The Progress of the Century

by Unknown

Briefly stated, the disease is transmitted chiefly by certain varieties of the mosquito, particularly the Anopheles. The ordinary Culex, which is present chiefly in the Northern States, does not convey the disease. The Anopheles sucks the blood from a person infected with malaria, takes in a certain number of parasites, which undergo development in the body of the insect, the final outcome of which is numerous small, thread-like structures, which are found in numbers in the salivary glands. From this point, when the mosquito bites another individual, they pass into his blood, infect the system, and in this way the disease is transmitted. Two very striking experiments may be mentioned. The Italian observers have repeatedly shown that Anopheles which have sucked blood from patients suffering from malaria, when sent to a non-malarial region, and there allowed to bite perfectly healthy persons, have transmitted the disease. But a very crucial experiment was made a short time ago. Mosquitoes which had bitten malarial patients in Italy were sent to London and there allowed to bite Mr. Manson, son of Dr. Manson, who really suggested the mosquito theory of malaria. This gentleman had not lived out of England, and there is no acute malaria in London. He had been a perfectly healthy, strong man. In a few days following the bites of the infected mosquitoes he had a typical attack of malarial fever.

The other experiment, though of a different character, is quite as convincing. In certain regions about Rome, in the Campania, malaria is so prevalent that in the autumn almost every one in the district is attacked, particularly if he is a new-comer. Dr. Sambron and a friend lived in this district from the 1st of June to the 1st of September, 1900. The test was whether they could live in this exceedingly dangerous climate for the three months without catching malaria, if they used stringent precautions against the bites of mosquitoes. For this purpose the hut in which they lived was thoroughly wired, and they slept with the greatest care under netting. Both of these gentlemen at the end of the period had escaped the disease.

The importance of these studies cannot be overestimated. They explain the relation of malaria to marshy districts, the seasonal incidence of the disease, the nocturnal infection, and many other hitherto obscure problems. More important still, they point out clearly the way by which malaria may be prevented: First, the recognition that any individual with malaria is a source of danger in a community, so that he must be thoroughly treated with quinine; secondly, the importance of the draining of marshy districts and ponds in which mosquitoes breed; and, thirdly, that even in the most infected regions persons may escape the disease by living in thoroughly protected houses, in this way escaping the bites of mosquitoes.

Venereal Diseases.—These continue to embarrass the social economist and to perplex and distress the profession. The misery and ill-health which they cause are incalculable, and the pity of it is that the cross is not always borne by the offender, but innocent women and children share the penalties. The gonorrhœal infection, so common, and often so little heeded, is a cause of much disease in parts other than those first affected. Syphilis claims its victims in every rank of life, at every age, and in all countries. We now treat it more thoroughly, but all attempts to check its ravages have been fruitless. Physicians have two important duties: the incessant preaching of continence to young men, and scrupulous care, in every case, that the disease may not be a source of infection to others, and that by thorough treatment the patient may be saved from the serious late nervous manifestations. We can also urge that in the interests of public health venereal diseases, like other infections, shall be subject to supervision by the State. The opposition to measures tending to the restriction of these diseases is most natural: on the one hand, from women, who feel that it is an aggravation of a shocking injustice and wrong to their sex; on the other, from those who feel the moral guilt in a legal recognition of the evil. It is appalling to contemplate the frightful train of miseries which a single diseased woman may entail, not alone on her associates, but on scores of the innocent—whose bitter cry should make the opponents of legislation feel that any measures of restriction, any measures of registration, would be preferable to the present disgraceful condition, which makes of some Christian cities open brothels and allows the purest homes to be invaded by the most loathsome of all diseases.

Leprosy.—Since the discovery of the germ of this terrible disease systematic efforts have been made to improve the state of its victims and to promote the study of the conditions under which the disease prevails. The English Leprosy Commission has done good work in calling attention to the widespread prevalence of the disease in India and in the East. In this country leprosy has been introduced into San Francisco by the Chinese, and into the Northwestern States by the Norwegians, and there are foci of the disease in the Southern States, particularly Louisiana, and in the province of New Brunswick. The problem has an additional interest since the annexation of Hawaii and the Philippine Islands, in both of which places leprosy prevails extensively. By systematic measures of inspection and the segregation of affected individuals the disease can readily be held in check. It is not likely ever to increase among native Americans, or again gain such a foothold as it had in the Middle Ages.

Puerperal Fever.—Perhaps one of the most striking of all victories of preventive medicine has been the almost total abolition of so-called child-bed fever from the maternity hospitals and from private practice. In many institutions the mortality after child-birth was five or six per cent., indeed sometimes as high as ten per cent., whereas to-day, owing entirely to proper antiseptic precautions, the mortality has fallen to three-tenths to four-tenths per cent. The recognition of the contagiousness of puerperal fever was the most valuable contribution to medical science made by Oliver Wendell Holmes. There had been previous suggestions by several writers, but his essay on the “Contagiousness of Puerperal Fever,” published in 1843, was the first strong, clear, logical statement of the case. Semmelweis, a few years later, added the weight of a large practical experience to the side of the contagiousness, but the full recognition of the causes of the disease was not reached until the recent antiseptic views had been put into practical effect.

THE NEW DISPENSATION IN TREATMENT

The century has witnessed a revolution in the treatment of disease, and the growth of a new school of medicine. The old schools—regular and homœopathic—put their trust in drugs, to give which was the alpha and the omega of their practice. For every symptom there were a score or more of medicines—vile, nauseous compounds in one case; bland, harmless dilutions in the other. The new school has a firm faith in a few good, well-tried drugs, little or none in the great mass of medicines still in general use. Imperative drugging—the ordering of medicine in any and every malady—is no longer regarded as the chief function of the doctor. Naturally, when the entire conception of the disease was changed, there came a corresponding change in our therapeutics. In no respect is this more strikingly shown than in our present treatment of fever—say, of the common typhoid fever. During the first quarter of the century the patients were bled, blistered, purged and vomited, and dosed with mercury, antimony, and other compounds to meet special symptoms. During the second quarter, the same, with variations in different countries. After 1850 bleeding became less frequent, and the experiments of the Paris and Vienna schools began to shake the belief in the control of fever by drugs. During the last quarter sensible doctors have reached the conclusion that typhoid fever is not a disease to be treated with medicines, but that in a large proportion of all cases diet, nursing, and bathing meet the indications. There is active, systematic, careful, watchful treatment, but not with drugs. The public has not yet been fully educated to this point, and medicines have sometimes to be ordered for the sake of the friends, and it must be confessed that there are still in the ranks antiques who would insist on a dose of some kind every few hours.

The battle against poly-pharmacy, or the use of a large number of drugs (of the action of which we know little, yet we put them into bodies of the action of which we know less), has not been fought to a finish. There have been two contributing factors on the side of progress—the remarkable growth of the skeptical spirit fostered by Paris, Vienna, and Boston physicians, and, above all, the valuable lesson of homœopathy, the infinitesimals of which certainly could not do harm, and quite as certainly could not do good; yet nobody has ever claimed that the mortality among homœopathic practitioners was greater than among those of the regular school. A new school of practitioners has arisen which cares nothing for homœopathy and less for so-called allopathy. It seeks to study, rationally and scientifically, the action of drugs, old and new. It is more concerned that a physician shall know how to apply the few great medicines which all have to use, such as quinine, iron, mercury, iodide of potassium, opium, and digitalis, rather than a multiplicity of remedies the action of which is extremely doubtful.

The growth of scientific pharmacology, by which we now have many active principles instead of crude drugs, and the discovery of the art of making medicines palatable, have been of enormous aid in rational practice. There is no limit to the possibility of help from the scientific investigation of the properties and action of drugs. At any day the new chemistry may give to us remedies of extraordinary potency and of as much usefulness as cocaine. There is no reason why we should not even in the vegetable world find for certain diseases specifics of virtue fully equal to that of quinine in the malarial fevers.