Calor, Rubor, Dolor, Tumor

 The Roman encyclopedist Aulus Cornelius Celsus in the first century CE noted the cardinal signs of inflammation in his book De Medicina: calor, rubor, dolor, and tumor. In English, they are heat, redness, pain, and swelling. As a first-year medical student at Temple in Philadelphia many years ago (where does the time go?), this Tetrad of Celsus was introduced. At the time, our understanding of inflammation in medical conditions was limited and students in 2020 can now discuss inflammation as an entity directed by cells and their secretions that produce these classic findings of inflammation. This is a big toe with acute gout; the redness and swelling are obvious, it is warm to the touch, and the person will tell you it hurts. 

Analogously, we are in the midst of the Tetrad of Celsus as a polity. Separating the cardinal signs we have a lot of redness and heat in the current political climate. As the first hearing of the January 6 Committee revealed, that heat came from people who have bought into the propaganda that the presidential election of 2020 was stolen and that Donald Trump remains the legitimate president. He does not. But their rubor burned on January 6 and continues to burn today. The heat intensifies as rationality has been overcome by fear, hatred, and emotion. The what of this fear, hatred, and emotion is inchoate; disaffected people want to belong to something. That something has at its core in an authoritarian strongman type government. This is inimical to democracy. 

That redness and heat were accompanied by swelling as thousands of people stormed the U.S. Capitol Building on January 6, with many injuries, 9 deaths (5 that day, 4 afterward by suicide), and immense physical damage to the Capitol but far worse damage to the idea rule by law. The GOP continues to put out lies, propaganda, and disinformation to increase the swelling. Aided by a complex web of right-wing media and social media platforms, their adherents can blame Democrats, foreigners, immigrants, people of color, the LGBTQ population – because they are the Other. How easy it is to forget that we are all human beings and are all part of the same United States. 

Of course, the fourth part of the tetrad is pain and we have a lot of it. At the root of the pain we have, I feel, is the gross inequality we have built up in American society. Add to this the horrific injuries of enslaving people for the first 200+ years of our history and then continuing the systemic racism to the current day. There is pain from treating women as second-class citizens and taking away rights from them in the process. And the heat and redness and swelling on a daily basis simply compound the pain. Add in an opioid epidemic, a fetish for guns and killing, and the anti-intellectual attitude of many Americans and you sink further into the dolorous depths.

Galen of Pergamon a century after Celsus added a fifth cardinal sign of inflammation – functio laesa, or loss of function. That gouty toe above loses function because of pain and swelling and remains dysfunctional until the inflammation is eliminated. What is true medically in the human body is true in the body politic as well. Our ability to function as the United States, a polity that is inclusive rather than tribal, that works to bring down barriers instead of erecting them, that recognizes the worth of every human in the country, is lost when the inflammatory process rages. We must recognize and stop the sedition that continues to threaten our nation. January 6 2021 was not an isolated incident and was not spontaneous. There is much more evidence to be brought forth from the January 6 Committee. It has to be followed by actions of the Department of Justice and by Congress itself. If our bare finger hold now on democracy is abolished at the polls in November, that will be another body blow to our Constitution and to a government that isn’t perfect but is a hell of a lot better than that of Russia or Hungary or Turkey or Brazil or India. It’s our choice – do something about the inflammation or curse the loss of democracy.