One Hundred Years of Healing and Mending.

Dominion, Volume 16, Issue 154, 17 March 1923, Page 11

One Hundred Years of Healing and Mending.

Centenary of a Famous Medical Journal.

(By

Professor J. A. Thomson,

in John O’ London’s Weekly).

F” i ,HE CENTENARY of our distinguished contemporary, ‘‘The B Lancet,” implies in itself a great achievement, and it raises many I thoughts. For the changes in the science and art of medicine and JL in the prac ;ice of surgery that have come about in the past century give eloquent evidence of man’s progress in the control of life. All that we can do here is to name some of the milestones. To Pasteur and others of his school we owe the momentous demonstration of the fact that diseases may be of microbic origin. That is to say, they may be due to bacteria that invade the body. This is true of such diseases as plague, cholera, typhoid, splenic fever, and tuberculosis. The pestilence that walketh in darkness was caught and labelled; what had been a dark mystery was illumined; and repeatedly it has turned out that the knowledge of the cause, was the first step to a discovery of the cure. This revelation of the microbic origin of many diseases changed the whole venue for medicine. ANTISEPTICS AND MICROBES. Rut we cannot think of Pasteur without thinking of Lister, who proved that what happened when an operation “went wrong,” or when man got a very dirty wound, w s the result of poison-producing bacteria which entered the raw surface and multiplied exceedingly. Lister showed that great cleanliness and the use of antiseptics, like carbolic or iodoform, kept the lethal bacteria from getting a secure footing. A farm-tragedy like “lockjaw” was a mystery a hundred years ago; we have known for long that it is duo to the tetanus bacillus, which sometimes lurks in the soil, finding its way into a wound. The terrible “gas-gangrene” of the war is, in the same way, due to the co-operation of three or four kinds of bacilli. There can never be too much cleanliness, hut the idea of “microscopic”, cleanliness was an idea of the past century, and how many useful lives it has saved! But alongside if bacteriology there has appeared a younger sister, protozoology, whose influence has already been extraordinary. For just as bacteria, belonging to the plant world, cause many diseases, so there are microscopic animals, certain kinds of protozoa, which aro not less terrible in their virulence when they intrude. We need only mention three, to Show the medical importance of these protozoa. There is the malaria animal introduced into man by the bite of a. mosquito that has happened to suck the blood of a malarial patient. There is the sleeping sickness animal introduced into l man by the bite of the tsetse fly which has happened to such the blood of some infected wild animal. There is the syphilis animal which is disseminated by sei tial contact. It is not merely that the causes of these terrible diseases have been discovered, but fihe possibilities of prevention and cure have been, in some measure, made clear. Moreover, there has passed into medicine, through the work of men like Ross, Bruce, and Manson, the Darwinian idea of the 'web of life, that.nothing lives or dies to itself. For these disease-producing animals have their “carriers,” and it is sometimes easier to get at the carrier than at the microscopic microbe. So malaria is banished from Khartoum by pouring a little paraffin on the stagnant pools where the larval mosquitoes live. The oily surface film is fatal and the. larvae drown. So there are no more mosquitoes to carry the microscopic malaria animal. Some years ago Sir Rav Lancaster gave a vivid instance of the change that has come over medicine within the century in referring to tho once mysterious “jail-fever” which used to spread from the prisoner in the dock to the judge and jury at Old Bailey. This “jail-fever” is now known to medical science as typhus, and it is doubtless microbic In nature; but mstead of speaking with bated breath of the “Angel of Death” we use sulphur to kill the lice that spread the dsiease. The days of dirt-disease are numbered. ' INFLAMMATION AND OPSONINS. We cannot, think of bacteria without thinking of “phagocytes” and of Metchnikoff, the discoverer of their importance. This has meant another fertile change in medicine. The phagocytes are very active and very hungry amoeboid cells that form a bodyguard in most animals. In ourselves they are white blood-coi pusoles of a particular kind and quality.’ They can pass out of tho blood-vessels to tissues endangered; they serve as sappers and miners When a change of structure is being effected; they transport

materials from one place in the body to another; they help in repair-pro-cesses and healing-processes; above all, perhaps, they engulf an<| digest intruding bacteria. What Metchnikoff made particularly clear was that in all processes of inflammation, when the organism is battling with invaders and their poisons, the phagocytes are busily at work, loyal to the organism to which they belong. It was a great step to have the meaning of inflammation cleared up But we cannot speak of Metchnikoff and his “phagocytes” without thinking of Sir Almroth Wright and his opsonins. These are substances produced in the blood which seem to appetize the phagocytes and render them more effective in destroying intrusive bacteria. But it was soon shown that recovery from microbic diseases was possible without any help from phagocytes, and this is because the blood can produce a counteractive or anti-toxin which checkmates the invaders and their poisons. An organism immune to a disease, such as measles, has abundant counteractives in its blood; but the blood of a non-immune animal can be rendered immuno by injecting a skilfully prepared serum from another organism. Thus sprang up the intricate devices of serum-treatment; and everyone knows how the death-rate among children attacked by the diphtheria microbe has been almost miraculously reduced by scrum-treatment. And there is prevention as well as cure. There are scores of these modern devices; so many that one is a little apt to forget that it was within the century (1858) that Virchow showed that all the pathological processes—all the ills that our flesh is heir to—have to be thought of in terms of the living cells that build up our body. That was the big milestone; the state of Denmark depends on the normal or abnormal, energetic or depressed, rythmic or irregular activities of the component cells. To change the subject, another milestone was the introduction of anaesthetics in surgery. It rendered so many impossible things possible, and it went far to lessen psychological shock. Here one has to remember the splendid persistence of Sir James 'Young Simpson (1847) in carrying through, in spite of opposition, the use of chloroform; but we must not forget that anaesthesia (by ether) was publicly introduced by Morton at the Massachusetts General Hospital on October 16th, 1846. With the 'help of anaesthetics what wonders of mending have been performed by surgeons of genius! The story told in Sir Arthur Keith’s “Menders of the Maimed” seems to us one of the noblest chronicles in the history of mankind. THE DUCTLESS GLANDS. It is not too much to say that the whole of physiology, and of medicine, as the associated art, has been changed by the discovery of the importance of tho ductless or endocrine glands which manufacture arousing hormones and soothing chalones—chemical messengers that are distributed through the body by the blood with incalculably beneficial results. To take one example, the cretinoid child, formerly irremediable, can be coaxed back into normality by treatment with thyroid extract; and, what is perhaps more important, the temporary lapses from normality, occasionally occurring in useful citizens, perhaps through overtaxing the energies, can bo dealt with in an effective way. It is plain, of course, that the kind of constitution that needs to be kept hobbling along on the crutches of injections is not one that should continue its kind

We have only to close our eyes for a moment to see a pageant: the campaign against “hookworm,” which is the cause of the thickest cloud of depression and disease that has ever shadowed the human race; the fight against tuberculosis; the struggle against venereal diseases; the conquest of the Bilharzia worm that infects every third child born in Cairo; the grafting of tissues; tlho understanding of diet; the discovery of the shadowy vitamines; the progress of neurology; the rise of psycho-therapy; the inquiry into heredity; the study of the influences of function and environment ; the rapid development of preventive medicine. Behind all this advance there is the steady growth of pure science from which all the biggest pract’cal advances spring. And along with this we must recognise the essential importance of media by which new medical knowledge is disseminated, both wisely and well. For its noble part in this educative W'ork we salute our contemporary —the “Lancet.”