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Historical Theories of Disease Causation: Demonic, Miasmatic, and Humoral, Study notes of Health sciences

Historical theories concerning the causation of disease, focusing on the demonic, miasmatic, and humoral theories. From the belief in disease being caused by evil spirits to the miasmatic theory of vapors or miasms coming from the ground, this text provides insight into the evolution of disease theories throughout history. The document also touches upon the role of religion in disease treatment and the emergence of more scientific approaches.

What you will learn

  • What were the early beliefs about the causation of disease?
  • What role did religion play in the treatment of disease throughout history?
  • How did the miasmatic theory of disease develop?

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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
pf3
pf4
pf5

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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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