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Understanding Infection: Not a Battle, But a Housecleaning
By Philip Incao. M.D.

I once saw a young African man in my practice who impressed me with his calm dignity and his radiant good health. I asked him what his parents had done when, as a child, he had come down with a fever. He replied that they had wrapped him in blankets to get him sweating. "Did they ever take your temperature?" I asked. He laughed and shook his head saying, "No, it was different from what is done here." We often hear that American medicine is the most advanced in the world. This is true in some areas of healthcare, but in other areas we could use a little of the deeply rooted wisdom that still informs some of the folk medicine in the developing world. I think this particularly applies to our modern concept and treatment of the illnesses we commonly call infections.

When we come down with a cold or a flu most of us imagine that some stress or other has weakened our defenses or our resistance and allowed a "bug" (a virus or bacterium) to enter our body, where it multiplies and attacks us from within. We think of this as an infection, that the new bug within us is making us sick, and that we will feel better as soon as our immune system has killed it off. When we don t feel better soon enough, we might seek remedies or antibiotics to kill the bug more effectively.

This pretty much describes the way almost everyone today, physicians included, thinks about what I refer to in this article as an acute infectious/inflammatory illness like a cold, flu or sore throat.

Yet this commonly held picture does not correspond to the facts. It is a deceptive misunderstanding that in itself is a characteristic sign of the simplistic and fear-based thinking that hinders progress in many areas of life today.

If we define infection as the presence within us of foreign microorganisms i.e., bacteria and viruses, then all of us are continually infected from the day we are born until we die. We all harbor trillions of microbes all the time, including various disease germs, yet we only occasionally get sick.

It is a shock to learn that for over one hundred years the evidence has shown that our immune system does not prevent us from becoming infected by germs. In the early years of Pasteur's germ theory in the nineteenth century, it was first assumed that healthy people were uninfected by bacteria and only sick people were infected. This assumption was soon disproven, as science found that the great majority of those infected with disease germs were healthy, and only a small fraction of them ever got sick. The majority of people infected with the bacterium of TB, for example, never got sick from tuberculosis, but only from the same coughs and colds that we all get. Infection alone is not enough to make us come down with a manifest illness. Something else is needed. Most of the time we are able to live in harmony with certain numbers of disease germs in our body without becoming ill. For this blessing we can thank our immune system, which is continually vigilant and active below the surface of our awareness in keeping the extremely varied and extensive germ population of our body under control. Thus, it is not necessarily the entrance of new germs into our body that makes us ill; it is the excessive multiplication of certain germs that may have already been in us for a longer or briefer time. In some cases the entrance of a new germ into the body is quickly followed by its rapid proliferation and in other cases the germ can remain dormant or latent in us for many years or even a lifetime while we remain healthy. This important fact receives far too little attention and is often totally forgotten in medicine today. Most of the trillions of germs that infect or inhabit our body from infancy onward are peacefully co-existing in us. They are our "normal flora".

Science has also identified a small minority of germs, called pathogens, that participate in human disease, like strep, staph, TB, diphtheria, etc., but these too have surprisingly more often been found peacefully coexisting in us rather than being involved in illnesses.

This is called latent or dormant infection, or simply the carrier state. Typhoid Mary was a famous example in the early 1900's of a cook who, though healthy herself, was a carrier of the salmonella bacterium and passed it on to others, some of whom became seriously ill and many others of whom remained healthy despite being infected. As the prominent microbiologist Rene Dubos stated in a medical textbook, "...the carrier state is not a rare immunologic freak. In reality, infection without disease is the rule rather than the exception...The pathogenic [germs] characteristic of a community do commonly become established in the tissues of a very large percentage of normal persons and yet cause clinical disease only in a very small percentage of them."1(Emphasis mine)

This leads us to the question which Rene Dubos, apparently alone among his colleagues, pondered for the rest of his life: if most of the time we are able to peacefully coexist with a disease germ in our body, (a fact which Pasteur did not adequately reckon with) what is it that happens when it suddenly starts multiplying rapidly and we get sick? Have our defenses weakened and allowed the germs to proliferate and go on the attack (which is the thought that frightens us so terribly) or are they merely multiplying because our body's biochemistry has been disturbed and is making available to the germs a suddenly increased supply of their preferred nourishment?

The latter is not a new thought; it was postulated by Pasteur's contemporaries. Scientists of Pasteur's time including Claude Bernard, Rudolf Virchow, Rudolf Steiner and Max Pettenkofer held the conviction that the decisive and determining factor in infectious diseases was not the microbe itself but rather the particular condition of the patient's "host terrain" that favored the growth of a particular microbe. In this view, microbes were not predators but were scavengers which fed on waste substances produced by imbalance in the host body's terrain just as flies feed on dung and garbage. For these scientists, killing microbes without improving the host terrain imbalances that fed the microbes was like killing flies in a messy, untidy kitchen without cleaning up the food scraps. Pettenkofer even drank a test tube of virulent cholera bacteria to prove his point that they would do no harm if the inner terrain was healthy. Pettenkofer's terrain apparently was healthy, because he suffered no ill effects at all from his bacterial brew. Nevertheless, the germ theory was an idea whose time had arrived, and for many reasons the concept of germs as vicious predators soon prevailed over the view that they were merely opportunistic scavengers.

The triumph of the germs-as-predators concept has led to a sea change in the way people think about acute illnesses such as colds, sinusitis, pneumonia, etc. Since ancient times these illnesses had been called inflammations, literally meaning a fire within. In the first century A.D. an early Roman author, Celsus, gave the classical definition of inflammation which is still taught today to physicians: a fire-like process in the body which manifests in "calor, rubor, tumor and dolor," i.e. warmth, redness, swelling and pain. These cardinal symptoms of inflammation, even when not externally visible, characterize all inflammations from a pimple to a pneumonia.

Human beings become infected with a great variety of the microbes in their environment, continuing life-long as they change environments, yet this fact of life-long infection does not explain why illness happens, anymore than auto accidents are explained by the fact that the victims are life-long drivers. An infection is not itself an illness, rather it is the normal human condition and the context in which acute infectious/inflammatory illnesses occur. Various stressors such as chilling, exhaustion, emotional stress, and imbalances of digestion and elimination can disturb our inner terrain so that it becomes like that untidy kitchen that attracts flies. That is when we become most vulnerable to catching a contagious inflammatory illness. Then a certain tribe of germs like strep, which almost everyone harbors to some extent, will start proliferating and trigger what should correctly be called "an acute strep-related inflammation" rather than "an acute strep infection." We need to fit our thoughts and words to the reality. The fact that a strep infection might precede a strep-related inflammation by days, months or years is essential to understanding how and why illness happens. Thus, the term" acute strep infection" commonly used by physicians and lay people is incorrect, and it creates an incorrect picture in our mind of the illness at hand. The incorrect picture is that strep bacteria have invaded our body from the environment and are injuring us. Most importantly, this incorrect picture leads to inappropriate feelings and actions of the physician, the caregiver and the patient who must respond to an illness. Thus the grave mischief caused by a "mere" incorrect mental picture becomes enormous - such is the power of this idea. The consequences of the germs-as-predators idea are millions of unnecessary prescriptions written for antibiotics, and thousands of injuries and deaths from drug reactions, including 450 deaths per year from Tylenol alone. The engine driving this inappropriate and dangerous use of antibiotics and anti-inflammatory drugs is the fear generated by our common misconception that we are under attack by predatory microbes whenever we experience fever, pain, congestion, cough and other symptoms of typical acute inflammations.

Our state of mind influences our capacity for self-healing. Thinking ourselves the hapless victims of microbial attack is decidedly disempowering and not conducive to healing. Such a mindset leads to an increasing dependency on drugs and doctors, and contributes significantly to the worsening health of Americans.

1Dubos, Rene J., Bacterial and Mycotic Infections of Man. Philadelphia: J.B. Lippincott, 1958, P. 21-22.

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