The jaundiced view.

R etribution is not an accepted concept in medicine. Retribution is something that happens in symbolic and abstract ways, not biologic and concrete ways. People get sick because of germs and genes and gluttony: items and events that are palpable, eradicable, manipulable. Illness is treatable and, even if fatal, transient; retribution marks a creature forever and may never cause sickness. Science and medicine have systematically, and scientifically, demolished many of the old admonishments; the adages that foretold illness caused by omissions and commissions. “Don’t get chilled or you’ll get your death of cold.” The first great modem scientific essayist, Sir Francis Bacon, is said to have died from the chill he took while packing a dead chicken with midwinter snow to see if the chicken would keep longer. Cf course, cold and colds are not causally related, but the old adages threatening biologic retribution were not entirely wrong. Respiratory infections were more common in winter when people huddled close to the fire and to each other. Cold induces crowding and crowding encourages transmission of infectious agents. Nowadays, the idea that nature can strike back or can punish transgressors is considered laughable. There is danger in the contemporary contempt for metaphor in medicine. By assiduously avoiding the retributive content of biologic homeostasis, we may fail to communicate urgent biologic truths to a large portion of our fellow human beings. The ecologic dismay of desertification due to overgrazing and improper farming techniques is hardly laughable, nor are the problems associated with toxic chemicals at the Love Canal and the selenium-contaminated marshes that receive the effluent from irrigation ditches in southern California. It seems to me that we should be taking the idea of retribution more seriously. Science and progress ought not to be an excuse or alibi for biologically bad behavior. Nature scorned or neglected is a furious creature. Diseases of progress serve as a reminder that life is homeostatic and may react to perturbations of equilibrium with disease, discomfort, and desolation. latrogenic infections, pollution, wasted soil from overgrazing and too much fertilizer ought not to be the surprises we find them. After we have spent several centuries documenting the. cyclical nature of living processes, we should perhaps take the notion of cycles more seriously. If a cycle is not allowed to complete itself, problems arise. Many of these contemporary plagues of progress can,not compare to the disasters that are being shaped by profligate reproduction and sexual activity. The growing problem of sexually transmitted disease was recently dramatized at the International Congress for Infectious Diseases in May 1985. Report after report documented the explosion in the number of seemingly new sexually transmitted organisms, including retroviruses, and the explosion in the number of infected and infectious persons throughout the world. What was not emphasized was that this burst of venereal infection has come hard at the heels of a burst in the reproductive rate. Increasing numbers of sexually active human beings and increased variations in sexual behavior have expanded the pool of susceptible victims and of sexually transmissable organisms. This too ought not to have been a surprise. However, the contemporary sexual mentality has steadfastly refused to recognize that not all aspects of sex are beneficial or benign. The sexual revolution of two decades ago is bearing unexpected and unwelcome fruit in unexpected and unwelcome ways. Increasing numbers of victims of sexually transmitted diseases are keeping pace with spiraling birth rates. It is as if nature is respondrng to profligate reproduction in