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Background reading material for Year 1 Semester 1 medical student PPSD session on 3rd October 2006 by Professor Omar Hasan Kasule, Sr.
1.0 CONCEPTS OF DISEASE
Disease is divergence from the normal, gaussian mean, but not all deviation is disease because of the reserve capacity and ability of the body to adjust to variations. The demarcation between pathology and normal physiological variation can be fine. The definition of disease is very relative being affected by age, gender, culture, beliefs, socio-economic status, attitudes, and prevalence of diseases. Definition of disease considers several dimensions that may operate singly or in combination: moral or spiritual, biological or pathological, psychosocial, or normative statistical.
Overall disease is a state of dis-equilibrium. A distinction must be made between disease as a pathological manifestation and illness that is a subjective feeling. Symptomatology is perhaps a better indication of disease severity because it includes the personality of the patient and reactions. Thus the same pathology does not produce the same symptomatology in all patients. Those with strong religious faith may complain less about pain than others.
Prognosis is an empirical estimate of the future course of the disease based on available data and is not definitive because the final outcome is part of the knowledge of the unseen. The physician does not have the privilege to say anything definitive about the future prognosis.
There is a 2-way interaction between diseases of the heart and diseases of the body. We must approach most diseases empirically and to be guided by experimental science. We should reject superstitious beliefs and practices in all their various forms and manifestations.
2.0 BASIS OF CLASSIFICATION OF DISEASE
Diseases may be classified by their duration as acute or chronic, by cause as diseases of the heart, and diseases of the body, by life-stage as congenital or acquired, by nature as mental or organic, as local or systematic, and by organs afflicted.
The physical environmental causes of disease are: infection, physical energy, degeneration, and breakdown of homeostatic control. Most disease processes are actually attempts by the body to repair damage. Some diseases are gender-specific because of the organ that is affected.
3.0 NATURE OF DISEASE
Disease is a pathophysiological disturbance is normally a response to a biological, physical, or chemical insult or injury to the body. Thus most disease manifestations including their symptoms and signs are a reaction to the injury and an attempt to re-adjust. In an Islamic context, disease does not always connote a negative or bad event. There are indeed many situations when what is a disease situation is actually beneficial. It forces us to rest, its pain teaches patience and forbearance. The trials that one goes through and the eventual patience can be a source of great reward.
4.0 CAUSES OF DISEASE
Every phenomenon in life has an immediate cause, sabab, that humans can search for and find. However behind all these causes is the power and majesty of the Creator who alone is the source of all causes. When all the factors that produce a certain pathological condition exist, we say that there is a sufficient cause of disease. There are empirical factors that must operate for a certain pathological condition to occur. These are referred to as necessary causes. Denying their existence is akin to superstitious belief. Human diseases, like the human organism, are complicated and usually several factors are involved in their causation. Humans may know some of the factors and ignore others. It is not necessary to know all the factors in order to treat a disease. Since the factors usually act in sequence, knowledge of only one may be sufficient to interrupt the causal pathway. The causation, progression, and resolution of disease are in the Creator’s pre-determination. It is the Creator’s pre-determination that a person falls sick. Humans try to understand disease processes in order to reverse them. This is not contradicting or opposing the Creator’s will. All what a physician does is with the Creator’s permission and is therefore part of pre-determination. Treatment and prevention of disease are not against pre-determination. They are subsumed under the principle that one pre-determination can reverse another pre-determination. In the end all cure is from Creator and not the human.