VII
Modern concepts of disease are the result of a linking
of scientific thought, practical achievements, and social
factors. Bacteriology developed at a time when West-
ern countries were entering a new phase of the indus-
trial revolution, marked by the association of tech-
nology and science. Antiseptic surgery offered an
immediate practical application of the germ theory.
From the mid-seventies an increasing number of dis-
eases were made accessible to surgical treatment; more
important perhaps, surgical treatment could increas-
ingly count on a successful outcome. Here was one
branch of medicine where medical help promised re-
sults rather than mere hope. Health began to take on
the nature of a purchasable good, but at the same time,
the purchase of health began to become more costly.
Major surgical operations now were more easily per-
formed in the hospital than at home, and the replace-
ment of antiseptic surgery by aseptic methods rein-
forced this trend. The pattern that surgery established
by utilizing scientific methods was followed by internal
medicine, which also relied more and more on the
laboratory and on hospital facilities. Application of the
principles of bacteriological sterilization led to obvious
results in decreasing infant mortality. Bacteriology and
immunology offered scientific tools for the sanitation
of disease-ridden districts and the prevention of many
infectious diseases. DDT proved a successful contact
poison against the insect vectors of pathogenic mi-
crobes. The sulfonamides (1935) and, by the end of
World War II, the antibiotics, presented “miracle
drugs” in the treatment of infectious diseases.
Helped by these scientific achievements, the disease
picture since the middle of the twentieth century
differs from that of around 1900. The infectious diseases
have yielded their place in the table of mortality to
degenerative diseases, to tumors, and to accidents, and
life expectancy (particularly at birth) in Western na-
tions has continued to rise. The more possible it has
become to avoid diseases, or to be cured of them and
to enjoy health, the more health appears as a desirable
good to which everybody has a “right.” Such a right
did not extend to other purchasable goods, but the
special status that Christianity once granted to the sick
prepared the way for this special claim. Social devel-
opments during the nineteenth century moved the
matter from the realm of religion and philanthropy
to that of politics. Compulsory sickness insurance was
introduced in Germany in 1883 as a strategic measure
in Bismarck's fight against the social democrats. In the
twentieth century, other countries followed. In the
United States, voluntary insurance and medicare and
medicaid programs all serve the idea of making medi-
cal care available to an increasing number of people.
Western achievements look no less desirable elsewhere,
including the so-called underdeveloped countries. Even
in the League of Nations the health activities continued
after the decay of the political body. Its UN successor,
the World Health Organization, has accepted a pro
gram geared to the definition of health as “a state of
complete physical, mental, and social well-being and
not merely the absence of disease or infirmity.”
The history of the ideas of health and disease begins
with the crystallization of these ideas out of human
suffering. Of the stages through which these ideas have
gone, some belong to the past, others have merely seen
a metamorphosis. Disease as a physiological process
and disease as an entity are recurrent themes which
have been likened to the struggle between nominalism
and realism. Disease has been seen as nothing but a
form of misery, and health as part of man's salvation.
But there are also those, like Thomas Mann (The Magic
Mountain), who see a positive value in disease as the
price at which a higher form of health must be bought.
The prevailing tendency at the present moment seems
to merge disease once more with much that formerly
was considered distinct from it and to take so broad
a view of health as to make it all but indistinguishable
from happiness.
The history of the ideas of health and disease cannot
decide these issues; it can only present them. In doing
so it can, however, point out that health and disease
have not shown themselves to be immutable objects
of natural history. Health and disease are medical
concepts in the broadest sense. This means that man's
life in its inseparable union of body and mind is seen
under the aspects of possible preservation and cure.
Thus they are distinguished from purely scientific con-
cepts on the one hand and from purely social ones on
the other.
