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THEORIES CONCERNING THE CAUSATION OF DISEASE
L. W. FEEZER,
Assistanit Director, Divisiont (^) of Veneral Diseases, Minnesota State Board of Health
Minneapolis, Minnii.
[The following article was (^) prepared some years ago by the (^) author with the aid and (^) assistance of Professor Selskar M. Gunn. (^) It was intended to be one of a* series of essays to be successive chap- ters in (^) a volume for laymen treating in a general way of the problems of public health. (^) This project, disturbed by the
war, is not now likely to be completed,
but since the presentation here is novel
and represents considerable literary
work, and is furthermore instructive, it
has been taken by the JOURNAL for pub-
lication. ] THE DENIONIC THEORY
Man's common belief as to the causa-
tion of those "thousand ills which human
flesh is heir to, has always been fairly
compatible (^) with the (^) general state of human knowledge. It (^) has always been pretty well related (^) to the state of civiliza- tion and (^) learning of the race or country. The (^) savage of (^) today and the races of
antiquity are^ at one in their reliance on
what is often spoken of as the demonic
theory.
According to this theory, disease wvas
produced by demons, one or more evil
spirits had fixed their abode in the vic-
tim's body. The sick man was possessed
of a devil. It was therefore logical to
attempt to cure him by a system of in-
cantation and sorcery, something calcu- lated (^) either to drive or coax the demon out. (^) Disease was conceived of, not so much as a condition of the (^) body itself, as an entity apart from man which dwelt with, or even replaced, the soul within its
ordained temple. Savage or primitive
imagination picturedI a great world of
things unseen and supernattiral and fron
this world the fathers of (^) the race drew
the characters who were assigned to plav
the villains' parts in the (^) great struggles
of the mortal body with its invading
maladies. The association of religion
with primitive medicine was very close.
The priest or man of religion was usually
the medicine man or doctor whose good
offices were required for (^) exorcising the
evil spirits of disease.
Much has been written of the history
of primitive belief in the demonic source
of disease and of the (^) superstitions con-
nected with its cure. These supersti-
tions and the (^) practices they direct were often very fantastic and interesting. Un- happily some of them still (^) survive in many of the most highly civilized coun- tries. In our own country a great nmany of these beliefs are still practicedl (^) among the laity, especially among the illiterate
of the mlore remote country places.
Magnetic rings are still worn for the cure of rheumatism. Dried potatoes and horse-chestnuts are still wearing holes in miany a trotusers pocket, parents are still making their children the object of (^) their little friends' ridicule by compelling (^) them to wear bags of assafoetida (^) to keep off communicable disease. (^) Breaking a mir- ror, beginning a journey on Friday (^) and a host of other (^) ridiculous, inconse- quential notions about ill luck are still unexploded (^) in the minds of a great many people. Successful men of business and refined modern (^) women, well informed about most things, continue to believe charlatans anid (^) quacks simply because they are not iniformed (^) as well upon the subject of their own bodies, (^) how they function and what will interfere (^) with those functions, as they are about the workings of an automobile or even the principles of (^) international law. TIIE PUNITIVE (^) THEORY The association of religion with the cure and treatment of sickness probably had much to do with the evolution of what we may call the punitive theory of 908
CAUSATION OF DISEAD?.
disease; the belief that one's attitude to- ward the deity was responsible as a cause of sickness. From a period centuries prior to the Christian era down to the present time, there have been good peo- ple who have believed disease was a pun- ishment meted out by an outraged God for the sins of the individual or the race. The old Testament bears evidence of the currency of this notion among the Hebrews of Bible time. We are told that Jehovah is a jealous God, we find him (^) recorded as rewvarding his chosen people in divers ways and as sternly punishing them in his displeasure. In II Chronicles, Chapter XXI, there is re- lated the story of a terrible plague in which the whole nation suffered for a sin of David and which was stayed only hy David's repentance and the making of a sacrifice. Following out this theory an (^) afflicted individual or a plagued people instead of cajoling evil spirits, sought to be healed by propitiating the deity. Piety, repent- ance of sin, prayer and sacrifice were esteemed to be of great value. As we have seen, David built an altar and made sacrifices. Jehovah saw that he had turned from evil, the divine wrath was appeased and the plague was stayed. In accepting this record of Hebrew life and (^) religion literally, the (^) early Chris- tian Church quite logically found^ a^ place for the punitive theory of disease. Spe- cial prayers and services, special rituals and even special saints, who should^ inter- cede for the victims of disease, came^ into being. The heated religious contro- versies of the Dark Ages are^ full^ of references to this subject. The best means of petitioning relief from disease wvas regarded as a^ religious question. The terrible outbreaks of^ bubonic^ plague which (^) ravaged Europe in the late medie- val and (^) early modern (^) period gave the church an occasion for (^) directing its energies to^ this^ matter.
THE MIASMATIC THEORY After long years we^ begin to^ emerge from the "thousand (^) years without a
bath," which made up the brilliant Age of Chivalry, and begin to hear more about the miasmatic theory of disease. That curious notion of vapors or miasms coming up out of the ground and striking down the people with disease was not really born at the time above (^) mentioned. It had been suggested long before (^) by the Greeks and the Romans. After being buried for centuries under the stupendu- ous weight of middle-age superstition and ignorance, this old idea began to re- vive. The people, who believed in this, said that the air arising from certain kinds of ground, especially low, swampy areas, was a cause of disease. Certain places were thus given a very evil repu- tation, because the ground was said to exude some invisible, insensible vapor, some (^) miasm, which produced disease. Such places were spoken of as unhealthy spots. Nbt only was the air of swamps misasmatic but so also was night air. The clever fellows who invented miasms have been the unwitting cause of much trouble on the part of modern physicians, who cannot get out of their patients' heads the persistent old superstition that, if they breathe the night air, all sorts of trouble will result. The fact that malaria was (^) prevalent in the (^) vicinity of (^) swampy land, and^ some^ evidence that^ people who ventured out in these swampy places were more (^) likely to (^) get the (^) disease, lent plausibility to this^ theory and it^ has^ been an almost (^) hopeless task to (^) dislodge it from the minds of a great many people. It (^) was the belief in the air as the causa- tive agent that^ gave malaria^ its^ name, the Italian for^ "bad^ air."^ Somewhere^ in^ the inexhaustible fund of (^) interesting in- formation which he drew (^) upon so (^) freely to (^) supplement his vivid (^) imagination, Shakespeare found^ this^ miasmatic^ con- ception of disease, for, in his Julius Caesar he makes Portia say to Brutus, who has been walking in^ the garden in the small hours of the night, "Is Brutus sick? and is it (^) physical To walk (^) unbraced, and suck the hu- mours
909
CAUSATION
operandi" and habits of his own bodily organs, but they were valuable as the opening wedge for the recognition of natural as opposed to supernatural causes.
GALEN AND THE FOUR HUMOURS The theoretical structure begun bv Hippocrates, or at least based upon his observations, was elaborated and de- scribed by Galen (331-201 B. C.) and is known as the theory of the four humours. It was conceived that there are in the normal body four humours in a definite amount and proportion. Any excess of any one or any irregularity in their dis- tribution disturbed the fine adjustment of the "going machine" and health was transformed to sickness. These humours ere blood, phlegm, yellow bile and black bile. The idea of the humours is the real reason for the practice of blood-letting. It is hard for us with our present won- derful (though still grossly inadequate and (^) incomplete) knowledge of human physiology and (^) pathology to conceive a more inane method of treating a man already weakened with disease than this indiscriminate practice of blood-letting. SYDENHAAM S TEACHIINGS Sydenham (1644-1689), often- called the English Hippocrates, first gave us the important thought that there are dif- ferent (^) specific things which should be held responsible for different diseases. Sydenham held that disease^ was^ the^ re- sult of the effort made-^ by the^ body to throw off, to^ expel these^ iiateries inorbi, the dead materials within^ it,' which^ had made the trouble.' The important result of Sydenham's studies was^ that^ a^ little close intelligent observation^ tupon the part of the doctor^ is^ worth^ more^ than any amount^ of^ dosing^ administered^ in blind observance of a (^) preconceived no- tion. It was a step (^) away from the four humours and from other later, but^ quite as artificial, theories. In^ short, Syden- ham did much to teach the^ medical^ pro- fession the value^ and^ importance of "studying the case." Sydenham's theory,
OF DISEASE 911
more or less mixed up with the really inconsistent four humours, probably had much to do with the long popular belief in "peccant humours of the blood," the quaint notion which asserts that a rash or eruption must "come out" and the more it comes out the better for the patient. Dr. Woods Hutchinson de- scribes this stage of medical progress in connection with a (^) discussion of certain of the diseases of (^) children in the follow- ing words. "They were regarded not merely by the laity but by grave and reverend physicians of the Dark Ages as a sort of necessary vital crisis peculiar and appropriate to each particular period of life-a sort of sweating out and erupt- ing of 'peccant humours' of the blood, which must be gotten (^) rid of or else' the individual would not thrive. Incredible as it (^) may seem, so far was this idea ex- tended that the great Arabian physician- philosopher, Rhazes, actually included smallpox in this group, as the last of the 'crises of growth' which had to appear and have its way in young manhood or womanhood." Quaint little echoes of
this simple faith still ring in the popular
mind, as, for instance, (^) in the wide-spread notion about the dangerousness of doing anything to check the eruption in measles and cause it to "strike (^) in." Any mother in Israel will tell you, the first time you propose a bath or a wet pack to reduce the temperature in (^) measles, that if (^) you so much as touch water to the skin of that child it will "drive the rash in" and
cause him to die in convulsions. And, of
course, one of the commonest of a phy-
sician's memories is the expression of re-
lief from the mother or aunt in many
of these mild eruptive fevers, where the
skin is well reddened and spotted: "Well
anyway, doctor, it is a splendid thing to
get the rash so well out."^ Until^ very
recently it was no uncommon^ thing to
hear the^ parents say, "There is^ a run^ of
measles, but^ I^ suppose we^ might just as
well have Johnnie go on to school and
get the disease and have done with it. It seems to be the real mild^ sort^ this
THE AMERICAN^ JOURNAL^ OF^ PUBLIC^ HEALTH
time." Of course this view was scien- tifically shattered two or more decades dgo by our recognition of the infectious nature of these diseases, but practically its hold on the public mind^ constitutes one of the most serious and vital ob- stacles in the way of the health-officer when he endeavors to attack and break up an epidemic of measles, whooping- cough, or^ chicken-pox." HAHNEMANN AND HOMOEOPATHY Homeopathy, in^ its^ essentials,^ is founded on the theory of Hahnemann, who urged that disease is due^ to^ some spiritual influence, that it^ consists^ of^ its symptoms taken collectively, that it^ may be treated by the removal of those symp- toms and that this result is to be obtained by introducing into the body of the sick person, in small quantities, such drugs as have been found to produce the identical symptoms in^ a^ well^ person.^ The^ whole fabric of this scheme is highly artificial and it^ was^ put forward^ by^ a^ man^ who was a theorist first and an observer and student of^ the^ human^ body^ and^ its^ ways only incidentally. In^ our^ day, when^ facts count for what^ they^ are^ and^ not^ for^ what we should like^ to^ have^ them, it^ is^ nat- urally unsatisfactory in^ its^ whole^ struc- ture. The school of^ homeopathy, as^ it remains with us today, has^ almost,^ if^ not entirely, shaken off this fanciful^ chain^ of reasoning by which, under^ Hahnemann, it was bound up with the^ empiricism of an earlier and even less^ enlightened pe-
riod and the homeopathic physicians of
today actually make use of^ much^ the^ same methods in^ diagnosis and^ treatment^ of disease as the so-called^ "regular" or^ "old schoor' physicians. The^ true^ physician,
under whatever name or creed he may have entered the communion of the heal- ing art, must in this day deal in fact, not theory. He must be, above all things, broad-minded and well informed; he must be ready to accept and to employ the discoveries of science as soon as their therapeutic value be established upon a firm basis in^ accordance^ with^ the most reliable^ tests^ of^ modern^ experi- mental medicine. EARLY SCIENTISTS There are a few other names which. should not be omitted in^ bringing^ the story within reach^ of^ modern^ science. Among these are Vesalius (1514-1564), who made anatomy a^ science;^ Harvey (1578-1657), mentioned in every school physiology, who discovered the circula- tion of the blood and first announced the function of the arteries, till then believed to be air passages from the fact that they were found empty after^ death;^ and Leeuwenhoek ( 1632-1723), whose in- vention of the microscope opened to scientific investigators the hitherto un- seen world of^ the^ infinitely^ small^ in which develop the^ causes^ of^ many^ of^ the ills that beset us. Kircher and Malpighi should be mentioned, the technicians who gave the first suggestion that the newly found microscope was to be the real dis- coverer of the causes of many of the diseases; and Jenner (1749-1823), fa- mous for the introduction of the first scientific use of a biological prophylactic, inoculation. These men paved the mray, so to speak, for the great modern leaders in bacteriology, Pasteur, Lister^ and Koch.
Are you coming to^ the^ Institute?^ Whether^ you^ are^ or^ not,^ you^ will be interested in^ the account^ of^ it^ and^ schedule^ of^ demonstrations^ published on (^) pages 928-930, this issue.
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