IT is related of an ambitions but pretentious lawyer that during his first argument before the Supreme Bench of the United States, it became necessary for the Chief Justice to interrupt him with the suggestion that “This court may be presumed to know something about law!” The admonition of the eminent jurist is not unheeded. I assume that he who takes the time and the trouble to read or to listen to these words is tolerably familiar with the present teachings of the science of bacteriology, the present state of development of the germ-theory.
Bacilli have been devoted attendants upon the human race, lo, these unnumbered ages. We made their acquaintance but yesterday. Not too late, however, for they will continue to abide with us a few centuries longer. It is for us simply to determine upon a proper style of department toward our newly-discovered companions.
The practical relations of human beings to such tiny yet murderous associates are susceptible of a threefold division natural at once and logical. The underlying conditions are: 1. The obnoxious microbes outside the unbroken covering, cuticular or mucous, of a vigorous healthy body. 2. Their actual storming of more or less accessible breaches in the vital armor, establishment by violence or by physiological processes. 3. Their establishment of camps within the human frame.
Evidently, the functions of a physician toward these conditions are as diverse as the situations indicated, although in any given instance he may be compelled to discharge them all. Concerning the bearing of a surgeon toward disease-germs, I will not presume to speak, although elsewhere I have intimated, by reference to unimpeachable authority, his subjection to the same principles which should govern his brother.
If a physician is consulted concerning pertinent matters when thoroughly satisfied none of these little creatures have discovered an entrance to his patron’s body, he must act simply as a hygeist. To the performance of that duty, however, he should bring all attainable knowledge of the resources of sanitary science. This service has, singularly enough, been dubbed by some “preventive medicine,” an incongruous and absurd appellation.
Should a doctor succeed in catching any of the well-nigh omnipresent wanderers in an attempt to scale any breach opening to the citadel of life, he would at once thoroughly, though gently, sweep thence the invading hosts, for, as was shown in detail one year ago, experience and bacteriology alike forbid the application of corrosive or irritating substances to raw surfaces.
If aid has not been summoned until invasion has been measurably accomplished, the attendant’s duty is still unmistakable. Since the chief physiological disturbances and anatomical changes (pathological conditions) subsequent to the lodgment of these impalpable foes within the human frame are the direct result not of themselves nor yet of their work, but of the efforts of the organism to free itself from their presence, it follows as naturally and as inevitably as does the day the night that the proper course of action is the administration of medicaments which shall intensify and sustain (reinforce) the exertions of the affected organism in its endeavors to expel the intruders; in other words, the dispensation of remedies capable of producing corresponding phenomena when given to the healthy and sound. The possession of such property by any substance can be definitely known, of course, only through antecedent experiment.
Parenthetically, it may be remarked (a) that it is perfectly proper to speak of a person’s being threatened with any one of many of the so-called diseases. Should an invading host be routed before it had deployed its columns, before it had clearly manifested its character, any assumption consistent with the apparent phenomena would be legitimate. (b) The inherent possibility of overwhelming the enemy at any time is also evident, although the synchronous destruction of his works is neither claimed nor expected. A reported cure at any stage of any case of an infections disease requires, therefore, no stronger proof than other commonplace statements of alleged facts. .
To resume: Since the laws of nature are general, not to say universal, originating not in human formulation, but in the established constitution of things, and since the known field of infections disease is broadening with marvelous rapidity, while extreme uncertainty attends the limitation of its boundaries, it is clear that with him lies the burden of proof who dares affirm that the administration to the sick of remedies capable of producing corresponding phenomena when given to the healthy, is not the proper course of action in all curable cases.
Finally, since the character of the work of many microbes varies with the age, sex and condition of their victim, and since autopsies frequently reveal their unsuspected pressure at important points, there is no reason to expect a parasitic pathology will prove a more reliable guide the healing art than have been the humoral, the methods and the pneumatic. Hence naught remains for the true physician but to exemplify the singularly significant motto of this World’s Congress, and day by day to treat.
NOT THINGS, BUT MEN”.
DISCUSSION.
L.C. GROSVENOR, M.D.: Mr. President, Ladies and Gentlemen. – If there is an evil principle in this world, it is always ready to jump on us when we are down. If we see a boy going to the bad, we say that is all I expected of him. I know him when he was a little fellow. There is another principle always ready to boost us when we are going up. Now, these two principles are just as active in our physical life as in our educational life, in our moral life, or anywhere else, when we are in high health or when we are in diseased condition. These microbes are of all denominations.
They are ready to jump onus and abuse us. When we are, in a general way, in fine health, they pass by an the other side of the street and take off their hats to us. This is one of the inducements, not only to us as doctors, but to our patients, to always live a high physical plane.
ALONZO BOOTHBY, M.D.: I could say anything on the other matter when you spoke to me, but when I get a chance on this subject, I always take advantage of it. I believe that remedies have a great deal of influence on septic disease, but I would not say that we have to depend upon them in all cases; and while the paper has hardly committed the writer to that position, yet that is what it leads to, or what has it led to? If we have a perfect condition of things, e do not need any antiseptic, but we do need the aseptic principle put into practice in every case; and I presume that hardly anybody here would think of attending a case of confinement, any more than they would attempt making a surgical operation, without having everything clean about them.
If you have everything clean and a healthy subject to deal with, I say you need nothing more than that. But suppose you have a diseased vagina; then are you not going to use your antiseptics, and is it not true that a cut surface anywhere will bear these applications with perfect immunity? I think that those who use them speak most positively in regard to them, and it is not to the advantage of any member of this Congress to suppose that they will do harm, because the one who has used them says that they did not do any good in the proper way. Some one spoke of using one to ten thousand of the bichloride solution.
Now, you might just as well use hot water. That is what you get when you use such an antiseptic. If you use an antiseptic, you must enough of it and use it long enough to produce some action on microbes. They would bear that solution for two or three minutes, and be just as lively as ever. Beside, we have not to adopt the germ- theory. It is possible that it is the poison accompanying the germ; but whether it is the one or the other, the effect is the same.
DR. FOSTER: Mr. Chairman, Ladies and Gentleman.-I have nothing to add to what has been said already. I might give you my own opinion about antisepsis in midwifery and asepsis, and I don’t know that it would carry any particular weight with this body. I think that if we have the evidence of septic infection present, we ought to use antiseptic measures to antidote the evil and if we haven’t any evidence whatever that there is any such thing wrong with the patient, then we ought not to have anything to do with antisepsis or asepsis, for our patient is aseptic already. One gentlemen said, what I don’t understand, that a solution of corrosive sublimate one to five thousand would be no more efficacious than hot water.
DR. BOOTHBY: I beg to correct that. It was one to ten thousand that would have no beneficial effect.
DR. FOSTER: Well, one to ten thousand has sometimes produced serious symptoms. One to five thousand has caused death, and that in more cases than one, so I don’t think corrosive sublimate is always safe even when made in as high a solution as one to ten thousand.
