THE words Bacteria, germs, microbes, have become very familiar of late years, and the problems of Bacteriology have grown to be important to every citizen, both in his public and his private capacity. The science of germs is of recent growth, but has rapidly advanced to being a great accumulation of knowledge and problems of great interest and significance arise out of it. Bacteria (which are sub-divided into Bacilli, Micrococci, Spirilla, etc.) are minute living unicellular organisms of the nature of Fungi, invisible individually, except to high microscopic magnification. There are very many varieties which can be distinguished by the expert. Of these many do not affect man, or are not harmful, but a certain number of ” pathogenic,” that is to say, they can, when circumstances favour them, multiply as parasites in the body, and cause sequences of disease phenomena which are fairly constant for each variety. In other words certain germs multiplying in the body are held on good evidence to be the cause of certain disease. The list of such disease is a long one; in other parts of this work the causal germ is noted in relation to each disease, which is held to be produced by it. The germs give rise to the disease in two ways. Multiplying locally at the site which has become infected with them, they can cause irritation, inflammation and often suppuration as the body reacts to their presence; but a more important cause of disturbance is the manufacture of poisons called toxins as a consequence of the growth of these parasites. Toxins result from germ growth, being either waste products of the germ life, excretions as it were, set free in the body of the victim, or substances produced in the tissues in the struggle which these make against the invaders. Conceivably both these sources (and possibly others) are responsible for the toxins symptoms of the patient, fever, malaise, etc., as well as certain of the local symptoms.
Bacterial diseases then are the result of Bacterial growth and manufacture of toxins. It is therefore, clear that to prevent the admission of certain germs to the body becomes a matter of the greatest importance. The suppuration of wounds which used to make even the slightest surgical operation fifty years ago a source of possible danger, was shown by Lister (following Pasteur) to be due to micro-organisms. This established, it became a problem for surgery to control the growth of these germs. Antiseptic methods represent the endeavour to destroy them when they have found a lodgment; asepsis the endeavour to prevent their entrance. This last procedure has attained such perfection that to day in the vast majority of cases, healing without suppuration can be guaranteed. The due preparation of the patient’s skin; the sterilizing (destruction of germs) of instruments, dressings, water, all in fact that comes in contact with the patient (generally by means of heat); the surgical cleanliness of surgeons’ and assistants hands, usually to-day achieved by wearing sterilized gloves; all the these procedures are directed to the one end of asepsis, prevention of entry of germs into wounds, and are notably successful in their attempt. Surgery owes its commanding success and assurance to its mastery of the principles of asepsis. But the citizen is influenced in his life (or should be) by the thought of germs in other ways. Few germs can long survive exposure to air and sunlight; hence the breaking up of slums, the provision of decent houses and open spaces, is not only a measure of philanthropy (not to say justice), but reacts in turn on the health of the whole community. For the fever bred in the slum may be carried to the villa or the mansion. Pathogenic germs like those of typhoid, diphtheria, infantile diarrhoea, etc., are introduced into the body by water or milk. Hence the supreme importance of controlling and investigating water and milk supplies and maintaining in them a good standard of purity, and the importance of efficient drainage, prevention of pollution of streams and all other means of making difficult the access of possible pathogenic germs to places from which they may be conveyed to human beings. Most of the work of Public Health is connected directly or indirectly with Bacteria, and a realization of the powers of these organisms should help the citizen to understand that it is policy as well as duty to spend freely on Public Health means private health. The surgeon, therefore, and Public Health Official have to prevent the access of pathogenic germs to human beings. Nevertheless, the defence is frequently broken through and patients contract germ diseases, becoming thereby the care of the physician. The physician can do much to limit infection, by isolating the diseased; even sufferers from nasal catarrh should realize that they are dangerous in some degree to others; indiscriminate expectoration is now rightly prohibited; the sputum contains germs of tubercle, pneumonia, etc., and when it dries to dust and blows about to be swallowed or inhaled it carries the potentialities of these diseases; but with all this preventive effort must go a curative effort as well towards the patient who has contracted sickness.
Homoeopathy supplies the best means of choosing remedies for the particular disease on the ground of similarity of symptoms, and apart from drugs much may be done to relieve the suffering, but it is of importance to realize the natural efforts of resistance which the body makes to the invader, apart from outside help, for otherwise the physician may hinder where he desires to aid. The defences of the body are primarily directed to destroying the bacteria. The white corpuscles of the blood have the power of ingesting and destroying the germs (phagocytosis), and this power is reinforced by the development in the body of a variety of substances which weaken the bacilli in various ways. These substances, called generically anti-bodies, vary in different diseases and have different powers according to which they receive different names, agglutinins, opsonins, lysins, etc.; it is not fully known from what they are manufactured; some are present normally in blood, ready for possible invaders, others are only produced in response to a specific enemy. It may be laid down as a general rule that whenever a living body is attacked by a pathogenic germ, the attack proves a stimulus to the body to produce a specific defence. If the defence fails the patient dies, or becomes the subject of a chronic disease, if the defence is adequate the invader is destroyed or rendered harmless, and the patient recovers. In other words, there are two factors in bacterial diseases. There is the seed and there is the soil. When the body has its resistance so perfected that an invader is helpless, it is said to be immune, and to reach a condition of immunity is the aim of treatment. In some persons this exists performed for some diseases: such persons, if attacked by one of these disease either show no symptoms, or only a few abortive ones, for symptoms are the expression of the struggle between the invader and the tissue. When the disease symptoms are unmistakeable that implies a struggle, and a gradual progress towards immunity and cure, or defeat and death (or chronic disease). In many cases immunity when reached persists for a longer or shorter time, and that is why one attack of some disease protects for a while against further attacks.
The effect of treatment therefore should be to encourage natural resistance. Attempts to act directly on the invaders are often made, but seem generally (if not always) futile. Malaria is due to an organism (not a bacterium but a so-called plasmodium), and Quinine is supposed to act directly upon it. It is true that outside the body, Quinine in a certain strength of solution will kill it, but to assume therefore that its action when swallowed is a similar one is to make a doubtful deduction. It is more probable that it acts through the body-mechanism for resistance, rousing it to efforts of which it was incapable without the stimulus.
It may now be asked what place treatment can have if it is held to be futile to attempt to attack the invader directly. The answer lies in the apparent fact that the body sometimes possesses a power of resistance which nevertheless lies talent; this latent; this latent power can be called forth by appropriate means and the invader routed. Otherwise apparently a patient may die or become chronically ill for want of some stimulus to evoke his latent powers. General hygienic treatment (fresh air and diet, etc.). aims at putting the body mechanisms in a favourable condition to respond, and has a value. The drug homoeopathically chosen, however, appears to be potent to give a more direct aid. There is some evidence that when appropriate to the patient and the condition (which is the meaning implied by the word homoeopathic) it stimulates the production of anti- bodies directly. Further in asmuch as it is attracted (because of its similarity) to the cells which are principally attacked it is likely that it stimulates them directly, enabling them to maintain their ground till such time as the anti-bodies are elaborated. For the defeat or victory of the invader is often determined by the time which can be allowed to the defence in the body of the citizen as well as with the body politic of the state. In these two ways the homoeopathic remedy gives it help and often decides the question of recovery or non-recovery, and often makes more speedy a recovery that would have taken place without it, though delayed. If it is freely admitted also that recovery is often natural and not drug aided, that in no way detracts from the wisdom of using the drug, for unlike the drugs which are non-homoeopathic, the similar remedy will at the least do no harm, and at the best may prove the decisive factor in the struggle.
The term immunity is now, it is hoped, clear, and the aim of drug giving to produce it or to help to produce it. But some interesting phenomena remain to be described. In investigating the problems of immunity it was found (as stated above) that in some diseases, notably in diphtheria and tetanus (lockjaw), the disease symptoms were mainly due to the circulation in the body of bacterial toxins, and that in these two cases an important part of the defence mechanism consisted in the elaboration of an antidote to the toxin, an anti-toxin, which directly counteracted the toxin and thereby gained time for the body to destroy the germs when otherwise it would have been overwhelmed by the poison. This discovery of Professor von Behring and Professor Roux was a most important one. It was found on following further these phenomena of antitoxin formation, that if toxin were injected into a healthy animal (preferably a horse) in a dose insufficient to kill, the body promptly formed anti-toxin in excess, so that after a few symptoms the animal, becomes quite well again, and circulating in its blood is found enough anti- toxin to counteract a good deal of fresh toxin. A further toxin injection sets this mechanism going again, and ultimately, with little or no discomfort to the animal, its blood serum becomes highly charged with anti-toxin. This serum can be drawn off and kept for a considerable time and forms the so-called antitoxic serum. When a case of diphtheria presents itself it is possible to inject this diphtheria anti-toxin to counteract the toxin which is being manufactured; conceivably the serum can counteract it so completely as to produce a condition of immunity, But this immunity being due to the antidote artificially produced and injected, and not to the powers of resistance of the body, is called passive, immunity in contra-distinction to active immunity. Of course, from the moment of invasion the natural powers of resistance are at work; the patient is producing his own anti-toxin as well as dealing with the bacilli directly. The function of the serum is to supplement the resources of the patient: therefore it is particularly valuable at the beginning of an attack before the forces of the defence are fully called out. Diphtheria is the best example of a disease wherein an anti- toxic serum has claims to be considered valuable, but tetanus (lockjaw) is another sickness where toxin and anti-toxin come into play, and serum has also been used with good effect (it is claimed) in certain streptococcal infections. This passive immunity, however, has on the whole been found to be a phenomenon which lends itself to use in treatment on rather a limited scale, and the hopes roused by the discovery of diphtheria anti-toxin (and to some extent justified in that disease) have not been much rewarded in attempting to deal with other diseases on similar lines. (* The use of anti-tetanic serum in the Great-War was very successful) However, the many and varied researches into problems of immunity were next rewarded by the placing of “vaccination” for bacterial disease on a sound footing, and vaccination is an attempt to produce active immunity. It has already been pointed out above why one attack of a bacterial disease gives some immunity against future attacks. The observation of this fact led first to inoculation with mild small-pox as a preventive of severe small-pox. When it was found that this process was very dangerous, as contagion from a mild case has the power to develop sometimes into a very severe form of the disease if the inoculated patient proved susceptible, the practice was given up in favour of ordinary cow-pox vaccination. The theory of cow pox vaccination is that disease is a modified form of small-pox and possesses the power to prevent the severe disease. As we should now phrase it, it leads, to the production of anti-bodies which are available against small-pox. The value of it has become a burning question and till the discovery of the germ or organism of variola it is difficult to marshal conclusive evidence, but the process which is unproven for smallpox rests on a better foundation for other bacterial diseases. The names vaccination and vaccine are retained for the process and the substance used, although in other bacterial diseases neither process nor substance has anything to do with cow-pox. Whenever a germ can with confidence be reckoned as a causal agent in producing a disease, experience teaches that the best agent (or one of the best) for calling out the resistance of the body and so achieving cure, can be made from the causal germ itself. The organism is grown on a suitable culture medium outside the body, killed by heat, and injected into the patient, and this “vaccination” is found to evoke a specific resistance to the particular germ. Active immunity to it is, in fact, produced. The process was at first used for prophylaxis, to protect against diseases such as typhoid by preliminary vaccination and advantage has been largely taken of vaccines for this purpose. But it was presently found that even patients suffering from the actual diseases could at times have a latent power of resistance evoked by the cautious use of vaccines. But in asmuch as the ultimate rise of resistance (positive phase of Sir A. Wright) is preceded by a lowering of resistance (negative phase), it was found necessary to use vaccines with great care and in small (often minute) doses. (* There is a form of vaccine made of so- called “sensitised” bacilli, which is claimed to be free of the danger of producing a negative phase, but there is nothing in the process of its manufacture and use that conflicts with the general theory of action of vaccines.)
Now consider these discoveries of the bacteriologist from the point of view of Homoeopathy. Here we find remedies for diseases made out of the very agents claimed to cause those diseases. The agents are slightly modified by culture outside the body, and the process of sterilization of the vaccines, and are then administered in small and infrequent doses. It would be difficult to find any other adjective than homoeopathic for the practice, and the realization of this fact has done more to undermine the prejudice against Hahnemann than any other discovery. Long before Bacteriology, Hering and Lux, and others, had tried to make remedies by potentizing disease products. Compton Burnett indeed used a remedy analogous to Tuberculin before Koch, and discovered out of his own clinical experience the rules for its application in infrequent doses, which are identical with those of the modern use of Tuberculin, except that Burnett employed potencies (and high potencies) where to-day Tuberculin is generally given in quantities, very small it is true, infinitesimal sometimes, but yet larger than those of Burnett. Also Tuberculin is generally injected (not always, however), and Burnett gave his Bacillinum by the mouth. The other homoeopathic users of “nosodes” (remedies made from disease products) also used only potencies, and to-day many homoeopathists prefer these potencies and make new ones from bacterial cultures instead of injecting dead bacilli in vaccines. There is little doubt that this is quite a satisfactory procedure and the principle is the same whichever method is adopted. And that principle can only be conceived as an endorsement (for these bacterial diseases at least) of the homoeopathic law, whereby homoeopathic physicians can take new courage for this is an aid to their cause unlooked for, but none the less most welcome.