The medicine of the past was a medley of superstition, faith, theory
and tradition, lightened by gleams of accurate observation and
logical thought. The medicine of today is a science founded on actual
observations of the manifestations of disease in man and in animals,
in both living and dead bodies. The medicine of an early day was based
largely on intricate hypotheses as to the causes of disease. There
was no systematic search in the unknown in any way comparable to the
steady, steadfast progress of medical science resulting from research
during the last fifty years. The medicine of a previous epoch included
only the physician who treated the individual patient. The medicine of
today has changed this old profession, whose only function was the care
of the individual sick man, into a dozen professions, which include not
only the care of the individual patient but also the study of disease,
its prevention, the attack on disease, and the care of the public
health.
No doubt everyone can remember the family physician of some twenty or
thirty years ago, who made his diagnosis largely by asking about the
progress of the disease from the time the patient first noted symptoms,
and by the use of such information as he could acquire with his unaided
senses. It must not be thought, however, that the information which
the physician acquires in this way is the less scientific because
it depends merely on the use of the hand, the ear and the eye. More
than one hundred years ago, two physicians made observations as to
the way in which changes within the human body could be discovered by
the use of these simple methods. Auenbrugger, in Austria, studied the
sounds that occur when the human chest is thumped. Everyone knows that
when you thump a cask that is half full of water the lower half will
sound different from the empty half. Indeed, an experienced Negro can
tell you the relative state of ripeness of a watermelon by a similar
test. And Auenbrugger used this simple method to ascertain when the
lung might be solidified by pneumonia, when the chest cavity might
contain fluid or pus as a result of some infection, when the heart was
enlarged beyond the normal limits as a result, perhaps, of overstrain
or disease. And when all of these things were carefully written down as
a result of thousands of observations made by physicians all over the
world, it became possible for those educated in this method to know,
with a fair degree of accuracy, the condition that existed within the
patient’s chest.
A little later, in Paris, a physician named Laennec, while walking to
the hospital, noted two boys at opposite ends of a log, one listening
and the other scratching the log with a pin. He found that the boy
listened because he could hear the sound transmitted through the
log. The outcome of this simple observation was the discovery of the
stethoscope, the device which the physician employs to determine the
sounds that go on within the human body when the organs function. On
listening to the heart in which one of the valves has given way, one
may hear gurgling and murmurs which are the result of physical changes
in the heart. On listening to the lungs, one may determine whether
the little spaces are filled with air, as they ought to be when the
patient breathes, or whether some disease has consolidated the lung
and made breathing impossible. These observations are just as regular
and certain as any mathematical formula; they are as scientific as the
observations made by an engineer; they are as definite as the diagnosis
of a broken valve or a carbon-choked cylinder in a motor car.
The textbooks in medicine of some fifty years ago were an unusual
conglomeration of the accumulated facts of the centuries and of
accurate observations made by careful physicians, mingled with queer
ideas as to why things were as they seemed to be and unestablished
rules based on the wrong interpretation of only partially understood
phenomena. There was, for instance, certain knowledge that the bark
of the cinchona tree, from which quinine comes, would stop the chills
and fever of malaria. There was not, however, the fact, later shown
by Laveran and by Rosa, that malaria is caused by an organism in the
blood which is transmitted from one person to another by a mosquito. It
had been observed that mercury would benefit syphilis, but no one knew
that syphilis was caused by a spiral organism which may be transmitted
from one person to another. It was known that certain drugs, such as
digitalis, would slow the beat of the heart and strengthen it, but it
was not known that it does this by action on the nerves leading to the
heart.
The time, then, was ripe for a scientist like Pasteur, and particularly
ripe for the attitude of skepticism with which he approached the
established beliefs of his day. The credit for the great advance of
the last fifty years in medicine must be given to several factors:
First, a changing conception of the way in which disease is brought
about in the human body, due to the establishment of what some people
still call the “germ theory.” Germs are no more a theory than is poison
ivy. The results of the action of germs within the human body are no
more theoretical than is the eruption that follows contact with poison
ivy in sensitive persons. The second great factor influencing medical
knowledge was the application to it of facts and materials derived
from such fundamental sciences as chemistry, physics, anatomy and
physiology. And the third important development was the invention of
mechanical accessories to aid the human senses in studying disease,
both within and without the human body.
After Pasteur had shown that bacteria do exist and that they cause
disease, Robert Koch, a German investigator and discoverer of the cause
of tuberculosis, established certain laws for determining whether
or not any single germ was actually responsible for producing any
certain disease. It is unnecessary to mention specifically each of
these laws; suffice to say that they involve the actual proof of the
fact that the germ is in the body of a person dying from disease, and
that the disease may be produced in animals by injecting them with the
germ. It would be undesirable to mention in this article all of the
diseases for which medical science now knows the bacterial cause; the
list would include, however, such diseases as tuberculosis, syphilis,
diphtheria, meningitis, typhoid fever, dysentery, pneumonia, lock-jaw,
cholera, malaria, anthrax, scarlet fever and a vast number of less
commonly known diseases. Hardly a year passes in which new germs are
not isolated and in which obscure conditions are not brought to light.
The recognition of this fact is of the greatest importance. If one
accepts the definitely proved facts as to the relationship of bacteria
to disease, one must at once discard all of those systems of healing
which claim that all diseases are due to a single form of disturbance
and are curable by a readjustment of that disturbance. There is not,
for instance, the slightest scientific evidence that pressures on the
nerves coming from the spine or on the blood vessels leading to the
various organs are responsible for the many diseases from which the
human body may suffer.
Now this does not mean that medical science is in possession of the
facts regarding all diseases. Much remains to be learned. There are
such diseases as measles, chicken pox, mumps, German measles, epidemic
sleeping sickness, and even common colds and influenza, for which we
have no germ that everyone will admit is the cause of the disease. But
medical science, with its careful, systematic methods, has learned many
facts regarding such diseases, and the application of these facts is
important in their proper diagnosis and healing.
I mention particularly the ways in which medical science calls on
mechanical aids in modern diagnosis. The modern physician utilizes
mirrors and lights to observe directly the inner lining of the
stomach, the bladder, the ear drum, the nose and the throat. You all
know the story of the young physician who put the mirror into the
woman’s mouth and said: “Madam, you have no idea how far we can see
with these things.” She leaped from the chair and said, “I beg your
pardon, doctor; I left home with a hole in the heel of my stocking.”
By means of the X-ray, the doctor is able to observe changes in solid
organs within the body; and through the injection of air into the
cavities, he is able, with the aid of the X-ray, to outline organs
heretofore not visible and to determine the condition of tissues
that cannot be touched. The laboratories have added information to
be gained from studies of the blood and from all of the secretions
and excretions of the body. Studies of the blood may show the type of
infection from which the patient suffers; may show the manner in which
he is responding to infection; may show whether he is anemic or has
a sufficient number of blood cells to conduct properly the chemistry
of his body. And these matters are not beyond the comprehension of
the ordinary human being. They may be demonstrated to any intelligent
person; in fact, in many laboratories these simple tests are regularly
performed by the people who have been trained only in the tests and
not in medical knowledge. The interpretation of the test, however, is
always a matter for a well-informed physician. Some of the cultists or
misguided persons who believe that all diseases are brought about by
pressures on nerves or on ligaments, by vibrations, by the influence
of the mind, or by any other narrow, restricted mechanism of disease
causation, should begin to realize that their theories must be
discarded in the face of such observations as these.
I pass over also the newer methods in the treatment of disease,
involving the use of newly discovered antiseptics, of glands and gland
substances, of vaccines and serums, and of unusual drugs. I pass over
the beneficent effects of modern surgery and the newer anesthetics
which have been developed and which enable the physician to perform
surgical operations painlessly and safely, as contrasted with the
conditions a century ago that made operating rooms bloody shambles.
Even the brain, particularly unapproachable in a previous century, is
now the subject of operations for the removal of tumors and the relief
of abscesses.
One by one, great infectious diseases and plagues have been brought
under control. Fever-infested swamps and the jungle of the tropics
have been freed of such menaces as yellow fever, malaria, African
trypanosomiasis, and other diseases transmitted to man by insects.
Through education in the value of a periodic physical examination and
through the teaching of personal hygiene, intelligent persons are
being enabled to live more and more comfortably. The death rate of
tuberculosis has been reduced by more than one-half; typhoid fever no
longer menaces communities which are willing to pay the price for good
milk supply, good water and proper sewage disposal; and inspection
of fresh and prepared foods has practically abolished the menace of
diseases formerly transmitted in this manner. Special attention given
to the problems of infant mortality has reduced the death rate in the
earlier years of life and an infant coming into the world today has a
far greater expectancy of life than did one coming into the world fifty
years ago. The child that might then have expected to live to somewhere
between thirty-five and thirty-nine years of age may now confidently
look forward, under all ordinary circumstances, to reaching the age of
fifty or fifty-five years. What hope, then, of giving that child an
opportunity to reach its allotted three score and ten?
Everyone knows from his own casual observations that a great many
more people are living to a ripe old age nowadays than was the case
formerly. Indeed, these observations are the exemplification of the
statistics that have been cited as to life expectancy. The diseases
that still remain to cut down the human being at an earlier age than
that at which he might reasonably expect to depart this life through
the actual wearing out of the machinery which is no longer able to
renew itself include particularly the diseases of the heart, blood
vessels and the kidney. Such conditions as Bright’s disease, a chronic
inflammation of the kidney; as hypertension, exemplified through high
blood pressure and the symptoms that accompany it; as arteriosclerosis,
or hardening of the arteries; as angina pectoris and inflammations
of the lining of the heart and of its valves--all such conditions
constitute a problem which the medical profession must meet and which
it apparently cannot meet properly without the complete education
and cooperation of the public. Here are diseases, the prevention of
which seems to lie in the prevention of infections of the throat in
childhood, in the training of the child and man in the proper hygiene
of the nose, throat and intestinal tract; in the teaching to the
adolescent and equally to the adult of the desirability of a quiet,
well-ordered existence with a proper amount of food, exercise and rest;
and, not the least by any means, in letting people know that there is
such a thing as mental hygiene, including relief from worry or mental
strain. And then there is pneumonia, a disease likely to affect the
older man much more severely than the young one, called, indeed, “the
old man’s friend” because of the quick death that it produces in the
senile; and the “captain of the men of death” because of its severely
fatal character. The complete conquering of this infection seems
somehow to be resting on the threshold of the future.
It is the belief of several competent statisticians who have given
careful consideration to the matter, that when these diseases are
brought under control, the life expectancy will be moved forward at
least another five years, but probably not a great deal more. The
trend of modern life seems to be toward speeding up, toward greater
mental strain and almost ceaseless activity. If, coincident with such
speeding, medical science is still able to promise another five years
of life expectancy to the phenomenal number of years that have thus far
been added, it will have accomplished a marvel beyond the dreams of the
medical scientists of fifty years ago.