Diseases of Civilization


Diseases of civilization are either caused by civilization or so greatly aggravated that it is almost the same thing as caused.  Infantile paralysis is an example of the latter.  Under primitive conditions with poor sanitation and contaminated water, everybody was frequently exposed to poliovirus from an early age.  Poliomyelitis is the modern synonym for infantile paralysis.  The new name resulted from the disease no longer being a disease of infancy.  The constant exposure to the virus under primitive conditions meant that most infants’ first contact with the virus was while they still had immunity from maternal antibody and colostrum resulting in an in-apparent infection conferring long term immunity.  Even in the 1950s when epidemics were prevalent, there were about 1000 in-apparent mild illnesses for every case of paralysis.  But the lack of early exposure because of modern sanitation resulted in many paralytic cases in young adults.


Asthma is becoming more prevalent in modern times for reasons that are not entirely clear.  It is known that allergic individuals have enhanced immunity to multicellular parasites such as hookworm and schistosomiasis.  Perhaps if these immune mechanisms are not pinned down resisting multicellular parasites they “spin their wheels” resisting ragweed, pollen and cat dander, a nonconstructive endeavor.  Other forms of chronic lung disease are even more associated with civilization than asthma.  Consider silicosis, asbestosis, farmer’s lung, silo filler’s disease, emphysema and even cancer of the lung.


The metabolic syndrome is a modern concept which includes obesity, diabetes mellitus, high blood pressure, hypercholesterolemia with more than one of them present in most individual cases.  The tie-in to civilization is abundance of food and less physical activity.  In my experience in the underdeveloped world in Afghanistan from 1968 to 1970, the only group at risk for metabolic syndrome was very important people with plenty of servants.  Perhaps under truly primitive conditions, even very important people would not have been that important.


Arsenic poisoning from deep wells in northeastern, India and adjacent Bangladesh has become a major problem in recent decades.  These wells were drilled unnecessarily deep by contractors paid by the foot.  The deeper aquifers turned out to be geologically contaminated by arsenic hearing strata.  This qualifies as a disease of civilization on several counts.  Ironically, the wells were created to provide safe water.


Lead pipes were used by the Romans in their water systems and the resulting lead poisoning probably contributed to the decline of the empire especially because affluent leaders could afford luxury plumbing.  If the Roman aristocrats didn’t get lead poisoning from plumbing, they could get it from wine stored in lead containers.  Wine dissolves more lead than water and the resulting lead acetate imparts a pleasant taste.


Widespread aware ness of the problem of lead poisoning is quite modern.  I remember a case report 50 years ago of a Hollywood starlet with weakness, indigestion and nervous irritability who, in frustration at no diagnosis by many physicians, studied her symptoms in a public library and concluded that she had lead poisoning.  She had great difficulty persuading any of her physicians to test her for lead because of no history of exposure.  Even after a local university tested her and found the lead poisoning, the source was not found for several months.  The answer was bone meal she was taking from a health food store in increasing doses as her illness progressed and she hoped to help her symptoms with larger doses of health foods.  It turned out

that retired London police horses were the source of the bone meal.  Small doses of lead can be gradually stored in bones without much toxicity.  These aged horses had acquired large quantities of lead in their bones without any apparent ill effects to them by breathing traffic fumes most of their lives.  In the 1920s, when an octane enhancer for gasoline was sought, ethanol very nearly won the decision over lead.  At that time, we certainly knew more about lead poisoning than the Romans, but we went with tetra-ethyl lead anyway.


As a physician, I am entitled to be somewhat authoritative about diseases of civilization and how to mitigate them.  Two years in an underdeveloped country gave me a gut feeling that if the rest of the world lived as we Americans do, mankind could trash the planet in one more generation.  I resolved never again to buy a car which didn’t get at least 30 miles per gallon, to use public transportation when feasible, build an energy efficient house, conserve water, compost appropriate wastes, live in a compact community where most errands are within walking distance, and minimize lawn area to avoid temptation to use unnecessary chemicals.  Note that the net cost of these measures is less than zero.


John A. Frantz

Chairman, Monroe City Board of Health

February 7, 2002




The “Pediatrician” as Unindicted Co-conspirator


Why to faucets drip?  Because they can’t go sni…i…i…f…f.  Even some grown up kids think this is funny.  It comes up in medical practice because vigorous nose blowing, like until your ears pop, may blow infected mucous through the tubes from your throat to the ear and promote a middle ear infection.  So how do you explain all this to a grandma who is only satisfied with a stentorian nose blowing?  You don’t.  You simply hide behind your handkerchief and sni…i…i…f…f, approximating the blowing sound.  The advanced conspiracy is to blow gently first, just in case of an extemporaneous inspection.


In my childhood, if you were sick enough to stay home from school, you stayed in bed.  Maybe the family doctor made a house call.  In those days, medicine was not as specialized as now:  Our family doctor was the head of the Department of Internal Medicine at Indiana University Medical School.  He talked directly to me and my mother listened in.  It was never like the veterinarian talking only to the farmer.  This man has been a medical role model for me.  I like to think the unindicted co-conspirator approach with young patients has enhanced their future relationships with physicians later in their lives.