Gerald N. Grob - Aging Bones: A Short History of Osteoporosis

AGING BONES

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Allan V. Horwitz, Anxiety: A Short History

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Gerald N. Grob, Aging Bones: A Short History of Osteoporosis

AGING BONES

A Short History of Osteoporosis

Gerald N. Grob

2014 Johns Hopkins University Press
All rights reserved. Published 2014
Printed in the United States of America on acid-free paper
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Library of Congress Cataloging-in-Publication Data

Grob, Gerald N., 1931
Aging bones : a short history of osteoporosis / Gerald N. Grob.
p. ; cm. (Johns Hopkins biographies of disease)
Includes bibliographical references and index.
ISBN 978-1-4214-1318-1 (pbk. : alk. paper)ISBN 1-4214-1318-3 (pbk. : alk. paper)
ISBN 978-1-4214-1319-8 (electronic)ISBN 1-4214-1319-1 (electronic)
I. Title. II. Series: Johns Hopkins biographies of disease.
[DNLM: 1. OsteoporosishistoryUnited States. WE 11 AA1]
RC931.O73
616.7'16dc23 2013028969

A catalog record for this book is available from the British Library.

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Disease is a fundamental aspect of the human condition. Ancient bones tell us that pathological processes are older than humankinds written records, and sickness and death still confound us. We have not banished pain, disability, or the fear of death, even if, on the average, we die at older ages, of chronic and not acute ills, in hospital or hospice beds and not in our own homes. Disease is something men and women feel. It is experienced in our bodiesbut also in our minds and emotions. It can bring pain and incapacity and hinder us at work and in meeting family responsibilities. Disease demands explanations; we think about it and ask questions when affected by it. Why have I become ill? And why now? How is my body different in sickness from its quiet and unobtrusive functioning in health? Why, when an epidemic rages, has a community been scourged?

Answers to such ageless questions necessarily mirror and express time- and place-specific ideas, social assumptions, and technological options. In this sense, disease has always been a social and linguistic entity, a cultural as well as a biological one. In the Hippocratic era, more than two thousand years ago, physiciansand we have always had them with uswere limited to the evidence of their senses in diagnosing a fever, a gradual wasting, an abnormal discharge, or seizures. Their notions of the material basis for such felt and visible symptoms necessarily reflected and incorporated then-prevalent philosophical and physiological notions, a speculative world of disordered humors, breath, and pathogenic local environments. Today we can call on a rather different variety of scientific understandings and an armory of diagnostic practicestools that allow us to diagnose ailments not felt by patients and imperceptible to a doctors unaided senses. In the past century, disease has also increasingly become a bureaucratic phenomenon, since sickness has been defined (and in that sense constituted) by formal disease classifications, screening practices, treatment protocols, and laboratory thresholds.

Sickness is also linked to climatic and geographic factors. How and where we live and how we distribute our resources all contribute to the incidence of disease. For example, ailments such as typhus, plague, malaria, dengue, and yellow fever reflect specific environments that we have shared with our insect contemporaries. But humankinds physical circumstances are determined in part by culture and climateand especially by agricultural practices in the millennia before the growth of cities and industry. Environment, demography, economic circumstances, and applied medical knowledge all interact to create distinctly mapped distributions of disease at particular places and specific moments in time. The twenty-first-century ecology of sickness in the developed world is marked, for instance, by the dominance of chronic and degenerative illnesskidney and cardiovascular-system ailments, and cancer. What we eat and the work we do or do not doour physical as well as our cultural environmentall help determine our health and longevity.

Disease is historically as well as ecologically specific. Or perhaps I should say that every disease has a unique past. Once discerned and named, every disease claims its own history. At the primary level, biology creates that identity. Symptoms and epidemiology, generation-specific cultural values, and scientific understanding all shape our responses to illness. Some writers may have romanticized tuberculosisthink of Greta Garbo as Camille but, as the distinguished medical historian Owsei Temkin noted dryly, no one has ever thought to romanticize dysentery. Tuberculosis was pervasive in nineteenth-century Europe and North America and killed far more women and men than cholera did, but the former contagion never mobilized the same widespread and policy-shifting anxiety as the latter. Tuberculosis was a familiar aspect of lifeto be endured if not precisely accepted. Unlike tuberculosis, cholera killed quickly and dramatically and was never accepted as a condition of life in Europe and North America. Its episodic visits were anticipated with fear. Sporadic cases of influenza are normally invisible, remaining indistinguishable among a variety of respiratory infections; waves of epidemic flu are all too visible. Syphilis and other sexually transmitted diseases, to cite another example, have had a peculiar and morally inflected attitudinal history. Some maladies, such as smallpox or malaria, have a long history; others, like AIDS, a rather short one. Some, like diabetes and cardiovascular disease, have flourished in modern circumstances; others reflect the realities of an earlier and economically less-developed world.

These arguments constitute the logic motivating and underlying Johns Hopkins Biographies of Disease. Biography implies an identity, a chronology, and a narrativea movement in and through time. Once each disease entity is inscribed by name in our collective understanding of medicine and the body, it becomes a part of that collective understanding, and thus inevitably shapes the way in which individual men and women think about the symptoms they experience and their future health prospects. Each historically visible entityeach diseasehas a distinct history, even if that history is not always coterminous with entities familiar to twenty-first-century physicians. The very notion of specific disease entitiesfixed and based on a defining mechanismis a historical artifact in itself. Dropsy and Brights disease are no longer terms in everyday clinical practice, but they are an unavoidable part of the history of chronic kidney disease. Nor do we speak today of essential, continued, bilious, and remittent fevers as meaningful categories. Fever is now a symptom, the bodys physiological response to a triggering circumstance. It is no longer a disease, as it had been through millennia of human history. Flux, or diarrhea, is similarly no longer an entity, but a symptom associated with a variety of specific and non-specific causes. We have come to assume there will be a diagnosis when we feel pain or suffer incapacitywe expect the world of medicine to at once categorize, explain, and predict ailments.