Proximate cause

“ Hence the difficulty of determining, under what class of diseases parturition should be arranged, consists in there being two kinds of diseased actions comprehended under one word; which have each their different proximate cause.
In Sect. XXXIX. 8. 4. and in Class II. 1. 1. 1. we have endeavoured to give names to four links of animal causation, which conveniently apply to the classification of diseases; thus in common nictitation, or winking with the eyes without our attention to it, the increased irritation is the proximate cause; the stimulus of the air on the dry cornea is the remote cause ”

“ He said:
'To treat proxima causa as the cause which is nearest in time is out of the question. Causes are spoken of as if they were as distinct from one another as beads in a row or links in a chain, but-if this metaphysical topic has to be referred to-it is not wholly so. The chain of causation is a handy expression, but the figure is inadequate. ”

“ It is difficult to believe, at any rate where physical laws are concerned, that the earlier part of the process which is the cause can make any difference to the effect, so long as the later part of the process which is the cause remains unchanged. Suppose, for example, that a man dies of arsenic poisoning, we say that his taking arsenic was the cause of death. ”

“ The conditions of every causation are multifarious as we look at them in a regressus of causes or a progressus of effects, and as the mind of the individual can make but one judgment at a time, it may be that the one of the causes or effects which is considered, is in fact a trivial element in the causation, for in all our language we are accustomed to speak of one of the causes as the special cause, for it must be the special one in consideration. ”

“ Morbid variations of structure and function present three leading phases of action, the acute, chronic, and diathetic. The primary causes of each are the same, a faulty personal hygiene and an unfavorable environment, but a derivative cause very generally predominates in the heritage of a defect or taint in the blood. In acute variations the struggle between the tendency to death and the tendency to reversion is usually short and severe, but decisive. The contending forces are often so nearly equal that a very little will turn the scale one way or the other. ”

“ Yet, in this respect, the prevailing notions are much less correct than they ought to be, and numbers are daily regarded as in perfect health, who, on a very slight examination, would shew evidences of such derangement of function, as only awaited an adequate exciting cause to be aroused into disease of the most intense activity. The habit too much obtains of ascribing the degree of severity of disease to the activity of the exciting cause. Much more truly would it be imputed to the state of constitution to which the exciting cause is applied. ”

“ Among the positive conditions, as we have seen that there are some to which, in common parlance, the term cause is more readily and frequently awarded, so there are others to which it is, in ordinary circumstances, refused. In most cases of causation a distinction is commonly drawn between something which acts, and some other thing which is acted upon; between an agent and a patient. ”

“ Uncertainty of conclusion.
(a) Plurality of causes is mentioned by Mill as constituting the “characteristic imperfection” of the method of agreement. As the term signifies, plurality of causes represents a condition where a given phenomenon has more than one cause, or where different causes produce the same effect. For example, “A poor crop” may be due to drought, neglect, pests, etc.; heat may be caused by friction, electricity, combustion. Unfavorable home conditions; ill health; dislike for teacher—any one of these might be followed by irregular attendance. ”

“ If casual or irregular disturbing causes exist, we should probably require many such cycles of results to render their effect inappreciable. We obtain the desired result by taking the mean of all the367 observations in which a cause acts positively, and the mean of all in which it acts negatively. ”

“ The Common Fundamental Cause in the Nature of Diseases All the phases of the process of development of the medical science, including those of the earliest periods of civilization, have in their way of understanding the causal nature of diseases that one thing in common that the diseases, owing to external causes, enter into the human body and thus, by force of a necessary or at least unavoidable law, disturb it in its existence, cause it pain and at last destroy it. ”

“ When the macroscopic changes are of moderate degree, and the disturbance of function relatively slight, while the concurrent alterations elsewhere, from the simultaneous action of the same cause, are predominant and characteristic of the disease, the condition is conveniently regarded as a degeneration occurring in the course of the latter, rather than an inflammation. ”

“ Is the circumstance of intercourse with the sick followed by the appearance of the disease in a proportion of cases so much greater than any other circumstance common to any portion of the inhabitants of the place under observation, as to make it inconceivable that the succession of cases occurring in persons having that intercourse should have been the result of chance? If so, the inference is unavoidable, that that intercourse must have acted as a cause of the disease. ”

“ There are, indeed, so many different causes suggested, sometimes of quite opposite or even contradictory effects, that it seems evident that the main element in the disease is some predisposition to sensitiveness in this region which is exaggerated and emphasized by the cause that is blamed. It occurs particularly in women, though it is occasionally seen in delicate or neurotic men. ”

“ Whence comes it that from any given exposure to an exciting cause, no two persons will be affected alike, or in the same degree? Some may suffer severely, others be slightly affected, while by far the greater number will escape altogether. ”

“ But when we seek after the cause of any propounded effect, we must in the first place get into our mind an exact notion or idea of that which we call cause, namely, that a cause is the sum or aggregate of all such accidents, both in the agents and the patient, as concur to the producing of the effect propounded; all which existing together, it cannot be understood but that the effect existeth with them ”

“ The aggregate of accidents in the agent or agents, requisite for the production of the effect, the effect being produced, is called the efficient cause thereof; and the aggregate of accidents in the patient, the effect being produced, is usually called the material cause; I say the effect being produced; for where there is no effect, there can be no cause; for nothing can be called a cause, where there is nothing that can be called an effect. But the efficient and material causes are both but partial causes, or parts of that cause, which in the next precedent article I called an entire cause. ”

“ The rejection of a specific acrimony as the cause of each disease, has unfortunately been followed by a belief in as many specific actions as there are different forms and grades of disease, and thus perpetuated the evils of our ancient systems of medicine. However varied morbid actions may be by their causes, seats, and effects, they are all of the same nature, and the time will probably come when the whole nomenclature of morbid actions will be absorbed in the single name of disease. ”

“ If he enter without any cause for the disease, why is the individual into whose body he enters not always sick? If he enter into a body that contains already a natural cause of disease, how far does he contribute to the disease? The natural cause is sufficient to produce the disease. It would be ridiculous to suppose that the disease would have a cause, but that, as soon as this cause is active there would be a demon ready to come and assist it. ”

“ The student has therefore failed to prove his argument that poor health, which is a legitimate cause, is responsible for his failure. The evidence shows that general dissipation, which is not a legitimate cause, has intervened between the alleged cause and the effect. ”

“ When we enumerate causes of disease we see among them many that under ordinary circumstances minister to life, health, and enjoyment; and I can hardly refer at all to the varying circumstances under which they become the medium of pain, disease and death. These circumstances are so various, so many of them are apt to be put in operation at the same time, and so little power have we of excluding them one after the other, so as to ascertain the exact efficiency of each, that our observation respecting their actual effects are open to much fallacy. ”

“ After a huge multiplication of instances, resulting in the elimination of every local condition that had been suggested as a possible cause, Hirsch came to the conclusion that the true cause must be a morbid poison, and that endemic goitre has to be reckoned among the infectious diseases.2
On this negative principle, that if a circumstance comes and goes without bringing the phenomenon in its train, the phenomenon is causally independent of it, common-sense is always at work disconnecting events that are occasionally coincident in time. ”

“ Those who composed what are called “The Cnidian Sentences” [531] have described accurately what symptoms the sick experience in every disease, and how certain of them terminate; and in so far a man, even who is not a physician, might describe them correctly, provided he put the proper inquiries to the sick themselves what their complaints are. But those symptoms which the physician ought to know beforehand without being informed of them by the patient, are, for the most part, omitted, some in one case and some in others, and certain symptoms of vital importance for a conjectural judgment. ”

“ There is, however, one precaution which must be observed, and without which the whole of the system just described is as uncertain and conditional as the rest of science. Before we can argue from what is to what has been, we must first know for certain what is. Before we can conclude that a patient has been healed by faith or cured miraculously of an incurable complaint, we must first have medical evidence to show that he had the disease. ”

“ Death, for example, may be brought about in different cases by different diseases or accidents. But if we understand by the total efficient cause of any given kind of effect the sum-total of agencies and conditions which when present necessitate this kind of an effect, and which are collectively and severally indispensable for its production, then it is obvious that a given kind of effect can have only one kind of such total group of antecedents as total cause, just as any one individual effect can have only one individual total cause, viz. ”

“ Just so it is with epidemic diseases. The cause is invisible, and, until it becomes discoverable by our senses, it can never be known; for, as has already been observed, a cause never can be known merely by its effects, unless we have seen it, or somebody who has seen it gives us information. ”

“ He definitely places the cause of the pathogenic conflict in the present moment and considers that in seeking for the cause in the distant past one is only following the desire of the patient, which is to withdraw himself as much as possible from the present important period. ”

“ IN the layman's eyes the symptom shows the nature of the disease, and cure means removal of symptoms. The physician, however, finds it important to distinguish the symptoms from the disease and recognizes that doing away with the symptoms is not necessarily curing the disease. Of course, the only tangible thing left over after the removal of the symptoms is the capacity to build new symptoms. Accordingly, for the time being, let us accept the layman's viewpoint and consider the understanding of the symptoms as equivalent to the understanding of the sickness. ”

“ To show how disease is not what it is supposed to be, by those who use the word, I must show the absurdity of error's reasoning, for error is the father of disease.
We are all taught by this error to call disease something that is independent of man. To make it more plain and show where the two modes of reasoning act, I will suppose a case and take that of a young man who feeling a little disturbed calls on a physician. The physician sounds his lungs, examines his heart, and tells the patient he is very liable to have the heart-disease. ”

“ He therefore felt justified in broadly concluding "that the only circumstance, within the range of those by which persons of similar conditions of life are affected, that is capable of producing a marked effect on the character of adults, is illness or some accident which causes physical infirmity. ”

“ If so little can be done by the experimental method to determine the conditions of an effect of many combined causes, in the case of medical science, still less is this method applicable to a class of phenomena, more complicated than even those of physiology, the phenomena of politics and history. There, Plurality of Causes exists in almost boundless excess, and the effects are, for the most part, inextricably interwoven with one another. ”

“ Such a dispute is precisely paralleled by a negative judgment, like, 'This flower is not red:' by which we merely deny the particular colour of the flower, but not its colour in general, which may be blue, yellow, or any other. Similarly death, as a negatively-infinite judgment, is distinguished from disease as simply-negative. In disease, merely this or that function of life is checked or negatived: in death, as we ordinarily say, body and soul part, i.e. subject and predicate utterly diverge. ”

“ The diseases are not only essentially the same, but the proportion which they bear to one another is nearly so, I mention this, because there is often a tendency to run after rare cases to the neglect of common ones; whilst, on the other hand, remarkable and instructive forms of disease are overlooked, simply because they are thought the curiosities rather than the elements of practice. You may carry your neglect of common cases, on the strength of their being common, too far. ”