John Lord.

Beacon Lights of History, Volume 14 The New Era; A Supplementary Volume, by Recent Writers, as Set Forth in the Preface and Table of Contents online

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powers, each giving rise to some definite specific disease, and certain
associations of different bacteria causing particular morbid conditions.
Generations ago physicians had a glimmering of what we now term the germ
theory of disease, as was shown by their use of such expressions as
_materies morbi_ and morbid poisons. Even the definite relationship of
special microscopic organisms to individual diseases was foreshadowed by
Salisbury nearly fifty years ago. But it was not until years after those
conceptions, and in no wise descended from or led up to by them, that an
intelligible and satisfactory germ theory of disease was formulated.

It is to Pasteur, the immortal chemist, that we owe this theory, as well
as that of the attenuation of viruses - both of more than theoretical
import, since they have given us aseptic surgery, the power of
frequently preventing hydrophobia, the antitoxine treatment of
diphtheria, and the ability to stay the hand of Death in the form of
many a stalking pestilence. Every infectious disease is now held to be
due to its own particular micro-organism, and many diseases that were
not until recently thought to be infectious are now classed as such
because they have been proved to be caused by living germs. Conspicuous
among these diseases is pulmonary consumption. In the case of almost
every one of these diseases we have discovered the specific germ and are
able to demonstrate its presence, either by its microscopical
appearance, by its behavior on contact with certain stains, or by the
forms that cultures of it assume. The micro-organism of small-pox and
that of cancer (the existence of which is assumed) have not yet been
isolated. Some of these germs, like that of tetanus (lockjaw), gain
entrance to the system only through a wound; others, like those of
typhoid fever and cholera, are swallowed; others, like that of
pneumonia, are inhaled; still others, like that of tuberculous disease,
are either swallowed or inhaled. Some are believed to be transmissible
to the unborn child; and a few are ordinarily harmless parasites,
becoming pathogenic only when they accidentally gain access to other
parts of the system than those which constitute their natural habitat.

These microscopic organisms do not by their mere presence set up
disease, unless indeed they are in such overwhelming numbers as to block
the capillary blood vessels mechanically. Some of them are carried
broadcast in the blood current, while others remain at the point of
entrance; in either case they elaborate certain products, termed
toxines, which act, either locally or through the circulation, to cause
the disease. These toxines eventually kill the micro-organisms that
produced them, quite as an animal may be smothered in its own
exhalations; or at least they would do so if the "host" survived long
enough for the completion of the process. Meantime, they have either
killed the "host" or been defeated by certain very interesting natural
processes. But before either of these occurrences has had time to take
place, fortunately, in the great majority of instances, save those of
exposure to the most deadly of infections, the vital power of the
invaded individual has coped successfully with the invaders at the very
point of attack - has repulsed the attacking party without appreciable
impairment of its own force - and no illness results. For example,
practically all of us inhale the germ of consumption repeatedly, but
most of us suffer no harm from it simply because the fluids which bathe
the surface on which the germ effects a lodgment are endowed with
properties which either kill the germ or rob it of its power for harm;
but these properties suffice only when the general health is unimpaired.

In case the attack is not successfully repelled at the outset, what
happens? There begins a struggle between the invaders and what may be
called the reserves of the organism, consisting of the white blood
corpuscles, which undergo a great augmentation in number. These
corpuscles are endowed with the faculty of amoeboid movement; that is to
say, they may shoot out projections from their substance, and even
convert themselves for the time being into traps, seizing upon the
pathogenic bacteria, incarcerating them within their own mass, and
carrying them away to be thrust out of the system by organs whose
function it is to eliminate extraneous matter. These corpuscles are,
indeed, said figuratively to _eat_ the malign micro-organisms, whence
they have been termed phagocytes (from [Greek: phagein], to eat, and
[Greek: kutos], a cell); also because they carry away refuse and
noxious material, they have been called "the scavengers of the system."
By means of their amoeboid movement they are enabled to worm themselves
through inconceivably minute apertures in the blood vessels, and attack
and devour peccant matter wherever it may have effected a lodgment.
These white corpuscles are also known as leucocytes, and their increase
in number when they are called upon to resist bacterial invasion is
spoken of as hyperleucocytosis. The discovery of their protective
function is to be credited to Metchnikoff, a Russian physician now
teaching in Paris. When they migrate from the blood vessels in great
numbers they finally, after having fulfilled their office as phagocytes,
degenerate into the corpuscular elements of pus, which is the creamy
liquid contained in an abscess. Their migratory power was discovered
by Cohnheim.

But as a general thing the phagocytes do not succeed in making away with
all the pathogenic germs, or even with enough of them to prevent the
illness which they tend to produce. The further combat is between the
poisonous products, termed toxines, engendered by the bacteria and
certain antidotal substances, called antitoxines, newly created in the
watery portion of the blood by some wonderful provision of Nature that
is not yet well understood. Each infective disease has its special
toxine, and for the destruction of each the blood prepares its
particular antitoxine; possibly, however, some of the antitoxines may be
efficacious against more than one kind of toxine, for there are
physicians who are convinced that vaccination is a temporary preventive
of whooping-cough. But the elaboration of an antitoxine takes time, and
the result in any given case, whether in recovery or in death, seems to
be settled by the ability or inability of the vital powers of the
individual to hold out until they are relieved by the evolution of the
necessary amount of antitoxine.

In the long run, provided the sick person survives, more antitoxine is
generated than is required to save life. The excess remains in the
system for a greater or lesser length of time, and this fact explains
the individual's subsequent immunity to the disease from which he has
recovered; any fresh invading force of the microbes of that disease
finds that defensive preparations have been made in advance. In the case
of some diseases this acquired immunity is usually lifelong, as in that
of small-pox; in others, of which influenza is a notable example, it is
as a rule very transitory; and there are all gradations between the two.
It is thought that this acquired immunity to some diseases may be
transmitted to the offspring, for it is quite certain that there are
many people who are from birth insusceptible to scarlet fever, no matter
what may be the extent of their exposure to that disease.

The recognition of Nature's elaboration of protective antitoxines has
led to their artificial cultivation in the lower animals, and, thus
produced, they have been used with brilliant results in the prevention
and cure of at least one formidable disease, diphtheria. The immense
reduction of the mortality from this disease that has followed the
introduction of the treatment with the artificial antitoxine we owe to
Behring, of Germany, and Roux, of France. Omitting unnecessary details,
we may describe the process of obtaining diphtheria antitoxine as
follows: A certain amount of diphtheritic poison (of the bacteriological
sort, prepared by cultivating the diphtheria microbe) is injected into
the circulation of a horse - sufficient to make the horse sick, but not
enough to endanger his life. The horse's system straightway begins to
elaborate the protective antitoxine, and there results from this one
injection a sufficient amount of it to save the horse, although far too
little to make the serum of his blood potent enough for medicinal use.
Hence, after the lapse of a suitable interval, he is again injected with
diphtheritic poison, and for the second time his blood begins to
generate the antitoxine. And the process is repeated again and again,
the virulence of the poison being increased each time, until the horse's
blood is fairly reeking with antitoxine. Then blood is drawn freely from
the horse, and it is allowed to separate into clot and serum, the
latter alone being the part destined for use. This serum is tested on a
small animal that has been inoculated with a deadly dose of the
diphtheritic poison; if it saves the little creature from death, it is
assumed to be potent enough for use on human beings, and, handled with
all possible precautions against putrefaction or any contamination with
pathogenic bacteria, it is furnished to physicians, its degree of
potency being designated in "units."

If in this brief article, which does not purport to be more than a
sketch of the tremendous strides made by medicine in the Nineteenth
Century, so much space has been given to the germ theory of disease, it
is because the demonstration of the truth of that theory has been
absolute, and has constituted the very marrow of almost all the medical
progress of the century that has been the outcome of continuous thought
and study as opposed to chance discovery.

Such results as the germ theory has now led to in the treatment of
diphtheria it had already accomplished in the field of surgery as a
consequence of that strict asepticism which, originating with Joseph
Lister (now Lord Lister), and rapidly carried by him to a condition
verging on technical completeness, was soon taken up by surgeons all
over the world and brought wellnigh to perfection, so that the mortality
of wounds of all sorts has been tremendously reduced, and many surgical
operations are now practised frequently - indeed, whenever the occasion
for them arises - that before the days of Listerism would have been
looked upon as almost tantamount to the patient's death-warrant. More
particularly is this the case as to operations which involve opening
into the abdomen, the chest, or the cranium. So little risk now attaches
to such operations, properly performed, that the opening of the
abdominal cavity for the mere purpose of ascertaining the condition of
its contents - "exploratory laparotomy," as it is called - is a matter of
constant occurrence. Curiously enough, in some way not yet
satisfactorily explained, that procedure in itself, without anything
further being done, has in many instances resulted in decided
amelioration of a morbid condition, if not in its cure. A striking
example of this is seen in the benefit that often results in cases of
one form of "consumption of the bowels," namely, tuberculous disease of
the membrane that lines the abdominal wall and invests the abdominal
organs. This is not the only operation that does good mysteriously; that
of cutting out a bit of the iris in a form of deep-seated eye disease,
glaucoma, that tends toward complete blindness, is hardly more
explicable; neither is an incision of the capsule of the kidney for
certain forms of Bright's disease, each of which stays the progress of
the trouble in a goodly proportion of instances.

Another of the great divisions of the healing art, that of midwifery,
has been enhanced quite as much as general surgery by the employment of
Listerism. The process of childbirth, although a perfectly natural one,
almost necessarily carries with it a certain amount of laceration, and,
through the wound surfaces thus produced, absorption of poisonous
material was formerly so frequent that puerperal fever figured
prominently in mortality reports. It was Oliver Wendell Holmes - a
graduate in medicine and a professor in the Harvard Medical School,
though we are accustomed to think of him only as a delightful
writer - who first declared that puerperal fever was the product of
infection from without the body, and Semmelweis demonstrated the truth
of the proposition. Holmes was a teacher of physiology, and his study of
that branch of medical science was in itself enough to convince him of
the doctrine which he inculcated.

Listerism must be credited, not only with having added immensely to the
safety of the major operations of surgery, but also with having led to
great improvement of their technics by reason of the greatly increased
frequency with which it has come to be thought justifiable to practise
them; what we do again and again we are apt in the end to do well,
whereas that which we turn to only in despair and as rarely as possible,
we do clumsily and imperfectly. Listerism has been unjustly alleged by
a few to be unworthy of the appreciation in which it is held by the
great majority of medical men of all countries; simple cleanliness, it
has been urged, is quite as efficient as the full Listerian precautions.
This is begging the question, for simple cleanliness, "chemical
cleanliness," is all that Listerism purports to accomplish. The use of
antiseptics has been decried in the interest of asepticism, as if the
whole purpose of antisepticism were not to secure asepsis. Lord Lister
is entitled to the full credit of establishing the aseptic surgery of
the present day, in spite of the facts that his doctrine followed rather
than preceded his early improvements, that aseptic procedures have been
brought nearer perfection elsewhere than in his own country, and that
the whole system rests on foundations laid by Pasteur.

While it is quite true that to the Listerian theory and practice are
almost wholly to be ascribed the favorable results of the major surgery
of the present day, we must not forget the immeasurable benefits to the
diseased, the injured, and the crippled that have arisen from patient
efforts and occasional brilliant intuition that have had no connection
with the germ theory of infection. Take the case of a broken leg, for
example, an injury that formerly condemned the victim to weeks and weeks
of confinement to bed, together with the suffering and danger almost
inseparable from the old methods of the long straight splint and tight
bandaging. At the present time he who has met with such a misfortune is
commonly able to be about on crutches within a few days, and his broken
bone mends while he is cultivating his appetite and indulging in
pleasant intercourse with his fellow-men. This great change has been
made possible by one device after another, invented by different men.
Josiah Crosby introduced the use of sticking-plaster for extension,
instead of the chafing bands previously employed; Gurdon Buck
substituted elastic extension by means of a weight and pulley for the
rude and arbitrary traction in vogue before; James L. Little devised the
plaster-of-Paris splint, whereby broken bones were immobilized with
hardly appreciable discomfort; and Henry B. Sands established the safety
and practicability of applying the plaster-of-Paris splint almost
immediately after the reduction ("setting") of the fracture. In the
meantime Nathan R. Smith and John T. Hodgen had demonstrated the
advantages of suspending a fractured limb from above. All these men were
Americans; surely our country has contributed powerfully to the
well-being of the subjects of fracture. Other Americans, notably Lewis
A. Sayre, have enabled sufferers with joint disease, including the
dreaded hip disease, to run about and gain health and strength, instead
of languishing in bed. Sayre, too, by his suspension treatment and the
plaster-of-Paris jacket, set the hunchback on his feet at a stage in his
disease in which before he had been forced to prolonged and painful
recumbency.

Although men professing special skill in certain operations, and
doubtless possessing it, flourished in old times, and left more or less
of their impress on the surgery of the present day, for that matter, it
was not until the second half of the Nineteenth Century that regional
surgery (which is what specialism virtually amounts to) was
systematically cultivated. Now there is hardly a portion of the body to
which practitioners who make its ailments a specialty do not direct
their searching methods of examination or on which they do not practise
their ingenious devices in the way of treatment. Specialism has always
been decried by a large section of the medical profession. On the other
hand, it has been and is still overrated by the laity. The true estimate
lies between the two. The specialists have advanced surgery immensely,
but, with many honorable exceptions, they have laid too much stress on
their several specialties, making too wide a range of ailments fall
within them. As for the community at large, their shortcoming lies in
the fact that most of them would seek for a specialist in mumps in case
that painful but transitory infliction were to come upon them, and in
their underrating of the family physician.

To change for a moment to a topic akin to the germ theory of disease,
the reader may be reminded that the antitoxine treatment of infectious
disease involves in almost every instance the use of some product
contained in the serum (that is to say, the watery part of the blood).
This leads to the subject of the use of natural and artificial serum in
the treatment of disease. To quote again from the article entitled, "The
Nineteenth Century in Medicine" ("New York Medical Journal," Dec.
29,1900): "It has been observed that the normal serum of certain animals
that are insusceptible to particular infectious diseases, if injected
into the human blood current or even into the subcutaneous tissue,
confers more or less of immunity against those diseases.... Artificial
serum seems to have been first employed by Edmund R. Peaslee as a benign
application to the peritonaeum in the operation of ovariotomy. His
conception of its mode of action is not very clear, but he was a very
successful ovariotomist, and we can only conjecture that he builded
better than he knew, like many another man. A few years ago much was
expected from transfusion of blood, but gradually the conviction has
forced itself upon us that it is wellnigh useless, and indeed that, on
the whole, it is worse than useless. It has virtually been abandoned....
But experiments in transfusion have not been fruitless; they have
culminated in demonstrating the inestimable value of infusions of
'normal,' or 'physiological,' solutions of sodium chloride, and not only
of infusions, but also of peritoneal irrigation with such solutions.
Many a life has been saved by resorting to this measure, even in
apparently desperate cases."

Within about a decade of the close of the century, Robert Koch, whose
discoveries and ingenious studies in bacteriology had brought him
world-wide renown, announced that he had produced a derivative of the
tubercle bacillus, which he termed tuberculin, that he thought might
prove curative of tuberculous disease. It was to be injected beneath the
skin. If the subject was really tuberculous, he would "react" by
manifesting a certain degree of fever, and repeated injections would
bring about elimination of the tuberculous deposits and thus effect a
cure. The world was carried away with such an announcement coming from
such a man, and it was thoroughly believed that at last "the great white
plague," consumption, was to be conquered. Tuberculin did, indeed, cure
certain minor forms of tuberculous disease, such as the skin affection
known as lupus, but it soon became evident that it was almost impotent
in the treatment of pulmonary consumption. It has, however, served to
enable the veterinarian to make out the existence of tuberculous disease
in cattle at an early stage of its course, and it is probable that by
the slaughter of cattle thus found to be tuberculous much infection of
human beings has been prevented.

Tuberculin failed of its prime purpose, but it does seem to have marked
the initiative of a campaign against consumption which has already
proved of incalculable benefit, and bids fair to put that omnipresent
disease toward the foot of the list of causes of death. We have made
substantial advances in our knowledge of the disease, and we no longer
regard it as incurable. We have learned that it is communicable from one
person to another, but also that its communication can easily be
prevented, so that there is no reason to shrink from association with
tuberculous persons. We have learned, too, that consumption in one's
progenitors, immediate or remote, hardly makes it even probable that he
himself is doomed to suffer with it; the only tuberculous heredity that
we now recognize is that of defective ability to withstand the
infection, and even this we regard as in most instances readily
surmountable. We have learned, furthermore, that pulmonary tuberculous
disease is by no means so fatal as it was formerly esteemed, for men
whose business it is to make great numbers of post-mortem examinations,
such as coroners' physicians and hospital pathologists, assure us that
in a very large percentage of cases of death from other causes they find
indubitable signs of past tuberculous disease of the lungs which had
ceased its activity - been, in fact, cured, either spontaneously or by
medical intervention. Such intervention, it has been abundantly proved,
is altogether likely to be successful if it is of the right sort and
employed early. There is, to be sure, no cure-all. Powerful as the
climatic treatment is, it must be supplemented by measures accurately
adapted to the individual case, and failure to comprehend this fact
still leads many a phthisical person to his grave. But information is
rapidly being diffused, sanatoria for such of the tuberculous as can
take advantage of them are multiplying, and those who are shut off from
their aid are growing more and more cognizant of how they should live in
order to give themselves the best chance of recovery and save their
associates from infection. The era of consumption-cures - meaning
drugs - is past; but the disease is cured in an ever-increasing
proportion of instances, and that, too, by medical though not
medicinal measures.

At almost every turn medicine has been powerfully assisted by the
sciences which should rather be termed correlative than subsidiary.
Notable among them is chemistry. The isolation of the active principles
of medicinal plants - such as morphine, quinine, strychnine, and
cocaine - has been a remarkable service rendered by chemistry to
medicine. How should we be handicapped if we still had to fight
malarial disease with the crude Peruvian bark instead of its chief
alkaloid, quinine! And how impracticable if not impossible would it be
to render the eye insensitive to pain with any extract of coca leaves,
no matter how concentrated - a purpose that we accomplish almost
instantly with cocaine! Of minor importance, perhaps, but not to be
despised, is the resulting liberation from the old slavery to bulky and
nauseous drugs. The isolation of active principles long antedated the
synthetical preparations, but the latter came at last - the marvellous
array of hypnotics, anodynes, and fever-quellers that are now at our
command, largely coal-tar products. But it is not to pure chemistry
alone that we are indebted for the elegant dosing of the present day;
progressive pharmacy, with its tablets, its coated pills, and its
capsules, has put to shame the old-time purveyor of galenicals. Right
jauntily do we now take our "soda mint" in case of slight derangement of
the stomach, happily oblivious of its vile prototype, the old rhubarb
and soda mixture. Even castor oil has been stripped of its repulsiveness
by the combinations which the soda water fountain affords.

It was but a step, we can now realize, from the employment of isolated
vegetable principles to that of preparations of certain glandular organs
of the animal economy, but the doctrine of "internal secretions" had to
intervene, and its evolution took time; not till toward the close of the
century did the venerable Brown-Séquard lead up to it. We have not yet
come to "eye of newt and toe of frog," but what we have incorporated


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Online LibraryJohn LordBeacon Lights of History, Volume 14 The New Era; A Supplementary Volume, by Recent Writers, as Set Forth in the Preface and Table of Contents → online text (page 25 of 26)