Civilization and health

Front matter

COLUMBIA LIBRARIES OFFSITE

C HEALTH SCIENCES STANDARD

HX64074480 RA431 H97 Civilization and hea

Contents

I. The Diseases of Civilization 3

II. The Dawn of the New Doctor 14

III. The Danger of Patent Medicines

Chapter I

NOTHING is more dangerous than strict logic — which is not quite sure of its premises. Some of the most damnable errors of history have been perfectly sound, logical conclusions from data which everybody knew to be sound and no one even doubted, — but which afterwards turned out to be false. Nothing outside of a book ever goes on to its full logical conclusion. Especially is this true in the realm of disease. To paraphrase Hamlet's famous lines, —

For by strict justice None of us should see salvation.

From the number and deadliness of the maladies that lie in wait for us we have no logical right to expect to survive; and yet we are here in defiance of logic. Of course, this world is a dangerous place and few of us ever get out of it alive; yet the race goes right on living, somehow, undaunted in spite of the new and terrible diseases that medical science keeps discovering.

It is easy enough to construct a prognostic for any disease which will be perfectly logical and absolutely appalling. All you have to do is to show by vital statistics that it is increasing at a certain rate per annum; that this rate is so many times greater than the rate of increase of the race; therefore, within so many years or decades the disease is certain to exterminate us. The latest disease to be submitted to this simple formula for calculating the date of the end of the world — for it does not make the faintest difference to us how long and stupidly the world goes on spinning after we have stopped, the real end of the world is when we end — is that clogging of the body-filters known as Bright's Disease.

The method is simplicity itself, and as convincing as it is simple. There appears to be no escape from its awful conclusion. From unimpeachable vital statistics taken from the records of certain cities and areas in these United States, it is shown that the deaths from Bright's Disease have increased in the past ten years one hundred and thirty-five per cent. As the rate of increase of the community from natural causes during the same time has been only fifteen per cent, it is perfectly obvious that it can only be a matter of five or six decades before we shall all be dead of Bright's Disease.

The only trouble with the method is that it proves too much. In fact the same modern Jeremiah who has constructed such a terrible horoscope for us under the sign of Bright's Disease has illustrated this defect by incautiously taking up another modern disease which he regards as a menace to the future of the race, namely, insanity. Applying the same formula here, he actually has the hardihood and heartless cruelty to announce that, at present rates of increase, every American-born citizen will have become insane by 1966, forgetting, apparently, that at least half of us are to be dead of Bright's Disease before that time.

And when you come to consider the claims as race exterminators of nearly a dozen equally-to-be-dreaded pathologic perils, such as appendicitis, cancer, heart disease, tuberculosis, alcoholism, meat-eating, cigarettes, race suicide, sugar, and syphilis, it is obvious that within half a century there will not be enough human beings left to go round among the diseases and furnish one meal a day to each. So that the process finally lands us in the consoling conclusion that just as surely as the human race becomes extinct so will the diseases, for lack of anything to feed upon; and perhaps the second conclusion may get ahead of the first. Certainly we are at liberty to take our choice between them and believe — as we generally do in matters of logic and conviction — whichever of the two we personally prefer.

We may even find ourselves in the frame of mind of the little boy in John B. Gough's story, who, one Sunday afternoon, was shown a picture of Christian martyrs being thrown to the lions in a Roman arena. After he had gazed at it like one fascinated for some ten or fifteen minutes, his mother asked him if it did not make him feel sorry for the poor Christians.

"Yes," he said, "I'm sorry for the poor Christians, but I 'm a great deal sorrier for that poor little Hon over there in the corner that has n't got any Christian."

Our sympathy may waver between our luckless posterity and the poor diseases that have no further material to feed on.

Every disease, like every dog, has its day; and this appears to be the day of Bright's Disease. The professional prognosticators and other prophets of evil have had their eye upon it for some time, ever since we began to get away from the "Dispensation-of -Providence " view of disease and that picturesque fatalism, so well illustrated by the Turkish pasha, who, when asked by an English consul for a list of the deaths in his province for the last ten years and the causes thereof, replied that there was no such list, for the labor of making it would be great and the foolishness thereof still greater, since these things happened according to the will of Allah which none could attempt to change without impiety.

When we began insisting upon knowing just what we died of and what could be done about it, we began to discover both some very encouraging and some rather alarming facts. The encouraging side of the shield was that nearly all the acute diseases and infections, like typhoid, tuberculosis, pneumonia, smallpox, cholera, et cetera, were considerably, and in most instances rapidly, decreasing. But, on the other hand, came the obverse side, that another, less fatal but still formidable group of diseases seemed to be steadily increasing. Chief among these last are ranked Bright's Disease, insanity and other diseases of the nervous system, heart disease, and cancer.

As this is — we are pleased to believe — a civilized age, and these diseases are increasing in this age, the conclusion was promptly jumped to that these were diseases of civilization and in some peculiar way dependent upon its new conditions. The next natural and indeed inevitable step in this hand-me-down logic was to sally forth among modern conditions and with as little delay as possible pick out and apprehend those which were responsible for these modern diseases.

The manner of fixing responsibility was, unfortunately, in some instances almost as summary as the judicial procedures of frontier times in California, where whenever a crime was committed the authorities exclaimed, "Fiat justitia, ruat c&lumi" and went forth and hanged a Chinaman. Whatever conditions were newest or most unpopular or most prominent at the time were immediately accused of being the causes of the new diseases. This was the method, in fact, of the Jeremiah of 1966, who asserts, with all the confidence in the world, that meat-eating, alcohol, and theater-going are the causes of these maladies.

On the same principle, he might just as well have incriminated postage stamps, paper collars, and suffragettes. For the sole connection between the effect and its alleged cause was that they were both modern !

The reasoning is of the childish naivete of the logic of the savage, to whose mind it is a striking point of resemblance between a cow and a comet that they both have tails. In fact, the whole argument about the so-called "diseases of modern civilization " is riddled with uncertainties, not to say absurdities.

In the first place, we have no valid proof that these diseases are any more common now than they were fifty, a hundred and fifty, or five hundred years ago. Diseases are "new" only in the sense of having been recently discovered, and they are discovered as Columbus discovered America or Watt the power of steam — they had always been there, but we had not had intelligence enough to recognize them !

Strange as it may seem, we have no positive proof of the origin of a single new serious disease since the dawn of recorded history. At least seventy per cent of all our serious diseases were well known to the Greeks and probably to the Egyptians. And the probability is that nearly half the remainder were also in existence then, though Bright's Disease, for instance, was only clearly recognized and traced to its anatomical cause, the kidney, some eighty years ago by Dr. Richard Bright, of Guy's Hospital, London, whose name it now bears. It had certainly existed for centuries, and probably for thousands of years before that. Obviously, any statement as to its being more or less common in the nineteenth century than, say, the fourteenth, can be nothing better than the merest guess.

The second fault in the argument about modern diseases and their menace is, that our systems and methods of vital statistics are so exceedingly new and young. There are no complete public or official records, of more than the mere bald fact of births and deaths, which date back more than fifty years, except for certain very limited areas and groups. The majority of our vital statistics are barely thirty years old, and even less than that in America.

Last and greatest of all comes the uncertainty as to how much of an apparent increase simply means better and prompter recognition of the disease.

Obviously, after a disease has been discovered it is some time before it becomes sufficiently well known to be readily recognized by the rank and file of the medical profession, and still longer before the laity come to believe in it and have any clear idea of its nature. Almost every new disease when it is first discovered is believed to be as rare as it is new; but often, when its picture has been distributed to the rogues' galleries of our hospital wards and consultation rooms all over the medical world, it comes to be recognized as quite a common criminal.

Such was the case with appendicitis, and in lesser degree with those two diseases which are exciting so much alarm at present — infantile paralysis and cerebro-spinal meningitis.

The former, for instance, is now pretty generally recognized as the real "Ethiopian in the woodpile" of those numerous stories of children who were let fall from their mother's or nurse's arms in infancy, and later developed a life-long lameness or paralysis, while cerebro-spinal meningitis has been helping to stock our blind asylums and our schools for deaf-mutes for centuries. As both popular and professional intelligence in regard to a disease increase, and more and more of the cases that occur are recognized and reported, it will appear to be increasing, and often at an alarmingly rapid rate.

Bright's Disease furnishes a very pretty illustration of the way in which diseases "increase" in modern times, and are manufactured by the very means devised for their recognition. The rapid, recent increase in frequency of Bright's Disease has run parallel with, and probably been chiefly due to, a most harmless and wholesome phenomenon, namely, the spread of the habit of life insurance and the consequent frequent examinations for albumen in the urine.

It is safe to say that we should not have upon our mortality records more than half as many cases of Bright's Disease as we now have had it not been for this widespread habit among business men of insuring their lives and having routine examinations of the urine made. Almost the first question that a doctor asks nowadays of a patient in whom he discovers Bright's Disease is, "When were you last examined for life insurance? " as such an examination is usually the first thing which attracts the patient's attention to the condition of his kidneys.

The same is true, though in lesser degree, of heart disease and of tuberculosis. There can be little question that the regular habit of careful physical examination set on foot by the life insurance companies has been of great hygienic value to the community, prolonging thousands of valuable lives and saving other thousands by warning them of their danger in time to take effective steps for its cure. Quite unintentionally the insurance companies are saving lives as well as insuring them; and now that they are becoming intelligent enough to do this intentionally and devote part of their huge surpluses to the active prevention of disease, they will add still more to the benefits which they confer upon and reap from the community.

There is a surprising amount of truth in the shrewd old Spanish proverb, "Threatened men live long." One of the many cheering features of modern medicine is that there is almost no known disease whose diagnosis is now equivalent to a death sentence, and scarcely a single disease in which a sufficiently early recognition is not merely half but nine tenths of a cure. Almost everybody knows that Bright's Disease is a disease of the kidney, and that it is connected with, and proclaimed by, the appearance of albumen in the urine. Every one is equally sure that its discovery is an intimation to make one's will and set one's house in order.

This last has proved, fortunately, to be one of the familiar overleaps of popular opinion. It was natural enough because, twenty or thirty years ago, a case of Bright's Disease was usually not recognized, nor even brought under the eye of a physician, until it had been in existence for years and had seriously damaged both kidneys and produced changes in the liver, heart, and nervous system which were beyond repair. Nowadays, although the presence of albumen in the urine is always a serious and disquieting symptom, yet it does not inspire the terror-stricken panic which it used to cause. We know that a great number of different influences may cause albumen to appear temporarily in the urine, so that a large number of cases of albuminuria are curable, or will get well of themselves.

Even if albumen persists in the urine it may be only due to an inflammation or damage of a small part of one kidney, and the kidney has wonderful powers of compensation, especially when assisted by the skin and the liver. So that by the skillful utilization of all the reserve powers of nature, by dieting, bathing, sweating, and the sparing use of certain helpful drugs, especially purges, we can hold the situation in balance, and keep the blood sufficiently purified for years and even decades; in fact, until the patient dies of something else.

The more carefully and broadly we consider the problem of the so-called diseases of civilization, the chronic decays of later life, the more we are impressed with the importance of attacking and preventing the spread of the ordinary acute infections. These were long regarded as dangerous chiefly on account of their immediate mortality, which is bad enough; but we are now finding that the damage they do by the marks and scars which they leave upon the hearts, kidneys, and nervous systems of those who survive them, though slower in showing itself, is almost as serious a matter in the long run as the immediate deaths they cause.

Sanitarians have been accused of saving children from the diseases of infancy, scarlet fever, and diphtheria, and young adults from pneumonia, tuberculosis, and typhoid, only to have them die in middle life from Bright's Disease and diseases of the heart and nervous system. Indeed, such real increase in these diseases as may have occurred is probably due to this fact. But now we know that the large majority of these so-called "diseases of later life" are the results of the innocent-looking little diseases of childhood. The so-called "new" diseases of civilization are chiefly due to our old enemies, the infectious diseases of barbarism.

We have no reason to dread the future, for almost everything that is new in our civilized conditions is an improvement, from a health point of view, upon the situation of our fathers and of our grandfathers, legends of the Good Old Days notwithstanding.

Even the overcrowding in our slums of which we hear so much is not half so bad or so unsanitary as the walled cities of the Middle Ages, or the dark, damp, undrained peasant's hut or laborer's cottage of fifty years ago.

The strains upon our nervous system, instead of being greater, are probably less than in any previous age of battle, murder, and sudden death; and the wear and tear upon our disgestions is certainly less, for food is far better, more abundant, and better cooked than ever before.

Stamping out completely, as will be done for most of them within fifty years, our infectious fevers and diseases will not cause us to live forever, but we shall certainly have to invent some other diseases to die of in later life than Bright's Disease, heart disease, and paralysis.

The new diseases of civilization are chiefly the results of the old diseases and conditions of barbarism. The remedy for the evils of civilization is more civilization!

Chapter II

IT was the boast of the cynics of the Renaissance that they believed nothing — save that ginger was hot in the mouth. And we know nothing certain about medicine a hundred years hence, save that it will taste bitter — and that none of us will be here to take it.

Moreover, it is probable that the bitterness of the medicine of the future will be tasted rather by classes than by individuals, by corporations than by children. And its after-effects will be even more salutary than they are now. The doctor of the future will prescribe for the community, rather than for the individual; then he will get lasting results instead of temporary ones. And the community will both take and administer his doses.

Of course it goes without saying, that huge progress will have been made upon the purely curative or reparative sides of the science and art of medicine — new drugs, wonderful antitoxins, marvelous surgery. But all this will simply have become only the Repairs and Alterations Department of a great Race-Building and Nation-Construction business, such as the world has never yet seen.

It is as certain as anything can well be, on this mundane sphere, that we shall have discovered an antitoxin for almost every known infection plague, but it is almost equally certain, and much more to be hoped, that we shall, long before the year 2014, have wiped out of existence all of these enemies of humanity, by preventing their spread and insisting upon wholesome and human conditions of life and work for all classes, and have as little use for our antitoxins as we now have for antidotes against snakebite.

And a good riddance the infections will be, for, although it may be faintly urged in their defense that they weed out a few of the weaklings and the unfit, they perform this slight racial service in about the clumsiest, most painful, and most expensive manner conceivable. And even those who survive them are not only not a whit the better for the experience, but often permanently the worse. Too often they carry the scars of them to their graves, and land in these the sooner on account of them.

Moreover, in the fight against them many a hoary error, many an ancient injustice, will fall. Indeed, the fight against contagious diseases is one of the most hopeful in its certainty of victory, one of the best worth while in the value of its conquests, and one of the prettiest quarrels that ever appealed to those who really love a fight, which includes eight tenths of male humanity when it is healthy — to say nothing of the New Woman.

The next two decades will see thousands of eagereyed youngsters enlisting for the war. There are few ventures in which they can embark with better chances of winning their spurs, as the real knights of the twenty-first century, than in the new practice of medicine.

It is practically certain that the laboratory of our synthetic chemists will have provided us with an array of new wonder-working drugs; that we shall have remedies specially created for particular disease conditions, from the knowledge of the effects of their chemical composition upon those chemical changes in our tissues which, when harmonious, we call life, when inharmonious, disease; that the physiological chemist, by his tireless analyses of the juices and secretions of all our glands, our organs, and our tissues, will be able to determine just what substances are the secret of their activity and what other acid, or salt, or globulin controls that activity and keeps it within the bounds of health. When these have been determined and supplied to us in pure form, we may possess a whole new Materia Medica of Nature's own remedies, with which we can stimulate whatever activity of whatever organ in the body we may find to be deficient, or check whatever may be in excess. It might even give us the power of temporarily filling the place and doing the work of any organ in the body which might have become disabled, and thus tide the organism over a period of otherwise fatal defect and enable it to regain its physiological balance.

But it is equally certain that we shall increasingly regard even such wondrous remedies as these as we already do our drugs — as mere makeshifts, patches and plasters, apologies for previous neglect, whether ignorant or culpable. As one of our leaders of medicine has already prophetically declared: "He is the best physician who best knows the worthlessness of most drugs."

Drugs are of priceless value when needed, but they are at best emergency measures of most temporary utility, — emetics for arsenic, bandages upon spurting arteries. The more effective they are in the right place, the more harmful in the wrong one. The medicine of the future will know but few drugs, and know those so exceedingly well that it will thoroughly understand just when not to use them.

It will devote at least three times as much time to keeping its patients well as it will to curing them after they are sick. It will save a man's life with drugs in order that it may cure him afterward with Nature's real remedies — food and fresh air.

There can be no question that surgery will have continued on that marvelous upward bound which began with the discovery of antisepsis, barely half a century ago. It has already reached the point of being able to remove with neatness, dispatch, and safety anything that appears to be superfluous in the body, whether a tumor, or an organ which is out of date, like the appendix, the ovary or, according to Metchnikoff , the large intestine.

It has made an encouraging start in the direction of substituting or engrafting healthy organs, or portions of them, in the place of diseased ones removed.

And while it hardly seems probable that it will be able to go so far as to invade the realm of religion, and give one convicted of physiological sin, such as rheumatism, a new heart, or "administer to a mind diseased" by supplying a new and healthy brain, yet it is within the limits of possibilities that by the year 2014 it will be able to graft in a piece of supplementary liver or kidney, or suprarenal or thyroid gland, which will be of the greatest temporary utility as a life preserver.

At the same time the more successful and effective the medicine of the future becomes, the less the surgeon will have to do. There will always remain a wide and incalculably useful field for his splendid skill in the repair of congenital effects and of unavoidable accidents, in the removal of tumors and of portions of the body which have become fatally diseased and threaten to involve the entire body in their destruction.

But if there were no tuberculosis, for instance, there would be comparatively little surgery of the spine or of the hip. The abolition of blood-poisoning and of venereal disease would do away with two thirds of all abdominal and pelvic operations, while enforcement of humane and proper laws against avoidable accidents in industry and travel would cut down bone-settings and amputations to the same degree.

By the year 2014 we may, perhaps, have a National Department of Public Health, with a doctor in the Cabinet, to balance the five lawyers! And we may even have come up to the level of Japan and given our army medical department full authority to prevent disease among our soldiers in the field.

But this is a dream rather than a prophecy. Certainly the new doctor will work with the architect in designing new buildings, especially schoolhouses, apartments, and theaters; with the engineer in city planning and laying out new additions; with the amusement promoter in devising new plays and sports for the people, and lose his present too exclusive association in the popular mind with the druggist and the undertaker.

The medicine of a century hence will concern itself largely with three great tasks: The intelligent control and supervision of the production and distribution of food; the study and improvement of education, and the rational adjustment of hours and conditions of

work.

It will concern itself with the production and preparation of food, rather than the production and preparation of drugs, because it knows that its only permanent results in the direction of improving health will be won by the former instead of by the latter. The kitchen is the best laboratory, and the doctor of the future may even take rank with the cook as a public benefactor.

The medical colleges of 2014 will teach the botany, geographical source, and methods of production and preparation of foods as carefully as they now do those of drugs. And their graduates will be able to play their part in a great National Commission, or Board of Food Supply and Distribution, which will spend as much time on this really vital problem as our governments now do on the tariff, the income tax, and how to sink as many of your neighbor's ships and kill as many of his citizens as possible in a given time.

The next sanitary problem would be to see that each individual got his proper share of that supply. For if there be anything that the medicine of the future is sure of, it is that no community can afford to allow any child born into it to grow up without a full and abundant supply of food, as well as air and liberty.

To permit anything short of this is simply to breed criminals and paupers, and the ancestors of more criminals, defectives, and paupers. No matter what its first cost, it will save the State five times that amount in the long run.

There will be difficulties in the way, but these could be overcome by patient and intelligent study, especially as our sister profession of the law would probably by that time have also moved forward and become a positive help to progress instead of a hindrance.

The doctor of the year 2014 will work shoulder to shoulder with the teacher. He will see to it that education shall train and develop the whole child, instead of just the expanded bulb at the top of him, leaving the rest of him to shift for itself in the intervals that remain. The new medicine will make schooling a thing of the open air instead of stuffy rooms, of fields and gardens instead of printed pages, of deeds instead of words.

It will fit children for life by living, instead of by reading in books how it should be done. It will not allow the schoolroom to interfere with the playground. It will fit instruction to the growing brain just as food to the stomach and exercise to the muscles.

Every child will be under its watchful eye from the day of its birth, to see that it is not robbed of any of its birthrights; that its eyes are keen and clear, not bleared by disease or dirt; its hearing sharp, not blunted by adenoids ; its teeth sound and white, not ragged and poisonous, and its back straight and sturdy, not bowed by premature toil, or burdens no child should carry.

Any guaranty of life, liberty, and the pursuit of happiness without these things is little better than a mockery. And the medicine of 2014 with the community behind it, will see that whosoever shall cause one of these little ones to offend, shall find that it were literally better for him that a millstone were hanged about his neck.

It is idle to lavish instruction upon starving children, or to strew mathematical pearls before brains fogged and dulled with sleeping in a beehive or a rabbit warren.

Perhaps by 2014 teachers may recognize that it is as important for a child to correctly bound and describe his liver as the countries of Europe, or the States of the Union, and to know at least as much of his own interior as he does of that of Hindustan. Education for life will include a sound, working knowledge of the body machine that he has to live and work with; of what food fuels will best and most economically supply it with energy; how its bearings are to be watched and its gears regulated; and how to make roadside repairs.

When every child is taught with his ABC's something of the dangers of impure water; of the different dirts that may get into it — from typhoid bacilli to the toxin of the yeast germ — and how to fight them; that dirty milk has slaughtered more innocents than a thousand Herods; that the fly is both a pest and a pestilence breeder, a product of filth and a cause of disease; that consumption is bred solely by the spit of consumptives, in the underfed and overworked; that malaria and yellow fever can be spread only by mosquitoes, and the black death solely by fleas and rats, — then the community will rise up and demand of its officers that they protect its life and its health, as well as — nay, rather than — its property.