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June 27, 2012

NEJM: How our perception of disease has evolved over 200 years

Daily Briefing

    In an article commemorating NEJM's 200th anniversary, Harvard researchers chronicle the evolution of diseases—and physicians' approaches to them—from 1812 to the present, emphasizing their "incontrovertibly social nature."

    Disease in the early 1800s

    According to the researchers, the earliest issues of NEJM describe "patients who might walk into a clinic today," while other cases "are nearly unrecognizable."

    For example, a bill of mortality from Boston in 1811 was dominated by patients who died from consumption, pneumonia, and diarrhea, but also who were killed by teething, worms, and drinking cold water. Similarly, physicians believed a near miss from a cannonball could shatter bones, blind, or even kill.

    Disease in the early 1900s

    However, only 100 years later, "the infections that filled the Journal had been redefined according to specific microbial causes." The researchers noted that NEJM was filled with mentions of scientific and medical progress.

    One NEJM editorial in 1912 suggested, "Perhaps in 1993, when all the preventable diseases have been eradicated, when the nature and cure of cancer have been discovered, and when eugenics has superseded evolution in the elimination of the unfit, our successors will look at back at these pages with a greater measure of superiority."

    However, some in NEJM expressed concern with modernization. A 1912 article decried the growing number of individuals who, thanks to automobiles, no longer walked more "than the few steps that are needed from the chamber to the elevator, from the elevator to the dining-room, or lounging-room, and then to the automobile."

    Disease since the mid-1900s

    The researchers write that chronic conditions gained prominence in the 20th century and "an obesity epidemic, feared in 1912, has come to pass." Meanwhile, infectious disease outbreaks like HIV and multidrug-resistant tuberculosis spurred ongoing vigilance against microbes.

    As a result, top causes of death evolved significantly over the course of the century. As of 2010, the top three causes of mortality were heart disease, cancer, and noninfectious airway diseases—whereas in 1900, the top three causes of death were pneumonia or influenza, tuberculosis, and gastrointestinal infections.

    Society's impact of disease—and its impact on society

    Mankind's impact on disease has taken many forms over the past 200 years, the researchers write. For example, advances in war technology removed cannonball injuries—frequent in 1812—from NEJM and replaced them with "a new and more terrible litany of war-related injuries." Similarly, advances in medicine and standards of living have changed disease trends. 

    "Diseases can never be reduced to molecular pathways, mere technical problems requiring treatments or cures," the researchers warn, adding, "Disease is a complex domain of human experience, involving explanation, expectation, and meaning." They conclude that physicians "must acknowledge this complexity and formulate theories, practices, and systems that fully address the breadth and subtlety of disease" (Jones et al., NEJM, 6/21 [subscription required]).

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    1. Current ArticleNEJM: How our perception of disease has evolved over 200 years

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