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Health and Disease, Their Determining Factors

1924; American Public Health Association; Volume: 14; Issue: 2 Linguagem: Inglês

10.2105/ajph.14.2.147-b

2330-9687

Roger Irving Lee,

THE dissemination of information concerning matters of health is not only generally accepted as desirable, but such education of the public is the basis of much as of the present-day work for better health.This attics tude is in marked contrast to that which has existed up to the immediate present.In the Middle Ages, for example, a medical treatise was issued in the vulgar ^b.c tongue, rather than in Latin, the customary language & of learning, and was carefully guarded lest it fall into the hands of the laity, in order " that these pearls should not be cast before swine."But at the present time " the medical profession is beginning to appreciate the eg value of intelligent cooperation on the part of the laity ^j and to respond to the insistent demands of their nong" professional brethren for instruction in the preservation O of health and the avoidance of disease.Through the gradual education of the public to the possibilities of health improvement, within the limits of a generation the death rate has decreased from thirty-one in a thousand of population to slightly over thirteen per thousand.That this decrease may continue until in time we may approximate the possibilities suggested by the knowledge which we have, the public must be viii PREFACEshown not only how to improve the health of the individual biit also how to improve that of the commu- nity.And the two considerations cannot be separated.No matter what state of individual efficiency in health may be obtained, it may prove entirely ineffective or worthless hi the event of a breakdown in the community hygiene.HEALTH AND DISEASE personal habits, while others can be controlled only by groups of individuals, i.e. the community.Still other factors cannot be controlled in the light of our present knowledge.Theoretically all disease is preventable.Such an assumption, however, implies the complete knowledge of the causes and determining factors of disease and the application of that knowledge.This is an ideal state of affairs which is far removed from actual practice, although it is true that our knowledge concerning disease is far ahead of our application of it.In 1915 there were 909,155 deaths reported in the registration area of the United States (about two-thirds of the total popula- tion).With these figures as a basis, statisticians have estimated that there are yearly in the entire United States over 600,000 deaths which might have been prevented ; that over a billion dollars is wasted annu- ally through unnecessary illness and premature death, and that, on the average, fifteen years of life are lost through the lack of application of the available knowl- edge concerning health and disease.To conserve all these lives would necessitate the ideal application of our knowledge.Such an ideal is prob- ably impossible of attainment; nevertheless, such statements illustrate the effect of the failure to dissemi- nate and apply the knowledge at hand.The responsibility for this unfortunate failure is to be divided among the experts, the community, and the individual.Only cooperative activities will insure the desired results.The whole conception of the prevention of disease is new.It is new because the necessary knowledge upon which the prevention of disease is based is new.Now it is necessary to reconstruct the primitive instinct for self-preservation on the firm and rational foundation of disease prevention and health preservation. Until recent years man was almost defenseless againstsuperior intelligence man has less defense against disease than have the lower animals.Then, too, for many years his energies were devoted, almost exclusively, to the cure of disease rather than to its prevention.At times, inspired by blind fear, man fled pestilence, and this may be said to represent the origin of the prevention of disease by quarantine and isolation.Out of ignorance there grew up superstitions and cus- toms which in part regulated the habits and life of man.Some of these were sound, while others were definitely harmful.Many of these customs finally became securely incorporated in religious beliefs.Thus the Mosaic Law gives instructions on habits of life, instruc- tions which are sound from the viewpoint of hygiene.But man regulated his life in accordance with his reli- gious beliefs, his customs, or his desires.Then came the growth of all the sciences and the birth of medical science.But, in general, people still regarded medical science as only applicable to the care and cure of the sick.Slowly, however, the true instinct of self-preservation began to assert itself.The preservation of life was, manifestly, the preser- vation of health.Equally obviously the preservation of health was the avoidance or the prevention of disease. HEALTH AND DISEASEWithin the past forty years medical science has made prodigious strides in solving the mysteries of health and disease.Hardly a year has passed without some discovery that has saved or prolonged life.As a result we have acquired a considerable knowledge of disease, its causation, and its prevention.While there is still much ignorance and many problems remain to be solved, it is not unreasonable to expect that the next forty years will see as great an advance in our knowledge as the past forty.Exactmedical knowledge is derivedJiom ajamLtitude of sources.Every science has been drawn jipon_to contribute its share.Chemistry has solved the mystery ofthe air we breathe, has analyzed our food and drink, our blood, our organs, and our excretions.Physics has given to us the microscope, the necessary imple- ment of exact medical information, the Roentgen ray, and other products of electricity.Bacteriology has revealed many of the minute organisms which cause the communicable diseases.The engineering sciences have accomplished the purification of water and the safe disposal of sewage.And so the list could be extended.Scientific medicine has taken from all the sciences.It is impossible to ascribe to any science or to any source its exact influence in shaping medical science and pre- ventive medicine.Three methods of investigation through the utiliza- tion of the various sciences have made possible our present knowledge of health and disease.These methods are the dissection of the body after death, animal experimentation, and the study of vital and morbidity statistics.Human anatomy and physiology are wonderfully contrived.The vital organs are so situated in the interior of the body, carefully protected by external structures against ordinary accidents, that the examina-disease must have its beginning and the onset of symptoms that attract the patient's attention is usually delayed until considerable progress has been made.From any point of view it is desirable that all per- sons should have periodic complete physical examina- tions.For the individual's own welfare it is essential that abnormalities be detected and corrected or con-For the welfare of the community it is necessary to detect and prevent the further dis- semination of any communicable disease.Lastly, for the increase of knowledge of health and disease by which every one benefits, the cumulative data derived from physical examinations enable the establishment of accurate standards for normal and abnormal under all conditions of life.The second source of information concerning health and disease is animal experimentation.This experi- mentation is not, as is not always realized, confined to the lower animals.Experimental fasts and diets carried out by human beings have largely solved many problems of metabolism.Man has repeatedly vol- unteered for experimentation, and we have a typically heroic instance in the fight against yellow fever.It should be emphasized that animal experimentation is by no means synonymous with pain and suffering.Many of our facts on heredity have been derived from simple experiments in breeding.Probably ninety-nine per cent of the experiments on the lower animals consist in inoculations, which, with the less sensitive nervous systems of such animals, produce less pain than a simple pricking of the finger by a pin.In the remaining one per cent, the experimentation is almost always carried out under the influence of anesthetics with the same surgical asepsis which characterizes operations on human beings.480 descendants.Thirty-six of these were illegiti- mate ; thirty-three sexually immoral ; twenty-four confirmed alcoholics; and three epileptics.Eighty-two died in infancy, three were criminals, and 143 were distinctly feeble-minded.Only forty-six who were ap- parently normal have been found.After Kallikak had started this degenerate line, he married a normal girl of good ancestry.From this union with a normal woman there have been 496descendants.Only two of this number showed any- thing but a normal mentality.Both exceptions were insane, probably due to marriage with an outside stock of insane tendency.Not a case of feeble-mindedness appeared among the 496; on the contrary, all oc- cupied positions in the upper walks of life, and there were no criminals among them.From this evidence it becomes obvious that feeblemindedness is not a question of environment, but largely, if not entirely, a matter of heredity.The law of heredity is that feeble-minded, who marry, will have feeble-minded children.Every child of two feeble-minded parents will be feeble-minded.Feeble-mindedness.Feeble-mindedness is of vary- ing degree.In the lowest scale is the idiot ; next comes the imbecile, and then the high grade mental defective, who is classified under the term, moron.The degree of mental development which constitutes feeble- mindedness has been arbitrarily fixed, for an adult, as that of a child of twelve.By the use of tests based on the principles first advocated by Binet and often called the Binet-Simon scale of intelligence, it is reason- ably simple to approximate the mental development of the feeble-minded person in terms of years up to twelve.These tests merely consist of simple questions and exercises appropriate for a child of a given age.The idiot is able to do the tests up to the level of the HEREDITY 15 normal child of two ; the imbecile the tests for a child between two and seven years, and the moron those of a child between seven and twelve.It is now believed that such tests are not applicable to mentalities cor- responding to children over twelve.While it is thus impossible to designate by examination as feeble- minded persons of manifest low mentality (that is above twelve years of age), such persons, called normal, are frequent in feeble-minded families, and are often a menace to the community.It should be borne in mind that feeble-mindedness is entirely a mental characteristic, for the body of the feeble-minded person is normal and often unusually well developed.But despite the bodies and physical ability of men and women, the feeble-minded are children, they have the minds of children and are controlled by the emotions of children.The anger of a child is impotent of physical harm through the lack of physical strength; not so the anger of the feeble- minded with the powerful adult frame.Hence we read of murders for trivial causes, which are inexplicable to the adult mind and often to the laws of justice.No less inexplicable is the absence of any attempt at concealment and the absence of remorse.The culprit, adult in body, views the affair with the mental vision of perhaps eight years.Stupid petty burglary and arson are the crimes to which the feeble- minded are prone, but the criminal bent of the feebleminded is determined entirely by environment.Among the feeble-minded we see, perhaps, best illustrated the dual influences of heredity and environ- ment.The childlike mind, free from evil influences and associations, may go through life and, possibly, only be regarded as somewhat simple.Complicated tasks and persistent endeavor, especially in the face of obstacles, are beyond the individual, but simple HEREDITY 17 portant hereditary disease we know.While brain injury and brain disease may cause a deficient men- tality, such a defect is not transmitted.Heredity plays an important r61e in the causation of other mental abnormalities, but in none, according to our present knowledge, is it the sole determining factor as is the case in feeble-mindedness.Nervous and mental instability of many varieties definitely run in certain families.Heredity, as well, is the most important factor in determining certain types of insanity.Certain more obvious physical phenomena and con- ditions, such as short fingers, deaf-mutism, hemophilia, albinism, forms of chorea and ataxia, cleft palate, myopia, and the like, are peculiarly present in families and are handed on from generation to generation.We have, furthermore, the most interesting observation that hemophilia is transmitted only through females and only to males.Color-blindness is essentially a male inherited characteristic.FOOD 27 residue after water has been extracted for all other functions.The average person, therefore, should con- sume from two to four liters or quarts of water a day.But this supply need not be taken as water.All foods contain some water, and the ordinary individual gets considerable quantities in such things as fruits and vegetables, not to mention the obvious liquids, milk, tea, coffee, and soup.The habits of rabbits throw a light on the relation of vegetables of high water content to the amount of water required by the system.Rab- bits which live on carrots and greens, both of which contain a large proportion of water, are never seen to drink water.They get sufficient in their food.If rabbits are fed on oats, they drink water in considerable quantities.Recent brilliant investigations have thrown light on the long-known curious phenomena that certain persons are poisoned by partaking of certain foods.This form of poisoning may manifest itself in many ways.Perhaps the most common manifestation is the