A widely held opinion among physicians admits the invariability of pathology.
All the diseases which have existed or which are bursting around us are related to fixed and preconceived types, and must go back willy-nilly in the frameworks established by the nosologists.
History and observation protest against this prejudice, and here is what they teach:
To diseases which have disappeared and whose memory is only found in the archives of science, succeed other diseases, unknown to the contemporary generation, and which come, for the first time, to assert their titles.
In other words, there are extinct diseases and new diseases .
I know the tenacity of the prejudices of doctrine, and I dare not hope that this book is for my readers, as it is for me, the demonstration of the great pathological fact that I state. Whatever happens, I have not stopped writing it to apply this reflection of La Bruyère: “We must seek above all to think and speak righteously, without wanting to bring others to our taste and our feelings: it’s too big a business .”
To put the terms of the question clearly, let us dispel a misunderstanding that could distort its meaning.
Diseases form in two ways: by reaction and by affection . The confusion of these pathogenic modes has been the radical vice of the Broussais doctrine.
Reactive diseases are those whose first phenomenon is a morbid act that immediately responds to a malignant impression from outside. Their symptoms vary according to the agents who provoke them and are related, with some exceptions, to the nature of the impression felt and the extent of the damage that has followed. Finally, they are so intimately linked to their original cause that it is up to us to produce them at will, subject to vital contingencies.
By contrast, affective diseases represent a general morbid condition prepared on a long-term basis, and which depends on possible locations. Their most common origin is in obscure, elusive causes. We can not determine their relation to ordinary morbid influences. It is therefore necessary that living activity should in itself have sufficient reason for the change which has taken place in the normal state of functions and organs. This is expressed by saying that these diseases are spontaneous , or reducible to an unusual modification of hygienic life, without the apparent concurrence of an external cause.
A large number of spontaneous affections are specific ( speciem facere ). Their nature is incomprehensible and refuses any rational theory. We have the empirical notion without being able to get the idea. These diseases express the highest degree of morbid individuality, and the original character they bear clearly distinguishes them from all others. They are incommutable, which means they can not turn into another disease. Their essential traits persist despite the external modifiers. Whatever has been said in recent times, they can do without specific provocations, since they are often seen to appear without being able to discover the prior action of an appropriate stimulus.
The dogma of spontaneity is in flagrant contradiction with the doctrine which places in the outside world the origin of all our evils. An attempt has been made to discredit him by accusing him of establishing the existence of diseases without a cause !
One must be very poor with serious arguments to lend an absurdity like an antipathetic doctrine.
When we say that a disease is spontaneous, we do not claim to affirm, in all cases and in an absolute way, that no external factor has taken part in its production. Life, as it appears to us in its organic manifestation, implies a more or less intimate relation between the mechanism it brings into play and certain modifying agents. But it is always true that the external cause of affective diseases would be vainly sought in external aggression. In the very cases in which an appreciable provocation would not have been foreign to the pathological fact, it could have acted only in conjunction with pre-existing internal modes, the organism of which keeps the secret.
Periodic returns of fever attacks, recoveries intermittent attacks of gout, are no more the effect of stimulation from outside than the revolutions of the ages and the successive phases of gestation.
One will better understand, after some examples, the importance of the distinction I have just made.
The discovery of gunpowder, which brought about a great revolution in the art of war, transformed the wounds and mutilations of the battlefield. In the face of firearm wounds, art, caught off guard at first, must have illuminated its inexperience by a long apprenticeship. Instruments appropriate to their new destination have swollen the arsenal of the army surgeon. Books signed by the most illustrious names have written the code for this part of the therapy. Observation has reduced to their value a host of prejudices which the unusual character of these disorders had seemed to justify at first, and the practice has been able to take advantage of the recovery of these obsolete theories. So here is a remarkable group of reactive diseases that took place in science only from the fourteenth century century.
The introduction of steam into industry, by multiplying the machinery, has created for the workers new dangers, of which their proverbial imprudence makes them too often victims. The instruments animated by the blind action of the motor tear, carry away, crush a portion of flesh, a limb, sometimes the whole body. Partially wrenched wounds, with some exceptions, which are easy to understand, are most often followed by a formidable reaction, especially when the amputation has been imprudently postponed. Whatever may be the common and anticipated character of the consecutive phenomena, it must be recognized that the mode of formation of these wounds belongs to the motives adopted by modern industry. Among the elders, the hand of man accomplished the work of the mechanical powers of our day, and opportunities to remedy such disorders must at least have been very rare. Celsus does not even mention it in his surgery.
These facts, the number of which may be enlarged, show the mobility of traumatic reactions which affect the structure and integrity of the organs, and which are more especially the domain of surgery. But the same observation applies to reactive diseases, which are more closely related to internal medicine, and which occupy such a large place in the history of the professions.
Ramazzini touched on this. But such a work is composed of changing and mobile elements that require frequent revision. If the march of civilization carries some occupational diseases, it is not long in replacing them by others, and hygiene always finds on its steps new problems: Uno avulso, no deficit alter .
Until recently all statistics attributed to metal gilders a sad privilege in the martyrology of industry. The ingenious application of electroplating has suppressed mercurial disease with its hideous train of symptoms, the death of which was the inevitable term.
Everyone has heard of great accidents and in particular necrosis of the maxillary bones resulting from the action of the phosphorus vapors which were disengaged in the workshops where the matches are made. These accidents were assuming threatening proportions, and it was urgent to clean up an industry which was endangering the health and life of the workers .
Chemistry, which is never in default, has taken charge of filling the indication, and red phosphorus has replaced a formidable poison by a harmless agent. When this process, freed from a few obstacles still to be respected, will have conquered in practice the monopoly assigned to it by the well-understood interest of public health, this strange form of reaction which translated the slow poisoning by white phosphorus. will be nothing more than a lost memory in the archives of industrial hygiene. In a few years, we will have seen the birth and death of a disease that has not been found in the past.
If there were only reactive diseases, I would not have burdened myself with arguments to show their variations. Everyone agrees on this point. The relationship between the harmful impression and the subsequent morbid acts is obvious.
But we stop getting along when we carry the question in the field of diseases by internal cause. As it has been decided, in principle, that the nosological framework open to these diseases is immutable, and that it has undergone, without addition or retrenchment, the ordeal of the centuries, if there be one whose appearance seems to reveal the novelty, one confuses it, without more examination, with that which is is the closest to his symptomatic affinities. It is even given the name of it, without asking whether we do not engage in the future, and if the progress of observation, enlightened by a more exact analysis, does not reserve a brilliant contradiction to this premature homonymy. When I speak of the great epidemic of the XIX thcentury, I will show that the qualification which has been hastily assigned to him, according to some superficial similarities, has contributed little to maintain, on its origin and its nature, false ideas which have not yet stopped being taught. I quote this recent example because it offers me the first to my thought. But I will have the opportunity to reproach the same fault to the doctors of all times who have decorated with the name of plague the unknown epidemics whose appearance has come to surprise them.
If I have clearly expressed myself, it has been understood that reactive diseases, which appear and withdraw with their determined provocations, can not be those whose chronological study I have undertaken. Since they are dependent on their causes, they must offer only a relatively small set of phenomena, varying in some degree only by their degree. If new species are discovered, it is possible to ensure that they will not depart much from recognized types.
But it is quite different for affective diseases; their source is inexhaustible. As long as the human race inhabits this world, we can expect to see new ones emerge in the true sense of the word; and they will not be distinguished by simple nuances, but by the incomparable specificity of their nature. It is in the generation of these diseases that the internal activity reveals a fertility the limits of which can not be fixed. History, attesting the successive appearance of serious affections who have remained faithful to us, suggests in the future the same eventualities.
The nosological distinction I have just made will not be accepted without objection. Close to these great words: affection , spontaneity , specificity , which sound bad in the ears of the science of the day, it may scare some readers who will fear to follow me in the imaginary spaces. That they allow me to reassure them.
Whatever the theoretical interpretation adopted and the formula that expresses it, it is impossible to deny that reactive diseases differ markedly, by their ostensible pathogenesis, from those which I call affective and spontaneous. The present state of science forbids confusing them. The chronic disease produced by the long-continued action of a poison does not obey, in its genealogy, the same law as the chronic disease known under the name of diathesis. The question is of the same order as that which agitated the pyretology so much and which has not ceased to be heavy with storms. The traumatic fever that follows the use of the cutting instrument; symptomatic fever caused by a well-defined organic lesion,essential . Provisionally one is obliged to impose silence on repugnance of doctrines and to accept such an obvious distinction, even if one must wait for improvements in science for the light it lacks.
I do not ask at this moment for any other concession, and I imagine that, in these terms, it will not seem exorbitant.
There will be no equivocation for anyone when I say that the diseases of which I come to demonstrate extinction and novelty in the succession of ages, belong to the order of affective diseases, the cause of which escapes our senses and our means of analysis. Whatever may be the claims of the systems in vogue on this point, they can be challenged to determine, without hypothesis, the essential conditions of their development .
A priori , and on the simple indications of analogy, the existence of new diseases is too likely to be real. Experience in turn confirms this prediction by giving this fact the scope of a general law.
Unless we admit with legend that diseases have fallen on earth like an avalanche, it must be admitted that they could only have been the work of centuries. The reason states that at the origin all the diseases of internal cause are born spontaneously. It is vain to relegate to the night of the most distant past, the first generation of new diseases, it will be necessary to admit that at their advent they had their reason for being. By what artifice of dialectic would one manage to prohibit these eventualities in the present and in the future?
It is undoubtedly contemporary diseases of the human species, which have always accompanied it, either sporadically or in epidemic form. These diseases are inherent to our nature, and derive from the necessary relations of the organism with the environment. Of this number are catarrhal , inflammatory , bilious diseases , to which we may add typhus of infectious origin.
But diseases which are due to obscure and slowly active causes, those which are characterized by a word the profound individuality by saying that they are specific, only became incorporated into humanity after a long elaboration.
Certainly gout , scrofulism , tuberculosis , herpetism, and other similar morbid entities have not been inscribed on the same date in the life of societies. Time has been an indispensable element in their final possession.
Physicians who reject the novelty of certain diseases by an end of absolute non-acceptance have never bothered to think of the following considerations which, by various means, lead to the same conclusion.
The nosogenic influences change with the countries, and it is countries which have the exclusive monopoly of certain endemics. The Plice of Poland , the Aleppo Button , the Sibbens of Scotland , the Ralezyge of Norway , the Egyptian Leprosy , the American Yaws , the Yaws of the Coasts of Guinea , the Tara of Siberia , the Waren of Westphalia , the Fégarite of Spain , the Rose of Asturias , the Ginklose of Iceland , the Noma of Sweden , the Chilolace of Ireland, represent as many morbid species which find the conditions of their development only in the indeterminate competition of certain topographical influences. The history of the travels widens the circle of this observation every day, and one does not exaggerate by saying that some regions have their pathology as they have their fauna and their flora .
Since the medical facts vary according to the geographical circumscriptions, and a simple displacement imposes new studies to us, what should not be, in this respect, the power of the great terrestrial revolutions whose geology reveals fulfillment after having followed it step by step. Modern discoveries show that the mobile physiognomy of the globe never remains the same. The transformations he has undergone in the succession of centuries are so extraordinary that one would be tempted to make reservations, if the proofs that one gives them were not mathematically deduced . I ask if it is possible to admit that the humanity witnessing these gigantic shocks did not feel the counter-blow? Why should diseases that are, after all, natural phenomena, escape this universal law of mutation whose effects are so striking?
The kind of life of the people, their customs, their customs, their habits, their tastes, their social conditions inevitably change, and wear out, as it were, by their very duration. When everything is renewed or transformed around it, how would pathology have the privilege of immobility?
The following example, which has been often quoted, is related, in the restricted sphere of a special event, to a more general observation.