THE RAPID DEVELOPMENT OF MEDICINE IN THE LAST FIFTY YEARS.--THE
INFLUENCE OF DARWIN.--PREVENTIVE MEDICINE.--THE DISSEMINATION OF
MEDICAL KNOWLEDGE.--THE DEVELOPMENT OF CONDITIONS IN RECENT YEARS
WHICH ACT AS FACTORS OF DISEASE.--FACTORY LIFE.--URBAN LIFE.--THE
INCREASE OF COMMUNICATION BETWEEN PEOPLES.--THE INTRODUCTION OF PLANT
PARASITES.--THE INCREASE IN ASYLUM LIFE.--INFANT MORTALITY.--WEALTH
AND POVERTY AS FACTORS IN DISEASE.
Certain conditions have arisen in the past fifty years which have
profoundly affected the thoughts, the beliefs and the activities of
man. Within this period what is generally known as Darwinism,
including under this evolution, has developed. Unlike theories which
came from philosophical speculation only, the theory of evolution was
one which could be subjected to observation and experiment. It freed
man's mind from dogmas, it stimulated the imagination, it enlarged the
territory in which it seemed possible to extend knowledge 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 of different
molecular pressures.
SPORE FORMATION--A mode of reproduction in lower forms of life by
which resistant bodies, _spores_, are formed. These have many
analogies with the seed of higher plants.
SYMBIOSIS--A mutual adaptation between parasite and host.
TRANSUDATION--The normal interchange of fluid between the blood and
the tissue fluids. The material interchanged is the transudate.
TROPISM--The influence of forces which direct the movement of cells.
ULTRA-MICROSCOPE--A form of microscope which by means of oblique
illumination renders visible objects so small as to be invisible with
the ordinary microscope.
VIRUS--A substance either living or formed by living things which may
cause disease.
INDEX
Amoeba, 13
Anthrax, 109
Antitoxin, 154
Bacteria, 116
adaptation in, 123
ærobic, 122
anærobic, 122
artificial cultivation of, 119
distribution in nature, 121
growth and reproduction, 118
mode of action in disease, 144
size, 117
spore formation, 118
substances affecting growth of, 123
toxin production by, 144
variations in, 123
Blood, 35
circulation of, 33, 80
vessels, 32
Body, 22
defenses of, 146
organs of, 28
reserve force of, 50
surfaces of, 22
Brain, 31
Cerebro-spinal meningitis, 188
Chemotropism, 93
Cretinism, 37
Darwinism, 240
Death, 57
decomposition after, 51
rigor after, 60
signs of, 59
Disease, 1
action of poisons, 44
acute and chronic, 219
industrialism as factor in, 243
lesions of, 46
superstitions concerning, 10
urban life as factor in, 244
wealth and poverty as factors in, 246
Ductless glands, 37
Embryo, 77
Epilepsy, 209
Eugenics, 215
Foetus, 32
infection of, 200
Foot and Mouth Disease, 129
Glands, 22
Growth, 62
Heart, 33, 221
disease of, 223
Heliotropism, 93
Heredity, 197
influence of alcohol, 206
of insanity, 209
variations and imitations, 204
Hookworm disease, 179
Immunity, 148
theories of, 149
natural, 150
Infection, 135
from external surface, 136
from genito-urinary surface, 137
from lungs, 138
from mouth, 138
from stomach and intestines, 139
from wounds, 141
in children, 195
in wild animals, 191
latent, 166
mixed, 160
racial susceptibility to, 191
resistance to, 143
by air, 170
by insects, 171
Infectious diseases, 97
carriers of, 185
comparison with fermentation, 108
epidemics of, 98
endemic, epidemic and sporadic forms, 188
modes of transmission, 161
Inflammation, 80
acute and chronic, 95
Injury, 54-74
Insanity, 231
causes of, 232
question of increase, 235
Lesion, 17
Leucocytes, 36
migration of, 92
Living matter, 10
Malaria, 175
rôle of mosquito in transmitting, 178
Malformations, 211
heredity of, 215
Maternal impressions, 212
Nervous system, 228
disease of, 230
effect of social life on, 233
Neurasthenia, 238
Old age, 51
atrophy in, 51
blood vessels in, 54
causes of death in, 56
in animals and plants, 55
mental activity in, 53
Osmosis, 91
Opsonius, 153
Ovum, 201
fertilization of, 198
infection of, 199
Phagocytosis, 86
Plague, 182
transmission by animals, 183
Plasmodium Malariae, 175
Preventive medicine, 242
Protozoa, 124
distribution in nature, 125
mode of growth, 125
sexual differentiation, 125
spore formation, 125
Polyomyelitis, 190
Repair, 46
conditions influencing, 47
Scar, 49
Skin, 21
Sleeping sickness, 173
Smallpox, 187
Spontaneous generation, 106
Sunburn, 83
Syphilis, 193
Tetanus, 142
Thymus, 52
Thyroid, 37
Tonsils, 52
Toxins, 144
Tropisms, 93
Trypanosomes, 172
Tuberculosis, 163
infection by sputum, 169
modes of extension, 163
Tumors, 64
benign and malignant, 69
cells of, 66
color, size and shape, 65
growth of, 65
importance of, 77
origin of, 66
question of increase, 69
theories of cause, 71
treatment of, 77
Typhoid fever, 170
Ultra-microscopic organisms, 128
Virus, 128
Yellow fever, 178