NATURE 



49 



THURSDAY, MAY 21, 1903. 



THE PRINCIPLES OF DISEASE. 

 ilie Prevention of Disease. Translated from the 

 German. With introduction by H. H. Bulstrode, 



tM.A., M.D. Pp. xviii+1063. (Westminster: A. 

 Constable and Co., Ltd., 1902.) Price 31s. 6d. net. 

 ^ all studies we are turning back to remoter and 

 f remoter causes, and to the investigation of 

 feins ; but, as we abstract and abstract, we are apt 

 Iget vaguer and vaguer, more and more are in- 

 vidual features merged in types, and in medicine we 

 mnv find ourselves reduced at last to the emptiness of 

 general counsels for a temperate and wholesome life. 

 Nevertheless, the modern physician cannot be content 

 with the knowledge that the patients under his care 

 are victims of phthisis, of Bright's disease, of failing 

 heart, of premature senile decay, and so forth, without 

 a desire to learn the nature and direction of the pro- 

 cesses by which such changes are initiated. As in but 

 few instances he has discovered these small beginnings 

 he is discontented ; and it is well that he should be so. 

 Our ancestors did not fail to see that diseases are 

 moving things, so active that some demon or evil 

 principle might be behind them; but this conception 

 of activity, effective enough for instant purposes, con- 

 tained no adequate notion of remote or latent causes. 

 Some such notions may be traced in the ancient 

 doctrines of the temperaments or diatheses, but 

 were speculative and comparatively barren. Initial 

 causes were, as we should expect, first observed and 

 revealed in the infections, when a definite external 

 pathogenic factor enters into a healthy or apparently 

 healthv person ; but even such events would seem to be 

 very inconstant in their occurrence. Of two men ex- 

 posed to such an attack, one would betray no sign of 

 suffering, while the other would fall 111 ; an inconstancy 

 indicating that the causation of an individual case 

 of infection consists of far more than the intrusive 

 element itself, which in some cases Impinges upon a 

 •series of cooperating, in others of antagonistic causes. 

 And if the patient succumbs, the outbreak of disorder 

 is not immediate ; a variable but specific interval 

 elapses before its first manifestations. Now If from 

 the recognised infections we turn to other dis- 

 eases, we try to discover if some of these also 

 arise from incidental agencies of a more occult kind, 

 but having also their latent periods and gradual 

 initiations. Others, again, may not be attributable to 

 « xternal elements, scarcely even as secondary and 

 irceleratlng causes; but arise as later terms of pro- 

 cesses Implicit in the organism itself, perhaps even 

 from the embryo. 



Now the more definite and prevalent the outer causes, 

 (s in the more notable Infectious diseases, the better 

 is our position, if we can discover the laws of them, 

 to take preventive and defensive measures on an ex- 

 tensive 'scale, and to entrust them to public physicians 

 acting on behalf of Individuals only as members of a 

 community. On the other hand, the more a disease 

 NO. 175 1, VOL. 68] 



is the outcome of individual and peculiar proclivities, 

 the less are such public and universal precautions avail- 

 able against it. Public health may be secured by uni- 

 versal rules and enterprises, but the health of in- 

 dividuals, so far as it involves a study of the constitu- 

 tion of each one of them, must be a matter of private 

 practice ; though diseases such as phthisis, which arise 

 from a cooperation of general and personal factors, 

 need for their prevention a combination of public and 

 private means. 



In respect of epidemic infections, which can be 

 studied on public lines, and have more definite causes 

 and periods, much has been done in the way of pre- 

 vention since the time of those first medical officers of 

 health, the fetlshman or voodoo ; but, as Dr. Bulstrode 

 says in his able preface to the volume before us, simi- 

 lar investigation of remote and initial causes, and the 

 preventions to be based upon them when detected, have 

 made but little way as yet in constitutional diseases. 

 Indeed, Dr. Bulstrode goes so far as to suggest, justly 

 as we think, that one of the uses of this book on the 

 prevention of disease in its broader and yet more inti- 

 mate sense, will be to force upon the notice of 

 physicians that, meritorious as it is to stem the tide 

 of established maladies, this function would be less and 

 less in demand if our Insight Into and means of de- 

 tection of their Incipient terms were more largely de- 

 veloped. It is the chief merit of the work before us 

 that, perhaps for the first time, our conception of pre- 

 ventive medicine is carried in a formal and imposing 

 way beyond the sphere of the infections ; and the first 

 comprehensive attempt Is made to apply preventive 

 principles to the initial phases of all diseases. 



The dangers of such an enterprise are obvious ; when 

 we leave conspicuous and specific phases of change, 

 and seek for the more abstract and universal springs 

 of disordered health, we run the risk of losing not only 

 colour and vivacity, but grip and precision also. As 

 we empty our conceptions of individual characters, we 

 may lapse into platitude. In the construction then 

 of a pioneer work on these broad lines, and on 

 these remoter and vaguer conditions of disease, especial 

 care should be taken to avoid such triviality, and to 

 convince the reader that in tracing rivers to their 

 sources the explorers have not lost themselves in a 

 multitude of shallow rills and in a confusion of forests 

 and watersheds. In this somewhat uncomely, and, 

 seeing that illustrations were not needed, expensive 

 volume, we think that the dangers we have indicated 

 have not been avoided altogether. In a cooperative 

 work we expect to find writers of very wide differences 

 of merit; some good, some middling, some really 

 trivial : but the jealous regard for precision and touch 

 with nature which, as we have seen, should be the note 

 of such a work, and the antidote to its sum- 

 mary methods, has not always been enforced by the 

 editors. The introductory article on the history 

 of the prevention of disease among the Hindoos, 

 Chinese, Israelites, &c., was scarcely worth doing on 

 so small a scale, and is certainly slight enough : it 

 contains some interesting points; but others are not 

 thought out, many statements are loose, and not a few 



