When the elegant exercises of Hume's skeptical empiricism woke Kant from the dogmatic slumbers of his continental rationalism, surely no one could have predicted the prodigious symphonies of German Transcendental Idealism to follow. Not, of course, that these were composed by Kant himself, but his “Copernican revolution” in epistemology prepared the way for them, as surely as the German compositions of the later Mozart prepared the way for Beethoven and Brahms - and, eventually, for the monstrous syntheses of Wagner. David Hume's secure place in the history of philosophy rests not on the construction of any philosophical system: quite simply, his essays constitute the most thorough job of deconstruction in modern intellectual history. (It is a pity, attributable, perhaps, to the French origins of the critical school - in French tradition, Locke has always been respected, Hume ignored - that modern deconstructionists have so neglected Hume, There are so many lessons available there, not only in the elegant simplicity of his arguments, but in the admirable lucidity of his Enlightenment prose.)

Which first, the good news or the bad news? In honor of optimists who test their commitments by rising above the worst, I submit a three-part package of disheartening wisdom. W. J. T. Mitchell on pictures and words: “The history of culture is in part the story of a protracted struggle for dominance between pictorial and linguistic signs, each claiming for itself certain proprietary rights on a 'nature' to which only it has access.” John Barrell on recent efforts to shelter the two arts of picturemaking and wordmaking under one critical label:“'Romanticism' has never become a well-established term in the discussion of English painting, and art historians do not seem, on the whole, to have found the term of great explanatory power even when applied to such obvious subjects as Turner, Palmer, or Blake himself.” And finally, the most quotable line ever written about all relations among all arts, Susanne Langer's heartstopping proclamation that “there are no happy marriages in art - only successful rape.”These warnings open suitably dark themes that we would be mistaken to bypass, because they are fundamentally true to life.

Romanticisms and Enlightenments

The readers of this volume will find Lovejoy's famous essay “On the Discrimination of Romanticisms” amply confirmed: Romanticism cannot be defined. To include an essay called “Romanticism and Enlightenment” seems to be an impossibility compounded. On any reasonably comprehensive view the eighteenth century was not dramatically more uniform than the early nineteenth. Indeed, in one crucial respect it was less so, for no fact so inescapably galvanized the Enlightenment mind as that of revolution did the mind of Romanticism. There are many versions of Enlightenment - aristocratic and bourgeois, rationalist and empiricist, modernist and classicist, mercantilist and laissez-faire, urban and pastoral, religious and secular. Properly speaking, this chapter should be entitled “Romanticisms and Enlightenments,” a multiplicity that leaves the student no hook except the little word “and” to hang a hat on.

During the last quarter of the twentieth century social historians and historical critics have been cautiously developing a language for studying the arts that breaks out of a narrowly aesthetic vocabulary. We have become interested not so much in literature or art or music, not even in “the arts” altogether, but in a given society's cultural production. The full consequences for our sense of how individual arts or artists operated at any particular point in time will take a very long time to absorb.

Part of the problem here is that old-style “literary history” and “art history” constructed a continuous narrative with claims, which now seem remarkably fragile, to explain where art came from. Powerful figures within the art world were held to wield the influence of despots. In order to understand younger artists it was enough to show who they copied and who they reacted against. Cultural history is of course far more impersonal than this. It also registers types of event, and of historical change, held by literary history to be of secondary significance, such as the passing or the repeal of laws affecting state censorship or copyright, and the two or three major advances in the technology of book-production. During the eighteenth century a combination of legal, financial and industrial factors produced a huge expansion in the bulk and influence of print culture, working one of those transformations that truly deserves the term revolutionary: yet the century in which it took place is notorious for being one of the quietest on literary-historical record.

Like “Romanticism” itself, Romantic Hellenism is a cultural and literary phenomenon whose existence is widely in evidence yet which remains elusive, problematic and difficult to define with inclusive rigor. Like Romanticism, it has often been simplified and misrepresented; contrary to general belief, it achieved expression in forms that were diverse, paradoxical, sometimes self-contradictory, and often controversially or adversarially related to received modes and ideas. Like Romanticism, it never achieved articulation as a coherent philosophy; it never generated a school of practitioners who might have advertised themselves as Romantic Hellenists; it was never consciously or programmatically identified by those who seem to have pursued or embodied it most creatively. Again like Romanticism, it is a retrospective label that yokes together for historical convenience a wide range of manifestations and examples centered in and around what we now call the Romantic period but with roots that go far back into the eighteenth century.

Questions about linguistic theory have assumed striking prominence in recent work on Romanticism. This is in part because literary criticism over the past two decades, like philosophy for a much longer time, has taken a distinctly linguistic turn. But in addition to the pervasive preoccupation these days with theoretical understandings of the linguistic sign and of verbal representation, more particular circumstances, at least in the United States, have focused attention on Romanticism and language. Romantic texts, most notably Wordsworthian texts, were among the first to be read through the linguistic turnings of poststructuralist criticism in its American guise. Jacques Derrida's extended critique of Rousseau's Essay on the Origin of Languages in Of Grammatology, along with his readings elsewhere of Shelley and other eighteenth- and nineteenth-century writers, have cast an even greater glamor on Romanticism's role in current theory. And since many Romantic texts, verse as well as prose, turn out to contain powerful, agitated broodings on their own status as language, poststructuralist readers have often found their theoretical concerns anticipated, not merely reflected back to them, in Wordsworth or Coleridge or Shelley.

The terms of my title will probably seem to some readers rather bland, to others inevitably contentious. Romanticism has functioned as a period term, with somewhat different limits in different countries, and its use has led to a tradition of attempts at defining what it is, or what is most central to it. Criticism tends to pass us by as an unassuming description of what we do if we teach or study literature in universities, while theory is one of those terms that has caused arguments in seminars and tantrums at dinner parties. But criticism is by no means an innocent term, nor need theory always bite in the way that its bark has seemed to promise, if indeed it bite at all.

So it may be as well to begin with some working definitions - not trenchant specifications of exclusive or exact definitions of these terms, but loose explanations of what I mean by them, and of how they will function in the following pages. By Romanticism I mean, very roughly, the writings of the late eighteenth and early nineteenth centuries, sharing a general historical situation but not necessarily held together by any essential or prescriptive characteristics. Literary critics and historians have traditionally posited such characteristics in a manner allowing them to distinguish between what is more or less “romantic,” early and late romantic, pre- and postromantic, highly or antiromantic. Such usages are seldom consistent, and have mostly been employed to justify one set of preferences over others according to some standard or other of exemplary historicality.

Poets are no more insulated from political events and controversies than are any other class of people. Indeed, they are less so, in that poets work in language, the same medium in which political concepts and demands are formulated, contested, and negotiated. If this is generally true it is of particular relevance in periods of significant historical change, when political issues impress themselves with increased urgency on all sections of society and give rise to vigorous debates concerning fundamental political principles. The period between 1780 and 1830, during which the great Romantic poets came to maturity and produced their most important works, was such a period, as they were all aware. Wordsworth told an American visitor that “although he was known to the world only as a poet, he had given twelve hours thought to the conditions and prospects of society, for one to poetry.” Coleridge and Southey were both active as political journalists, and Coleridge produced a number of significant works of political theory. Byron spoke on political issues in the House of Lords, as well as satirizing political opponents and the political situation in general in his poetry.

Carrión’s disease is an infectious disease caused by a microorganism of the genus Bartonella. Two species have been described, the bacilliformis type and the verrugiformis type. These bacteria are parasites of human red blood and histiocytic cells. The bacilliformis type produces two stages of the disease, a febrile acute hemolytic anemia known as “Oroya fever,” followed by a granulomatous mucocutaneous eruption known as “Verruga Peruana.” The verrugiformis type produces only the verrucose stage.

Etiology and Epidemiology

B.bacilliformis are pleomorphic bacteria, well stained with the Romanovsky stain. In the red blood cells and in the histiocytic cells, the bartonella assumes a rodlike (bacillus) or coccoid shape, 1 to 3 microns in size (Figure VIII.22.1). The electron microscope shows the flagella of the bartonella. It grows well in liquid and in semisolid blood media. The human bartonella is closely related to the nimal bacteria Hemobartonella, Eperythrozoon, and Grahamella.

In 1913 Charles Townsend identified the sandfly Phlebotomus verrucarum as the insect vector of the disease. The female is the only transmitter, and the transmission occurs during the night. Carrión’s disease is a rural disease, and, like yellow fever, it does not need a human reservoir because the bartonella lives in the small animals in the area.

Immunology (Experimental Transmission) Between 1948 and 1950, the author and collaborators conducted a series of experimental transmission on human volunteers. Thirty healthy men were inoculated with parasitic blood through subcutaneous, intramuscular, and intravenous routes. None of the volunteers developed the disease, and the blood culture remained negative after more than 120 days.

The members of genus Treponeme, family Treponemataceae, and order Spirochaetales consist of Treponeme pallidum (first described in 1905), which causes syphilis and nonvenereal syphilis; Treponeme pertenue (first described in 1905), which is responsible for yaws; and Treponeme carateum (first described in 1938), which produces pinta. Or at least this is the way that most medical texts would have it. It may be, however, that the three pathogens in question are actually only one, for although they produce different pathological processes, the pathogens themselves are virtually indistinguishable under the microscope, and the diseases they cause respond to the same treatment. The origin of this infamous family and the relationship of its members to one another have been topics of considerable and very interesting debate since the 1970s, largely because such questions bear directly on the centuries-old debate of whether the Americans bestowed syphilis on the rest of the world.

Many agree that the treponemes probably evolved from microorganisms that originally parasitized decaying organic matter, and which later – perhaps hundreds of thousands of years ago – came to specialize in human hosts, but probably only after first parasitizing another animal host (Wood 1978). There is little disagreement that the first treponemes to parasitize humans did so by entering their bodies through traumatized skin and were subsequently passed on to other humans by skin-to-skin transmission. Real disagreement begins, however, over questions of where the first humans were infected, and the identity of the disease they were infected with.

Black and brown lung are the names given by workers in the coal and textile industries, respectively, and by some physicians and public officials, to symptoms of respiratory distress associated with dusty work. Most physicians and epidemiologists have, however, preferred to categorize these symptoms as they relate to findings at autopsy and studies of pulmonary function and to name their appearance in particular patients as, respectively, coal workers’ pneumoconiosis and byssinosis. The terms “black lung” and “brown lung” are historical legacies of intense negotiations about the causes of respiratory distress and mortality among workers in the coal and textile industries of Europe and North America, especially since the nineteenth century. (For the conventional medical definitions of the pathology subsumed under the terms black lung and brown lung, see the extensive bibliographies in papers by Fox and Stone [1981] and Corn [1980]).

History and Geography

For many centuries, medical observers, and workers and their employers, have recognized respiratory distress and its consequences as an occupational hazard among underground miners and employees of industries that generate considerable dust (notably refineries, foundries, and the manufacturing of cotton, flax, and hemp). Pliny described the inhalation of “fatal dust” in the first century. In the sixteenth century, Agricola observed that miners, physicians, and engineers were aware of shortness of breath and premature death. In the early nineteenth century, pathologists observed that some miners in Scotland had black lesions on the lung at autopsy. The term pneumoconiosis appears to have been invented in 1867. Brown lung seems to have been named by analogy with black lung, apparently in the 1960s.

Nonvenereal syphilis has apparently occurred in many forms and places, and one interpretation of this phenomenon is that venereal syphilis can revert to nonvenereal transmission. Others see it as a discrete disease with its own etiologic epidemiology. The most common and enduring form of the disease is called bejel; it occurs in the arid regions of North Africa, the Middle East, and the eastern Mediterranean, and seems to have antedated venereal syphilis as a disease entity by a considerable period of time. It is one of the endemic treponematoses caused by spirochetes, bacteria belonging to the genus Treponema. Other diseases in this group are yaws and pinta. Like yaws, bejel is essentially a disease of children, although those who escape the illness as children are likely to acquire it as adults, often from their own children. Its specific cause seems to be Treponema pallidum, the same agent as that of syphilis, although it may be a treponema intermediary between T. pallidum and Treponema pertenue, the agent of yaws. Although treponemal disease has been transferred experimentally to animals, humans appear to be the only natural reservoir.

Etiology, Epidemiology, and Clinical Manifestations

Because the treponemas that cause yaws, nonvenereal syphilis, pinta (an American disease), and syphilis are morphologically and serologically indistinguishable, it is believed that at least the Old World diseases may represent an evolutionary continuum running from south to north. Yaws, thought to be the oldest, spreads by skin-to-skin contact and flourishes in the hot and moist regions of Africa south of the Sahara where individuals have historically worn little clothing.

Islamic and Indian medicine originated in distinct cultural traditions but have been in close contact for many centuries. The terms Islamic and Indian as they refer to medicine do not describe static, idealized, or monolithic systems that can be categorized by referring to the medical texts of a distant golden age. Medical practices in Islamic and Indian cultures were, as elsewhere, eclectic and pluralistic, evolving in response to complex influences that varied according to time and place. This essay briefly traces the origins and the major components of the two traditions and compares and contrasts their institutional responses to the challenges of modern times.

Islamic medicine is based largely on the Greek medical knowledge of later antiquity and is more properly called Greco-Islamic or Galenic-Islamic medicine, reflecting the influence of Galen, whose works dominated medical learning in the eastern Hellenic world. At the time of the Muslim conquests of the seventh century A.D., the major centers of Greek medical learning in the eastern Mediterranean were flourishing.

Because of theological constraints, Greek Orthodox scholars were more interested in the Greek sciences, which included medicine and philosophy, than in literature, historiography, and other humanistic subjects. The Muslim conquerors recognized the excellence of Greek learning, and the Umayyid and Abbasid caliphs subsequently sponsored the translation of a large portion of the available scholarly works into Syriac and Arabic (Ullmann 1978).

The term croup is used in an inclusive way to identify several different respiratory illnesses of children manifested by varying degrees of inspiratory stridor, cough, and hoarseness due to upper-airway obstruction. Classically croup was a manifestation of diphtheria. In the twentieth century, many other infectious causes of croup syndromes are recognized, and in addition, similar illnesses can be caused by noninfectious processes.

A classification of crouplike illnesses is presented in Table VIII.30.1. Although long-term obstruction in the glottic and subglottic regions can lead to chronic illnesses, croup syndromes are described here as acute self-limited or fatal illnesses. Most cases of croup today are either laryngotracheitis or spasmodic croup.

Etiology

Acute epiglottitis (inflammation of the epiglottis) is virtually always caused by Haemophilus influenzae type B; rare cases have been due to Streptococcus pneumoniae and Staphylococcus aureus. Laryngitis is usually due to the common respiratory viral agents, the most important of which are adenoviruses and influenza viruses.

Laryngotracheitis and spasmodic croup are common illnesses in children and are due to viruses or Mycoplasma pneumoniae. The most important agent is parainfluenza virus type 1. This virus, as well as parainfluenza type 2 and influenza A and B viruses, results in outbreaks of disease. In areas of the world where diphtheria toxoid immunization is not carried out, laryngotracheitis is also caused by Corynebacterium diphtheria.

Laryngotracheobronchitis and laryngotracheobronchiopneumonitis are frequently caused by the same viruses that cause laryngotracheitis. These two illnesses are caused also by S. aureus, Streptococcus pyogenes, S. pneumoniae, and H. influenzae.

Leprosy occurs naturally only in humans and is caused by infection with Mycobacterium leprae. Known also in the twentieth century as “Hansen’s disease,” after the Norwegian microbiologist A. G. H. Hansen who first isolated the microorganism in 1873, true leprosy is a chronic, debilitating, and disfiguring infection. However, the long history of disease attributed to leprosy undoubtedly includes a broad range of skin and systemic afflictions that only resembled leprosy symptoms.

The leprosy bacillus multiplies quite slowly, usually in the sheaths of peripheral nerves. Losing sensation in discrete, patchy areas of the skin is often the earliest, but ignored, symptom of infection. Lacking adequate innervation, the affected dermis can be damaged without evoking a pain response as, for example, by a burn or a cut. Repair of the tissue is then hindered by poor regulation of local blood supply. Hence, secondary infection and inflammation of an involved area are common, leading to scarring and callusing of surviving tissues. This long process can result in the loss of fingers, toes, nasal tissue, or other parts of the body frequently exposed to the elements. A “bear claw” foot or hand becomes one of the characteristically maiming and stigmatizing features of the leper. Involvement of the nasal cartilage and vocal cords, common sites for the organism’s growth, leads to profound disfiguration of the center of the face and also to the raspy, honking voice described in some historical accounts of true leprosy.

Cystic fibrosis, also called fibrocystic disease of the pancreas, and mucoviscidosis, is a genetically determined disease of infants, children, and young adults. Most of its many manifestations result from the abnormally viscous mucus, which interferes with pulmonary function, and the insufficient production of pancreatic digestive enzymes, which causes nutritional deficiencies and developmental retardation.

Etiology

Among Caucasians, cystic fibrosis (CF) is the most common fatal disease having an autosomal recessive inheritance. Despite the primary involvement of several organs, the disease is caused by a single defective gene that is located on chromosome 7 and is carried by about 4 percent of the Caucasian population. Its expression is similar in both sexes.

Clinical Manifestations

CF manifests itself at birth in about 8 percent of cases through mechanical obstruction of the small intestine by the secretion of abnormally viscous mucus (meconium ileus). Symptoms of insufficient secretion of exocrine (noninsulin) digestive enzymes by the pancreas appear during the first year of life in 90 percent of cases. The development of such symptoms indicates that pancreatic function is less than 10 percent of normal; and the more severe the deficiency of pancreatic enzymes, the more severe the fecal excretion of undigested fat, usually as diarrhea. As much as 80 percent of dietary fat may be lost, thus partially explaining malnutrition. Loss of undigested nutrients can be corrected only partially by treatment with pancreatic enzyme tablets. Pulmonary disease is responsible for most of the debility and mortality. Onset occurs in the first 2 years of life in at least 75 percent of cases, and by the age of 6 years in most of the remaining cases.

Pneumonia is an acute inflammatory condition of lung parenchyma (lung tissue excluding the airways) caused by a variety of infectious agents and toxins and favored by aspects of the environment and/or the general physical status of the patient. The term “pneumonia” is derived from the Greek word περιπλευμονιη meaning “condition about the lung”; the word refers to a clinicopathological state that arises in several different yet specific disease patterns. All of these are characterized by some degree of fever, cough, chest pain, and difficulty in breathing. Technically speaking, pneumonitis, which means “inflammation of the lung,” is a synonym for pneumonia, but the former is usually reserved for benign, localized, and sometimes chronic inflammation without major toxemia (generalized effects). Many modifiers and eponyms are applied to the term pneumonia to reflect the cause (e.g., embolic pneumonia) or the localization (e.g., pleuro- or broncho pneumonia). The classic form is lobar pneumonia, an infectious but not particularly contagious condition usually localized to part or all of one of the five lobes of the lungs, and caused by a pneumococcus, the gram-positive organism Streptococcus pneumoniae (formerly called Diplococcus pneumoniae). Untreated lobar pneumonia has a mortality of about 30 percent, but the advent of antibiotic treatment has improved survival rates.

Several other pathogens (bacterial, viral, fungal, and parasitic) are recognized causative agents. The extent of the pulmonary involvement; the onset, pattern, and duration of symptoms; as well as the mortality rate depend on both the causative organism and precipitating factors. Chemical irritation, environmental exposure to noxious substances, or hypersensitivity can occasionally cause pneumonia.