The Essential Nature of Disease


   What is disease? The whole philosophy of drug medication or of Hygienic care turns on this single question. It is quite clear that until medical men can solve this problem--what is disease--medical science cannot advance. It must remain a science without a system, a superstructure standing on nothing. Although the minds of medical men have given origin to diverse theories of the nature and cause of disease, they have all revolved around a common center. Disease has been regarded as a positive and organized entity which attacks the body from without.

   Our forefathers would conjure up for themselves some hideous monster and imagine him dancing around, peeping in windows, slipping in at doors and ready to pounce upon them at any minute. They were entirely unarmed; there was no protection. Although this ancient conception of disease has faded somewhat, it is not entirely dead. From the time of the incantations and charms of the era of the magician down to the present time, that mysterious imaginary monster, disease, has been the thing aimed at; and remedies supposed to possess curative virtues have been employed with which to combat, expel and kill it. Whatsoever was done, whether by ceremonies or by drugging, the sick have had faith in the "power to cure" possessed by the act performed or by the drug taken. If they failed to recover under the treatment, this did not lessen their faith in "nature's remedies." They thought only that they had failed to find one suitable to their case. Hence it is and has been that invalids have always been and are perpetually and continually resorting to one thing after another to cure them of their maladies.

   Whether the people and their physicians really imagine that disease is a thing--an entity--destroying the patient in like manner as a worm gnawing at its root destroys a plant and that, consequently, the disease must be destroyed as we would destroy the worm, it is certain that their treatment, when ill, is directed to this end. From the dawn of human history to the present, all magic and all medication has been employed, no matter what the theory, upon the assumption that disease is a positive organized force that has attacked the body. Accordingly, a power outside the living organism has been sought after and used for the purpose of curing disease.

   We regard an understanding of the essential nature of disease as not only important to the establishment of a successful mode of caring for the sick, but as essential to the establishment of a true science of life. The natural termination and course of a so-called disease can be known and understood only by the man who observes its progress from beginning to end without interfering in any way with its processes. From Hippocrates down to the present no physician who gives drugs has ever studied the natural history of disease. How can a man tell the natural history of anything who has never seen it in its natural relations? How are physicians to understand the nature of disease so long as they continue to meddle with it at every stage of its progress?

   One difficulty in defining disease is that it is a generic term that covers a rather wide variety of phenomena, some of them directly opposite to others. For example, there may be violent action or there may be a complete loss of power of action. So long as the word disease is employed as a blanket term covering so many and opposite phenomena, a satisfactory definition is not possible. The medical dictionary defines disease as "a departure from the normal." It is obvious that such a definition also covers a wide variety of phenomena, often of opposite character. Other than this, it is unsatisfactory for the reason that it fails to define the normal. How can we define a departure from the normal until we know what is normal? Under this definition a child born with six fingers on one hand would be diseased; yet it is quite obvious that as much as a departure from the normal as the six fingers would be, this is something entirely different from pneumonia or typhoid fever. We are much in need of a terminology that will clearly distinguish between the various kinds of departures from the normal.

   A large part, if not all, of the physical world is composed of continua, by which is meant that a continuum is a heterogeneous unity, each point of which differs from all the other adjacent points, but differs from them by such subtle gradations in any particular quality that there exists no boundaries within the unity, but which can be divided into parts only by imaginary and arbitrary boundaries. If we think of temperature and the wide range between the lowest and highest possible temperatures and consider for a minute the fact that there is no point on the thermometer where we can place our finger and say with certainty that precisely at this point cold ends and heat begins, or vice versa, and that all the little markings, crude and gross though they be, on the thermometer by which we measure degrees of temperature, do not represent actual divisions of temperature, but arbitrary and imaginary divisions, we get an idea of one continuum.

   We can think of health and disease also as a continuum. Comparing these two phases of life (the state of being alive) to temperature, let health represent heat and disease represent cold. At what precise point on our vitometer can we place the thin edge of a knife and say with certainty that here health ends and disease beings? The two states shade imperceptibly into each other as do the colors of the rainbow. This is not to say that health and disease are the same thing, any more than heat and cold are the same thing, but that, just as heat and cold are two phases of the same thing (temperature), so health and disease are two phases of the same thing (life) and that, just as heat and cold merge imperceptibly into each other, so health and disease also merge imperceptibly into one another.

   In truth, many aspects (stages) of disease are continua, existing in such subtle gradations and in such varied degrees of abstractness that the differentiations made by pathologists in the course of their analyses and the terms they employ as symbols of their analytical divisions reflect only very roughly the pathological situation that exists in reality. All the phenomena of health and disease proceed from the living system. Disease is no more an extra-body entity than is health. Both health and disease readily change under changed conditions, according as the body is related to the changed circumstances. Disease is a vital struggle (biogony) to remove offending substances (toxins) and repair damages. It is a modification, for the most part, of the regular, orderly processes of life designed to accomplish some unusual end--the removal of toxins engendered or taken in from without. Pathology, in this view, is the dramatic exaggeration or diminution of normal processes--it is not healthy action, but is health-restoring in effect.

   Only by obliterating all distinctions between health and disease can such actions be called "healthy actions." This would be something like obliterating the distinctions between heat and cold and declaring them both to be heat. They are both temperature, but cold is not heat. Of course, both normal and abnormal actions are vital actions; but they are not both physiological. Physiological circulation is free and easy and occasions no redness, swelling, pain or interference with function. Inflammation is a circulatory adjustment that, while vital, is pathological rather than physiological. Inflammation is the process by which broken bones are knit, wounds are healed and parts are protected from damage. Death or mortification of the inflamed part represents the unsuccessful termination of the remedial effort--the disease.

   Disturbances and inflammation within the organism are as much vital actions as deglutition and digestion; the difference being that in the first instance the organism is resisting and expelling inimical substances; in the second it is performing its normal or healthy functions. Healthy action is the action of a healthy or normal organ under normal conditions. Remedial action is action which tends to restore the healthy condition. Inflammation is remedial action because, though not normal action, it is designed to resist and remove causes and repair damages, thus restoring the healthy condition. To say that inflammation is healthy action is tantamount to saying that disease is health.

   Inflammation is simply a great increase in the amount of blood in a circumscribed area of the body. The pain, the redness, the swelling, the heat and the impairment of function are all due to the local excess of blood. The blood contains the repair materials--the ordinary elements of nutrition and the special repair elements that are produced for the occasion. Inflammation, whether in a wound or in a so-called disease, is a remedial, a reparative and, also, a defensive process. Instead of something that needs to be cured or that can be cured, it is the process by which healing is accomplished.

   What we have said of inflammation applies with equal force to such actions as coughing, sneezing, spitting, vomiting, diarrhea, diuresis, night sweats, dizziness, fever, pain, vertigo and other types of remedial action. What are these but symptoms of disease? And yet, each and everyone of them represents a modification or exaggeration of some function of life. It may be said that acute disease represents a series of exaggerations and diminutions of the regular activities of life designed to remove offending substances and to repair damages. When we examine the functional and structural changes that occur in the body in the early stages of disease, there seems to be alterations of a compensatory character or of such a nature that they reduce the general disturbances of the organism from the threat associated with the altered condition of life to a minimum. They are of a remedial character--expulsive, resistive and compensatory.

   This definition of disease--remedial effort--first expressed by Dr. Trall, must be applied in its fullness to acute disease only. Paralysis, for instance, under this definition of disease, should not be classed as a disease, nor should apoplexy, blindness, deafness and a number of other structural and functional defects. Certainly blindness is not a remedial effort. Certainly the bleeding into the brain in apoplexy is not a remedial effort. These facts again emphasize the need for a more precise terminology.

   Acute disease is vital action in some one or all of the living tissues or organs in resisting and expelling injurious substances and influences and in repairing damages. In this sense, disease is an effort to preserve the organism from destructive influences and to maintain or restore functional harmony.

   The living organism is endowed with an inherent power and instinct of self-preservation. A familiar example will illustrate the workings of this power and instinct. A poison is taken into the stomach; the organism senses the presence of a non-usable and harmful substance and prepares to act accordingly. It is sent out by vomiting, or it is sent along the digestive tract into the colon and is expelled by means of a violent diarrhea. It does not take a profound understanding of the science of biology for the reader to grasp the fact that the vomiting or the diarrhea are the means of defense and expulsion. We call them disease or symptoms of disease, but we should also recognize them as parts of the process of healing. Disease is not the enemy of life that we have been taught it is, but the means employed by life to defend and repair itself. In this instance, the vomiting and diarrhea, instead of being foes of life, are actions of life in self-defense. The enemy in this instance is the drug (poison), not the processes of life that expel the poison.

   It has been said that fever is not disease. Is it health? Is it something between health and disease? What, then, shall we call it? Fever is but a dramatic exaggeration of the normal temperature of the body. Its production is strictly a vital process, but it is not a healthy state. It is remedial effort, whether successful or not.

   We do not think it correct to say that fever, meaning by this, the increased temperature, "is no more than a concomitant of a process of reaction against injury or a foreign disturbance." We think the rise in temperature is an essential element of the so-called reaction (we would call it a primary action--one of defense) and that it is necessary to other elements of the defensive action, without which they would not occur. But when it is said that we can follow nature's example by endeavouring to create a feverish condition for the purpose of healing, we object that this is a return to the old principle of curing disease by producing disease.

   A fever is the consequence of accumulated impurities in the system, the disease consisting essentially in the effort to expel the accumulated toxin. How can the introduction of a poison or of any number of poisons either prevent the accumulation of impurities or cast them out once they have accumulated? We do not think that fever has any "dangerous features" and think that these are but figments of the medical man's imagination. All forms of acute disease are remedial efforts and the disease is mild or severe as the quantity or kind of poisons or impurities in the system necessitate a lesser or greater degree of violence of the remedial effort.

   People are said to be attacked by fever. They are also said to catch typhoid or to catch scarlet fever, etc. Editorially, Trall said (September 1859) that "no person ever was or ever will be exposed to the contact of the fever which they manifest. The thing is impossible. We say, further, that there never was an individual on earth attacked by a fever." We need only add that if there is any attack, fever is part of the body's attack upon impurities.

   Writing in 1850, Houghton, discussing the action of the body in disease, said, in the words of Dr. Jennings, "that action is right action." The convulsive and often painful movements of the bowels in a violent diarrhea, such as may be occasioned by a cathartic, is disease. The early Hygienists regarded vomiting, diarrhea in its various forms, biliousness and "morbid discharges from the bowels" as processes of drainage. Nature, they said, has "set up a 'drain' to save the system from dangerous effects that would otherwise ensue . . . In other words, morbid discharges from the intestines mean something, and it behooves everyone to ponder the 'writing on the wall,' and find out its true significance, even at the risk of finding themselves 'wanting.'" It should be obvious to the reader that diarrhea is but a dramatic exaggeration of the normal function of the bowels and that it is designed to remove offending materials from the alimentary canal. It is certainly not something to be cured or suppressed, but should be permitted to complete its work.

   Coughing and sneezing each represent an exaggeration of the ordinary or normal process of exhalation. Air is forcibly expelled from the lungs in an effort to dislodge and expel obstructing and irritation-occasioning substances from the air passages. Sneezing is a peculiar action which follows immediately the introduction of snuff or a bread crumb into the nostrils of those unaccustomed to it. It is an effort to relieve the membranes of the nostrils of whatever occasions irritation. Sneezing is an action of the body itself and its ends are constructive. The healthy action of the respiratory apparatus is respiration. In health it does not sneeze or cough; it does not exude great quantities of mucus and, perhaps, some blood; it is not painful. In pneumonia there is coughing and exudate in the lungs; there is some blood in the exudate; there is pain and marked impairment of the healthy function of the respiratory organs. Health is never painful; disease is often exceedingly painful.

   Physical suffering is evidence that remedial operations are in progress. If we view the painless indolent ulcer that fails to heal until it becomes acute or evolves a painful stage, we see that remedial operations are, in most cases at least, accompanied by painful symptoms. A slight injury will evolve only slight symptoms; severe injury calls for the development of severe symptoms. While drugs cannot contribute to the healing of torn ligaments and muscles in cases of dislocation, the pain, restlessness, fever, inflammation, suspension of digestion, etc., all symptoms of disease, constitute parts of the healing process by which damaged tissues are repaired. The force of the remedial effort will ever be found to be in exact ratio to the needs of the case.

   How stupid to regard pain as a malignant demon that comes unbidden and requires exorcism by the infliction of expurgatorial penalties! Pain is an instructor pointing the way to improvement; it should not be thought of as an enemy. Rather should we recognize as evil the occasion for the pain. The pain itself is but an exaggeration of the ordinary sense of feeling.

   The hypertrophy (enlargement) of the tonsils or of the remaining kidney after the removal of the other does not destroy the structural design nor the innate aptitude of the organ to perform its function. Instead, it makes possible an increase or intensification of function, amounting, in effect, to an increase of functioning capacity and an intensification of its protective activities. The enlargements that muscles undergo when subjected to repeated strain are primarily defensive developments. Just as these muscular developments increase the powers of the muscles, so the enlargement of the remaining kidney enables it to do the work of two kidneys and the enlargement of the tonsils enables them to increase their work.

   Extra effort is not necessarily disease. One may run rapidly and breathe deeply as a consequence and he may pant, but we do not mistake all of this extra effort for disease. We know that there is also extra effort by the heart and that the blood is coursing through the arteries, capillaries and veins at an extra rate, but the individual so running is not sick. Indeed, we are aware that running is one of the ordinary and normal activities of life. To class exaggerated activity as disease, it must be extraordinary and abnormal.

   The question may not be amiss: if the vital structures are actively engaged in building up, maintaining and restoring physiological harmony and integrity and in counteracting and expelling the causes of disease, in what does disease itself consist? Certainly, the depressing causes are not the disease, else would everything that is incompatible with health be a disease. Neither can disease be the effect of remedial action--which is either health or death. The inevitable conclusion is forced upon us that disease is the effort of the living organism to throw off a morbific cause and restore normal physiological equilibrium. Instead, then, of the disease and the vis medicatrix naturae being antagonistic forces battling for supremacy, they are one and the same thing.

   After saying that the cause is not disease and the symptoms are not disease, Dr. Walter enumerates a list of symptoms common to various acute diseases--chills, fever, prostration, furred tongue, quickened pulse, restlessness, delirium, coma, stupor, etc.--and says: "There must be something behind to produce all these varied manifestations; and that something is disease." If disease cannot be identified either with its causes or its symptoms, he says, "it must of necessity exist between the two, following the causes and preceding the symptoms. Between the two, then, what do we find? An entity? A real existence? A living thing with bad character and evil disposition? A something having form and shape that can be weighed, measured or observed? Not at all! No such thing has ever been found or ever will be. There is nothing to bridge the chasm but the vital properties of the living organism. The living force acting in self-defense is the only connecting link between the causes of disease and its symptoms.

   "Disease, therefore, in its essential nature, is the vis medicatrix naturae-- powers of nature acting self-preservatively. The existence of this vis medicatrix naturae has long been recognized by the most eminent medical men; but they have failed hitherto to perceive its identity with the disease. Their mistake has been in attempting to crowd into the slight chasm between the causes of disease and its symptoms two powerful opposing agencies--the disease on the one hand and the vis medicatrix naturae on the other, acknowledging all the while that both these forces were too indefinite and mysterious to be understood. Which is very true. They cannot be understood, except by viewing them as one and the same thing."

   Graham's view of the essential nature of disease is well summed up in his statement that "all parts (of the body) sympathise with the suffering organ, and by a general consentaneousness of action, strive together to remove the offending cause-and when the emergency is great, and the danger imminent, the agonizing energy of organic life is poured upon those muscles of animal life concerned in respiration, and violent vomitings, &c., ensue. In all these operations the organic instinct acts determinately, and as it were, rationally, with reference to a final cause of good, viz, the removal of the offending cause."

   Graham was hardly prepared to go as far as did Jennings in accepting convulsions or spasms as orthopathic in character, but he did view them as being of the same essential character, although resulting from a misdirection of the remedial efforts. They represented to him excessive activity, consequent upon too prolonged or too frequently repeated "disturbing cause." Essentially, however, they represented actions initiated by the "perceiving organic sensibilities" as "immediate measures" to "shield the special domain (he is discussing the stomach) from the pernicious action of the (offending) substance." First, there is "increased secretion;" then, "if the quantity and quality of the substance be such as to endanger seriously, the vital interests of the whole system, the special center gives alarm to the great common center of organic life."

   "Few things," he said, "will more speedily and completely prostrate the muscular powers of even the strongest man, than light irritation of the alimentary canal." "Epilepsy and other convulsive fits and spasmodic affections almost universally result from irritations in the domain of organic life, and the alimentary canal is most generally the seat of these irritations."

   A genuine science of life (biology) will demonstrate that those abnormal actions and processes of the living organism that are designated disease are not extraneous somethings bent on the destruction of life, but that they are operations of the same forces that are operative in the actions and processes that we designate health. A genuine biology will demonstrate that those actions and processes that are designated disease are under control of immutable laws and are designed for the preservation of individual life, the repair of injuries or the removal of harmful or destructive substances.

   The vomiting and diarrhea, for example, that often follow the accidental taking of a poison, are precisely the same as the vomiting and purging that accompany what is called disease and serve the same ends. Poisoning may occur in the healthiest individual. This means that the healthy man employs as a means of preserving his life precisely the same processes and actions that the sick man employs. If we look at these processes closely, we cannot fail to discover that the process that is designed to save life in accidental poisoning is precisely the same as the process that we call disease. In other words, disease is the remedial process.

   Since any organismic disturbance, whatever its origin or locus, constitutes a menace to the organism's continued existence, it automatically occasions the mobilizations of the body's "mechanism" of defense. Do healing or reconstructive operations ever take place when there is nothing requiring healing or restoration? The answer to this question would seem to be self-evident. There can be no healing process when there is nothing to heal; and if this is correct, the healing process will always be concentrated where there is injury to repair. Coughing never occurs when the lungs and bronchial tubes are clear; sneezing never occurs when the nasal passages are free of irritation and obstruction; diarrhea does not occur if there is nothing in the digestive tract that should be hurridly removed; vomiting occurs only when there is something requiring forceful ejection from the stomach, and so on with the other processes of defense, ejection and repair.

   Self-preservative processes are necessary and fundamental conditions of life. It is a fact of universal observation that principles never fail when the conditions requisite to their operation are present. The self-preservative principles of organisms which operate to restore health must, therefore, become operative when a living organism is injured, impaired or poisoned. Should it ever fail, this would be proof that it is not a principle of life.

   Can we prove, by reference to facts, that there is an invariable connection between healing operations and the existence of a need for them? Perhaps not, for it is absolutely impossible for us to search into the depths of human life and observe all that occurs. But all the facts that can be seen tend to prove that the connection is invariable. Certainly, no fact has ever been established against it.

   If this position is not true, we have no basis for our practice. If it is true, it is the only correct basis; hence, all who deny it are necessarily practicing on a wrong theory and, hence, more liable to error. As we understand this subject, the whole popular system of drug-medication is based on an erroneous apprehension of the nature of disease and it is this error which causes so many Hygienic practitioners to introduce greater or lesser portions of such practices into their work. The theory we adopt leads us to the rejection of all drug-medicines and it is certainly an important question--who is right.

   If disease is vital action, if it is a self-preservative process, the greater the strength and vigor of the patient, the greater the vital action should be under the same injury. If disease is remedial force, the greater the vital activity, the more vigorous the symptoms, the more certain the recovery. If disease is a purely destructive process, as is popularly and scientifically supposed, the exact opposite should be the case.

   A man who, in health, is vigorous and active will, in disease, manifest a corresponding symptomatic vigor; the vigorous and active man or woman will act in relation to drug poisons with double the force that a sluggish or greatly impaired person will act. A man whose energies are low will act feebly in relation to the same dose. If our position is correct, why is it that the strongest person, when he becomes ill, is likely to have the most violent sickness? Why, also, is it true that the patient who has the most violent symptoms is most likely to get well and to get well most rapidly?

   Related to this very subject is a statement made by Dr. Jackson that "among the rules--organic, fundamental or vital, as you may please to call them--which nature has for the preservation of health to her subjects, is this: the removal of disease from parts or portions of the body which can ill afford to bear derangement to parts or portions which can much better afford to be diseased." His examples are not convincing, but suggestive. He said: "General disturbance of the system is not near as likely to follow inflammation of the mucous lining of the eyelids as it is to follow inflammation of the mucous lining of the stomach. If, from any cause, there is likelihood of the appearance of inflammation of the latter, nature, unmeddled with, is sure to do one of two things: either set up direct curative action, or remove the difficulty by some organ whose derangement is comparatively of little consequence. The latter action is what physicians call metastasis, or change in the seat of the disease and is common, but salutary, where the vital or protective forces of the system produce it, and is also common, but quite otherwise than salutary, where the changes are produced by drugs."

   If disease is a remedial effort, why do not the sick recover? The answer to this perfectly logical question is: sick people do get well. They get well in all cases, except three. These are:

  1. In cases where the causes of disease are overwhelming.
  2. In cases where the causes of disease are maintained beyond the power of recovery.
  3. In cases in which the remedial effort is suppressed or thwarted by drugs and treatments that frustrate the powers of life and render ineffectual the efforts toward restoration.

   It will readily be perceived that these three exceptions, where one or more of them exists, provide ample grounds for occasional failures and if the facts reveal that the sick do recover, except where these conditions exist, our answer rather conclusively establishes the soundness of the Hygienic theory. It is, of course, necessary to distinguish between remedial action itself and the ultimate results of such action. The action is no less remedial when it fails than when it succeeds.

   The forces of life are not infallible. Their efforts are not always successful. They may prove abortive, but they are always in the right direction. There may be accidents in these efforts, as when vomiting is vigorous enough to result in a hemorrhage or in a hernia. But these accidents do not invalidate the important fact of vital agency in the case, nor destroy the principle of remedial action. Even should the hemorrhage prove fatal, the vomiting was still a remedial effort. Such incidental effects of the vital struggle (and they are very rare) must be regarded as accidents. We may say, indeed, from a theoretical point of view, that such destructive accidents result because the fibers of which the tissues are composed, not being sufficiently strong and elastic to endure the increased effort or energy of vital action, break. Even death itself may be regarded as a mere incidental effect of the body's great and sublime effort to reach the grand and glorious ultimate in human perfection. "Victory or death" would seem ever to be the battle cry of the living organism when useless and highly toxic substances are introduced into it.

   Medical objectors to what they call the "expulsion theory" of disease declare that it does not distinguish between the two opposite conditions of health and disease, but confounds them together and makes them essentially one. For, it was contended, expulsion and rejection are natural and normal processes and as necessary to life and health as they are to disease. In every living organism the two processes of rejection of what is not needful and expelling what is poisonous, etc., goes on ceaselessly and simultaneously and cannot be arrested without danger. Expulsion of poisons is, therefore, coincidental with and an essential condition of health and their retention the reverse--disease.

   "Are we, then, to believe that health is disease?" they asked, "and that life is one long-continued 'remedial effort to expel' poisons generated by itself?" The oneness of vital processes in health and disease seems to be a strange idea to the foes of the new conception of the essential nature of disease. They wanted some new, extra-vital and super-physiological force or process to constitute the disease. They seem not to be able to recognize health and disease as constituting a continuum--that is, that the actions of the body in expelling the poisons of disease are more or less dramatic exaggerations of the ordinary normal actions of life.

   Our hypothesis of the essential nature of disease, its rationale, is deduced from the principles of physiology. The pathology of the schools of medicine, although growing more and more in accord with physiology, has in the past stood in contradiction of physiology. To date, although their pathology is being brought more and more into line with the fundamental principles of physiology, their therapies have not moved in this direction. They are still teaching in their colleges and practicing at the bedside "therapies" that are based on the old conception of disease as an "attacking entity."

   Diseases are studied, classified and arranged into a branch of biological science called pathology, without knowledge of which none are considered competent to care for the sick. Medicines are studied, classified and arranged into another, but false science, called materia medica and therapeutics, without a thorough knowledge of which none are considered equipped to prescribe for the sick. With a knowledge of these two sciences, the physician sets out to conquer disease (really to make war upon life itself) and without knowing what he is doing, counters the very principles he is called upon to preserve.

   Physicians are well versed in pathology, but alas! ignorant of the body in a state of health and of the basic needs of the living organism. They are conversant with the chemical constitutions of their drugs and know much of the effects that follow their administration; but they ignore the fact that when these drugs are introduced into the body in a state of health, they speedily reduce it to a state of disease. Their efforts to cure disease, therefore, result in the production of disease. There are several acute diseases that the medical profession classes as self-limited. These are said to run more or less variable or definite courses to recovery. If we can accept the principle that disease is remedial effort, we can understand that a "self-limited" disease is exactly analogous to "self-limiting" digestion. The process of digestion ends when the meal is digested and there is no longer any work for the digestive organs to carry on. In like manner, the remedial effort comes to a spontaneous end when the cause of disease has been removed and there is no longer any need for remedial effort.

   An acute disease may properly be regarded as the evidence of a crisis in the affairs of the body. The so-called "exciting causes" of disease constitute the last feather that "breaks the camel's back." The vital organism has been hitherto moving along, accommodating itself as far as possible to its impaired state, until some additional and, perhaps, slight demand made upon it, necessitates, in order for self-preservation, a rearrangement of its activities. Suddenly, as it were, the internal foulness becomes so great that a vigorous cleansing becomes urgently needed and a great eliminating effort results. In this view, there are not many diseases, but many symptom-complexes, each of which represent the remedial effort more or less marshalled in a different part of the body. The unimaginative recognize inflammation in each part of the body as a distinct disease--hence, we have "many diseases." The crisis, which exhibits itself through a multiplicity of symptoms, is a very complex thing. To say that it stems from one cause is too great a simplification for the average mind.

   So long as disease continues to be regarded, even if only subconsciously, as an entity, a terrible something that must be resisted, cast out and destroyed, and medicines are thought of as equally positive entities, either prepared by nature or devised by man for the destruction of disease and, so long as the great problem of the devotees of the various systems of medicine is to find a medicine which, when administered to the sick, will destroy or cast out the disease and save the sick alive, just so long will a rational and scientific approach to the problems of human suffering remain impossible.

   The absurd notion that organismic convulsions (disease) and weakness are of exotic origin is so crucial to the prosperity of the medical profession that the physician is compelled, in sheer self-defense, to contest with every weapon he can command, the verities that the "diseases" listed in medical nosologies constitute climacteric symptomatologies of sub-clinical impairments of autogeneous origin and that these "diseases" cannot be mitigated or recovered from so long as the mode of life that engenders them continues to be carried out. The physician must, at all times, remain committed to the crotchet that "diseases" constitute physiological miscarriages localized in particular organs--and that the restitution of these organs to their original state is equivalent to the eradication of human pathologies.

   When Hygienists defined disease as remedial effort, they had reference primarily to acute disease. Their view of chronic disease is well stated by Dr. George H. Taylor, who said of it: "Nor does it 'still educe good from seeming evil,' by doing a disagreeable, though perchance kind labor; but comes, with bare bones and jagged scythe, to hew by ineffectual inches." It is, however, not nearly as devoid of remedial processes as our Hygienic predecessors thought. Its cause is not, as some of the early Hygienists thought, "inwrought and compounded with the constitution itself," but is an integral part of the daily life of the individual. Chronic disease is commonly characterized by recurring crises, which are only symptoms of struggle, always imminent or present because those who suffer are constantly despoiling themselves. Chronic disease results from chronic provocation.

   Hygienists early recognized that the suppression of acute disease is one of the chief causes of chronic disease. When poisonous matter has accumulated in the system to the point where it becomes a menace to life, the body makes a violent effort to cast it out and we have pain, inflammations, fevers, and the whole train of acute diseases. The poisons of the system and the poisons of the physician weaken the powers of the body and we have the less violent, but more protracted agonies of chronic disease. The struggle of the system to cast out its accumulated toxins continues so long as the organism remains alive. Every effort of nature is for health and the symptoms of disease are but the actions or powers of the body in expelling toxins and remedying damages. It is the work of the Hygienist to facilitate these efforts, not by treatments, but by supplying appropriate physiological conditions.