Disease and Its Causes, William Thomas Councilman [best historical fiction books of all time .txt] 📗

by the methods of science, and has resulted in an enormous increase of knowledge. This has been more striking in medical science than elsewhere, and in this of more far-reaching influence. Evolution coincided with another important development. History shows that all great periods of civilization have at their back sources of energy. In the civilizations of the past such sources of energy have come from the enslavement of conquered peoples or from commerce, or more direct forms of robbery, which have enabled a favored class to appropriate for its purposes the results of the work of others. While these sources have not been absent in the development of our civilization, the great source of energy has come from the rapid, and usually wasteful and reckless, utilization of the stored energy of the earth. The almost incredible advance in medical and other forms of scientific knowledge and the utilization of this knowledge is largely due to the greater forces which we have become possessed of.

Disease plays such a large part in the life of man and is so closely related to all of his activities that the changes in this period must have exerted an influence on disease. We have already seen that within the period we have obtained knowledge of the causes of disease and the conditions under which these causes became operative. The mystery which formerly enveloped disease is gone; disease is recognized as due to conditions which for the most part are within the control of man, and like gravity and chemical attraction it follows the operation of definite laws. There has been developed within the period what is known as preventive medicine, which aims rather at prevention than cure, and the resources of prevention are capable of much greater extension.

Have there been new conditions developed within the period, or an increase of existing conditions which can be regarded as disease factors and which counterbalance the results which have come from the knowledge of prevention and cure? There has been an increase of certain factors of immense importance in the extension of disease. These are:

1. The increase in industrialism, involving as this does an increase in factory life. In many ways this is a factor in disease. (a) By favoring the extension of infection, particularly in such diseases as tuberculosis. (b) The life indoors, and frequently with the combination of insufficient air and space, produces a condition of malnutrition and deficient general resistance. (c) The family life is interfered with by the mothers, whose primary duty is the care of home and children, working in factories, and the too frequent conversion of the house into a factory. (d) The influence of factory life is towards a loss of moral stamina rendering more easy of operation the conditions of alcoholism and general immorality. How great has been this increase in industrialism, fostered as it has been by conditions both natural and artificially created by unwise legislation, is shown in the figures from the last census. The number of factory operatives increased forty per cent between 1899 and 1909 and the total population of the country in the period between 1900 and 1910 increased twenty per cent. It is probable that the future will see an extension rather than a diminution of mass labor.

2. The increase in urban life is as conspicuous as the increase in industrialism. In 1880, twenty-nine and five-tenths per cent of the population was urban and seventy and five-tenths per cent was rural; in 1910, forty-six and three-tenths per cent was urban and fifty-three and seven-tenths was rural, the increase being most marked in cities of over five hundred thousand inhabitants. Of the total increase in population between 1900 and 1910, seven-tenths per cent was in the cities and three-tenths per cent in the country. City life in itself is not necessarily unhealthy and there are many advantages associated with it. The conditions which have chiefly fostered it are the immigration of people who are accustomed to community life, the increase in factory life and the increased number of people of wealth who seek the advantages which the city gives them. The city has always been the favored playground for the social game. The unhealthy conditions of city life are due to the crowding, the more uncertain means of livelihood, the greater influence of vice and alcoholism. Prostitution and the sexual diseases are almost the prerogatives of the cities.

3. All means of transportation have increased and communication between peoples has become more extended and more rapid. In the past isolation was one of the safeguards of the people against disease. With the increase and greater rapidity of communication there is a tendency not only to loss of individuality in nations as expressed in dress, customs, traditions and beliefs, but many diseases are no longer so strictly local as formerly—pellagra, for example. Only those diseases which are transmitted by insects which have a strictly local habitat remain endemic, although the region of endemic prevalence may become greatly extended, as is seen in the distribution of sleeping sickness. Diseases of plants and of animals have become disseminated. Any plants desirable for economic use or for beauty of foliage and flower become generally distributed, their parasites are removed from the regions where harmonious parasitic inter-relations have been established, and in new regions the parasites may not find the former restrictions to their growth. There have been many examples of this, such as the ravages of the brown-tail and gypsy moths which were introduced into New England and of the San Jose scale which was introduced into California. There have been many other examples of the almost incredible power of multiplication of an animal or plant when taken into a new environment, removed from conditions which held it in check, as the introduction of the mongoose into Jamaica, the rabbit into Australia, the thistle into New South Wales and the water-plant chara into England.

It is very difficult to say, but it seems as though there is an increasing unevenness in the distribution of wealth, an increase in the number of persons who live at the expense of the laboring class. Mass labor, effective though it be, makes it easier to divert the proceeds of labor from the laborers. The evidence of this is seen in the increase in number and the prosperity of those pursuits which purvey to luxury, as the automobile industry and the florists' trade and the greatly increased scope and activity of the social game. On the other hand, there is an increase in the number of people who are to a greater or less extent dependent upon extraneous aid, evinced among other ways by the increase in the asylum populations. Both these conditions, wealth and poverty, are important disease factors. Tuberculosis is now a disease of the proletariat chiefly. The measures both of prevention and cure can be and are carried out by the well-to-do, but the disease must remain where there are the conditions of the slums. Of all the conditions favoring infant mortality poverty comes first. In Erfurt, a small city of Germany, of one thousand infants born in each of the different classes, there died of the illegitimate children three hundren and fifty-two; of those of the laboring class, three hundred and five; of those in the medium station (official class largely), one hundred and seventy-three; of those in higher station, eighty-nine. The same relation of infant mortality to poverty becomes apparent when estimated in other ways. In Berlin, with an average infant mortality of one hundred and ninety-six per thousand, the deaths in the best districts of the city were fifty-two and in the poorer quarters four hundred and twenty. The effect of poverty is seen particularly in the bottle-fed infants; with natural nursing the child of poverty has almost as good a chance as the child of wealth. From reasons which are almost self-evident, the mortality in illegitimate infants is almost double that of the legitimate. The greater infant mortality in poverty is due to the more numerous children preventing individual care, the separation of the mother from the nursing child in consequence of the demand made upon her earning capacity, and the decline in breast nursing. Wealth is on the whole more advantageous from the narrow point of view of disease than is poverty, but if we regard its influence on the race its advantages are not so evident. Nothing can be worse for a race than that it should die out, and wealthy families have never reproduced themselves. Conditions always tending to destruction are a necessary part of the environment of poverty; wealth voluntarily creates these conditions, and chiefly by the pernicious influence of its amusements on the young.

A new and in many respects a nobler conception of medicine has been developed. Formerly medical practice was almost exclusively a personal service to the sick individual, and measures looking toward the general relief of disease and its prevention received scanty consideration. The idea of a wider service to the city, to the state, to the nation, to humanity rather than the personal service to the individual, is becoming dominant in medicine. This is seen in the establishment of laboratories by boards of health in cities and states in which knowledge obtained by exact investigations can be made of direct service to the people; in the medical inspection of schools and factories; in promulgating laws directed against conditions which affect health, in the extension of hospitals, and in divers other ways. The idea of public service and of returning to the people in an effective way some of the results of their labor also underlies the large donations which have been given for the creation of special laboratories and institutes in which, through research, greater knowledge of disease may be obtained and made available. The researches which have been made on the nutrition of man and the nutritive value of different foods are of great importance, and this knowledge has not yet begun to be applied as it should be.

There seems to be a balance maintained between the restriction of disease by prevention and the increased influence of social conditions which are in themselves factors of disease. Preventive medicine seems to have made possible, by restricting their harmful influence, the increase in industrialism, in urban life, and in the intercommunications of peoples. The most important aid in the future to the influence of preventive medicine must be the education of the people so that the conditions of disease, the intrinsic and the extrinsic causes and the manner in which these act, shall all become a part of general knowledge, and the sympathy of the people with health legislation and their active assistance in carrying out measures of prevention may be obtained. The effect of social conditions on disease must become more generally recognized.

Glossary

ATROPHY—A condition of imperfect nutrition producing diminution in size and loss of function of parts.

BERTILLON—A French anthropologist who devised a system of measurements of the human body for purposes of identification.

BLOOD-PLASMA—The fluid of the blood.

CELL—The unit of living matter. Living things may be unicellular or composed of a multitude of cells which are interdependent. The general mass of material forming the cell is termed cytoplasm. In this there is a differentiated area termed nucleus which governs the multiplication of cells. In the nucleus is a material termed chromatin which bears the factors of heredity.

CHEMOTROPISM—The influence of chemical substances in directing the movement of organisms.

EXUDATE—The material which passes from the blood into an injured part and causes the swelling.

FIBRIN—The gelatinous material formed in the blood when it clots.

HÆMOGLOBIN—A substance which gives the red color to the blood; by means of its ready combination with the oxygen of the air in the lungs this necessary element is carried to all parts of the body.

INFLAMMATION—Literally a "burning"; the changes which take place in a part after injury.

LYMPH—The fluid which is contained in the lymphatic vessels—nodes. Circumscribed masses of cells connected with the lymphatic vessels.

OSMOSIS—The process of diffusion between fluids