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By Alec Burton
One of the main features which distinguishes Hygiene from systems of caring for people is the unique conception of the nature of disease. Health and disease represent a continuum that goes from the absolute optimum of functional excellence to the extreme of structural degeneration, just short of death. Health and disease are relative terms not absolutes. Absolute health and absolute disease are both nonsense terms. If, as we claim, health and disease are processes, they must also be relative.

The degree of health attainable by an organism, given the most favourable environment, is limited by genetic and congenital factors that impose irrevocable limitations on its functional performance. For practical purposes this may not be important but alternatively it may be crucial. Health and disease are varieties of functional display, the former we call normal, the latter, abnormal. Health represents a dynamic quality of physiological action sustained by the organism where the internal environment is conducive to its survival.

The internal state is autonomously regulated to meet the fluctuating demands of a continuously changing external environment. The actions of self-regulation and the resulting efficiency with which the organism copes with the demands of its environment represent its health the only essential difference in disease is that the internal environment is not conducive to survival. There has been some disturbance of homeostasis, (stability of the internal environment). But the autonomous regulation is attempting to restore this medium to a salubrious condition by modifying the physiological actions to a point where we consider them pathological (accelerating, diminishing, suspending) etc. At the point where a function is arbitrarily deemed abnormal, disease is manifested.

There is often no clear distinction between normal and abnormal function. The normal performance of the stomach as an organ of digestion is to retain food. If it fails to do this and vomiting occurs this is a sign or feature of disease. It is abnormal and pathological, however, the action of the organism cannot be separated from the causes and the assessment of health must be related to the conditions favourable and unfavourable that comprise the environment in which the organism survives. Vomiting is abnormal, it is pathological it represents one of the signs of disease but it does not necessarily mean the organism is not, in a broad sense, healthy. An organism manifesting an optimum state of health, May, inadvertently, ingest some virulent poison and suddenly health is impaired, disease develops (within a matter of seconds or minutes) vomiting occurs, distress, pain, frustration, dehydration, pallor, palpitation, delirium, coma and death. During this brief period, the actions of the organism have been modified from physiological to pathological, from maintaining the internal constancy (homeostasis) to desperately attempting to restore it.

It is important then that we understand that our use of the terms “health” and “disease” refer to actions or processes not to states or conditions. Actions can change almost instantly and the healthy can display disease very quickly. The autonomous processes restoring normality and health is restored.

Therefore the concepts do not imply any static condition which is stable and rigid. Health and disease are fluctuating qualities on a continuum with optimum health at one end and death at the other.

However, all of us tend to lapse into a semantic error occasionally and we use the word “health” to describe our general and fluctuating condition, but the danger is when we use the term several times in a discussion with different meanings at one time from another. As the term?s “health” and “disease” are important to our total philosophy it is essential that we restrict their meanings to prevent ambiguity or equivocation. Both terms have meanings other than the one I have chosen to adopt but unless we are clear about what the hygienists means by the terms our literature will be as confusing and contradictory as most others on the subject. As an example, we commonly find in popular magazines, newspapers

As an example, we commonly find in popular magazines, newspapers and medical books disease referred to as communicable, contagious, infectious, inflammatory, disabling, neo-plastic, etc. Measles is a disease, anaemia is a disease, paralysis is a disease, contagious disease is a problem of identity. The disease is regarded as an entity capable of being transferred from one person to another. It is implicitly independent of the body which it is said to “attack”.

Now in the context in which the term is used it becomes apparent that it is not the disease which is transferred but its assumed cause, the virus or germ. So one common fallacy involves the use of the term “disease” to designate a “cause”. Processes of information, fever and vomiting in common with the hygienists’ views, designated symptoms and signs of disease, such as we might encounter in so called measles. Finally conditions such as anaemia, paralysis and cataract are included as a category of disease, which in the hygienists opinion are not “actions” but “degenerations” or end results of the causes. The point is that the term “disease” is used to refer to three distinct concepts:
1. The cause
2. The process
3. The results of the cause upon living tissue

To make the point more distinct, consider the following example: a man strikes his hand with a hammer whilst carelessly woodworking. The tissues are bruised, torn, bleeding, the bones are broken and the joints crushed.

What is involved?
1. The immediate cause of the injury is the hammer
2. The tissues are painful, bleeding and inflamed

These are legitimate processes of disease, the repair of damage, defensive, reparative and adaptive change the bleeding ceases, the inflammation subsides, the lesions heal, the bones knit. Recovery has taken place; the “disease” no longer exists.
3. There is a resulting deformity and scar formation that is permanent. This is not disease but the end results of the cause.

Infectious disease refers to the “cause”; inflammatory disease refers legitimately to “actions”. Anaemia, cataract etc. refer to the end results of causes, they’re not processes, although there are processes involved at some stage which do represent the “disease”.

The processes are the organisms unsuccessful mechanisms of defence and adaptation to the persistent cause. Therefore it becomes obvious that people do not die from disease but from the causes, where degeneration and death are the results of persistent causes, causes which proceed ignored and unremoved.