a folly. Though in the tone which many of the scientific adopt towards them, the defenders of Religion may find some excuse for this alienation, yet the excuse is an insufficient one.
On the side of Science, as on their own side, they must admit that short-comings in the advocates do not tell essentially against that which is advocated. Science must be judged by itself; and so judged, only the most perverted intellect can fail to see that it is worthy of all reverence. Be there or be there not any other revelation, we have a veritable revelation in Science — a continuous disclosure of the established order of the Universe.
This disclosure it is the duty of every one to verify as far as in him lies; and having verified, to receive with all humility. Thus there must be right on both sides of this great controversy. Religion, everywhere present as a warp running through the weft of human history, expresses some eternal fact; while Science is an organized body of truths, ever growing, and ever being purified from errors.
And if both have bases in the reality of things, then between them there must be a fundamental harmony. It is impossible that there should be two orders of truth in absolute and everlasting opposition. Only in pursuance of some Manichean hypothesis, which among ourselves no one dares openly avow, is such a supposition even conceivable. That Religion is divine and Science diabolical, is a proposition which, though implied in many a clerical declamation, not the most vehement fanatic can bring himself distinctly to assert. And whoever does not assert this, must admit that under their seeming antagonism lies hidden an entire agreement.
Each side, therefore, has to recognize the claims of the other as representing truths which are not to be ignored. It behoves each to strive to understand the other, with the conviction that the other has something worthy to be understood; and with the conviction that when mutually recognized this something will be the basis of a reconciliation.
How to find this something thus becomes the problem we should perseveringly try to solve. Not to reconcile them in any makeshift way, but to establish a real and permanent peace. The thing we have to seek out is that ultimate truth which both will avow with absolute sincerity — with not the remotest mental reservation. There shall be no concession — no yielding on either side of something that will by-and-by be reasserted; but the common ground on which they meet shall be one which each will maintain for itself. We have to discover some fundamental verity which Religion will assert, with all possible emphasis, in the absence of Science; and which Science, with all possible emphasis, will assert in the absence of Religion.
We must look for a conception which combines the conclusions of both — must see how Science and Religion express opposite sides of the same fact: the one its near or visible side, and the other its remote or invisible side. Already in the foregoing pages the method of seeking such a reconciliation has been vaguely shadowed forth. Before proceeding, however, it will be well to treat the question of method more definitely. To find that truth in which Religion and Science coalesce, we must know in what direction to look for it, and what kind of truth it is likely to be.
Only in some highly abstract proposition can Religion and Science find a common ground. Neither such dogmas as those of the trinitarian and unitarian, nor any such idea as that of propitiation, common though it may be to all religions, can serve as the desired basis of agreement; for Science cannot recognize beliefs like these: they lie beyond its sphere. Not only, as we have inferred, is the essential truth contained in Religion that most abstract element pervading all its forms, but, as we here see, this most abstract element is the only one in which Religion is likely to agree with Science.
Similarly if we begin at the other end, and inquire what scientific truth can unite Science with Religion. Religion can take no cognizance of special scientific doctrines; any more than Science can take cognizance of special religious doctrines. The truth which Science asserts and Religion indorses cannot be one furnished by mathematics; nor can it be a physical truth; nor can it be a truth in chemistry.
No generalization of the phenomena of space, of time, of matter, or of force, can become a Religious conception. Such a conception, if it anywhere exists in Science, must be more general than any of these — must be one underlying all of them. Assuming, then, that since these two great realities are constituents of the same mind, and respond to different aspects of the same Universe, there must be a fundamental harmony between them, we see good reason to conclude that the most abstract truth contained in Religion and the most abstract truth contained in Science must be the one in which the two coalesce.
The largest fact to be found within our mental range must be the one of which we are in search. Uniting these positive and negative poles of human thought, it must be the ultimate fact in our intelligence. Before proceeding let me bespeak a little patience. The next three chapters, setting out from different points and converging to the same conclusion, will be unattractive.
Students of philosophy will find in them much that is familiar and to most of those who are unacquainted with modern metaphysics, their reasonings may prove difficult to follow. Our argument, however, cannot dispense with these chapters, and the greatness of the question at issue justifies even a heavier tax on the reader's attention. Though it affects us little in a direct way, the view we arrive at must indirectly affect us all in our relations — must determine Our conceptions of the Universe, of Life, of Human Nature — must influence our ideas of right and wrong, and therefore modify our conduct.
To reach that point of view from which the seeming discordance of Religion and Science disappears, and the two merge into one, must surely be worth an effort. Here ending preliminaries let us now address ourselves to this all-important inquiry. Chapter 2. Ultimate Religious Ideas. When, on the sea-shore, we note how the hulls of distant vessels are hidden below the horizon, and how, of still remoter vessels, only the uppermost sails are visible, we may conceive with tolerable clearness the slight curvature of that portion of the sea's surface which lies before us.
But when we try to follow out in imagination this curved surface as it actually exists, slowly bending round until all its meridians meet in a point eight thousand miles below our feet, we find ourselves utterly baffled. We cannot conceive in its real form and magnitude even that small segment of our globe which extends a hundred miles on every side of us, much less the globe as a whole. The piece of rock on which we stand can be mentally represented with something like completeness: we are able to think of its top, its sides, and its under surface at the same time, or so nearly at the same time that they seem present in consciousness together; and so we can form what we call a conception of the rock.
But to do the like with the Earth is impossible. If even to imagine the antipodes as at that distant place in space which it actually occupies, is beyond our power much more beyond our power must it be at the same time to imagine all other remote points on the Earth's surface as in their actual places. Yet we commonly speak as though we had an idea of the Earth — as though we could think of it in the same way that we think of minor objects.
What conception, then, do we form of it? That its name calls up in us some state of consciousness is unquestionable; and if this state of consciousness is not a conception, properly so called, what is it? The answer seems to be this: — We have learnt by indirect methods that the Earth is a sphere; we have formed models approximately representing its shape and the distribution of its parts; usually when the Earth is referred to, we either think of an indefinitely extended mass beneath our feet, or else, leaving out the actual Earth, we think of a body like a terrestrial globe; but when we seek to imagine the Earth as it really is, we join these two ideas as well as we can — such perception as our eyes give us of the Earth's surface we couple with the conception of a sphere.
And thus we form of the Earth not a conception properly so called, but only a symbolic conception. A large proportion of our conceptions, including all those of much generality, are of this order. Great magnitudes, great durations, great numbers, are none of them actually conceived, but are all of them conceived more or less symbolically; and so, too, are all those classes of objects of which we predicate some common fact.
When mention is made of any individual man, a tolerably complete idea of him is formed.
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If the family he belongs to be spoken of, probably but a part of it will be represented in thought: under the necessity of attending to that which is said about the family, we realize in imagination only its most important or familiar members, and pass over the rest with a nascent consciousness which we know could, if requisite, be made complete.
Should something be remarked of the class, say farmers, to which this family belongs, we neither enumerate in thought all the individuals contained in the class, nor believe that we could do so if required; but we are content with taking some few samples of it, and remembering that these could be indefinitely multiplied. Supposing the subject of which something is predicated be Englishmen, the answering state of consciousness is a still more inadequate representative.
Yet more remote is the likeness of the thought to the thing, if reference be made to Europeans or to human beings. And when we come to propositions concerning the mammalia, or conceding the whole of the vertebrata, or concerning all organic beings, the unlikenesses of our conceptions to the realities become extreme. Throughout which series of instances we see that as the number of objects grouped together in thought increases, the concept, formed of a few typical samples joined with the notion of multiplicity, becomes more and more a mere symbol; not only because it gradually ceases to represent the size of the group, but also because, as the group grows more heterogeneous, the typical samples thought of are less like the average objects which the group contains.
This formation of symbolic conceptions, which inevitably arises as we pass from small and concrete objects to large and to discrete ones, is mostly a useful, and indeed necessary, process. When, instead of things whose attributes can be tolerably well united in a single state of consciousness, we have to deal with things whose attributes are too vast or numerous to be so united, we must either drop in thought part of their attributes, or else not think of them at all — either form a more or less symbolic conception, or no conception.
We must predicate nothing of objects too great or too multitudinous to be mentally represented, or we must make our predications by the help of extremely inadequate representations of them. But while by doing this we are enabled to form general propositions, and so to reach general conclusions, we are perpetually led into danger, and very often into error.
We mistake our symbolic conceptions for real ones; and so are betrayed into countless false inferences. Not only is it that in proportion as the concept we form of any thing, or class of things, misrepresents the reality, we are apt to be wrong in any assertion we make respecting the reality; but it is that we are led to suppose we have truly conceived many things which we have conceived only in this fictitious way; and then to confound with these some things which cannot be conceived in any way. How we fall into this error almost unavoidably it will be needful here to observe. From objects fully representable, to those of which we cannot form even approximate representations, there is an insensible transition.
Between a pebble and the entire Earth a series of magnitudes might be introduced, severally differing from adjacent ones so slightly that it would be impossible to say at what point in the series our conceptions of them became inadequate. Similarly, there is a gradual progression from those groups of a few individuals which we can think of as groups with tolerable completeness, to those larger and larger groups of which we can form nothing like true ideas. Thus we pass from actual conceptions to symbolic ones by infinitesimal steps.
Note next that we are led to deal with our symbolic conceptions as though they were actual ones, not only because we cannot clearly separate the two, but also because, in most cases, the first serve our purposes nearly or quite as well as the last — are simply the abbreviated signs we substitute for those more elaborate signs which are our equivalents for real objects. Those imperfect representations of ordinary things which we make in thinking, we know can be developed into adequate ones if needful.
Those concepts of larger magnitudes and more extensive classes which we cannot make adequate, we still find can be verified by some indirect process of measurement or enumeration. And even in the case of such an utterly inconceivable object as the Solar System, we yet, through the fulfilment of predictions founded on our symbolic conception of it, gain the conviction that this stands for an actual existence, and, in a sense, truly expresses certain of its constituent relations. So that having learnt by long experience that our symbolic conceptions can, if needful, be verified, we are led to accept them without verification.
Thus we open the door to some which profess to stand for known things, but which really stand for things that cannot be known in any way. The implication is clear. When our symbolic conceptions are such that no cumulative or indirect processes of thought can enable us to ascertain that there are corresponding actualities, nor any fulfilled predictions be assigned in justification of them, then they are altogether vicious and illusive, and in no way distinguishable from pure fictions.
And now to consider the bearings of this general truth on our immediate topic — Ultimate Religious Ideas. To the primitive man sometimes happen things which are out of the ordinary course-diseases, storms, earth-quakes, echoes, eclipses. From dreams arises the idea of a wandering double; whence follows the belief that the double, departing permanently at death, is then a ghost.
Ghosts thus become assignable causes for strange occurrences. The greater ghosts are presently supposed to have extended spheres of action. As men grow intelligent the conceptions of these minor invisible agencies merge into the conception of a universal invisible agency; and there result hypotheses concerning the origin, not of special incidents only, but of things in general.
A critical examination, however will prove not only that no current hypothesis is tenable, but also that no tenable hypothesis can be framed. Respecting the origin of the Universe three verbally intelligible suppositions may be made. We may assert that it is self-existent; or that it is self-created; or that it is created by an external agency. Which of these suppositions is most credible it is not needful here to inquire.
The deeper question, into which this finally merges, is, whether any one of them is even conceivable in the true sense of the word. Let us successively test them. When we speak of a man as self-supporting, of an apparatus as self-acting, or of a tree as self-developed, our expressions, however inexact, stand for things that can be figured in thought with tolerable completeness. Our conception of the self-development of a tree is doubtless symbolic. But though we cannot really represent in consciousness the.
That is, we know that our symbolic conception of self-development can be expanded into something like a real conception; and that it expresses, however rudely, an actual process. But when we speak of self-existence and, helped by the above analogies, form some vague symbolic conception of it, we delude ourselves in supposing that this symbolic conception is of the same order as the others.
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On joining the word self to the word existence, the force of association makes us believe we have a thought like that suggested by the compound word self-acting. An endeavour to expand this symbolic conception, however, will undeceive us. In the first place, it is clear that by self-existence we especially mean an existence independent of any other — not produced by any other: the assertion of self-existence is an indirect denial of creation.
In thus excluding the idea of any antecedent cause, we necessarily exclude the idea of a beginning. Self-existence, therefore, necessarily means existence without a beginning; and to form a conception of self-existence is to form a conception of existence without a beginning. Now by no mental effort can we do this. To conceive existence through infinite past-time, implies the conception of infinite past-time, which is an impossibility. To this let us add that even were self-existence conceivable, it would not be an explanation of the Universe.
No one will say that the existence of an object at the present moment is made easier to understand by the discovery that it existed an hour ago, or a day ago, or a year ago; and if its existence now is not made more comprehensible by knowledge of its existence during some previous finite period, then no knowledge of it during many such finite periods, even could we extend them to an infinite period, would make it more comprehensible.
Thus the Atheistic theory is not only absolutely unthinkable, but, even were it thinkable, would not be a solution. The assertion that the Universe is self-existent does not really carry us a step beyond the cognition of its present existence; and so leaves us with a mere re-statement of the mystery. The hypothesis of self-creation, which practically amounts to what is called Pantheism, is similarly incapable of being represented in thought. Certain phenomena, such as the precipitation of invisible vapour into cloud, aid us in forming a symbolic conception of a self-evolved Universe; and there are not wanting indications in the Heavens, and on the Earth, which help us in giving to this conception some distinctness.
But while the succession of phases through which the visible Universe has passed in reaching its present form, may perhaps be comprehended as in a sense self-determined; yet the impossibility of expanding our symbolic conception of self-creation into a real conception, remains as complete as ever. Really to conceive self-creation, is to conceive potential existence passing into actual existence by some inherent necessity, which we cannot. We cannot form any idea of a potential existence of the Universe, as distinguished from its actual existence.
If represented in thought at all, potential existence must be represented as something, that is, as an actual existence: to suppose that it can be represented as nothing involves two absurdities — that nothing is more than a negation, and can be positively represented in thought, and that one nothing is distinguished from all other nothings by its power to develop into something. Nor is this all. We have no state of consciousness answering to the words an inherent necessity by which potential existence became actual existence.
To render them into thought, existence, having for an indefinite period remained in one form, must be conceived as passing without any external impulse into another form; and this involves the idea of a change without a cause — a thing of which no idea is possible. Thus the terms of this hypothesis do not stand for real thoughts, but merely suggest the vaguest symbols not admitting of any interpretation. Moreover, even were potential existence conceivable as a different thing from actual existence, and could the transition from the one to the other be mentally realized as self-determined, we should still be no forwarder: the problem would simply be removed a step back.
For whence the potential existence? This would just as much require accounting for as actual existence, and just the same difficulties would meet us.
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The self-existence of a potential Universe is no more conceivable than the self-existence of the actual Universe. The self-creation of a potential Universe would involve over again the difficulties just stated — would imply behind this potential universe a more remote potentiality, and so on in an infinite series, leaving us at last no forwarder than at first. While to assign an externa1 agency as its origin, would be to introduce the notion of a potential Universe for no purpose whatever. There remains the commonly — received or theistic hypothesis — creation by external agency.
Alike in the rudest creeds and in the cosmogony long current among ourselves, it is assumed that the Heavens and the Earth were made somewhat after the manner in which a workman makes a piece of furniture. And this is the assumption not only of theologians but of most philosophers. Equally in the writings of Plato and in those of not a few living men of science, we find it assumed that there is an analogy between the process of creation and the process of manufacture. Now not only is this conception one which cannot by any cumulative process of thought, or the fulfilment of predictions based on it, be shown to answer to anything actual; but it cannot be mentally realized, even when all its assumptions are granted.
Though the proceedings of a human artificer may vaguely symbolize a method after which the Universe might be shaped, yet imagination of this method does not help us to solve the ultimate problem; namely, the origin of the materials of which the Universe consists. The artizan does not make the iron, wood, or stone, he uses, but merely fashions and combines them.
If we suppose suns, and planets, and satellites, and all they contain to have been similarly formed by a "Great Artificer," we suppose merely that certain pre-existing elements were thus put into their present arrangement. But whence the pre-existing elements? The production of matter out of nothing is the real mystery which neither this simile nor any other enables us to conceive; and a simile which does not enable us to conceive this may as well be dispensed with.
Still more manifest becomes the insufficiency of this theory of things, when we turn from material objects to that which contains them — when instead of matter we contemplate space. Did there exist nothing but an immeasurable void, explanation would be needed as much as it is now. There would still arise the question — how came it so? If the theory of creation by external agency were an adequate one, it would supply an answer; and its answer would be — space was made in the same manner that matter was made. But the impossibility of conceiving this is so manifest that no one dares to assert it.
For if space was created it must have been previously non-existent. The non-existence of space cannot, however, by any mental effort be imagined. And if the non-existence of space is absolutely inconceivable, then, necessarily, its creation is absolutely inconceivable. Lastly, even supposing that the genesis of the Universe could really be represented in thought as due to an external agency, the mystery would be as great as ever; for there would still arise the question — how came there to be an external agency?
To account for this only the same three hypotheses are possible — self-existence, self-creation, and creation by external agency. Of these the last is useless: it commits us to an infinite series of such agencies, and even then leaves us where we were. By the second we are led into the same predicament; since, as already shown, self-creation implies an infinite series of potential existences.
We are obliged, therefore, to fall back on the first, which is the one commonly accepted and commonly supposed to be satisfactory. Those who cannot conceive a self-existent Universe, and therefore assume a creator as the source of the Universe, take for granted that they can conceive a self-existent Creator. The mystery which they recognize in this great fact surrounding them on every side, they transfer to an alleged source of this great fact, and then suppose that they have solved the mystery.
But they delude themselves. As was proved at the outset of the argument, self-existence is inconceivable; and this holds true whatever be the nature of the object of which it is predicated. Whoever agrees that the atheistic hypothesis is untenable because it involves the impossible idea of self-existence, must perforce admit that the theistic hypothesis is untenable if it contains the same impossible idea. Thus these three different suppositions, verbally intelligible though they are, and severally seeming to their respective adherents quite rational, turn out, when critically examined, to be literally unthinkable.
It is not a question of probability, or credibility, but of conceivability. Experiment proves that the elements of these hypotheses cannot even be put together in consciousness; and we can entertain them only as we entertain such pseud-ideas as a square fluid and a moral substance — only by abstaining from the endeavour to render them into actual thoughts.
Or, reverting to our original mode of statement, we may say that they severally involve symbolic conceptions of the illegitimate and illusive kind. Differing so widely as they seem to do, the atheistic, the pantheistic, and the theistic hypotheses contain the same ultimate element. It is impossible to avoid making the assumption of self-existence somewhere; and whether that assumption be made nakedly or under complicated disguises, it is equally vicious, equally unthinkable.
Be it a fragment of matter, or some fancied potential form of matter, or some more remote and still less imaginable mode of being, our conception of its self-existence can be framed only by joining with it the notion of unlimited duration through past time.
And as unlimited duration is inconceivable, all those formal ideas into which it enters are inconceivable; and indeed, if such an expression is allowable, are the more inconceivable in proportion as the other elements of the ideas are indefinite. So that in fact, impossible as it is to think of the actual Universe as self-existing, we do but multiply impossibilities of thought by every attempt we make to explain its existence. If from the origin of the Universe we turn to its nature, the like insurmountable difficulties rise up before us on all sides — or rather, the same difficulties under new aspects.
We find ourselves obliged to make certain assumptions; and yet we find these assumptions cannot be represented in thought. When we inquire what is the meaning of the effects produced on our senses — when we ask how there come to be in our consciousness impressions of sounds, of colours, of tastes, and of those various attributes we ascribe to bodies, we are compelled to regard them as the effects of some cause.
We may stop short in the belief that this cause is what we call matter. Or we may conclude, as some do, that matter is only a certain mode of manifestation of spirit, which is therefore the true cause. Or, regarding matter and spirit as proximate agencies, we may ascribe the changes wrought in our consciousness to immediate divine power. But be the cause we assign what it may, we are obliged to suppose some cause.
And we are obliged not only to suppose some cause, but also a first cause. The matter, or spirit or other agent producing these impressions on us, must either be the first cause of them or not. If it is the first cause the conclusion is reached. If it is not the first cause, then by implication there must be a cause behind it, which thus becomes the real cause of the effect.
Manifestly however complicated the assumptions, the same conclusion must be reached. We cannot ask how the changes in our consciousness are caused, without inevitably committing ourselves to the hypothesis of a First Cause. But now if we ask what is the nature of this First Cause, we are driven by an inexorable logic to certain further conclusions.
Is the First Cause finite or infinite? If we say finite we involve ourselves in a dilemma. To think of the First Cause as finite, is to think of it as limited.
To think of it as limited implies a consciousness of something beyond its limits: it is impossible to conceive a thing as bounded without assuming a region surrounding its boundaries. What now must we say of this region? If the First Cause is limited, and there consequently lies something outside of it, this something must have no First Cause — must be uncaused. But if we admit that there can be something uncaused, there is no reason to assume a cause for anything.
If beyond that finite region over which the First Cause extends, there lies a region, which we are compelled to regard as infinite, over which it does not extend — if we admit that there is an infinite uncaused surrounding the finite caused; we tacitly abandon the hypothesis of causation altogether.
Thus it is impossible to consider the First Cause as finite. But if it cannot be finite it must be infinite. Another inference conceding the First Cause is equally necessary. It must be independent. If it is dependent it cannot be the First Cause; for that must be the First Cause on which it depends. It is not enough to say that it is partially independent; since this implies some necessity which determines its partial dependence, and this necessity, be it what it may, must be a higher cause, or the true First Cause, which is a contradiction.
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Book Description : Fully rewritten and updated, Spencer's Pathology of the Lung, 6th edition follows in its predecessors' footsteps as the gold-standard textbook of pulmonary diseases. Buy New View Book. Customers who bought this item also bought. Stock Image. New Quantity Available: Seller Rating:. Flieder MD. Published by Cambridge University Press