Letters to the Editor

LETTERS TO THE EDITOR Dear Sir: I have been intrigued by Dr. Richards' article in the last number ofPerspectives on "Homeostasis: Its Dislocations and Perturbations." Specific terms for designating the different reactions distinguishable in the disease process have long been desirable; it is to be hoped that the words suggested do not suffer the fate in store for most such neologisms. Forme, the portiondealing with "responses" serves to supplementthe all too briefdiscussion on "action and reaction" given by White in The Meaning ofDisease, while that¦part concerned with "disorder" brings to mind Schneider's essay concerning the "unnatural " in Naturalism and the Human Spirit, edited by Krikorian. Most ofall, however, consideration is reverted to the writings ofT. C. E. Edouard Auber. Though Richards in his earlier contribution wrote, "In searching for the beginning of an idea, one can go into history as remotely as one pleases, and find some sort ofanalogy almost as far back as the written word can be traced," yet I note that now he is led to add, "Ifthe things we are thinking about were also in the minds ofother men at other times and in other places, there should be some gain in having before us even a part ofthose earlier thoughts." Auber had Richards' problems much in mind (Traité de la philosophie médicale [1839]; Traitéde ¡ascience médicale [1853]), tracing these questions all the way back to Hippocrates (Institutions ¿Hippocrate [1864]). To be sure, conceptions concerning "stability, equilibrium, change, and novelty"—as Lillie has phrased them in their fundamental guise—in relation to the theory of disease have ever been to the forefront in medical thinking, as is amply evidenced by Neuburger inhis Die Lehre von der Heilkraft derNatur.Justification here for calling attention especially to Auber rests on the circumstance that this thinker—one devoting his entire life to the cause ofthe philosophy ofmedicine—is a person lost to the annals ofmedical history. Anent Richards' problems, Auber in his Traité of 1853 has chapters dealing with such matters as: De la nosologie et de l'état morbide; de la science des causes morbifiques; de !action morbide ou de l'affection; de !action médicatrice ou de la réaction; de la maladieproprement dite; etc. Viewing the morbid state as representing the rencounter of life forms with diseaseproducing incitements, Auber is led to aver that there are three things to examine: the cause, the effect, and the consequence ofthat effect. The disease-state is met with in three degrees: indisposition, affection, and true sickness or malady. Indisposition, that "neutral constitution," (constitutio neutra), as Fernel put it, where one "is morbidly disquieted in his habitual or physiologic status," I must pass over in order to stay within the limits ofa simple communication. I think it not amiss, however, to cite a few of Auber's passages concerning affection and malady. 443 "By morbid affection is denoted thatlife state in which the economy, passively affected by a morbific cause, is the site ofan organic or vital lesion. It is the feature ofgravity that distinguishes affection from indisposition. In an affection, the economyis moreprofoundly acted on and more compromised than in an indisposition, but yet it supports the ill without expressly opposing the violence; it seeks to eliminate, to neutralize or destroy the source of the harm, but it still employs only mild measures and simple resources, thus avoiding in so far as possible the adding ofa greater affliction to a prior disorder. "True sickness, malady [malum adest, le mal est la] is the third and most severe degree of the disease-state; it is a complex condition in which an affection and a reaction are found conjointly. It is the contest ofnature against morbiferous influences. It is a torment oflife in which reaction is in struggle contra the affection and acts with full reparative power. In such case, force is opposed to force, where the spectator is witness to a combat in which nature menaced deploys all its means and all its resources. And what one must be fully cognizant ofis that in this struggle between morbiferal agent and nature the economy may succumb in one ofseveral ways: at times through the direct action...