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Nature, Disease, Germs and Contagion
- Wilfrid Laurier University Press
- Chapter
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Nature, Disease, Germs and Contagion I n this last part we return to the broad themes outlined in the introduction: Nightingale’s views on the nature of health and disease, the causes of disease (especially germ theory vs. contagion ) and the role in health promotion of medicine, nutrition and preventive sanitary measures such as clean water and safe sewage disposal . Here we see Nightingale make her case that ‘‘medicine does not cure,’’ but rather is the means to ascertain the obstacles in Nature’s way and to remove them. ‘‘Nature only’’ cures (see p 510 below). The material consists of letters, often in answer to specific inquiries, and notes, arranged chronologically. There is one short paper. The issues range among scarlet fever, scurvy, pyemia, cretinism and idiocy, cholera, leprosy, consumption, ulcerated legs, typhus, ‘‘poisoned’’ air, cancer and quack doctors, ‘‘hydropathic’’ treatment (water cures), the need for physical exercise in schools, nutrition, children’s epidemics, ventilation and drainage in schools, soft vs. hard water, the influence of weather and climate on health status, cattle plague and animal slaughter , quarantine and the safe disposal of human and animal waste. One letter asks a question regarding gender balance in plans for the Aylesbury Infirmary in Buckinghamshire, noting the underrepresentation of women generally in county hospitals and the fact that ‘‘never (or hardly ever)’’ were women given a ‘‘capital operation’’ (see p 517 below). This appears only as a matter of fact to be ascertained , for no female surgical ward would be needed should this disproportion be expected to hold in Buckinghamshire. Nightingale did not campaign for more operations for women; she was medically conservative , generally preferred the least intervention possible and knew the risks of hospital stays. Did she wonder whether, if ‘‘capital operations ’’ were good for men, they were not used more for women? The material spans nearly all of Nightingale’s professional lifetime, from 1857 (early post-Crimea) to the late 1890s. Throughout it we see / 509 her key principles: to build health with positive measures (clean air and water, healthy diet), drawing on relevant experience and especially statistics to determine the most effective means of intervention. She brings the best expertise to bear on the subject at hand. She seeks the most appropriate administrative structure for optimum results and brings in international examples where experience warrants it. In examining Nightingale’s response it is important to remember both components of her underlying philosophical approach to disease and health care: the determination of scientific laws and belief in a perfect God who seeks the good of all creatures. It is difficult for those of us who read her now in societies where science has been the reigning philosophy for decades to realize how different the intellectual climate was in her day. Many people then believed that disease, like famine and war, were visitations of divine wrath to punish people for their sins. Churches by and large taught this (although many church leaders did not share this view). Nightingale’s own church still used the litany which asked God to ‘‘deliver’’ us from these various horrible things. The scientific community of course rejected any view of divine revenge, but the widely held doctrines of the political economy school led to a similar quiescence. Plague and disease were held to be naturally caused and functional for population control; human intervention was discouraged and derided as futile or even counterproductive . Nightingale and her kindred spirits rejected, with the scientists , any view that divine wrath plays a role in the causation of disease , but insisted on the possibility, even the urgent need, for vigorous intervention in disease prevention and health promotion, for God called people to be co-workers with Him in the world. Knowledge, gained with scientific tools, could be used to make the world better. Following this far-ranging material comes Nightingale’s work, most of it late in life, to address the specific issue of rural health. The same principles of course apply: health promotion and disease prevention, which are now to be the work of a new occupation, women ‘‘health missioners.’’ The section ends with Nightingale’s 1894 paper, ‘‘Rural Hygiene,’’ which sums up these concerns. Source: Undated note, Add Mss 45845 ff4-5 Medicine does not cure. It is Nature only that cures. All that medicine has to do is to find out what prevents the operations of Nature in curing —and then by the most careful accumulation of facts to ascertain what is the remedy to remove the obstruction...