CHAPTER X. THE MODERN LABORATORY ITS DOMINATION.
Innumerable pathological questions have been studied in the modern laboratory. These studies have brought to light new facts have rewarded their workers in many ways concerning organic and functional life. There has been the energetic spirit to investigate great problems and so find just how happens those things that do take place in the human organism in health or in disease. While some things are determined many are confused or remain in doubt. This may be a confirmation of the possibility that not by some of those paths do we reach the vital need of the patient.
It must be remembered above all thing that the clinical laboratory is an aid to diagnosis, but rarely can it alone furnish a conclusion and, therefore, in all cases I enjoin you to carefully consider together the evidence afforded by the clinical history, the physical examination, and the clinical laboratory. BARTUS TREW, M.D.
The assumption that disorder of any kind or disease of any kind is caused by a specific germ or bacterium is one of the enterprising evidences of so-called science in medicine. The premise does of course afford a substantial beginning for what is generally known as common sense. This being so, the next conclusion follows, that if you destroy the germ you destroy the disease. Which sounds plausible.
We may not look upon the diagnosis of a disease as presenting a distinct entity of invasion, as something from without that has seized the subject regardless of his invitation. We may not estimate a disorder as introduced by an outside morbific agent like a bacillus, from which the organism has no defense or protection. Human disorder must start with the human subject; moreover, with some hospitable welcome from that subject. There is something in the vitality of some subject which repels invasion. In fact, the bacterium may enter, but the disease never.
This gives rise to the inquiry, “What is the germ then doing?” And the query follows, “Is the germ a protector of the organism against invasion?” Or, if there has been invasion, and germ is there, is the germ not on an errant of mercy? All of which sounds very foolish to the present-day bacteriologist. However foolish it sounds now, it does completely dispose of the unnecessary alarm over pathogenic germs in the throat, lungs, and kidneys of healthy individuals.
The truly scientific method of study is that which begins with accurate observation. There is nothing scientific in the effort to prove anything whatever. Which does not give of itself sufficient evidence of its truth. Science is what is so, not what is supposed to be expedient, not what conforms to some favored belief, not what we might like to believe. Science is what is veritably true-nothing more, nothing less-and what may be demonstrated under suitable conditions as being undeniable.
Until these terms are met and satisfied we may not march under the banner of Science, we may not flaunt before the eyes of any audience our mere conjectures as signs of established fact. But repetition of what ought to be obvious in this respect is necessary. We have to remind ourselves of just these obvious propositions again and again in age when too many subjects and systems and projects masquerade in the name of Science.
When we approach the subject of microbiology, the study of the vital energy, function, and relation of the microorganism bearing on all the phenomena of life, we enter a department of research that is comparatively new. It is true that men of centuries past have figured in their philosophical or scientific reasoning the existence of the microorganism as the logical explanation of some problems presented to their conscious vision as a consequence of delving into different concrete difficulties.
The mysteries of vitality from the point of view of the human mind have always sought solution on some one or another material basis. Man likes best what he can see or feel or hear or control. Man is his purely natural state is averse to recognizing the fact that all knowledge or all wisdom is not to be translated into terms of materialism; that when mysteries exist for him he makes them none the less mysterious by giving them names which in no sense describe them.
While mysticism need not be cultivated, and that which is understood may be explained; and while practical truths need no envelope of abstruse or occult jargon, yet there are mysteries which we do not elucidate however we may claim to do so.
Each and every single phenomenon of vital existence is in a real sense a mystery.
There is no denying there are mysterious phases in bacteriology as yet far from being penetrated by rational analysis. Much as has been learned about the habits of the bacterium, much as has been stated as to its definite function in the economy of life, in both normal and wholesale environments (as in nutritive foods) as well as in relation to diseased states of the human family, this microorganism, this minute germ, this active, infinitesimal form of life, is an entity whose power and place are as yet incompletely comprehended.
It is certainly in order to insist upon such definite contention, since a brief review of the science of bacteriology as presented to the world by its masters will evidence the accuracy of such statement. Let it be limited, however, in this discussion to the relation of the microbe not to beneficent and constructive activities in the great realm of nature, but to the roles which have been so conspicuously assigned to it in all the range of human disorders, to disease, to pathology. This is the important filed in which every one is personally concerned. Everybody is interested to know whether the germ causes the disease, whether obliterations of the germ will result in cure of the disease, whether methods of obliteration of the germ in cases of disease will result in benefit to the patient.
Successive postulates in bacteriological science have been presented, each of which in turn has been proffered by its author as “a basis of argument too obvious to require proof.” Well, for a time this may have seemed to be so, but always some ghostly factor would appear, requiring a new postulate, so that begging the question as to the germ being the first cause of the disease has become the rule.
Perhaps every new postulate as it has issued fresh from the laboratory on the eve of some new and important discovery has been well worded to meet the ethics of scientific demand, but in the present discussion we are concerned with the practical demands-whether or not scientific-they have made on the public. It is the effect on the human patient which constitutes the crucial question in all matters related to medical science and medical art.
As to the microbes themselves, they are marshalled in splendid array by the command of students and scholars in this field who have devoted themselves to this labor. The identification and verification of pathogenetic microbes progresses with speed and skill on the part of the laboratory worker. The confirmed association of a certain microorganism with a certain disease is now one of the facts of pathology, whatever variations may enter into this association or indeed, if at times the association may seem not to exist in a given case. Diphtheria is an example or irregularity. It is perhaps the best instance we have wherein the role of the specific germ suffers many deflection.
Now, while it is largely true that in some instances microorganisms cause disease and entail much of the laborious work of every-day life, it is also true that bacteria are our most important coadjutors and friends – THEODORE J GRAMM. M.D.
Bacteriology must undergo important changes before its standards as now formulated can be accepted as reasonable.
A single ounce of soil has been calculated to contain a hundred and seventy million bacteria, and a single bacterium under favorable conditions can, it is said, multiply in twenty – four hours to one hundred and eighty millions. If noxious to the part of nature which man is, they are not noxious to nature as a whole; on the contrary, they rightly, serve it by killing him when, being weaker life, he is a proper subject to be killed and rendered innocuous, which he is apt to think he never is. Hostile as the typhoid bacillus and other bacilli are to him, they do not hurt in when he is strong and fit to live; for they are often found inhabiting his body in typhoid-carries when he appears to be in quite good health. Are they then functionless, as supposed, in respect of him, only waiting harmlessly on guard to act and end him at the proper time? – HENRY MAUDSLEY, M.D., from Organic to Human, Macmillan, London, 1916, page 158.
The bacterium as the direct and specific cause of its defined malady is such a plausible item of common sense that one seems plain ignorant to doubt it, much less to question it. And yet conjectures will crop up in the plain mind. Questions like; Why do the germs always select the weak subject? Why not take good healthy organism for their attack? Why pick on poor soil, when there is plenty of good? Why wait till the good soil becomes poor before beginning to make war? What are the germs doing in so-called “carriers” while they refuse to make the carrier sick.