Brian Altonen, MPH, MS

The following is from the Appendix of an 1848 book on Medicinische-Geographische.  The original text is in German.

This section is provided due to the unique take the German culture had on the environmental, the onset of disease in humans and the gestalt of the two.  The question during this time is ‘does disease happen because of place, people, or both?’  If it occurs because of place, than can we avoid it by moving to another location?  and when we do decide to move, what diseases are there waiting for us?

The questions stem from the ongoing issue of heritage and tendency for people to get ill due to lineage.  This would later be equated with the concept of inheriting the bad genes from a family, but such a conclusion was still generations away from being developed.  Charles Darwin’s work on evolution and natural selection had yet to impact large numbers of people.   So the ongoing belief was that we adapted to our environment, meaning that in a generation or two our children or grandchildren will be more able to survive the conditions that threaten our health today.

Now of course, some diseases were never avoidable from one generation to the next.  Consumption was such an example.  People moved from one place to the next to reduce their problems with the consumption, and so this supported the links being drawn between place and manifesting your disease state.

By the 1850s, just before the second world cholera epidemic, enough theories were out there about the cause for disease for a very detailed nosology or classification system of diseases to develop based on the theory as to their causes.  There were two chief nosologies then forming–that of the physicians who believed in the zymotic theory and those who believed in the miasma theory.  The zymotic theory is covered elsewhere, and relies heavily upon assigning blame for certain diseases on the lack of a sanitative, hygienic lifestyle.  The miasma theory removed some of this blame on the victims of the disease, and pointed the finger at nature, although human choices were still responsible for your exposing yourselves to these risks of nature.

This disease philosophy is primarily from the German literature.  It fits into the eclectic medicine scheme of philosophies more than the pro-zymotic allopaths.  But the other alternative medicine for the time, homeopathy, would probably have the most followers familiar with and believing in this German theory for diseases.  The German communities in central Pennsylvania near Allentown, on west into the Great Plains would respond most to this belief system.  This is why when we explore the various theories proposed for cholera during the 1849 to 1856 period of time, we find many telluric and miasmatic theories being defined.  Some of these would later be summarized.

The Germanic aspect of the miasma theory focused on both the atmospheric/climatic and telluric or earthen element for the development of miasma by nature.  This philosophy was open to electromagnetic field theories as well when it came to defining certain diseases.  In America, the theorists became more focused on the physical world and disease, using such bits of nature as as rocks, minerals, water, plants and decaying organic debris to explain the causes.  The Germans would add telluric energy and magnetic conditions involving the sun, earth, meteors, thunderstorms, volcanoes, etc. to remain more metaphysical about the pathogenic process.  On some occasions, the English doctors also tried to take off with certain parts of these energy based theories.  When zymotic theory was at its peak in the 1870s, we see the English telluric and energy field theories also reaching a peak.  They too are covered on other pages at this site.

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APPENDIX

A MIASMA MEDICINISCHE-GEOGRAPHISCHE DISEASE THEORY, TAXONOMY & NOSOLOGY

Introduction

In recent years, a great majority of physicians have together claimed that there is special pathology people suffer comprised of ontological entities or beings that together they have assigned the special name Ontologisten. This widespread following recognizes the main feature of such an entity to be a particular set of symptoms or Symptomatic groupings, a complex of external signs and symptoms that are related to one another and that together are considered indicators of the construct of the disease, of the disease entity or true inner reason for why the disease exists, and something to concern themselves with, something for which they would be considered reckless if they did not stringently investigate any physiological relationship they had with a sickness phenomena, in its internal and external characters, instead of simply indulging in the empirical knowledge of the disease, and with the final goal of developing a treatment against this particular disease, a widely adoptable plan of salvation, an entire course of action to pursue as a physician.

There has always been a certain crudeness of the practices engaged in by empiricist veterans, who were overly anxious to dissect the concrete cause of an illness on down to its physiological relations and to speak figuratively, penetrating just the outer surface of the focus for this conversation. They were happy when they were the young children in this profession, easily identifying the external characteristics of a disease to which they give a name, with which they could thereby define its required medical treatment. The glory of this practice as an art was also taken for granted by these empiricists, the number of whom never seemed to be exhausted; but there were always those the doctors who had to do better, by comparing the external symptoms with the inner body. This interest in pathological anatomy is not a new-born child of our day, and it would be ungrateful if we forgot the overweening confidence its recent acquisitions have had, such as the interest in knowledge made by Bonet, Morgagni and others Scholars that supercede other much earlier, more outdated writings.

One should want to take the abstract concept of that which we call disease [today], related it to the expression of one’s own self existence, one’s being self-contained, living as a healthy organism put together in association with its own laws of life or being (the ens); [this is] a popular belief to many, with the loud uplifting voice of the Reformists of this profession using it to partly or fully express their rights to this view. I fear, however, due to their fear of taking on this ontological way of looking at risk, that they are throwing out the baby with the bathwater, along with the special pathology so close to this way of thinking, concealing it completely, in order to allow more space to be filled in some other semiotical way.  Specific diseases are identical to the special pathology they have, or have symptoms that may get lost if a fragmented perception of these individual conditions were only to develop.  Therefore, we must ask the question whether to a certain degree, are Symptoms Complexes (“Symplomencomplexe”) signs of cause of disease, or are they the disease itself?

This corresponds to whether the nature of the disease is that which is or can be deduced from a hospital medical interpretation of the patient. We generally do not explain the general meaning of the term pathological disease. Suffice it to say that any kind of deviation from that type of [pathological] approach in which one recognizes health, is generally not applied to disease.

All life is manifested in the expressions of life we make.  From the diversity of the expressions of life we can be seen how far our functions represent a type of healthy living faithfully and relate them to a knowledge of the Symptoms Complex, to determine how different the two routes are once the two routes collide to form one, with one leading from the inside of the body to the outside, or the other, from the outside on to the inside.  This is the second empirical theory of health– both [routes] complement each other and are the roots of the tree of the knowledge of disease.

Thus the investigation of the disease is twofold in terms of the object of observations. First, initiate and maintain your treatment for reasons related to the morbid material or function that is totally changing within the organism, and as a result, the healing of organic abnormality ensues; the disease must then also be examined for its genetic and its other formal reasons for happening or relationships to the individual so afflicted.

[Large Section Skipped]

Through the knowledge of the causes which have brought about the current as pathological changes, we gain an understanding of the whole process. Due to the diversity of causal factors influencing the variety of the effects of these changes in the organic matter, these changes are not limited. I have already remarked that for the study of the origin of each form of the disease, there is a genetic side of importance of knowledge that must be pursued regarding how the two complement each other. I draw special attention to this for of etiology everywhere in this work.

The disease causes are either

1) natural, always acting on the organism through external stimuli, which are only disease-causing when the interactions between them and the individual (often already diseased or predisposed) organism produces changes that are different from the health type, and so what you eat and drink, the air, heat, the sensory stimuli, etc. are  injurious. How that happens is to be discussed in more detail, in terms of the general pathology.

Or

2) some special agents which are not amongst the natural stimuli causes, and often are very peculiar, specifically change the organism; these are the poisons, miasmas, contagions, and parasites.

The relation of this last class of medical healing and how it causes the disease is unique. The heat generated by the noxious agent or change in organic matter must still abide by the general physiological laws of life. But the harmful agent itself often has a degree of independence, which does not undergo a matching influence by the organism to reason; according to its own laws, this indwelling causative agent is only received for a short time, during which it survives and then eventually disappears after a certain duration.  It most clearly occurs as a result of substance generated by miasma, or for contagion diseases of a parasitic nature with a causative agent that can not be ignore; the same can be produced by germs that the organism receives and incorporates into the body.  This agent avenges the body in a fixed form during a certain period of time, and then passes through different stages of development in the blood, multiplies and produces new seeds, which are then transferred to other organisms that go through the same process again.

It is certainly conducive to contemplation, that those diseases whose cause is known or which specifically do not otherwise arise as from a special agent, can have reasons cause to unite in a particular class [in a special way] and are reviewed in a separate investigation of these forms of disease. These conditions deserve the name: special sickness processes or Кrankheitsprocesse (they have also been called disease species, which seems to me less fit). The phenomena of these specific diseases can be traced back to humans; the specific cause of the disease divides but the form of the disease in choosing the modified portions of organs, design and development of the phenomena with a peculiar character, which witness to the independence of the disease causing potency testimony. Their course is usually strictly cyclic, and can often be in any way possible interruptive and arbitrary in nature and frequency, even started unalterably as if bound to a fixed period of time, and afterward, resulting in the termination of life, as if the organism had a limited life beyond which they could no longer survive disease-ridden [Krankheitsresiduen], it infects and leaves the infected individual only once. These diseases are usually of pandemic occurrence and are realted to peculiar natural events (cosmic disease processes).

In the present state of science, it is very difficult to determine with confidence which diseases are included in the class of the specific disease processes, etc.  We herein allow a certain latitude and define those diseases by their etiological factor, which although not constant often remains the same, even when not all of the above enumerated characteristics are applicable to them. The outermost boundary types of disease may well be grouped with the certain disease morbid processes. It must be accepted that nowadays a fixed,unchanging classification of diseases is generally not possible.  Any such attempts to produce one of these is only a temporary middle of the road approach for preparing a report on the disposition of matters at hand for those so afflicted.

It is also a futile and worthless effort to engage in this so long as the specific disease causes are not known and summarized.  Anysuch endeavor, if it is to be, is for something that needs to appear scientifically completed, meeting certain multiple needs, perhaps even of a hostile nature. Nevertheless, the Generalist way of thinking contained within the human mind is not entirely immune to the temptation for such activities, and may look in such a direction as part of conscious merely hypothetical sense of wishing to linked points together for what can together formed by the scattered thoughts of individuals.

From this standpoint, I describe the specific morbid processes detailed above as follows:

Ordnungen 1

Specifische exanthematische Krankheitsprocesse

Exanthematous specific disease processes

Variola Variolois Varicella

Einleitung 11

(Vaccinia, eigentlich su den durch Thiergifte erzeugten Krankheilen gehörig, aber sich auch natürlich als Schutzmittel hier anreihend).

(Vaccinia, actually below those produced by animal poisons medical healing properly, but also as part of a protection course here)

Or,

(Vaccinia, actually belong to the venoms produced by medical cure, but also as a natural preservative anreibend here)

Scharlach

Masern

Miliaria

Erysipelas

Erythema

Zoster

Urticaria

Rotheln

2 Malaria seuchon (Krankheitsprocesse durch speeifische tellurisch atmosphärische Miasmen erzeugt)

Recommended Has: Malaria seuche (Krankheitsprozesse durch spezifische tellurisch atmosphärische Miasmen erzeugt)

Malaria disease (disease processes by specific telluric atmospheric miasma generated)

Malaria seuchon (morbid processes generated by speeifische telluric atmospheric miasma)

Wechselfieber (Intermittent)

Gelbes Fieber (Yellow)

Cholera

Pest

Ruhr (Dystentery)

3 Typhen (Krankheitsprocesse durch specifisches animales Miasma erzeugt) (disease processes by specifisches animales miasma generated)

Petechialtyphus (Typhus)

Ileotyphus (Enteric Fever)

Ruhr oder Colotyphus (Dysentery)

4 Atmosphärilische Seuchen (Krankheitsprocesse, durch atmosphärische Agentien die sich zuweilen zu Miasmen gestalten, erzeugt) (disease processes, by atmospheric agents sometimes make the miasms to be created)

Recommended: Atmosphärische Seuchen (Krankheitsprozesse, durch atmosphärische Agentien die sich zuweilen zu Miasmen gestalten, erzeugt)

Atmospheric disease (disease processes, by atmospheric agents sometimes to make the miasma created)

A.  Erkältungskrankheiten (Colds)

a Rheumatosen

b Catarrhe; Influenza; Keuchhusten (Whoopng Cough)

B Hitzekrankheiten (Heat Illnesses)

Cholosen

5 Thiergiftseuchen (Krankheitsprocesse, durch speeifische Krankheitsgifte von Thieren erzeugt) (Poison animal diseases (disease processes, generated by speeifische disease poisons of animals)

Rotz (Glanders)

Anthrax

Hundswuth (Hydrophobia)

Vaccinia

Räude (Maul- und Klauenseuche) etc  (Mange (foot-and-mouth disease))

6 Chronische Seuchen, durch specifische Contagien oder specifisch endemische Verhältnisse erzeugt. (Chronic diseases, generated by specific contagions or specifically distinct endemic proportions.)

Syphilis

Lepra

Weichselzopf

Als Anhang durften bier als auch durch eigentümliche, sich gleich bleibende Ursachen hedingte Krankheilszustände anzureihen sein (As Appendix allowed beer and by peculiar, unchanging causes hedingte hospital medical conditions to be lined)

a) Toxicosen (durch Gifte aus dem anorganischen und organischen Reiche erzeugte Krankheiten) (by poisons from the inorganic and organic kingdoms produced diseases)

b) Traumen (durch äussere Verletzungen erzeugte Krankheiten) (generated by external injuries diseases)

c) Evolutionskrankheiten (Krankheiten, welche durch gewisse Entwicklungszustände des Organismus erzeugt oder modificirt warden, wie durch Dentition Menstruation, Wochenbett etc) (Evolution diseases (diseases that generated by certain developing states of the organism or modified warden, etc by dentition as menstruation, childbirth)

Angeborne Bildungsfehler (bone formation error)

d) Auch die Epi- und Entozoen gehören mit gewissem Rechte hieher (The epi-and entozoa belong here with certain rights)

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Without order but is scientific illustration of a doctrine is not possible and I do not think that those who deliberately the term lack of a sound Classificationsprincips spurn any systematic or sichs satisfy even let in a poor alphabetical list, proving by this resignation of science an essential service. They are similar sophists, like those who do not sin when they sleep. How wrong was also a regularity princip, — it brings its benefits in that it offers the criticism substance, the science wins not only the fact that they discovered truths, but also that it corrects errors.

Auf diese Gefahr hin stelle ich unter der allgemeinen Rubrik: chronische Dyskrasien oder Individualitätskrankheiten, folgende Krankheitsprocesse zusammen:

In this hazard that I put under the general heading: chronic blood dyscrasias or Individualitätskrankheiten together, following disease processes:

a)      Dyskrasien mit quantitativer oder qualitativer Veränderung natürlicher Blutbestandtheile

Polyämie (Plethora)

Anämie (Chlorose) [Mangel an Blutroth]

Scorbut und Morbus haemorhagicus [Mangel an Fibrin]

Cyanose

a) dyscrasias with quantitative or qualitative alteration of natural blood constituents Polyämie (plethora) Anemia (chlorosis) [lack of blood Roth] Scurvy and disease haemorhagicus [lack of fibrin] cyanosis

b)   Dyskrasien aus Zurückhaltung natürlicher Excretionsstoffe im Blute:

Dyscrasias from natural reticence Excretionsstoffe in the blood:

Icterus (gallige Dyskrasie) (bile dyscrasia)

Menoschesis, Menoplanie

Uroschesis, Urodialysis, Uroplanie

c) Dyskrasien mit Vorwiegen venöser Blutbeschaffenheit und Neigung zu kritisch homoplastischer Productbildung

Dyscrasias with predominance of venous blood consistency and inclination to critically homo plastic Product formation

Hämorrhoiden

Gicht (gout)

Weichselzopf

d)  Dyskrasien mit heteroplaslischer Productbildung

Dyscrasias with heteroplastic Product formation

Scrophulosis und Tuberculosis

Rhachitis

Krebsdyskrasie