Man's Redemption of Man: A Lay Sermon

by Sir William Osler

But the third and greatest glory is that the leaves of the tree of science have availed for the healing of the nations. Measure as we may the progress of the world—intellectually in the growth and spread of education, materially in the application to life of all mechanical appliances, and morally in a higher standard of ethics between nation and nation, and between individuals, there is no one measure which can compare with the decrease of disease and suffering in man, woman and child. The Psalmist will have it that no man may redeem his brother, but this redemption of his body has been bought at a price of the lives of those who have sought out Nature's processes by study and experiment. Silent workers, often unknown and neglected by their generation, these men have kept alive the fires on the altars of science, and have so opened the doors of knowledge that we now know the laws of health and disease. Time will only permit me to refer to a few of the more important of the measures of man's physical redemption.

Within the life-time of some of us a strange and wonderful thing happened on the earth—something of which no prophet foretold, of which no seer dreamt, nor is it among the beatitudes of Christ Himself; only St. John seems to have had an inkling of it in that splendid chapter in which he describes the new heaven and the new earth, when the former things should pass away, when all tears should be wiped away, and there should be no more crying nor sorrow. On October 16, 1846, in the amphitheatre of the Massachusetts General Hospital, Boston, a new Prometheus gave a gift as rich as that of fire, the greatest single gift ever made to suffering humanity. The prophecy was fulfilled—neither shall there be any more pain; a mystery of the ages had been solved by a daring experiment by man on man in the introduction of anæsthesia. As Weir Mitchell sings in his poem, "The Death of Pain"—

Whatever triumphs still shall hold the mind,
Whatever gifts shall yet enrich mankind,
Ah! here, no hour shall strike through all the years,
No hour so sweet as when hope, doubt and fears,
'Mid deepening silence watched one eager brain
With Godlike will decree the Death of Pain.

At a stroke the curse of Eve was removed, that multiplied sorrow of sorrows, representing in all ages the very apotheosis of pain. The knife has been robbed of its terrors, and the hospitals are no longer the scenes of those appalling tragedies that made the stoutest quail. To-day we take for granted the silence of the operating-room, but to reach this Elysium we had to travel the slow road of laborious research, which gave us first the chemical agents; and then brave hearts had to risk reputation, and even life itself in experiments, the issue of which was for long doubtful.

More widespread in its benediction, as embracing all races and all classes of society, is the relief of suffering, and the prevention of disease through the growth of modern sanitary science in which has been fought out the greatest victory in history. I can only refer to three subjects which illustrate and lead up to the question which is in the minds of all of us to-day.

You have in Scotland the merit of the practical introduction of a method which has revolutionized the treatment of wounds, and changed the whole aspect of modern surgery. I am old enough to have been a dresser in a large general hospital in the pre-Listerian days, when it was the rule for wounds to suppurate, and when cases of severe pyæmia and septicæmia were so common that surgeons dreaded to make even a simple amputation. In the wards of the Edinburgh Royal Infirmary and of the Glasgow Royal Infirmary, Lord Lister's experimental work on the healing of wounds led to results of the deepest moment to every individual subject to an accident, or who has to submit to an operation. It is not simply that the prospect of recovery is enormously enhanced, but Listerian surgery has diminished suffering to an extraordinary degree. In the old days every wound which suppurated had to be dressed, and there was the daily distress and pain, felt particularly by young children. Now, even after operations of the first magnitude, the wound may have but a single dressing, and the after-pain is reduced to a minimum. How well the older ones of us realize that anæsthetics and asepsis between them have wrought a complete revolution in hospital life. I asked the Superintendent of Nurses at the Royal Infirmary to let me know how many patients last night in the wards had actual suffering, and she has sent word that about one in eight had pain, not all of them acute pain.

But man's redemption of man is nowhere so well known as in the abolition and prevention of the group of diseases which we speak of as the fevers, or the acute infections. This is the glory of the science of medicine, and nowhere in the world have its lessons been so thoroughly carried out as in this country. It is too old a story to retell in detail, but I may remind you that in this city within fifty years there has been an annual saving of from four to five thousand lives, by measures which have directly prevented and limited the spread of infectious diseases. The man is still alive, Sir Henry Little-John, who made the first sanitary survey of the city. When one reads the account of the condition of the densely crowded districts on the south side of the High Street, one is not surprised that the rate of mortality was 40 and over per thousand. That you now enjoy one of the lowest death rates in Europe—15.3 per thousand for last year—is due to the thoroughness with which measures of recognized efficiency have been carried out. When we learn that last year there were no deaths from smallpox, not one from typhus, and only 21 from fevers of the zymotic group, it is scarcely credible that all this has been brought about within the memory of living men. It is not too much to say that the abolition of small-pox, typhus and typhoid fevers have changed the character of the medical practice in our hospitals. In this country typhoid fever is in its last ditch, and though a more subtle and difficult enemy to conquer than typhus, we may confidently hope that before long it will be as rare.

Here I would like to say a word or two upon one of the most terrible of all acute infections, the one of which we first learned the control through the work of Jenner. A great deal of literature has been distributed, casting discredit upon the value of vaccination in the prevention of small-pox. I do not see how any one who has gone through epidemics as I have, or who is familiar with the history of the subject, and who has any capacity left for clear judgment, can doubt its value. Some months ago I was twitted by the Editor of the Journal of the Anti-Vaccination League for maintaining a curious silence on the subject. I would like to issue a Mount Carmel-like challenge to any ten unvaccinated priests of Baal. I will take ten selected vaccinated persons, and help in the next severe epidemic, with ten selected unvaccinated persons (if available!). I should choose three members of Parliament, three anti-vaccination doctors, if they could be found, and four anti-vaccination propagandists. And I will make this promise—neither to jeer nor to jibe when they catch the disease, but to look after them as brothers; and for the three or four who are certain to die I will try to arrange the funerals with all the pomp and ceremony of an anti-vaccination demonstration.

A blundering art until thirty or forty years ago, preventative medicine was made a science by the discovery of the causes of many of the serious epidemic diseases. To any one of you who wishes to know this side of science, what it is, what it has done, what it may do, let me commend Radot's Life of Pasteur, which reads like a fairy tale. It is more particularly in connection with the great plagues of the world that man's redemption of man may be in the future effected; I say in the future because we have only touched the fringe of the subject. How little do we appreciate what even a generation has done. The man is only just dead, Robert Koch, who gave to his fellow-men the control of cholera. Read the history of yellow fever in Havana and in Brazil if you wish to get an idea of the powers of experimental medicine; there is nothing to match it in the history of human achievement. Before our eyes to-day the most striking experiment ever made in sanitation is in progress. The digging of the Panama Canal was acknowledged to be a question of the health of the workers. For four centuries the Isthmus had been a white man's grave, and during the French control of the Canal the mortality once reached the appalling figure of 170 per thousand. Even under the most favourable circumstances it was extraordinarily high. Month by month I get the Reports which form by far the most interesting sanitary reading of the present day. Of more than 54,000 employés (about 13,000 of whom are white), the death rate per thousand for the month of March was 8.91, a lower percentage, I believe, than any city in the United States. It has been brought about in great part by researches into the life history of the parasite which produces malaria, and by the effectual measures taken for its destruction. Here again is a chapter in human achievement for which it would be hard to find a parallel. But let us not forget that these are but illustrations of wide-spread possibilities of organization on modern lines. These are sanitary blessings. To make them available in the Tropics is the heaviest burden of the white man; how heavy you may know from the startling figures which have just been issued from British India. Exclusive of the native states for the year 1908, the total deaths from fever and cholera exceeded 5,000,000, out of a population of 226,000,000. The bright spot in the picture is the diminution of the mortality from plague—not fewer than a million fatal cases as compared with 1907.

These are brief indications of the lines along which effective progress is being made in man's redemption by man. And all this has a direct bearing upon the disease, the fight against which brings us together. Tuberculosis is one of the great infections of the world, and it has been one of the triumphs of our generation to determine its cause. With the improvement of sanitation there has been a reduction in its mortality, amounting since 1850 to above 40 per cent. But it still remains the most formidable single foe, killing a larger number of people than any other disease—some 60,000 in Great Britain and Ireland in 1908, and 589 of this city. Practically between 10 and 11 per cent. of all deaths are due to it. A plain proposition is before the people. We know the disease—how it is caused, how it is spread, how it should be prevented, how in suitable cases it may be cured. How to make this knowledge effective is the prime reason of this conference. It is a campaign for the public; past history shows that it is a campaign of hope. The measures for its stamping out, though simple on paper, present difficulties interwoven with the very fabric of society, but they are not insuperable, and are gradually disappearing. It is for this reason we urge you to join with enthusiasm in the crusade; remembering, however, that only the prolonged and united efforts, carried through several generations, can place the disease in the same category with typhus fever, typhoid and small-pox.