Wednesday, October 31, 2007

Prior to The School of Tropical and Preventive Medicine

The Genesis of
Tropical and Preventive Medicine

Prior to 1948 and the STPM
A Halstead Perspective

The History of Tropical Medicine, the meaning of “Preventive”, the Adventist contribution and the Bruce W. Halstead Perspective on the School of Tropical and Preventive Medicine

Table of Contents

I. The Colonial Roots of Tropical and Preventive Medicine

II. Sir Doctor Patrick Manson - Father of Tropical Medicine

III. The Role and Purpose of Tropical and Preventive Medicine

IV. Early Definition for the Term “Preventive Medicine”

V. The Role and Contribution of the Adventist Health Message

VI. Halstead’s Background, Influence, and Focus on
Tropical and Preventive Medicine prior to STPM

VII. Summary of Pre-1948, Pre-STPM Era, Pre-Halstead,
Role and Status of Tropical
and Preventive Medicine

I. The Colonial Roots of
Tropical and Preventive Medicine

It is quiet possible to have a contemporary understanding of tropical and/ or preventive as terms that are applied to a field of medicine without really understanding the origin and definition of those terms from a historical perspective. The words tropical and preventive, when used as adjectives to describe fields of medicine that exist today, are defined in a much evolved and broadened manner as to somewhat loose the stricter definition of its origins.

It is perhaps a sad commentary that tropical medicine originated as an outgrowth and bi-product of our colonial history. Colonialism is defined as a nation extending its influence and sovereignty beyond its territorial boundaries for purposes of having control and possession of the region they conquer. These resources includes: inexpensive labor or slavery, markets, raw materials, manufactured products, or additional territory. Colonialism eventually evolved into imperialism which differs only in that the territory being conquered remains as an independent sovereign nation, even if in name only.

The very act of conquering and spreading colonialism brings with it a system and structure of cultural, political, and religious values that become the intervention and domination by the more powerful country over a weaker one. Colonialism brought with it a set of beliefs that were utilized to give legitimacy and even promote the goals of colonialism. Arguably the ugliest aspect of these beliefs was the superiority of the European white people as at the top of the animal kingdom and therefore should dominate in every way over the non-European indigenous people of the world. This includes the domination of European religious beliefs and medical practices.

Colonialism is something that is not limited to any race of people or any region of the world and extends through the antiquity of time. But the roots of tropical and preventive medicine was created out of that colonialism that was part of the European Colonialist efforts starting with the Spanish Inquisition and extended into the world domination of the British Empire. As European colonialism spread through the world and especially the tropical regions of South America, Asia, Africa, India, and the South Pacific, the invading forces were met with new medical challenges that were considerably different than the cooler climates from which they came.

The initial invading forces of colonialism are generally composed of military armies that take control by force and violence. But they are soon joined by a range of other people that includes: back up military personnel, colonial administrators, explorers, settlers, businessmen, and Christian missionaries. These newcomers were generally unprepared for a new set of diseases, that were both prevalent and well adapted to warm, humid, tropical regions. It was imperative for all of the newcomers, invading, and conquering intruders, to address the “tropical diseases” that they were encountering with their lack of immunity, and lack of western medical knowledge or experience.

It would be wonderful to state that the study of tropical medicine was motivated out of an altruistic concern for the indigenous peoples whose land was being invaded, but sadly that is not the case. The primary motivation was for the well being of the new inhabitants whose immune systems were ill prepared for the challenges and consequences of tropical diseases. To the extent that the indigenous peoples were able to benefit from the breakthroughs in the treatment of tropical diseases was limited to the colonialist benefit of helping protect their human resources and maximize their profits from their labor resources, be it exploited workers or slavery.

II. Sir Doctor Patrick Manson
- Father of Tropical Medicine

The person who is credited with being “The Father of Tropical Medicine” was a Scottish Doctor named Patrick Manson (1844–1922), who worked in relative obscurity in the small village of Amoy, South China. Working with the most humble medical resources he uncovered the remarkable mystery of filariasis. Filarial disease, which causes the disfiguring elephantiasis, was highly prevalent in that region of China.

Doctor Manson initiated a new era of thinking that winged arthropods (flying insects) may be associated with the spread of disease in man. Manson was instrumental in making several original discoveries in parasitology and helminthology. His pioneering efforts led to the establishment of a new discipline in medicine, coined “tropical medicine” which is the only field of medicine that is named after a region of the world. In 1899, Doctor played a key role in establishing tropical medicine as a formal structured discipline with the founding of the London School of Tropical Medicine.

So the role and definition of tropical medicine that was birthed in colonialism and was “fathered” by Doctor Patrick Manson was about understanding the diseases and the transmission of those diseases in the tropical regions being conquered by the colonial powers.

III. The Role and Purpose of
Tropical and Preventive Medicine

An appropriate summary of the pre-World War II model and definition of tropical medicine is found in a book on the subject by John Farley, entitled: “Bilharzias - A History of Imperial Tropical Medicine”. In that publication, Farley writes:

“The basic goal of tropical medicine was to render the tropical world fit for white habitation and white investment. Its practitioners were member of colonial services, armies of occupation and mining and fruit companies. What, if anything, should be done about the health of the native inhabitants was determined by the policies of these Western agencies without reference to the needs of the indigenous communities. Not surprisingly their health needs became a priority only when their diseases were felt to threaten the health or profits of the white man, or when imperial policies demanded that the health needs of the indigenous populations be addressed. In addition, because of Christian duty and the white man’s burden always included medical and sanitary work, medical missionaries were also an important part of the picture…”

With the WWII, the American military was drawn into the South Pacific regions after the bombing of Peal Harbor by the Japanese. One result of this was that the U.S. military developed an interest in tropical medicine and started putting resources into the development of the emerging field of medicine. By now, colonialism had been replaced by imperialism but what did not change was the scope and definition of tropical medicine. In John Farley’s work on the subject, he describes the post WWII evolution of tropical medicine as follows:

“….that tropical medicine after World War II was also imperialistic in the sense that health policies continued to be imposed by the outside agencies, whether they were the declining imperial powers or the increasingly influential professional classes and international organizations. Tropical medicine, as before, continued to be imported, technical, and scientific; and even when, as in the 1940’s a more socially oriented approach briefly appeared, it was only because Western medicine was at that time flirting with so-called social medicine. There was, however, in this postwar era a rising concern with what were perceived to be the health problems of the tropical or Third World communities, but both the nature of these problems and the solutions to them continued to be imposed and Western. Even if control slowly passed into the hands of Third World personnel, no fundamental changes took place, for they had been trained in Western ideas and shared the professional goals and beliefs of their Western Colleagues.”

“I believe that a fundamental shift away from this imperial-styled medicine began to take place only in the 1980’s. In 1979, the WHO finally endorsed the idea that all people have the right to participate in their own health care planning and implementation, to dictate priorities, and to utilize methods that they can use and afford. Community participations has become the new creed, and minimally trained health workers are becoming the major agents of this new primary health care delivery system.”

IV. Early Definition for the Term
“Preventive Medicine”

Given all of the aforementioned, the early references to the term preventive medicine was strictly limited to the “prevention” of these tropical diseases through vector control, early drug intervention in the disease process, and risk management. The study of tropical medicine was the study of those tropical diseases that were prevalent in the warmer, more humid, tropical regions.

The goal of the study of tropical medicine was to “prevent” the spread of those diseases by breaking the cycle by which vectors such as mosquitoes could spread those diseases. Therefore, using malaria as an example, the term “prevention” would be defined in the historical context of tropical medicine as the eradication of mosquitoes, protection from contact with mosquitoes, the use of prophylactic drugs, or the early detection and treatment of the disease.

The term “prevention” as applied to tropical medicine, had little in common to how the term is generally used and understood today. Prevention in those days had nothing to do with super nutrition, immune enhancement, vitamin supplementation, herbal medicine, exercise, a vegetarian diet, or any of these other lifestyle changes that have come to define the term “prevention“ of the modern era.

Nor did it have any thing in common with the current use of the word prevention as applied to the innovative development of health modalities such as Chelation Therapy, Hyperbaric Oxygen Therapy, DMSO, or any of the other therapies now in use for the “prevention” of chronic and generative diseases such as: heart attacks, stoke, senility, or even cancer. In this sense prevention also means “age reversal” and “life extension”, where immune enhancement and optimal health are the primary goals. These later criteria for prevention of optimum health are also known as holistic, wholistic medicine, and natural medicine, which has nothing to do with the word preventive in the traditional practice of tropical medicine.

V. The Role and Contribution of the
Adventist Health Message

Ellen White is well known for the health message that is the trademark of the Adventist church today. She in turn was heavily influence about health issues by her close friend and associate, John Harvey Kellogg, M.D., who influenced the worldwide development and philosophy of Seventh-day Adventist medicine more than did anyone except Mrs. White. Kellogg relied on the fundamental principals outlined in White's books and then developed that message into a lifelong study and research into optimum health. Chapter 14 of Schaefer's book Legacy, is about the amazing story of Kellogg, who founded the Battle Creek Sanitarium and invented the Kellogg cereal.

Kellogg was a physician, surgeon, that with nearly 50 books was a prolific writer and delivered over 5,000 lectures. He was a student of Pasteur's work on microbiology and relied on it as the basis to advocate for a vegetarian diet. But his approach to optimum health went way beyond simply avoiding meat. It was a natural healthy lifestyle which he termed "Biologic living" which also required "total abstinence from alcohol, tea, coffee, tobacco, and animal flesh. It included proper diet, adequate rest and exercise, fresh air, healthful dress, and (in case of illness) simple, natural remedies."

This is the essence of the Adventist health message and is what has now become fashionable these days with the popularity of the trendy health spas. Sanitarium is a term that in those days was simply used to define a hospital that embraced those natural health "spa" like principals, including massage, sauna, herbs, and hot tubs. These principals are not only the basis on which the church was founded, it was the message they believed they were to spread to the rest of their world in their "evangelistic" efforts; thus the name "College of Medical Evangelist."

So the Adventist message deserves credit for having a background orientation of healthy lifestyle that are included in much of current trends in holistic (wholistic) health, natural medicine, and even preventive medicine as it is now defined. Seventh Day Adventist integrated that message into their religion. Adventist were founded with the beliefs of Kellogg and White that were demonstrated in the sanitarium/hospitals that they created based upon Ellen White’s visions.

So it is fair to say that Adventist have from the start, become a religion that: 1 advocates a progressive healthy lifestyle, 2. they use those health principals to administer to the “physical and spiritual health” of people around the world, and 3. believe in training doctors and nurses to become “medical evangelist” to the world. And into the world they went, just as fast as they could train them, they went out to the “mission fields” and commenced to setting up schools, churches, clinics, and hospitals.

In this sense, Seventh Day Adventist were part of the history of the spread of Christianity, that began with the Christian Crusades and continued through the entire colonial era, eventually evolving into what is now the modern era of Christian missionaries. This isn’t a statement about the qualitative value of the effect of the spread of Christianity as much as it is to document the role of Christianity in the development of tropical medicine.

VI. Halstead’s Background, Influence, and
Focus on
Tropical and Preventive Medicine
prior to STPM

Doctor Halstead started taking an obsessed, even unexplainable interest in travel, the South Pacific, and Tropical fish beginning at as early as age 5. Starting in 1935 at age 15, Halstead started studying at the Golden Gate Academy of Sciences under his greatest influence and mentor, Howard Walton Clark.

Clark taught him about all of the natural sciences but most notably, ichthyology (fish), scientific methodology, scientific identification, and an extensive emphasis on parasitology. The history of tropical medicine is always associated and dependent upon the field of parasitology with all of the vectors that spread the tropical diseases.

After the death of Clark in 1941, the Golden Gate Academy of Sciences, hired Dr. Wilbert McCloud Chapman, to assume the duties of Clark. By then the War was well under way and everyone was doing their part including the Academy. Under Chapman, Halstead learned the politics of science as Chapman was constantly in touch with members of Congress and our military. Later Chapman had a role in expanding the use of tropical medicine when he convinced the Armed Forces to supply our troops with fresh fish to eat. The idea caught on with our War Department and Chapman was off to the Asia-Pacific Theatre.

Halstead continued his understudy work at Golden Gate Academy while he received an Associates of Arts degree in biology at San Francisco City College, his B.A. Degree in zoology at U.C. Berkeley, and student teaching at Pacific Union College. While still at U.C. Berkeley, Halstead was encouraged to join the Army Specialized Training Program which structured his education with the intent of continuing on to medicine.

While at medical school at Loma Linda, he remained Private First Class Halstead and was required to wear his uniform at school. Also while attending medical school, Halstead would find any opportunity to go spend time at Golden Gate Academy of Sciences.

Drawing on his background at the Academy, he excelled at parasitology and tropical medicine. During his spare time, he would go out and collect parasitology specimens from cows, pigs, chickens, and anywhere else he could find, earning the school the best collection of it’s kind at any learning institution around. He was an assistant instructor of parasitology and tropical medicine by his sophomore year and was the instructor immediately upon completion of his senior year.

In July of 1947, when it was time to select an internship, Halstead decided to intern at the Marine Hospital of the U.S. Public Health Service in San Francisco, California, where he became a Lieutenant Junior grade in the Public Health Service.

Upon completion of his internship, Halstead returned to Loma Linda to work with Dr. Mozar in developing the School of Tropical and Preventive Medicine.

VII. Summary of Pre-1948, Pre-STPM Era,
Role and Status of
Tropical and Preventive Medicine

In order to put into context, the relative value of the contribution of Doctor Halstead’s work, it is important to examine the field of tropical medicine and even the term “preventive medicine” at the time that he launched his career at the School of Tropical and Preventive Medicine at Loma Linda, in 1948.

By 1948, WWII had just ended and the U.S. military along with the allied forces, was still fresh with the experiences of waging combat in tropical regions ranging through the Asia-Pacific Theatre, China, the Mediterranean, the African Continent, and the Middle East. The military had encountered the limits and challenges of western medicine on tropical diseases which helped put some much needed attention on the problem.

It can be argued that the military had helped expand the role of tropical medicine, under the leadership of Dr. Chapman of the Golden Gate Academy of Sciences, when Chapman succeeded in developing local sea food as a dietary source to feed the troops. This event opened the door to the value and need for Doctor Halstead’s work on Poisonous and Venomous Marine Animals that followed.

With that single exception, the definition and role of tropical medicine had not changed from its inception. That is to say that tropical medicine was still limited to dealing with the existence of tropical diseases primarily for the survivability of the newcomer foreigners in those tropical regions. Prevention had none of the holistic, wholistic, or natural medicine connotations that it has today.

To put into context Doctor Halstead’s contribution to Loma Linda University, it is important to examine where the Adventist church and the school at Loma Linda were focused and where they were either totally inexperienced and/or totally resistant. In a nutshell, Loma Linda and the Adventist church had adopted a solid health message but had demonstrated little if any interest in research into the principals supporting that health message or expanding the development of new health modalities. Consequently, they had no background or experience in grant acquisition from either the government or the private sector.

So for Loma Linda University, Doctor Halstead is the father of research and the father of grant acquisition. For the field of tropical medicine, Doctor Halstead was the first to expand its role into research into poisonous and venomous marine animals as a source for new drugs from the sea. He is also the first to reverse the model of imposing western medicine onto indigenous native people. Instead, Doctor Halstead gave credence and respect for the hundreds, if not thousands of years of traditional tribal medicine, as a worthy field of investigation for the possibility of scientific validation of herbal/botanical compounds for new drug discoveries.

In the larger world of medical science, Doctor Halstead is the pioneer and the father of the field of bio-toxicology. Largely self taught on the subject, he became the leading world authority on Bio-toxicology and devoted his life to discovering the secrets of natural occurring compounds on land and the sea that could advance the science of human health.

Even more impressive is the career that began with the formation of the School of Tropical and Preventive Medicine and pioneered these scientific research fields of endeavors, evolved into the founding of World Life Research Institute where Doctor Halstead researched and pioneered, new health modalities in the emerging field of Alternative Medicine.

In this context of 1948 tropical and preventive medicine, and in this context of 1948 Loma Linda University (CME), and in this context of Bruce Halstead, fresh out of thirteen years as an understudy at the Golden Gate Academy of Sciences and having just graduated President of his medical class; the birth of The School of Tropical and Preventive Medicine is no small incident but was a major milestone, a new beginning, and a turning point for Loma Linda, Bruce Halstead, and the medical and scientific research that followed.

What was Doctor Halstead's vision for Loma Linda and Research into tropical medicine at the School of Tropical and Preventive Medicine?


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