Preventable Diseases

by Woods Hutchinson

When a fever has run its course, as we now know nearly all infections do, within periods ranging from three or four days to as many weeks, it simply means that it has taken the liver and the other police-cells this length of time to handle the rioters and turn them into peaceable and law-abiding, even though not well-disposed citizens. In this process the forces of law and order can be materially helped by skillful and intelligent coöperation. But it takes brains to do it and avoid doing more harm than good. It requires far more intelligence on the part of the doctor, the nurse, or the mother, skillfully to help nature than it did blindly to fight her.

This is what doctors and nurses are trained for nowadays, and they are of use in the sick-room simply because they have devoted more time and money to the study of these complicated processes than you have. Don't imagine that calling in the doctor is going to interfere with the natural course of the disease, or rob the patient of some chance he might have had of recovering by himself. On the contrary, it will simply give nature and the constitution of the patient a better chance in the struggle, probably shorten it, and certainly make it less painful and distressing.

If these symptoms of the summer fevers and fluxes are indicative of nature's attempts to cure, those of the winter's coughs and colds are no less clearly so. As we walk down the streets, we see staring at us in large letters from a billboard, "Stop that Cough! It is Killing you!" Yet few things could be more obvious to even the feeblest intelligence, than that this "killing" cough is simply an attempt on the part of the body to expel and get rid of irritating materials in the upper air-passages. As long as your larynx and windpipe are inflamed or tickled by disease-germs or other poisons, your body will do its best to get rid of them by coughing, or, if they swarm on the mucous membrane of the nose, by sneezing. To attempt to stop either coughing or sneezing without removing the cause is as irrational as putting out a switch-light without closing the switch. Though this, like other remedial processes, may go to extremes and interfere with sleep, or upset the stomach, within reasonable limits one of the best things to do when you have a cold is to cough. When patients with severe inflammations of the lungs become too weak or too deeply narcotized to cough, then attacks of suffocation from the accumulation of mucus in the air-tubes are likely to occur at any time. Young children who cannot cough properly, not having got the mechanism properly organized as yet, have much greater difficulty in keeping their bronchial tubes clear in bronchitis or pneumonia than have grown-ups. Most colds are infectious, like the fevers, and like them run their course, after which the cough will subside along with the rest of the symptoms. But simply stopping the cough won't hasten the recovery. Most popular "Cough-Cures" benumb the upper throat and stop the tickling; smother the symptoms without touching the cause. Many contain opium and thus load the system with two poisons instead of one.

Lastly, in the realm of the nervous system, take that commonest of all ills that afflict humanity—headache. Surely, this is not a curative symptom or a blessing in disguise, or, if so, it is exceedingly well disguised. And yet it unquestionably has a preventive purpose and meaning. Pain, wherever found, is nature's abrupt command, "Halt!" her imperative order to stop. When you have obeyed that command, you have taken the most important single step towards the cure. A headache always means something—overwork, under-ventilation, eye-strain, underfeeding, infection. Some error is being committed, some bad physical habit is being dropped into. There are a dozen different remedies that will stop the pain, from opium and chloroform down to the coal-tar remedies (phenacetin, acetanilid, etc.) and the bromides. But not one of them "cures," in the sense of doing anything toward removing the cause. In fact, on the contrary they make the situation worse by enabling the sufferer to keep right on repeating the bad habit, deprived of nature's warning of the harm that he is doing to himself. As the penalties of this continued law-breaking pile up, he requires larger and larger doses of the deadening drug, until finally he collapses, poisoned either by his own fatigue-products or by the drugs which he has been taking to deaden him against their effect.

In fine, follow nature's hints whenever she gives them: treat pain by rest, infections by fresh air and cleanliness, the digestive disturbances by avoiding their cause and helping the food-tube to flush itself clean; keep the skin clean, the muscles hard, and the stomach well filled—and you will avoid nine-tenths of the evils which threaten the race.

The essence of disease consists, not in either the kind or the degree of the process concerned, but only in its relations to the general balance of activities of the organism, to its "resulting in discomfort, inefficiency, or danger," as one of our best-known definitions has it. Disease, then, is not absolute, but purely relative; there is no single tissue-change, no group even of changes or of symptoms, of which we can say, "This is essentially morbid, this is everywhere and at all times disease."

Our attainment of any clear view of the essential nature of disease was for a long time hindered, and is even still to some degree clogged, by the standpoint from which we necessarily approached and still approach it, not for the study of the disease itself, but for the relief of its urgent symptoms. Disease presents itself as an enemy to attack, in the concrete form of a patient to be cured; and our best efforts were for centuries almost wasted in blind, and often irrational, attempts to remove symptoms in the shortest possible time, with the most powerful remedies at our disposal, often without any adequate knowledge whatever of the nature of the underlying condition whose symptoms we were combating, or any suspicion that these might be nature's means of relief, or that "haply we should be found to fight against God." There was sadly too much truth in Voltaire's bitter sneer, "Doctors pour drugs of which they know little, into bodies of which they know less"; and I fear the sting has not entirely gone out of it even in this day of grace.

And yet, relative and non-essential as all our definitions now recognize disease to be, it is far enough (God knows) from being a mere negative abstraction, a colorless "error by defect." It has a ghastly individuality and deadly concreteness,—nay, even a vindictive aggressiveness, which have both fascinated and terrorized the imagination of the race in all ages. From the days of "the angel of the pestilence" to the coming of the famine and the fever as unbidden guests into the tent of Minnehaha; from "the pestilence that walketh in darkness" to the plague that still "stalks abroad" in even the prosaic columns of our daily press, there has been an irresistible impression, not merely of the positiveness, but even of the personality of disease. And no clear appreciation can possibly be had of our modern and rational conceptions of disease without at least a statement of the earlier conceptions growing out of this personifying tendency. Absurd as it may seem now, it was the legitimate ancestor of modern pathogeny, and still holds well-nigh undisputed sway over the popular mind, and much more than could be desired over that of the profession.

The earliest conception of disease of which we have any record is, of course, the familiar Demon Theory. This is simply a mental magnification of the painfully personal, and even vindictive, impression produced upon the mind of the savage by the ravages of disease. And certainly we of the profession would be the last to blame him for jumping to such a conclusion. Who that has seen a fellow being quivering and chattering in the chill-stage of a pernicious malarial seizure, or tossing and raving in the delirium of fever, or threatening to rupture his muscles and burst his eyes from their sockets in the convulsions of tetanus or uræmia, can wonder for a moment that the impression instinctively arose in the untutored mind of the Ojibwa that the sufferer was actually in the grasp, and trying to escape from the clutch, of some malicious but invisible power? And from this conception the treatment logically followed. The spirits which possessed the patient, although invisible, were supposed to be of like passions with ourselves, and to be affected by very similar influences; hence dances, terrific noises, beatings and shakings of the unfortunate victim, and the administration of bitter and nauseous messes, with the hope of disgusting the demon with his quarters, were the chief remedies resorted to. And while to-day such conceptions and their resultant methods are simply grounds for laughter, and we should probably resent the very suggestion that there was any connection whatever between the Demon Theory and our present practice, yet, unfortunately for our pride, the latter is not only the direct lineal, historic descendant of the former, but bears still abundant traces of its lowly origin. It will, of course, be admitted at once that the ancestors of our profession, historically, the earliest physicians, were the priest, the Shaman, and the conjurer, who even to this day in certain tribes bear the suggestive name of "medicine men." Indeed, this grotesque individual was neither priest nor physician, but the common ancestor of both, and of the scientist as well. And, even if the history of this actual ancestry were unknown, there are scores of curious survivals in the medical practice of this century, even of to-day, which testify to the powerful influence of this conception. The extraordinary and disgraceful prevalence of bleeding scarcely fifty years ago, for instance; the murderous doses of calomel and other violent purges; the indiscriminate use of powerful emetics like tartar emetic and ipecac; the universal practice of starving or "reducing" fevers by a diet of slops, were all obvious survivals of the expulsion-of-the-demon theory of treatment. Their chief virtue lay in their violence and repulsiveness. Even to-day the tendency to regard mere bitterness or distastefulness as a medicinal property in itself has not entirely died out. This is the chief claim of quassia, gentian, calumbo, and the "simple bitters" generally, to a place in our official lists of remedies. Even the great mineral-water fad, which continues to flourish so vigorously, owed its origin to the superstition that springs which bubbled or seethed were inhabited by spirits (of which the "troubling of the waters" in the Pool of Bethesda is a familiar illustration). The bubble and (in both senses) "infernal" taste gave them their reputation, the abundant use of pure spring water both internally and externally works the cure, assisted by the mountain air of the "Bad," and we sapiently ascribe the credit to the salts. Nine-tenths of our cells are still submarine organisms, and water is our greatest panacea.

Then came the great "humoral" or "vital fluid" theory of disease which ruled during the Middle Ages. According to this, all disease was due to the undue predominance in the body of one of the four great vital fluids,—the bile, the blood, the nervous "fluid," and the lymph,—and must be treated by administering the remedy which will get rid of or counteract the excess of the particular vital fluid in the system. The principal traces of this belief are the superstition of the four "temperaments," the bilious, the sanguine, the nervous, and the lymphatic, and our pet term "biliousness," so useful in explaining any obscure condition.