MICROBES, MICROBOPHOBIA AND THE ABUSE OF GERMICIDES


Inimical microbes as well as body cells are composed of protoplasm. Both are simple in form and structure but highly organized chemically, and in the course of evolution have come to be the peers of each other as a result of the struggle for existence. In Natures eyes, “one is just as good as the other”, and both have a right to live.


Dr. Robert T. Morriss book, Fifty Years a Surgeon, which was reviewed in the July issue of this magazine, contains lessons of the greatest value, both to medical men and laymen. His views on microbes and the abuse of germicides are of outstanding importance and value and they should be read with the greatest attention, coming as they do from a man of the greatest practical experience in surgery. I am sure that many of the readers of this magazine will wish to read the book, and it is well worth buying. It is published by Geoffrey Bles at the very reasonable price of 10s. 6d.

Inimical microbes as well as body cells are composed of protoplasm. Both are simple in form and structure but highly organized chemically, and in the course of evolution have come to be the peers of each other as a result of the struggle for existence. In Natures eyes, “one is just as good as the other”, and both have a right to live.

Anything which is destructive to the protoplasm of microbes is likely to be destructive to the protoplasm of body cells as well. Germicides, which were introduced into our armamentarium during the Third Pathologic Era in surgery, have done an enormous amount of harm when employed without knowledge of the fact that they are injurious to body cells. Many germicides killed not only inimical microbes, but also those body cells which should have been left physically free to resist the entrance of microbes of any sort.

In addition to the use of germicides, detailed cleansing of wounds which had for its purpose the removal of products of infection sometimes exhausted the natural store of energy of the patient and left him less well equipped for taking up his personal cell fight against microbes. Further than that, our confidence in measures for securing asepsis and antisepsis –together with improved method in anaesthesia– led us to forget that when operating we were at work upon a living, sentient organism.

Operations which were conducted speedily were held to be carelessly-performed operations because of neglect of petty technical details. Operations conducted through short incisions were held to be incomplete because “they failed to expose all of the pathology”.

10.

Every test supported my hypothesis; the patient, on the whole, is his own best antiseptic.

Unless the reader chanced to be on the scene at that period he cannot readily appreciate how radical this proposition was.

In the nineties it was customary for surgeons to treat cases of appendicitis in which there was infection of the peritoneum by making long incisions which caused shock. Incisions suitable for killing bears were being applied to weak patients. Surgeons made multiple incisions for purposes of drainage and these also caused shock. At that time gauze-packing and large drains were used in great quantity. The mere presence of such foreign lumbar in the abdominal cavity brought on shock and prevented the patient from readily summoning his own physiological resistance factors.

I asked the profession what would happen if ten hearty policemen were to be brought from their beats to the hospital and a yard of gauze inserted into the peritoneal cavity of each one of them. Would they be doing as well as expected next morning? Yet this was accepted treatment for abdominal infections for a while. Patients sometimes had to be given an anaesthetic when adherent gauze was removed for change of dressings.

In addition to ordinary packing and drains, iodoform gauze was commonly used, and this had a special death-rate of its own because of insidious iodoform poisoning — the symptoms of which are so like those of sepsis that deaths were set down to the account of sepsis when really due to iodoform. A well-known surgeon told me that he had not seen a case of iodoform poisoning in his wards. I seemed to recognize at least one as we went through, and persuaded him to have urine examinations made. To his great surprise, we found three such cases in that one ward.

It is almost impossible to persuade nurses and assistants to avoid wiping or washing a healing wound. They are impelled by a love for gross cleanliness which would appeal to kitchen maid. Fourth Era surgery recognizes that pus on the surface of a healing wound contains few if any harmful bacteria. If it is likely to macerate new repair cells we may apply pressure over a perforated waterproof protective covering which guides epithelium cells instead of entangling them as gauze does.

Dawbarn demonstrated that pus could not all be removed, anyway. He poured milk into the abdominal cavity of a cadaver and then tried to get it completely out. It cannot be done, but such an important experiment attracted almost no attention at the time.

Robert T. Morris
Robert T. Morris, A. M., M. D., was a Professor in Surgery at the New York Post-Graduate Medical School (around 1912).
The renowned New York doctor, Robert T. Morris (1857-1945), who struggled with a reactionary profession to pioneer sterility, small incisions, and better wound-healing in surgery. Blessed with abundant energy, sagacity, and long life, he also achieved distinction as a naturalist, horticulturist, and explorer, celebrating nature with brilliant prose and poetry. For those days, Morris was a rare visionary, grounded in science and courageously fighting on the side of suffering humanity, though few remember him today.